Overt Hypothyroid Patients Research Articles

Respiratory Manifestations of Hypothyroidism: A Systematic Review.

Hypothyroidism has been associated with increased pulmonary morbidity and overall mortality. A systematic review was conducted to identify the prevalence and underlying mechanisms of respiratory problems among patients with thyroid insufficiency. PubMed and EMBASE databases were searched for relevant literature from January 1950 through January 2015 with the following study eligibility criteria: English-language publications; adult subclinical or overt hypothyroid patients; intervention, observational, or retrospective studies; and respiratory manifestations. The Preferred Reporting Items for Systematic reviews and Meta-Analyses statement was followed, and Cochrane's risk of bias tool was used. A total of 1699 papers were screened by two independent authors for relevant titles. Of 109 relevant abstracts, 28 papers underwent full-text analyses, of which 22 were included in the review. Possible mechanisms explaining respiratory problems at multiple physiological levels were identified, such as the ventilator control system, diaphragmatic muscle function, pulmonary gas exchange, goiter caused upper airway obstruction, decreased capacity for energy transduction, and reduced glycolytic activity. Obstructive sleep apnea syndrome was found among 30% of newly diagnosed patients with overt hypothyroidism, and demonstrated reversibility following treatment. The evidence for or against a direct effect on pulmonary function was ambiguous. However, each of the above-mentioned areas was only dealt with in a limited number of studies. Therefore, it is not possible to draw any strong conclusions on any of these themes. Moreover, most studies were hampered by considerable risk of bias due for example to small numbers of patients, lack of control groups, randomization and blinding, and differences in body mass index, sex, and age between subjects and controls. Mechanistic data linking hypothyroidism and respiratory function are at best limited. This area of research is therefore open for retesting hypotheses, using appropriate study designs and methods.

Serum fibroblast growth factor 19 is decreased in patients with overt hypothyroidism and subclinical hypothyroidism

As a newly emerging metabolic regulator, accumulating evidence suggests that the circulating fibroblast growth factor 19 (FGF19) level correlated with lipid and glucose metabolism. Several independent groups have found that FGF19 was highly likely associated with multiple metabolic disorders. Thyroid dysfunction is believed to be associated with metabolism diseases. However, to date, few studies have investigated the role of FGF19 in patients with thyroid dysfunctions. For this purpose, a cross-sectional study was done to estimate the role of FGF19 in patients with different thyroid functions. Compared with the healthy control, the present study revealed that serum FGF19 levels were significantly decreased in overt hypothyroidism patients (78.7 [52.7–121.2] vs 292.4 [210.2–426.5] pg/mL, P <0.001). FGF19 concentration was also lower in the subclinical hypothyroidism group than it was in the healthy control group (95.8 [71.7–126.3] vs 292.4 [210.2–426.5] pg/mL, P <0.001). However, there was no significant difference in FGF19 level between the isolated thyroid autoantibody positive group and the healthy control group (252.0 [205.9–353.5] vs 292.4 [210.2–426.5] pg/mL, P >0.05). Also, serum thyroid stimulating hormone (TSH) was an independent predictor of FGF19. In conclusion, thyroid insufficiency but not thyroid autoimmunity may have impacted serum FGF19 concentrations. As the role of FGF19 is becoming more and more important in the pathogenesis of many metabolic diseases, we proposed that the thyroid hormone level should be taken into account when the serum concentration is explained. Further studies are needed to elucidate the role of FGF19 in the development of hypothyroidism.

Serum Total Sialic Acid Level is Elevated in Hypothyroid Patients as an Atherosclerotic Risk Factor.

Serum total sialic acid (TSA) concentration is regarded as an indicator of the risks of atherosclerosis and cardiovascular diseases. The association between SA levels and atherosclerosis risk factors has not been assessed in patients with thyroid diseases. Sixty newly diagnosed treatment-naive hypothyroid patients, 35 with subclinical and 25 with overt hypothyroidism, and 30 euthyroid individuals were analyzed. SA was measured in fasting blood samples, as were routine biochemical parameters, some atherosclerosis markers and carotid artery intima media thickness (CIMT). Mean SA (38.1 ± 12.0 vs. 46.0 ±15.8; P = 0.019) and CIMT (0.57 ± 0.06 vs. 0.62 ± 0.12; P = 0.013) were found to be higher in the patient group compared with the control group. Mean sialic acid was higher in overt hypothyroidism patients compared with subclinical hypothyroidism patients and the control group. No difference was found between the subclinical hypothyroidism group and the control group. Sialic acid level and CIMT had a positive correlation in both the entire population and the hypothyroidism group. The linear regression model established for mean CIMT level in the entire population showed that risk factors of LDL (B ± SE = 0.454 ± 0.206; P = 0.030), uric acid (B ± SE = 1.902 ± 0.686; P = 0.007), hs-CRP (B ± SE = 1.003 ± 0.380; P =0.010), and SA (B ± SE = 2.419 ± 0.450; P < 0.001) were independent predictors of CIMT level. Sialic acid level is elevated in hypothyroid patients. However, this elevation is not related to thyroid hormone levels and autoantibodies. Correlations between SA and atherosclerosis indicators, such as CIMT, LDL, hs-CRP, and uric acid, in hypothyroid individuals suggest that SA may be an indicator of atherogenesis in these patients.

Alterations in lipid profile in old age hypothyroid patients

The current investigation was designed to study the changes of lipid profile in hypothyroid patients in local population and t o investigate the importance of thyroid profile in oId age dyslipidemia patients. Ninety five newly diagnosed untreated h ypothyroid patients (aged 4 9.2112.47 years, BMI 3 0.365.8, 74 females and 21 males) were identified from thyroid OPD of INMOL, PGMI, Lahore. Patients were compared with 78 control subjects (aged 48.8011.00 years, BMI 30.5104.70, 54 females and 24 males) matched by age and body mass index (BMI). Serum TSH, FT4, FT3, Triacylglcerol (TAG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) were measured. Significantly increased levels of TC and LDL-C in overt hypothyroid patients were observed. No significant differences were found in HDL-C and TAG in overt hypothyroid patients as compared to the control group. Elevated levels of TC and LDL-C in hypothyroid patients represent an increased risk of ischaemic heart disease that requires therapeutic intervention. The deranged lipid profiles in hypothyroidism can not be corrected without the treatment for hypothyroidism in these patients. Therefore, all older patients referred for diagnosis and treatment of dyslipidemia should also be screened for hypothyroidism.

Lipoprotein (a), Lipid Profile and Mean Platelet Volume in Hypothyroid Patients in Sana'a, Yemen: A Case-Control Study

Objectives: This study aimed to measure lipoprotein (a) [Lp(a)], lipid profile and mean platelet volume (MPV) in hypothyroid patients compared to healthy controls.Methods: An unmatched case-control study was conducted involving 100 subjects (50 overt hypothyroidism patients and 50 healthy controls admitted to the University of Science and Technology Hospital, Al-Thawra Hospital and Al-Jomhori Hospital- Sana'a, Yemen during the period from May 2013 to March 2014. Data were collected by in-person interview using a structured questionnaire followed by weight and height measurements. Fresh blood samples were collected and analyzed using electrochemiluminescent, spectrophotometric and immunoturbidimetric methods for estimating Lp(a), lipid profile and MPV parameters.Results: Hypothyroid patients had a significantly higher concentration of Lp(a) compared to the control. Total cholesterol (TC), triglycerides and low-density lipoprotein-cholesterol (LDL-C) levels were also significantly higher in hypothyroid patients. Serum level of free triiodothyronine (FT3) was negatively correlated with Lp(a), TC and LDL-C (r=–0.380, p=0.007; r=–0.354, p=0.012; r=–0.350, p=0.013, respectively). However, serum thyroid-stimulating hormone was positively correlated with Lp(a), TC and LDL-C (r=0.344, p=0.015; r=0.299, p=0.035; r=0.405, p=0.004, respectively) among hypothyroid patients. MPV levels, on the other hand, showed a strong positive correlation with (r=0.611, p=0.001).Conclusions: These findings indicate that overt hypothyroidism patients tend to have increased Lp(a) and atherogenic lipids that may contribute to increasing risk of atherosclerosis. However, hypothyroid patients showed no significant difference compared to the controls regarding the MPV

Levels of endothelial cell-specific molecule-1 (ESM-1) in overt hypothyroidisim

ABSTRACTPurpose: Endothelial cell-specific molecule-1, endocan, is a proteoglycan that is expressed by the vascular endothelium. Endocan can be a biomarker of endothelial dysfunction caused by endothelial cell-dependent disorders. Endothelial dysfunction is an early step of atherosclerosis and is developed in hypothyroid patients, which indicates an association between hypothyroidism and atherosclerosis. Therefore, we aimed to investigate whether circulating endocan levels are associated with endothelial dysfunction in overt hypothyroid patients. Materials and methods: Forty patients with hypothyroidism diagnosed in the last 5 years and 30 healthy subjects were recruited. Results: The mean endocan value in all patients was 0.63 ± 0.26 pg/ml, which was higher than that in controls (0.36 ± 0.10 pg/ml, p < 0.05). When we subgrouped the patients as hypothyroid and euthyroid, all groups demonstrated significantly different endocan levels, and hypothyroid patients had the highest endocan levels. A correlation analysis demonstrated that endocan levels were positively correlated with body mass index (BMI), thyroid-stimulating hormone (TSH), anti-thyroid peroxidase, and anti-thyroglobulin and negatively correlated with free thyroid hormone 4 (FT4) and vitamin D levels. In addition, in the patient group, endocan levels were correlated with FT4 levels independently in a covariance analysis. Conclusions: The circulating endocan level increased in hypothyroid patients, suggesting that endocan levels may be an early biomarker of the development of endothelial dysfunction in patients with hypothyroidism. They may also prove useful in the prediction of cardiovascular diseases after further studies using cardiovascular disease biomarkers. In addition, targeting endocan levels to decrease cardiovascular risk may be a new treatment strategy in these patients.

The Effect of Hypothyroidism on Insulin Sensitivity and Their Influence on the Serum Lipid Profile and Renal Function

The overt and subclinical hypothyroidism is more prevalent in patients with diabetes mellitus than in general population. Recently, more studies have been warranted to elucidate the relationship between thyroid hormones disorders and the insulin activity. The present study aims to investigate the correlations between the thyroid hormone levels in subclinical and overt hypothyroid patients with the insulin resistance and their impact on serum lipid profiles and kidney function. Methods: A total of fifty newly diagnosed hypothyroid patients were recruited for the study and classified into: 1) Subclinical hypothyroid (SH) group: n-26; 2) Overt hypothyroid (OH) group: n=24, and control (C) group: n=18. Fasting blood was collected and serum was used for biochemical analysis. Results: The fasting serum insulin, glucose levels and the estimated insulin resistance index (HOMA) of the SH and OH groups were significantly (P<0.001) elevated compared to control. The regression analysis reviled a significant negative correlation between FT4 and insulin (r=-0.32, P=0.04) and significant positive correlations between TSH and insulin (r=0.57, P=0.002), between TSH and HOMA (r=0.51, P=0.001), between HOMA and uric acid (r=0.37, P=0.02), and between TSH and TG (r=0.47, P=0.002). The serum creatinine, urea and uric acid concentrations were significantly (P<0.001) elevated in the OH group but not the SH. The serum total cholesterol, TG and LDL-cholesterol were significantly elevated in both SH and OH. Conclusion: Hypothyroidism is associated with insulin resistance, renal impairment, hyperurecemia and dyslipidemia, which are atherosclerotic risk indicators. The TSH had maximum impact on the changes. Subclinical and overt hypothyroid patients with elevated TSH are at high risk of developing atherosclerosis, thus may need close monitor to contain the rise in plasma TSH.

Lipoprotein (a), Lipid Profile and Mean Platelet Volume in Hypothyroid Patients in Sana'a, Yemen: A Case-Control Study

Objectives: This study aimed to measure lipoprotein (a) [Lp(a)], lipid profile and mean platelet volume (MPV) in hypothyroid patients compared to healthy controls.Methods: An unmatched case-control study was conducted involving 100 subjects (50 overt hypothyroidism patients and 50 healthy controls admitted to the University of Science and Technology Hospital, Al-Thawra Hospital and Al-Jomhori Hospital- Sana'a, Yemen during the period from May 2013 to March 2014. Data were collected by in-person interview using a structured questionnaire followed by weight and height measurements. Fresh blood samples were collected and analyzed using electrochemiluminescent, spectrophotometric and immunoturbidimetric methods for estimating Lp(a), lipid profile and MPV parameters.Results: Hypothyroid patients had a significantly higher concentration of Lp(a) compared to the control. Total cholesterol (TC), triglycerides and low-density lipoprotein-cholesterol (LDL-C) levels were also significantly higher in hypothyroid patients. Serum level of free triiodothyronine (FT3) was negatively correlated with Lp(a), TC and LDL-C (r=–0.380, p=0.007; r=–0.354, p=0.012; r=–0.350, p=0.013, respectively). However, serum thyroid-stimulating hormone was positively correlated with Lp(a), TC and LDL-C (r=0.344, p=0.015; r=0.299, p=0.035; r=0.405, p=0.004, respectively) among hypothyroid patients. MPV levels, on the other hand, showed a strong positive correlation with (r=0.611, p=0.001).Conclusions: These findings indicate that overt hypothyroidism patients tend to have increased Lp(a) and atherogenic lipids that may contribute to increasing risk of atherosclerosis. However, hypothyroid patients showed no significant difference compared to the controls regarding the MPV

Effect of steroid replacement on thyroid function and thyroid autoimmunity in Addison's disease with primary hypothyroidism.

Background:Steroid replacement without thyroxine supplementation normalizes thyroid function test (TFT) in some but not all Addison's disease patients with primary hypothyroidism. Both autoimmune and nonautoimmune mechanisms contribute to this improvement in TFT. However, the documentation of the change in thyroid autoimmunity after cortisol replacement is very limited in the literature. The aim of this study was to determine the effect of steroid replacement on TFT and anti-thyroid peroxidase antibody (anti-TPO-Ab) titer in Addison's disease with primary hypothyroidism.Materials and Methods:This observational study was conducted in a tertiary care center in South India. Six Addison's disease patients with primary hypothyroidism, who were only on steroid replacement, were included in the study. Low serum cortisol (<83 nmol/L) with high plasma adrenocorticotropic hormone (>22 pmol/L) and/or hyperpigmentation of skin/mucous membranes was considered as the diagnostic criteria for Addison's disease. Primary hypothyroidism (both overt and subclinical) was defined as high thyroid stimulating hormone (TSH) with/without low free thyroxine (fT4). TFT and anti-TPO-Ab were performed before and after steroid replacement in all of them.Results:Poststeroid replacement, there was a normalization of TSH in all but one subjects. In overt hypothyroidism patients, fT4 also normalized. The improvement in TFT was not associated with decreasing titer of the anti-TPO-Ab in all six patients. However, there was a significant difference in TSH after steroid replacement compared to the baseline status.Conclusions:The concept of normalization of primary hypothyroidism with cortisol replacement in patients with Addison's disease should be recognized to avoid iatrogenic thyrotoxicosis caused by thyroxine replacement. Both autoimmune and nonautoimmune mechanisms contribute to these alterations.

Total antioxidant status and serum lipid profile in hypothyroid patients in tertiary care hospital of Northern India

Objective: To study the Total Antioxidant status, thyroid profile and lipid profile in patients of overt and subclinical hypothyroidism. Also to assess the sex differences in thyroid function and to compare our results to previously published reference data. Results: In the present study 93.3% cases were females, suggesting hypothyroidism is more prevalent in the female population. The TAS levels were decreased in 20 cases(66.7%) and 1 control(5%). The difference was statistically highly significant (p

Overt and subclinical hypothyroidism among Bangladeshi pregnant women and its effect on fetomaternal outcome.

Thyroid disorders are among the common endocrine problems in pregnant women. It is now well established that not only overt but subclinical thyroid dysfunction also has adverse effects on maternal and fetal outcome. There are few data from Bangladesh about the prevalence of thyroid dysfunction in pregnancy. With this background, this study aims to find out thyroid dysfunction (both overt and subclinical hypothyroidism) in pregnancy and its impact on obstetrical outcome. We studied the evaluation of 50 admitted pregnancies corresponding to 29 women with subclinical hypothyroidism and rest 21 was overt hypothyroidism. Detailed history and examination were performed. Apart from routine obstetrical investigations, Thyroid Stimulating Hormone (TSH) estimation was done. Their obstetrical and perinatal outcomes were noted. Overt hypothyroidism was significantly (p < 0.05) higher in 25 to 44 years age group. However two and three abortions were significantly (p < 0.05) higher in overt hypothyroidism patients. In sub clinical hypothyroidism 86.2% conceived firstly within 2 years and 66.7% in overt hypothyroidism patients conceived firstly in between 3 to 5 years after marriage. Overt hypothyroids were prone to have pregnancy-induced hypertension 42.9%, intrauterine growth restriction (P = 0.001) and gestational diabetes (38.1%) as compared to subclinical cases. Neonatal complications were significantly more in overt hypothyroidism group. Mean TSH level was significantly (p < 0.05) higher in overt hypothyroidism patients but mean FT4 level was almost similar in both groups. Majority of the patient underwent caesarean section in both groups due to associated medical and obstetrical complications. None of the babies showed hypothyroidism by cord blood tests. In this analysis our results showed that overt hypothyroidism among Bangladeshi pregnant women are associated with more maternal complication & adverse parental outcome than subclinical hypothyroidism. The adequate treatment of hypothyroidism during gestation minimizes risks and generally, makes it possible for pregnancies to be carried to term without complications. Significant adverse effects on maternal and fetal outcome were seen emphasizing the importance of routine antenatal thyroid screening.

Serum total sialic acid levels in overt and subclinical hypothyroid patients and its relationship with atherosclerotic risk factors

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Ischemia-modified albumin levels in overt and subclinical hypothyroidism.

Free radical-mediated oxidative stress (OS) has been implicated in the pathogenesis of thyroid disorders. The ischemia-modified albumin (IMA) has been proposed as a marker of protein oxidative damage, which has been found to reflect hypoxic stress. Our aim was to evaluate IMA, malondialdehyde (MDA), and reduced glutathione (GSH) levels in patients with overt hypothyroidism (OHT) and subclinical hypothyroidism (SHT) in comparison to euthyroid controls. Albumin, IMA, IMA/albumin ratio, MDA, GSH, total cholesterol (TC), triglycerides (TG), HDL-Cholesterol were assessed in 105 subjects grouped into OHT, SHT patients, and euthyroid controls with 35 subjects in each group. MDA and IMA levels were significantly elevated while the GSH concentrations were significantly lower in OHT and SHT patients compared to controls (p < 0.01). When IMA values were normalized for albumin concentrations, the IMA/albumin ratio was also significantly elevated in both patient groups compared to controls (p < 0.01). These changes were more pronounced in the OHT group when compared to SHT group. In OHT group, thyroid-stimulating hormone (TSH) levels showed significant positive correlation with MDA (r = 0.470, p = 0.004), IMA (r = 0.530, p = 0.001), and IMA/albumin ratio (r = 0.525, p = 0.001). Both IMA (r = -0.342, p = 0.041), IMA/albumin ratio (r = -0.378, p = 0.023) showed significant negative correlation with GSH in OHT patients. No significant correlation between variables was, however, observed in SHT group. Increase of MDA and IMA levels with decreased antioxidant status indicate the presence of OS in hypothyroid patients, which was more pronounced in OHT patients. Elevated levels of IMA can be a clinically useful marker of protein oxidative damage and OS in hypothyroidism.

Serum Lipid Profile in Hypothyroid Patients in Nepal

INTRODUCTION: Hypothyroidism is non-curable common endocrine disorder in which the thyroid gland is unable to produce enough thyroid hormone. Present with a number of symptoms, Having a low level of thyroid hormone affects our whole body. Untreated hypothyroidism can be the cause of raised cholesterol levels. Many study have shown association between hypothyroidism and lipid profile. In this study, we evaluate the mean lipid profile status in subclinical hypothyroidism and hypothyroid patients. MATERIAL AND METHODS: A hospital based retrospective study done from the record card maintained in Alka Hospital, Jawalakhel. Total number of participants were 215. Out of which 73 had overt hypothyroidism, 92 had subclinical hypothyroidism and 50 were taken as control. SPSS version 20 was used for data analysis. RESULTS: The level of LDL, TG and TC was significantly higher in case of overt hypothyroidism as compared to control group, but no significant difference was found in subclinical hypothyroidism and control group. TG level was significantly lower in subclinical hypothyroidism cases. CONCLUSION: Elevated HDL, LDL &amp; TC is seen in overt hypothyroid patients. It is important to screen for lipid profile in hypothyroid patients.DOI: http://dx.doi.org/10.3126/jucms.v2i4.12065Journal of Universal College of Medical Sciences (2014) Vol.02 No.04 Issue 08Page: 33-36

The Effect of Hypothyroidism on Color Contrast Sensitivity: A Prospective Study

Background: Thyroid hormone has been shown to control retinal cone opsin expression, the protein of color vision, in adult rodents. Objectives: The aim of this study was to evaluate the effect of hypothyroidism on color contrast sensitivity in adult overt hypothyroid patients. Methods: Thirty-eight overt hypothyroid (31 females, 7 males) subjects and 20 euthyroid (16 females, 4 males) controls were studied prospectively. Color vision examination was performed by Chromatest, a software program analyzing the tritan (blue-yellow) color contrast threshold (tritan CCT) and protan (red-green) color contrast threshold (protan CCT). Color contrast sensitivity analyses of hypothyroid subjects were performed on admission and after <smlcap>L</smlcap>-thyroxine treatment when biochemical euthyroidism was achieved. Results: After a median period of 90 (90-210) days, 24 (19 females, 5 males) patients were euthyroid and eligible for a second color vision examination. Baseline tritan CCT and protan CCT values were significantly higher in the hypothyroid group compared to euthyroid controls, which clinically translates into impaired color contrast sensitivity (p < 0.001 and p < 0.001, respectively). There was a significant decrease in tritan CCT (p = 0.002) and protan CCT (p < 0.001) values in the hypothyroid group after euthyroidism was achieved, which denotes improvement in color contrast sensitivity. Conclusions: It is a novel finding of the current study that color contrast sensitivity is impaired in hypothyroidism and significantly improves after euthyroidism is achieved.

Evaluation of serum prolactin level in patients of subclinical and overt hypothyroidism.

Prolactin secretion is controlled by prolactin inhibitor factor that is secreted from hypothalamus; factors like vasoactive inhibitory peptide (VIP) and thyroid releasing hormone (TRH) lead to increase in prolactin secretion. Hyperprolactinemia is a common condition that can result from a number of causes including hypothyroidism. Objective of the study was to determine correlation between serum levels of prolactin and thyroid hormones in euthyroid, subclinical and overt hypothyroid cases. Consecutive patients presenting for various thyroid related problems were segregated into two groups subclinical and overt hypothyroidism according to their diagnosis based on history and clinical examination, laboratory reports, inclusion and exclusion criteria. Newly diagnosed 75 patients in each group were finally enrolled. Similar number of age and sex matched controls were selected. All subjects filled a predesigned questionnaire for the evaluation of hypothyroid symptoms. Thyroid profile for T3, T4 (total and free), TSH and prolactin were determined in all the subjects and analyzed. Prolactin elevation was found in 16 patients (21.33 %) with overt hypothyroidism, and in six patients (8%) with subclinical hypothyroidism. The control group and subclinical hypothyroid patients exhibited no significant difference in terms of total and free T3, total and free T4. For TSH and prolactin on the other hand, a statistically significant elevation was found in patients with overt hypothyroidism when compared with subclinical hypothyroidism; and in patients with subclinical hypothyroidism when compared to the controls. A significant statistical difference was observed between the two groups of hypothyroid patients for all hypothyroid symptoms except alopecia and hirsuitism. The incidence of hyperprolactinemia in hypothyroidism was found to be higher when compared with normal controls. Serum prolactin assessment should be performed on all patients with hypothyroidism (overt and subclinical) before performing further tests.

Serum Adiponectin Levels and Changes in Glucose Metabolism before and after Treatment for Thyroid Dysfunction.

Adiponectin is an adipokine which is known to decrease in individuals associated with obesity and insulin resistance. In this study, we aimed to investigate the serum adiponectin levels and glucose metabolism in patients with thyroid dysfunction before and after treatment. Newly diagnosed overt hypothyroid (n=20) and thyrotoxic (n=23) patients and healthy controls (n=20) with a body mass index of <30 kg/m(2) were evaluated prospectively. Patients with a known state of insulin resistance, including prediabetes and overt diabetes, and individuals with chronic diseases were excluded. Thyroid function and fasting plasma glucose (FPG), insulin, homeostatic model assessment (HOMA) insulin resistance (HOMA-IR) and HOMA-beta cell function (HOMA-beta), lipid and adiponectin levels were investigated in the basal state and after the restoration of euthyroidism. The basal fasting FPG levels were lower in the hypothyroid patients than the control subjects (p=0.02) and similar between the thyrotoxic patients and control subjects (p=0.127). The basal HOMA-beta levels were higher in the patients with hypothyroidism than in those with thyrotoxicosis (p=0.015). Following the restoration of euthyroidism, the FPG levels significantly increased in the hypothyroid patients (p=0.002) and decreased in the thyrotoxic (p=0.001) patients. The basal plasma adiponectin levels were 14.55±8.4 mcg/mL, 13.79±9.13 mcg/mL and 11.68±6.0 mcg/mL in the hypothyroid and thyrotoxic patients and healthy controls, respectively (p=0.503). The adiponectin levels decreased significantly in the patients with hypothyroidism (p=0.047), whereas they did not change in the patients with thyrotoxicosis (p=0.770) after achieving euthyroidism. In this study, following the restoration of euthyroidism, the FPG levels increased in the hypothyroidism patients and decreased in the thyrotoxicosis patients, despite the lack of changes in the HOMA-IR and HOMA-beta levels. Meanwhile, the hypothyroid, thyrotoxic and euthyroid subjects had similar basal adiponectin levels, and a significant decrease in the adiponectin levels was observed after treatment for hypothyroidism, despite the absence of changes after treatment for thyrotoxicosis, indicating the need for further studies with a larger sample size.

Evaluation of body composition changes, epicardial adipose tissue, and serum omentin-1 levels in overt hypothyroidism.

Our aim was to investigate body composition changes, epicardial adipose tissue thickness (EATT), serum omentin-1 levels, and the relationship among them along with some atherosclerosis markers in overt hypothyroidism. Twenty-eight newly diagnosed overt hypothyroid patients were evaluated before and after 6 months of thyroid hormone replacement therapy (THRT) and compared to the healthy subjects in this prospective longitudinal study. Body compositions were measured with dual-energy X-ray absorptiometry, and EATT was measured by echocardiography. Carotid intima-media thickness (c-IMT), flow-mediated dilatation (FMD), thyroid hormone levels, lipid parameters, high sensitive c-reactive protein, homocysteine, and omentin-1 levels were measured in all subjects. Body weight and lean body mass were higher in patients with hypothyroidism compared to euthyroid state after THRT (p = 0.012, 0.034, respectively). EATT was higher in patients with hypothyroidism than the control group (p < 0.001) and decreased with THRT (p = 0.012) but still remained higher than the control group (p < 0.001). Free T4 levels were found to be an independent factor to predict EATT (p < 0.001). In hypothyroid state, omentin-1 levels were lower than controls (p = 0.037) but increased in 6 months with THRT (p = 0.001). The c-IMT was higher, and FMD was lower in hypothyroidism compared to euthyroid state and control group (p < 0.05). Increasing lean body mass, but not adipose tissue mass, was found to be responsible for weight gain in hypothyroidism. The increased amount of EATT and decreased omentin-1 levels can contribute to the development of atherosclerosis in addition to other factors in hypothyroidism.

Abstract 333: Hypothyroidism As a Predictor of Worse Clinical Outcomes After Percutaneous Coronary Interventions: 1 Year Follow Up Study

Background: Although hypothyroidism (HT) is known to be associated with worse cardiovascular outcomes, little data exists on its influence on clinical outcomes in patients undergoing percutaneous coronary interventions (PCI). Methods: In this prospective observational registry at a single center, we studied 1317 patients who underwent successful PCI (without complications) from ‘01-'12 and had thyroid function tests performed within 1 year prior to PCI. We excluded patients with cardiogenic shock at index PCI. We compared 1-year mortality and major adverse cardioascular events (MACE) between HT (both subclinical and overt hypothyroid patients, defined as TSH ≥5.5, n=78) and Euthyroid (ET) (TSH &lt;5.5, n=1239) groups. Results: Both the groups were similar in baseline clinical and angiographic characteristics except for higher prevalence of prior myocardial infarction (MI) and thyroid supplement use in HT group (table 1). At 1-year, HT was associated with higher all cause mortality as compared to ET group (14%[11/78] Vs 6.7%[83/1239], p=0.014) and remained an independent predictor of mortality in the multivariate analysis (adjusted odds ratio=2.6, 95% CI: 1.2-5.3, p=0.011). There was a trend towards higher MACE in the HT vs ET group, although this was not statistically significant. (21% [16/78] Vs 16% [203/1239]respectively, p=0.342, adjusted odds ratio=1.3, 95%CI: 0.7-2.3, p=0.455) Individual 1-yr outcomes are shown in Figure 1. Conclusion: Although there was no difference in MACE, HT was associated with higher all cause mortality after PCI. We suggest monitoring of thyroid function for patients who undergo PCI. Treatment may improve survival in hypothyroid patients post PCI, however further outcome studies are needed.

English

OBJECTIVE: To evaluate the morphology of non-toxic goiter, the role of auto-immunity and lipid abnormalities in overt and sub-clinical hypothyroid goiter patients. METHODS: A descriptive observational study was undertaken amongst goiter patients without thyrotoxic features comprising 50 randomly selected cases within the range of 12-65years. Goiter patients with thyrotoxic features, acute illness and other visceral diseases were excluded. The patients were evaluated with thyroid function tests, USG-thyroid, FNAC-thyroid, anti-TPO and lipid profile after thorough clinical examination. RESULTS: In my study, most patients were female (with male: female ratio 1:5.25) and were middle aged (between age group 30-49years). Among all patients 60 %( i.e. 30) patients had Hashimoto's thyroiditis, 24% (i.e. 12) patients had diffuse colloid goiter and 16% (i.e. 8) patients had nodular goiter. 52% (i.e. 26) of all patients and 76.6% (i.e. 23) of Hashimoto's goiter patients were anti-TPO positive. Majority of colloid goiter (i.e. 66.7%) and nodular goiter (50%) patients were euthyroid but majority of Hashimoto's goiter patients were hypothyroid (65.38% overt and 33% sub-clinical). Majority of anti-TPO positive patients were hypothyroid (65.38% overt and 30.62% sub-clinical) and majority of anti-TPO negative patients (66.67%) were euthyroid. Within reference range of TSH, there was a linear increase in total serum cholesterol, LDL- cholesterol, triglyceride and decrease in HDL-cholesterol with increase in TSH. This lipid profile changes are mainly seen in Hashimoto goiter patients. CONCLUSION: this study emphasizes the role of auto-immunity in non-toxic goiter patients especially Hashimoto's thyroiditis patients and lipid profile changes in those patients.