Thyroid Function Test Results Research Articles

A Nearly Missed Hashimoto’s Thyroiditis: A Case of Refractory Anaemia

This is a case of a 68-year-old man who was diagnosed late with Hashimoto’s thyroiditis following a few admissions for symptomatic anaemia. Although hypothyroidism is common among the elderly, the classic symptoms are less likely to be evident and anaemia can be the first sign of hypothyroidism. This patient had multiple comorbidities including ischaemic heart disease, diabetes and chronic kidney disease which might have contributed to the delay in finding the underlying cause of his anaemia. He initially presented with symptomatic anaemia and received blood transfusions and iron supplementation. On subsequent follow up, his anaemia failed to improve. He was then referred to our primary care clinic. Hashimoto’s thyroiditis was diagnosed based on his clinical features, thyroid function test results and antithyroid peroxidase level. This case highlights the importance of determining the cause of anaemia as his haemoglobin level improved significantly after thyroxine was commenced. It also serves as a reminder that hypothyroidism should be considered in patients with anaemia, especially in those with uncertain aetiology.

SAT-573 Eruptive Xanthomas in a Patient with Hypertriglyceredemia and Type 2 Diabetes Mellitus

BACKGROUND: Eruptive xanthomas are rare, asymptomatic, cutaneous lesions and are markers for serious underlying metabolic disorders that demand an early diagnosis to prevent morbidity and mortality. Clinical Case: A 27 years old obese female presented with generalized, pruritic eruptions. The eruptions had been present for approximately three weeks. Crops of firm yellow-red circumscribed Papules (diameter 1–3 mm) distributed on the extensor surfaces of both the upper and the lower extremities which were few in numbers to begin with but increased in density subsequently spreading to involve her back, abdomen, knees, and posterior thighs. The patient besides being obese had no other significant past medical or family history. Labs: FBS:258 mg/dl (80-100mg/dl), HbA1c:11.7%(<5.6%), Total lipids: 3680 mg/dl (400–1000 mg/dl), Total Cholesterol: 857 mg/dl (120–200 mg/dl), Triglycerides: 5428 mg/dl (70–150 mg/dl), HDL:15mg/dl (45–64 mg/dl), LDL: 371 mg/l(<130 mg/dl),VLDL: 402 mg/dl (<30 md/dl). Results of kidney, liver and thyroid function tests were normal, as well as amylase and lipase. X-ray chest and abdominal ultrasound were unremarkable. Biopsy of the papules was not carried out due to non-affordability on the part of the patient. The patient was managed by an interdisciplinary approach for diabetes mellitus type 2 and hyperlipidaemia. Treatment was started with oral hypoglycaemic along with lipid lowering agents and the required lifestyle modifications including weight control, adopting a low-fat diet, and regular exercise were advised. The papules resolved within six weeks of the treatment and lab reports indicated improvement in her glycemic control and hypertriglyceridemia. It was clinically diagnosed as Eruptive Xanthomas of secondary hypertriglyceridemia due to diabetes mellitus.CONCLUSION:Recognizing eruptive xanthomas and being aware of its association with hypertriglyceridemia and diabetes mellitus can help to decrease any lag between a patient being seen by a physician and treatment for a serious medical conditions such as coronary artery disease and pancreatitis. REFRENCES: Digby M; Belli R; McGraw T; Lee A (2011). “Eruptive xanthomas as a cutaneous manifestation of hypertriglyceridemia: a case report”. J Clin Aesthet Dermatol. 4: 44–6. PMC 3030216Freely accessible. PMID 21278899.

The Effect of Endocrinological Parameters on Sleep Quality, Life Quality, Depression and Anxiety Levels in Pregnancy

Objectives: Examining the relation between sleep quality, quality of life, depression and anxiety levels with some endocrinological parameters in pregnancy.Methods: The oral glucose loading test and thyroid function test results of the pregnant women who were in the 24-29th weeks of pregnancy were used in the study. Non-pregnant women, who were matched with the study group in terms of sociodemographic data, were also included in the study as the healthy control group. All participant completed a standardized sociodemographic data collection form and the following scales; Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Pittsburg Sleep Quality Scale (PDCA), Quality of Life Scale (SF-36).Results: No significant differences were detected between the sociodemographic data of the participants except for the educational status and living area. As a result, statistically significant differences were detected between the “sleep latency” (p=0.016), “usual sleep activity” (p=0.004), “sleep disorder” (p=0.000) subcomponents compared to the control group. For SF-36, on the other hand, the results of the pregnant group in “physical function” (p=0.000), “physical role limitation” (p=0.002) and “pain” (p=0.000) sub-dimensions were worse than the control group. The Thyroid Stimulating Hormone (TSH) value was positively correlated with “sleep time” (r=0.233); the “fasting blood glucose” was positively correlated with “pain” sub-dimensions (r=0.497); and the “physical function” sub-dimension was negatively correlated (r=-0.192).Conclusion: Our data suggest that the depression and anxiety scores of the pregnant women were high, and life and sleep quality was impaired in certain sub-dimensions.

Geriatrik yaş grubunda kemik mineral dansitesinin hematolojik parametrelerle ilişkisi

Introduction: As populations gradually become older, osteoporosis manifests itself as an important public health problem. Studies have shown that inflammation plays a critical role in the pathogenesis of osteoporosis. NLR (neutrophil to lymphocyte ratio) and PLR (platelet to lymphocyte ratio) are simple, non-invasive, and inexpensive markers of inflammation in malignancies and inflammatory diseases. This study aims to compare osteopenic, osteoporotic, and control subjects, who do not have other known diseases or a history of medication use, in terms of their NLR and PLR levels and evaluate the relationship between NLR, PLR levels and BMD.Methods: This cross-sectional study included a total of 308 patients aged 65 or above. Total bone mineral density (BMD) was measured using dual energy X-ray absorptiometry (DEXA). Complete blood count (CBC), biomarkers of inflammation (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), glucose/lipid metabolism, and thyroid function test results were recorded.Results: The osteoporosis group demonstrated higher NLR levels compared to the osteopenic and control groups (respectively 3.58 ± 4.22, 2.64 ± 1.99, and 2.36 ± 1.39), and this relationship between the groups was found to be statistically significant (p=0.025). Our data revealed higher sedimentation values for the osteoporosis group than for the osteopenic and healthy control groups with statistical significance (p=0.011).Conclusions: The fact that individuals with geriatric osteoporosis demonstrate elevated NLR levels and that this elevation is also seen in sedimentation suggests that inflammation plays an important role in bone remodelling.

Twelve-Month Volume Reduction Ratio Predicts Regrowth and Time to Regrowth in Thyroid Nodules Submitted to Laser Ablation: A 5-Year Follow-Up Retrospective Study.

ObjectiveLaser ablation is a therapeutic modality used to reduce the volume of large benign thyroid nodules. Unsatisfactory reduction and regrowth are observed in some treated nodules. The aim of the study was to evaluate the long-term outcomes of laser treatment for solid nodules during a 5-year follow-up period, the regrowth rate, and the predictive risk factors of nodule regrowth.Materials and MethodsWe retrospectively evaluated patients with benign, solid, cold thyroid nodules who underwent laser ablation and were followed-up for 5 years. According to the selection criteria, 104 patients were included (median baseline nodule volume, 12.5 mL [25.0–75.0%, 8–18 mL]; median energy delivered, 481.5 J/mL [25.0–75.0%, 370–620 J/mL]). Nodule volume, thyroid function test results, and ultrasound were evaluated at baseline and then annually after the procedure.ResultsOf 104 patients, 31 patients (29.8%) had a 12-month volume reduction ratio (VRR) < 50.0% and 39 (37.5%) experienced nodule regrowth. Of these 39 patients, 17 (43.6%) underwent surgery and 14 (35.9%) underwent a second laser treatment. The rate of nodule regrowth was inversely related to the 12-month VRR, i.e., the lower the 12-month VRR, the higher the risk of regrowth (p < 0.001). The mean time for nodule regrowth was 33.5 ± 16.6 months. The 12-month VRR was directly related to time to regrowth, i.e., the lower the 12-month VRR, the shorter the time to regrowth (p < 0.001; R2 = 0.3516). Non-spongiform composition increased the risk of regrowth with an odds ratio of 4.3 (95% confidence interval [CI] 1.8–10.2; p < 0.001); 12-month VRR < 50.0% increased the risk of regrowth with an odds ratio of 11.7 (95% CI 4.2–32.2; p < 0.001).ConclusionThe VRR of thyroid nodules subjected to similar amounts of laser energy varies widely and depends on the nodule composition; non-spongiform nodules are reduced to a lesser extent and regrow more frequently than spongiform nodules. A 12-month VRR < 50.0% is a predictive risk factor for regrowth and correlates with the time to regrowth.

Tiroid Fonksiyon Testlerinde Anormallik Saptanan Çocukların Özellikleri ve Tanısal Dağılımı

INTRODUCTION: Thyroid function tests are among the most frequently implemented laboratory tests in primary, and secondary healthcare institutions. The aim of the present study was to investigate the demographic and clinical characteristics and final diagnosis of children referred by primary and secondary healthcare institutions with the suspicion of an abnormality in thyroid function test and/or with the initial diagnosis of specific thyroid disease. METHODS: A total of two hundred eighty-nine pediatric patients, aged between 4 and 18 years admitted to the outpatient clinics of Behçet Uz Children’s Health and Diseases Hospital between January 2018 and January 2020, were included in the study. The patient data were obtained retrospectively from the hospital records. RESULTS: A total of 66% of the patients who were included in the study were female with a median age of 12 years (8.7-14.4), while 64% of them were pubertal; and 78% of the cases were referred by secondary healthcare institutions. The most common reason for referral was isolated elevation of thyroid stimulating hormone (TSH). A total of 56% of the patients were asymptomatic at the time of admission, and thyroid function test results of 75% of them were within normal limits. When evaluated according to their final diagnoses, the children were normal/healthy (64%), diagnosed with Hashimoto thyroiditis (30%), nodular thyroid disease (3%), Graves disease (2%) and isolated increase of TSH was related to obesity in 5 patients (1%). DISCUSSION AND CONCLUSION: It is essential to evaluate children with abnormal thyroid function test results with detailed history and physical examination. Besides, the thyroid function tests should be performed with reliable and sensitive methods in standardized laboratories to reach the correct diagnosis in these children.

Fine-needle aspiration of goiter (benign and non-neoplastic) with thyroid function abnormalities

Introduction: Thyroid nodule is the prime indication for FNA, which is also a cheap and effective investigation. The current study seeks an association between benign goiter and aberrant thyroid function tests (TFTs). Can thyroid FNA anticipate overt morbidity resulting from thyroid function abnormalities? Materials and Methods: FNA records of 173 patients were studied along with the TFT results. A slide review was undertaken where the FNA impression did not correspond to the TFT. Results: The female:male ratio was 149:24. Two (1.15%) had inadequate cellularity. Nearly 95/173 cases had abnormal TFTs. Multinodular goiter (126), Hashimoto's thyroiditis (43), and two and one cases of granulomatous and unclassified thyroiditis, respectively, constituted our diagnostic profile. Abnormalities in TFT did not correlate with age group, gender, or FNA diagnoses. However, hypothyroidism (clinical and subclinical) was significantly observed in Hashimoto's thyroiditis (HT) cases. Further, scant colloid and hurthle cell change were significantly correlated with HT. A histological correlation was obtained in 46 cases. Four neoplastic cases among which three papillary carcinomas arising in small focal areas within cysts were seen. Conclusions: The major observation in this study is the subset of euthyroid and subclinically hypothyroid cases (23/43, 53.48%) of Hashimoto's thyroiditis (P = 0.0021). If treated with thyroxine replacement, overt hypothyroidism, particularly in pregnant women who are at risk of developing antithyroid antibodies, may be prevented. Besides, the inadequacy rate (1.15%) in the current study is low. False negatives 3/46 (6.5%), though available on a meager and selected subset of the patient population is still within the range of published data.

Use of strain ultrasound elastography versus fine-needle aspiration cytology for the differential diagnosis of thyroid nodules: a retrospective analysis

OBJECTIVE:Fine-needle aspiration cytology is the risk stratification tool for thyroid nodules, and ultrasound elastography is not routinely used for the differential diagnosis of thyroid cancer. The current study aimed to compare the diagnostic parameters of ultrasound elastography and fine-needle aspiration cytology, using surgical pathology as the reference standard.METHODS:In total, 205 patients with abnormal thyroid function test results underwent ultrasound-guided fine-needle aspiration cytology on the basis of the American College of Radiology Thyroid Imaging-Reporting and Data System classification and strain ultrasound elastography according to the ASTERIA criteria. Histopathological examination of the surgical specimens was performed according to the 2017 World Health Organization classification system. Moreover, a beneficial score analysis for each modality was conducted.RESULTS:Of 265 nodules, 212 measured ≥1 cm. The strain index value increased from benign to malignant nodules, and the presence of autoimmune thyroid diseases did not affect the results (p>0.05 for all categories). The sensitivities of histopathological examination, ultrasound elastography, and fine-needle aspiration cytology for detection of nodules measuring ≥1 cm were 1, 1, and 0.97, respectively. The working area for detecting nodule(s) in a single image was similar between strain ultrasound elastography and fine-needle aspiration cytology for highly and moderately suspicious nodules. However, for mildly suspicious, unsuspicious, and benign nodules, the working area for detecting nodule(s) in a single image was higher in strain ultrasound elastography than in fine-needle aspiration cytology.CONCLUSION:Strain ultrasound elastography for highly and moderately suspicious nodules facilitated the detection of mildly suspicious, unsuspicious, and benign nodules.

Thyroid dysfunction in patients with suspected or documented supraventricular tachyarrhythmia

Background and objectivesThe association between thyroid dysfunction and supraventricular tachyarrhythmia (SVT) other than atrial fibrillation (AF) is not well elucidated. We hypothesized that patients with suspected or documented SVT have undetected thyroid dysfunction more frequently than general population.Subjects and methodsPatients with symptoms suggestive of SVT other than AF who were planned to undergo an EP study at our center were eligible for this study. Patients with known thyroid disease, medications affecting thyroid function test (TFT) or atrial fibrillation were excluded. The primary outcome was prevalence of TFT abnormalities in the study population. The secondary outcome was prevalence of clinically significant arrhythmia during the EP study.ResultsA total of 533 patients were analyzed. Patients were divided into the two groups according to TFT results. Fifty-six (10.5%) patients had abnormal TFT results (thyroid dysfunction group), while 477 (89.5%) had normal thyroid function (euthyroidism group). The overall prevalence of thyroid dysfunction was 10.5%. The thyroid dysfunction group showed a tendency for higher induction of clinically significant SVT than the euthyroidism group. However, thyroid dysfunction was not an independent predictor of clinically significant SVT during EP study.ConclusionIn this study, patients with suspected SVT who were planned for EP study had a relatively high incidence of thyroid dysfunction. Clinically significant arrhythmia tended to be induced more frequently in the thyroid dysfunction group than in the euthyroidism group. Further investigations are needed to verify the clinical implications of TFT in patients with SVT other than AF.

Prevalence, risks, and comorbidity of thyroid dysfunction: a cross-sectional epidemiological study

BackgroundWorldwide, the incidence of individuals with thyroid dysfunction is increasing and represents approximately 30–40% of the patients seen in an endocrine clinic. The undiagnosed thyroid dysfunction may adversely affect the metabolic control and add more risk to already predisposing cardiovascular risk factors. Thus, the objective of the present study was to assess the prevalence of undiagnosed thyroid dysfunction and its association with other comorbidities.Patients and methodsA cross-sectional study was conducted on 430 patients who attended the outpatient clinic of Diabetes and Endocrinology, the Internal Medicine Department, Zagazig University Hospitals. All patients underwent clinical and laboratory evaluations. A total of 304 patients had normal thyroid function (euthyroid) and 126 patients had thyroid dysfunction, who were stratified into one of the following groups based on the reference of the normal thyroid function test result: hyperthyroidism, subclinical hyperthyroidism, hypothyroidism, and subclinical hypothyroidism. Thyroid-stimulating hormone and free thyroxine were used as the screening tests to diagnose thyroid dysfunction.ResultsOur results show the prevalence of thyroid dysfunction was 29.3%. Among thyroid dysfunction groups, the prevalence of subclinical hypothyroidism was 44.4%, hypothyroidism was 20.6%, hyperthyroidism was 19.2%, and subclinical hyperthyroidism was 15.8%. The prevalence of overall thyroid dysfunction among studied patients with type 2 diabetes mellitus was 27.6%, whereas in type 1 diabetes mellitus, the prevalence of overall thyroid dysfunction was 38.7%. Patients with subclinical hypothyroidism and hypothyroidism had a high prevalence of hypertension compared with those with subclinical hyperthyroidism and clinical hyperthyroidism. Approximately 8% of studied pregnant female patients had subclinical hypothyroidism. Among the 15% of female patients in the postpartum period who had thyroid dysfunction, 10% had clinical hypothyroidism and 5% had clinical hyperthyroidism. Among postmenopausal women, 20% had thyroid dysfunction (12% had subclinical hypothyroidism and 8% had clinical hypothyroidism).ConclusionThe most frequently undiagnosed thyroid dysfunction was subclinical hypothyroidism. Thyroid dysfunction was common in certain age groups: reproductive age and postmenopausal as well as in patients with diabetes mellitus and hypertension; thus, screening for thyroid disease among those groups of patients should be routinely performed.

Thyroid dysfunction in preterm infants born before 32 gestational weeks

BackgroundThyroid hormones are critical for growth and brain development during the newborn period and infancy. Because of delayed maturation of the hypothalamic-pituitary-thyroid axis in preterm infants, thyroid dysfunction is common, and thyroid stimulating hormone (TSH) elevation is often delayed in preterm infants. The objective of this study was to determine the incidence of thyroid dysfunction requiring levothyroxine treatment and to identify its risk factors in preterm infants.MethodsA retrospective cohort study was performed on preterm infants who were born before 32 gestational weeks and admitted to a single tertiary academic center for more than 8 weeks between January 2008 and December 2014. In these infants, serial thyroid function tests (TFTs) measuring serum TSH and free thyroxine (fT4) were routinely performed at 1, 3, and 6 weeks of postnatal age.ResultsOf the 220 preterm infants enrolled, 180 infants underwent TFTs at 1, 3, and 6 weeks of postnatal age and were included in the study. Of the 180 infants, 35 infants (19.4%) were started on levothyroxine treatment based on the results of serial TFTs. Among the 35 infants who were treated with levothyroxine, 16 infants (45.7%) had normal results on the initial TFT. Three of these 16 infants continued to have normal results on the second TFT. Thyroid dysfunction requiring levothyroxine treatment was significantly associated with maternal pregnancy-induced hypertension (adjusted odds ratio 2.64, 95% confidence interval 1.02–6.81).ConclusionsThyroid dysfunction requiring levothyroxine treatment occurred in nearly one-fifth of preterm infants born before 32 gestational weeks. Nearly half of the preterm infants who were treated with levothyroxine had normal TSH and fT4 levels at 1 week of postnatal age. The findings of the present study suggest that serial TFTs is important to find preterm infants who require levothyroxine treatment.

Environmental neurotoxins in food in a perspective of global health approach

The increasing incidence of Autism Spectrum Disorders (ASD) suggests a causal environmental factor. Neuropathological brain changes in autism are consistent with alteration of neuronal cortical migration occurring early in gestation (gestational age 8-12 weeks). Maternal thyroid hormones are critical for neuronal migration. Thyroid function depends on appropriate iodine content in the diet and numerous environmental factors affect thyroid function. A large number of anti-thyroid compounds are present in natural and man-made products and many neuroendocrine disruptors have been identified. The main anti-thyroid compounds and endocrine thyroid disruptors will be reviewed in this presentation (Berbel, Navarro, Roman Front Endocrinol 2014;5:146). Based on clinical and experimental evidence, Román (J Neurol Sci 2007;262:15-26) postulated that maternal hypothyroxinemia (low T4) during the first trimester of gestation may adversely affect neuronal migration leading to abnormal cortical formation of brain and cerebellum resulting in autism. Using the database from a cohort of mothers and their children in “The Generation R Study” in Rotterdam, The Netherlands (Eur J Epidemiol 2006;21:475-84) a total of 9,778 mothers with a delivery date between April 2002 and January 2006 were recruited in the study. The Generation R Study was approved by the Medical Ethical Committee of the Erasmus Medical Center, Rotterdam, and samples for the biobank were obtained (Eur J Epidemiol 2007: 22:917–23). Statistical data analyses were performed to determine the correlation existing between maternal thyroid function during gestation and the incidence of ASD in case-control studies comparing the group of cases (mothers of children with diagnosis of ASD) versus a matched control group (mothers of children without ASD) using gestational age at time of thyroid function tests and results of thyroid function tests (TSH, T3, T4) in the mothers. The incidence of ASD in women with early maternal hypothyroxinemia was found to be higher than in normal controls with increased risk. The effect of neuroendocrine disruptors will be analyzed. We hope these results will help to prevent autism.

Thyroid Dysfunction and Cytological Patterns among Patients Requested for Thyroid Function Test in an Endemic Goiter Area of Gondar, North West Ethiopia.

Background Thyroid dysfunction is the most common endocrine disorder in clinical practice, and about half of the population with thyroid dysfunction remains undiagnosed. There is a fairly wide spectrum of thyroid dysfunction, which can be identified by patterns of thyroid function test results. The prevalence of thyroid dysfunction among the population varies in different studies. Methods A cross-sectional study was conducted from February 8th to April 8th, 2017, among patients who requested for the thyroid function test in an endemic goiter area at the Gondar Hospital, University of Gondar. A pretested structured questionnaire was used to collect the data. Three milliliters of blood samples was collected in a plain test tube and centrifuged for serum separation. The thyroid function test was done by using the MINI-VIDAS automation following the manufacturer manual (Setema PLC, Italy). Data were entered and analyzed using SPSS version 20. Descriptive statistics were used for data presentation, and P value < 0.05 was considered significant. Result Of the total 384 study participants, 346 (90.1%) were females and the study participants' mean age was 38 ± 13.9 years. The overall thyroid dysfunction prevalence was 26.3% (101): 1.6% was identified as subclinical hypothyroidism, 0.5% hypothyroidism, 9.6% subclinical hyperthyroidism, and 14.6% hyperthyroidism, and 23.4% had goiter. Furthermore, for cytological pattern analysis, 144 study participants who fulfilled indications for fine-needle aspiration cytology (FNAC) in thyroid nodules were included. Of the total, 3 (2.1%) had thyroid carcinoma, 46 (32%) had cystic degenerated follicular cells, and 82 (57%) had nodular thyroid goiter. In addition, a clinical presentation of a total of 144 study participants, showed lymphadenites in 7 participants (4.8%), hypertension in 9 (6.2%), and cardiac failure in 12 (8.3%). Conclusion The prevalence of thyroid dysfunction was high. The majority of thyroid dysfunction cases were newly diagnosed and more common in females. In addition, the most common disorders were subclinical hyperthyroidism and hyperthyroidism. Follicular cell with cyst degeneration and thyroid nodular goiter were the predominant FNAC findings. For early diagnosis and appropriate intervention in goiter endemic areas, the thyroid function test should be closely monitored.

The spectrum of thyroid disorders at the Endocrine Clinic of Olabisi Onabanjo University Teaching Hospital, Sagamu, South-west, Nigeria

Background: Thyroid disorders constitute the second most common endocrine disorders worldwide, but they are less commonly researched in this environment due to low cost-effectiveness. Objective: To study the spectrum of thyroid disorders at the Endocrinology Clinic of a tertiary health facility in Sagamu, South-west, Nigeria, over two years. Method: This retrospective study was conducted on all new clinic attendees with thyroid disorders between January 2016 and December 2017. The data retrieved included clinical data, results of thyroid function tests and thyroid ultrasonographic scan. The patients were grouped clinically into euthyroid, hypothyroid and thyrotoxic states. Results: A total of 93 thyroid cases were seen, and this constituted 13.64% of all new endocrine consultations (682 patients). The mean age (±SD; range) of the patients was 37.6 (13.6; 15-78) years. Majority of the patients were females with a female-to-male ratio of 4.5:1. Out of these, 77.4% had Goitrous enlargement. Thyrotoxicosis was the most common form of thyroid dysfunction, (72; 77.40%), mainly due to hyperthyroidism from Graves’ disease (50; 69.44%), followed by toxic multinodular goitre (12; 16.67%), toxic solitary nodular goiter (5; 6.94%) and others (5; 6.95 %). Hypothyroidism constituted 10.75% while euthyroid goitre constituted 11.85% of all thyroid cases. Conclusion: Auto-immune thyroid disease remains the most common thyroid disorder among endocrine clinic attendees. There is a need for further studies to elucidate the likely aetiologies.

A 10-year longitudinal study of evaluation of ovarian reserve in women with transfusion-dependent beta thalassaemia major

ObjectiveAlthough spontaneous fertility and successful pregnancies have been reported in well-chelated and transfused women with beta thalassaemia major (BTM), majority of women are subfertile due to hypogonadotropic hypogonadism (HH). Little is known about the effect of iron overload on ovarian follicles and whether ovarian reserve is affected by the disease or treatment status. This study compares the markers of ovarian reserve in women with transfusion-dependent BTM over a period of ten years with healthy women from a control population. Study designWe performed a 10-year mixed (retrospective and prospective) longitudinal study in 17 women with transfusion-dependent BTM from our thalassaemia clinic between July 2007 to June 2017. The results were compared with 52 age-matched healthy women without any medical conditions (control population) attending our fertility clinic. Patient demographics, medical history, menstrual history, hormonal parameters (serum levels of FSH, estradiol, TSH and AMH) and antral follicle count were recorded in all women from both groups. Serum levels of ferritin, cardiac T2*, liver iron concentration, thyroid function (TSH) and liver function test results were also recorded at three different time points. ResultsSerum AMH levels, estradiol levels and antral follicle count were significantly lower in women with BTM compared with the control group (p < 0.05 for all). Low AMH levels were noted in both groups of women (with and without HH) with a background of BTM. Serum AMH levels positively correlated with AFC in women with BTM. ConclusionSerum AMH level and AFC were significantly lower in women with transfusion dependent BTM as compared to age-matched healthy controls suggesting a direct impact of the disease activity or iron overload on the ovary.

SUN-546 Coexistent Resistance to Thyroid Hormone Beta and Viral Thyroiditis

Background Resistance to thyroid hormone beta (RTHbeta) is a rare genetic disorder caused by a defective beta form of the thyroid hormone receptor and is characterized by elevated T3 and T4, non-suppressed TSH and variable tissue resistance to thyroid hormone (TH). In most cases a heterozygous mutation in THRB gene is identified. Clinical case A 32 year old adopted Caucasian woman presented with chest pain in the primary care setting in December 2016. Associated symptoms included palpitations, insomnia, poor concentration, restlessness, tremor, mood swings, headaches, irritability, increased appetite, dry scalp, cold extremities, weight gain and diarrhoea. She had no goitre. Based on thyroid function test (TFT) results, she was suspected to have hyperthyroidism and was commenced on antithyroid drugs for 13 months, but treatment was later stopped due to mouth ulcers. At this stage, further tests in our hospital showed elevated fT3 (8.4 pmol/L, RR 3.5-6.5 pmol/L) and fT4 (33.5 pmol/L, RR 10.0-19.8 pmol/L) and non-suppressed TSH (1.35 mU/L, RR 0.35-5.50 mU/L), without evidence of assay interference. SHBG and MRI pituitary were normal. THRB sequencing identified a heterozygous pathogenic mutation (R438H). She further reported that she struggled in school which prevented her from completing university education and remembered that her biological mother had learning disability. She was further assessed in our clinical research facility. Surprisingly, TFT results were very different: fT3 23.6 pmol/L, fT4 97.3 pmol/L and fully suppressed TSH (<0.03mU/L). Resting energy expenditure (REE) measured by indirect calorimetry was markedly raised [0.214 MJ/kg of lean body mass (LBM)]; compared to that seen in healthy controls (mean (SD): 0.148 (0.013) MJ/kg LBM). Given a recent coryzal illness and negative TRAB, thyrotoxicosis was deemed to be in keeping with thyroiditis. The TFT pattern evolved, without treatment, to mild hypothyroidism (fT3 6.8 pmol/L, fT4 16.2 pmol/L and TSH 21.54 mU/L), then returned to the pattern at presentation: elevated fT3 and fT4 and non-suppressed TSH (fT3 10.6 pmol/L, fT4 31.6 pmol/L, TSH 2.09 mU/L). Given ongoing thyrotoxic symptoms, identical to those present at time of referral, Tri-iodothyroacetic Acid (TRIAC) was commenced. Conclusion Coincident thyroid dysfunction can further complicate interpretation of TFTs in patients with RTHbeta. Notably, individuals with RTHbeta and coexistent thyrotoxicosis can exhibit a suppressed TSH, with underlying pituitary resistance to TH action only becoming evident once TH levels fall. Although thyroiditis rarely complicates RTHbeta, it has been reported that autoimmune thyroid disease occurs more commonly, so interpretation of such unusual TFT patterns may be required during the course of management of these individuals.

Association between skeletal muscle mass and serum concentrations of lipoprotein lipase, GPIHBP1, and hepatic triglyceride lipase in young Japanese men

BackgroundTwo important regulators for circulating lipid metabolisms are lipoprotein lipase (LPL) and hepatic triglyceride lipase (HTGL). In relation to this, glycosylphosphatidylinositol anchored high-density lipoprotein binding protein 1 (GPIHBP1) has been shown to have a vital role in LPL lipolytic processing. However, the relationships between skeletal muscle mass and lipid metabolism, including LPL, GPIHBP1, and HTGL, remain to be elucidated. Demonstration of these relationships may lead to clarification of the metabolic dysfunctions caused by sarcopenia. In this study, these relationships were investigated in young Japanese men who had no age-related factors; participants included wrestling athletes with abundant skeletal muscle.MethodsA total of 111 young Japanese men who were not taking medications were enrolled; 70 wrestling athletes and 41 control students were included. The participants’ body compositions, serum concentrations of lipoprotein, LPL, GPIHBP1 and HTGL and thyroid function test results were determined under conditions of no extreme dietary restrictions and exercises.ResultsCompared with the control participants, wrestling athletes had significantly higher skeletal muscle index (SMI) (p < 0.001), higher serum concentrations of LPL (p < 0.001) and GPIHBP1 (p < 0.001), and lower fat mass index (p = 0.024). Kruskal–Wallis tests with Bonferroni multiple comparison tests showed that serum LPL and GPIHBP1 concentrations were significantly higher in the participants with higher SMI. Spearman’s correlation analyses showed that SMI was positively correlated with LPL (ρ = 0.341, p < 0.001) and GPIHBP1 (ρ = 0.309, p = 0.001) concentration. The serum concentrations of LPL and GPIHBP1 were also inversely correlated with serum concentrations of triglyceride (LPL, ρ = − 0.198, p = 0.037; GPIHBP1, ρ = − 0.249, p = 0.008). Serum HTGL concentration was positively correlated with serum concentrations of total cholesterol (ρ = 0.308, p = 0.001), low-density lipoprotein-cholesterol (ρ = 0.336, p < 0.001), and free 3,5,3′-triiodothyronine (ρ = 0.260, p = 0.006), but not with SMI.ConclusionsThe results suggest that increased skeletal muscle mass leads to improvements in energy metabolism by promoting triglyceride-rich lipoprotein hydrolysis through the increase in circulating LPL and GPIHBP1.

The Relationship between Thyroid Nodules Detected through Ultrasonography and Thyroid Function Test Results in Healthy Individuals

The Relationship between Thyroid Nodules Detected through Ultrasonography and Thyroid Function Test Results in Healthy Individuals

Efficacy and safety of a combination of hydrodissection and radiofrequency ablation therapy for benign thyroid nodules larger than 2 cm: A retrospective study.

Radiofrequency ablation (RFA) is a safe, highly effective, and novel method used to treat benign thyroid nodules. This study aimed to evaluate the efficacy and safety of a combination of RFA and hydrodissection for treating benign thyroid nodules larger than 2 cm. The data of 137 patients with at least one thyroid nodule ≥2 cm who underwent RFA combined with hydrodissection at our medical center from November 2014 to October 2016 were analyzed. Ultrasound-guided RFA was applied to 532 nodules, including 139 nodules ≥2 cm and 393 nodes <2 cm. The volumes of thyroid nodules, complications, and changes in thyroid function were analyzed. Ablation treatments were successfully performed without intraoperative skin burns, serious bleeding, or serious thyroid storm. A positive correlation was observed between ablation time and nodule size (R2 = 0.674). Only one patient (0.7%) experienced laryngeal nerve injury after operation. Moreover, the results of thyroid function tests (free triiodothyronine, free thyroxine, and thyroid-stimulating hormone) remained within normal ranges both before and after ablation. The complete ablation rate was 99.06%. The volumes of both nodules ≥2 cm and <2 cm significantly decreased after ablation. Six months after ablation, the average volume of nodules ≥2 cm had decreased to 1.02 ± 2.42 mL, and the volume reduction ratio was 83.11%. The combination of ultrasound-guided RFA with hydrodissection very effectively treats benign thyroid nodules while reducing damage to the surrounding tissues. This method is safe and effective for treating benign thyroid nodules.

The role and relationship of the serum D-dimer level and autologous serum skin test response in chronic spontaneous urticaria

Background: The severity of chronic urticaria (CU) may be associated with the D-dimer level, and CU patients often have other autoimmune disorders. The autologous serum skin test (ASST) is believed to identify autoimmune/autoreactive diseases in CU patients. Aim: This study evaluated whether the levels of D-dimer, total immunoglobulin E (IgE), and autoimmune markers, such as antithyroid peroxidase (TPO) and antithyroglobulin (TG), differ between ASST-positive and ASST-negative patients among CU patients. In addition, the study assessed whether these laboratory findings were related to CU severity. Methods: The study enrolled 54 adults with CU (16 ASST positive, 38 ASST negative). D-dimer, total IgE, autoimmune marker (anti-TPO and anti-TG), and thyroid hormone levels and the urticaria activity score (UAS) were measured. Results: The levels of D-dimer, total IgE, anti-TPO, and anti-TG and the thyroid function test result showed no difference between the ASST-positive and ASST-negative groups. The UAS was higher in the ASST-positive group than in the ASST-negative group, but the ASST-positive group showed a better treatment response. The UAS was higher in patients with an elevated D-dimer level than in those with a normal level. Total IgE was related to the UAS in only the ASST-negative group, and anti-TPO and anti-TG levels were not related to the UAS. Conclusions: There were no associations between the ASST response and the D-dimer level, total IgE level, thyroid function test results, and thyroid autoantibody levels. However, our findings suggest that the ASST response, D-dimer level, and total IgE level are potential predictors of CU severity.