Normal Thyroid Status Research Articles

Prevalence of Thyroid Disorders in Patients with Type 2 Diabetes Complicated with Diabetic Neuropathy

Abstract Background Diabetic peripheral neuropathy(DPN) is the most common complication of Type 2 diabetes mellitus (T2DM), affecting as many as 50% of diabetic patients. Thyroid dysfunction and diabetes mellitus are closely linked. Several studies have documented the increased prevalence of thyroid disorders particulary hypothyroidism in patients with diabetes mellitus and vice versa. Recent studies have shown that free triiodothyronine (fT3), free thyroxine (fT4) and thyroid-stimulating hormone (TSH) levels have been linked to insulin resistance and chronic complications of diabetes particulary DPN. Aim of work: This study aims to investigate the prevalence of thyroid dysfunction in patients with type 2 diabetes mellitus complicated with diabetic peripheral neuropathy. Patients and Methods This study was a cross sectional study that was conducted at Diabetes outpatient clinic at Ain Shams university Hospital. This study was performed on 250 patients with type 2 diabetes with diabetic peripheral neuropathy aging from 18 to 60 years old not known to have thyroid dysfunction, with a clinical diagnosis of diabetes (type 2) and diabetic peripheral neuropathy. All candidates were subjects to full history, full clincal, neurological and thyroid examination and laboratory investigations (Fasting blood glucose, 2hrs post prandial, HbA1c, lipid profile. Tsh, ft3,ft4, alb/cr ratio, Alt, Ast, urea, creatinine, urine analysis and thyroid U/S if needed). Results Among the studied 250 patients, 192 (76.8%) patients have Normal thyroid status, 58 (23.2%) patients have thyroid dysfunction distributed as the following : 23 (9.2%)patients with Subclinical Hypothyrodism, 19 (7.6%) patients with Hypothyrodism, 7 (2.8%)patients withSubclinical hyperthyroidism and 9 (3.6%) patients with Hyperthyrodism. Regarding the DPN grade, 43 (17.2%) patients have Mild DPN, 167(66.8%) patients have Moderate DPN and 40(16.0%) patients have DPN according to DPN grade using the known questionnaire of neuropathy (total ssympto NTSS-6 questionnaire). Among the studied population 79 (31.6%)patients are males while 171(68.4%) are females and their ages ranged from 35 to 64 years (mean 52.11 years), The Mean BMI was 27.59 ± 3.77kg/m2. Among patients with Thyroid Dysfunction There were statistically significant difference between Severity of DPN and Thyroid function tests. Among patients with thyroid dysfunction, moderate DPN was the most prevelant47/58patients (81.0%)followed by mild DPN 8/58 patients (13.8%) and the least was severe DPN 3/58 patients (5.2%). Also Among the euthyroid patients, moderate DPN was the most frequent 120/192 patients (62.5%),but followed by severe DPN 37/192 patients (19.3%) and the least was mild DPN 35/192 patients (18.2%). (P value = 0.015) There were highly statistically significant difference between patients with normal Thyroid status and patients with Thyroid dysfunction regarding Cholesterol (P value=0.000), Triglyceride (P value = 0.000) and LDL (P value = 0.001) being higher in those with thyroid dysfunction, and there were statistically significant difference between patients with normal thyroid status and patients with thyroid dysfunction regarding Alb/cr R (p value=0.034), and there were no statistically significant difference between patients with normal Thyroid status and Thyroid dysfunction regarding FBG(mg/dl), 2hrs PP(mg/dl), Hba1c(%), FT3(pg/ml), FT4(ng/dl) and HDL (mg/dl) Conclussions Thyroid dysfunction mainly subcinical hypothyroidism is more prevalent among T2DM subjects with DPN.

Thyroid scintigraphy: establishing a clinically useful normal range for 99mTc pertechnetate uptake.

This study aims to establish a normal range for the thyroid uptake derived from 99mTc pertechnetate scans. In particular, variations of uptake with TSH stimulation and other factors such as urinary iodine concentration are taken into account and compared with the calculation of a raw uptake value. Clinical multicentric (center A, B and C) prospective study on 125 consecutive healthy patients undergoing thyroid scans for thyroid nodules. Normal functional thyroid status was assured by normal TSH, normal thyroid size, no thyroid antibodies and no symptoms of thyroid functional disorders. Calculations of raw Tc-uptake (uptake) and modified uptake values regarding current TSH value (uptakeTSH1), urinary iodine concentration (uptakeTSH1&uic), gland volume, age, smoking status, weight and tissue thickness ventral to the thyroid were performed. There is a positive correlation of thyroid uptake with TSH allowing for the calculation of a normalized uptake value (uptakeTSH1). The normal range for uptakeTSH1 compares favourable to that for raw uptake in that it yields a clear distinction from thyroid functional disorders. The additional normalization for urinary iodine concentration (uptakeTSH1&uic) may even improve the distinctive power whereas further normalizations such as for gland volume, age and others are not warranted by this study. The 95% CI of uptakeTSH1 for sites A, A&B, and A&B&C were 0.21%-2.06%, 0.22%-2.38% and 0.24%-2.40%. A normal range for the thyroid uptake can be established with respect to the current TSH stimulation. This normalization (uptakeTSH1) overcomes the drawback of raw uptake by yielding a clinically useful parameter with obviously high distinctive power against functional thyroid disorders.

THU663 Therapeutic Plasma Exchange In Refractory Atrial Fibrillation Secondary To Thyroid Storm.

Abstract Disclosure: S.M. ALShehri: None. M.S. Bafadel: None. N.J. Aljohani: None. Thyrotoxic crisis (thyroid storm) is a severe form of hyperthyroidism. It has a wide range of symptoms, including cardiovascular manifestations that can be life-threatening and require prompt management. Cardiac manifestations of thyroid storm include hypertension, tachycardia, congestive heart failure, cardiac ischemia, and atrial fibrillation. Standard therapeutic approaches of thyroid storm are based on the use of thionamides, corticosteroids, and nonselective beta-blockers to inhibit thyroid hormone synthesis and release while also blocking thyroxin's peripheral effects. This approach is an effective measure in the management of these manifestations. However, when a patient fails to respond to conventional therapy or there is end organ damage and surgery is not feasible, therapeutic plasma exchange (TPE) is a life-saving measure. Here, we report a case of a 32-year-old female who is known to have hyperthyroidism, but she was not compliant with her medication. She presented with symptoms of hyperthyroidism and was found to have thyroid storm with refractory atrial fibrillation. Despite the effort to control her symptoms, she developed cardiac arrest, after 15 minutes of cardiopulmonary resuscitation she revived. Amiodarone, beta blockers, and cardioversion have all failed to improve the patient's status, and her condition has deteriorated. So, we decided to use TPE, and she received three sessions in total. After the first session of TPE, her rhythm converted to sinus rhythm, and her heart rate was controlled to less than 100 beats per minute. She showed dramatic improvement clinically and biochemically. In conclusion, cardiac complications are potentially lethal complications of thyroid storm. Prompt restoration of a normal thyroid state can reverse these complications. When conventional therapy fails to ameliorate symptoms or organ deterioration is rapid and severe, TPE can be a safe and effective measure. Presentation: Thursday, June 15, 2023

E70 A new mutation of uncertain significance in Farber disease

Abstract Introduction Farber disease is a rare autosomal recessive lysosomal storage disorder. It is caused by a mutation in the ASAH1 gene, which results in a deficiency of acid ceramidase and subsequently an accumulation of ceramide in various tissues. The manifestations are diverse and the cardinal symptoms of the Farber disease triad include subcutaneous nodules, joint pain and hoarseness. Aims To recall the clinical features of this rare disease in order to avoid a late diagnosis and to inform about the identification of a novel mutation in a Moroccan patient known until now as a mutation of uncertain significance in the acid ceramidase gene. Method About a clinical case reported retrospectively with a prospective follow-up. Results We report the case of a fourteen-year-old boy born from healthy, consanguineous Moroccan parents after an uneventful pregnancy and delivery. He had normal development until the age of 9 months. The first symptoms appeared at the end of the first year of life with joint stiffness, hoarseness, subcutaneous nodules, blepharitis resulting in amblyopia, dental enamel defect, gingival hyperplasia, and severe failure to thrive, without any visceral manifestations. Routine laboratory investigations revealed normal hydroelectolytic, glycemic, hepatic, renal, and thyroid status. Standard radiography revealed diffuse bone demineralization, laryngoscopy showed laryngeal dyskinesia, echocardiography and abdominal ultrasound were normal. Biopsy of a nodule revealed hyalinosis deposition leading initially to the hypothesis of systemic hyalinosis. The diagnosis of Farber disease was suspected at the age of eight and definitively confirmed at the age of fourteen after a genetic study of ASAH1 revealing a novel compound homozygous mutation in exon 3 c.194T>G (p.Leu65Trp) whose significance was considered uncertain to date with an acid ceramidase enzyme assay that showed a markedly reduced leucocyte acid ceramidase activity, consistent with a homozygous status for acid ceramidase deficiency. Treatment with analgesics based on paracetamol and nonsteroidal anti-inflammatory drugs, with iron, calcium and vitamin D supplements was prescribed. Physiotherapy was recommended but was very difficult as the child is so painful. Discussion and Conclusion Farber disease is a rare condition with only about 200 cases identified worldwide. It is caused by mutations in the ASAH1 gene. The disease has a wide range of clinical presentations, and this case report highlights the challenge of diagnosis, with a long delay due to lack of awareness of the disease among clinicians. Furthermore, this case describes a novel homozygous mutation in the ASAH1 gene: c.194T>G (p.Leu65Trp) of the ASAH1 gene in a Moroccan patient, expanding the phenotypic spectrum of the disease. Genetic testing should be considered in patients with a clinical presentation consistent with the disease, supplemented by an acid ceramidase enzyme assay in case of doubt as was done in our patient. To date, there is no cure for Farber disease, and treatment is symptomatic and supportive. However, early diagnosis and appropriate management can help improve the quality of life for patients and their families. This case highlights the importance of further research in order to develop more effective treatments for this rare condition. Clinical trials are planned in the close future. Ethics The patient and his family members provided informed consent for publication of indirectly identifiable data.

Immunohistochemical markers of the activity of apoptosis and proliferation in women with adenomyosis who had papillary thyroid carcinoma

Research objectives: to evaluate the activity of apoptosis and proliferation mechanisms of eutopic endometrium in patients with adenomyosis who had a history of papillary thyroid carcinoma (PTC).Materials and methods. 63 women of reproductive age were examined: group I – 31 patients with adenomyosis and PTC in history, group II – 32 patients with adenomyosis and normal thyroid status. The intensity of pelvic pain was assessed using a visual analog scale in all women. The material for morphological research was obtained with Pipelle biopsy of the endometrium in the secretory phase of the menstrual cycle. A morphological study was performed on 30 biopsies of eutopic endometrium (15 samples from patients of group I and 15 samples from patients of group II). An immunohistochemical study was performed using monoclonal antibodies to cell-specific markers Bcl-2 (DAKO, clone 124) and Ki-67 (DAKO, clone MIB-1).Results. High expression of Bcl-2 was detected in the endometrial glandular epithelial cells (EGECs) in 70% and 62.5% of samples in group I and II respectively (р > 0.05), the number of Bcl-2-positive cells was significantly higher in samples from group I (80.0 ± 13.1% versus 60.0 ± 15.2% in group І and ІІ respectively, р < 0.05). In endometrial stromal cells (ESCs) high expression of Bcl-2 was detected in 90% and 100% of samples from group I and II respectively (р > 0.05), no significant difference in the number of positive cells was found between groups (18.9 ± 12.2% and 12.6 ± 9.1% in group І and ІІ respectively, р > 0.05). Expression of Ki-67 was detected in the EGECs in 70% and 62.5% (р > 0.05) of samples in group І and ІІ respectively and in the ESCs in 100% of samples from groups I and II respectively. The immunocytochemical Ki-67 labelling index was much more prominent in group I (45.0 ± 11.4% versus 25.8 ± 16.7% EGECs (р < 0.05); 26.5 ± 10.2% versus 16.3 ± 8.9% ESCs (р < 0.05) for group I and II respectively).Conclusions. Altered proliferation of the eutopic endometrium with marked resistance to apoptosis was found in reproductive aged female with adenomyosis and PTC in history, that is can be considered as a marker of the aggressiveness of the disease course in this cohort of patients.

How widespread is Thyroid Disorders among Patients undergoing Coronary Artery Bypass Grafting? A Study from Tertiary Care Hospital

Coronary artery bypass grafting (CABG) is the most commonly performed cardiac procedure and thyroid disorders (hypothyroidism and hyperthyroidism) are the most widespread endocrine diseases. Till date, there is no Indian study pertaining to prevalence of thyroid disorders among subjects undergoing CABG. The aim of this study was to determine the prevalence of thyroid disorders among subjects undergoing CABG in a tertiary care hospital. This is a prospective observational hospital-based study having 560 subjects who underwent CABG. Pre-operative thyroid tests were conducted of all the subjects. On the basis of this test, subjects were divided into groups, “Euthyroid” (normal thyroid status) and Thyroid subjects, that is, Subclinical Hypothyroidism (SCHypo), Overt Hypothyroidism (OVHypo), Subclinical Hyperthyroidism (SCHyper), and Overt Hyperthyroidism (OVHyper), based on thyroid function test. The proportion of the disorders was calculated. The study population included 560 subjects (Males: 457 females: 103). The overall prevalence of thyroid function abnormalities was 41.07%. The SCHypo was the most pervasive thyroid disorder (33.75%), followed by SCHyper (4.28%), OVHypo (2.32%), and OVHyper (0.7%). Highest number of thyroid subject (57.8%) was in 40–59 age group and lowest (0.86%) in 18–39. Thyroid was more prevalent among females (45/103) than in males (185/457). Among subjects undergoing CABG, SCHypo was most common followed by SCHyper, OVHypo, and OVHyper. Among the subjects undergoing CABG, maximum thyroid cases are in the age group of 60–79 with female preponderance.

Thyroid dysfunction and its relation to myocardial performance among patients with acute myocardial infarction

Background: The cardiovascular system is one of the most important targets on which thyroid hormones act, thyroid hormone has a major role in the cardiovascu­lar system function and cardiac hemodynamics. Objectives: The primary aim of our study was to evaluate the prevalence of thyroid dysfunction in patients with acute myocardial infarction and to study the impact of these dysfunctions on in-hospital morbidity and mortality among those subjects. Patients and Methods: This study was conducted on one hundred critically ill patients admitted to the critical care department with the diagnosis of acute myocardial infarction in the period from April 2017 to January 2019. Results: According to thyroid profile, 78 patients (78%) had euthyroid status and the remaining 22 patients (22%) had thyroid dysfunctions which include: 12 patients (54.54%) were euthyroid sick syndrome, 7 patients (13.81%) had subclinical hypothyroidism, 3 patients (13.63%) had subclinical hyperthyroidism. Conclusion: Thyroid dysfunction in association with acute myocardial infarction affect the myocardial performance and this was evident in our study by lower ejection fraction, higher initial killip class, higher wall motion score index, and increased myocardial performance index compared to those with normal thyroid status but it has no impact on the in-hospital mortality.

Quality of life of women with a history of adenomyosis and papillary thyroid carcinoma

The objective: to assess the quality of life of women with a history of adenomyosis and papillary thyroid carcinoma (thyroid).Materials and methods. 124 women aged 24–45 years old were examined: the I group included 61 women with a history of adenomyosis and papillary thyroid carcinoma, and the II group included 63 women with adenomyosis and normal thyroid status. The severity of pelvic pain was assessed on a visual-analog scale (VAS) in the intermenstrual and menstrual periods. Quality of life of the persons was assessed on the basis of a non-specific quality of life questionnaire Short Form Health Status Survey (SF-36).Results. According to results of VAS there was no significant difference in the intensity of pain between patients of the I and II groups. The average intensity of pelvic pain in menstrual (6.9±0.76 cm in the I group and 6.7±0.79 cm – in the II one) and intermenstrual periods (5.9±1.0 and 5.5±0.85 cm, respectively) corresponded to the level of “severe pain”.Analysis of the results of the SF-36 questionnaire demonstrated a decrease in quality of life scales in patients of both groups. Despite the absence of a significant difference in the intensity of pain between women in both groups, the indicators of physical functioning scale (61.5±13.1 points in the I group and 78.50±8.2 points – II group; p<0.05), general health (21.8±11.2 and 48.2±12.0 points, respectively; p<0.05), vital activity (31.5±9.9 and 51.0±7.4 points; p<0.05), mental health (40.4±10.4 and 50.4±7.1 points; p<0.05) and integrated indicators of physical (37.3±5.5 and 41.4±4.3 points; p<0.05) and psychological components of patient health (32.6±5.3 and 36.9±7.5, points; p<0.05) in the I group were significantly lower compared to patients in the II group.Conclusions. The physical and psychological health of women with a history of adenomyosis and papillary thyroid carcinoma is influenced by a combination of factors, including clinical manifestations of adenomyosis and the effects of thyroid carcinogenesis, which lead to reduced physical and psychological functioning.

75. Hyperproliferative pathology of the reproductive system among female thyroid cancer survivors

Introduction and aim: Papillary thyroid carcinoma (PTC) is the most rapidly increasing cancer worldwide, affecting mainly women aged 30–39. To determine if there is an increased risk of hyperproliferative pathology of the reproductive system in female PTC survivors under the age of 45. Methods: We analyzed medical records and performed a follow-up examination of 116 women aged 20 to 45 years who had undergone thyroidectomy for PTC in the period from 1994 to 2018. The control group included 90 age comparable females with normal thyroid status.

Study of the Risk Factors for Coronary Artery Disease and their Correlation with Thyroid Hormone Profile amongst Women with ST Segment Elevation in Acute Myocardial Infarction

Background: Thyroid hormone has a major role in the cardiovascular function and cardiac hemodynamics as well as to maintain the cardiovascular homeostasis. The present study was planned to assess risk factors for coronary artery disease and their correlation with thyroid hormone profile amongst women with ST segment elevation in acute myocardial infraction. Material and Methods: A total number of 78 females having ST elevation myocardial infarction diagnosed through detailed clinical history and ECG evaluations were included after they satisfy the eligibility criteria. Patients were subsequently evaluated for presence of risk factors of ischemic heart disease such age, marital status, parity, and menopause, use of oral contraceptives, family history, obesity, diabetes mellitus, hypertension, hypercholesterolemia and hypertriglyceridemia. Their thyroid hormone profiles (T3, T4, TSH) were done and were correlated with risk factors for ischemic heart disease. Results: A total 78 patient included in the study most of the study population belongs to the age group of 40 to 50 years (43.6 %). Hypertension was the most common clinical features amongst study population (59%) followed by Diabetes (50%). Most of the study population had Normal Thyroid status (57.69%) followed by Hypothyroidism (25.64%) and Hyperthyroidism (16.67%) and SERUM TSH is the most sensitive test for evaluation. Diabetes Mellitus was statistically significant risk factor (p value<0.05) in patients with STEMI with different levels of thyroid. Conclusion: Patients with coronary artery disease especially in the presence of other risk factors should be screened for thyroid dysfunction specially diabetes. We recommend tests for thyroid disorders in acute coronary syndrome can give predictor for risk of morbidity and mortality in those subjects.

Selected Essential and Toxic Chemical Elements in Hypothyroidism-A Literature Review (2001-2021).

Thyroid hormones are known for controlling metabolism of lipids, carbohydrates, proteins, minerals, and electrolytes and for regulating body temperature. Normal thyroid status depends on the chemical/elemental composition of body fluids and tissues, which changes depending on physiological state, lifestyle and environment. A deficiency or excess of certain essential chemical elements (selenium, zinc, copper, iron or fluorine) or exposure to toxic (cadmium or lead) or potentially toxic elements (manganese or chromium) interacts with thyroid hormone synthesis and may disturb thyroid homeostasis. In our review, accessible databases (Scopus, PubMed and Web of Science) were searched for articles from 2001–2021 on the influence of selected chemical elements on the development of hypothyroidism. Our review adopted some of the strengths of a systematic review. After non-eligible reports were rejected, 29 remaining articles were reviewed. The review found that disruption of the physiological levels of elements in the body adversely affects the functioning of cells and tissues, which can lead to the development of disease.

Thyroid hormones in the regulation of brown adipose tissue thermogenesis.

A normal thyroid status is crucial for body temperature homeostasis, as thyroid hormone regulates both heat loss and conservation as well as heat production in the thermogenic tissues. Brown adipose tissue (BAT) is the major site of non-shivering thermogenesis and an important target of thyroid hormone action. Thyroid hormone not only regulates the tissue’s sensitivity to sympathetic stimulation by norepinephrine but also the expression of uncoupling protein 1, the key driver of BAT thermogenesis. Vice versa, sympathetic stimulation of BAT triggers the expression of deiodinase type II, an enzyme that enhances local thyroid hormone availability and signaling. This review summarizes the current knowledge on how thyroid hormone controls BAT thermogenesis, aiming to dissect the direct actions of the hormone in BAT and its indirect actions via the CNS, browning of white adipose tissue or heat loss over body surfaces. Of particular relevance is the apparent dose dependency of the observed effects, as we find that minor or moderate changes in thyroid hormone levels often have different effects as compared to high pharmacological doses. Moreover, we conclude that the more recent findings require a reevaluation of older studies, as key aspects such as heat loss or central BAT activation may not have received the necessary attention during the interpretation of these early findings. Finally, we provide a list of what we believe are the most relevant questions in the field that to date are still enigmatic and require further studies.

Hyperthyroidism in Takotsubo syndrome: prevalence, clinical features and long-term outcomes

Abstract Background Takotsubo syndrome (TTS) is an increasingly recognized form of transient left ventricular dysfunction, often completely reversible. The exact pathogenesis is not fully understood, but central role of adrenergic dysfunction has been widely accepted. A possible link between hyperthyroidism and TTS has been hypothesized, since thyroid and adrenergic systems are in closely connection. Nevertheless, clinical study to define the association between hyperthyroidism and TTS is still lacking. Purpose This study aimed to assess prevalence, clinical features and long-term outcomes of hyperthyroidism at presentation in TTS patients. Methods Overall, 590 TTS patients from 23 centers were included in this prospective registry. Thyroid profile was available for 314 patients at time of TTS admission. Patients in hypothyroid state (n=32) according to TSH value were excluded. The remaining 282 patients were divided in normal thyroid state and hyperthyroid state according to TSH value, respectively 240 (85%) and 42 (15%) patients. Results The median age was 73±10 and the female rate was 93%. TTS related to physical trigger was mostly detected in hyperthyroidism patients (52% vs 30%, respectively in hyperthyroid state and normal thyroid state; p=0.005); while, TTS related to emotional trigger was less common (19%, vs 38%, respectively in hyperthyroid state and normal thyroid state; p=0.016). In TTS unprovoked by a stress factor, there was no statistical difference in thyroid state (29% vs 31%, respectively in hyperthyroid state and normal thyroid state; p=0.690). Follow-up rate was 95% and follow-up length was 41±36 months. At long-term follow-up, mortality rate was 39% and 20% in hyperthyroidism and normal thyroid state, respectively (p=0.008; Figure 1) and adverse event rates (the composite of all-cause death, myocardial infarction and stroke) were 39% and 24% in hyperthyroid state and normal thyroid state, respectively (p=0.034). At multivariable analysis, hyperthyroidism resulted as a strong predictor of mortality (OR 3.82, 95% CI: 1.71–8.50; p=0.001) and of adverse event rates (OR 2.18, 95% CI: 1.19–3.98; p=0.011). Conclusion Hyperthyroidism at presentation is relatively common in TTS patients and associated with physical triggers and unfavorable long-term prognosis. Figure 1. Kaplan-Meier curves Funding Acknowledgement Type of funding source: None

Effects of omega-3 on thyroid function tests in healthy volunteers

Supplements play a pivotal role in medicine especially fish consumption or supplementation with omega 3. Omega-3 and thyroid hormones are important in keeping some essential body functions working normally and alterations of thyroid hormones levels can result in many pathological states. Our study aimed to investigate whether omega-3 supplementation (1000 mg/day for 2 months given orally) would affect thyroid hormones and thyroid-stimulating hormone in healthy volunteers with normal thyroid status. Normal thyroid status of the experimental group was well defined by serum levels of triiodothyronine (T3), thyroxine (T4), and by thyroid-stimulating hormone. Thyroid hormones (T3 and T4) levels were increased insignificantly in treated volunteers compared to the same volunteers before consumption of omega-3 (2.20 ± 0.37 to 2.23 ± 0.39 and 89.87 ± 9.93 to 90.98 ± 11.85 nmol/L, respectively). On the other hand, thyroid-stimulating hormone significantly increased after 2 months of omega-3 consumption (1.46 ± 0.47 to 1.68 ± 0.39 μIu/L). In conclusion, supplementation of omega-3 in the present study did not significantly modify either T3 or T4 and bodyweight in healthy volunteers. These data reinforce recommendations that indicate consumption of omega-3 is considered safe as far as thyroid function is concerned in healthy human volunteers. These findings advocate continued investigation of omega-3 for more than 2 months and higher dose to confirm its safety.

The Cutoff of Ferritin for Evaluation of Hypothyroidism in Patients With Thalassemia.

Thalassemia major is a genetic disease with a recessive autosomal pattern of inheritance that occurs as a result of disorder in hemoglobin synthesis. Researchers aimed to investigate the cutoff of ferritin for the development of hypothyroidism in patients with thalassemia major. This was a retrospective analytic cross-sectional study that was conducted on the medical records of patients with thalassemia major. Overt hypothyroidism was defined as thyroid stimulating hormone (TSH) level of >6.5 mIU/L and T4 level of < 4.2 ng/dL and subclinical hypothyroidism was defined as TSH level of >6.5 mIU/L and T4 level of >4.2 ng/dL. Data were gathered by a form including age, sex, weight, height, body mass index, thyroid test results, and the mean of last 3 consecutive hemoglobin and ferritin levels. In this study, 67 patients were evaluated. The mean age of the participants was 15.37±3.73 years. The frequency of subclinical hypothyroidism was 10.4%, and no cases of clinical hypothyroidism were noted as well as secondary hypothyroidism. Although there was a significant linear correlation between mean ferritin level and TSH (P=0.008), no significant correlation was noted between levels of ferritin and T4 levels. As ferritin was significantly correlated with TSH, the results showed that the mean serum level of ferritin in β-thalassemia major patients with hypothyroidism was higher than that in β-thalassemia major patients with normal thyroid status (P=0.013). The cutoff point for ferritin was 1953 ng/mL (sensitivity=85.7%, specificity=60%). It seems that considering the development of hypothyroidism by reaching the ferritin cutoff point, intensification of the iron chelation regimen along with a shorter interval for laboratory endocrine examinations can be recommended.

Differential diagnosis of thyroid diseases by the x-ray fluorescent method

Intrathyroid stable iodine (ISI) was measured in 249 women aged 36 to 55 living in Moscow. 179 of these suffered from thyroid tumors and autoimmune thyroiditis and 70 without history of thyroid diseases with normal thyroid status confirmed by clinical laboratory data and ISI values of at least 200 pg/g, considered as the critical, were controls. ISI concentrations were measured using a Russian commercial sample for noninvasive x-ray fluorescent analysis. Using the same device, ISI was measured in thyroid samples with cancer and benign tumors, embedded in paraffin blocks, sent from the USA (n - 47) and Russia (n = 126); in addition, these samples were examined histologically. ISI concentrations were lower in cancer, thyroid adenomas, and autoimmune thyroiditis than in control. An ISI concentration lower than 200 pg/g indicates autoimmune thyroiditis with a probability of 96%. Use of L- thyroxin test increases the probability of the disease recognition to 98%.

STUDY OF THE RISK FACTORS FOR CORONARY ARTERY DISEASE AND THEIR CORRELATION WITH THYROID HORMONE PROFILE AMONGST WOMEN WITH ST SEGMENT ELEVATION IN ACUTE MYOCARDIAL INFARCTION

Background: To assess risk factors for coronary artery disease and their correlation with thyroid hormone profile amongst women with ST segment elevation in acute myocardial infarction.&#x0D; Method: A total number of 78 females having ST elevation myocardial infarction diagnosed through detailed clinical history and ECG evaluations were included after they satisfy the eligibility criteria. Patients were subsequently evaluated for presence of risk factors of ischemic heart disease such age, marital status, parity, and menopause, use of oral contraceptives, family history, obesity, diabetes mellitus, hypertension, hypercholesterolemia and hypertriglyceridemia. Their thyroid hormone profiles (T3, T4, TSH) were done and were correlated with risk factors for ischemic heart disease.&#x0D; Result: A total 78 patient included in the study. Most of the study population belongs to the age group of 40 to 50 years (43.6 %). Hypertension was the most common clinical features amongst study population (59%) followed by Diabetes (50%). most of the study population had Normal Thyroid status (57.69%) followed by Hypothyroidism (25.64%) and Hyperthyroidism (16.67%). and SERUM TSH is the most sensitive test for evaluation. Diabetes Mellitus was statistically significant risk factor (p value &lt;0.05) in patients with STEMI with different levels of thyroid.&#x0D; Conclusion: Patients with coronary artery disease especially in the presence of other risk factors should be screened for diabetes and also for thyroid dysfunction as in our study cases of Hypothyroidism was seen in 25.64% of the population under study. Hence it can be postulated that hypothyroidism may be a predictor for myocardial injury in STEMI. Here we recommend that tests for thyroid disorders in acute coronary syndrome can give predictor for risk of morbidity and mortality in those subjects.&#x0D; These results also may warrant further larger study to investigate whether reversing the hypothyroidism could benefit the STEMI patients.&#x0D; Keywords: STEMI- ST segment elevation myocardial infarction, MI- Myocardial Infarction, Hyperthyroidism, Hypothyroidism, TSH- Thyroid Stimulating Hormone

A model of functional thyroid disease status over the lifetime.

Mathematical models of the natural history of disease can predict incidence rates based on prevalence data and support simulations of populations where thyroid function affects other aspects of physiology. We developed a Markov chain model of functional thyroid disease status over the lifetime. Subjects were in one of seven thyroid disease states at any given point in their lives [normal, subclinical hypothyroidism, overt hypothyroidism, treated thyroid disease (ever), subclinical hyperthyroidism, overt hyperthyroidism, and reverted to normal thyroid status]. We used a Bayesian approach to fitting model parameters. A priori probabilities of changing from each disease state to another per unit time were based on published data and summarized using meta-analysis, when possible. The probabilities of changing state were fitted to observed prevalence data based on the National Health and Nutrition Examination Survey 2007–2012. The fitted model provided a satisfactory fit to the observed prevalence data for each disease state, by sex and decade of age. For example, for males 50–59 years old, the observed prevalence of ever having treated thyroid disease was 4.4% and the predicted value was 4.6%. Comparing the incidence rates of treated disease predicted from our model with published values revealed that 82% were within a 4-fold difference. The differences seemed to be systematic and were consistent with expectation based on national iodine intakes. The model provided new and comprehensive estimates of functional thyroid disease incidence rates for the U.S. Because the model provides a reasonable fit to national prevalence data and predicts thyroid disease status over the lifetime, it is suitable for simulating populations, thereby making possible quantitative bias analyses of selected epidemiologic data reporting an association of thyroid disease with serum concentrations of environmental contaminants.

Functions of stem cells of thyroid glands in health and disease.

Thyroid gland has been implicated in the regulation of many functions using endocrine, paracrine and autocrine signals. Functional thyroid follicular cells derived from stem cells attracted a great interest from researchers as a strategy for thyroid's regenerative therapy. Thyroid has a very low rate of turnover; however, studies showed that the regenerative ability is enhanced following diseases or thyroidectomy, which promotes the role of stem cell. The objective of this review is to summarize the morphological characterization and the expression of stem cell genes/markers in the thyroid. Also, to highlight the mechanisms of tumor formation in thyroid via its stem cells. The most important thyroid stem cell's markers are: stem cell antigen 1 (SCA-1), octamer-binding transcription 4 (OCT-4), p63, CD34+ CD45-, paired box gene 8 (PAX-8), thyroid transcription factor 1 (TTF-1), thyroid transcription factor 2 (TTF-2), hematopoietically expressed homeobox protein HHEX, the transcription factor GATA-4, hepatocyte nuclear factor 4-α (HNF-4-α) and homeobox transcription factor Nanog (hNanog). This review highlights the functional characterization describing the mechanisms of stem cell's differentiation into functional thyroid follicle and proposing mechanisms involving in cancer formation through one of these cell types: fetal cell, thyroblasts, prothyrocytes, certain genetic mutation in the mature thyroid cells or presence of a special type of cells (cancer stem cell) which are responsible for different types of cancer formation. Understanding the mechanisms of thyroid's stem cell in cancer formation and the expression of the biomarkers in normal and abnormal thyroid status are promising physiological tools in promoting thyroid regeneration and in provision management for thyroid cancer.

Subclinical hypothyroidism is not a risk factor for polycystic ovary syndrome in obese women of reproductive age

Obese women are at high risk for polycystic ovary syndrome (PCOS). Subclinical hypothyroidism (SCH) has been associated with weight gain, insulin resistance and impaired fertility, which are also factors involved in PCOS. However, there is limited information regarding the influence of SCH on the presence of PCOS. In order to determine whether SCH increases the prevalence of PCOS, we performed a cross-sectional study in a cohort of reproductive-aged obese women. All subjects underwent anthropometric evaluation, laboratory tests and ultrasound examination. Diagnosis of PCOS was based on the Rotterdam criteria. A total of 534 obese women were included and 108 (20.2%) of them were diagnosed with SCH. Patients with SCH showed similar insulin resistance, comparable androgen levels, and higher triglycerides levels (1.7 vs. 1.5 mmol/L, p = .002) compared to those with normal thyroid status. The frequency of PCOS did not differ between the two groups (56.1% for normal thyroid function vs. 60.2% for subclinical hypothyroidism, p = .514). In logistic regression analysis, SCH was not an independent risk factor for PCOS after adjusting for confounding factors (OR = 0.984, 95% CI 0.581–1.667). For the first time, our results suggest that SCH does not increase the risk of PCOS in obese women of reproductive age.