Role Of Hypothyroidism Research Articles

Anemia Status Changes Among Patients With Obesity Following Bariatric Surgery.

Objective This study aims to investigate trends in anemia severity among patients with pre-existing anemia who underwent bariatric surgery due to obesity. It also examines how different bariatric surgery techniques impact anemia outcomes. Methods This prospective study included 280 patients aged 18 to 65 with obesity who underwent bariatric surgery. The patients were categorized into three groups based on the type of surgery: sleeve gastrectomy, one-anastomosis gastric bypass, and Roux-en-Y gastric bypass. Anemia severity was evaluated over a 12-month follow-up period. Chi-square tests were used to assess the homogeneity of baseline factors among the groups, and McNemar tests along with generalized estimating equations were used to compare anemia outcomes. Results Before surgery, the rates of moderate anemia across the three surgical groups ranged from 18.2% to 22.4%, with no cases of severe anemia observed. There was no significant difference among the groups (p=0.949). During the 12-month follow-up, the odds ratio for reducing anemia severity in the sleeve gastrectomy and Roux-en-Y gastric bypass groups were 2.13 and 1.91, respectively, compared to the one-anastomosis gastric bypass group. Additionally, the odds ratio for reducing anemia severity in patients with hypothyroidism was 1.84 compared to those without hypothyroidism. Conclusion The choice of bariatric surgery technique significantly affects anemia outcomes, with sleeve gastrectomy showing a higher success rate in reducing anemia severity. The role of hypothyroidism in anemia management also appears to be significant.

The Role of Hypothyroidism in the Etiology of Hyponatremia - Case Report and a Short Review

Abstract Hyponatremia induced by hypothyroidism is a rare phenomenon and a correlation between them can be argued only with possible mechanisms. Hyponatremia often results from the concomitant development of several overlapping pathological events. The association between hypothyroidism and hyponatremia should be considered only if explanations for any other etiological causes have been exhausted. We present the case of a female patient aged 67 years who has previously undergone surgery for a meningioma and who presented with symptoms such as nausea, biliary vomiting, headache and epigastric pain. Laboratory results indicated multiple electrolyte imbalances, including hyponatremia, but the brain imaging studies did not confirm cerebral edema or the presence of tumor development. Under electrolytic correction treatment which was supplemented with L-thyroxine, the biochemical parameters were corrected and normalized and the patient was relieved of her symptoms. This case thus raises the possibility that hyponatremia could be induced or at least precipitated by hypothyroidism. Thyroid dysfunction tests should be targeted in cases of hyponatremia with non-specific causes, even if hypothyroidism is rarely the cause.

Maternal hypothyroidism in rats impairs placental nutrient transporter expression, increases labyrinth zone size, and impairs fetal growth

IntroductionHypothyroidism during pregnancy is associated with fetal growth restriction (FGR). FGR is commonly caused by placental insufficiency and yet the role of hypothyroidism in placental regulation of fetal growth is unknown. This study aimed to investigate the effects of maternal hypothyroidism on placental nutrient transporter expression, placental morphology, and placental metabolism. MethodsHypothyroidism was induced in female Sprague-Dawley rats by adding methimazole (MMI) to drinking water at moderate (MOD, MMI at 0.005% w/v) and severe (SEV, MMI at 0.02% w/v) doses from one week prior to pregnancy and throughout gestation. Maternal and fetal tissues were collected on embryonic day 20 (E20). ResultsHypothyroidism reduced fetal weight (PTrt<0.001) despite causing fetal hyperglycaemia (PTrt = 0.016). Placental weight was not affected by hypothyroidism however placental efficiency was reduced (PTrt<0.001), as was the junctional zone (JZ):labyrinth zone (LZ) weight ratio (PTrt = 0.005). LZ glycogen content was increased (PTrt = 0.029) and while mRNA expression of glucose transporters was reduced by hypothyroidism, only GLUT1 protein expression was reduced in male LZs. Maternal hypothyroidism reduced mitochondrial content (PTrt = 0.031), particularly in SEV males relative to CON males (P = 0.004). Protein expression of Complex V (P < 0.001) and Complex III (P = 0.002) of the electron transport chain were also reduced in males. Maternal hypothyroidism reduced LZ (PTrt<0.001) and fetal plasma triglycerides (P = 0.019) while fetal free fatty acids and the expression of LZ lipid transporters was not affected. DiscussionOverall, maternal hypothyroidism may lead to FGR through reduced maternal T4 availability, changes to placental morphology, altered nutrient transporter expression and sex-specific effects on placental metabolism. Changes to LZ glycogen and triglyceride stores as well as mitochondrial content suggest a metabolic shift from oxidative phosphorylation to anaerobic glycolysis in males. These changes also likely impact fetal substrate availability and therefore fetal growth.

ODP486 Hypothyroidism And Its Relation To Clinical Outcome In Covid-19 Inpatients

Abstract Thyroid dysfunction associated with Coronavirus infection (COVID-19) such as thyroiditis and sick euthyroid syndrome have been reported in recent studies, but the role of hypothyroidism in disease progression and severity remains uncertain. Our aim was to assess the frequency of hypothyroidism and its relationship with clinical outcome in patients hospitalized for COVID-19. The study was retrospective and observational with a cohort of 966 patients hospitalized for COVID-19 infection from February to August 2021, separated into two groups, with and without previous hypothyroidism, and compared in relation to the following variables: age, index of body mass (BMI), type of care, gender, initial hospitalization sector, comorbidities, requirement mechanical ventilation (MV), oxygen supplementation (O2), levothyroxine dose, thyrostimulating hormone (TSH) and free thyroxine (T4L) levels, total length of hospital stay and death. Of the 966 patients evaluated, 87 (9%) had hypothyroidism prior to hospital admission. Patients with hypothyroidism were on average 6.5 years older and had a significantly greater mean age than those without hypothyroidism. The outcome of death was evidenced in 38% of the total sample, with no statistically significant difference between the groups. In uni and multivariate analysis groups matched for sex, age and comorbidities, only older age (increase of 1.8% for each year) and the need for mechanical ventilation (increase of 9.5 times) were associated with a higher risk of death,with no impact of hypothyroidism in requirement mechanical ventilation, oxygen supplementation (O2), total length of hospital stay and death. Presentation: No date and time listed

Особливості ураження нервової системи при первинному гіпотиреозі (огляд літератури)

В огляді наведені дані про патогенетичні механізми розвитку патології центральної та периферичної нервової системи при первинному гіпотиреозі. Нестача тиреоїдних гормонів призводить до змін в організації центральної нервової системи, зниження енергетичного забезпечення нейронів, зміни синтезу деяких специфічних білків нервової системи, що зумовлює розвиток кретинізму в дітей. Доведена роль гіпотиреозу у виникненні когнітивних порушень у дорослих, таких як зниження пізнавальної функції, пам’яті й уваги. Погіршення логічного мислення виявляється вже у хворих на субклінічний гіпотиреоз. Порушення медіаторного обміну призводить до формування депресії. Найбільш вивченими при гіпотиреозі є нервово-м’язові порушення (гіпотиреоїдна міопатія й міотонічний феномен) та ураження периферичних нервів. Приховувати первинний гіпотиреоз можуть тунельні нейропатії, полінейропатія й атактичний синдром. Попри численні дослідження, що стосуються гіпотиреозу та його неврологічних ускладнень, деякі питання патогенезу, діагностики, перебігу й лікування неврологічної патології при первинному гіпотиреозі потребують подальшого дослідження.

Influence of thyroid-stimulating hormone on the recurrence after radiofrequency ablation for atrial fibrillation

Atrial fibrillation is one of the most common sustained disorders of cardiac rhythm and is associated with an increased risk of mortality, morbidity due to thromboembolic complications, and heart failure. It is important to highlight that the causative factors are vast. It is well-known that thyroid dysfunction has a proarrhythmic effect and increases the risk of cardiovascular disease. Hyperthyroidism or thyrotoxicosis is recognized to be a baseline risk factor for the development of atrial fibrillation. However, the role of hypothyroidism in atrial arrhythmogenesis is less recognized and not fully understood. At the moment radiofrequency catheter ablation is actively used in the treatment of atrial fibrillation, which in most cases has high efficiency and persistent effect. Despite that, the recurrence of supraventricular tachyarrhythmia can be observed in some patients even after radiofrequency catheter ablation. Patients with a history of hypothyroidism or even high-normal thyroid-stimulating hormone levels are more likely to have a recurrence of supraventricular tachyarrhythmia after radiofrequency catheter ablation. Therefore, thyroid-stimulating hormone levels should be determined in patients who have undergone radiofrequency catheter ablation of atrial fibrillation, especially paroxysmal atrial fibrillation. Consequently, it should be noted that the assessment and correction of modifying risk factors before radiofrequency catheter ablation may provide opportunities for future prevention of recurrence of supraventricular paroxysmal arrhythmias, improve the prognosis and overall quality of life in patients of this group. We have demonstrated the clinical case and emphasized the association of high-normal thyroid-stimulating hormone levels with supraventricular tachyarrhythmia recurrence after radiofrequency catheter ablation for atrial fibrillation.

Unraveling the Role of Hypothyroidism in Non-alcoholic Fatty Liver Disease Pathogenesis: Correlations, Conflicts, and the Current Stand.

Non-alcoholic fatty liver disease (NAFLD) has become one of the most common causes of chronic liver diseases globally. Because thyroid hormones play a crucial role in lipid metabolism, thyroid dysfunction has been implicated in NAFLD pathogenesis in the past decade, with hypothyroidism-induced NAFLD being regarded as a distinct disease entity. However, there has been no common consensus yet, and several studies have found contradictory results. Hence, we conducted this systematic review to represent the current view on the role of hypothyroidism (HT) and individual thyroid function parameters such as thyroid-stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TGAb) in NAFLD pathogenesis. We searched PubMed, PubMed Central, and Semantic Scholar databases from inception until January 2021 to identify relevant observational (case-control, cross-sectional, and longitudinal) studies. A total of 699 articles were recognized through our database search. After applying the eligibility criteria and performing quality assessment, 10 studies involving 42,227 participants were included in the final systematic review. Each of these studies assessed different thyroid function parameters, and NAFLD was found to be associated with HT in two studies, elevated TSH in three studies, suppressed T4 in three studies, elevated T3 in one study, and elevated TPOAb in one study. There was also a wide heterogeneity in HT definition, study population characteristics, and study design among these studies, making a direct comparison difficult. Because the recognition of HT-induced NAFLD has possible diagnostic, therapeutic, and prognostic implications, we recommend that comprehensive, long-term prospective studies be carried out to determine if HT or thyroid function parameters are causally associated with NAFLD.

The relationship between liver histology and thyroid function tests in patients with non-alcoholic fatty liver disease (NAFLD).

BackgroundData on the role of hypothyroidism in the pathogenesis of non-alcoholic fatty liver disease (NAFLD) and liver fibrosis are conflicting, although selective Thyroid Hormone Receptor (THR)-β agonists have been identified as potential therapy in patients with non-alcoholic steatohepatitis (NASH). Therefore, we investigated the association between hypothyroidism and NAFLD histological features potentially associated with progressive liver disease.MethodsBetween 2014 and 2016, consecutive patients with histologically proven NAFLD and frozen serum available for thyroid function tests assessment were included. NAFLD was staged according to the NAFLD Activity Score (NAS), and fibrosis according to Kleiner. NASH was defined as NAS ≥4, significant fibrosis as F2-F4 and significant steatosis as S2-S3. Thyroid function tests (TFT; TSH, FT3, FT4, rT3), TPO-Ab and Tg-Ab were also assessed.ResultsFifty-two patients were analyzed: median age 54 years, 58% females, LSM 7.8 kPa, 27% diabetics, 14% hypothyroid. At histology, NASH was present in 21 (40%), F2-F4 in 28 (54%) and S2-S3 in 30 (58%) patients. Rates of hypothyroidism were similar independently of the presence of NASH (p = 0.11), significant fibrosis (p = 0.21) or steatosis (p = 0.75). However, hypothyroid patients displayed a higher NAS (p = 0.02) and NASH (p = 0.06) prevalence. At multivariate analysis, TFT were not independently associated with histology.ConclusionHypothyroidism was highly prevalent in NAFLD patients, and was associated with increased NAFLD activity, but not with fibrosis and steatosis severity. Thus, thyroid dysfunction might play a direct and/or indirect in the pathogenesis of NAFLD and NASH.

Role of Hypothyroidism on Ovarian and Uterine Morphology in Sonography of Women at Reproductive Age

Role of Hypothyroidism on Ovarian and Uterine Morphology in Sonography of Women at Reproductive Age

The role of hypothyroidism in weaning patients from mechanical ventilation: a clinical trail

Objective: Hypothyroidism is a relatively common disease around the world; and as a clinical condition due to the lack of secretion of thyroid hormone from the thyroid gland, due to some structural and/or functional disorders, thyroid hormone production is defined. The purpose of this study is to investigate the isolation of the problem of mechanical ventilation caused by hypothyroidism in hospitalized patients. Methods: In this clinical trial, 80 patients admitted to the ICU ward of Imam Reza Hospital and intubated for more than one week were studied. Patients were classified into two subgroups (each subgroup was 40). Levothyroxine was prescribed for the case group 0.1 mg of the first morning; while no Levothyroxine was prescribed to the patients in the control group. Differences between the two groups is evaluated in the time of weaning. Results: There was a significant difference between two groups regarding TSH, T3 and T4. There was also a significant difference between final outcome of the patients and time of weaning from the mechanical ventilation between the two groups; which can be attributed to the effect of the role of levothyroxine on the recovery of patients and the reduction of weaning from mechanical ventilation. Conclusion: The thyroid function of intubated patients should be monitored to be kept in normal levels to accelerate the recovery of these patients or in some cases prevent them from deterioration.

Outcomes of Patients With Hypothyroidism and COVID-19: A Retrospective Cohort Study

Coronavirus diseases (COVID-19) is associated with high rates of morbidity and mortality and worse outcomes have been reported for various morbidities. The impact of pre-existing hypothyroidism on COVID-19 outcomes remains unknown. The aim of the present study was to identify a possible association between hypothyroidism and outcomes related to COVID-19 including hospitalization, need for mechanical ventilation, and all-cause mortality. All patients with a laboratory confirmed COVID-19 diagnosis in March 2020 in a large New York City health system were reviewed. Of the 3703 COVID-19 positive patients included in present study, 251 patients (6.8%) had pre-existing hypothyroidism and received thyroid hormone therapy. Hypothyroidism was not associated with increased risk of hospitalization [Adjusted Odds Ratio (ORadj): 1.23 (95% Confidence Interval (CI): 0.88- 1.70)], mechanical ventilation [ORadj: 1.17 (95% CI: 0.81–1.69)] nor death [ORadj: 1.07 (95% CI: 0.75–1.54)]. This study provides insight into the role of hypothyroidism on the outcomes of COVID-19 positive patients, indicating that no additional precautions or consultations are needed. However, future research into the potential complications of COVID-19 on the thyroid gland and function is warranted.

Role of Hypothyroidism on Postoperative Fistula Development following Salvage Oropharyngectomy

Role of Hypothyroidism on Postoperative Fistula Development following Salvage Oropharyngectomy

Role of hypothyroidism and associated pathways in pregnancy and infertility: Clinical insights.

Thyroid disorders are the most common endocrine problems in women. In most of the cases, thyroid can lead to infertility or miscarriages. The etiology of infertility is multifactorial with thyroid disorders as the most common presenting factor, hypothyroidism in particular. Infertility in women can lead to emotional and psychological stress. The prevalence of hypothyroidism during pregnancy is estimated to be 0.3%–0.5%. Hypothyroidism and hyperthyroidism can result in menstrual irregularities and anovulatory cycles, thus affecting the fertility. There is a significant high prolactin (PRL) level in infertile women with hypothyroidism when compared to euthyroid patients, indicating the relation between hypothyroidism and hyperprolactinemia. The amount of thyrotropin releasing hormone (TRH) from the hypothalamus is markedly increased by inhibition of pyroglutamyl peptidase II, the enzyme catalyzing TRH. The increased TRH in hypothyroidism causes increased thyroid-stimulating hormone and PRL secretion by pituitary, leading to infertility and galactorrhea. In recent years, a neuropeptide called kisspeptin, encoded by Kiss1 gene, a potent stimulus for GnRH secretion, has been recognized, which suggests a future direction of treatment with kisspeptin and benefits the fertility induction among hyperprolactinemic infertile patients. Untreated hypothyroidism during pregnancy can lead to subfertility, fetal deaths, premature deliveries, and abortions. Therefore, women planning for pregnancy and infertile women should be assessed for thyroid hormones and serum PRL.

English

English

Resolution of Hypothyroidism Restores Cold-Induced Thermogenesis in Humans.

Background: Hypothyroidism is a frequent endocrine disorder with common symptoms of increased cold sensitivity and unintended weight gain, indicating changes in energy expenditure (EE) and response to cold exposure. Thyroid hormones (TH) play an important role for proper function of brown adipose tissue (BAT) and cold-induced thermogenesis (CIT) in rodents, but the role of hypothyroidism on CIT in humans is uncertain.Methods: This was a prospective observational study. Forty-two patients presenting with subclinical or overt hypothyroidism in whom TH replacement was planned were recruited. Thirty-three patients completed the study. Thermogenesis was measured by indirect calorimetry during warm conditions and after a mild cold stimulus of 90 minutes, both during the hypothyroid state and after at least three months of sufficient TH replacement. CIT was determined as the difference between EE during mildly cold and warm conditions. The primary endpoint was the change of CIT between the hypothyroid and euthyroid state.Results: EE during warm conditions increased from a median of 1330 (interquartile range [IQR] 1251–1433) kcal/24 hours in the hypothyroid state to a median of 1442 (IQR 1294–1579) kcal/24 hours in the euthyroid state (+8.5%; p = 0.0002). EE during mild cold exposure increased from 1399 (IQR 1346–1571) kcal/24 hours to 1610 (IQR 1455–1674) kcal/24 hours (+15%; p < 0.0001). The median CIT was 55 (IQR 1–128) kcal/24 hours at the baseline visit, after restoration of euthyroidism CIT increased by 102% to a median of 111 (IQR 15.5–200) kcal/24 hours (p = 0.011). Serum levels of free thyroxine at the respective visit and mean outdoor temperature during the preceeding 30 days were significantly associated with CIT (p = 0.021 and p = 0.001, respectively).Conclusion: Restoring euthyroidism significantly increases CIT in hypothyroid humans.

Uloga hipotiroidizma u nastanku metaboličkog sindroma i hepatične steatoze

Uloga hipotiroidizma u nastanku metaboličkog sindroma i hepatične steatoze

Hypothyroidism and hyponatremia: data from a series of patients with iatrogenic acute hypothyroidism undergoing radioactive iodine therapy after total thyroidectomy for thyroid cancer.

The aim of the present study was to evaluate the role of hypothyroidism as a cause of hyponatremia in a clinical model of iatrogenic acute hypothyroidism due to thyroid hormone withdrawal prior to ablative radioactive iodine (RAI) therapy after total thyroidectomy. The study group consisted of 101 differentiated thyroid cancer (DTC) patients (77 women and 24 men). Plasma concentration of thyroid-stimulating hormone ([TSH]) and sodium ([Na+]) was evaluated before total thyroidectomy (pre[TSH] and pre[Na+]) and on the day of RAI therapy (post[TSH] and post[Na+]). The frequency of hypothyroidism-associated hyponatremia was 4% (4/101). Pre[Na+] was significantly higher than post[Na+] (140.7±1.6 vs 138.7±2.3mEq/L, p=0.012). Moreover, a linear correlation was identified between pre[Na+] and post[Na+]. Iatrogenic acute hypothyroidism-related hyponatremia is uncommon. However, because of the significant reduction of [Na+] in the transition from euthyroidism to iatrogenic hypothyroidism, the value of pre[Na+] should be viewed as a parameter to be considered. Since it acts as an independent risk factor for the development of hyponatremia, patients with a pre[Na+] close to the lower limit of normal range may deserve a closer monitoring of [Na+].

Role of hypothyroidism in obstructive sleep apnea: a meta-analysis

Objective: This study evaluates the role of hypothyroidism in obstructive sleep apnea (OSA) by comparing the OSA indices in hypothyroid OSA (OSA-HYPOT) with euthyroid OSA (OSA-EUTHY) patients. Methods: After literature search in several electronic databases and selection of studies by following eligibility criteria, meta-analyses of mean differences/standardized mean differences were performed to compare OSA indices at the time of diagnosis between OSA-HYPOT and OSA-EUTHY patients. Metaregression analyses were carried out to examine the relationship between age, BMI, sample size, and gender vs OSA indices in OSA-HYPOT patients. Results: Twelve studies and five case reports recruiting 192 OSA-HYPOT and 1423 OSA-EUTHY patients were included in the meta-analysis. Prevalence (mean ± SD) of clinical hypothyroidism in OSA patients was 8.12 ± 7.13% and that of subclinical hypothyroidism 11.07 ± 8.49%. Apnea–Hypopnea Index, time of sleep with oxygen desaturation <90%, and Epworth Sleepiness Scale were significantly higher in the OSA-HYPOT patients at diagnosis, whereas there was no significant difference in arousal index, respiratory disturbance index and sleeping efficiency between OSA-HYPOT and OSA-EUTHY patients. Body mass index was positively associated with Apnea–Hypopnea Index in OSA-HYPOT patients. Conclusions: Hypothyroidism is found to be associated with severity of OSA. However, obesity can be a confounder in the outcomes observed herein.

Prevalence of hypothyroidism in patients with biliary stones: a prospective study

Background: Biliary stones (gall bladder stones and common bile duct stones) are hardened concretions that develop due to supersaturation of bile. The known risk factors for development of biliary stones include genetics, body weight, high fat diet, diabetes, women taking estrogen containing pills and decreased motility of gall bladder. Of late there has been discussion whether hypothyroidism could lead to formation of biliary stones. Aim of our study is to analyze the prevalance of hypothyroidism in patients of biliary stones and subsequently finding a correlation between hypothyroidism and formation of biliary stones. Methods: The present study was conducted on 100 patients of biliary stones admitted in inpatient department of Surgery at SGRDIMSAR, Amritsar. Their fasting thyroid and lipid profiles were tested to study the prevalence of hypothyroidism in these patients of biliary stones. Results: Percentage of males with gall stones who were diagnosed as hypothyroid, euthyroid and hyperthyroid is 24%, 64% and 12% respectively. Whereas males with common bile duct (CBD) stones who were hypothyroid, euthyroid and hyperthyroid were 18%, 62.5% and 18.75% respectively. Percentage of females with gall stones diagnosed hypothyroid, euthyroid and hyperthyroid was 24.4%, 65.85% and 1% respectively. Percentage of females with common bile duct stones who were hypothyroid, euthyroid and hyperthyroid were 27.7%, 61.1% and 1.1% respectively. Conclusions: We therefore conclude that the role of hypothyroidism with respect to biliary stone formation in human beings is currently not well investigated and further research is needed.

Activation of brown adipose tissue in hypothyroidism

Background Brown adipose tissue (BAT) attracts growing interest as a potential therapeutic target for obesity and diabetes. Hyperthyroidism is well-known to increase BAT activity, but the role of hypothyroidism is controversial. We aimed to investigate the association between different thyroid hormone (TH) states and BAT activity.Methods FDG-PET studies were retrospectively evaluated in thyroid cancer patients after total thyroidectomy both at euthyroidism during TH replacement or at hypothyroidism after TH cessation. Serum TH levels were compared between patients with active BAT and control patients with non-active BAT matched for age, gender, and body mass index. Additionally, animal experiments with controls (n = 5) and hypothyroid rats (n = 5) were performed.Results Out of 124 patients, 6 patients with active BAT were identified. These patients showed significantly higher thyroid-stimulating hormone (TSH) levels than matched controls (P < 0.05). In animal experiments, all hypothyroid animals showed BAT activation at room temperature (24 °C), whereas controls did not (P < 0.001). Increased BAT activity was also confirmed by increased expression of UCP-1 and D2.Conclusions Increased BAT metabolism appears to be related with hypothyroidism, which might be the result of a feedback mechanism to maintain body temperature in a state of reduced basal thermogenesis. Future research needs to explore the underlying mechanistic and biological implications.Key MessagesIncreased brown adipose tissue (BAT) metabolism appears to be related with hypothyroidism, which might be the result of a feedback mechanism to maintain body core temperature in a state of reduced basal thermogenesis.