Thyroid Function Test Results Research Articles

Thyroid Function in the Time of COVID-19: A Systematic Review of Disease Progression and Vaccination Effect

Objectives: This systematic review sought to address three key questions: (1) what differences in abnormal thyroid function test results are observed between COVID-19 patients and healthy individuals? (2) How does the severity of COVID-19 infection influence the development of thyroid dysfunction? (3) What impact do COVID-19 vaccines have on thyroid function and autoimmune processes? Methods: A literature search was conducted in PubMed, Web of Science, and Scopus from December 2019 to April 2023 to identify studies on thyroid dysfunction in COVID-19 patients without pre-existing thyroid conditions. The search focused on observational and case-control studies. Results: The literature search yielded 329 reports, from which duplicates and unrelated publications were excluded. Ultimately, 21 studies met the inclusion criteria and were selected for review. A second literature search yielded 605 reports, from which 5 studies were selected for inclusion in the systematic review. Conclusions: The findings suggest that SARS-CoV-2 infection can induce transient and reversible thyroid dysfunction, possibly through direct viral effects on the thyroid gland or via indirect immune-mediated mechanisms. Clinicians should be mindful of the potential, albeit rare, thyroid-related adverse effects of COVID-19 vaccines and monitor thyroid function, particularly in high-risk individuals.

Comparison of orexigenic and anorexigenic neuropeptide levels in hyperemesis gravidarum patients with normal pregnant women: A prospective cohort study.

The aim of this study was to determine whether orexigenic neuropeptides, orexin and galanin, and anorexigenic neuropeptides, alpha-melanocyte-stimulating hormone (α-MSH) and cocaine- and amphetamine-regulated transcript (CART), are implicated in hyperemesis gravidarum (HG). Fifty pregnant women who had been diagnosed with HG between April 2022 and February 2023 at the Siirt University Faculty of Medicine Training and Research Hospital (tertiary center) were recruited for this study. An equal number of pregnant women without an HG diagnosis were included in the study as the control group. Participants' age, pregnancy history, medical history, thyroid function test results, complete blood count results, and electrolyte levels were recorded, and their orexin, galanin, α-MSH, and CART serum levels were analyzed using an enzyme-linked immunosorbent assay. No statistically significant differences in orexigenic neuropeptides (orexin and galanin) were observed between the HG and control groups. A statistical difference was found between an anorexigenic neuropeptide (α-MSH) and the control group (P = .012). Based on a receiver operating characteristic analysis, the α-MSH parameter was statistically significant for distinguishing between participants with an HG diagnosis and those without, with a sensitivity of 63.6%, specificity of 65.9%, and cutoff value of 11769.3 pg/mL (P = .012, area under curve: 0.655). Based on the severity classification of ketonuria (ketonuria levels of +1 or +2 were classified as mild, whereas levels of +3 or +4 were classified as moderate to severe), the anorexigenic CART neuropeptide was found to be a statistically significant diagnostic indicator of severe ketonuria (P = .020). α-MSH and CART levels were found to be related in HG patients and in HG patients with severe ketonuria.

6492 Novel compound heterozygous mutations in the SBP2 gene

Abstract Disclosure: H. Jeong: None. Mutations in the selenocysteine insertion sequence binding protein 2 gene (SECISBP2 also known as SBP2) result in a multisystemic disorder. A 4-year-old Korean girl presented with atypical thyroid function test result, characterized by normal TSH 2.13 μIU/mL, decreased T3 0.51 ng/mL, free T3(FT3) 1.71 (pg/mL), and elevated free thyroxine (FT4) 4.28 ng/dL. Additionally, she exhibited short stature below 2 standard deviations and delayed bone age. She has not yet begun speaking, and her waking ability commenced only recently. She conceived twins through natural pregnancy, but tragically, her twin sibling passed away in utero at 8 weeks of gestation.A targeted next-generation sequencing panel revealed compound heterozygous mutation in SBP2 gene (p.Arg120Ter/p.Arg672Ter) and in TPO gene (p.Glu413Gln).Her serum selenium level was relatively low,, easuring at 6.94 ng/dL. She underwent T3 supplementation and received a daily selenium supplement of 20mcg. Subsequently, her thyroid function tests normalized. Presentation: 6/2/2024

Homeopathic Management of Hypothyroidism: A Case Series Study

Hypothyroidism is a common endocrine disorder that affects metabolic processes in the body. Conventional treatment includes synthetic thyroxine supplements, but homeopathic remedies have been gaining attention for their individualized, holistic approach. This study presents a series of hypothyroid cases treated at KEMT Virar Homoeopathic College and OPD using homeopathic remedies. It evaluates their outcomes based on clinical improvement and thyroid function test results.

Data-Driven Strategies for Carbimazole Titration: Exploring Machine Learning Solutions in Hyperthyroidism Control.

University Hospitals Dorset (UHD) has over 1,000 thyroid patient contacts annually. These are primarily patients with autoimmune hyperthyroidism treated with Carbimazole titration. Dose adjustments are made by a healthcare professional (HCP) based on the results of thyroid function tests, who then prescribes a dose and communicates this to the patient via letter. This is time-consuming and introduces treatment delays. This study aimed to replace some time-intensive manual dose adjustments with a machine learning model to determine Carbimazole dosing. This can in the future serve patients with rapid and safe dose determination and ease the pressures on HCPs. Data from 421 hyperthyroidism patients at UHD were extracted and anonymised. A total of 353 patients (83.85%) were included in the study. Different machine-learning classification algorithms were tested under several data processing regimes. Using an iterative approach, consisting of an initial model selection followed by a feature selection method the performance was improved. Models were evaluated using weighted F1 scores and Brier scores to select the best model with the highest confidence. The best performance is achieved using a random forest (RF) approach, resulting in good average F1 scores of 0.731. A model was selected based on a balanced assessment considering the accuracy of the prediction (F1 = 0.751) and the confidence of the model (Brier score = 0.38). To simulate a use-case, the accumulation of the prediction error over time was assessed. It was determined that an improvement in accuracy is expected if this model was to be deployed in practice.

Case 333.

A 61-year-old male patient without prior history of ophthalmologic problems presented with pain and redness in the left eye associated with slowly progressive proptosis over the previous 6 months. The patient also had diplopia in rightward and downward gaze. There was no vision loss. Mild fullness was seen in the periorbital tissues without any redness or fluctuance and with no purulent discharge from the left eye. The patient was otherwise healthy, with a 6-year history of diabetes mellitus and an 8-year history of hypertension managed well with medication. There was no history of trauma to the head or face. At clinical examination, conjunctival edema and redness with proptosis were noted. The cornea was clear. Evaluation of eye movements revealed restricted motion of the left eye in medial gaze and downward gaze. Ophthalmoscopic evaluation did not show any substantial abnormality. The retina and retinal vascularity were unremarkable. The right eye was unremarkable. Uncorrected visual acuity was 20/30 in the right eye and 20/40 in the left eye. Corrected visual acuity was 20/20 in both eyes. Complete blood cell count, as well as liver and kidney function test results, were within normal limits. The erythrocyte sedimentation rate and C-reactive protein level were normal. Thyroid function test results were normal. The patient subsequently underwent CT of the orbits without and with contrast enhancement (Fig 1) followed by further evaluation with MRI of the orbits without and with contrast enhancement (Figs 2-4).

Delta check limits for thyroid function tests adjusted for clinical settings

BackgroundThis study aimed to determine practical delta check limits (DCLs) for thyroid function tests (TFTs) to detect sample misidentifications across various clinical settings. MethodsBetween 2020 and 2022, 610,437 paired TFT results were collected from six university hospitals. The absolute DCL (absDCL) was determined using the 95th percentile for each clinical setting from a random 60 % of the total data. These absDCLs were then tested within and across different settings using the remaining 40 % of the data, alongside mix-up datasets for result and sample comparisons. The sensitivities of absDCL were calculated within and across groups in the mix-up datasets. ResultsHealth screening absDCLs were notably lower than in other settings (2.58 vs. 5.93–7.08 for thyroid-stimulating hormone; 4.12 vs. 8.24–10.04 for free thyroxine; 0.49 vs. 0.82–0.91 for total triiodothyronine). The proportion of results exceeding absDCL of health screening differed from those of other clinical settings. Furthermore, sensitivity between health screening and other clinical settings was significantly different in both the result mix-up and sample mix-up datasets. ConclusionsThis study determined practical DCLs for TFTs and highlighted differences in absDCLs between health screening and other settings. These findings emphasize the importance of tailored DCLs in improving the accurate reporting of TFTs.

The frequency of clinical and subclinical hypothyroidism in transfusion dependent thalassemia patients in Slemani city /Iraq

Background and objective: Thyroid disorders caused by blood transfusion in thalassemia patients could affect human health and growth, this study was conducted to determine the frequency of clinical and subclinical hypothyroidism in blood transfusion-dependent thalassemia patients in the city of Slemani, Kurdistan Region, Iraq. Methods: The current study is a retrospective cross-sectional study (comparative analysis) conducted in Slemani center for thalassemia patients and congenital blood, between December 2021 and July 2022. Participants included l07 thalassemia patients with medical records the sampling method was a convenience method. The data was collected through the review of patients' files and blood tests, including( thyroid hormones, hemoglobin level, serum ferritin level), with a questionnaire that was completed through an interview with the patients. Results: The results of thyroid function tests have shown that 21/107 pateints (19.6%) have hypothyroidism, 6 patients have overt hypothyroidism, and 15 patients have subclinical showed that 23/107 patients and 4/107 patients had hight and low levels,respectively, and there was statistically a significant difference in the average Thyroid stimulating hormone and serum thyroxin levels in two groups of hypothyroid and euthyroid patients and mean ferritine serum level between these two groups was 2166.7±2174.8 and 2068.37±1919.97 respictively ,which was not a statistically significant difference . Conclusion: Considering the high prevalence of hypothyroidism in thalassemia patients, measuring Thyroid stimulating hormone and thyroxin can be very important and vital in the initial screenings,effective treatment and follow-up of patients.

Subclinical hypothyroidism in Wales from 2000 to 2021: A descriptive cohort study based on electronic health records.

Subclinical hypothyroidism (SCH) is a biochemical thyroid disorder characterised by elevated levels of Thyroid Stimulating Hormone (TSH) together with normal levels of thyroid hormones. Evidence on the benefits of treatment is limited, resulting in persistent controversies relating to its clinical management. This study describes the demographic and clinical characteristics of patients identified as having subclinical hypothyroidism in Wales between 2000 and 2021, the annual cumulative incidence during this period and the testing and treatment patterns associated with this disorder. We used linked electronic health records from SAIL Databank. Eligible patients were identified using a combination of diagnostic codes and Thyroid Function Test results. Descriptive analyses were then performed. 199,520 individuals (63.8% female) were identified as having SCH, 23.6% (n = 47,104) of whom received levothyroxine for treatment over the study period. The median study follow-up time was 5.75 person-years (IQR 2.65-9.65). Annual cumulative incidence was highest in 2012 at 502 cases per 100,000 people. 92.5% (n = 184,484) of the study population had TSH levels between the upper limit of normal and 10mIU/L on their first test. 61.9% (n = 5,071) of patients identified using Read v2 codes were in the treated group. 41.9% (n = 19,716) of treated patients had a history of a single abnormal test result before their first prescription. In Wales, the number of incident cases of SCH has risen unevenly between 2000 and 2021. Most of the study population had mild SCH on their index test, but more than a third of the identified patients received levothyroxine after a single abnormal test result. Patients with clinically recorded diagnoses were more likely to be treated. Given the expectation of steadily increasing patient numbers, more evidence is required to support the clinical management of subclinical hypothyroidism.

Agreement between routinely used immunoassays for thyroid function testing in non-pregnant and pregnant adults.

Thyroid function tests are common biochemical analyses, and agreement between the routinely used immunoassays is important for diagnosis and monitoring of thyroid disease. Efforts are continuously made to align the biochemical assays, and we aimed to evaluate the agreement between immunoassays used in a clinical laboratory setting among non-pregnant and pregnant adults. Cross-sectional study. Serum samples were obtained from 192 blood donors (non-pregnant adults) and from 86 pregnant women in the North Denmark Region with no known thyroid disease. Each sample was used for measurement of thyroid-stimulating hormone (TSH) with the routinely used automatic immunoassays in the regional Departments of Clinical Biochemistry (Alinity, Abbott Laboratories, Cobas, Roche Diagnostics, and Atellica, Siemens Healthineers) and reported as the median with 95% confidence interval (95% CI). In nonpregnant adults, the level of TSH was higher with Cobas and Atellica than with Alinity as reflected by median (Alinity: 1.39 mIU/L (95% CI: 1.30-1.51 mIU/L); Cobas: 1.57 mIU/L (95% CI: 1.48-1.75 mIU/L); Atellica: 1.74 mIU/L (95% CI: 1.61-1.83 mIU/L)). Similarly, a trend was seen towards higher median TSH with Cobas than with Alinity among pregnant women (Alinity: 1.90 mIU/L (95% CI: 1.37-2.82 mIU/L); Cobas: 2.33 mIU/L (95% CI: 1.69-3.62 mIU/L)). Results of thyroid function tests obtained with different immunoassays were not interchangeable when evaluated among pregnant and non-pregnant adults. The distinct differences are relevant for clinical decision making and emphasize the necessity of clinical laboratory information when different assays are used for diagnosis and monitoring of patients with thyroid disease.

Diagnoses of obstetric and postpartum thyroid disease: a Danish validation study

Different diagnoses of thyroid disease are available in the 10th International Classification of Diseases (ICD-10), but the validity of diagnoses related to obstetric and postpartum thyroid disease is unknown. This was a retrospective cohort study of all patients in the North Denmark Region with a diagnosis of postpartum thyroiditis (PPT) (ICD-10: O905) from 2016 to 2019 or obstetric thyroid disease in 2019 (ICD-10: O992B (hypothyroidism) or O992C (hyperthyroidism)) registered in the Danish National Hospital Register. Information from nationwide registers and medical records were used to assess the validity. Among patients with an O905-diagnosis (n = 40), abnormal thyroid function test results were seen in all cases. A total of eight patients (20.0%) were positive for thyrotropin receptor antibodies postpartum, however, in low titers, and PPT was verified in 39 of 40 cases (97.5%). Altogether 45 of 50 patients with an O992B-diagnosis (90.0%) correctly had hypothyroidism, whereas hyperthyroidism was found in 25 of 39 patients with an O992C-diagnosis (64.1%). This is the first study to validate ICD-10 diagnoses of obstetric and postpartum thyroid disease. A high validity was seen for PPT (O905) and obstetric hypothyroidism (O992B), whereas for obstetric hyperthyroidism (O992C), the diagnosis could not be verified in one third of the cases.

Clinical features and Surgical Outcomes of Thyroid Goitre Presenting to Ear, Nose and Throat Department of Queen Elizabeth Central Hospital, Blantyre, Malawi.

In Malawi there is a perception that goitre is common and causes significant public health and economic burdens. The purpose of this study was to assess the demographic distribution, clinical presentation, investigations, management, outcomes and complications of goitre seen at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi. A single hospital-based descriptive retrospective study from January 2017 to December 2018 for all patients presenting with goitre. Out of 9073 patients who presented to ENT department, 105 patients presented with goitre representing 1% of all patients seen during the study period. The Male: Female ratio was 1:25. The mean symptom duration with goitre was 4 years (SD +/- 6.4). Thyroid function test results were available in 54 patients and out of these, 53(98%) patients were euthyroid. Ultrasound scan (USS) reports were available in 44 patients, of these 32(73%) were multinodular goitres. In 70 cases, pathology results were available and showed that 20% were thyroid cancers and that papillary thyroid carcinoma was the commonest cancer (64%). Two recurrent laryngeal nerve injuries were recorded in 79 surgical procedures representing 2.5% of patients (6.3% overall complication rate). Inpatient stay ranged from 2 days to 49 days (median 3 days). Goitre at our centre is more common in women than in men. One in five patients in this cohort had thyroid cancers. This prevalence is higher than other areas in the world highlighting the need for cytology services on every patient before surgery and histology services after surgery. Recurrent laryngeal nerve injury and other complications were infrequent demonstrating local high safety of thyroid surgery, despite late presentation to the ENT department.

P-19 A case of Birt Hogg Dube syndrome presented with parathyroid carcinoma

Abstract Introduction The Birt Hogg Dube syndrome is an autosomal dominant genodermatosis caused by a mutation in the folliculin gene. It is characterized by benign lung cysts with spontaneous pneumothorax, kidney tumors, and hair follicle tumors. Other solid tumors may accompany. Our case is a man with Birt Hogg Dube Syndrome who has parathyroid cancer. Clinical Case A 50-year-old male was referred to our clinic for treatment of hypercalcemia and elevated parathormone; he complained of weakness, muscle, and joint discomfort. His previous medical history included Renal Cell Carcinoma, Coronary artery by-pass graft, pulmonary thromboembolism, hypertension, nephrolithiasis, and stage 4 chronic kidney disease. There was a familial history of colon cancer, with both his aunt and uncle having been diagnosed. The systemic evaluation revealed the presence of constipation, polyuria, pollakiuria. A palpable 3 cm nodular lesion was discovered in the inferior lobe of the patient's left thyroid, and the patient's vital signs were stable. There were lesions on the inner surface of the right thigh and the skull. The biopsies obtained from the lesions on the skin revealed a lipoma on the cranium and a fibrofolliculoma on the thigh upon pathological examination. Regarding laboratory exams, both the hemogram and transaminase levels were within normal limits. Serum albumin was measured at 4.9 g/L creatinine at 2.5 mg/dl, calcium at 12 mg/dl, ionized calcium at 5.9 mg/dl, phosphorus at 2.4 mg/dl, parathormone at 373 ng/dL, and 25-OH Vitamin D at 32 ng/ml. Alkaline phosphatase was determined to be 66 U/L, and 24-hour calcium output was 60 mg/day. The thyroid function test results were euthyroid, while the anterior pituitary panel was normal. The patient underwent a left inferior parathyroidectomy after thyroid ultrasonography and parathyroid scintigraphy revealed a parathyroid adenoma. The parathyroid carcinoma is identified in the pathology report. The ultrasound-observed nodule on the isthmus of the thyroid has been identified as thyroid papillary carcinoma. Bone mineral density was normal. A previously performed CT scan of the thorax for dyspnea revealed the presence of multiple cystic structures in the lungs. Taking into account the patient's history of multiple malignancies, an 18-FDG-PET CT scan was performed, revealing a significant FDG uptake (SUV Max: 22) in the patient's sigmoid colon. Pathology analysis of the removed lesion confirmed that it was a tubulovillous adenoma with high-grade dysplasia. The patient, who showed heterozygosity for the Folliculin gene, was identified as having Birt-Hogg-Dube syndrome after further genetic panel testing. Conclusion According to the most recent literature evaluation, our patient is the first Birt Hogg Dube individual to present with parathyroid carcinoma. There is some evidence in the published literature linking somatic mutation of the Folliculin gene to the development of parathyroid cancer.

O-09 A rare cause of acute pancreatitis: Werner Syndrome

Abstract Introduction Lipodystrophies are rare disorders characterized by loss of body fat resulting in leptin deficiency. Patients are predisposed to metabolic complications such as severe insulin resistance, hypertriglyceridemia, and hepatic steatosis. Werner syndrome (WS) is among the progeroid syndromes in the classification of lipodystrophy. Due to its extremely rare occurrence, it can often be overlooked by the clinician. Clinical Case A 19 years old male patient hospitalized for non-biliary acute pancreatitis was consulted for hypertriglyceridemia and hyperglycemia. He had no history of any disease or medication use. His sister was diagnosed with type 2 diabetes mellitus at age 29. She was using linagliptin and gliclazide for 3 years. She had short stature (147 cm) and low body weight (40 kg) and had scleroderma-like skin findings. The patient also had short stature (157 cm) and low body weight (41 kg). He had scleroderma-like skin findings and generalized loss of subcutaneous adipose tissue. The laboratory results were; glucose, 261 mg/dl; creatinine, 0.46 mg/dl; ALT, 24 U/l; lipase, 161 U/l; HbA1c, 9.6%; triglyceride, 799 mg/dl; HDL, 9.6 mg/dl; LDL, 75 mg/dl; c-peptide, 4.3 ng/dl. The thyroid function test results (TSH: 29.7 µIU/ml, fT4: 6.81 pmol/L, Anti-TPO: negative) were consistent with primary hypothyroidism. Hepatosteatosis was observed in abdominal ultrasonography. We initiated intensive insulin, metformin as well as fenofibrate and levothyroxine treatment. The patient needed high insulin doses (60 IU/day). Measured serum leptin levels were found to be low (2.11 ng/ml) in suspicion of lipodystrophy. Genetic analysis of the patient and his sister showed homozygous mutation in the WRN gene (c.1105C>T p.Arg369Ter, Homozygous) which was compatible with WS. The patient was started on leptin analog therapy in a clinical trial. Conclusion WS is an exceptionally rare autosomal recessive genetic disorder characterized by premature aging and multisystemic complications. The clinical features encompass scleroderma-like skin changes, short stature, low body weight, alopecia, cataracts, osteoporosis, and a propensity for atherosclerotic complications and malignancies. Impaired glucose tolerance is reported in 15%–20% of WS subjects, diabetes mellitus in 55%–70%, and dyslipidemia in 60%–85%. The presence of hypertriglyceridemia, diabetes mellıtus and generalized lack of subcutaneous adipose tissue led us to suspect from lipodystrophy. Although acute pancreatitis due to hypertriglyceridemia can be seen in lipodystrophy (15-20%), first presentation of WS presenting with acute pancreatitis is very rare in the literature. The most common mutation in non-Japanese patients in WRN gene is c.1105 C>T (18.6%). Metreleptin, an analog of human leptin, is shown to ameliorate the metabolic derangements. WS remains a diagnostic challenge due to its rarity, atypical presentation, and should be kept in mind in patients with severe dyslipidemia and insulin resistance.

Atherogenic Indices as Early Predictors of Cardiovascular Diseases among Patients with Subclinical and Overt Hypothyroidism in a Tertiary Care Hospital, Karnataka: A Cross-sectional Study

Introduction: Hypothyroidism is a common health issue that decreases the functional ability of life. It is strongly associated with altered levels of serum lipids, leading to an increased risk of Cardiovascular Disease (CVD). Lipid profile and Atherogenic Indices (AIs) can serve as better markers for evaluating CVD risk. Aim: The aim of this cross-sectional study is to evaluate the role of dyslipidaemia and AIs as predictors of CVD risk among patients with Subclinical Hypothyroidism (SCH) and Overt Hypothyroidism (OH) compared to euthyroid controls. Materials and Methods: The present cross-sectional study was conducted at the Clinical Biochemistry Section of Mandya Institute of Medical Sciences in Mandya, Karnataka, India from August to September 2019. A total of 150 subjects aged between 25-60 years were enrolled. Fasting lipid profile and Thyroid Function Test (TFT) were analysed. Based on TFT results, subjects were categorised into SCH, OH, and euthyroid groups. Data on anthropometry {(height, weight, Body Mass Index (BMI), and Blood Pressure (BP)}, lipid profile, Atherogenic Index of Plasma (AIP), Castelli Risk Index-I (CRI-I), CRI-II, and Atherogenic Coefficient (AC) were collected. Statistical analysis was performed using Pearson’s correlation and Receiver Operating Characteristic (ROC) curve analysis. Results: Out of the 150 subjects, 104 (69.3%) were females and 46 (30.7%) were males, with a mean age of 41.08±11.24 years. Both the SCH and OH groups showed statistically significant dyslipidaemic changes and elevated AIs compared to euthyroid controls. Among OH patients, there was a statistically significant positive correlation between TSH and Total Cholesterol (TC) (r=0.463), Low-Density Lipoprotein cholesterol (LDL-c) (r=0.448), CRI-I (r=0.414), CRI-II (r=0.412), and AC (r=0.411). Conversely, there was a statistically significant negative correlation between fT3 and TC (r=-0.393), LDL-c (r=-0.363), CRI-I (r=-0.300), CRI-II (r=-0.301), and AC (r=-0.298). Among the AIs, AIP showed the maximum Area Under the Curve (AUC) in both the SCH (0.707) and OH (0.747) groups. Conclusion: AIs aid in the better assessment of dyslipidaemia and CVD risk compared to lipid profile alone in hypothyroid subjects. Incorporating AIs enables early prediction of high-risk individuals for CVD risk.

THE POTENTIAL CORRELATION BETWEEN HYPERURICEMIA AND HYPERTHYROIDISM IS BEING EXAMINED

Hyperuricemia is characterized by high levels of uric acid in the bloodstream, while hyperthyroidism refers to excessive thyroid gland activity. Both conditions can significantly affect a patient's quality of life. This study aimed to comprehensively analyze a sample size of 100 patients at MTI LRH, Peshawar, to address the research gap in this area. The study employed a prospective design, which involved collecting patient data over time. The study was conducted at the Department of Medicine, Medical Teaching Institution Lady Reading Hospital (MTI LRH), Peshawar, from January to July 2021. One hundred patients were chosen randomly from those who presented at MTI LRH during the study period. The inclusion criteria were individuals 18 or older who had documented thyroid function test results and had blood uric acid levels on record. The study participants included 50 males and 50 females, with a median age of 41. Most participants (55%) were between the ages of 31 and 50, with 25% in the 31-40 age group and 30% in the 41-50 age group. The remaining 45% were younger than 30 or older than 50. The data showed a slight negative correlation (r = -0.15) between TSH and uric acid levels, indicating that as TSH levels decreased, uric acid levels increased. However, this correlation was not statistically significant (p=0.20). The study found no significant correlation between thyroid function and uric acid levels in the sample population. Although there have been inconsistencies in previous literature on this topic, our results were consistent with past investigations.

A machine learning-assisted system to predict thyrotoxicosis using patients’ heart rate monitoring data: a retrospective cohort study

Previous studies have shown a correlation between resting heart rate (HR) measured by wearable devices and serum free thyroxine concentration in patients with thyroid dysfunction. We have developed a machine learning (ML)-assisted system that uses HR data collected from wearable devices to predict the occurrence of thyrotoxicosis in patients. HR monitoring data were collected using a wearable device for a period of 4 months in 175 patients with thyroid dysfunction. During this period, 3 or 4 thyroid function tests (TFTs) were performed on each patient at intervals of at least one month. The HR data collected during the 10 days prior to each TFT were paired with the corresponding TFT results, resulting in a total of 662 pairs of data. Our ML-assisted system predicted thyrotoxicosis of a patient at a given time point based on HR data and their HR-TFT data pair at another time point. Our ML-assisted system divided the 662 cases into either thyrotoxicosis and non-thyrotoxicosis and the performance was calculated based on the TFT results. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of our system for predicting thyrotoxicosis were 86.14%, 85.92%, 52.41%, and 97.18%, respectively. When subclinical thyrotoxicosis was excluded from the analysis, the sensitivity, specificity, PPV, and NPV of our system for predicting thyrotoxicosis were 86.14%, 98.28%, 94.57%, and 95.32%, respectively. Our ML-assisted system used the change in mean, relative standard deviation, skewness, and kurtosis of HR while sleeping, and the Jensen–Shannon divergence of sleep HR and TFT distribution as major parameters for predicting thyrotoxicosis. Our ML-assisted system has demonstrated reasonably accurate predictions of thyrotoxicosis in patients with thyroid dysfunction, and the accuracy could be further improved by gathering more data. This predictive system has the potential to monitor the thyroid function status of patients with thyroid dysfunction by collecting heart rate data, and to determine the optimal timing for blood tests and treatment intervention.

Cytological study of different thyroid lesions and its correlation with thyroid function test

The research relevance of the combined use of fine needle aspiration cytology, sonography, and thyroid function tests is determined by accurate diagnostics of thyroid enlargement in both adults and children. The study aimed to analyse thyroid lesions through cytological analysis and their correlation with thyroid function test results. This cross-sectional study enrolled 100 patients with suspected thyroid disorders and nodules. Comprehensive assessments included clinic demographics, fine needle aspiration cytology procedures, and thyroid hormone profiles. Based on the Bethesda system, cytological diagnoses were correlated with thyroid function test results using the chemiluminescent microparticle immunoassay method. Non-tumour thyroid lesions were found to be the most common (95%), with colloidal goitre being the most common. Neoplastic cases mainly included papillary and follicular carcinoma. Most thyroid lesions occurred among the 21-30 age group, non-neoplastic cases were more frequent among the 10-20 age group, and neoplastic cases were more common in those aged 21-40. All patients had neck swelling. Most cases were euthyroid (76%), predominantly classified as Category 2. A strong correlation between cytological diagnoses and thyroid hormone levels (p=0.04) was observed. Fine needle aspiration cytology demonstrated good sensitivity (80%) and high specificity (98.46%), with an 80% positive predictive value and 98.46% negative predictive value, resulting in a diagnostic accuracy of 97.14%. The study highlights the valuable role of fine needle aspiration cytology, when coupled with thyroid function tests, in effectively guiding the management of patients with thyroid lesions, owing to its impressive accuracy, sensitivity, and specificity

FRI518 Good For Hair, Skin, And Nails But Bad For Thyroid Lab Tests

Abstract Disclosure: S. Khan: None. P. Kachhadia: None. S. Aldasouqi: None. A. Abu Limon: None. Introduction: Biotin also known as Vitamin B7 is very commonly used for hair, skin and nail growth. It can cause falsely high levels of free thyroxine (FT4), and free triiodothyronine (FT3) and falsely low thyroid stimulating hormone (TSH) levels. This can lead to a false diagnosis of hyperthyroidism. The ATA has recommended to stop taking biotin at least 2 days prior to lab testing to avoid spurious results. We present a case of a patient with hypothyroidism on a stable dose of levothyroxine who developed abnormal thyroid function tests (TFTs) due to biotin supplements. Case Presentation: A 57 years old female with long-standing hypothyroidism had been a on stable dose of Levothyroxine, 100 mcg daily. She was compliant with treatment. Her TFTs, done on periodic follow ups every 3-6 months were normal. Recently, on semi-annual lab work, thyroid function tests revealed elevated free T4 and T3, but normal TSH values. The patient was clinically euthyroid. Due to the unexpected thyroid function test result which did not portray clinical hyperthyroidism, repeat detailed history was taken which revealed that the patient was taking Biotin 1000 mg twice daily, as a hair-skin-nail beauty product. TFTs were repeated after she was instructed to stop Biotin for 3 days, which resulted in normal values. Patient was well-educated by our team to stop Biotin before labs, in the future. Once again, close to a year later, TFTs showed elevated FT4 and borderline low TSH. When contacted, she admitted forgetting to stop Biotin before labs. Labs off biotin once more showed normalization of FT4. Discussion: A variety of laboratory immunoassay blood tests utilize Biotin (Vitamin B7) in view of its high affinity to Streptavidin. At physiological concentrations, Biotin does not interfere with thyroid function tests. However, excessive Biotin use which is often taken as a beauty supplement is known to interfere with these tests. Typically, excessive Biotin intake will result in falsely elevated T4 and T3 and falsely low TSH. Furthermore, it will result in falsely elevated immunoglobulins that are markers for Graves’ disease. Our patient was taking a total of 2000mcg of biotin daily over the counter. This interference, which is not uncommon in clinical practice, has led to many misdiagnoses with potential for unnecessary workup, and sometimes initiation of inappropriate or potentially harmful treatment regimens. In this case report, though this patient’s thyroid function test results were suggestive of hyperthyroidism, biotin use is what caused in-vitro interference with the Biotin-Streptavidine Immunoassay. For this reason, clinicians should remain attentive to common biotin use in patients and advise them to hold biotin at least 2 days before labwork to avoid such outcomes. Furthermore, lab centers should also be informed of this interference and should avoid lab draw in those patients did that not hold biotin appropriately. Presentation: Friday, June 16, 2023

SAT450 High Diagnostic Yield Of NGS Analysis In Congenital Hypothyroidism With Thyorid Dyshormongenesis

Abstract Disclosure: E. Joo: None. S. Kim: None. J. Lee: None. Introduction: Congenital hypothyroidism is the most common neonatal metabolic disorder and detected at a rate of 1 in 3000 to 4000 live births. 10-15 % of congenital hypothyroidism is caused by thyroid dyshormonogenesis. And Its clinical manifestations are individually different. Thus, to evaluate exact causes and predict clinical course for congenital thyroid dyshormonogenesis and establish precise strategies for treatment, we conduct Next-Generation Sequencing (NGS) to patients who diagnosed congenital hypothyroidism with normal thyroid gland and analysis the results. Methods: We conducted NGS to 31 patients patients who were diagnosed congenital hypothyroidism with normal contour of thyroid gland in ultrasonography from Jan. 2018 to April. 2022 in a single university hospital. We also analyzed their thyroid function test results, dose of levothyroxine and clinical manifestations. Result: Among the 31 patients, 25patients were detected from NGS. 4patients have oligogenic mutations. 7 DUOX2 variants were detected in 7 patients (22.6%), 3 DUOXA2 variants were detected in 4 patients (12.9%), 4 TSHR variants were detected in 7 patients (22.6%) 5 TG variants were detected in 4 patients (12.9%), 2 GLIS3 variants in 2 patients (6.5%), 1 TPO variants in 1 patient, 1 THRB variants in 1 patient, 1 NKX2-1 variants in 1 patient, 1 TRH variants in 1 patient, 1 SLC5A5 variants in 1 patient. The patients with GLIS3 stop levothyroxine at 3years old and have remission. The patients with DUOX2 variants and DUOXA2 variants showed low remission rate. DUOXA2 variants has high association with goiter. None of the patients with TSHR c.1349G>A mutation to stop medicine. But patients with other mutation of TSHR stop levothyroxine at 3 years old and have remission. None of the patients with TG variants showed remission. The patients with GLIS3 have remission at 3 years old. Conclusions: We cautiously recommend that using the NGS to strategize treatment plan for CH based on the clinical manifestations and genetic analysis of the family members of the index patients. Presentation: Saturday, June 17, 2023