Presence Of Thyroid Antibodies Research Articles

Thyroid hormone status during pregnancy in Bangladesh

ABSTRACT Background: Pregnancy is a physiological condition where early detection of any pathological change of thyroid hormone is very important to prevent complications. Population-specific thyroid hormone reference intervals are a key to this. Since Bangladesh is yet to develop such reference intervals, the aim of this study was to establish trimester-specific reference intervals addressing the physiological changes of thyroid hormone during pregnancy for Bangladeshi women. Materials and Methods: One thousand nine hundred and thirty-seven women with singleton pregnancy consuming iodinated salt were selected for this cross-sectional study. Participants having a history of thyroid disorder (TD), any illness influencing thyroid function, presence of goiter, recent history of consumption of thyroid status-altering medications, family history of TDs, and presence of thyroid antibodies were excluded from the study. 1038 pregnant women with thyroid-stimulating hormone (TSH) level within normal (nonpregnant) laboratory reference value (0.35–5.5 μIU/mL) were considered eligible for the study. Results: The mean age of the eligible cases was 28.06 ± 4.633 years ranging from 18 years to 42 years. The mean gestational ages of the study population while checking thyroid function were 8.83 ± 2.344 weeks, 19.99 ± 4.824 weeks, and 31.77 ± 2.123 weeks during 1st, 2nd, and 3rd trimesters, respectively. TSH level raised significantly from 1st trimester to 2nd trimester (1.85 ± 1.00 vs. 2.03 ± 1.02; P = 0.018) but the decline in 3rd trimester comparing to 2nd trimester (2.03 ± 1.02 vs. 1.90 ± 0.90; P = 0.071) was not statistically significant. The 2.5th–97.5th percentiles of TSH level of the study population were 0.440–4.050 μIU/mL, 0.531–4.570 μIU/mL, and 0.622–3.917 μIU/mL in 1st, 2nd, and 3rd trimesters, respectively. Conclusion: Reliance on nonpregnant reference intervals or any generalized gestational reference interval can hinder the desired progression of pregnancy influencing diagnosis and management for TDs in case of certain populations. Establishment of individual reference intervals for thyroid hormone in pregnancy bears great clinical importance for every population.

Study of Thyroid Autoantibodies in Infertile Women Visiting Chittagong Medical College Hospital, Chattogram, Bangladesh

Background: Thyroid hormones are essential for normal growth, sexual development and reproductive function. Thyroid dysfunction can lead to a variety of gynaecological disorders ranging from menstrual irregularities to infertility. Autoimmune thyroid disease (AITD) is now one of the most important causes of female infertility. Thus, this study was designed to study possible relationship between thyroid disorders, as well as thyroid autoimmunity and unexplained infertility.
 Methodology: This was a hospital based cross-sectional observational study comprising hundred (100) infertile women aging 18-35 years in Outpatient Department of Obstetrics & Gynaecology and Endocrinology in Chittagong Medical College Hospital and Department of Biochemistry, Chittagong Medical College, Chattogram. Samples were taken by non-probability consecutive sampling. Important variables in this study were serum FT3, FT4, TSH and thyroid antibodies (anti TPO and anti TG).
 Results: The majority of the infertile women were 21-30 years. Primary and subclinical hypothyroidism were 5% and 17% cases in this study. On the other hand, 22% cases of this study had anti-TG antibody positive and 26% cases had anti-TPO antibody positive.
 Conclusions: The results of the present study suggest that, increased anti thyroid antibody were associated with a higher prevalence of thyroid dysfunction and mainly hypothyroidism. So, we propose that a systematic screening of TSH, FT3, FT4 and the presence of thyroid antibodies could be considered in all women with a female cause of infertility.
 EMCJ. July 2022; 7(2): 6-9

ODP534 Repercussions of Thyroid Autoimmunity on Neonatal Outcomes in Pregnant Hypothyroid Women

Abstract Introduction The impact of thyroid autoimmunity in pregnancy on neonatal outcomes remains unclear. Studies to date have revealed a positive correlation between thyroid antibodies and preterm births and miscarriages. However other aspects of neonatal outcomes need further exploration. Advanced maternal age is associated with the escalation of the prevalence of thyroid antibodies. Not only this, advanced maternal age in itself is a proven factor for unfavourable fetal outcomes. Most of the studies to date in this regard have an age-related bias as women of all groups were included to assess the neonatal outcomes in women with thyroid antibodies. Our study was conducted in hypothyroid women who were less than 35 years of age with thyroid antibodies to assess outcomes on the neonates unbiased of advanced maternal age. Hypothesis To evaluate the effects of maternal thyroid autoimmunity on neonatal outcomes. Methodology A retrospective chart review was conducted on 7978 women delivered in the study timeline in a secondary hospital of Qatar. 287 women were hypothyroid and out of these 198 women with age less than 35 years were included in the study. Neonatal outcomes such as preterm births, small for date babies, admission to neonatal intensive care units (NICU) and intrauterine fetal deaths (IUFD) were noted and compared with 200 euthyroid women who were selected by random sampling. Statistical Package for the Social Sciences version 27. 0 was used for statistical analysis. The Odds’ ratio was calculated and results with a value of p<0. 05 was considered significant. Results Thyroid autoimmunity was noted in 30.30% of hypothyroid pregnant women. All these women had thyroid peroxidase antibody and thyroglobulin antibody was observed in 4.44%. The range of TPO antibodies was 67-1350 IU/ml (mean 497 IU/ml). 10% vs 4.5% (OR- 2.22, 95%CI-0.760 to 6.495, P = 0.14) preterm births and 10% vs 3% (OR-3.33, 95%CI-1. 037-10.71, p<0. 05) small for dates babies were observed in women with thyroid antibodies in comparison to the control (euthyroid pregnant women). Higher incidence of NICU admissions (22% Vs 8.5%, p<0. 05) and IUFD rates (5% Vs 0.5%, p<0. 05) were noted in women with thyroid autoimmunity. Conclusion This study demonstrates the detrimental effects of thyroid autoimmunity on neonates of hypothyroid women less than 35 years of age. In this age group of hypothyroid women, testing for thyroid immunity should be considered. Antenatal fetal surveillance is advisable in the presence of thyroid antibodies.

Two PerPLEXing Cases of Hashimoto’s Encephalopathy Unresponsive to Steroid and Intravenous Immunoglobulin Therapy

Hashimoto’s encephalopathy is a nebulous entity over which much controversy exists. Often referred to as steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), it describes a myriad of neurological sequelae that typically are observed to occur in patients with the presence of thyroid antibodies. We aim to raise clinical awareness of this seldom diagnosed entity as a potential etiology for altered mental status in patients who present with supporting clinical features and elevated thyroid antibodies. While steroid responsiveness is deemed a typical presenting feature of this medical condition, our cases aim to describe two cases that required escalation of therapy to intravenous immunoglobulins, and ultimately, plasmapheresis therapy for improvement in their clinical status. Our patients had a dramatic improvement in their mentation within three to four sessions of plasmapheresis, improving rapidly toward their baseline. Such a dramatic improvement, coupled with the corresponding reduction in their thyroid antibody titer supports the diagnosis of Hashimoto's encephalopathy and highlights the importance of having a low clinical threshold for the diagnosis of this entity in patients who, despite extensive evaluation, reveal no apparent cause for their altered mental status.

Is the link between elevated TSH and gestational diabetes mellitus dependant on diagnostic criteria and thyroid antibody status: a systematic review and meta-analysis.

Clinical studies have investigated the prevalence of gestational diabetes mellitus (GDM) in women with subclinical hypothyroidism (SCH). While some studies demonstrate a clear association, others do not. It is possible this may be due to varied diagnostic criteria for SCH and the presence of thyroid antibodies (TA). We conducted a meta-analysis, separating patients diagnosed with SCH using a diagnostic cut-off <4.0 mIU/L from those diagnosed using a cut-off >4.0 mIU/L and determined the association with GDM and factored TA status into our analysis. A computerised search of five databases including PubMed, Embase, Cochrane Library, Web of Science and CINAHL returned 787 records. Two independent reviewers assessed abstracts and full texts against pre-specified inclusion and exclusion criteria. Ten cohort studies were included in the final analysis. The diagnostic criteria for SCH and incidence of GDM were extracted from each study. Study quality and risk of bias was assessed by two reviewers. TSH levels <4.0 mIU/L for SCH diagnosis was not associated with GDM unless patients were TA positive. Studies that used a diagnostic cut-off >4.0 mIU/L saw a significant increase in the odds of GDM, regardless of TA status (OR = 1.60, 95% CI 1.33-1.93). Women with TSH levels >4.0 mIU/L have an increased odds of GDM regardless of TA status but at TSH levels <4.0 mIU/L, GDM is dependent on TA status. The use of TSH levels to identify pregnancies at risk of GDM is a novel concept that warrants exploration.

High Prevalence of Anti Thyroid Antibodies in an Albanian Cohort of Patients

Introduction: Albania is classified as iodine deficient region and endemic goiter in this country has been a concern for public health. A salt iodization program has been implemented in Albania since 2008. Most of regions still remain with a mild or moderate iodine deficiency there are no studies on prevalence of thyroid autoimmune disorders. The purpose of this study was to assess thyroid function and the presence of thyroid antibodies in subjects that were not previously diagnosed or treated for thyroid disorders. Methods: This is a cross-sectional study performed in a cohort of patients in Albania during a 2 year period (january 2018-january 2020). We assessed the prevalence of thyroid function disorders and presence of thyroid antibodies in 5047 subjects (81% females and 19% males). Individuals previously diagnosed or treated for thyroid disease were excluded from the study. TSH, Free T4, total T3, Anti TPO(thyroid peroxidase) and anti TG (thyroglobulin) were measured with electrochemiluminescence method with Cobas 6000 Roche Diagnostics. We calculated the frequency of thyroid antibodies and the abnormal thyroid function. Statistical analysis was performed to see if there was a difference between individuals with positive antibodies and those negative for antibodies. Results: 91 % (4596) of subjects resulted euthyroid. We found a low prevalence of overt thyroid dysfunction (hyperthyroidism 0.48% and hypothyroidism 1.69%). The rates of subclinical hypothyroidism and hyperthyroidism were 5.5% and 1.4% respectively. The prevalence of positive thyroid antibodies, at least one of them was 28% in females and 14% in males (2:1 ratio). 97.3 % of subjects who testet negative for antibodies had normal thyroid function compared to 73.5% in antibodies positive group. There was a significant difference for subclinical hypothyroidism and other thyroid disorders between antibodies positive group and antibodies negative group (p value <0.0000119% of individuals(from 5047 examined) had normal thyroid function and resulted positive for anti TPO or anti TG. Conclusions: Undiagnosed biochemical thyroid dysfunctions were common in subjects living in a mild to moderate iodine-deficient area especially subclinical hypothyroidism. TSH level correlated well with the presence of antibodies resulting in significant difference in thyroid function between 2 groups. We found a high prevalence (19%) of thyroid antibodies in euthyroid subjects. TPO antibodies in euthyroid subjects can be used to identify subjects with increased risk for hypothyroidism such as women who are pregnant (to predict first trimester or postpartum thyroid dysfunction), patients with other autoimmune diseases, subjects on drugs like amiodarone or relatives of patients with autoimmune thyroid diseases.

Thyroid Dysfunction and Infertility of Women of Reproductive Age

Autoimmunity of the thyroid gland (TAI) or its dysfunction is quite common among women of reproductive age, and there are suggestions in the literature that they are associated with an unfavorable level of fertility and a negative outcome of pregnancy, as in the case of spontaneous conception or after assisted reproductive technologies (ART).&#x0D; This assumption makes it necessary to screen autoantibodies to thyrotropin (TSH) and thyroid peroxidase among infertile women who have made a number of attempts to become pregnant.&#x0D; Some authors have conducted a number of studies where they have examined the relationship between autoimmunity of the thyroid gland, thyroid function, and fertility. However, there is currently no consensus on the upper limit of the norm for TSH to determine thyroid dysfunction and the limits for intervention. Despite the recent update of the American thyroid Association (ATA) on guidelines for the diagnosis and treatment of thyroid diseases during pregnancy and the postpartum period, many issues remain unresolved in ART. The author came to the following conclusions: open thyroid dysfunction often leads to menstrual disorders, fertility problems, and pregnancy complications, and therefore should be treated accordingly. Currently, there is little evidence to recommend treatment with levothyroxine at TSH levels between 2.5 and 4.0 MMU / l, given the possible side effects of overtreatment, especially in patients with mild thyroid dysfunction. We suggest careful longitudinal monitoring, especially in the presence of thyroid antibodies in women undergoing ART. The 4 MMU / l limit for TSH appears as the intervention level for SCH treatment in women with and without transabdominal utrasound in ART.

Clinical significance of thyroid hormone and antibodies in patients with idiopathic interstitial pneumonia.

BackgroundHypothyroidism was recently reported to be common and to predict mortality in patients with idiopathic pulmonary fibrosis (IPF). In addition, a high prevalence of hypothyroidism was shown in patients with idiopathic pleuroparenchymal fibroelastosis. However, in idiopathic interstitial pneumonia (IIP), a clinical significance of thyroid function has not been clarified in detail. The goal of this study was to investigate the clinical significance of thyroid function and the presence of thyroid antibodies in IIP.MethodsWe have reviewed IIP patients, and analyzed the positivity of thyroid antibodies at first. Next, the relationship of clinical characteristics with thyroid function and the positivity of thyroid antibodies was analyzed. Lastly, the positivity of thyroid antibodies and other autoantibodies was evaluated.ResultsIn IIP patients, thyroglobulin and thyroid peroxidase antibodies were positive in 17 and 16%, respectively, and 22% of patients had either or both antibodies. Subclinical and/or overt hypothyroidism was confirmed in 7% of IIP patients. The free thyrotropin level had a significant positive correlation with vital capacity and a significant negative correlation with the C-reactive protein and surfactant protein-A levels, and erythrocyte sedimentation ratio (ESR). In addition, autoantibodies suggestive of connective tissue diseases (CTDs) were positive in more than two thirds of IIP patients with the thyroid antibody, and the positive rate of antinuclear and proteinase-3 anti-neutrophil cytoplasmic antibodies was significantly higher in IIP patients with thyroid antibodies than those without the antibodies.ConclusionsAlthough thyroid dysfunction is not frequent, thyroid hormones and thyroid antibodies are possibly involved in the pathogenesis of IIP and their evaluation may be clinically useful to identify the clinical phenotype of IIP with autoimmune features.

Schilddrüse und Schwangerschaft

Pregnancy has a profound impact on the thyroid gland and its function. This has to be considered in the assessment of thyroid function tests on the basis of trimester-specific reference intervals during pregnancy and in the decision making when to start therapy.The adverse impact of overt thyroid disorders in pregnancy is well understood, while the relevance of subclinical thyroid disorders and presence of thyroid antibodies remains a bit controversial. In euthyroid pregnant women with positive thyroid antibodies, levothyroxine (LT4) therapy may be discussed individually in the case of recurrent abortions. Furthermore, the risk of adverse pregnancy outcomes seems to be increased in the presence of both thyroid-stimulating hormone (TSH)-elevation and positive thyroid antibodies. Therefore, in case of subclinical hypothyroidism, taking in consideration the thyroid peroxidase antibody (TPO-Ab)-status individual decision-making and liberal initiation of LT4 therapy is recommended. In contrast, overt hypothyroidism is a strong indication for LT4 administration, aiming at rapid achievement of euthyroidism.The most common cause of hyperthyroidism is transient gestational thyrotoxicosis mediated by human chorionic gonadotropin (hCG), which leads to a reduction or suppression of TSH in the first trimester that does not require antithyroid medication. In other causes of overt hyperthyroidism antithyroid drugs (propylthiouracil or thionamides) need to be considered carefully and require interdisciplinary management.The presented recommendations are based on the current guideline of the American Thyroid Association (ATA) and the European Thyroid Association (ETA) as well as recently published literature.

Effect of moderately increased thyroid-stimulating hormone levels and presence of thyroid antibodies on pregnancy among infertile women.

PurposeTo study the effects of mildly elevated thyroid‐stimulating hormone (TSH) levels and thyroid antibodies on pregnancy rates among infertile women and their potential contribution to prolonged infertility treatment.MethodsThis case‐control study included 1479 women who underwent infertility treatment between March 2015 and August 2017. Cumulative pregnancy and miscarriage rates after assisted reproductive technology (ART) or non‐ART treatments were compared between women with TSH <2.5 mIU/L and those with TSH 2.5‐3.5 mIU/L and between women with and without thyroid antibody positivity.ResultsThe cumulative pregnancy rate of women with TSH 2.5‐3.5 mIU/L was similar to that of women with TSH <2.5 mIU/L in the non‐ART (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.56‐1.23) and ART (HR, 1.17; 95% CI, 0.93‐1.47) groups. Thyroglobulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) had no correlation with cumulative pregnancy rates. In the non‐ART and ART groups, HRs for TgAb were 0.87 (95% CI, 0.55‐1.32) and 1.09 (95% CI, 0.84‐1.39) and HRs for TPOAb were 0.88 (95% CI, 0.52‐1.39) and 1.29 (95% CI, 0.97‐1.68), respectively.ConclusionsCumulative pregnancy rates and miscarriage rates were similar between women with TSH <2.5 mIU/L and those with TSH 2.5‐3.5 mIU/L and were independent of thyroid antibody positivity.

A study on thyroid dysfunction in acne vulgaris

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; This study was done to evaluate the role of thyroid function i.e., free T3, free T4 and thyroid stimulating hormone (TSH) in relation to the occurrence of acne vulgaris.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 50 patients clinically diagnosed with acne vulgaris were subjected to a thyroid function test and results were evaluated.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; While all the 50 patients had normal free T3 and free T4 levels, 9 (18%) of the 50 patients displayed an elevated TSH level. Gender distribution among the patients with elevated TSH learned more towards the male population with 6 patients while there were only 3 female patients with elevated TSH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; There have been few studies regarding the role of thyroid function in acne vulgaris in relation to free T3, free T4 and TSH, though the presence of thyroid antibodies have been highlighted in quite a few studies. This study has shown the insignificance of thyroid function in acne vulgaris thus accentuating the negative.&lt;/p&gt;

Genome-wide association analysis suggests novel loci underlying thyroid antibodies in Hashimoto\u2019s thyroiditis

Thyroid antibodies against thyroglobulin (TgAb) and thyroid peroxidase (TPOAb) are key markers of Hashimoto’s thyroiditis (HT), the most common autoimmune thyroid disorder. Genetic determinants of thyroid antibodies are still poorly known, especially as they were not studied in patients with thyroid diseases. We performed the first genome-wide association analysis of thyroid antibodies in 430 HT patients that may be considered as population extremes for thyroid antibodies distribution. We detected two suggestively associated genetic variants with TgAb, rs6972286 close to ANKRD7 and LSM8 (P = 2.34 × 10−7) and rs756763 inside CA10 (P = 6.05 × 10−7), and one with TPOAb, rs12507813 positioned between TRIM61 and TRIM60 (P = 4.95 × 10−7). Bivariate analysis resulted with three suggestively associated genetic variants that predispose to both antibodies: rs13190616 inside RP11-138J23.1 (P = 2.01 × 10−6), rs561030786 close to DUBR (P = 7.33 × 10−6) and rs12713034 inside FSHR (P = 7.66 × 10−6). All identified genomic regions have a substantial literature record of involvement with female-related traits, immune-mediated diseases and personality traits that are all characterized by increased thyroid antibody levels. Our findings demonstrate the existence of genetic overlap between thyroid autoimmunity in HT and different non-thyroid diseases characterized by the presence of thyroid antibodies. We also suggest that genetic variants that regulate antibody levels may differ between HT patients and individuals with normal thyroid function.

Thyroid auto immune antibodies in children with Type-I Diabetes mellitus in relation to diabetes control.

Background & Objective:As an autoimmune disease, Type-1 diabetes mellitus (DM) may be associated with other autoimmune disorders, the presence of thyroid antibodies could be negatively impact the diabetic control. Our objective was to investigate thyroid autoimmunity in a cohort of children and adolescents with Type-1 diabetes and the Influence of the presence of thyroid autoimmune abnormalities on the control of diabetes in group of Iraqi pediatric patients with Type-I D.M.Methods:This study was conducted at the Medical City Complex, Children Welfare Hospital, Baghdad, Iraq. This study was carried out from the first of January 2016 till the end of September 2017. Data were analyzed from 150 patients with Type-1 diabetes, aged 1–18 years who were treated and are coming for regular follow up in the diabetic clinic. Thyroid functions tests, Antibodies to thyroglobulin (anti-TG) and thyroperoxidase (anti-TPO) were measured, documented and correlated with diabetic control according to glycated haemoglobin (HbA1c) level.Results:In the total of 150 patients, positive Antibodies to thyroglobulin (anti TG) were more in ≤3 years duration group of Diabetes mellitus(DM) and negative anti TG was less in the >3 years duration of DM group with statistically significant results (p=0.043), Regarding the distribution of thyroid antibodies (AB) according to HbA1c group, there was progressive positive anti thyroperoxidase (anti TPO) titer with glycemic status, good glycemic control had the lowest positive anti TPO titer and poor glycemic control group had the highest positive anti TPO titer and the result was statistically significant (p=0.048).Conclusions:Thyroid autoimmunity may be associated with poor diabetic control and elevated TSH levels, indicating subclinical hypothyroidism that my affect the diabetic control.

Is only Thyroid Peroxidase Antibody Sufficient for Diagnosing Chronic Lymphocytic Thyroiditis?

Objectives:Recently, only anti-thyroid peroxidase (anti-TPO) has been suggested as an autoantibody in the diagnosis of chronic lymphocytic thyroiditis (CLT). In contrast, anti-thyroglobulin (anti-Tg) positivity has also been reported to be important. To evaluate this relationship more clearly, we planned to retrospectively investigate the autoantibody levels of the patients who underwent thyroid surgery for various reasons and those with CLT in postoperative pathology.Methods:We evaluated 670 patients who underwent thyroid surgery (total/subtotal thyroidectomy) for various reasons at our hospital between January 2015 and March 2017. Patients with indications of Graves’ disease, toxic multinodular goiter, and all malignancies except for thyroid papillary carcinoma (TPC) were excluded. Eighty-nine patients whose pathology findings were compatible with CLT and preoperative thyroid autoantibodies were identified enrolled in to the study. Patients with absence and presence of thyroid antibodies were included in the seronegative CLT group and seropositive CLT group, respectively. In addition, patients were divided into thyroid papillary carcinoma (TPC) and benign groups.Results:According to the study criteria, 89 (83 females, six males) (mean age, 46.08±11.19 years) patients who had preoperatively identified autoantibodies were detected. Anti-TPO positivity was found in 47 (52.8%) cases, whereas anti-Tg positivity was found in 49 (55.1%). Only anti-TPO positivity was found in 18 (20.2%) cases, whereas only anti-Tg positivity was detected in 20 (22.5%). Twenty-two (24.7%) of the patients were seronegative. On comparing the seronegative and seropositive groups, seronegativity was more frequent in male patients (p=0.03). Thyroid-stimulating hormone was found to be significantly higher in the seropositive group (p=0.01). TPC was detected in 36 (40.4%) of all cases. No difference regarding age, thyroid function tests, and antibody levels was found between the benign and TPC groups.Conclusion:Although all of our cases were histopathologically diagnosed with CLT, serologically, 75.3% of thyroid autoimmunities could be shown when both antibodies were evaluated together. When only anti-TPO was considered, this rate decreased to 52.8%. Therefore, anti-Tg appears to be still important in showing autoimmunity. Prospective studies are needed to evaluate this relationship more clearly.

Subclinical hypothyroidism: Should we treat?

Subclinical hypothyroidism (also known as compensated hypothyroidism or mild hypothyroidism) is a condition associated with a raised serum concentration of thyroid stimulating hormone (TSH) but a normal serum free thyroxine (FT4). It is common, affecting about 10% of women above the age of 55 years. Autoimmunity is the commonest cause of subclinical hypothyroidism. About 2.5% of patients with subclinical hypothyroidism progress to clinically overt hypothyroidism each year; the rate of progression is higher in patients with thyroid autoantibodies and higher thyroid stimulating hormone levels. However, thyroid function normalises spontaneously in up to 40% cases. Only a small minority of patients with subclinical hypothyroidism have symptoms, and the evidence to support that levothyroxine ameliorate the symptoms in these patients is weak. Subclinical hypothyroidism in younger patients (<65 years) is associated with an increased risk of coronary heart disease, heart failure and cerebrovascular disease. The risk increases with increasing levels of thyroid stimulating hormone, and is particularly high in patients with TSH levels ≥10.0 mu/L. There is lack of evidence from randomised controlled trials as to whether levothyroxine treatment can prevent these risks, although a large observational study of the UK general practice research database has shown that levothyroxine may reduce the risk of coronary heart disease in younger patients (<70 years). Therefore, the decision whether to treat or not to treat subclinical hypothyroidism should be made after careful consideration of the patient's age, the presence of symptoms, the presence of thyroid antibodies and other risk factors such as cardiovascular disease.

Increase in thyroglobulin antibody and thyroid peroxidase antibody levels, but not preterm birth-rate, in pregnant Danish women upon iodine fortification.

The presence of thyroid antibodies in pregnancy has been associated with preterm birth. In the non-pregnant population, the implementation of the Danish iodine fortification program has increased the prevalence of thyroid antibodies. This study investigated the prevalence of thyroid peroxidase antibodies (TPOAbs) and thyroglobulin antibodies (TgAbs) in pregnant Danish women before, during and after implementation of the iodine fortification program and association with preterm birth. Comparative cohort study of 1368 pregnancies from three cohorts gathered before (1996-1998), during (2000-2003) and after (2008-2009) the iodine fortification program. In cohort 1 (n = 297), TPOAbs were measured (DYNOtest (BRAHMS)). In cohorts 2 (n = 148) and 3 (n = 923), both TPOAbs and TgAbs were measured (Kryptor immunofluorescent assay (BRAHMS)). The prevalence and effect of antibody positivity were explored using three cut-offs: TPOAbs and/or TgAbs >100 kU/L, TPOAbs and/or TgAbs >60 kU/L and TPOAbs >30 and/or TgAbs >20 kU/L. National preterm birth data were extracted from the National Birth Registry. In the three cohorts, TPOAb levels >60 kU/L were found in 5.4, 8.1 and 12.0% (χ2(2, n = 1367) = 11.7, P = 0.003) respectively, and TPOAbs and/or TgAbs >60 kU/L in 8.1 and 16.2% in cohorts 2 and 3 respectively (χ2(2, n = 1070) = 6.5, P = 0.01). TgAb levels (>20 kU/L) had increased plenty-fold from cohort 2 to 3 (χ2(1, n = 1071) = 136.5, P < 0.001). Preterm birth occurred in 4.1% of all pregnancies with no effect from antibody positivity (TPOAbs and/or TgAbs >60 kU/L, χ2(1, n = 1039) = 0.0, P = 0.98, aOR = 1.1, 95% CI (0.4-2.7)). The national preterm birth-rate showed no increase over the same period. Thyroid antibody positivity in Danish pregnant women has more than doubled upon the implementation of the iodine fortification program without an increase in preterm birth-rate.

Using Hashimoto thyroiditis as gold standard to determine the upper limit value of thyroid stimulating hormone in a Chinese cohort.

BackgroundSubclinical hypothyroidism, commonly caused by Hashimoto thyroiditis (HT), is a risk factor for cardiovascular diseases. This disorder is defined as merely having elevated serum thyroid stimulating hormone (TSH) levels. However, the upper limit of reference range for TSH is debated recently. This study was to determine the cutoff value for the upper normal limit of TSH in a cohort using the prevalence of Hashimoto thyroiditis as “gold” calibration standard.MethodsThe research population was medical staff of 2856 individuals who took part in health examination annually. Serum free triiodothyronine (FT3), free thyroxine (FT4), TSH, thyroid peroxidase antibody (TPAb), thyroglobulin antibody (TGAb) and other biochemistry parameters were tested. Meanwhile, thyroid ultrasound examination was performed. The diagnosis of HT was based on presence of thyroid antibodies (TPAb and TGAb) and abnormalities of thyroid ultrasound examination. We used two different methods to estimate the cutoff point of TSH based on the prevalence of HT.ResultsJoinpoint regression showed the prevalence of HT increased significantly at the ninth decile of TSH value corresponding to 2.9 mU/L. ROC curve showed a TSH cutoff value of 2.6 mU/L with the maximized sensitivity and specificity in identifying HT. Using the newly defined cutoff value of TSH can detect patients with hyperlipidemia more efficiently, which may indicate our approach to define the upper limit of TSH can make more sense from the clinical point of view.ConclusionsA significant increase in the prevalence of HT occurred among individuals with a TSH of 2.6–2.9 mU/L made it possible to determine the cutoff value of normal upper limit of TSH.

Is there an association between thyroid function abnormalities and breast cancer?

The aim of this study was to evaluate the association between thyroid function abnormalities and breast cancer and, in particular, the prognostic markers of breast cancer.. Baseline levels of thyrotropin, free triiodothyronine, free thyroxine and thyroid autoantibodies were measured in 97 women with primary breast cancer, 27 women with benign breast disease, and 4 women with atypical ductal hyperplasia. Their baseline levels were compared with those in 48 healthy women with a normal mammography in the last 2 years. There were no significant associations between history of thyroid disease and breast cancer (p = 0.33). The mean baseline levels of triiodothyronine and thyrotropin did not differ significantly between the compared groups. The mean baseline levels of free thyroxine were found to be significantly higher in the breast cancer group, even after adjusting for thyroid replacement therapy. The presence of thyroid antibodies did not differ significantly between the compared groups. In a subgroup analysis, breast cancer cases with thyroid disease and particularly hypothyroidism had a significantly lower incidence of lymph node metastases compared with breast cancer cases without thyroid disease. Our data confirmed the proliferative effect of thyroid hormones on breast cells, which had previously been shown in vitro. Additionally, thyroid disease and particularly hypothyroid function appeared to be associated with a lower incidence of lymph node metastases. Further studies to determine the prognostic role of thyroid hormones in breast cancer are warranted.

Impact of Levothyroxine in Miscarriage and Preterm Delivery Rates in First Trimester Thyroid Antibody-Positive Women With TSH Less Than 2.5 mIU/L.

Thyroid disease during pregnancy is associated with multiple adverse maternal and fetal outcomes. In particular, multiple observational studies have demonstrated an association between the presence of thyroid antibodies in euthyroid women in the first trimester of miscarriage and an increased rate of spontaneous miscarriage and preterm delivery. The present study is a prospective intervention trial of the effect of levothyroxine on the rate of miscarriage and preterm delivery in euthyroid thyroid-antibody positive women in the first trimester of pregnancy. A total of 8530 women in the first trimester of pregnancy in Southern Italy were screened for TSH and thyroid antibodies. Group A consisted of 198 euthyroid thyroid antibody positive women treated with levothyroxine, group B consisted of 195 untreated euthyroid thyroid antibody positive women, and group C consisted of 197 untreated thyroid antibody negative women. The rate of miscarriage did not differ between the 3 groups (11.6%, 14.9%, and 8.1 %, P = .11). The rate of preterm delivery between the 3 groups was 6.9%, 10.8%, and 2.8% and was statistically significant (P = .01). The rate of preterm delivery was significantly different between groups B and C (P = .02) but was not significantly different between groups A and B (P = .27). In conclusion, the present study found that levothyroxine intervention had no impact on the rate of miscarriage and preterm delivery in euthyroid thyroid antibody positive women.

Special Topics in Pediatric Bipolar Disorder: An Update from the ISBD Pediatric Bipolar Task Force

Aim: The aim of this study is to evaluate neuro-immune changes and relate them to psychopathology development in a prospective study among children of a bipolar parent. Methods: Bipolar offspring (n = 140), originating from the prospective “Dutch Bipolar Offspring Study”, were evaluated cross-sectionally within a longitudinal context in adolescence, young adulthood and adulthood and compared with aged matched controls. We examined the expression of 44 inflammation-related genes in monocytes and the presence of thyroid antibodies (TPO-abs) in bipolar offspring and their bipolar parents. Results: During adolescence, bipolar offspring showed an increased inflammatory gene expression in monocytes, this remained, although to a lesser degree, during young adulthood. But in adulthood circulating monocytes had lost their activation state. A strong positive correlation of TPO-abs over time in bipolar offspring was found (Rs = 0.82 p < 0.001 resp. Rs = 0.72, p < 0.001). No significant familial association/aggregation of increased TPO-abs positivity prevalence in bipolar families was found. All immunological abnormalities were related to familial high-risk status, but independent of psychopathology at all stages. Conclusions: This study suggest an aberrant neuro-immune state in bipolar offspring, following a dynamic course form adolescents to adulthood, irrespective of lifetime or future mood disorders. It seems to reflect a general state of vulnerability for mood disorders.