Prevalence Of Thyroid Disorders Research Articles

Proposal of New Key Step in Lateral Approach Thyroidectomy in Light of Comparison of Surgical Outcomes of Medial versus Lateral Approach Thyroidectomy: A Randomised Controlled Study.

Objective Thyroid surgery has travelled a long path, from a surgery which once was considered deemed to fail and even led to death, to the current time when newer techniques are being tested to make the incision smaller and smaller. The aim of our study is to give a precise detailed stepwise description of medial and lateral surgical approach with the anatomical basis and to compare their feasibility and safety. Methods 104 cases presenting with thyroid swelling in the Department of Otorhinolaryngology, Assam Medical College Dibrugarh from January 1, 2019, to December 31, 2019, were selected and randomisation was done based on day of admission from OPD. Basic demographic data, preoperative diagnosis, operative time, blood loss, need for transection of strap muscles, and complications were recorded. Result The distribution of thyroid cases according to age ranged from 17 to 81 years. The prevalence of thyroid disorders was the highest (37.5%) in the age group of 31–40 yrs. Of a total of 104 thyroid cases, 49 were colloid goitre, 24 were multinodular goitre, 9 were follicular neoplasm category 4, 4 were papillary thyroid carcinoma, 2 were follicular neoplasm category 3, and 3 were follicular neoplasm category 5. Conclusion Out of the two approaches, lateral approach thyroidectomy showed better results with fewer complications. A single structure (superior belly of omohyoid) can be used as a guide to preserving all vital structures related to the thyroid gland.

TO STUDY THE PREVALENCE OF THYROID DYSFUNCTION AND IT'S EFFECTS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS IN TERTIARY CARE HOSPITAL

Background: The relationship between normal thyroid function and type 2 diabetes has been a particular focus of concern. Type 2 Diabetes being the most common endocrine, metabolic disorder, there lies a curiosity to understand and learn the association of this disease with another common endocrine gland that is the thyroid gland. This study is aimed to describe the association of poorly controlled diabetes and thyroid dysfunction. OBJECTIVES: Ÿ To study the thyroid functions in patients with type 2 diabetes mellitus. Ÿ To study the spectrum of thyroid dysfunction in patients with type 2 diabetes mellitus. Materials And Methods: A hospital-based observational prospective study was conducted in the Santhiram Medical College and General Hospital for six months. Patients with type 2 diabetes mellitus of age more than 30 years, from OPD and IPD of all the departments in Santhiram General Hospital irrespective of glucose control and treatment, with informed written consent were studied. Thyroid prole tests, target organ evaluation for type 2 diabetes mellitus were performed for all patients in this study group. Thyroid USG was done. Results: 100 cases of type 2 diabetes mellitus without proven thyroid disease were included in the study . Thyroid disorders were diagnosed in 29 % cases . Hypothyroidism in 1 , hyperthyroidism in 13 and subclinical hypothyroidism in 15 cases. In this study 50 patients were male, 50 were females. Females ( 36%) had high incidence of thyroid disorder than males ( 22%). Subclinical hypothyroidism was more common (31.25%) in elderly age group. Elderly females had high incidence of subclinical hypothyroidism (18.2%). Clinical features of hyperthyroidism are seen in 8 patients. In the patients with hyperthyroidism( 55.5%) there was poor glycemic control . Duration of diabetes has no relation with incidence of thyroid disorders. Majority of patients with subclinical hypothyroidism had uncontrolled sugars with microvascular complications. Conclusion: Prevalence of thyroid disorders in diabetes mellitus is 29%. Incidence is higher in elderly population . Duration of diabetes mellitus has no impact on thyroid dysfunction. Severe diabetic complications are noted in patients with subclinical hypothyroidism. Subclinical hypothyroidism is seen commonly among females. Diabetes with hyperthyroidism has poor glycemic control

Review on Hypothyroidism as per Ayurveda

Hyperthyroidism is one of the most common disorder of Thyroid gland which is increasing day by day globally especially in developing countries. Ayurvedic classics have no direct reference of Hyperthyroidism. Considering various factors, it can be compared with Atyagni or Tikshnagni or Bhasmaka Roga (related to increased agni). Approaximately 300 million people worldwide are affected by thyroid dysfunction as it is a common endocrine disorder. Globally about 1-5% population are affected by hyperthyroidism. The prevalence of thyroid disorders in Nepalese population is 4.32% and among them 13.7% population has Hyperthyroidism. Available treatments of Hyperthyroidism in contemporary medicine cause lots of adverse effects and complications in the long run. So, it is very necessary to find out an effective alternative treatment for hyperthyroidism. Therefore this study was an attempt to get the understanding of disease Hyperthyroidism as per Ayurveda through various Ayurvedic principles so as to set its management strategies.
 Keywords: Hyperthyroidism, Atyagni, Tiksnagni, Bhasmaka rog

Thyroid disorders in arsenic prevalent area in Bangladesh

Background and Objectives: Due to geographical position and geological nature, Bangladesh (BD) has been the worst affected country in the world by arsenic contamination. The aim of this study was to highlight the association of chronic arsenic intoxication with thyroid disorders (TDs). Materials and Methods: This cross-sectional study was conducted from March 2019 to February 2020 at Ad-din Women's Medical College and Hospital. One thousand one hundred and thirty-seven patients were randomly selected, who visited the outpatient departments of medicine faculty with thyroid-stimulating hormone test report. Rest of the thyroid function tests were done if required. Considering the arsenic level in irrigation and drinking water, 64 districts of BD were divided into two regions “arsenic prevalent area” and “less arsenic prevalent area” and patients hailing from those areas were divided as Group 1 and Group 2, respectively. All patients were subjected to history taking and physical examination. Chi-square test and one-way ANOVA test were used to compare the variables. Results: Prevalence of TD were significantly higher in Group 1 (60.14%; P = 0.001) and so was the prevalence of goiter (19%;P = 0.021). Older (31.17 ± 9.81;P = 0.001) and female patients (94.92%;P = 0.001) were more prone to develop TD. Conclusion: It will require more studies at larger scale for better understanding of the association of thyroid disorders with chronic arsenic intoxication.

Prevalence of thyroid disorders among diabetes mellitus patients in al-Basra southern of Iraq

Prevalence of thyroid disorders among diabetes mellitus patients in al-Basra southern of Iraq

Prevalence of thyroid disorders among pregnant women in lower Assam

Prevalence of thyroid disorders among pregnant women in lower Assam

English

BACKGROUND Malnourishment is a major public health challenge in India. The prevalence of thyroid disorders is about 15 – 25 % in different parts of the country. As Thyroid hormone is essential for normal erythropoiesis, anaemia often accompanies thyroid disorders. It is also observed that iron deficiency anaemia state negatively influences the thyroid hormone function. So, the relationship between anaemia and thyroid disorders is complex and both have to be addressed. Keeping this in view, we tried to study the haematological parameters of inpatients with thyroid disorders in our hospital. METHODS A retrospective hospital based observational study was conducted in Gayatri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam. All adults (> 18 yrs. of age), non-pregnant patients admitted during the period November 2017 to November 2018 with a diagnosis of thyroid disorder at discharge were included in the study. Fasting thyroid profile (using Siemens advanced fully automated analyser) and haematological parameters (using automated haematology analyser - LABLIFE NOBLE III) were obtained. Data analysis was done using Microsoft Excel 2013 and SPSS version 26. RESULTS 107 patients were included in the study. Mean age of the patients was 33.20 (± 12.45) years with majority being female (91.6 %) and of the age group 18 – 40 years (80.3 %). Hypothyroidism (73.83 %) was the most common thyroid disorder observed followed by subclinical hypothyroidism (19.63 %) & hyperthyroidism (6.54 %). About 79.6 % of female patients and all male patients had anaemia of varying degree. Majority of the patients had moderate degree of anaemia [haemoglobin of 8 - 11.9 gm / dL (females) / 8 - 12.9 gm / dL (males)]. Both microcytic hypochromic anaemia (53.8 %) and normocytic normochromic anaemia (46.2 %) were almost equally prevalent in female patients. Statistically significant positive correlation was observed between TSH (Thyroid Stimulating Hormone) and mean corpuscular volume. (Pearson’s correlation = 0.324, significant correlation at the level 0.01.). CONCLUSIONS Our study highlighted the association between anaemia and thyroid dysfunction. As anaemia is common in our country and the occurrence of hypothyroidism and other thyroid disorders is on the rise, it is essential for clinicians to understand the interrelation between both the disorders and make appropriate therapeutic decisions for simultaneous treatment of anaemia as well as thyroid dysfunction as one may be the cause of the other. KEYWORDS Anaemia, Thyroid Dysfunction, Hypothyroidism

An evaluation of urine and serum iodine status in the population of Tibet, China: No longer an iodine-deficient region.

Iodine is a critical trace element for the synthesis of thyroid-related hormones, and either low or high iodine status can lead to thyroid dysfunction. This study aimed to evaluate the iodine status of the Tibetan population. From September 2016 to August 2018, we enrolled 1499 healthy adults from three areas of varying altitudes in Tibet. Urine iodine concentrations (UICs), adjusted UICs, and serum iodine concentrations (SICs) were measured using inductively coupled plasma mass spectrometry. The median UIC, adjusted UIC, and SIC was 137.9 μg/L, 118.4 µg/gCr, and 58.3 μg/L, respectively. Of the participants, 30.4% had UICs <100 µg/L, 63.0% had UICs ranging from 100 to 300 µg/L, and 9.6% had UICs >300 µg/L. The correlation between UIC, adjusted UIC, and SIC was good (r > 0.65, P < 0.01). The SICs were more stable than the UICs, and were not associated with age or sex. The prevalence of clinical hyperthyroidism, clinical hypothyroidism, subclinical hyperthyroidism, subclinical hypothyroidism, positive thyroid peroxide antibody, positive thyroglobulin antibody, either positive and both positive was 0.5%, 1.3%, 1.7% and 17.9%, 9.3%, 6.5%, 12.5%, and 2.5%, respectively. The prevalence of almost all thyroid disorders was higher in women than in men. This multicenter cross-sectional study found that the human iodine status of adults in Tibet was considered adequate, based on the World Health Organization's criteria.

Prevalence of Thyroid Disorders in Patients with Type 2 Diabetes Mellitus

Background and Objectives: Thyroid disorders are very common in the general population, and it is second only to diabetes as the most common condition to affect the endocrine system. In this study, we try to observe the prevalence of the type of thyroid dysfunction in patients with type 2 diabetes mellitus (T2DM). and its effect on glycemic parameters and the prevalence of autoimmune thyroid disorder in patients with T2DM. Settings and Design: This study included adults having T2DM. Patients were explained about the nature of the study and consent was obtained. Materials and Methods: Clearance was taken from the ethics committee. All participants who met the inclusion criteria were subjected to detailed clinical examination and relevant investigation. Statistical Analysis: Chi-square test was used for the analysis. Results: Two hundred and thirty-four patients (112 males and 122 females) were included in the study. The mean body mass index was high (26.21 ± 3.13 kg/m2). The mean hemoglobin (Hb) A1c was 8.81% ± 1.96%, whereas mean HbA1c in patients with both T2DM and thyroid dysfunction was 9.68% ± 1.35%. Thyroid dysfunction was found in 84 cases (35.8%), out of which the most common thyroid abnormality was overt hypothyroidism (61.9%) followed by subclinical hypothyroidism (27.3%). Out of 84 cases with thyroid dysfunction anti-thyroid peroxidase (TPO) was found positive in 45 cases (53.5%), and the most common thyroid dysfunction associated with positive anti-TPO was subclinical hypothyroidism (44%). Conclusions: The study shows a high prevalence of thyroid dysfunction among patients with T2DM and its association with poor glycemic control. The study also shows the prevalence of anti-TPO among patients and its significant correlation with thyroid dysfunction.

Prevalence of hyperthyroidism, hypothyroidism, and euthyroidism in thyroid eye disease: a systematic review of the literature

BackgroundThyroid eye disease is an autoimmune disorder of the orbital retrobulbar tissue commonly associated with dysthyroid status. The most frequent condition is hyperthyroidism, although it is also present in hypothyroid and euthyroid patients. The prevalence of thyroid conditions in patients with thyroid eye disease had been previously evaluated; however, there is no consensus on a global prevalence. The study aims to estimate the prevalence of hyperthyroidism, hypothyroidism, and euthyroidism in patients with TED, through a systematic review of literature.MethodsWe conducted a systematic review of the literature following the PRISMA guidelines, in MEDLINE, COCHRANE, EMBASE, Science Direct, and LILACS databases. Inclusion criteria were primary studies of patients with a diagnosis of thyroid eye disease made by an ophthalmologist or with diagnosis criteria, with measurement of thyroid function (TSH, T3, and free T4), and diagnosis of the primary thyroid condition. A quality assessment was made through the Joanna Briggs Institute Quality tools. Finally, we extracted relevant details about the design, the results, and the prevalence of thyroid disorders in thyroid eye disease.ResultsThe initial search revealed 916 studies, of which finally thirteen met inclusion criteria. Six studies were performed in Europe (Germany, Wales, and Spain), five in Asia (Iran, South Korea, Japan, and Singapore), one in North America (USA), and one in Africa (Ghana). The global prevalence, in patients of thyroid eye disease, was 10.36% for hypothyroidism, 7.9% for euthyroidism, and 86.2% for hyperthyroidism.ConclusionsProfessionals should be aware that thyroid eye disease can be present in patients with a normal thyroid function. The assessment for these patients is based on orbital images; serum TSH, T3, and free T4; antibody levels as thyrotropin receptor antibodies; and thyroperoxidase levels. Additionally, we want to encourage research in this field in other regions of the world such as Latin America.Systematic review registrationPROSPERO ID CRD42020107167

Prevalence of thyroid disorders in antenatal women and its impact on maternal and foetal outcome

Introduction: Thyroid disorders are the commonest endocrine disorders affecting women of reproductive age group. The most frequent thyroid disorder in pregnancy is maternal hypothyroidism. Antenatal period can be viewed as a state in which a combination of events concurs to modify the thyroidal economy. Thyroid dysfunction has varied impact on pregnancy outcome. In this study we have assessed the prevalence and the impact of thyroid disorders among antenatal woman registered in the Urban Health Training Centre of a Tertiary care teaching hospital in Kerala, Southern India. Materials and Methods: A prospective observational study was done among 451 antenatal women registered in the Urban Health Training centre of a Tertiary care hospital. Prevalence of thyroid disorders was assessed based on TSH, Free T4 and Anti TPO antibody status. Maternal and Foetal outcomes with respect to their Thyroid function status were also evaluated. Results: The prevalence of thyroid dysfunction in pregnancy was 22.39%, subclinical hypothyroidism (20.63%) was the most common thyroid disorder among these women. Statistically significant association was found between thyroid disorders and maternal complications (P value= Conclusions: This study concludes that there is a high prevalence of thyroid disorder in pregnancy. Subclinical hypothyroidism was found to be the major thyroid disorder as per this study. Keywords: Antenatal thyroid disorder, Pregnancy thyroid dysfunction, Maternal complications, Foetal complications.

Thyroid dysfunction in Iranian pregnant women: a systematic review and meta-analysis

BackgroundThyroid dysfunction during pregnancy is associated with adverse outcomes for both mother and fetus. The present meta-analysis was conducted to evaluate thyroid dysfunction in Iranian pregnant women.MethodsWe registered this review at PROSPERO (registration number: CRD42020166655). The research steps in this systematic review and meta-analysis were performed according to the MOOSE protocol, and finally, reports were provided based on the PRISMA guidelines. The literature search was performed in October 2019 using the international online databases, including Web of Science, Ovid, Science Direct, Scopus, EMBASE, PubMed/Medline, Cochrane Library, EBSCO, CINAHL, Google Scholar as well as national databases were reviewed. Data were extracted after applying the inclusion and exclusion criteria and qualitative evaluation of the studies. I2 index and Q test were used to assess differences in studies. All analyses were performed using Comprehensive Meta-Analysis Software. P-value less than 0.05 was considered statistically significant. We identified 1261 potential articles from the databases, and 426 articles remained after removing the duplicate and unrelated studies. After evaluating the full text, 52 articles were removed.ResultsFinally, 19 eligible studies including 17,670 pregnant women included for meta-analysis. The prevalence of thyroid dysfunction in Iranian pregnant women was 18.10% (95%CI: 13.89–23.25). The prevalence of hypothyroidism, clinical hypothyroidism, and subclinical hypothyroidism in Iranian pregnant women was respectively estimated to be 13.01% (95%CI: 9.15–18.17), 1.35% (95%CI: 0.97–1.86) and 11.90% (95%CI: 7.40–18.57). The prevalence of hyperthyroidism, clinical hyperthyroidism, and subclinical hyperthyroidism in Iranian pregnant women was respectively estimated to be 3.31% (95%CI: 1.62–6.61), 1.06% (95%CI: 0.61–1.84) and 2.56% (95%CI: 0.90–7.05). The prevalence of anti-thyroperoxidase antibody was estimated to be 11.68% (95%CI: 7.92–16.89).ConclusionThe results of this meta-analysis showed a high prevalence of thyroid disorders, especially hypothyroidism. The decision to recommend thyroid screening during pregnancy for all women is still under debate, because the positive effects of treatment on pregnancy outcomes must be ensured. On the other hand, evidence about the effect of thyroid screening and treatment of thyroid disorders on pregnancy outcomes is still insufficient. Nevertheless, a large percentage of general practitioners, obstetricians and gynecologists perform screening procedures in Iran.

Timing, prevalence, and dynamics of thyroid disorders in children and adolescents affected with Down syndrome.

Objectives Limited data on the evolution of thyroid disorders (TD) in Down syndrome (DS) are available. We characterized the timing, prevalence, and dynamics of TD in patients with DS during a long-term follow-up. Methods We retrospectively evaluated 91 children and adolescents with DS (12.5±8.3; follow-up 7.5±6.2). Children were monitored at birth, 6, and 12months of age and twice a year thereafter. Thyroid status and autoimmunity were periodically investigated. Results TD were detected in 73.6% of patients, in particular congenital hypothyroidism (CH), autoimmune thyroid diseases (ATD) and subclinical hypothyroidism (SH) were recorded in 16.4, 31.8, and 25.3%, respectively. CH was diagnosed at newborn screening in 86.7% of cases and in the first 6months of life in the remaining 13.3%; the condition was persistent in 61.5% of patients. In more than 30% of CH cases, glandular hypoplasia was also revealed. In the ATD group, 63.1% of patients with Hashimoto's disease (HD, 82.6%) were treated with levothyroxine and subjects with Graves' Disease (GD, 17.4%) started therapy with methimazole. DS with SH were treated in 42.1% of cases. A thyroid hypogenic echopattern, without autoantibody positivity was identified in 27.6% of SH patients. Conclusions The high prevalence and evolution of TD in SD requires frequent monitoring starting in the first months of life. CH can be misdiagnosed at screening. In DS subjects, there is a high prevalence of ATD and non-autoimmune diseases with early antibody-negative phases should not be excluded.

A study of correlation between thyroid disorders and menstrual disorders in reproductive age group

Present study to evaluate and detect thyroid dysfunction and its correlation in patients with a menstrual disorder in the reproductive age group. Research objectives are to study the prevalence of thyroid disorders in relation to menstrual disorders and study the correlation between menstrual irregularities and thyroid dysfunction. Precise assessments of thyroid hormones in serum become achievable easily and accurately with the introduction of new hormographical research techniques. Hypothyroidism diagnosis is advantageous because it typically relieves the patient of all symptoms. Therefore, the assessment of thyroid activity forms an essential component for the evaluation of a female with menorrhagia or otherwise menstrual irregularities. The individuals are rescued from repeated curettage from hysterectomy by early diagnosis of hypothyroidism Objectively measured menstrual blood losses were 35 ml per menstrual cycle (patients in the age group exposures.

THYROID DISORDERS AND POLYCYSTIC OVARY SYNDROME Dr. B S Meena1, Dr. Neeta Meena2

Background: Polycystic ovarian syndrome (PCOS) is the most common form of chronic anovulation associated with androgen excess; perhaps occurring in 5-10% of reproductive women. &#x0D; Methods: Observational study done in the Department of Obstetrics &amp; Gynaecology, SMS Medical College, Jaipur. Forty cases of women with PCOS based on Rotterdam’s criteria and an equal number of age-matched controls (women without PCOS) were included in the study.&#x0D; Results: T4 level was significantly lower in PCOS group with mean free T4 level 0.87 ± 0.75 ng/ml in PCOS group v/s 1.92 ± 0.84 ng/ml in control group (p-value = 0.001). TSH level was significantly higher in PCOS group with mean TSH level 8.86 ± 7.57 mU/L in PCOS group v/s 3.40 ± 1.21 mU/L in control group (p-value = 0.001)&#x0D; Conclusion: High prevalence of thyroid disorders in PCOS patients thus points towards the importance of early correction of hypothyroidism in the management of infertility associated with PCOS.&#x0D; Keywords: T4, T3, TSH, PCOS

An Observational Study on the Prevalence of Thyroid Disorders in Reproductive Aged Women with PCOS

An Observational Study on the Prevalence of Thyroid Disorders in Reproductive Aged Women with PCOS

Study of prevalence of thyroid disorders in pregnancy and its outcome

Study of prevalence of thyroid disorders in pregnancy and its outcome

Current Iodine Nutrition Status and Prevalence of Thyroid Disorders in Tibetan Adults in an Oxygen-Deficient Plateau, Tibet, China: A Population-Based Study.

Background: Iodine deficiency (ID) is a global problem in individuals living in an iodine-deficient environment, specifically in mountainous regions. However, data regarding the iodine nutritional status of Tibetan people in the plateau are limited. Methods: A population-based survey was conducted from July 2016 to July 2017 in Lhasa, Tibet, including 12 communities in Lhasa city and 10 surrounding rural areas. The iodine nutritional status of Tibetan people was evaluated using the traditional iodine nutrition indexes: urinary iodine concentration (UIC), thyroid size, serum thyroxine, thyrotropin, thyroglobulin antibody and thyroid peroxidase antibody (TPOAb). Results: A total of 2295 healthy participants were screened, and 2160 participants who had completed all the required examinations were enrolled in this study (response rate, 94.1%). Urinary iodine showed a skewed distribution, with a median (upper and lower quartiles) of 154 (99-229) μg/L. The percentages of low iodine (UIC <100 μg/L), adequate iodine (UIC, 100-199 μg/L), and high iodine (UIC ≥200 μg/L) were 25.6%, 42.0%, and 32.4%, respectively. The urinary iodine level in the urban region was higher than that in the rural region (p < 0.05). Urinary iodine levels were lower with increasing age (p < 0.05). The prevalence of hyperthyroidism, hypothyroidism, goiter, TPOAb positivity, and thyroglobulin antibody positivity was 1.0%, 21.8%, 4.7%, 6.6%, and 10.4%, respectively. Logistic regression analysis found that urinary iodine was an independent risk factor for TPOAb positivity (odds ratio = 0.997 [95% confidence interval, 0.995-0.999]; p < 0.001). Conclusions: Compared with individuals living in the plains of China, Tibetan adults have a higher rate of ID. UIC was an independent risk factor for TPOAb positivity. This public health issue should be further investigated.

To study the prevalence of thyroid disorders in chronic renal disease patients

To study the prevalence of thyroid disorders in chronic renal disease patients

Thyroid dysfunction in Egyptian patients with hepatitis C virus: prevalence and possible triggering

BackgroundThe contribution of chronic hepatitis C virus (HCV) infection per se in thyroid autoimmunity and dysfunction remains controversial. We investigate the prevalence of thyroid disorders and the possible association between thyroid dysfunction and different factors in a cohort of HCV-untreated patients.Patients and methodsA total 1050 patients with untreated HCV infection were enrolled in this study. Thyroid function tests, antiperoxidase (TPO-Ab), antithyroglobulin, thyroid ultrasound, real-time PCR to assess HCV RNA viral load, and fibroscan to determine degree of hepatic fibrosis were done.ResultsThyroid dysfunction was found in 17.1% of patients: 11.5% hypothyroidism and 5.6% hyperthyroidism. Subclinical hypothyroidism, overt hypothyroidism, subclinical hyperthyroidism, and overt hyperthyroidism were detected in 8.6, 2.8, 3.3, and 2.3% of patients, respectively. Thyroid ultrasound showed abnormality in 10.2% of patients. TPO-Ab and antithyroglobulin were positive in 5.1 and 6.4% of patients, respectively. TPO-Ab was more frequently positive in hyperthyroid patients compared with euthyroid (P<0.001) and hypothyroid (P<0.001) patients. Positive TPO-Ab was only significantly associated with thyroid state (P<0.001) and duration of HCV infection (P=0.02).ConclusionThe prevalence of thyroid dysfunction is 17.1% among patients with HCV infection. Furthermore, thyroid disorder is related mainly to thyroid autoimmunity independent of age, sex, or level of viremia.