Previous History Of Thyroid Disease Research Articles

The Impact of Physical Activity on Thyroid Health: Insights From Representative Data in Korea.

Thyroid hormones are essential for energy metabolism related to thermogenesis and oxygen consumption. This study evaluated the potential association of thyroid function including thyroid peroxidase antibodies (TPOAb) with physical activity in nationally representative data. This retrospective cohort study used data from the Korean National Health and Nutrition Examination Survey between 2013 and 2015. Physical activity (PA) was assessed using metabolic equivalents based on the validated Korean version of the International Physical Activity Questionnaire Short Form. PA level was categorized into 3 groups of high, moderate, and low. Participants with abnormal thyroid function test, restricted activity, or previous history of thyroid disease were excluded in the study. A total of 5372 participants was finally selected. The free T4 level was lowest in the low PA group, while TSH was not significantly different among the groups. TPOAb titers increased in the following order: moderate PA, low PA, and high PA. After adjustment for confounding factors, moderate PA was associated with a high T4 level and a decrease in TSH and TPOAb with significance. However, there were no significant changes in free T4, TSH, or TPOAb titer in the high PA group. In a subanalysis, females with moderate PA showed a significant decrease in TSH and TPOAb. In both males and females, insulin sensitivity was increased with moderate PA. In obese participants, TSH negatively correlated with PA, and free T4 levels decreased in the low PA. The sensitivity to thyroid hormone did not differ in our study. The present study found an association between thyroid function and moderate PA. Therefore, moderate-intensity PA should be recommended to improve thyroid function.

Evaluation of Thyroid Function Tests in Patients With COVID-19.

Background SARS-CoV-2 infects cells via angiotensin-converting enzyme 2 (ACE2). ACE2 levels are high in the thyroid gland. Although the thyroid gland can be directly infected in COVID-19 patients, the hypothalamic-pituitary-thyroid axis is also affected. Therefore, changes in thyroid function occur in COVID-19 patients. This study aimed to examine the effect of thyroid function tests on the prognosis of COVID-19. Methodology A total of 146 patients who were diagnosed with COVID-19 and treated in the intensive care unit between August and November 2021 and who had no previous history of thyroid disease were included in the study. Demographic information, laboratory tests, and thyroid hormone levels during hospitalization and discharge patterns were evaluated. The patients were divided into two groups: group I includedthose who were discharged after recovery, and group II included those who did not respond to treatment and died. Results When the fT3 and fT4 levels of the patients were compared, the hormone levels decreased as the clinical severity of the disease increased. The amount of decrease in hormone levels was mostly seen in group II. In the recovered patient group, the amount of hormone decreased was less. The difference between fT3 and ft4 values between the groups was found to be statistically significant (P= 0.015 and P= 0.004). In addition, the difference between the groups' C-reactive protein (CRP), D-dimer, and ferritin values was statistically significant (P= 0.036, P= 0.022, and P< 0.000, respectively).There was no statistically significant difference between the groups in terms of demographic characteristics (P> 0.05). Conclusions Thyroid hormone changes were found to be an important prognostic parameter affecting disease severity and mortality in COVID-19 patients and can be used to predict mortality.

Two Cases of Autoimmune Thyroid Disorders after COVID Vaccination in Dialysis Patients

SARS-CoV-2 infection and vaccination have been associated with autoimmune thyroid dysfunctions. Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) and molecular mimicry have been referred to as potential causes. Such a case has not been reported in immunocompromised end-stage renal disease (ESRD) patients. Herein we present two dialysis patients with no previous history of thyroid disease who developed immune mediated thyroid disorders after BNT162b mRNA vaccine against SARS-CoV-2. The first patient is a 29-year-old man on hemodialysis diagnosed with Grave’s disease four months post-vaccination and the second one is a 67-year-old female on peritoneal dialysis who developed Hashimoto’s thyroiditis two months post-vaccination. Grave’s disease is uncommon in dialysis patients, whereas Hashimoto’s thyroiditis has a higher incidence in this population. Time proximity in both cases suggests potential causality. To our knowledge, this is the first report of de novo immune-mediated thyroid disorders in dialysis patients following vaccination against SARS-CoV-2.

Thyroid Diseases and Chronic Rhinosinusitis: A Nested Case-Control Study Using a National Health Screening Cohort.

This study aimed to investigate the association between thyroid diseases and chronic sinusitis (CRS) in a matched cohort in a study conducted within the Korean National Health Insurance Service-Health Screening Cohort (2002–2015). A total of 6024 patients with CRS were 1:4-matched for age, sex, household income, and region of residence with 24,096 control participants. Effects of a previous history of thyroid disease, including hypothyroidism, hyperthyroidism, thyroiditis, autoimmune thyroiditis, and Graves’ disease, were investigated using conditional logistic regression. Subgroup analyses were performed in regard to the presence of nasal polyposis. A history of hypothyroidism (2.8% vs. 1.8%), hyperthyroidism (2.0% vs. 1.5%), thyroiditis (1.1% vs. 0.8%), autoimmune thyroiditis (0.4% vs. 0.3%), and Graves’ disease (0.3% vs. 0.2%) was not more prevalent in the CRS group than in the control group according to univariate analysis (all p > 0.05). Hypothyroidism was associated with CRS in the multivariate-adjusted model (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.00–1.57). In the subgroup analyses, thyroid diseases were not statistically significantly associated with CRS after being classified according to the presence or absence of nasal polyps. Additional studies are required to elucidate the relationship between thyroid diseases and CRS, as this may aid in screening and clinical decision making.

SARS-CoV-2 vaccine-associated subacute thyroiditis: insights from a systematic review

PurposeTo perform a systematic review on published cases of subacute thyroiditis (SAT) secondary to SARS-CoV-2 vaccination, to highlight main features and increase the awareness of this condition.MethodsOriginal reports of SAT developed after SARS-CoV-2 vaccination (mRNA, viral vector, or inactivated virus vaccines) were retrieved from a search of electronic databases. Individual patient data on demographics, medical history, type of vaccine, workup and therapies were collected. Wilcoxon rank-sum, Kruskal–Wallis and chi-squared tests were employed for comparisons.Results30 articles including 48 reports were retrieved, 3 additional cases evaluated by the Authors were described and included for analysis. Of the 51 patients, 38 (74.5%) were women, median age was 39.5 years (IQR 34–47). Patients developed SAT after a median of 10 days (IQR 4–14) after the vaccine shot. Baseline thyroid exams revealed thyrotoxicosis in 88.2% of patients, decreasing at 31.6% at follow-up. Corticosteroids were used in 56.4% of treated patients. Patients undergoing non-mRNA vaccines were most frequently Asian (p = 0.019) and reported more frequently weight loss (p = 0.021). All patients with a previous diagnosis of thyroid disease belonged to the mRNA vaccine group.ConclusionSARS-CoV-2 vaccine-associated SAT is a novel entity that should be acknowledged by physicians. Previous history of thyroid disease may predispose to develop SAT after mRNA vaccines, but further studies and larger cohorts are needed to verify this suggestion. SARS-CoV-2 vaccine-associated SAT is usually of mild/moderate severity and could be easily treated in most cases, thus it should not raise any concern regarding the need to be vaccinated.

Solitary Fibrous Thyroid Tumor: A Case Report

Introduction: Solitary fibrous thyroid nodules are rare tumors and can mimic benign thyroid goiter and neoplasms. Case Description45 years old Caucasian female, with no significant past medical history, who presented to endocrinologyclinic for left neck mass evaluation. She denied previous history of thyroid disease, weight loss, cold/heatintolerance, menstrual irregularity, toxic or obstructive thyroid related symptoms. Her family history issignificant for maternal pancreatic cancer. Clinical exam was unremarkable except for left thyroid mass. An initial thyroid ultrasound showed left thyroid nodule 20 x16 x 25 mm in size five years prior topresentation. Repeated Fine Needle aspiration yielded benign follicular cells, histiocytes and fewlymphocytes. The nodule continued to increase in size reaching 46 mm in the long axis per thyroidultrasound at presentation to clinic. Her TSH, FT4 and total T3 remained within normal ranges. She wasreferred for surgical evaluation and underwent left thyroid lobectomy. Pathology reported 50 mm wellcircumscribed intrathyroidal neoplasm composed of spindle cells with pauci to moderate cellularity with noincreased mitotic activity, nuclear atypia, or necrosis. Immunohistochemistry was positive for STAT 6 andCD34and negative for PAX-8, TTF-1, S100 and SMA. The patient remains euthyroid with no lymph nodeor organ involvement after 5 years from initial presentation. Discussion: Solitary fibrous tumors (SFT) of the thyroid are rare although they have been described in differentanatomic sites (1). It presents as slow growing, painless, non toxic nodule in middle age of both sexes (1,2). The diagnosis of these tumors via FNA is difficult due to cellular paucity. Histologic findings may bechallenging due to shared features with other thyroid undifferentiated, papillary and follicular cancervariants. Immunohistochemistry are warranted to assist in confirmation-STAT6 and CD34 (3). SFT tumorsare mostly benign tumors and carries favorable prognosis.

Knowledge of Thyroid Disease Manifestations and Risk Factors Among Residents of the Eastern Province, Saudi Arabia.

Background: Thyroid disorders are worldwide common endocrine disorders. These disorders are frequently under-diagnosed. In general, lack of knowledge and understanding of thyroid disorder effects can lead patients to go undiagnosed. This study aims to figure out the level of the general knowledge about thyroid disease manifestations, risk factors, and preventive behaviors among the general population. Method: This cross-sectional study was conducted among 882 participants in the Eastern province of Saudi Arabia from July 2020 to October 2020, and were selected randomly. The representative sample included Saudi and non-Saudi males and females of different age groups (18-60 years).Result: The overall mean knowledge score was 8.67 (SD 3.69) with 44.7%, 41.2%, and 14.2% were classified into low, average, and high knowledge, respectively. In the comparison of mean knowledge score among the socio-demographic profiles and previous history of thyroid disease, the current study shows that being a female, living in Al Ahsa, being a student, those with a previous history of thyroid disease, family history of the disease, and those who underwent thyroid gland examination were significantly more associated with having better knowledge toward thyroid diseases.Conclusion: Nearly, half of the studied sample has low awareness scores regarding thyroid disease manifestations and its risk factors. The health authorities should hold more successful health education methods to improve the public and their caregivers' awareness of the various aspects of thyroid disorders and the value of their early detection and adequate control.

English

BACKGROUND Patients with critical illness can have changes in thyroid hormone metabolism along with changes within the hypothalamus-pituitary-thyroid axis, even though there is no previous history of thyroid disease. Such changes have been named as “Sick Euthyroid Syndrome” or “Non-Thyroidal Illness Syndrome (NTIS)”. Such alterations in thyroid function can be seen in patients with sepsis and they are known to affect the prognosis of the disease. The most common abnormality in sick euthyroid syndrome is low serum T3. This study aims to find the proportion and pattern of sick euthyroid syndrome in patients with sepsis. METHODS This was a hospital based cross sectional study done in the Department of Internal Medicine in a tertiary care centre in south Kerala. 100 patients with diagnosis of sepsis were selected based on American College of Chest Physician / Society of Critical Care Medicine 2001 Consensus Conference definitions, and included in the study. Serum levels of total T3, total T4 and TSH were measured and the proportion of patients with various abnormalities in thyroid hormone levels and the pattern of abnormalities were analysed. RESULTS The mean age of study group was 67.9 years (with standard deviation of 7.184). Female to male ratio was 1.08:1. Proportion of sick euthyroid syndrome in patients with sepsis was 71 %. Low T3 was seen in 69 % patients, low T4 in 11 % and low TSH in 11 %. TSH was above reference range in 3 % patients. The most common pattern of sick euthyroid syndrome was low T3 with normal T4 and TSH in 54 % patients. Low T3 with low T4 and normal TSH was seen in 6 % patients; low T3, T4, TSH in 5 % patients; low T3, elevated TSH, normal T4 in 3 % patients; low TSH with normal T3 and T4 in 2 % patients and low T3, low TSH and normal T4 in 1 % patients. CONCLUSIONS Proportion of sick euthyroid syndrome in sepsis was 71 % and the most common pattern was low T3 with normal T4 and TSH seen in 54 % patients. KEYWORDS Sick Euthyroid Syndrome, T3, T4, TSH

Thyroid scintigraphy in the era of fine-needle aspiration cytology.

To evaluate whether thyroid scintigraphy would alter the clinical management of patients referred for fine-needle aspiration cytology (FNA). We reviewed the medical and imaging records of patients referred to our Department between 2016 and 2019. All the patients had to take a serum thyrotropin test administered in our hospital at least two months before the FNA; where the TSH level was ≤1.5mIU/L, the patients were subjected to a scan and subsequently to FNA, where indicated. We selected only healthy patients with no previous history of thyroid disease, who were not taking any drugs and who had a TSH level of ≤1.5mIU/L. We excluded patients with multinodular goitre. A total of 176 patients were analysed. A total of 67/176 patients (38%) showed a serum of TSH≤0.27mIU/L. Scintigraphy identified a hot nodule in 142 lesions (80.7%), a warm nodule in 8 lesions (4.5%) and a cold nodule in 26 lesions (14.8%). The ROC curve analysis indicated that a TSH value of ≤0.42mIU/L identified patients with hyperfunctioning nodules with a sensitivity of 65% and a specificity of 77%. All patients with cold and warm nodules were submitted to FNA: 22/26 (85%) and 5/8 (63%) lesions showed suspected malignancy or were compatible with malignancy, respectively. Speculating on our data, if we had subjected our patients to FNA as indicated by the 2015 ATA guidelines, we would have subjected 117 patients to cytology, from whom 83 had undetected hot nodules. Conversely, by adopting scintigraphy for all patients with TSH≤1.5mIU/L, 109 patients have avoided FNA. However, our study was performed in a region with a history of mild iodine deficiency. Therefore, we cannot claim that our observation is valid for patients born and living in areas with sufficient iodine uptake. We recommend thyroid scintigraphy for treating single thyroid nodules in euthyroid patients born and living in regions with an iodine deficiency, when TSH levels are below 1.5mIU/L before FNA.

SAT-476 Alemtuzumab Induced Graves Disease

Introduction: Immune reconstitution therapy (IRT) with the monoclonal antibody alemtuzumab (anti-CD 52) has been shown to be superior to β-interferon in relapsing-remitting multiple sclerosis. It can cause early hyper-population of immature B cells which increases the risk of autoimmune disorders. The most common autoimmune adverse effect is autoimmune thyroid disorder (AITD) which has not been well recognized by internists, especially primary care physicians. We present a case of alemtuzumab-related hyperthyroidism. Most of these cases are mild and can be easily managed. Case presentation: A 44-year-old female with history of multiple sclerosis (MS) presented to the office with a two-month history of fatigue, palpitations, tremors, weight loss and pruritus after completing a course of Alemtuzumab. Her symptoms started 1 month after completing 2 years of a consecutive series with IRT. Her thyroid function panel was not checked before starting IRT. She had no previous history of thyroid disease. Family history is positive for goiter in her mother. She had no exposure to contrast dye, steroids, amiodarone, supplements or biotin use. On exam, she had tachycardia, dry skin, tremors on outstretched hands and a non-tender goiter with no palpable nodules. Her initial labs showed a suppressed TSH (<0.005 mIU/L), elevated FT4 (>7.77 ng/dL), elevated T3 (647 NG/dL) and TSI of 338% (<140%), consistent with Graves’ Disease. She was started on methimazole. Two months into treatment, she became clinical and biochemical euthyroid without medication side effects. Discussion: This patient might have Graves’ disease before IRT which can be easily treated if TFTs were routinely checked; or her Grave’s disease was induced by IRT later. Lack of TFTs checked before, during and after IRT put those patients at risk of unawareness of thyroid abnormalities. Based on this case, we strongly recommend doing routine TFTs (TSH, free T4) check before starting IRT to rule out existing thyroid function abnormalities and provide treatment accordingly. We also recommend checking TSI, TPO antibody for high-risk patients (positive family history, past history) and thyroid US for those who have nodules or goiters before starting IRT. For those found to have abnormal TFTs, TSI or TPO, routine follow up with an Endocrinologist should be recommended during, and even after therapy completion.

Alteration of levels of thyroid hormones in acute ischemic stroke and its correlation with severity and functional outcome

Introduction – With increasing life expectancy and changing trends in diseases, lifestyle diseases come forward and become a major concern. Ischemic stroke is an emerging public health issue leading to significant morbidity and mortality. To improvise positive outcome in acute ischemic stroke (AIS) and optimizing healthcare resources, accurate and timed prognostication of functional outcome is important. Various studies implied derangement of Hypothalamo-pituitary-thyroid (HPT) axis in AIS, thereby advocates neuroprotective properties to these hormones. This is, still, an open field for active research. Thyroid hormones can, therefore, be used as a surrogate tool for outcome predilection in AIS. This prospective observational cohort study aimed to investigate the alteration of levels of thyroid hormones in AIS and simultaneously correlate their levels in assessment of clinical severity and predicting the functional outcome. Materials and methods – We had collected data from 60 patients of, radiologically confirmed new cases of AIS who sought medical help within 72 hours of initiation of stroke symptom and had no previous history of thyroid disease. Blood samples for thyroid function test [TSH, FreeT3 (FT3), and FreeT4 (FT4)] were collected within 24 hours after admission and subsequently at 7th and 30th day of discharge .On admission neurological clinical severity was assessed by using National Institute of Health Stroke Scale (NIHSS). Functional outcome was assessed by Modified Rankin Scale (mRS) at 7th and 30th day of discharge. Result – Out of 60 AIS patients, 40 were having Non thyroidal illness Syndrome (NTIS). Low T3 was most common NTIS observed. Negative correlation was observed between FT3 levels and on admission NIHSS score and mRS score on follow up. Conclusion – This study thereby concludes that low T3 levels were associated with clinical severity and poor functional outcome in AIS. Keywords: stroke, thyroid profile, correlation, NIHSS, mRS, NTIS.

Proptosis secondary to rosiglitazone treatment

Objective: To report a case of new onset proptosis secondary to treatment with rosiglitazone. Methods: Case report Results: A patient developed symptomatic bilateral proptosis requiring surgical intervention, two years and a half after treatment with rosiglitazone. Conclusion: Asymptomatic eye protrussion is a frequent finding in patients treated with thiazolidinediones. In a few cases, the proptosis may be clinically significant and may present in patients with or without a previous history of thyroid disease.

Type 2 diabetes mellitus and thyroid disease: a two-sided analysis

To assess the prevalence of thyroid diseases in patients with type 2 diabetes mellitus (T2DM) in comparison with normal population; to determine prevalence of T2DM in patients with thyroid diseases. First group consisted of 60 patients with T2DM without previous history of thyroid disease. Second group consisted of 60 patients with thyroid disease without any previously known impairment of glucose metabolism. Control group (CG) included 100 subjects who had no previous history of thyroid disease or glucose metabolism impairment. Blood tests were performed to evaluate thyroid and glucose metabolism parameters. We found a significantly higher prevalence of thyroid diseases in patients with T2DM when compared to CG. Patients with T2DM showed to have higher serum levels of free triiodothyronine (fT3), thyroid‑stimulating hormone (TSH) and anti-thyroid peroxidase (anti-TPO) autoantibodies. We found no statistical significance in prevalence of T2DM in patients with thyroid diseases and CG. Among parameters of glucose metabolism, there were only higher fasting glucose levels in patients with hyperthyroidism and autoimmune thyroid disease (AITD). Patients with T2DM showed to have higher prevalence of AITD and primary hypothyroidism. We did not find higher prevalence of T2DM in patients with thyroid diseases (Tab. 3, Ref. 29).

Renal metastases as the initial presentation of papillary thyroid carcinoma: A case report and literature review.

Distant metastasis of thyroid carcinoma is rare, and it occurs particularly rarely in renal regions, which represent ~3% of all thyroid distant metastases, with fewer than 30 single case study reports existing in the literature. The present study (and subsequent literature review) of papillary thyroid carcinoma (PTC) reports the case of a 53-year-old male patient who presented with a left renal mass and who had no previous history of thyroid disease. Following renal and thyroid surgery, postoperative pathology confirmed the case to be a follicular variant of PTC, accompanied by renal metastasis. The patient exhibited brain metastasis during a later follow-up. In conclusion, thyroid metastases to the renal site are extremely rare events, particularly for men who present initially with renal neoplasms, which may easily be misdiagnosed as renal cell carcinoma. PTC tends to have a good prognosis; however, when it is accompanied by distant metastasis, the prognosis becomes less favorable.

Amiodarone-induced myxoedema coma as a rare differential diagnosis of consciousness disturbance

Myxoedema coma is an uncommon and life-threatening endocrine emergency with a high mortality rate. This entity is the extreme expression of severe hypothyroidism and the cardinal features are decreased mental status and hypothermia. Diagnosis is challenging and a high index of suspicion is crucial because it allows an early recognition of this condition and prompt initiation of supportive measures along with adequate thyroid replacement therapy. Herein, we report an extremely rare case of myxoedema coma secondary to amiodarone in a 90-year-old female with no previous history of thyroid disease, which was successfully treated with thyroid hormone replacement. Although its rarity, we emphasize that myxoedema coma should be included in the differential diagnosis of consciousness disturbances, particularly in patients under amiodarone therapy.

Comparison and relationship of thyroid hormones, IL-6, IL-10 and albumin as mortality predictors in case-mix critically ill patients

ObjectiveTo compare the ability of thyroid hormones, IL-6, IL-10, and albumin to predict mortality, and to assess their relationship in case-mix acute critically ill patients. MethodsAPACHE II scores and serum thyroid hormones (FT3, FT4, and TSH), IL-6, IL-10, and albumin were obtained at EICU admission for 79 cases of mix acute critically ill patients without previous history of thyroid disease. Patients were followed for 28days with patient’s death as the primary outcome. All mean values were compared, correlations assessed with Pearson’ test, and mortality prediction assessed by multivariate logistic regression and ROC. ResultsNon survivors were older, with higher APACHE II score (p=0.000), IL-6 (p<0.05), IL-10 (p=0.000) levels, and lower albumin (p=0.000) levels compared to survivors at 28days. IL-6 and IL-10 had significant negative correlation with albumin (p=0.001) and FT3 (p⩽0.05) respectively, while low albumin had a direct correlation with FT3 (p<0.05). In the mortality prediction assessment, IL-10, albumin and APACHE II were independent morality predictors and showed to have a good (0.70–0.79) AUC-ROC (p<0.05). Despite that the entire cohort showed low FT3 serum levels (p=0.000), there was not statistical difference between survivors and non-survivors; neither showed any significance as mortality predictor. ConclusionsIL-6 and IL-10 are correlated with Low FT3 and hypoalbuminemia. Thyroid hormones assessed at EICU admission did not have any predictive value in our study. And finally, high levels of IL-6 and IL-10 in conjunction with albumin could improve our ability to evaluate disease’s severity and predict mortality in the critically ill patients. When use in combination with APACHE II scores, our model showed improved mortality prediction.

Thyroxine in acute myocardial infarction (ThyrAMI) - levothyroxine in subclinical hypothyroidism post-acute myocardial infarction: study protocol for a randomised controlled trial.

BackgroundCardiac disease is the most common cause of morbidity and mortality in the United Kingdom. Even minor changes in thyroid hormone concentration may impact adversely on the cardiovascular system. Subclinical hypothyroidism (SCH) after admission for an acute cardiac problem has been associated with an increase in cardiac mortality and overall death. We have designed protocols for a prospective observational study to assess the association of thyroid function at the time of acute myocardial infarction (AMI) with cardiovascular outcomes, and a double-blinded randomised placebo-controlled trial of levothyroxine to evaluate its effect on LV function and vascular health.Methods/DesignThyrAMI 1: This will be a prospective longitudinal observational study of patients with AMI that will be followed for 24 months to study the association between thyroid status at the time of AMI (within 24 hours of diagnosis) with vascular outcomes.ThyrAMI 2: This will be a prospective double-blinded randomised placebo-controlled trial of levothyroxine of 12 months duration in patients with AMI and SCH.Setting: Patients will be recruited from five hospitals in the North East of England.Participants: One hundred patients with thyroid function tests within the subclinical hypothyroid range upon admission with an AMI and no previous history of thyroid disease.Intervention: Levothyroxine will be administered at a starting dose of 25 mcg once daily, which will be increased at intervals if needed to maintain a TSH level between 0.4 to 2.5 mU/L, versus a placebo.Randomisation: Participants will be randomized with a computerised randomisation algorithm, stratified by type of MI (NSTEMI versus STEMI), in a 1:1 ratio to levothyroxine therapy or placebo (as container or bottle numbers), starting within 21 (+/− 7) days of AMI.Blinding: Assignment to either the LT4 or placebo arm will be double-blinded.Outcomes: The outcome will be the effect of levothyroxine on ventricular function, endothelial function and blood coagulability and rheology.DiscussionThere is evidence to suggest that treatment of SCH can improve cardiovascular parameters. Therefore, ThyrAMI 1 and ThyrAMI 2 will be the first trials investigating SCH in AMI to give a better insight into whether thyroid hormone levels are a key target for improving cardiovascular outcomes.Trial registrationISRCTN number: ISRCTN52505169. Date of registration: 09/01/2015

Relation between third trimester urinary iodine concentrations and newborn thyrotrophic hormone

Relation between third trimester urinary iodine concentrations and newborn thyrotrophic hormone Mohammad Reza Rezvanfar, Heidar Farahani, Mohammad Rafiei, Elaheh Salehi, Elham Ebrahimi, Rezvan Kazemi-Majd Abstract Background: The aim of the study was to evaluate the third trimester urinary iodine excretion and to assess its relation with newborns thyroid function. Materials and Methods: A total of 208 healthy third trimester pregnant women without previous history of thyroid disease were included in the study. Urinary iodine levels of mothers were measured and neonatal TSH levels were screened on the 3- 5th day following birth. Results: The median urinary iodine level in the mothers was 50μg/L. According to WHO criteria for iodine status:14.9%, 34.1% and 49.6% had severe, moderate and mild iodine deficiency, respectively, and only 1.4%, had the adequate iodine intake . In 6 neonate (2.8%) who their TSH level were between 5- 10 IU/ml, nobody had criteria for congenital hypothyroidism at recall visit (15th day). Our results showed the reverse relation between mean Neonatal TSH levels and mother’s third trimester iodine level (r= -0.19, p=0.006). Conclusion: Although all of mothers included in this study stated that they were using iodized salt, iodine deficiency was frequent . There was also a significant relation between mean neonatal TSH levels and mother’s third trimester iodine urinary level.Keywords: Pregnancy, Iodine status, Newborn, Thyroid function

Changes in serum iodine concentration, urinary iodine excretion and thyroid function after hysterosalpingography using an oil-soluble iodinated contrast medium (lipiodol).

Reports of hypothyroidism after hysterosalpingography (HSG) using lipiodol are emerging. The present study was designed to investigate the changes in serum iodine concentration (SIC), urinary iodine concentration/creatinine excretion (UI/Cr), and thyroid function before and after HSG using lipiodol. The prospective observation study included 22 infertile euthyroid women with no previous history of thyroid disease. All underwent HSG between April 2007 and August 2008 at our institution. We examined SIC, UI/Cr, and thyroid function before HSG, and at 4, 8, 12, and 24 weeks, and 9-12 months after HSG. The median value of SIC and UI/Cr peaked at 4 weeks after HSG and remained at significantly high levels at 8, 12, and 24 weeks post-HSG compared with pre-HSG. In sync with the increase of iodine, the mean level of TSH significantly increased at 4, 8, 12, and 24 weeks post-HSG compared with pre-HSG. After 24 weeks, differences in SIC, UI/Cr, and TSH levels before and after HSG became nonsignificant. The mean value of free triiodothyronine and free thyroxine showed no significant difference at any of the time points compared with pre-HSG. Three cases (13.6%) showed transient high TSH (>5 μIU/L) with normal thyroid hormones at 4 or 8 weeks after HSG. Thyroid monitoring should be conducted in the first 4-8 weeks after HSG using lipiodol and attention to thyroid dysfunction should be paid for up to 6 months after the procedure due to the possibility of excess iodine.

Polymorphisms of methylenetetrahydrofolate reductase and glutathione S-transferase are not associated with the risk of papillary thyroid cancer in Korean population

Korea has the highest incidence of thyroid cancer of any nation. We conducted a population-based, case-control study of the association between the risk of papillary thyroid cancer (PTC) in the Korean population and polymorphisms of methylenetetrahydrofolate reductase (MTHFR) C677T, glutathione S-transferase class mu (GSTM1), and glutathione S-transferase class theta (GSTT1). The study subjects consisted of 2,194 newly diagnosed PTC cases and 1,669 population-based healthy controls. Odds ratios adjusted by age, sex, body mass index, smoking, drinking, serum thyroid-stimulating hormone level, family history of thyroid cancer, and previous history of thyroid disease, with 95% confidence intervals, were estimated using logistic regression analysis. The frequencies of MTHFR 677TT genotypes, and null genotypes of GSTM1 and GSTT1 were 19.2, 56.8, and 51.4% among PTC cases and 17.4, 54.1, and 50.6% among the controls, respectively. No significant associations between PTC and TT genotypes of MTHFR C677T, null genotypes of GSTM1 and GSTT1, or double-null (GSTM1-GSTT1) genotypes were found. These findings suggest that polymorphisms of the MTHFR C677T, GSTM1 and GSTT1 genotypes do not contribute to the development of PTC susceptibility in the Korean population.