Primary Hypothyroidism Research Articles

Clinical Significance of Thyroid Autoantibodies in Differential Diagnosis and Predicting the Course of Programmed Cell Death Protein-1 Inhibitor-Induced Thyroid Dysfunction

ObjectiveThyroid immune-related thyrotoxicosis is one of the most common adverse effects in patients treated with programmed cell death protein-1 (PD-1) inhibitors. We investigated the significance of levels of serum anti-thyroglobulin antibodies (TgAbs), anti-thyroid peroxidase antibodies (TPOAbs), and thyroid-stimulating hormone receptor antibodies (TRAbs) in the identification of anti-PD-1-induced thyroid thyrotoxicosis. MethodsWe divided 161 patients with thyroid dysfunction who received PD-1 inhibitors at our hospital between January 2022 and June 2024 into 3 groups: primary hypothyroidism group, primary hyperthyroidism group, and destructive thyroiditis group. The characteristics of the 3 groups were determined, and the positivity rates of serum TgAbs, TPOAbs, and TRAbs were assessed. An additional 42 patients diagnosed with Hashimoto’s thyroiditis were selected as the control group for PD-1 inhibition-induced destructive thyroiditis. Age, sex, and time of transition from thyrotoxicosis to hypothyroidism in the 2 groups were compared. ResultsIn the primary hypothyroidism group, only 1 case was TPOAbs-positive (1/1%). In the destructive thyroiditis group, the positivity rate for TPOAbs or TgAbs was 92.9%, and TPOAbs and TgAbs were negative in the primary hyperthyroidism group. TRAbs were undetectable in all 3 groups. There were statistically significant differences in age, sex, and time from thyrotoxicosis to hypothyroidism in the PD-1 induced destructive thyroiditis and Hashimoto’s thyroiditis groups. ConclusionsIn patients with thyrotoxicosis caused by PD-1 inhibitors, serum TgAb, and TPOAb levels can be used to distinguish between primary hyperthyroidism and destructive thyroiditis. This study provides insights into novel treatment targets and effective management strategies for PD-1-induced thyrotoxicosis.

Replacement Dose for Overt Hypothyroidism Induced by Programmed Cell Death Protein 1 Antibodies May Be Higher than Recommended.

The present recommendations, consensus, or guidelines for the replacement dosage for hypothyroidism induced by programmed cell death protein 1 (PD-1) therapy are not uniform, and there are very few special clinical trials that have examined the replacement dosage for it. This article illustrates the clinical characteristics of hypothyroidism induced by PD-1 antibodies (Abs) and reports the recommended replacement dosage for hypothyroidism. Eighteen patients with overt primary hypothyroidism induced by PD-1 Abs (group 1) were selected from 655 patients with different tumor types. Retrospective analysis was performed on patients in group 1 and 18 patients with natural courses of overt primary hypothyroidism who were age- and sex-matched with the patients in group 1 (group 2). The replacement dosages required for the patients in the two groups were compared. Thyroid dysfunction occurred in group 1 after approximately 3.0 ± 1.4 cycles of PD-1 therapy (1-6 stages), with a median time of 61.5 days. The median time of onset of hypothyroidism among all patients was 87.5 days (30-240 days). Most of the patients with hypothyroidism were asymptomatic, and the onset of hypothyroidism was independent of age, sex, TPOAb, TgAb and TSH in group 1 (P>0.05). The average replacement dosage for patients in group 1 was 1.8 ± 0.6 μg/kg/d (0.6-3.2 μg/kg/d). Multiple linear regression analysis showed that sex, age, TPOAb, TgAb and TSH were not correlated with drug dosage. It seemed that the average maintenance dosage of levothyroxine might need to be 1.8 μg/kg/day for patients with overt hypothyroidism induced by PD-1 Abs.

Patterns of thyroid gland dysfunction among hospitalized patients with COVID-19 pneumonia

BackgroundSince the onset of the COVID-19 pandemic, multiple studies have reported a bidirectional between COVID-19 and dysfunction of the thyroid gland. These studies have identified various forms of thyroid dysfunction that have been found to affect the severity and outcome of COVID-19 infection. However, the data from these studies have been inconsistent and conflicting. Our objective was to assess the prevalence of various types of thyroid dysfunction among moderate to severe cases of COVID-19 pneumonia. In addition, the study aimed to evaluate the outcome of thyroid dysfunction after recovery from COVID-19 infection.Patient and methodsIn this observational prospective study data on the clinical features of individuals with moderate to severe COVID-19 pneumonia who were admitted to Zagazig University isolation hospitals from April to December 2022 and their laboratory results were gathered and examined. Thyroid function tests, including TSH, FT3, and FT4, were conducted for all patients upon admission. Follow-up testing was performed on patients who initially had aberrant thyroid lab results 90 days after recovering from COVID-19 infection.ResultsThe study comprised a total of 136 patients who had moderate (44.1%) to severe (55.9%) COVID-19 infection. Sick euthyroid syndrome was the most prevalent form of thyroid dysfunction, accounting for 58.7% of patients with thyroid disorders on admission. After 90 days of post-COVID-19 examination, thyroid dysfunction recovery was observed in 61% of cases. A statistically significant correlation was noted between the severity of COVID-19 and the levels of TSH, free T3, and the ratio of free T3 to T4. A large percentage of patients who showed complete recovery had sick euthyroid syndrome. All patients diagnosed with primary hypothyroidism maintained their hypothyroidism condition, whereas those with hyperthyroidism showed complete recovery.ConclusionCOVID-19 patients may experience several patterns of thyroid dysfunction, including nonthyroidal illness syndrome. These dysfunctions are associated with the intensity of the inflammatory response and the severity of the COVID-19 infection. Nevertheless, these alterations are predominantly reversible upon recovery from a COVID-19 infection.

Impact of Lowering TSH Cut-Off on Neonatal Screening for Congenital Hypothyroidism in Minas Gerais, Brazil.

A higher incidence of primary congenital hypothyroidism (CH) has been related to increased sensitivity in neonatal screening tests. The benefit of treatment in mild cases remains a topic of debate. We evaluated the impact of reducing the blood-spot TSH cut-off (b-TSH) from 10 (Group 2) to 6 mIU/L (Group 1) in a public neonatal screening program. During the study period, 40% of 123 newborns with CH (n = 162,729; incidence = 1:1323) had b-TSH between 6 and 10 mIU/L. Group 1 patients had fewer clinical signs (p = 0.02), lower serum TSH (p < 0.01), and higher free T4 (p < 0.01) compared to those in Group 2 at diagnosis. Reducing the b-TSH cut-off from 10 to 6 mIU/L increased screening sensitivity, allowing a third of diagnoses, mainly mild cases, not being missed. However, when evaluating the performances of b-TSH cut-offs (6, 7, 8, 9, and 10 mIU/L), the lower values were associated with low positive predictive values (PPVs) and unacceptable increased recall rates (0.57%) for a public health care program. A proposed strategy is to adopt a higher b-TSH cut-off in the first sample and a lower one in the subsequent samples from the same child, which yields a greater number of diagnoses with an acceptable PPV.

A novel maternal thyroid disease prediction using multi-scale vision transformer architecture with improved linguistic hedges neural-fuzzy classifier.

Early pregnancy thyroid function assessment in mothers is covered. The benefits of using load-specific reference ranges are well-established. We pondered whether the categorization of maternal thyroid function would change if multiple blood samples obtained early in pregnancy were used. Even though binary classification is a common goal of current disease diagnosis techniques, the data sets are small, and the outcomes are not validated. Most current approaches concentrate on model optimization, focusing less on feature engineering. The suggested method can predict increased protein binding, non-thyroid syndrome (NTIS) (simultaneous non-thyroid disease), autoimmune thyroiditis (compensated hypothyroidism), and Hashimoto's thyroiditis (primary hypothyroidism). In this paper, we develop an automatic thyroid nodule classification system using a multi-scale vision transformer and image enhancement. Graph equalization is the chosen technique for image enhancement, and in our experiments, we used neural networks with four-layer network nodes. This work presents an enhanced linguistic coverage neuro-fuzzy classifier with chosen features for thyroid disease feature selection diagnosis. The training procedure is optimized, and a multi-scale vision transformer network is employed. Each hop connection in Dense Net now has trainable weight parameters, altering the architecture. Images of thyroid nodules from 508 patients make up the data set for this article. Sets of 80% training and 20% validation and 70% training and 30% validation are created from the data. Simultaneously, we take into account how the number of training iterations, network structure, activation function of network nodes, and other factors affect the classification outcomes. According to the experimental results, the best number of training iterations is 500, the logistic function is the best activation function, and the ideal network structure is 2500-40-2-1. K-fold validation and performance comparison with previous research validate the suggested methodology's enhanced effectiveness.

Study of the Efficacy of Sublingual Route Administration of Levothyroxine Na Tablets vs Oral Route in Cases with Refractory Primary Hypothyroidism

Abstract Background Hypothyroidism is a common disorder, with a prevalence of approximately 5% and incidence of approximately 250 /100,000 per year in the adult population both prevalence and incidence keep raising. Levothyroxine is the recommended hormone for replacement therapy in both overt and subclinical hypothyroidism. Aim of the Work Levothyroxine (L-T4) is the standard therapy of hypothyroidism. Our purpose was to compare the efficacy of the L-T4 sublingual tablet administration to standard oral L-T4 tablet in hypothyroid patients with refractory hypothyroidism. Subjects and Methods Our study was conducted on 40 patients who were documented to be refractory to oral thyroxine age range 18- 55, 38 females and 2males. Patients were recruited from Endocrinology and Metabolism clinic at Ain-Shams University and Internal medicine outpatient clinic at 6th of October University during the period from June 2019 to October 2020 Informed consent was obtained from all subjects. Results In our study showed a significant decrease in mean TSH (write the figures) on sublingually administrated levothyroxine tablets compared to orally administrated levothyroxine tablets and a significant rise of mean free T4 after 1 week. yet after 6 weeks there was insignificant difference of FT4 compared to oral levothyroxine. Patients who were antiparietal cell antibody positive demonstrated a non significant rise of free T4 level with almost doubling of level compared to oral levothyroxine at 1 week and 6 weeks interval, this was associated with a significant decline of serum TSH at 6 weeks interval. Also This was associated with a significant improvement in hypothyroidism symptoms Conclusion In conclusion, our study indicated that sublingual route for LT4 tablet administration was safe and innovative route for LT4 administration,it could improve compliance, overcome many obstacles with oral administration for intake with food,coffee,drug interaction and GI malabsorption.

Mucoepidermoid Carcinoma of the Thyroglossal Duct: Two Rare Entities in a Unique Case Report.

Mucoepidermoid Carcinoma (MEC) of the thyroid represents less than 0.5% of all thyroid neoplasms. Thyroglossal duct cyst carcinoma is a rare condition with only approximately 300 cases reported. A 34-year-old pregnant woman at 37 weeks gestation presented to an endocrinological center for primary autoimmune hypothyroidism. The thyroid ultrasound revealed a pseudonodular pattern. The patient was followed up after two years. She reported a full-term delivery without complications. A new thyroid ultrasound was performed, showing a cystic lesion in the median suprathyroid area, measuring 6 x 9 x 10 mm, not previously reported. After 4 months, the suprathyroid cystic lesion was confirmed by thyroid ultrasound, measuring 6 x 11 x 12 mm. The patient was referred for fine-needle aspiration cytology. Cytological examination showed lymphocytes, red blood cells, and some epithelial aggregates with large cytoplasm and nuclear polymetrism with oxyphilic aspects. The patient underwent the Sistrunk procedure for the suprathyroid lesion. The histological examination revealed lymphocytic thyroiditis in heterotopic thyroid tissue with solid cell nest, epidermoid epithelium, and mucus-secreting cells suggestive of low-grade mucoepidermoid carcinoma. The immunohistochemistry study was positive, exhibiting thyroid transcription factor 1 and cytokeratin-19. No positivity was observed for thyroglobulin, calcitonin, galectin-3, and Hector Battifora mesothelial antigen 1. The recent follow-up examination, 13 months after the surgery, has been found negative for disease recurrence. This is the first case of an MEC occurring within a thyroglossal duct. Considering the age of the patient, the histological diagnosis, and the absence of thyroid nodules and metastasis, we decided on the Sistrunk procedure without total thyroidectomy.

The clinical diversity of primary hypothyroidism presenting as a spontaneous ovarian hyperstimulation syndrome.

Ovarian hyperstimulation syndrome (OHSS) usually occurs in patients undergoing assisted reproduction techniques and ovulation induction. Its variant, spontaneous ovarian hyperstimulation syndrome, a potentially life-threatening disorder, is uncommon and only a few cases have been reported in association with hypothyroidism. This study analysed five patients with untreated chronic hypothyroidism presenting with multicystic ovaries, isosexual precocious puberty, and delayed bone age; subsequently, the follow-up and regression of ovarian pathology was assessed. Two patients had presented to the emergency department with menorrhagia and hypotension, of these, one had ovarian torsion at presentation. Three patients presented to the outpatient department: one for evaluation of short stature, one for premature menarche, and another with polycystic ovaries. They were all diagnosed with long-standing, untreated chronic hypothyroidism. There was regression of the size of the cystic ovaries on subsequent follow-up. In all these patients, long-standing hypothyroidism had resulted in ovarian hyperstimulation syndrome. The potentially life-threatening complications of this syndrome may be prevented by careful screening and a strong index of clinical suspicion at the outset. Long-standing, untreated primary hypothyroidism may result in spontaneous ovarian hyperstimulation syndrome. A high index of suspicion is required for an early and accurate diagnosis. The requirement for interdepartmental collaboration between gynaecology and endocrinology departments is essential for the successful management of this life-threatening but easily treatable disorder.

Correlation between estradiol-to-testosterone ratio and thyroid peroxidase antibody positivity in men with treatment-naïve primary hypothyroidism or euthyroidism.

Thyroid diseases pose a substantial socioeconomic burden globally. The aim of this study was to evaluate the correlation between estradiol-to-testosterone (E2/T) ratio and thyroid peroxidase antibody (TPOAb) positivity in male patients with hypothyroidism or euthyroidism. Cross-sectional observational study including 115 male patients with hypothyroidism or euthyroidism. The patients were divided into two groups based on positive or negative TPOAb results, with TPOAb positivity defined by a serum TPOAb value ≥ 35 IU/mL. Patients with positive TPOAbs, compared with those with negative TPOAbs, had a higher prevalence of goiter and obesity and higher levels of total cholesterol, triglycerides, and low-density lipoprotein (LDL) cholesterol. The median estradiol level was higher, and the median total testosterone and sex-hormone binding globulin (SHBG) levels were lower in the TPOAb-positive versus the TPOAb-negative group (p < 0.001). In subgroup analysis including only patients with hypothyroidism (n = 80), the median E2/T ratio was higher in the TPOAb-positive group (p = 0.016). The prevalence of TPOAb positivity increased with the increase in E2/T ratio quartiles, from 37.9% in the lowest quartile to 96.2% in the highest quartile (p value for trend across all quartiles < 0.001). On adjusted multivariate analysis, the E2/T ratio emerged as an independent predictor of TPOAb positivity. An E2/T ratio cutoff value of 6.565 x10-3 demonstrated the best diagnostic accuracy, with a sensitivity of 78.2% and specificity of 67.6%. The present study provides insights into the role of the E2/T ratio as a predictor of thyroid disorders.

Primary hypothyroidism in a patient with germ cell tumor: A case report

Germ cell tumors (GCTs) are known to present with thyroid dysfunction, typically manifesting as hyperthyroidism due to human chorionic gonadotropin secretion. However, hypothyroidism among GCT patients is a relatively underexplored phenomenon, which could be attributable to low clinical suspicion and the potential masking of hypothyroidism by cancer-related symptoms. Moreover, the impact of hypothyroidism on cancer-related outcomes remains uncertain. Here, we present a case of incidentally detected primary hypothyroidism in a 16-year-old girl with an ovarian GCT. Remarkably, her condition improved at an unexpected rate after cancer-directed treatment. In our evaluation, we identified various causes of reversible hypothyroidism, all of which are comprehensively reviewed in this case report.

Unraveling the Diagnostic Implications of Elevated Prealbumin Levels in Lithium-Induced Hypothyroidism: A Case Report

Prealbumin, a multifunctional protein synthesized primarily in the liver, serves as a critical biomarker in clinical practice, offering insights into nutritional status and prognostic outcomes. While its precise physiological role remains incompletely understood, prealbumin is known to facilitate hormone transport, particularly of thyroxine, and contribute to neuroprotection. Clinically, prealbumin levels are sensitive indicators of recent changes in protein intake and absorption, making them invaluable in guiding therapeutic interventions. Alterations in prealbumin levels have been associated with various medical conditions, including chronic kidney disease, liver disease, and cancer, emphasizing its prognostic significance across diverse clinical contexts. we report a case of a 42-year-old male with bipolar disorder managed on lithium therapy, presenting with depressive symptoms and unexpected hyperprealbuminemia. Subsequent investigation revealed primary hypothyroidism secondary to lithium intoxication, highlighting the intricate relationship between lithium therapy, prealbumin levels, and thyroid dysfunction. We discuss the mechanisms and clinical implications of lithium-induced hypothyroidism, emphasizing the importance of considering thyroid function in patients with elevated prealbumin levels. This case underscores the necessity for vigilant monitoring and timely intervention to optimize patient outcomes in cases of lithium-induced thyroid dysfunction. Continued research is crucial for elucidating the complex interactions between prealbumin, lithium therapy, and thyroid function, enhancing our understanding and management of these metabolic disturbances.

Cardiac tamponade - a rare cause of sudden death in autoimmune polyglandular syndrome.

A 27-year-old male died suddenly due to cardiac tamponade arising from pericarditis complicating autoimmune polyglandular syndrome (APS) type 2. He had a history of primary Addison disease and autoimmune hypothyroidism which were corroborated at autopsy. In addition a florid fibrinous pericarditis was associated with 287g of turbid fluid in the pericardial sac. Although pericarditis with tamponade is a potential complication of APS, it has rarely if ever, been reported as a cause of sudden death. Lethal mechanisms may involve both compressive and restrictive effects.

Features of post-surgical menopause with concomitant primary hypothyroidism: A prospective single-stage clinical study

Background. In recent decades, the frequency of surgical interventions on reproductive system organs has been steadily increasing. In gynecological practice, preference is given to minimally invasive surgery and precision treatments, especially involving ovaries. Despite the modern approach, it is not always possible to preserve this endocrine organ, which leads to post-surgical menopause (PSM). The relatively high incidence of total hysterectomy-associated PSM and primary hypothyroidism in late reproductive age often leads to their combination. Clinical manifestations aggravating each other form an unfavorable vicious circle. Aim. To study the features of the PSM course with concomitant primary hypothyroidism. Materials and methods. A prospective clinical study included 130 women aged 45 to 55 years with a history of PSM. The main group consisted of 70 patients with PSM with subclinical primary hypothyroidism. A control group included 60 PSM patients without thyroid disorders. We assessed the effect of hypothyroidism on the PSM course by comparing several indicators in the main and control groups. Results. It was found that in the main group patients, severe 26.5% and moderate 38.8% menopausal syndrome prevailed, while in the control group patients, such forms were twice as common. In the women of the main group, the levels of triglycerides were higher than those in the control group by 1.3 times (2.6±0.86 mmol/L and 1.43±0.33 mmol/L, respectively). The total serum alkaline phosphatase activity in patients in the study groups was 29.8% higher than in healthy women. Conclusion. It can be concluded that the severity of menopausal disorders depends on the thyroid status, with more severe in patients of the main group with hypothyroidism. In addition, in patients of the main group with hypothyroidism, dyslipidemia is more pronounced, which predisposes them to severe diseases in the future, in particular cardiovascular disorders, the unfavorable course of metabolic syndrome, and the development of postmenopausal osteoporosis.

Comorbidity of Autoimmune Thyroid Disease and Psychiatric Disorders: A Cross-Sectional Study from Southern India.

Background and Aims: Autoimmune thyroid disease (AITD) is associated with a multitude ofneuropsychiatric symptoms and cognitive impairment. Though it is one of the most common cause ofacquired primary hypothyroidism, there is a dearth of literature regarding the psychiatricpresentations of thyroid autoimmunity in southern India. Objectives: To study the psychiatriccomorbidities in patients with AITD and determine the relationship between thyroid peroxidaseantibody level with severity of psychiatric illness and cognitive impairment. Materialsand Methods: This cross-sectional study of one year duration was conducted in department of Psychiatry ofatertiary-care hospital in Kerala. Subjects with AITD andnew onset behavioural symptoms wereselected, diagnosis was made based on DSM 5 diagnostic criteria, illness severity was assessed usingHAM-A, HAM-D, BPRS rating scales and severity of cognitive impairment was assessed usingMoCA scale. Statistical analysis was done using percentage, mean , SD andSpearmann’s correlationcoefficient. Results: Out of 60 subjects, 82%were women and 52%had a family history of thyroiddysfunction. The most common psychiatric diagnosis were Major Depressive Disorder, Panic disorderand Schizophreniform disorderwith moderate to severe illness and mild cognitive impairment. Significant positive correlation between thyroid peroxidase antibody level and severity of depressiveand anxiety disorder was found. Conclusion: The common psychiatric comorbities, its severity andcognitive impairment in AITD and its relation with thyroid peroxidase antibody level could bedescribed. A holistic teamwork comprising of endocrinologists and psychiatrists can help in earlydetection and management of these issues. Keywords: anxiety, autoimmunity, cognition, depression, psychosis, thyroid

Effect of Selenium Yeast Tablets Combined with Levothyroxine Sodium on Thyroid Function and Inflammatory Factors in Patients with Hypothyroidism

Objective To investigate the clinical efficacy of selenium yeast tablets combined with levothyroxine sodium in the treatment of hypothyroidism and its effect on thyroid function and inflammatory factors. Methods 110 patients with primary hypothyroidism admitted to The first Affiliated Hospital of Yangtze University from January 2018 to December 2018, and were randomly divided into the observation group (55 cases) and the control group (55 cases). The patients of the control group were given sodium levothyroxine, while the observation group received selenium yeast tablets combined with levothyroxine sodium therapy. The indexes of thyroid function/clinical efficacy/adverse events were compared between the two groups. Results The total effective rate of the observation group was 92.73%, and 72.73% in the control group, there was a significant difference between the two groups (P&lt;0.05). After treatment, T3, T4, FT3 and FT4 levels were significantly increased compared with that before treatment the differences were statistically significant (P&lt;0.05). And TSH, TGAb and TPOAb levels were significantly lower compared with that before treatment, and the difference were statistically significant (P&lt;0.05). After treatment, T3, T4, FT3 and FT4 degree of observation group were better than those of the control group, the differences were statistically significant (P&lt;0.05). After treatment, the levels of IL-12 and IFN-γ in both groups decreased, but the levels of IL-12 and IFN-γ the observation group were lower than those in the control group (P&lt;0.05). After treatment, the level of IL-10 increased in two groups, but the level of IL-10 in the observation group was higher than that of the control group (P&lt;0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P&gt;0.05). Conclusion The selenium yeast tablets combined with levothyroxine sodium in treatment of hypothyroidism can obtain obvious theraeputtic effects. which can not only improve the levels of various thyroid indexes, but also can improve patient's inflammatory factors levels, with good safety, without serious adverse reactions, therefor, which has important clinical application value. Key words: Selenium; Yeast Tablet; Hypothyroidism; Inflammatory Factor.

T3 in 2023: LT3 + LT4 combination therapy for primary hypothyroidism

T3 in 2023: LT3 + LT4 combination therapy for primary hypothyroidism

Indications for Intravenous T3 and T4.

Therapy with thyroid hormones normally is restricted to substitution therapy of patients with primary or secondary hypothyroidism. Typically, thyroid hormones are given orally. There are few indications for intravenous use of thyroid hormones. Indications for parenteral application are insufficient resorption of oral medications due to alterations of the gastrointestinal tract, partial or total loss of consciousness, sedation in the intensive care unit or shock. In almost all cases, levothyroxine is the therapy of choice including congenital hypothyroidism. In preterm infants with an altered thyroid hormone status, studies with thyroid hormones including intravenous liothyronine showed a normalisation of T3 levels and in some cases an amelioration of parameters of ventilation. A benefit for mortality or later morbidity could not be seen. Effects on neurological improvements later in life are under discussion. Decreased thyroid hormone levels are often found after cardiac surgery in infants and adults. Intravenous therapy with thyroid hormones improves the cardiac index, but in all other parameters investigated, no substantial effect on morbidity and mortality could be demonstrated. Oral liothyronine therapy in these situations was equivalent to an intravenous route of application. In myxoedema coma, intravenous levothyroxine is given for 3 to 10 days until the patient can take oral medication and normal resorption in the gastrointestinal tract is achieved by restoring at least peripheral euthyroidism. Intravenous levothyroxine is the standard in treating patients with myxoedema coma. A protective effect on the heart of i.v. levothyroxine in brain-dead organ donors may be possible.

Biochemical pattern and prevalence of thyroid disorders among adults in a tertiary hospital in North-East Nigeria

Thyroid disorders are a relatively common group of endocrine disorders globally. Thyroid function tests are critical for diagnosing, screening, and prognosticating thyroidal and non-thyroidal diseases, and their accurate interpretation is required for effective and accurate patient management. A retrospective analysis of thyroid function tests - Thyroid Stimulating Hormone (TSH), Free Thyroxine (fT4), and Free Triiodothyronine (fT3) - was carried out at a Nigerian tertiary hospital between January 2017 and January 2024. The tests were conducted using an enzyme-linked fluorescent immunoassay system and interpreted following standard protocols. A preponderance of female patients was investigated for thyroid diseases, with a male-female ratio of 2.2:1. The majority (80.8%) of the analyzed requests showed a euthyroid pattern; primary hyperthyroidism was the most common biochemical pattern of thyroid dysfunction observed, accounting for 10.8% of all the analyzed requests. Secondary hyperthyroidism and hypothyroidism were generally rare. Occasional cases (0.3%) of T3 toxicosis were also observed. Goiters remain a common presentation of thyroid diseases in our environment. Primary hyperthyroidism and primary hypothyroidism are the most common forms of thyroid dysfunction observed.

Identification of important symptoms and diagnostic hypothyroidism patients using machine learning algorithms

Background: Hypothyroidism is one of the most common endocrine diseases. It is, however, usually challenging for physicians to diagnose due to nonspecific symptoms. The usual procedure for diagnosis of Hypothyroidism is a blood test. In recent years, machine learning algorithms have proved to be powerful tools in medicine due to their diagnostic accuracy. In this study, the authors aim to predict and identify the most important symptoms of Hypothyroidism using machine learning algorithms. Method: In this cross-sectional, single-center study, 1296 individuals who visited an endocrinologist for the first time with symptoms of Hypothyroidism were studied, 676 of whom were identified as patients through thyroid-stimulating hormone testing. The outcome was binary (with Hypothyroidism /without Hypothyroidism). In a comparative analysis, random forest, decision tree, and logistic regression methods were used to diagnose primary Hypothyroidism. Results: Symptoms such as tiredness, unusual cold feeling, yellow skin (jaundice), cold hands and feet, numbness of hands, loss of appetite, and weight Hypothyroidism gain were recognized as the most important symptoms in identifying Hypothyroidism. Among the studied algorithms, random forest had the best performance in identifying these symptoms (accuracy=0.83, kappa=0.46, sensitivity=0.88, specificity=0.88). Conclusions: The findings suggest that machine learning methods can identify Hypothyroidism patients who show relatively simple symptoms with acceptable accuracy without the need for a blood test. Greater familiarity and utilization of such methods by physicians may, therefore, reduce the expense and stress burden of clinical testing.

Comparative analysis of scaffold fibre diameter-modulated responses on immortalized and primary thyroid cells: Implications for thyroid regeneration

Primary hypothyroidism results from thyroid gland damage, commonly due to radiotherapy for head and neck cancer. Primary hypothyroidism severely impacts patient quality of life and is expected to increase in incidence due to the aging population and rising cancer survivor rates. Tissue engineering approaches are starting to emerge as a potential treatment.Electrospinning techniques have yet to be investigated in conjunction with thyroid tissue. Here, electrospun polycaprolactone scaffolds with varying fibre diameters were fabricated and their effects on immortalized human thyrocytes (Nthy-ori 3–1) and primary murine thyroid cells were investigated. Four groups of scaffolds were produced with fibre diameters ranging from approximately 0.5 µm to 4 µm, to understand the impact of these microenvironments on their potential for thyroid regeneration.Results showed that fibre size influenced mechanical properties, porosity and cell response. Nthy-ori 3–1 cells performed best on the scaffold with medium-sized fibres while primary cells preferred the scaffold with larger fibres. Nonetheless, the scaffold with the smallest fibre diameter encouraged the secretion of collage-like fibrils, potentially indicating favourable conditions for regeneration.This study highlights the potential of electrospun PCL scaffolds as promising candidates for tissue engineering applications in the treatment of primary hypothyroidism. The findings demonstrate the importance of tailoring scaffold properties and considering cell-type specific responses when designing biomaterials for tissue-engineered solutions for thyroid regeneration. Further research is necessary to elucidate the underlying mechanisms and optimize scaffold properties for successful thyroid tissue regeneration.