Routine Thyroid Function Tests Research Articles

Comparative Study of Subclinical Hypothyroidism in Patients with and Without Metabolic Syndrome

Background: A group of metabolic abnormalities known as metabolic syndrome (MetS) greatly raises the risk of type 2 diabetes mellitus and cardiovascular illnesses. People with MetS frequently have subclinical hypothyroidism (SCH), which is defined by high levels of thyroid-stimulating hormone (TSH) with normal free thyroxine (T4). The research examined the relationship between thyroid function and metabolic parameters, as well as to assess the incidence of subclinical hypothyroidism in individuals with and without MetS. Methods: There were 960 participants in all, 480 of whom had a diagnosis of MetS and 480 of whom were healthy controls. Blood pressure and waist circumference were measured clinically. After an overnight fast, blood samples were taken utilising fully automated clinical chemistry and hormone analyzers to assay lipid profile, fasting blood glucose (FBG), and thyroid function tests (T3, T4, and TSH). The Pearson correlation coefficient and Student's t-test were used to analyse the data. Results: Statistically, there was a significant variation in the prevalence of subclinical hypothyroidism between the MetS group (16.3%) and the control group (5%; p < 0.001). In addition to having decreased HDL cholesterol, MetS patients also had higher FBG, blood pressure, triglycerides, and waist circumference. TSH levels and the elements of MetS, such as waist circumference (r = 0.41, p < 0.001), systolic blood pressure (r = 0.38, p < 0.001), FBG(r = 0.44, p < 0.001), triglycerides (r = 0.39, p < 0.001), and HDL cholesterol (r = -0.32, p < 0.001), were found to be significantly correlated with each other. Conclusion: The results of the study indicate that people with metabolic syndrome have a higher incidence of subclinical hypothyroidism, which may indicate a relationship between thyroid function and metabolic health. Regular thyroid function testing could help improve clinical outcomes by enabling early detection and management of SCH in MetS patients. Recommendations: When treating patients with metabolic syndrome, healthcare professionals should think about doing routine thyroid function tests. To manage thyroid dysfunction in patients with metabolic syndrome (MetS), further research is required to investigate the underlying mechanisms and create tailored therapies. Keywords: Metabolic Syndrome, Subclinical Hypothyroidism, Thyroid Function, Cardiovascular Risk, Metabolic Health

Low Utility of Routine Thyroid Function Testing for Bowel Symptoms: A Population-Based Assessment.

Chronic constipation, diarrhea, and fecal incontinence (FI) are prevalent with significant impact on quality of life and healthcare utilization. Thyroid dysfunction was recognized as a potential contributor to bowel disturbances in selected populations, but the strength/consistency of this association remain unclear. To investigate the relationship between thyroid function and bowel health measures (constipation, diarrhea, and FI) in a nationally representative sample of the U.S. We conducted a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) in 2005-2008. Adults aged ≥ 20 with TSH, free T4 (fT4), and bowel health data were included. Multivariable logistic regression models were constructed to examine associations between thyroid function and bowel health measures, adjusting for potential confounders. Among 6,552 participants, 93.6%, 4.3%, 1.7%, and 0.4% had TSH levels of 0.24-5.4, 5.4-10, < 0.24, and ≥ 10 mIU/L, respectively. There were no significant differences in prevalence of thyroid dysfunction between individuals with constipation or diarrhea and those without. In fully adjusted models, TSH was not a significant predictor of constipation, diarrhea, or FI, but higher fT4 was protective against constipation as a continuous variable (OR 0.47, CI: 0.26-0.85, p = 0.014)). Neither hypothyroid nor hyperthyroid status significantly correlated with constipation or diarrhea, although hyperthyroidism was associated with FI (OR 3.58, CI:1.51-8.49, p = 0.005). While bowel disturbances were common in this nationally representative sample, the yield of thyroid function testing was low. Overt hypo- and hyperthyroidism were not significantly associated with constipation or diarrhea. Clinical utility of routine thyroid testing for bowel symptoms may be low in patients without systemic manifestations of severe thyroid disease.

Optimizing Care for Primary Glomerulonephritis: The Role of Thyroid Evaluation.

The coexistence of primary glomerulonephritis and autoimmune thyroid disease has not been investigated. This study aimed to assess thyroid morphology using sonography, determine the prevalence of autoimmune thyroid disorders, and evaluate thyroid function status in patients diagnosed with primary glomerulonephritis. This single-center cross-sectional and observational study included 58 consecutive patients with primary glomerulonephritis and 58 healthy controls (HC). All participants underwent thyroid examination through laboratory tests and thyroid ultrasonography. The findings were subsequently compared between the two groups. Among the patients, 17.2% (n = 10) exhibited subclinical hypothyroidism, while 8.6% (n = 5) had overt hypothyroidism. None of the HCs showed overt hypothyroidism, whereas 3.4% (n = 2) of them exhibited subclinical hypothyroidism. Patients displayed significantly lower free triiodothyronine (FT3) levels than HCs (p < 0.001). A linear correlation was observed between patients' thyroid-stimulating hormone (TSH) levels and the degree of proteinuria (p = 0.044). Furthermore, thyroid volume (p < 0.001), hypoechogenicity (p < 0.001), heterogeneous structure (p < 0.001), pseudonodular hypoechoic infiltration (p = 0.05), and the presence of nodules (p < 0.001) were notably higher in patients compared to HCs. The prevalence of both overt and subclinical hypothyroidism, along with the frequency of nodular goiter, was found to be elevated in patients with primary glomerulonephritis. Considering that primary glomerulonephritis predominantly afflicts young individuals, and these patients bear the lifelong burden of chronic kidney disease, we underscore the significance of routine thyroid function tests and sonographic examinations for the early detection of thyroid disorders.

Management Aspects of Medical Therapy in Graves Disease.

Graves disease (GD) is the most common cause of hyperthyroidism. Treatment options include antithyroid drugs (ATDs), radioactive iodine, and surgery. In this review, we focus on the medical aspects of managing GD. The authors conducted a literature review of PubMed to include studies and review articles on GD management, ATDs, long-term safety of antithyroid drugs, hyperthyroidism in pregnancy, Graves ophthalmopathy, and special circumstances related to hyperthyroidism. In adjunction to ATDs, medical management for GD also includes beta-blockers, glucocorticoids, and iodine containing agents. ATDs are currently the preferred option for initial management of GD, reflecting a shift in practice observed in the United States over the past 2 decades. ATDs in appropriate doses are well-tolerated and safe when used for longer duration, during pregnancy, and other circumstances discussed in this article. Routine thyroid function tests are important for monitoring. Thyrotropin receptor antibody plays an essential role in determining duration of treatment and assessing the likelihood of recurrence. Medical management of GD with antithyroid drug is safe and effective. Long-term use beyond 24 months in patients with elevated thyrotropin receptor antibody is a reasonable alternative option to surgery and radioactive iodine due to higher rates of remission.

8581 Unusual Case of Multifactorial Hyperthyroidism

Abstract Disclosure: D.D. Bagar: None. E. Meyers: None. M. Correia: None. Background: Nivolumab is an immune checkpoint inhibitor that is used to treat specific types of cancer, including melanoma, by increasing the ability of the immune system to detect cancer through activating cytotoxic T-cells. The side effects of immune checkpoint inhibitors are mainly through the overactivation of the immune system that can affect many organs with autoimmune diseases, including endocrine glands, which could be severe and irreversible, like hypothyroidism or immune thyroiditis. The uniqueness of this case is the presence of multifactorial causes of hyperthyroidism; in addition, it is one of the few cases of immune checkpoint inhibitor induced positive TSI thyroiditis.Clinical Case: An 82-year-old male with a known history of atrial fibrillation on amiodarone presented to his dermatologist with a left forearm lesion. A shave biopsy showed melanoma, and he underwent wide local excision with negative sentinel lymph node biopsy. However, he had significant melanoma in situ present within 5 mm of the margin and was deemed not a candidate for further excision. Tumor board recommended close surveillance. He then received two cycles of pembrolizumab for one year, followed by nivolumab. During his treatment course, he had CT scans with iodinated contrast every 8-12 weeks for the clinical trial. At his clinic visit, routine thyroid function tests were significant for hyperthyroidism with a TSH &amp;lt;0.01 and free T4 of 6.07 (0.8-1.8). He was asymptomatic except for unintentional weight loss. He denied using any biotin supplements. His labs also showed positive thyroid stimulating immunoglobulin (TSI) of 1.10 (&amp;lt;=0.54 IU/L). A thyroid US with doppler showed two nodules less than 1.1 cm and no increased vascularity. Amiodarone was discontinued, and prednisone and methimazole were started. His free T4 has since normalized and both prednisone and methimazole are being tapered down. Conclusion: This case is a multifactorial cause of hyperthyroidism. He had been using amiodarone for atrial fibrillation, had multiple imaging studies with iodinated contrast, and was on immune checkpoint inhibitor therapy with a positive TSI. The uniqueness of this case is not only that combined factors can affect thyroid function but also that he developed a positive TSI, which indicates either Graves’ disease or immune-induced thyroiditis by nivolumab, which has been reported only in a few cases. Presentation: 6/3/2024

8581 Unusual Case Of Multifactorial Hyperthyroidism

Abstract Disclosure: D.D. Bagar: None. E. Meyers: None. M. Correia: None. Background: Nivolumab is an immune checkpoint inhibitor that is used to treat specific types of cancer, including melanoma, by increasing the ability of the immune system to detect cancer through activating cytotoxic T-cells. The side effects of immune checkpoint inhibitors are mainly through the overactivation of the immune system that can affect many organs with autoimmune diseases, including endocrine glands, which could be severe and irreversible, like hypothyroidism or immune thyroiditis. The uniqueness of this case is the presence of multifactorial causes of hyperthyroidism; in addition, it is one of the few cases of immune checkpoint inhibitor induced positive TSI thyroiditis.Clinical Case: An 82-year-old male with a known history of atrial fibrillation on amiodarone presented to his dermatologist with a left forearm lesion. A shave biopsy showed melanoma, and he underwent wide local excision with negative sentinel lymph node biopsy. However, he had significant melanoma in situ present within 5 mm of the margin and was deemed not a candidate for further excision. Tumor board recommended close surveillance. He then received two cycles of pembrolizumab for one year, followed by nivolumab. During his treatment course, he had CT scans with iodinated contrast every 8-12 weeks for the clinical trial. At his clinic visit, routine thyroid function tests were significant for hyperthyroidism with a TSH &amp;lt;0.01 and free T4 of 6.07 (0.8-1.8). He was asymptomatic except for unintentional weight loss. He denied using any biotin supplements. His labs also showed positive thyroid stimulating immunoglobulin (TSI) of 1.10 (&amp;lt;=0.54 IU/L). A thyroid US with doppler showed two nodules less than 1.1 cm and no increased vascularity. Amiodarone was discontinued, and prednisone and methimazole were started. His free T4 has since normalized and both prednisone and methimazole are being tapered down. Conclusion: This case is a multifactorial cause of hyperthyroidism. He had been using amiodarone for atrial fibrillation, had multiple imaging studies with iodinated contrast, and was on immune checkpoint inhibitor therapy with a positive TSI. The uniqueness of this case is not only that combined factors can affect thyroid function but also that he developed a positive TSI, which indicates either Graves’ disease or immune-induced thyroiditis by nivolumab, which has been reported only in a few cases. Presentation: 6/3/2024

Thyroid Profile in Liver Cirrhosis Patients-Correlation with Disease Severity and Recommendations for Clinical Practice: A Cross-sectional Observational Study.

Liver diseases are increasingly recognized as significant public health concerns in India, prompting investigations into novel approaches for assessing disease severity and prognosis. Recognizing the potential utility of thyroid hormone levels in these assessments, we conducted an observational cross-sectional study at our tertiary care hospital. Our study included 89 patients aged 12 years and above, admitted to medicine wards with ultrasound-diagnosed liver cirrhosis, excluding pregnant women and those on thyroid-altering medications. Our findings revealed a male-to-female ratio of 4.23:1, with the majority of patients falling within the 40-60 age-group, averaging 46.93 years. Notably, 87.6% of patients exhibited thyroid abnormalities, primarily low free T3 (FT3) syndrome and subclinical hypothyroidism. Classifying patients according to Child-Pugh (CP) score, 2.2% were CP class A, 22.5% were CP class B, and the remaining 75.3% were CP class C. Across all CP classes, low FT3 syndrome was prevalent, particularly in CP class C. Correlations between thyroid hormone levels and liver disease severity, assessed via CP and model for end-stage liver disease (MELD) scoring systems, were observed. Specifically, FT3 levels demonstrated a negative correlation with liver disease severity (p = 0.001), while no significant correlations were found for free T4 (FT4) and thyroid-stimulating hormone (TSH) levels. Based on our findings, we recommend routine thyroid function testing for all liver cirrhosis patients, irrespective of disease severity, to facilitate early detection and intervention. However, our study had limitations, including a small sample size and a precision error of 10% due to resource constraints for thyroid function testing. Moreover, reliance solely on ultrasound for liver cirrhosis diagnosis may lead to missed diagnoses, highlighting the need for complementary noninvasive tests such as FibroScan and aspartate aminotransferase to platelet ratio index (APRI) scores. Our study underscores the importance of considering thyroid function in the management of liver cirrhosis patients and provides valuable insights for enhancing clinical practice in this context.

Approach to management of hypo and hyperthyroidism in Bangladesh: a nationwide physicians' perspective survey.

Thyroid disorders are common clinical conditions globally. The objective of the present study was to evaluate the physicians' approach to the diagnosis and treatment of thyroid disorders in Bangladesh. The present nationally representative cross-sectional study was conducted among 662 physicians of different levels (general practitioners as well as specialists) from different hospitals in Bangladesh from January to June 2023. A self-administered semi-structured questionnaire including information about demographics and practice patterns for the diagnosis and management of thyroid disorders was used for data collection. Descriptive statistics were used to analyze the data. The American Thyroid Association (ATA) guidelines were the most commonly followed guidelines for the diagnosis and management of thyroid disorders (60%), followed by the American Association of Clinical Endocrinologists (AACE) guidelines (18%) and the European Thyroid Association (ETA) guidelines (9%). Serum TSH, free T3 and free T4 levels were the most frequently used diagnostic tests for the evaluation and follow-ups of both hypothyroid and hyperthyroid states in adults, pregnant women and children, followed by total T3 and total T4 levels. Other tests, such as anti-TPO antibody, anti-TG antibody, anti-TPO, ultrasound scan of the thyroid gland, etc., were rarely used by the participating physicians. Levothyroxine at a dose of 25 to 50 mcg and carbimazole at a dose of 30 to 45 mg were the most frequently used drugs for hypothyroid and hyperthyroid patients, respectively. Almost 65% of the physicians suggested routine thyroid function tests before surgery. In addition, more than 90% of the physicians agreed that thyroid screening for pregnancy, neonates, school children and adults would be mandatory. The majority of the physicians participating in our study followed relevant guidelines for the diagnosis and management of thyroid disorders in Bangladesh. However, there are still some gaps to be improved, as a good number of physicians did not follow specific guidelines for these disorders.

Study of Feto-Maternal Outcome in Pregnancy with Subclinical Hypothyroidism

Background: Hypothyroidism has a great impact on pregnancy. But there is a controversy about the maternal and perinatal outcomes of subclinical hypothyroidism (SCH). This study was placed to know the significant effects. Methods and Materials: A descriptive longitudinal study was held in Z. H. Sikder Women’s Medical College &amp; Hospital, Dhaka, Bangladesh. 400 pregnant women were included in this study with purposive sampling. All antenatal patients from booking visit at 1st trimester to delivery were monitored by serum TSH and serum FT4 levels in each trimester and fetal outcomes were also monitored. 200 pregnant women were diagnosed as subclinical hypothyroidism (SCH) with random screening of initial thyroid function tests. Another 200 pregnant women were euthyroid. The study period was 3 years, from January 2020 to December 2022. To evaluate the thyroid status, maternal serum samples were collected in each trimester, total three times. Maternal outcomes, which we studied, were gestational hypertension, gestational diabetes mellitus, maternal anemia, antepartum hemorrhage, postpartum hemorrhage, placental abruption, preterm delivery, premature rupture of membranes (PROM), caesarean deliveries; perinatal outcomes were low birth weight (LBW), intrauterine growth restriction (IUGR), low Apgar score, stillbirth, congenital anomaly and NICU admission. Result: This study includes 400 pregnant women, among which 200 were euthyroid and 200 were with SCH. The mean age was 27.12 ± 0.05 years in pregnancy with euthyroid group and 26.31 ± 0.25 in pregnancy with SCH group. Among the pregnancy with euthyroid group, 141 women were nullipara and 59 women were nullipara. Among the pregnancy with SCH group, 87 women were nullipara and 113 women were nullipara. Serum TSH level was 4.44 ± 0.11 in 1st trimester, 4.74 ± 0.19 in 2nd trimester, 5.45 ± 0.17 in 3rd trimester. Serum free T4 level was 8.29 ± 0.13 in 1st trimester, 6.65 ± 0.15 in 2nd trimester, 6.67 ± 0.34 in 3rd trimester. In pregnancy with SCH group gestational hypertension, miscarriage, placental abruption and premature rupture of membranes (PROM) were significantly higher (p&lt;0.001). Antepartum hemorrhage (APH), preterm delivery and Caesarian deliveries were also higher in this group (p&lt;0.05). Among the neonatal outcomes, low birth weight and intrauterine growth restriction (IUGR) babies were more born in pregnancy with SCH group. Anti TPO antibody titer was significantly higher in pregnant women with SCH. Conclusion: Subclinical hypothyroidism (SCH) is associated with increased risk of gestational hypertension, premature rupture of membranes (PROM), abruptio placentae and fetuses have more risk of IUGR and LBW. Therefore, routine maternal thyroid function test should be done to protect from adverse maternal and fetal outcome.

Evaluation of Efficacy and Safety of Nivolumab in Treatment of Relapsed/Refractory Classical Hodgkin Lymphoma at King Abdulaziz Medical City-Jeddah/the Kingdom of Saudi Arabia Experience

Introduction: Hodgkin's lymphoma (HL) is one of the most common lymphoid cancers. Preclinical studies suggest that Reed-Sternberg cells exploit the programmed death 1 (PD-1) pathway to evade immune detection. In classic Hodgkin's lymphoma, alterations in chromosome 9p24.1 increase the abundance of the PD-1 ligands, PD-L1 and PD-L2, and promote their induction through Janus kinase (JAK)-signal transducer and activator of transcription (STAT) signaling. Nivolumab, an immune checkpoint inhibitor, which has shown great efficacy in relapsed/refractory cHL (R/R cHL) in multiple clinical trials. The aim of this study is to evaluate the efficacy and safety of Nivolumab in R/R cHL patients treated at King Abdulaziz Medical City in Jeddah-Kingdome of Saudi Arabia Methods: We conducted a retrospective analysis on all patients received nivolumab for R/R cHL at King Abdulaziz Medical City, Jeddah, Saudi Arabia. From introduction of nivolumab in our center till the present time, it was used in a total of 21 patients, all of them were included in our analysis. Data of these patients were entered into an Excel sheet, and analyzed using SPSS software version 25.0. Statistical significance was determined as (P&amp;lt;0.05). Results: Total of 21 patient were included in this analysis. The average age of the participants was 26 years, almost equal gender distribution, 63% were advanced stage, 72% were nodular sclerosis subtype. Patients had received a median of 5 prior regimens (range 4-7). 12 patients received Nivolumab as post-ASCT salvage and 9 patients did not undergo ASCT prior Nivolumab treatment. The number of treatment cycles with Nivolumab ranged between 3 and 121, with an average of 31 cycles. Overall response rate (ORR) was 84.2% includes 52.6% of patients has achieved complete response (CR). In the patients who received the Nivolumab as post-ASCT salvage, 40% had CR, 20% had PR, 10% had stable disease and 30% had disease progression. ORR was 60% and 40% of those patients had disease progression later. 28.6% of the patients studied were still on Nivolumab, and the main reason for stopping the Nivolumab was the disease progression. Nine patients still required treatment after Nivolumab. Our study showed that neutropenia and hypothyroidism were the most common adverse effects of Nivolumab therapy, 33.3%, and 19.0%, respectively, whereas fatigue, tachycardia, fever, itching, pneumonitis and cough were less common, 4.8% for each. Conclusion: Nivolumab is a safe drug and could be given to patients with HL. However, neutropenia and hypothyroidism were the most common adverse effects; therefore, routine complete blood count and thyroid function tests should be obtained. Regarding the efficacy of Nivolumab, our results revealed relatively low survival and response rates.

SAT594 Thyroid Dysfunction Is Very Common In Patients With Pheochromocytoma And Paraganglioma: A Cross-sectional Study

Abstract Disclosure: C. Ramirez-Renteria: Speaker; Self; Ipsen. M. Garcia-Saenz: None. N. Morin-Martinez: None. A. Albarran-Sanchez: None. Background: Thyroid function abnormalities are reported in 8-9% of the general population, but the prevalence may change according to different ages, populations, iodine intake, etc. Preoperatory evaluations for pheochromocytoma (Pheo) and paragangliomas (PGN) don’t include routine thyroid function tests, but uncontrolled hypo- or hyperthyroidism may result in adverse effects outcomes during surgery. Aim: to describe the frequency of thyroid function abnormalities in patients evaluated for Pheo and PGN in a referral center. Materials and Methods: All the medical files of adult patients evaluated for Pheo or PGN between January 2018 and December 2022 were reviewed. The available clinical, biochemical, imaging, and pathology data confirming the diagnosis were retrieved. We determined the frequency of patients with a previous diagnosis of thyroid disease, type of disease, and date of diagnosis and recorded the data of patients without a diagnosis but that had their thyroid function tested during the perioperative evaluation. Results: 359 patients with Pheo/PGN were evaluated, 72.7% had a neck PGN, 88% were women and the median age at diagnosis was 56.5 years (IQR 45-66), thyroid function tests were performed in 51.3%, and only 22.8% were normal, 20.9% had primary hypothyroidism, 3.9% had hypothyroidism after a procedure, 2.5% had hyperthyroidism, and 1.1% had thyroiditis. The patients with neck PGN were the most likely to present with hypothyroidism (p=0.006) and they were also the most likely to have hypothyroidism during follow-up, Abnormal thyroid images were found in 19.2%. Thyroid dysfunction was detected before the tumor in 21.5%, during the evaluation of the tumor in 25.8%, and after in 52.7%. Hypertensive cardiomyopathy was more common in patients with abnormal thyroid function (OR 1.969, CI 95% 1.052-3.685, p=0.032), as well as cardiomegaly (OR 2.145, CI 95% 1.200-3.835) and hypertension (OR 1.937, CI95% 1.269-2.956). Conclusions: Pheo/PGN are frequently associated with thyroid dysfunction. Heart disease and hypertension are more common in patients with both comorbidities. Thyroid function tests are suggested during perioperative evaluation in patients with a history of thyroid disease, thyroid abnormalities in imaging, poor blood pressure control, or heart disease. Thyroid function may require an additional evaluation in some cases during the follow-up of Pheo/Para. Presentation: Saturday, June 17, 2023

EFFECT OF SUBCLINICAL HYPOTHYROIDISM ON MATERNAL AND PERINATAL OUTCOME

Background:Adverse maternal outcomes and perinatal complications are closely associated with overt maternal hypothyroidism, but whether these complications occur in women with subclinical hypothyroidism (SCH) during pregnancy remains controversial.The aim of this study was to evaluate the effects of SCH on maternal and perinatal outcomes during pregnancy. Methods:This retrospective cohort study was conducted by examining the pregnant women who applied to the Gynaecology Department of Hind Institute of Medical Sciences and Hospital at their 6th to 14th gestational weeks and had antenatal follow-ups between February 1, 2021 and December 31, 2022. Results: The TSH concentration was significantly lower in the first trimester than in the third trimester (P,0.001). The fT4 concentration was higher in the first trimester than in the second and third trimesters (P,0.001). The incidences of GH and PROM were significantly higher in women with SCH than in euthyroid women (5% vs. 1.57%, P= 0.020 10% vs. 5%, P= 0.002).IUGR was more frequent in women with SCH than in euthyroid women (7.5% vs. 1.3%, P,0.001). More LBW infants were delivered in the SCH group than in the euthyroid group (12.5% vs. 5%, P,0.001). Conclusion:The results of this study indicate that pregnant women with SCH had increased risks of GH and PROM, and their foetuses and infants had increased risks of IUGR and LBW. Thus, routine maternal thyroid function testing is necessary to improve maternal and perinatal outcomes.

Prevalence of Cerebellar Ataxia in Patients with Hypothyroidism

Objectives: To determine the prevalence of cerebellar Ataxia in patients with hypothyroidism. Materials and Methods: The design of this study was cross sectional study design and this study was conducted in Shaheed Mohtarma Benazir Bhutto Medical University, Larkana. This study was conducted in the duration of 6 months from July 2022–Dec 2022. Total 13 patients with hypothyroidism were enrolled. Routine blood investigation and Thyroid Function Tests were done for all patients. MRI was done for all patients in order to rule out demyelinating, vascular and structural causes of cerebellar ataxia. All the data was collected in predesigned questioner. Results: A total of 13 patients with mean age of 50.92±11.21 years were enrolled. Out of total, 69.2% patients were male and 30.8% patients were female. Clinical characteristics of enrolled patients are given in table 1-0. The mean and SD value of T3, T4 and TSH were 50.9±11.21, 2.80±0.63 and 77.30±10.57 respectively. The TPO antibodies test were performed that shows mean value of 31.15±3.38, that fall in normal range. And MRI brain was also normal. Distribution of patients on the basis of Ataxia was done and it was found that 4 (30.8%) had ataxia. Practical implication: This study will help the clinical practitioner to keep in mind that there is chance of ataxia in patients suffering from hypothyroidism. So the clinical practitioner should take care of the patients to avoid such complication. There is evidence that the ataxia has been reversed by thyroid replacement therapy. Conclusion: It is concluded that Hypothyroidism is responsible to cause cerebellar ataxia. Therefore early treatment should be taken to avoid this manifestation. Keywords: Cerebellar Ataxia, hypothyroidism, Thyroid Function Tests

Frequency of Hyperthyroidism in patients of Atrial Fibrillation

Aim: To find the frequency of hyperthyroidism in patients of atrial fibrillation admitted in Mayo hospital Lahore. Study setting: The study was conducted at Emergency Department, Cardiology Department and Department of Internal Medicine in Mayo Hospital Lahore\ Duration of study: It was from May 20, 2019 to November 20, 2019. Study design: It was Cross-Sectional study\ Methods: patients suffering with atrial fibrillation fulfilling the operational definition and inclusion criteria were enrolled. After aseptic measures, blood sample of 5 ml was drawn from left cubital vein with low sucking pressure. Sample was deposited to Center for Nuclear Medicine (CENUM) Laboratory at Mayo Hospital Lahore for thyroid function tests. Serum Thyroid Stimulating Hormone, Thyroxine and Triiodothyronine levels were noted and hyperthyroidism labeled as per the operational definition. Data was collected by the researcher himself noted on a specially designed proforma and presented in the form of tables and diagrams. Results: The mean value of age in our study was 55.13±14.01 year. In our study 40(42.6%) patients had hyperthyroidism. Conclusion: High frequency of hyperthyroidism in our study, suggests that routine thyroid function tests using sensitive thyroid-stimulating hormone assay with free T4 &amp; free T3 levels is required in all those with acute atrial fibrillation. Keywords: Hyperthyroidism, Atrial Fibrillation.

A study of foetomaternal outcome among pregnant hypothyroid women

During pregnancy one of the most common endocrinological disorder which are very often overlooked during pregnancy because of their nonspecific symptoms and the hypermetabloic state of pregnancy is Thyroid disorder. Optimal maternal thyroid function during pregnancy is important for both the mother and fetus.The study was planned to determine the prevalence of hypothyroidism using the classical reference range of normal serum TSH as 0.4-6.2μIU/L. It also aimed to study the foetomaternal outcome among pregnant hypothyroid women, using the classical reference range and a lower cut off (&amp;#60;3μIU/L) of TSH for diagnosing hypothyroidism in pregnancy.This was a longitudinal prospective study conducted in the Department of Obstetrics &amp; Gynaecology, Suryanagari Hospital, in collaboration with the Departments of Endocrinology, Laboratory Medicine &amp; Paediatrics. Before starting the study, clearance was taken from ethical committee of the hospital. A total of 522 pregnant women attending the antenatal OPD were recruited to determine the prevalence of hypothyroidism on the basis of TSH evaluation. With our study we concluded that these very high prevalence of hypothyroidism in India and routine maternal thyroid function testing must be done as soon as pregnancy is confirmed thus saving lives of many infants who could lead rest of their lives happily and prosperously.

Thyroglobulin as an Evolving Biomarker of Iodine Reserve in Thyroid Dysfunction Assessment in Pregnancy

Background: Despite the use of routine thyroid function tests, thyroid dysfunction is often missed in pregnant women, who may have fluctuating iodine reserves and this may be associated with an increased risk of adverse maternal and fetal outcomes due to thyroid dysfunction. Therefore, thyroglobulin (Tg) as a marker of iodine reserve may be added to improve the diagnostic value of the thyroid testing panel. Materials and Methods: This study was a multicenter descriptive cross-sectional study with 501 healthy pregnant women, carried out over 9 months, in which blood and urine (spot) specimens were collected and analysed for serum thyroid-stimulating hormone, free thyroxine, free triiodothyronine, and Tg using enzyme-linked immunosorbent assay, and urinary iodine concentration by modified Sandell–Kolthoff reaction. Results: The prevalence of thyroid dysfunction in pregnant women using thyroid function tests alone was 12.4% (62) with 9.6% (48) being hypothyroid and 2.0% (10) hyperthyroid. The addition of Tg was able to identify more participants with thyroid dysfunction who were iodine deficient, and initially missed using thyroid function tests alone. This newly added biomarker to routine thyroid function tests profile increased the prevalence of thyroid disorders in this study population from 12.4% (62) to 17.6% (88) (P &lt; 0.01), whereas urine iodine concentration was adequate for each trimester falling within the WHO range of 150–249 μg/l. Conclusion: The true prevalence of thyroid dysfunction in pregnant women in Makurdi was 17.6%. The addition of Tg had an impact on thyroid function tests by identifying more participants with iodine-related thyroid dysfunction, who were missed in the initial assessment of the thyroid. The mean urine iodine concentration was adequate, falling within the WHO range of 150–249 μg/l.

Influence of Mild Thyroid Dysfunction on Outcomes after Off-Pump Coronary Artery Bypass Surgery.

We retrospectively evaluated the association between preoperative mild thyroid dysfunction (subclinical hypothyroidism [SCH] or low triiodothyronine [T3] syndrome) and outcomes in patients who underwent off-pump coronary surgery (OPCAB). Further, 800 patients (2015–2020) were divided into euthyroid, low T3, and SCH groups. The primary outcome assessed the association with composite endpoints (myocardial infarction, prolonged mechanical ventilation [>24 h], acute kidney injury, and 30-day/in-hospital mortality). The secondary outcome assessed the association with long-term mortality and 10% and 8% of the patients exhibited low T3 and SCH, respectively. Incidences of composite endpoints were significantly higher in the low T3 and SCH groups versus the euthyroid group (50.6%, 45.2%, 17.4%, respectively, p < 0.001). Multivariable regression analysis revealed chronic kidney disease, anemia, EuroSCORE, low T3, and SCH as independent risk factors of composite endpoints. The long-term mortality rate (median follow-up, 30 months) was higher in the low T3 and SCH groups than in the euthyroid group (9.6%, 11.3%, 2.4%, respectively, p < 0.001). In the absence of overt thyroid dysfunction, low T3 and SCH were associated with increased risk of adverse outcomes after OPCAB. Moreover, the adverse influences of low T3 and SCH seem to extend to long-term mortality, implying that routine thyroid function tests may enhance accurate risk stratification.

Abnormal Calcium, Calcinosis, and Creatinine in Down's syndrome

The hypercalcaemia in association with trisomy 21 (Down's syndrome) is often not recognised and therefore underdiagnosed. Patients present with the tetrad of hypercalcaemia, Down’s syndrome, renal impairment, and nephrocalcinosis. 1-3 A 30-month old child with Down’s syndrome had a long history of nonspecific symptoms, constipation and feeding difficulties. He was on excessive bottle feeds, taking 14 bottles daily, each with six ounces of milk. He presented with a cardiac arrest having been unwell with an acute illness. Blood tests showed hypercalcemia, raised urea and creatinine which were not explained by any other aetiologies. Post-mortem analysis showed acute pyelonephritis and nephrocalcinosis. In children with Down’s syndrome, early detection of hypercalcaemia and introduction of low calcium feeds may prevent morbidity and mortality. Awareness and monitoring of serum calcium levels along with routine thyroid function tests in children with Down syndrome, would be important to prevent such occurrences.

O-129 Subclinical hypothyroidism and antithyroid autoantibodies in women with subfertility or recurrent pregnancy loss: a scientific impact paper

Abstract Study question How should subclinical hypothyroidism (SCH) and autoimmune thyroid disease (ATD) be managed in women with subfertility or recurrent pregnancy loss? Summary answer This Royal College of Obstetricians and Gynaecologists (RCOG) scientific impact paper provides evidence based recommendations on the testing for and management of SCH and ATD. What is known already Subclinical hypothyroidism and autoimmune thyroid disease have been linked to adverse pregnancy outcomes such as miscarriage and premature birth. There is debate about whether there should be routine testing of thyroid function in both the general population and individuals who are trying for a baby. In addition, the strategies used to manage certain thyroid problems are questioned. Discussions around testing and subsequent management particularly relate to women with a history of subfertility or recurrent pregnancy loss (RPL). Study design, size, duration The purpose of this scientific impact paper is to provide evidence based clinical practice recommendations about the controversial subjects of SCH and antithyroid autoantibodies in women with a history of subfertility or RPL. This has been done by reviewing and collating the published evidence and international guidance. Participants/materials, setting, methods This body of work is a literature review of published primary studies, systematic reviews and international guidelines relating to the screening for and management of SCH and ATD in women with subfertility or recurrent pregnancy loss. Recommendations for practice and areas for further research have been identified. Main results and the role of chance Population-trimester and laboratory-specific reference ranges for serum thyroid stimulating hormone (TSH) and free thyroxine (fT4) should be applied when defining SCH. Untreated mild–moderate SCH (TSH 4.0-10.0mIU/l) is associated with early pregnancy loss and there is low-quality evidence that levothyroxine (LT4) treatment of such women is associated with improved pregnancy and live birth rates. Routine preconception TSH and fT4 testing should be offered to women with history of RPL or subfertile women undergoing assisted reproduction. Women receiving LT4 treatment for SCH should have an empirical dose increase in pregnancy, doubling the dose on 2days per week once pregnancy is confirmed, with regular TSH measurements from 7–9weeks gestation. There is no benefit from LT4 treatment in improving pregnancy outcomes for euthyroid TPOAb-negative women. Knowing TPOAb status allows for stratification of women who will require thyroid function monitoring during pregnancy. The option of performing preconception TPOAb testing for women with infertility or a history of RPL versus routine early pregnancy thyroid function testing alone are both acceptable strategies, until clinical and cost-effectiveness analyses are available. Further studies are required to determine the role of selenium or steroids in improving pregnancy outcomes for euthyroid TPOAb-positive women. Limitations, reasons for caution The evidence for treatment of SCH in women with RPL or subfertility is of low quality and therefore must be interpreted with caution. Wider implications of the findings SCH and ATD are common conditions and management strategies are widely debated, particularly in women with history of subfertility or recurrent pregnancy loss. Further high quality studies are needed in this area to help strengthen our knowledge on how to manage such patients. Trial registration number Not applicable

Elevated Thyroxine Concentration and Lithium Intoxication-An Analysis Based on the LiSIE Retrospective Cohort Study.

(1) Background: It has been suggested that hyperthyroxinaemia is a risk factor for lithium intoxication by altering tubular renal function. (2) Methods: We determined the relevance of hyperthyroxinaemia as a risk factor for lithium intoxication in patients with bipolar or schizoaffective disorder in the framework of the LiSIE (Lithium-Study into Effects and Side Effects) retrospective cohort study. Of 1562 patients included in the study, 897 patients had been exposed to lithium at any time between 1997 and 2017 with 6684 person-years of observation. (3) Results: There were 65 episodes of unintentional lithium intoxication in 53 patients. There were nine episodes with hyperthyroxinaemia at the time of lithium intoxication, yielding an incidence of 1.3 episodes/1000 person-years. For all nine episodes, we could identify alternative, more plausible, explanations for the observed lithium intoxications. (4) Conclusions: We conclude that hyperthyroxinaemia-associated unintentional lithium intoxication is an uncommon event. A direct causal link between hyperthyroxinaemia and altered tubular renal function remains elusive. Increasing the frequency of routine thyroid function tests seems unlikely to decrease the risk of lithium intoxication.