Risk Factors For Thyroid Disease Research Articles

Oxidative stress a potent risk factor for thyroid diseases in young pregnant females.

Objective: To evaluate the potent role of oxidative stress in thyroid disease development and progression in young pregnant females during 1st and second trimesters compared with matched healthy pregnant females of the same gestational age. Study Design: Cross-sectional Comparative study. Setting: Institute of Molecular Biology and Biotechnology (IMBB), The University of Lahore, Pakistan. Samples were collected at the Punjab Institute of Nuclear Medicine (PINUM), Faisalabad, and the Department of Obstetrics at DHQ Hospital, Chiniot. Period: July 2019 to July 2021. Material & Methods: Thyroid disease- comorbid pregnant women and euthyroid pregnant women were compared for serum levels of oxidative stress markers and antioxidants. The markers were evaluated between 68 healthy subjects in Group A and 43 subjects in Group B known for having thyroid diseases. Blood samples were taken under highly sterile conditions after gaining written consent from all subjects and stored at –8°c to –30°c. A spectrophotometer at 532nm was used to measure serum concentrations of oxidative stress markers. ELISA kits were used to determine serum levels of triiodothyronine, thyroxin, and thyroid-stimulating hormone. Data was analyzed using independent student t-test, multiple logistic regression, and receiver operating characteristic curve (ROC) analysis using SPSS version 25. Results: Group A and Group B had a mean age of 26.07±4.88 and 29.19±4.17 years, respectively. Pregnant women having thyroid dysfunction had decreased superoxide dismutase levels (0.05±0.01 nmol/ml) than group A (0.06±0.01). Other indicators of lipid peroxidation showed a non-significant mean difference compared between both groups (p>0.05). Multiple linear regression studies revealed healthy pregnant women with a positive thyroid medication history had higher SOD levels among group B than those without antithyroid medicine, with a Beta coefficient of +0.26 and p=0.04. According to ROC curve analysis, the Superoxide Dismutase biomarker area under ROC was 67.25% at p=0.002. Thus, it may be used as a diagnostic and predictive biomarker. A cutoff value of 51.5pg/ml was proposed, at which sensitivity is 79% and specificity is 69%. It can be a diagnostic and predictive biomarker. Conclusion: The results of the current study concluded that oxidative stress can be considered a potent risk factor for the development and progression of thyroid disease in young pregnant females.

Iodine status and its association with prevalence of thyroid diseases in adults from Jiangxi Province, China.

Iodine is an essential element for the biosynthesis of thyroid-stimulating hormone (TSH). Both excessive and deficient iodine are major risk factors for thyroid diseases, including thyroid dysfunction, thyroid nodules, and thyroid autoimmunity (TAI). This study aimed to elucidate the relationship between iodine status and the prevalence of thyroid diseases through a national cross-sectional epidemiological survey in Jiangxi province (China). This population-based, cross-sectional study enrolled 2636 Chinese local inhabitants who aged over 18 years old from April to August in 2015. Physical examination was performed and biochemical indices, urinary iodine concentration (UIC), and TSH level were measured. The Chi-square test, nonparametric test, and 4 multivariate logistic regression models adjusted for risk factors were applied to analysis. Spearman correlation coefficients were calculated to investigate the relationship between iodine intake level and the prevalence of thyroid diseases. The median UIC was 176.4 μg/L, and a significant difference was found in median UIC between men (182.45 μg/L) and women (169.25 μg/L) (P = 0.03). Among these study subjects, 14.4%, 44.5%, 26.1%, and 15.0% had deficient, adequate, more than adequate, and excessive iodine concentrations, respectively. The prevalence rates of hyperthyroidism, subclinical hyperthyroidism, hypothyroidism, subclinical hypothyroidism, thyroid nodules, and TAI were 0.91%, 0.57%, 0.34% and 7.89%, 9.45%, and 12.7%, respectively. Significant differences were found in iodine status, waist circumstance, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), TSH, thyroid nodules, and TAI between men and women (P < 0.05). Compared with those with adequate UIC, subjects with excessive UIC had higher prevalence rates of thyroid dysfunction (odds ratio (OR) = 1.74, 95% confidence interval (CI): 1.40-2.54) and thyroid nodules (OR = 3.33, 95%CI 1.32-8.42). In addition, subjects with deficient and excessive UIC were at the higher risk of TAI compared with those with adequate UIC (OR = 1.68, 95%CI: 1.19-2.60; OR = 1.52, 95%CI: 1.04-2.96, respectively). UIC was positively correlated with the prevalence rates of thyroid nodules (r = -0.44, P < 0.01) and TAI (r = -0.055, P < 0.01). On the contrary, UIC was negatively correlated with the risk of thyroid dysfunction (r = -0.24, P > 0.05). Adult inhabitants from Jiangxi province in the TIDE study were in the adequate iodine status. Excessive iodine status was noted as a risk factor for thyroid dysfunction and thyroid nodules. In addition, both iodine deficiency and excessive iodine were risk factors for TAI.

Metabolic Disease and Risk of Thyroid Disease: Evidence from the National Nurse Health Cohort in China.

Previous studies have shown that metabolic diseases are risk factors for thyroid disease; most studies are cross-sectional design. We aimed to evaluate the causal relationship between thyroid and metabolic diseases in a cohort of Chinese nurses. We conducted an ambispective cohort study of the National Nurses' Health Study. Thyroid disease data based on ultrasonography from 2017 to 2021 were collected. We described thyroid disease incidence and the risk factors associated with a cluster of metabolic factors. We used the Mann‒Whitney U test, repeated-measures ANOVA and multivariable Cox proportional hazard regression to analyze the data. A total of 1529 female nurses without thyroid disease were enrolled in 2017, of which, complete data were available for 1269 nurses. In 2018-2020, thyroid nodule incidence ranged from 32.8%-46.3%, thyroiditis incidence was 13.4%-14.3%, and goiter incidence was 4.1%-29.1%, thyroid adenoma and thyroid tumors incidence were 0.1%-0.5% and 1%-1.5%. We also found that NAFLAD was an independent risk factor for thyroid adenoma (p = .003). The age at diagnosis was an independent risk factor for goiter (p <. 001) and thyroid nodules (p < .001). Fasting blood glucose was an independent risk factor for thyroid tumors (p = .004). The age at diagnosis (p = .003), Body Mass Index (p = .006) and menopause (p = .031) were risk factors for thyroiditis. Thyroid disease incidence among nurses is increasing. Age at diagnosis, BMI, fasting blood glucose, and nonalcoholic fatty liver disease are independent risk factors for different types of thyroid disease. This study provides evidence for future studies to further explore the pathogenesis and prevention of thyroid diseases.

Oxidative Stress and Decreased Serum Levels of Superoxide Dismutase (SOD) as a Potent Risk Factor for Thyroid Disease among Local Pregnant Females in Punjab

Aim: To assess the potent role of oxidative stress biomarkers in pregnant females with thyroid disease. Study design: Cross sectional comparative study. Place and duration of study: Institute of Molecular Biology &amp; Biotechnology (IMBB), The University of Lahore from 1st July 2019 to 31st July 2021. Methods: The study was designed to compare serum levels of oxidative stress markers and serum antioxidant levels between pregnant females who had thyroid disease as comorbidity and euthyroid pregnant controls. The markers were measured in fifty cases and fifty control serum samples using various laboratory tests and ELISA kits. Samples were collected from PINUM, Faisalabad and Obstetrics &amp; Gynaecology Department, DHQ Chiniot, Faisalabad division. Results: Mean ages of cases and controls were 29.19±4.17 and. 26.07±4.88 years. The serum levels of SOD were significantly decreased (p≤0.001) in pregnant females having thyroid dysfunction (0.05± 0.01 nmol/ml) as compared to the control group (0.06±0.01nmol/ml). None of the other oxidative markers showed a significant difference between cases and controls (p&gt;0.05). Conclusion: The lower serum SOD levels may be a potential risk factor for the development of thyroid disease in local pregnant females. Keywords: Oxidative stress, Thyroid-stimulating hormone, Thyroid dysfunction, Superoxide dismutase, malondialdehyde,

PSAT220 Severe Vitamin D Deficiency and Hypocalcemia during Pregnancy Masquerading as Thyroid Storm

Abstract Background Hypocalcemic tetany in young female patients is a clinical entity that is well-described in literature. Here we present a potentially life-threatening case of hypocalcemia secondary to severe Vitamin D deficiency and hyperemesis gravidarum mimicking thyroid storm. Case Presentation A 22-year-old Caucasian woman at 21 weeks gestation was transferred to our hospital for suspected thyroid storm with TSH &amp;lt;0.01 mIU/L (0.05-5.7). She had no history of nor risk factors for thyroid disease and presented with severe agitation, hallucinations, and muscle spasms after weeks of vomiting and poor oral intake. In the ambulance her temperature was 106.6F (rectal) and she was tachycardic (216/minute). EKG revealed ventricular arrhythmia with QTc 532 ms. EMS interventions included unsuccessful cardioversion with 100J and 300mg IV amiodarone bolus. In the ED, serum calcium level was 5.9 mmol/L (8.4-10.2), albumin 2.8 g/dL (3.3-4.5), magnesium 1.0 mmol/L (1.7-2.3), potassium 3.1 mmol/L (3.5-4.8), lactic acid 9.5 mmol/L (0.5-2.2), Free T4 1.36 ng/dL (0.58-1.65), troponin 2.21 ng/ml (0.00-0.03), β-hcg 48,775 mIU/ml, CK 9960 U/L (0-188), AST 171 U/L (8-34), ALT 45 (0-24). She received IV calcium gluconate, aggressive IV hydration and electrolyte repletion. Free T3 was drawn prior to initiating empiric thyroid storm treatment (hydrocortisone, propylthiouracil) returned at 3.8 pmol/L (2.5-3.9). Thyroid storm was further ruled out with negative antibodies for TPO and TSI and ultrasound revealing normal-sized gland without nodules and with normal vascularity. Hydrocortisone and Thionamide therapy were discontinued. The patient had rapid improvement in mentation and vitals with continued hydration and electrolyte repletion. 25-hydroxy-Vitamin D level was undetectable and PTH 118 pg/mL (12-88), consistent with secondary hyperparathyroidism. Celiac disease was ruled out with negative tissue transglutaminase IgA and IgG. At her follow-up clinic visit, symptoms had resolved with calcium and Vitamin D supplementation. Discussion Though a common phenomenon in pregnant women, metabolic derangements due to hyperemesis gravidarum can be quite severe and/or life-threatening, as in our case. Literature search revealed an isolated case of hyperemesis gravidarum presenting with severe electrolyte derangement and subsequent paraparesis which resolved after vitamin D and calcium supplementation. Hyperthyroidism is typically associated with hypercalcemia in the Western population. This patient's presenting features of hyperpyrexia, malignant cardiac arrhythmia, hepatitis, and altered mentation were reminiscent of thyroid storm and could easily be attributed to such in a pregnant patient with suppressed TSH. This could lead to continued use of thionamide and further hepatic damage. Thus, it is prudent to consider hypocalcemia in the differential diagnosis of thyrotoxicosis-like presentation, particularly in pregnant patients. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Hypertension and Obesity: Risk Factors for Thyroid Disease.

Thyroid disease instances have rapidly increased in the past few decades; however, the cause of the disease remains unclear. Understanding the pathogenesis of thyroid disease will potentially reduce morbidity and mortality rates. Currently, the identified risk factors from existing studies are controversial as they were determined through qualitative analysis and were not further confirmed by quantitative implementations. Association rule mining, as a subset of data mining techniques, is dedicated to revealing underlying correlations among multiple attributes from a complex heterogeneous dataset, making it suitable for thyroid disease pathogenesis identification. This study adopts two association rule mining algorithms (i.e., Apriori and FP-Growth Tree) to identify risk factors correlated with thyroid disease. Extensive experiments were conducted to reach impartial findings with respect to knowledge discovery through two independent digital health datasets. The findings confirmed that gender, hypertension, and obesity are positively related to thyroid disease development. The history of I131 treatment and Triiodothyronine level can be potential factors for evaluating subsequent thyroid disease.

An Investigation on the Risk Factors of Thyroid Diseases in Community Population in Hainan.

Background In recent years, the incidence of thyroid diseases has increased significantly, which has seriously affected people's work and life. The purpose of this study was to explore the epidemiological characteristics of thyroid diseases and autoantibodies. Method According to the principle of overall sampling, resident residents ≥18 years and who will not move within 5 years are randomly selected. A total of 2136 eligible individuals were divided into case and control groups according to whether they have thyroid disease. Finally, the impact of potential risk factors on thyroid diseases was evaluated. Results The overall prevalence of thyroid disease was 58.3%, and there was a significant difference in the prevalence of thyroid disease between women and men (p = 0.004). Except for the age group ≥70 years, with the increase in age, the prevalence gradually increased (p < 0.05). Participants with positive thyroid autoantibodies (TPOAb or TgAb) had a higher prevalence than participants with negative autoantibodies. The positive rate of autoantibodies in women was higher than that in men (p < 0.05). UIC (p = 0.004) and free thyroid hormone (FT4) (p = 0.001) levels of men were higher than those of women, and the TSH level of women was higher than that of men (p = 0.002). The regression analysis showed that women, older age, and family history of thyroid disease were independent risk factors for thyroid disease. Conclusion The prevalence of thyroid diseases in Hainan was high. Women are more susceptible to thyroid disease than men, and the prevalence increased with age.

Cluster Analysis: A New Approach for Identification of Underlying Risk Factors and Demographic Features of First Trimester Pregnancy Women

Thyroid pathology is reported internationally in 5–10% of all pregnancies. The overall aim of this research was to determine the prevalence of hypothyroidism and risk factors during the first trimester screening in a Mexican patients sample. We included the records of 306 patients who attended a prenatal control consultation between January 2016 and December 2017 at the Women’s Institute in Monterrey, Mexico. The studied sample had homogeneous demographic characteristics in terms of age, weight, height, BMI (body mass index) and number of pregnancies. The presence of at least one of the risk factors for thyroid disease was observed in 39.2% of the sample. Two and three clusters were identified, in which patients varied considerably among risk factors, symptoms and pregnancy complications. Compared to Cluster 0, one or more symptoms or signs of hypothyroidism occurred, while Cluster 1 was characterized by healthier patients. When three clusters were used, Cluster 2 had a higher TSH (thyroid stimulating hormone) value and pregnancy complications. There were no significant differences in perinatal variables. In addition, high TSH levels in first trimester pregnancy are characterized by pregnancy complications and decreased newborn weight. Our findings underline the high degree of disease heterogeneity with existing pregnant hypothyroid patients and the need to improve the phenotyping of the syndrome in the Mexican population.

The Prevalence of Thyroid Dysfunction and Autoimmunity in Women With History of Miscarriage or Subfertility.

To describe the prevalence of and factors associated with different thyroid dysfunction phenotypes in women who are asymptomatic preconception. Observational cohort study. A total of 49 hospitals across the United Kingdom between 2011 and 2016. Women aged 16 to 41years with history of miscarriage or subfertility trying for a pregnancy. Prevalences and 95% confidence intervals (CIs) were estimated using the binomial exact method. Multivariate logistic regression analyses were conducted to identify risk factors for thyroid disease. None. Rates of thyroid dysfunction. Thyroid function and thyroid peroxidase antibody (TPOAb) data were available for 19213 and 19237 women, respectively. The prevalence of abnormal thyroid function was 4.8% (95% CI, 4.5-5.1); euthyroidism was defined as levels of thyroid-stimulating hormone (TSH) of 0.44 to 4.50 mIU/L and free thyroxine (fT4) of 10 to 21 pmol/L. Overt hypothyroidism (TSH > 4.50 mIU/L, fT4 < 10 pmol/L) was present in 0.2% of women (95% CI, 0.1-0.3) and overt hyperthyroidism (TSH < 0.44 mIU/L, fT4 > 21 pmol/L) was present in 0.3% (95% CI, 0.2-0.3). The prevalence of subclinical hypothyroidism (SCH) using an upper TSH concentration of 4.50 mIU/L was 2.4% (95% CI, 2.1-2.6). Lowering the upper TSH to 2.50 mIU/L resulted in higher rates of SCH, 19.9% (95% CI, 19.3-20.5). Multiple regression analyses showed increased odds of SCH (TSH > 4.50 mIU/L) with body mass index (BMI) ≥ 35.0 kg/m2 (adjusted odds ratio [aOR] 1.71; 95% CI, 1.13-2.57; P = 0.01) and Asian ethnicity (aOR 1.76; 95% CI, 1.31-2.37; P < 0.001), and increased odds of SCH (TSH ≥ 2.50 mIU/L) with subfertility (aOR 1.16; 95% CI, 1.04-1.29; P = 0.008). TPOAb positivity was prevalent in 9.5% of women (95% CI, 9.1-9.9). The prevalence of undiagnosed overt thyroid disease is low. SCH and TPOAb are common, particularly in women with higher BMI or of Asian ethnicity. A TSH cutoff of 2.50 mIU/L to define SCH results in a significant proportion of women potentially requiring levothyroxine treatment.

Prevalence and risk factors of thyroid structural abnormalities among adults in Heilongjiang Province, China

Background and Objectives: The prevalence of adult thyroid structural abnormalities has increased significantly worldwide. However, no study has examined the thyroid structure and urine iodine levels of adults in Heilongjiang Province in the last decade. Therefore, this study aims to investigate the rate and risk factors of thyroid structural abnormalities among the residents of this province. Methods and Study Design: A probability proportional sampling method was used, and a total of 3,645 individuals in Heilongjiang Province were included. The subjects was asked to complete a thyroid ultrasound and fill out a questionnaire. Furthermore, urine iodine levels and salt iodine content were determined, and multivariate logistic regression was used to identify the independent risk factors for thyroid diseases. Results: The prevalence of thyroid structural abnormalities in Heilongjiang Province was 56.0%. Univariate analysis showed that there were significant differences between the structural abnormalities group and the normal thyroid group in terms of sex, age, body mass index, hypertension, diabetes, smoking, alcohol consumption, frequency of seafood consumption and pickled food consumption, employment status, and urine iodine level (p ＜ 0.05). Multivariate analysis showed that the following were independent risk factors of thyroid disease: female, increased age, hypertension, diabetes, cigarette smoking frequent seafood consumption, employment, and urine iodine levels. Conclusions: The prevalence of thyroid structural abnormalities in adults in Heilongjiang Province was relatively high. Therefore, to help prevent the occurrence of thyroid disease in adults in Heilongjiang Province, the risk factors of thyroid structural abnormalities should be better understood.

Urine iodine level and multiple risks are associated with thyroid structural abnormalities among adults in Heilongjiang Province, China.

The prevalence of adult thyroid structural abnormalities has increased significantly worldwide. However, no study has examined the thyroid structure and urine iodine levels of adults in Heilongjiang Province in the last decade. Therefore, this study aims to investigate the rate and risk factors of thyroid structural abnormalities among the residents of this province. A probability proportional sampling method was used, and a total of 3,645 individuals in Heilongjiang Province were included. The subjects was asked to complete a thyroid ultrasound and fill out a questionnaire. Furthermore, urine iodine levels and salt iodine content were determined, and multivariate logistic regression was used to identify the independent risk factors for thyroid diseases. The prevalence of thyroid structural abnormalities in Heilongjiang Province was 56.0%. Univariate analysis showed that there were significant differences between the structural abnormalities group and the normal thyroid group in terms of sex, age, body mass index, hypertension, diabetes, smoking, alcohol consumption, frequency of seafood consumption and pickled food consumption, employment status, and urine iodine level (p<0.05). Multivariate analysis showed that the following were independent risk factors of thyroid disease: female, increased age, hypertension, diabetes, cigarette smoking frequent seafood consumption, employment, and urine iodine levels. The prevalence of thyroid structural abnormalities in adults in Heilongjiang Province was relatively high. Therefore, to help prevent the occurrence of thyroid disease in adults in Heilongjiang Province, the risk factors of thyroid structural abnormalities should be better understood.

Iodine status and characteristics of Korean adolescents and their parents based on urinary iodine concentration: a nationwide cross-sectional study

PurposeIodine is a major component of thyroid hormones. Both deficiency and excess of iodine are major risk factors for thyroid disease, making it important to accurately assess iodine level in the human body. Urinary iodine concentration (UIC) is a commonly used measure of iodine status. However, there is little research on iodine status and related characteristics in Korean adolescents.MethodsUsing data from the sixth Korea National Health and Nutrition Examination Survey (KNHANES VI) for the years 2013–2015, we analyzed UIC and thyroid function test results in adolescents aged 10–18 years and their parents. We also investigated the influence of socioeconomic factors and family history of thyroid disease on iodine status.ResultsMean UIC in Korean adolescents was 963.5±55.7 μg/L. Among evaluated subjects, 6.6%±1.0%, 29.8%±1.7%, and 63.9%±1.9% had low (UIC<100 μg/L), adequate (UIC: 100–299.9 μg/L), and excess (UIC≥300 μg/L) iodine concentrations, respectively. Based on regional trends, the incidence of iodine deficiency exceeded 10% in several regions, even though there was a dominance of regions with excess iodine. Parental UIC, female sex, average monthly income, and expenditure were all found to affect the iodine status of Korean adolescents.ConclusionsAlthough regional differences exist, the iodine status in Korean adolescents is mainly affected by the eating habits of their families and socioeconomic factors. Therefore, monitoring of iodine status is necessary in this population.

MON-586 Practice Variation in the Management of Subclinical Hypothyroidism During Pregnancy: Results From a National Survey of Endocrinologists in the US

Background: Evidence regarding subclinical hypothyroidism (SCH) effects on pregnancy and the benefits of levothyroxine (LT4) treatment is inconsistent. The American Thyroid Association (ATA) Guidelines for the management of thyroid diseases in pregnancy were published in 2017; the impact of these guidelines on clinical practice remains uncertain. Aim: To conduct a national survey among endocrinologists studying knowledge and perception regarding SCH diagnosis, treatment and impact on pregnancy. Methods: An online survey was sent by email invitation to endocrinologists who are active members of the Endocrine Society in the U.S. (n=5914). The questionnaire included demographic data and clinical scenarios with multiple choice questions to assess diagnostic evaluation, initiation of therapy, and follow up in pregnant women with SCH. Results: The survey was completed by 154 endocrinologists (9/5/18-10/31/18). On average each clinician had treated 5 (IQR 3-10) women with SCH in the past 6 months. The 2017 ATA guidelines were reviewed by 75% of whom 52% consider that these guidelines actually changed their clinical practice. Universal screening is done by 53%, 31% screens when there are associated risk factors for thyroid disease (e.g. clinical symptoms, family history, etc.) and 16% never screens. For the diagnosis of SCH, only 25% uses a TSH>4.0 mIU/L and 5.8% a population-based cutoff as recommended by ATA, while the most used cutoff was TSH>2.5 mIU/L (52%). Following ATA guidelines, 87% would immediately treat a woman with a 1st trimester TSH>4.0 mIU/L and TPO-Abs+ (strong recommendation) vs. 50% if TPO-Abs– (weak recommendation), followed by the option of repeating TSH within a month in 12% and 45% respectively. If a woman had TSH between 2.5-4.0 mIU/L, 58% would treat her if TPO-Abs+ (weak recommendation) vs. 17% if TPO-Abs- (no recommendation), followed by the option of repeating TSH within a month in 39% and 55% respectively. We found similar practices for the treatment of women in the 2nd trimester with the same clinical and laboratory characteristics. Clinicians reported considering the following factors for LT4 treatment decision: TSH level, TPO-Abs, history of miscarriages, and guidelines recommendations. Interestingly, 70-80% of the clinicians who would start LT4, consider treatment would have a small impact (10-20% reduction) or very small impact (<10% reduction) on maternofetal complications regardless the clinical scenario. Only 50% of the clinicians take into consideration the patient’s preferences and 19% the side effects related to LT4 use. Conclusions: Despite recently updated guidelines, there is still a wide variation in the clinical practice regarding the diagnosis and management of SCH in pregnancy. Although LT4 is frequently used as the treatment for SCH in pregnancy, the expected risk reduction is small, and patient’s preferences are often disregarded.

Incident thyroid disease in female spouses of private pesticide applicators

BackgroundLittle is known about modifiable risk factors for thyroid disease. Several pesticides have been implicated in thyroid disruption, but clinical implications are not clear. ObjectiveWe assessed associations between pesticide use and other farm exposures and incident hypothyroidism and hyperthyroidism in female spouses of farmers in the Agricultural Health Study (AHS). MethodsWe used Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals for risk of thyroid disease in 24,092 spouses who completed at least one follow-up questionnaire. ResultsWe identified 1627 hypothyroid and 531 hyperthyroid cases over 20 years of follow-up. The fungicides benomyl, maneb/mancozeb, and metalaxyl, the herbicide pendimethalin, and among those over 60 years of age the insecticides parathion and permethrin (applied to crops) were associated with elevated hypothyroidism risk, with HR ranging from 1.56–2.44. Conversely, the insecticide phorate, and the herbicides imazethapyr and metolachlor were associated with decreased risk (HR ranging 0.63–0.73), as were long-term farm residence and other farm-related activities (HR ranging 0.69–0.84). For hyperthyroidism, the insecticide diazinon, the fungicides maneb/mancozeb, and the herbicide metolachlor were associated with increased risk (HR ranging 1.35–2.01) and the herbicide trifluralin with decreased risk (HR: 0.57). ConclusionsSeveral individual pesticides were associated with increased risk of hypothyroidism and hyperthyroidism, although some pesticides were associated with decreased risk. Some of the findings, specifically associations with fungicides, are consistent with results from an earlier analysis of prevalent diseases in AHS spouses.

The application of serum iodine in assessing individual iodine status

The prevalence of thyroid disease in China is on the rise, and this could be partly associated with excessive iodine intake in some individuals; therefore, increased attention is being paid to individual iodine status. However, current indices are not appropriate for evaluating individual iodine status. To evaluate the association between serum iodine and urinary iodine (UI), as well as thyroid diseases, and provide an excellent base for future individual iodine status assessment. A total of 902 adults were enrolled in this study including 325, 286 and 291 subjects from regions in China where iodine is adequate, sufficient and in excess, respectively. Serum iodine, UI and thyroid function were assessed, and ultrasonography performed in all subjects. The median serum iodine values of adults with subclinical hypothyroidism, high serum autoantibody and thyroid nodules were significantly higher than those of euthyroid adults (P<0.05). A serum iodine level higher than 100μg/L was considered as a risk factor for thyroid diseases. Serum iodine had strong nonlinear correlations with UI and thyroid function. When thyroid function was taken as a gold standard, the area under the receiver operating characteristic (ROC) curve for serum iodine was 0.752 and UI was 0.507 for subjects with lower serum iodine and UI levels. The area for serum iodine was 0.773 and UI was 0.638 for subjects with higher serum iodine and UI levels. The areas under these curves were significantly different (P<0.001). In adults, serum iodine had a strong nonlinear correlation with UI and a high level of serum iodine was a risk factor for thyroid diseases.

Thyroid testing in acutely ill patients may be an expensive distraction.

In health, an efficient negative feedback mechanism maintains serum thyroid hormone concentrations within an exquisitely controlled narrow range. Therefore any change that occurs to thyroid hormones in intrinsic thyroid disease is concordant and easy to interpret. Optimal functioning of the many tissues they influence is thereby facilitated. The situation in acute illnesses is different. Mechanisms that operate in these circumstances influence the hypothalamic-pituitary-thyroid axis and its components producing thyroid test results, which are discordant, do not fit recognizable patterns and are difficult to interpret. The yield of abnormalities is also low (about 7%). As many studies indicate, thyroid tests are expensive and consume large amounts of the hospital budget and resources of hospital laboratories. Other studies have shown that when abnormalities are detected, clinicians do not intervene or follow up these subjects. Therefore the clinical utility of thyroid testing in acutely ill patients is debatable. Interventions to change requestor behaviour with regard to thyroid testing in acutely ill subjects and the success of some audit and educational interventions are worthy of note. Thyroid testing in acutely ill patients is often an expensive distraction and is of limited clinical value. Targeted thyroid testing should be offered in this group only to those with: (a) symptoms or signs of thyroid disease e.g. goiter or orbitopathy; (b) risk factors for thyroid disease, previous or family history of thyroid disease; (c) taking drugs which potentially affect thyroid function e.g. thyroxine replacement therapy, amiodarone, lithium, mechanistic target of rapamycin (mTOR) inhibitors, interferon, alemtuzumab etc; (d) unexplained tachydysrhythmias.

Stimulation of Thyroid Function by Human Chorionic Gonadotropin During Pregnancy: A Risk Factor for Thyroid Disease and a Mechanism for Known Risk Factors.

Thyroid autoimmunity is a major risk factor for gestational thyroid disease, and recently various other risk factors have been identified, including maternal age, body mass index (BMI) and parity. Human chorionic gonadotropin (hCG) is an important determinant of gestational thyroid function, yet it is unknown to what extent differences in hCG concentration affect the risk for thyroid disease. We have recently shown that thyroperoxidase antibody positivity impairs the thyroidal response to hCG stimulation, which may suggest that this is a mechanism through which thyroid autoimmunity acts as a risk factor for thyroid disease. The purpose of this study is to determine whether hCG is a risk factor for thyroid disease entities and whether recently identified risk factors for thyroid disease may influence the thyroidal response to hCG stimulation. Human chorionic gonadotropin, thyrotropin (TSH), and free thyroxine (FT4) were measured in 5435 pregnant women participating in a prospective cohort. The association of hCG with thyroid disease entities, and the association of known risk factors with thyroidal response to hCG stimulation were studied using multivariable linear regression models. Higher hCG concentrations were associated with a higher risk of subclinical and overt hyperthyroidism. Lower hCG concentrations were associated with a higher risk of hypothyroxinemia. In contrast, hCG concentrations were not associated with subclinical hypothyroidism. Further analyses showed that in women with hypothyroxinemia, high hCG concentrations still suppressed TSH. However, in women with subclinical hypothyroidism, high hCG concentrations were not associated with higher FT4. Higher BMI, male fetal sex, and maternal parity >2 were associated with a lower thyroidal response to hCG stimulation. Human chorionic gonadotropin is associated with the risk of (subclinical) hyperthyroidism and hypothyroxinemia, but not with the risk of (subclinical) hypothyroidism. Women with hypothyroxinemia have a normal response to thyroidal stimulation by hCG, but this was abnormal in women with subclinical hypothyroidism. Known risk factors for thyroid dysfunction (BMI and parity), and also male fetal sex, are associated with a lower thyroidal response to hCG stimulation.

Late Effects Following Treatment of Hodgkin Lymphoma During Childhood and Adolescence. Results of the Hodgkin Lymphoma Late Effects Research Project.

Survival rates have been excellent in patients treated for Hodgkin lymphoma (HL) during childhood and adolescence. Unfortunately, severe treatment related late effects have been observed. It was therefore an important aim of the cooperative pediatric HL therapy studies in Germany to reduce the number of late effects without jeopardizing the excellent treatment results. Progress and relapses of HL were analyzed to obtain important information for the future salvage therapy. All late effects were documented and their etiologies analyzed. Information obtained from bacterial infections and late deaths following splenectomy were used to inform patients at risk and their local physicians about necessary preventive measurements. Procarbazine was recognized as major gonadotoxic agent in boys and eliminated successively from the treatment regimens. Parenthood was normal in female patients when compared to the German female population documenting normal ovarian function except in patients with pelvic radiation. Radiation was the most important risk factor for thyroid diseases, cardiac late effects and subsequent malignant neoplasms, especially thyroid and breast cancer. A special screening program was initiated for women with chest radiotherapy, since they had a high risk of breast cancer already at a young age. The results of the HL Late Effects Research Project are important for the aftercare of patients and for the design of future HL treatment regimens.

Management of concomitant hyperparathyroidism and thyroid diseases in the elderly patients: a retrospective cohort study.

Thyroid disease and hyperparathyroidism are the most common endocrine disorders. The incidence of thyroid disease in patients with hyperparathyroidism ranges in the different series from 17 to 84%, and thyroid cancer occurs with an incidence ranging from 2 to 15%. The aim of our study was to analyze the management of elderly patients with concomitant thyroid and parathyroid disease in order to define the best surgical therapeutic strategy and avoid reoperations associated with a higher risk of complications. All consecutive patients (64 patients, age range 60-75years), undergoing surgery for hyperparathyroidism, from January 2011 to June 2014, were retrospectively evaluated. Enrolled patients were divided into two study groups of patients affected by hyperparathyroidism with or without a concomitant thyroid disease. Out of 64 patients enrolled in our study (24 men, age range 60-75years), affected by hyperparathyroidism, 34 had an associated thyroid disease and were treated with total thyroidectomy and parathyroidectomy. The group, who underwent parathyroidectomy associated with thyroidectomy, had no greater complications than the group receiving only parathyroidectomy. Thyroid disease must be excluded in patients affected by hyperparathyroidism. It is difficult to determine whether hyperparathyroidism can be considered a risk factor for thyroid disease, but an accurate preoperative study is essential for a surgery able to treat both thyroid and parathyroid disease. In this way, we avoid the elderly patient, with associated morbidity and increased surgical risk, to undergo a reoperation for thyroid disease, burdened with major complications.

Craniosynostosis and risk factors related to thyroid dysfunction.

Thyroid disease is a common problem among women of reproductive age but often goes undiagnosed. Maternal thyroid disease has been associated with increased risk of craniosynostosis. We hypothesized that known risk factors for thyroid disease would be associated with risk of craniosynostosis among women not diagnosed with thyroid disease. Analyses included mothers of 1,067 cases and 8,494 population-based controls who were interviewed for the National Birth Defects Prevention Study. We used multivariable logistic regression to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI). After excluding women with diagnosed thyroid disease, younger maternal age (AOR 0.7, 95% CI 0.6-0.9, for <25 years versus 25-29), black or other race-ethnicity (AOR 0.3, 95% CI 0.2-0.4 and AOR 0.6, 95% CI 0.4-0.8, respectively, relative to non-Hispanic whites), fertility medications or procedures (AOR 1.5, 95% CI 1.2-2.0), and alcohol consumption (AOR 0.8, 95% CI 0.7-0.9) were associated with risk of craniosynostosis, based on confidence intervals that excluded 1.0. These associations with craniosynostosis are consistent with the direction of their association with thyroid dysfunction (i.e., younger age, black race-ethnicity and alcohol consumption are associated with reduced risk and fertility problems are associated with increased risk of thyroid disease). This study thus provides support for the hypothesis that risk factors associated with thyroid dysfunction are also associated with risk of craniosynostosis. Improved understanding of the potential association between maternal thyroid function and craniosynostosis among offspring is important given that craniosynostosis carries significant morbidity and that thyroid disease is under-diagnosed and potentially modifiable.