Normal Thyroid-stimulating Hormone Levels Research Articles

Thyroid stimulating hormone (TSH) and infertility: the effect of TSH on embryo quality and IVF outcomes

OBJECTIVE: Currently accepted normal values for TSH have been questioned. Patients with TSH values in the high end of the normal range (2.5 to 5.0 IU/L) appear to be at increased risk for development of hypothyroidism compared to patients with TSH values in the low end of that range (0.5 to <2.5 IU/L). Some experts have recommended treatment for such patients who may be at risk for adverse effects of hypothyroidism, including patients attempting to conceive, but this remains controversial. This study examines the relationship between TSH values, embryo quality, and IVF outcome. DESIGN: A retrospective study of 622 first IVF cycles from 1999 to 2003 at a private infertility clinic. MATERIALS AND METHODS: Patients with TSH values of 0.5 to 5.0 IU/L were included and divided into two groups: Group A) TSH 0.5 to <2.5 IU/L, and Group B) TSH 2.5 to 5.0 IU/L. Patients using donated oocytes, with endocrine disorders, and severe endometriosis were excluded. The student's t-test, and the chi-square test were used for statistical analyses. RESULTS: There were no significant differences between Groups A and B with respect to patient age, number of oocytes retrieved, cell number on day 3, fragmentation on day 3, number of day 3 high quality embryos, number of embryos replaced per transfer, embryos frozen, fertilization rate, implantation rate, spontaneous abortion rate, or live birth rate. The percent of day 3 embryos with multinucleated (23.7 vs 21.4, p = 0.019), uneven (36.4 vs 32.8, p = 0.001), and disorganized (21.8 vs 20.4, p = 0.042) blastomeres appeared to be significantly higher in Group B than Group A. CONCLUSIONS: The possibility that some patients with normal TSH levels may have subclinical hypothyroidism is of significant concern in the context of infertility treatment. While our study suggests that overall quality of the embryo cohort in patients with low normal TSH levels may be better than those in patients with high normal TSH levels, this difference is not reflected in the implantation or live birth rate. Therefore it remains to be seen in larger studies whether treatment of IVF patients with high normal TSH levels is clinically justified.

“False-Positive” Newborn Thyroid Screen May Predict Future Subclinical Hypothyroidism

Endocrinology| September 01 2008 “False-Positive” Newborn Thyroid Screen May Predict Future Subclinical Hypothyroidism AAP Grand Rounds (2008) 20 (3): 31–32. https://doi.org/10.1542/gr.20-3-31-a Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation “False-Positive” Newborn Thyroid Screen May Predict Future Subclinical Hypothyroidism. AAP Grand Rounds September 2008; 20 (3): 31–32. https://doi.org/10.1542/gr.20-3-31-a Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: false-positive results, subclinical hypothyroidism, thyroid screening, thyrotropin, hyperthyrotropinemia, thyroid function tests Source: Leonardi D, Polizzotti N, Carta A, et al. Longitudinal study of thyroid function in children with mild hyperthyrotropinemia at neonatal screening for congenital hypothyroidism. J Clin Endocrin Metab. Rapid Electronic Publication first published on April 29, 2008; doi:10.1210/jc.2007-2612 To better understand the natural history of children with unexplained transient increase in thyroid stimulating hormone (TSH) in the newborn period, researchers from the University of Catania in Catania, Italy, followed children who had a “false positive” newborn thyroid screen into late childhood. This study was an extension of previously published work describing children with transient increase in TSH who, when studied at 16–44 months of age, demonstrated a high incidence (50%) of subclinical hypothyroidism.1 Infants with Down syndrome, prematurity, small for gestational age, and newborns of thyroid autoimmunity-positive mothers were excluded. Thyroid function and morphology in children with transient unexplained hyperthyrotropinemia in infancy were compared with control children who had normal newborn TSH levels at three time periods: age 16–44 months, age 4.1–6.6 years, and age 7.2–9.5 years. Measures of function included TSH, free T4 (FT4), free T3 (FT3), anti-thyroglobulin (anti-Tg), and anti-thyroperi-oxidase (anti-TPO) antibodies. Morphology was evaluated by ultrasound and thyroid volume was calculated and compared with reference values. A total of 44 children were followed until an average age of eight years. At age 16–44 months all children had a normal serum FT4, but mean serum TSH and FT3 levels were significantly higher than those of controls. Based on TSH levels at this time, children were divided in two groups: group 1 (16 patients) had normal serum TSH levels of <4.0mU/L and group 2 (28 patients) had slightly elevated serum TSH (4.0–10.1 mU/L). Levothyroxine treatment was given to reduce TSH in 20 of 28 children in group 2. At age 4.1–6.6 years, serum FT4 was within normal range in all children, with average values similar in groups 1 and 2. Serum TSH was within normal range in all 16 group 1 children and in nine of 28 group 2 children (group 2a); however, when the 25 children with normal serum TSH were compared with the control group, their average TSH levels were significantly higher. In the remaining 19 of 28 group 2 children, serum TSH was persistently elevated (group 2b). FT3 values were significantly higher compared with controls. Anti-thyroid antibodies (anti-TPO and/or anti-Tg) were slightly positive in 11 of 44 children in early childhood; however, they were weakly positive in only one child in group 2 at 30 months of age. At age 7.2–9.5 years, TSH serum values remained in the normal range in all group 1 children and in the nine group 2a children. Of the 19 group 2b children, TSH remained elevated in 14 but normalized in five children. Of the eight children treated with levothyroxine, seven had persistent elevation of TSH. Out of these seven children, six were determined to have genetic and/or morphological abnormalities of the thyroid as the possible cause of their... You do not currently have access to this content.

Optimal Free Thyroxine Levels for Thyroid Hormone Replacement in Hypothyroidism

To determine whether a difference exists in the free thyroxine level required to achieve a normal thyrotropin (thyroid-stimulating hormone or TSH) level between patients with primary hypothyroidism and euthyroid control subjects and compare the free thyroxine levels in patients with primary and secondary hypothyroidism receiving thyroid hormone replacement. We retrospectively assessed TSH and free thyroxine values in 58 patients with primary hypothyroidism and 78 euthyroid control subjects for whom screening thyroid function tests had been performed. From the medical records, we also obtained free thyroxine values for 23 patients with central hypothyroidism receiving stable levothyroxine replacement therapy. The mean free thyroxine level was significantly higher in patients with primary hypothyroidism than in euthyroid control subjects (1.36 +/- 0.201 ng/dL versus 1.10 +/- 0.155 ng/dL, respectively; P<or=.0001), whereas the corresponding mean TSH concentrations did not differ significantly (1.60 +/- 1.183 mIU/L versus 1.73 +/- 0.792 mIU/L; P = .46). The mean free thyroxine value was also significantly higher in the patients with central hypothyroidism in comparison with that in the euthyroid control subjects (1.31 +/- 0.278 ng/dL versus 1.10 +/- 0.155 ng/dL, respectively; P<or=.0001), and no significant difference was noted between the patients with primary and central hypothyroidism (1.36 ng/dL versus 1.31 ng/dL; P = .60). Patients with hypothyroidism require a higher level of serum free thyroxine to achieve a normal TSH value in comparison with euthyroid control subjects. This finding suggests that patients with central hypothyroidism should be treated to achieve free thyroxine levels in the upper part of the reference range.

Percutaneous Ethanol Injection of Hyperfunctioning Thyroid Nodules: Long-Term Follow-Up in 125 Patients

The purpose of this study was to assess the long-term efficacy of percutaneous ethanol injection (PEI) for the treatment of hyperfunctioning thyroid nodules. One hundred twenty-five patients (88 women, 37 men; age range, 17-76 years; mean age, 53 years) with 127 hyperfunctioning thyroid nodules (volume, 1.2-90 mL; mean, 10.3 mL) were treated with PEI. There were 1-11 PEI sessions per patient (average, 3.9) performed, with injection of 1-14 mL of ethanol per session (total injected ethanol per patient, 3-108 mL; mean, 14.0 mL). Efficacy of the treatment was assessed with color Doppler sonography; scintigraphy; and free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) assays. Follow-up (9-144 months; median, 60 months) was performed with TSH and color Doppler sonography every 2 months for 6 months and every 6 months thereafter. Three (2.4%) of 125 patients refused completion of PEI therapy because of pain. Results are reported in 122 patients with 124 nodules. All 122 patients showed posttreatment normal levels of FT3, FT4, and TSH. A complete cure (absent uptake in the nodule and recovery of normal uptake in the thyroid parenchyma) was obtained in 113 (93%) of 122 patients-115 (92.7%) of 124 treated nodules. Residual hyperfunctioning nodular tissue along with decreased thyroid parenchyma uptake (partial cure) was present in nine patients accounting for nine (7.3%) of 124 nodules. Rates of complete cure after PEI were: overall nodules, 115 (92.7%) of 124; nodules < or = 10 mL, 63 (94.0%) of 67; nodules > 10 to < or = 30 mL, 32 (91.4%) of 35; nodules > 30 to < or = 60 mL, 17 (89.5%) of 19; nodules > 60 mL, three (100%) of three. The overall rate of major complications (transient laryngeal nerve damage, two patients; abscess and hematoma, one patient each) was four (3.2%) of 125 patients. Follow-up examinations showed marked shrinkage of 112 treated nodules ranging from 50% to 90% of the pretreatment volume (mean, 66%) and new growth of hyperfunctioning tissue in four patients at color Doppler sonography and scintigraphy at 12, 18, 18, and 48 months' follow-up, respectively. However, all patients remained euthyroid (low or normal TSH and normal FT3 and FT4) during follow-up. PEI of hyperfunctioning thyroid nodules seems to be an effective and safe alternative to traditional treatment. It also appears to be effective in patients with hyperfunctioning thyroid nodules larger than 30 mL.

TSH alone is not sufficient to exclude all patients with a functioning thyroid nodule from undergoing testing to exclude thyroid cancer

The purpose of the study was to analyze whether the thyroid-stimulating hormone (TSH) alone avoids tests to exclude malignancy in all patients with functional thyroid nodules (FTN). Sixty-nine patients with FTN on (99m)Tc scintigraphy, radioiodine uptake test (RIU), (99m)Tc thyroid uptake, TSH assay, T3, and T4 obtained within 48 h were retrospectively identified out of 2,356 thyroid scans performed from January 2000 to April 2007. FTNs were classified as causing total, partial, or no inhibition of the thyroid as group 1, 2, or 3, respectively. TSH was subnormal in 21 of 69 (30.43%) patients. In group 1 (N = 23, 33.3%), TSH was subnormal, normal, and high in eight, nine, and six patients; in group 2 (N = 17, 24.6%), TSH was subnormal, normal, and high in four, six, and seven patients, and in group 3 (N = 29, 42%), TSH was subnormal, normal, and high in 9, 13, and 7 patients, respectively. TSH was significantly lower in group 1. In T3, T4, (99m)Tc thyroid uptake, and RIU, there were no differences between the three groups. Only 30.43% of patients had subnormal TSH. TSH alone cannot avoid tests to exclude malignancy in all patients with FTN. FTN existence can only be accurately assessed by thyroid scintigraphy. The current incidence of FTN may be unknown because scintigraphy is not routinely performed in all patients with thyroid nodules. Thyroid scintigraphy of patients with high TSH can detect diseases such as Hashimoto's thyroiditis and identify patients with FTN in whom no further diagnostic procedures would be needed in patients with normal TSH levels with nondiagnostic fine-needle aspiration results.

Structural evaluation of type 3 dopaminergic receptor gene (DRD3) in chronic anovulatory women

Dopamine receptor type 3 (DRD3) expressed in the limbic system sites involved in the regulation of GnRH seems to play a role in neuroendocrine control. We hypothesized that women with chronic anovulation should show exacerbated secretion of prolactin (PRL) after thyrotropin-releasing hormone (TRH) stimulation test, having more chances for dopamine inhibitory dysfunction due to alterations in the structure of DRD3. The DRD3-coding region was evaluated in 60 women with chronic anovulation (35 without and 25 with hyperresponse of PRL after TRH stimulation), and in 34 controls. Statistically similar frequencies of homozygous AGC polymorphism (43.4 and 33.4%) and heterozygous polymorphism (33.4 and 47.9%) at position 9 were found in controls and patients, respectively. Homozygous GCG polymorphism at position 17 was identified in 3.4% of the patients, while heterozygosis occurred in 20.8% of the patients and in 6.6% of the controls. The novel 41563_41567delTAAGT polymorphism of DRD3 was identified in 14.7% of the controls and 8.6% of the women with chronic anovulation displaying hyperresponse of PRL after TRH stimulation. Alteration 41563_41567delTAAGT of DRD3 was not found in patients who did not show hyperresponse of PRL after TRH stimulation. Normal baseline and peak levels of PRL and thyroid-stimulating hormone were similar for women with and without 41563_41567delTAAGT in the DRD3 gene. It is concluded that the novel polymorphism in DRD3 identified in this study is not associated with the response of PRL to TRH stimulation in women with chronic anovulation.

A Novel Monocarboxylate Transporter 8 Gene Mutation as a Cause of Severe Neonatal Hypotonia and Developmental Delay

Monocarboxylate transporter 8 acts as a specific cell membrane transporter for thyroxine and especially triiodothyronine into target cells. It is expressed in brain neurons and in many other tissues. The monocarboxylate transporter 8 gene resides on chromosome Xq13.2. An 11-month-old male infant was referred because of severe hypotonia from early life and global developmental delay. Thyroid-function tests showed normal thyrotropin levels and the characteristic for the disorder, including high serum triiodothyronine and low thyroxine concentrations. Molecular analysis of the monocarboxylate transporter 8 gene showed that the patient was hemizygous for a novel missense mutation P537L. This case highlights the importance of determining thyroid hormone levels, especially triiodothyronine, in infants with severe neonatal hypotonia.

Interference in free thyroxine immunoassay

We report two patients who presented with non-specific symptoms of tiredness that prompted their clinician to order a thyroid function test. In both cases, free thyroxine (T4) was reported to be high, with a normal thyroid-stimulating hormone (TSH). Repeated blood tests from the same laboratory using the same assay method yielded similar results. Due to discrepancies between the clinical and laboratory findings, we decided to repeat the blood tests at another laboratory using a different assay method. This revealed normal free T4 and TSH levels, suggesting that heterophile antibodies were interfering with the free T4 assay, leading to clinical confusion.

Health Status, Psychological Symptoms, Mood, and Cognition in L-Thyroxine-Treated Hypothyroid Subjects

Many hypothyroid subjects receiving L-thyroxine (L-T4) complain of psychological symptoms or cognitive dysfunction. However, there is limited validated information on these self-reports. Cross-sectional comparison of 20 euthyroid and 34 treated hypothyroid subjects, aged 20-45 years, with normal thyroid-stimulating hormone (TSH) levels. Subjects underwent the following validated measures: Short Form 36 (SF-36); Symptom Checklist 90-Revised (SCL-90-R); Profile of Mood States (POMS); and tests of declarative memory (Paragraph Recall, Complex Figure), working memory (N-Back, Subject Ordered Pointing, Digit Span Backwards), and motor learning (Pursuit Rotor). L-T4-treated subjects had higher mean TSH and free T4 levels, but free triiodothyronine (T3) levels were comparable to controls. L-T4-treated subjects had decrements on SF-36 and SCL-90-R summary scales and subscales. These subjects performed slightly worse on N-Back and Pursuit Rotor tests. Neither TSH nor thyroid hormone levels were associated with performance on psychological or cognitive measures. This group of L-T4-treated subjects had decrements in health status, psychological function, working memory, and motor learning compared to euthyroid controls. Higher mean TSH levels suggest this may be related to suboptimal treatment, although there were no correlations between TSH levels and outcomes. These findings are limited by potential selection bias, and randomized studies targeting different TSH levels and memory subdomains would clarify these issues.

Pten Loss in the Mouse Thyroid Causes Goiter and Follicular Adenomas: Insights into Thyroid Function and Cowden Disease Pathogenesis

Inactivation and silencing of the tumor suppressor PTEN are found in many different epithelial tumors, including thyroid neoplasia. Cowden Disease patients, who harbor germ-line PTEN mutations, often display thyroid abnormalities, including multinodular goiter and follicular adenomas, and are at increased risk of thyroid cancer. To gain insights into the role PTEN plays in thyroid function and disease, we have generated a mouse strain, in which Cre-mediated recombination is used to specifically delete Pten in the thyrocytes. We found that Pten mutant mice develop diffuse goiter characterized by extremely enlarged follicles, in the presence of normal thyroid-stimulating hormone and T4 hormone levels. Loss of Pten resulted in a significant increase in the thyrocyte proliferative index, which was more prominent in the female mice, and in increased cell density in the female thyroid glands. Surprisingly, goitrogen treatment did not cause a substantial increase of the mutant thyroid size and increased only to some extent the proliferation index of the female thyrocytes, suggesting that a relevant part of the thyroid-stimulating hormone-induced proliferation signals are funneled through the phosphatidylinositol-3-kinase (PI3K)/Akt cascade. Although complete loss of Pten was not sufficient to cause invasive tumors, over two thirds of the mutant females developed follicular adenomas by 10 months of age, showing that loss of Pten renders the thyroid highly susceptible to neoplastic transformation through mechanisms that include increased thyrocyte proliferation. Our findings show that constitutive activation of the PI3K/Akt cascade is sufficient to stimulate continuous autonomous growth and provide novel clues to the pathogenesis of Cowden Disease and sporadic nontoxic goiter.

Subclinical hypothyroidism in infertile women: The importance of continuous monitoring and the role of the thyrotropin-releasing hormone stimulation test

The aim of our study was to assess the prevalence of subclinical hypothyroidism (SH) after administering a thyrotropin-releasing hormone (TRH) stimulation test among women with normal serum thyroid-stimulating hormone (TSH) levels and various causes of infertility. Eighty-seven infertile women (39 with ovulation disorders and 48 with other causes of infertility) had a TRH stimulation test on day 3 – 7 of their cycle. Exaggerated TSH response (>30 mIU/l at 20, 40 or 60 min) following intravenous injection of 400 µg TRH was defined as SH. The TRH test was performed 2 – 4 months after the first visit to the clinic. We found that the prevalence of SH was significantly higher among women with ovulation disorders (20.5%) than among women with normal ovulation (8.3%). In addition, we found that although basal TSH levels were normal at recruitment, 2 – 4 months later these levels were abnormally high in 8% of the women. All these women had an abnormal TRH test. We recommend performing TRH stimulation testing in women suffering from ovulation disorders who have normal basal TSH levels, followed by repeat assessments of thyroid function to enable treatment with thyroxine in cases with abnormal results.

PENGARUH PEMBERIAN POVIDONE IODINE DAN IODIUM TINCTURE SECARA TOPICAL TERHADAP FUNGSI KELENJAR TIROID

ABSTRACT Background: Iodine Deficiency Disorder (IDD) is one of the main nutritional problems in Indonesia. The classic manifestation of IDD is goiter endemic and cretinism. Efforts have been conducted to eliminate IDD such as oral iodine supplementation and salt iodization. An alternative method that had been tried was through topical medication using iodine containing solution such as iodine tincture or povidone iodine. Both solutions were relatively cheap and almost available in every drug shop. This study was to explore the medicine to eliminate IDD which is rubbing self treatment and the danger of excessive iodine uptake is minimized. Objectives: The study was to investigate the effect of povidone iodine and iodine tincture by topical usage to the thyroid gland function. Methods: The study design was quasi experiment trial with pre- post design. Location of study was Srumbung and Dukun Subdistricts of Magelang District, Central Java. The subject was women of child bearing age (15–45 years) with visible goiter and normal thyroid stimulating hormone (TSH) level or hypothyroid. The subject were divided into two groups, each group consisted of 30 women of child bearing age. Group I was rubbed with povidone iodine on the neck every two days for 2 months and, group II was rubbed with iodine tincture with the same scheme as the first group. The level of TSH, free thyroxine (free T4) and urinary iodine excretion (UIE) were compared before and after intervention. Results: TSH level on povidone group (Group I) decrease from 3,6 μU/L (before) to 2,17 μU/L (after intervention). On tincture group also decrease from 2,7 μU/L to 1,42 μU/L. The median of free T4 on povidone group increase from 0,86 ng/dl (before) to 1,03 µg/dl (after intervention), whereas on tincture group the median of free T4 also increase with small value. The median of UIE on povidone group decrease from 383 μg/L (before) to 130 μg/L (after intervention), whereas on tincture group increase from 235 μg/L to 311 μg/L. The size of neck circle on povidone group showed that no significant difference between before and after intervention, whereas the tincture group had significant difference. Conclusions: The topical usage on thyroid gland of topical povidone iodine and iodine tincture improved TSH and free T4 levels. The treatment with iodine tincture decreased the size of goiter. [Penel Gizi Makan 2007, 30(1): 25-30] Keywords : povidone iodine, iodine tincture, TSH, free T4, UIE.

Determining the time androgens and sex hormone-binding globulin take to return to baseline after discontinuation of oral contraceptives in women with polycystic ovary syndrome: a prospective study

In this study, discontinuation of oral contraceptive pills in women with polycystic ovary syndrome was followed by the return of all measured androgens and sex hormone-binding globulin levels to basal values after 8 weeks. These observations are pertinent to the measurement of androgens and sex hormone-binding globulin levels in subjects who currently are taking oral contraceptive pills and have symptoms that are related to polycystic ovary syndrome.

Impact of iodine deficiency on the thyroid and neuromental development in children with neonatal transient hypothyroidism

Ninety-five preschool age children living in an iodine deficiency area were examined. Neonatal screening forcongenital hypothyroidism showed that 79 and 16 children had a thyroid-stimulating hormone (TSH) level of 20-50 and 51-100 uIU/ml, respectively, which became normal in the first 6 months of life. A control group comprised 35 children of the same age who had a TSH level of as high as 20 uIU/ml. A study of thyroid function revealed subclinical hypothyroidism in 16.8% of cases and an isolated increase in free triiodothyronine with the normal levels of TSH and free T«. Volumetry Indicated detected thyroid hypoplasia in 36.8% of the children. In the study group, the neuropsychological development Index was 90-110scores in 38(40.0%) children, 80-89 scores in 24(25.3%), and less than 80 scores In 33 (34.7%). The found changes in the pituitary-thyroid system in the study group determine a risk for thyroid disease and cognitive defects, which requires a follow-up of such children and drug correction of thyroid function.

P-891: Clinical profile of insulin resistant PCOS subjects. Characterization of a Latin American population

To determine the clinical and laboratory profile of those subjects having the more elevated levels of insulin resistance according to the homeostasis model assessment (HOMA) in a population of Latin American PCOS subjects. Prospective descriptive clinical trial. Thirty three (33) consecutive subjects with diagnosis of PCOS were prospectively recruited. All patients had, at least, 12 weeks without any hormonal treatment and normal levels of thyroid-stimulating hormone, and prolactin before entering the study protocol. The diagnosis of PCOS was established by the exclusion of other conditions chronic anovulation with associated hyperandrogenism: 21-OH-deficient-non classic adrenal hyperplasia, ovarian-adrenal tumors, and Cushing’s syndrome. A detailed physical examination was performed and registered. We measured Body Mass Index (BMI), Ferriman Galwey score (FG), Waist to Hip ratio (W/H), ovarian volume (OV) by ultrasound and menstrual cycle length. Additional laboratory assessment was obtained including fasting glucose and insulin, and plasminogen activator inhibitor 1 (PAI-1). Serum samples for measuring androgens at the end of recuitment period were also collected and were frozen at -20 °C. Statistical analysis was performed using KwikStat-4 Statistical Data Analysis Program (TexaSoft, Cedar Hill, TX). We did obtain a mean HOMA value for entire study population; we then classified those subjects having HOMA values above the mean as insulin resistant and those with HOMA values below the mean as non insulin resistant. A total of 24 subjects completed the clinical and laboratory protocol. The mean HOMA value for the entire study population was 2.43. Ten from 24 (41.6%) subjects had values higher than the general mean, and constituted the insulin resistant group. Mean age of insulin resistant group was higher compared to non insulin resistant subjects (28.8 vs 24.62) but without reaching statistical significance. Overall, the insulin resistant group had a more severe clinical condition as it is suggested by the fact that they had statistically significant higher values of BMI (30.52 Kg/m2 vs 24.40 Kg/m2), W/H ratio (0.84 vs 0.78), menstrual cycle length (72.50 days vs 49.64 days), PAI (18.13 ng/mL vs 10.39 ng/mL), and A4 (4.11 ng/mL vs 3.33 ng/mL). Of note insulin resistant women had significantly lower values of DHEAS (154 ug/dL vs 208 ug/dL) In this population of Latin American PCOS women, we have demonstrated that PCOS subjects with higher insulin resistant state have a more severe disease, being older, with a major degree of obesity, elevated levels of PAI-1 and poorer menstrual function. Unexpectedly, adrenal androgens were lower in the insulin resistant group.

Thyroid hormone and heart failure

Thyroid hormone metabolic disarray has been identified as a risk factor for the progression of heart disease and the development of heart failure (HF). Both hyper- and hypothyroidism have been associated with a failing myocardium. Poor cardiac contractility and low cardiac output due to hyperthyroidism is a rare occurrence and is mostly seen in patients with preexisting heart disease. Referred to as a "rate related" phenomenon, hyperthyroid-induced sustained sinus tachycardia or atrial fibrillation may further reduce ventricular contractility. Increasingly, the hypothyroid state, and in particular a low triiodothyronine level, has been associated with a reduced cardiac performance and poor prognosis in HF, even in the presence of normal thyroid-stimulating hormone levels. Low thyroid hormone levels alter cardiac gene expression and increase systemic vascular resistance, both resulting in a reduction of cardiac contractility and cardiac output. This review summarizes current data on thyroid dysfunction and HF as well as the emerging implications of the "low triiodothyronine state."

Persistent Auditory Hallucinations That Are Unresponsive to Antipsychotic Drugs

Persistent Auditory Hallucinations That Are Unresponsive to Antipsychotic Drugs

Hyperthyroidism after parathyroid exploration

We hypothesized that hyperthyroidism after parathyroid exploration may be an underreported phenomenon with a course more severe than recognized previously. We examined pre- and postoperative thyroid function and outcomes in 199 consecutive patients who, since March 2000, had parathyroid exploration for primary sporadic hyperparathyroidism (HPTH). We excluded patients with prior thyroid or parathyroid surgery, preoperative thyroid medication, concurrent total thyroidectomy, or follow-up <5 months. Of 125 patients with normal preoperative serum thyroid-stimulating hormone levels, 39 (31.2%) were hyperthyroid postoperatively. Mean thyroid-stimulating hormone levels (mean +/- SD) dropped with operation from 2.0 +/- 1.1 microIU/mL to 1.2 +/- 1.4 microIU/mL (P < .0001). Nineteen patients (15%) reported symptoms 1 to 2 weeks after operation. The clinical course of hyperthyroidism typically was short, but 5 patients (4%) had symptomatic hyperthyroxinemia requiring medical therapy. Hyperthyroidism was independent of age, severity of HPTH, anatomic/pathologic features, operative time, and other measures of operative difficulty, but was associated with lithium therapy, bilateral exploration, and absence of concurrent thyroid lobectomy. Risk of hyperthyroidism may be underappreciated after routine parathyroid surgery for HPTH. Use of lithium and degree of dissection appear contributory. Patients undergoing parathyroid exploration need counseling and surveillance for hyperthyroidism, which may be reduced by minimizing the extent of parathyroid surgery.

Screening for congenital hypothyroidism: the value of retesting after four weeks in neonates with low and very low birth weight

Thyroid-stimulating hormone (TSH), normally a reliable screening test for congenital hypothyroidism (CH), may fail to detect cases among infants who have low and very low birth weight. The purpose of this study was to identify neonates with false-negative screening results. A province in Poland in which 3,854 neonates had body weight <or=2,500 g, between 1999 and 2001. TSH levels in blood on filter paper were measured in all neonates between the third and sixth days after birth, but were repeated in low and very low birth weight infants after four weeks of age. The repeat test showed TSH levels >or= 10 mIU/L in 19 of the 3,854 low birth weight neonates. The final diagnosis in these neonates was permanent CH in two, transient CH in five, possible compensated CH in six and transient high TSH in six. Of the 19, 16 (84%) required iodine and/or thyroxine replacement therapy. In neonates with low and very low birth weight, normal TSH levels measured between the third and sixth day of life do not exclude thyroid dysfunction, but a repeat TSH measurement after the fourth week of life identifies the false-negative results. In our data, the prevalence of primary and secondary hypothyroidism (both permanent and transient) was about 0.5%.

Time Androgens and Sexual Hormone Binding Globulin (SHBG) Take to Return to Baseline Levels Following Discontinuation of Oral Contraceptives Pills (OCP), in Women With Polycystic Ovary Syndrome (PCOS), A Prospective Study

To determine the time that it takes for androgens and SHBG in women with PCOS to return to their pretreatment levels, following discontinuation of therapy with an OCP containing drospirenone and ethinyl-estradiol. Prospective descriptive clinical trial. Eight (8) subjects with diagnosis of PCOS were assigned to receive a combination OCP containing drospirenone 3 mg and ethinyl-estradiol 30 μg for 12 weeks. After this treatment period, subjects discontinued OCP and were followed up during 8 weeks. All patients had, at least, 12 weeks without hormonal treatment and normal levels of thyroid-stimulating hormone, and prolactin before entering the study protocol. The diagnosis of PCOS was established by the exclusion of other conditions that can cause chronic anovulation with associated hyperandrogenism: 21-OH-deficient-non classic adrenal hyperplasia, ovarian-adrenal tumors, and Cushing’s syndrome. Serum samples were collected prior to and at week 12 of treatment, and also 4 and 8 weeks after discontinuation of OCP. Samples were frozen at -20 °C. We measured total (TT) and free testosterone (FT), dehydroepiandrosterone sulfate (DHEAS), and SHBG levels, by ELISA and RIA. Statistical analysis was performed using KwikStat-4 Statistical Data Analysis Program (TexaSoft, Cedar Hill, TX). A total of 7 PCOS subjects completed the study. Mean age was 26.29 years. Mean body mass index (BMI) at basal conditions and end of treatment period were 24.35 and 24.29 kg/m2, respectively (p = 0.86). Ferriman-Gallwey score decreased during treatment period, but change did not reach significance (mean baseline and post-treatment values were 4.14 and 3.86; p = 0.36). Mean initial and after 12 weeks of treatment levels for TT, FT, DHEAS, and SHBG were 4.14 nmol/L (119 ng/dL) and 1.9 nmol/L (54.86 ng/dL); 0.01 nmol/L (0.28 ng/dL) and 0.004 nmol/L (0.11 ng/dL); 4.4 μmol/L (164 μg/dL) and 2.84 μmol/L (105 μg/dL); 59 nmol/L and 311 nmol/L, respectively. Following discontinuation of OCP androgen levels increased progressively, at 4 and 8 weeks. Levels of TT (3.72 nmol/L = 107.3 ng/dL) and DHEAS (3.81 μmol/L = 140 μg/dL) at week 4 were not significantly different from those measured at baseline. Alternatively, FT (0.008 nmol/L = 0.22 ng/dL) and SHBG (54.4 nmol/L) returned to levels not significantly different from baseline values, only at week 8 post discontinuation of OCP. In this population of PCOS women, discontinuation of an OCP containing drospirenone 3 mg and ethinyl estradiol 30 μg was followed by return of TT and DHEAS to baseline levels in 4 weeks. On the other hand, levels of FT and SHBG returned to basal values only 8 weeks after discontinuation of OCP. These observations are pertinent when measuring androgens and SHBG in subjects suspected of having PCOS, who are currently taking OCP.