Serum Thyroid-stimulating Hormone Levels Research Articles

The association between plasma thyroxine levels and neurocognitive impairment in early-onset schizophrenia and other psychosis spectrum disorders

Background/aimLimited studies have delved into the association between thyroid hormones and neurocognition in schizophrenia. We aimed to evaluate the relationship between thyroid hormone levels and neurocognitive functions in patients with schizophrenia and other psychosis spectrum disorders (SSD). MethodA total of 135 patients with early-onset SSD were included in the study. The participants underwent a cognitive assessment. Blood samples were collected to measure serum levels of thyroid-stimulating hormone (TSH), free thyroxine (fT4), and free triiodothyronine (fT3). Subgroup analyses were conducted based on the severity of the psychosis. FindingsThe results revealed a significant association between fT4 levels and various cognitive domains, including processing speed, verbal fluency, working memory, verbal learning, verbal memory, and visual memory. However, serum TSH and fT3 levels exhibited no significant association with neurocognitive impairment in adjusted linear regression models. Specifically, the correlation between fT4 levels and global cognition was more pronounced in patients with higher scores. ConclusionsSerum fT4 levels were associated with the performance across various cognitive domains in cases of early-onset psychotic disorders. This correlation was accentuated among patients with higher illness severity. Future studies could focus on the effects of specific pathways that can affect the course and progression of psychosis.

Thyrotropin induces atherosclerosis by upregulating large conductance Ca2+-activated K+ channel subunits

Hypothyroidism is associated with elevated levels of serum thyrotropin (TSH), which have been shown to promote abnormal proliferation of vascular smooth muscle cells and contribute to the development of atherosclerosis. However, the specific mechanisms underlying the TSH-induced abnormal proliferation of vascular smooth muscle cells remain unclear. The objective of this study was to investigate the role of TSH in the progression of atherosclerosis. Our research findings revealed that hypothyroidism can trigger early atherosclerotic changes in the aorta of Wistar rats. In alignment with our in vitro experiments, we observed that TSH induces abnormal proliferation of aortic smooth muscle cells by modulating the expression of α and β1 subunits of large conductance Ca2+-activated K+ (BKCa) channels within these cells via the cAMP/PKA signaling pathway. These results collectively indicate that TSH acts through the cAMP/PKA signaling pathway to upregulate the expression of α and β1 subunits of BKCa channels, thereby promoting abnormal proliferation of arterial smooth muscle cells. These findings may provide a basis for the clinical prevention and treatment of atherosclerosis caused by elevated TSH levels.

Higher serum free thyroxine levels are associated with increased risk of hip fractures in older men.

Overt and subclinical hyperthyroidism are associated with an increased fracture risk, but whether thyroid hormones are associated with fracture risk in individuals with normal thyroid-stimulating hormone (TSH) has mostly been investigated in women. Therefore, we investigated if serum levels of free thyroxine (FT4) or TSH are associated with fracture risk in Swedish men. We followed (median 12.2yr) elderly men (n = 1825; mean age 75, range 69-81yr) participating in the Gothenburg and Malmö subcohorts of the prospective, population-based MrOS-Sweden study. The statistical analyses included Cox proportional hazards regression. Men receiving levothyroxine treatment were excluded. In our total cohort, serum FT4 (per SD increase) was associated with increased risk of major osteoporotic fractures (MOFs; n = 479; fully adjusted hazard ratio [HR] 1.14, 95% CI, 1.05-1.24) and hip fractures (n = 207; HR 1.18, 95% CI, 1.04-1.33). Also, in men with normal TSH (n = 1658), FT4 (per SD increase) was significantly associated with increased risk of MOF and hip fractures. Furthermore, men in the highest FT4 quartile had a 1.5-fold increase in hip fracture risk compared with men in the three lower FT4 quartiles, both in the total population and in men with normal TSH (fully adjusted: HR 1.45, 95% CI, 1.04-2.02 and HR 1.51, 95% CI, 1.07-2.12, respectively). In contrast, the risk of MOF was not statistically different in the highest FT4 quartile compared with the three lower FT4 quartiles. Finally, serum TSH was not associated with fracture risk after full adjustment for covariates. In conclusion, serum FT4, but not serum TSH, is a predictor of hip fracture risk in elderly Swedish men. Additionally, there was an association between FT4 (per SD increase) and the risk of MOF.

Risk assessment of transgender people: implementation of a demasculinizing–feminizing rodent model including the evaluation of thyroid homeostasis

BackgroundIndividuals whose gender identity differs from the biological sex and the social norms are defined as transgender. Sometimes transgender undergo gender affirming hormone therapy, which lasts for the entire life making essential to evaluate its potential long-term effects. Moreover, transgender can represent a susceptible sub-group of population and specific attention is needed in risk assessment, including the development of targeted animal models. Aim of the study is the implementation of a rodent demasculinizing–feminizing model through the setting of appropriate dose of hormone therapy and the selection of specific biomarkers to evaluate the sex transition. Specific attention is paid to thyroid homeostasis due to the close link with reproductive functions. Four male adult rats/group were subcutaneously exposed to three doses plus control of β-estradiol valerate plus cyproterone acetate at: 0.045 + 0.2 (low), 0.09 + 0.2 (medium) and 0.18 + 0.2 (high) mg/dose, five times/week. The doses were selected considering the most recent recommendations for transgender woman. Sperm count, histopathological analysis (testis, liver, thyroid), testosterone, estradiol, triiodothyronine and thyroid-stimulating hormone serum levels and gene expression of sex dimorphic CYP450 were evaluated.ResultsThe doses induced feminizing–demasculinizing effects: decreased testosterone serum levels at the corresponding cisgender, increased estradiol, impairment of male reproductive function and reversal of sex-specific CYP liver expression. However, the medium and high doses induced marked liver toxicity and the low dose is considered the best choice, also for long-term studies in risk assessment. The alterations of thyroid indicated follicular cell hypertrophy supported by increased thyroid-stimulating hormone serum levels at the higher doses.ConclusionsThe implementation of animal models that mimic the effects of gender affirming hormone therapy is essential for supporting clinical studies in transgender people and filling data gap in order to ensure an appropriate risk assessment and a more accurate, personalized care for transgender people.

Effects of altitude on thyroid disorders according to Chinese three-rung, ladder-like topography: national cross-sectional study

BackgroundChinese topography appears a three-rung ladder-like distribution of decreasing elevation from northwest to southeast, which is divided by two sloping edges. Previous studies have reported that prevalence of thyroid diseases differed by altitude, and geographical factors were associated with thyroid disorders. To explore the association between three-rung ladder-like regions and thyroid disorders according to unique Chinese topographic features, we conducted an epidemiological cross-sectional study from 2015–2017 that covered all 31 mainland Chinese provinces.MethodsA total of 78,470 participants aged ≥ 18 years from a nationally representative cross-sectional study were included. Serum thyroid peroxidase antibody, thyroglobulin antibody, and thyroid-stimulating hormone levels; urine iodine concentration; and thyroid volume were measured. The three-rung ladder-like distribution of decreasing elevation from northwest to southeast in China was categorized into three topographic groups according to elevation: first ladder, > 3000 m above sea level; second ladder, descending from 3000—500 m; and third ladder, descending from 500 m to sea level. The third ladder was further divided into groups A (500–100 m) and B (< 100 m). Associations between geographic factors and thyroid disorders were assessed using linear and binary logistic regression analyses.ResultsParticipants in the first ladder group were associated with lower thyroid peroxidase (β = -4.69; P = 0.00), thyroglobulin antibody levels (β = -11.08; P = 0.01), and the largest thyroid volume (β = 1.74; P = 0.00), compared with the other groups. The second ladder group was associated with autoimmune thyroiditis (odds ratio = 1.30, 95% confidence interval [1.18–1.43]) and subclinical hypothyroidism (odds ratio = 0.61, 95%confidence interval [0.57–0.66]) (P < 0.05) compared with the first ladder group. Group A (third ladder) (500–100 m) was associated with thyroid nodules and subclinical hypothyroidism (P < 0.05). Furthermore, group B (< 100 m) was positively associated with autoimmune thyroiditis, thyroid peroxidase and thyroglobulin antibody positivity, and negatively associated with overt hypothyroidism, subclinical hypothyroidism, and goiter compared with the first ladder group(P < 0.05).ConclusionWe are the first to investigate the association between different ladder regions and thyroid disorders according to unique Chinese topographic features. The prevalence of thyroid disorders varied among the three-rung ladder-like topography groups in China, with the exception of overt hyperthyroidism.

Sustained Euthyroidism during Thionamide Antithyroid Drug Treatment: Comparison of Short- and Long-term Methimazole Therapy

Background: Extended low serum thyrotropin (TSH) levels may increase the risk of cardiovascular events in patients with hyperthyroidism. Objectives: This study aimed to compare the time spent with sustained normal TSH concentration following short- and long-term methimazole treatment. Methods: A total of 258 patients with Graves’ hyperthyroidism completed 18 - 24 months of methimazole therapy and were randomized to discontinue treatment (n = 128, short-term group) or continue an additional 36 - 102 months of methimazole therapy (n = 130, long-term group). Clinical and laboratory evaluations were performed every 6 months for 132 months after randomization. Results: There was no difference in serum-free thyroxine, triiodothyronine, and TSH concentrations between the 2 groups at the time of randomization. Of 128 patients in the short-term group, 5 left in follow-up, 2 became hypothyroid, 67 (54%) had a relapse of hyperthyroidism, and only 54 (44%) were euthyroid at the end of the study. Among 130 patients on the long-term methimazole therapy, 4 were left in follow-up, 24 developed hyperthyroidism, 4 developed hypothyroidism, and 98 (78%) were euthyroid 132 months post-randomization. Total time spent on euthyroidism was 90.4% ± 8.1% of the study period in the short-term and 95.8% ± 7.0% in the long-term treatment groups (P &lt; 0.001). The lowest time spent in euthyroidism (74.6% ± 6.4% of the study period) belonged to 29 (24%) patients in the short-term group under levothyroxine therapy because of fluctuation in serum TSH. Patients in both groups with hyperthyroidism relapse who chose methimazole therapy spent &gt;90% of the study time in euthyroidism. Conclusions: In patients with Graves' hyperthyroidism, sustained normal serum TSH levels were more common in the long term as compared to the short-term methimazole treatment.

The Predictive Value of Conventional Ultrasound Signs Plus Serological Indices for Neck Lymph Node Metastasis in Papillary Thyroid Cancer

The present study aimed to evaluate the predictive value of conventional ultrasound signs and serological indices in the detection of neck lymph node metastasis in papillary thyroid cancer (PTC). A total of 80 patients with PTC scheduled for surgery in our hospital between August 2019 and December 2022 were recruited. Patients with neck lymph node metastasis were categorized as the experimental group, and patients without neck lymph node metastasis were included in the control group. Patients’ ultrasound signs were analyzed, and serological indices were determined. Logistic analysis was performed to determine the risk factors for the development of postoperative neck lymph node metastasis in papillary thyroid cancer, and the receiver operating characteristic (ROC) curve was employed to assess their diagnostic efficiency. Significant differences were observed in the number of lesions, nodule size, calcification, blood flow RI, and PI values comparison between the two arms (P &lt; 0.05), while no significant differences were found in other ultrasound signs (P &gt; 0.05). Patients with neck lymph node metastasis exhibited significantly higher serum concentrations of thyroid stimulating hormone (TSH) and anti-thyroglobulin antibodies (TG-Ab) versus those without metastasis (P &lt; 0.05). Nodule size, number of lesions, and serum TSH level were independent risk factors for metastasis in neck lymph nodes in patients with papillary thyroid cancer (P &lt;0.05). Conventional ultrasound signs, combined with serologic indices, demonstrated the highest diagnostic efficiency for predicting neck lymph node metastasis in patients with papillary thyroid cancer. These findings showed a sensitivity of 0.868, specificity of 0.894, and an area under the ROC curve (AUC) of 0.918. Additionally, the Jorden index was calculated to be 0.761. Analysis revealed that nodule size, number of lesions, and serum TSH concentration were independent risk factors for neck lymph node metastasis in papillary thyroid cancer patients. The combination of conventional ultrasound signs and serologic indices provided a higher diagnostic value compared to using a single diagnostic modality, thus indicating promising clinical benefits.

Lack of Association Between Depression and Subclinical Hypothyroidism in Adolescents Presenting for Routine Physical Examinations.

There are conflicting results in the existing studies regarding the association between depression and subclinical hypothyroidism in adolescents. Subclinical hypothyroidism is defined as elevated thyroid stimulating hormone (TSH) levels above the reference range without signs or symptoms of hypothyroidism. The focus of this study is to determine whether there is any association between depression and subclinical hypothyroidism, (as defined by the serum TSH levels) in a population of healthy adolescents. Quantitative-based cross-sectional study of a representative subset of the adolescent population. We carried out a cross-sectional study to determine the association between major depressive disorder (MDD) and subclinical hypothyroidism, in adolescents presenting for annual physical examinations during the peak period of the COVID-19 pandemic in the USA, a period deemed high for adolescent depression. All the adolescents were screened for depression by the PHQ-9 screening tool and had their TSH measured. Of the 304 subjects analyzed, 179 (58.88%) were minimally or not depressed according to the Patient Health Questionnaire (PHQ-9) screening tool (mean PHQ 1.80 ± 1.49). 70 (23.03%) had mild depression (mean PHQ 6.59 ± 1.46), 50 (16.45%) had moderate depression (mean PHQ 13.70 ± 2.75), and 5 (1.64%) had severe depression (mean PHQ 21.40 ± 1.67). Mean TSH values were 1.93 ± 0.99, 1.77 ± 1.05, 2.10 ± 0.98, and 1.57 ± 0.32 mIU/L, respectively in the four groups. All values were within the recommended range of 0.50 to 4.30 mIU/L, without statistically significant inter-group differences. We conclude that there is no statistically significant association between depression and subclinical hypothyroidism, in a population of adolescents presenting for physical examinations, and if the screening for depression by the PHQ-9 tool indicates depression, a screening TSH test for subclinical hypothyroidism is not justified.

Thyroid-stimulating hormone and total bile acids can predict adverse pregnancy outcome among patients with gestational hypertension.

To investigate the correlation between serum thyroid-stimulating hormone (TSH) and total bile acid (TBA) levels in gestational hypertension and their combined predictive value for pregnancy outcome. A total of 194 patients with gestational hypertension (GH), treated from June 2020 to May 2022, were included in this study. The patients were divided into two subgroups based on pregnancy outcome: an adverse pregnancy outcome group (77 cases) and a normal pregnancy outcome group (117 cases). Additionally, 50 healthy pregnant women undergoing routine prenatal checkups during the same period served as the control group. In this study, serum TBA and TSH levels were measured and compared between the control and GH groups as well as between adverse pregnancy outcome and normal pregnancy outcome groups. The independent risk factors for adverse pregnancy outcome were screened using logistic regression, and their predictive value for pregnancy outcome in patients with GH was analyzed using receiver operating characteristic (ROC) curves. Serum TSH and TBA levels were significantly higher in the GH group compared to the normal group (both P < 0.001). Logistic regression analysis revealed that age, body mass index (BMI), TSH, and TBA were independent risk factors for adverse pregnancy outcome. ROC curve analysis showed that combined TSH and TBA for predicting adverse pregnancy outcome had an Area Under the Curve (AUC) of 0.896, surpassing the AUCs of each individual index (0.843 for TSH and 0.765 for TBA), which indicates a stronger predictive value (P < 0.001). The combined measurement of serum TBA and TSH can serve as a valuable predictive tool for pregnancy outcome in patients with gestational hypertension.

Thyroid Hormone Changes Correlate to Combined Breast Cancer with Primary Thyroid Cancer.

Breast cancer and thyroid cancer are two prevalent malignancies in women, and a potential association between the two diseases has been suggested. This retrospective case-control study was conducted involving 97 patients with breast cancer and thyroid cancer (BC-TC group) and 97 age-matched patients with breast cancer alone (BC group). Thyroid hormone levels, including triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH), were analyzed in healthy controls, BC patients, and BC-TC patients. BC-TC patients exhibited a higher rate of estrogen receptor (ER) and progesterone receptor (PR) positivity compared to BC patients. Serum T3 levels were significantly decreased in BC and BC-TC patients compared to healthy controls. However, there was no significant difference in T3 levels between BC and BC-TC patients. Serum TSH levels were significantly higher in BC-TC patients compared to BC patients. ER positivity, PR positivity, and serum TSH levels greater than 4.45 mU/L were independent risk factors for primary thyroid cancer in breast cancer patients.

Efficacy of a levothyroxine dosage regimen based on serum thyrotropin level, for primary hypothyroidism. An open label dose finding study.

There are no guidelines on individualized initial levothyroxine dosage in primary hypothyroidism. This prospective observational study was done to assess whether a predetermined dose of levothyroxine based on Thyroid Stimulating Hormone (TSH) levels would be able to make the patient euthyroid during a period of six weeks and to find other factors which influence the levothyroxine requirement. Newly diagnosed patients with primary hypothyroidism or those patients who were not on levothyroxine therapy were divided into TSH-based groups-Group 1, 5-9.99, Group 2, 10-29.99, Group 3, 30-99.99 and Group 4, >100 μIU/ml and treated with an initial levothyroxine dose of 25,50,75 and100 μg/day for next six weeks. Factors correlating with levothyroxine requirement were determined. Of the 171 patients who were included 142 completed the study, 34,46,28 and 34 patients were included in groups 1 to 4, respectively. Normalization of TSH with the above criteria was achieved in 111 (78.7%) out of 141 patients, and 91%, 67%, 75%, and 82% respectively in the 4 groups. Among adequately replaced patients pre-treatment TSH level (r = 0.81), T4 level (r = 0.61), and body weight (r = 0.19) correlated with the levothyroxine requirement. Based on these factors predicted initial dose (μg/day) was found to be 0.54 (Body Weight [Kg]) +0.47 (TSH [μIU/m]) - 1.4 (Total T4 [μg/dl]) +17.79 or 0.27 (Body Weight) +0.553 (TSH) +21. Serum thyrotropin-based categorization for initial levothyroxine dose leads to euthyroidism in nearly four of five patients with primary hypothyroidism. The dose required for adequate replacement of levothyroxine has correlation with pre-treatment serum TSH levels serum thyroxine levels and body weight.

Evaluation of the relationship of digital phototrichogram findings of patients with diffuse hair loss with blood TSH, ferritin and vitamin B12 levels.

Telogen effluvium (TE) is a type of alopecia that is frequently seen in women. Among factors resulting in hair loss, many reasons such as endocrine diseases, nutrition disorders, stress, anemia, low ferritin levels, vitamin B12 deficiency, and thyroid diseases are found. A digital phototrichogram is one of the non-invasive methods of diagnosis in the evaluation of alopecia. In this study, it was aimed to compare biochemical parameters of female patients with diffuse hair loss with phototrichogram findings. 108 female patients with diffuse hair loss were included in the study. Patients were divided into two groups: acute and chronic TE, and a hair pull test was applied. Total blood count, blood biochemistry, iron, iron binding capacity, ferritin, thyroid stimulating hormone (TSH), sT3, sT4, folic acid, and vitamin B12 levels were examined. The telogen/anagen ratios and hair densities of patients were determined with a phototrichogram. The serum biochemical parameters (aspartate aminotransferase, alanine aminotransferase, urea, creatinine), TSH, sT3, sT4, and folic acid levels of patients were within normal limits. Telogen ratio, anagen ratio, hair density, number of shed hairs, family history, blood ferritin, TSH, and vitamin B12 levels were found to be similar between groups having acute and chronic TE. In our study, while mean anagen and telogen ratios with trichoscan were similar to literature data, no statistically significant correlation was determined between patients' ages and examined trichoscan findings (p>0.05). The hair pull test positivity of patients with chronic TE was higher compared to patients with acute TE (p<0.05). In patients with positive hair pull tests, the telogen ratio and hair density were found to be higher. In the group with <40 ng/mL ferritin level, the mean telogen ratio was detected to be significantly higher than the mean anagen ratio (p<0.05). No significant correlation was determined between vitamin B12 and TSH levels in patients and phototrichogram findings (p>0.05). The findings of this study showed that ferritin has an important role in diffuse hair loss, and the phototrichogram method is an auxiliary method for the physician in the diagnosis of TE.

Minipuberty period of children with atopic dermatitis compared to healthy children.

Atopic dermatitis (AD) is an inflammatory, pruritic, noncontagious, chronic relapsing skin disease. Skin barrier abnormalities, excessive T helper 2 activity, and immune dysregulation are held responsible. Androgens have a negative effect on the integrity of the epidermal skin barrier, while estrogen has a positive effect. We aimed to investigate whether hormones make a difference between healthy children and children with AD during minipuberty. A total of 96 infants (postnatal 4-13 weeks), 48 diagnosed with AD and 48 controls, were included. Each group consisted of 23 girls (47.9%) and 25 boys (52.1%). Anthropometric examinations and hormone measurements were compared. The two groups, having similar age, sex, body mass index, and weight-for-length standard deviation scores, were compared. Serum free thyroxine (FT4) levels were found to be lower and insulin-like growth factor binding protein-3 (IGFBP3) levels were found to be higher in children with AD (p < 0.001 and p = 0.038, respectively). In girls with AD, estradiol, FT4, and insulin-like growth factor-1 (IGF-1) levels were found to be lower, but thyroid-stimulating hormone (TSH) levels were found to be higher (p = 0.023, p < 0.001, p = 0.038, and p = 0.034, respectively). In boys with AD, the FT4 level was found to be lower (p = 0.023). Serum FT4 and TSH levels were within normal reference ranges in all comparisons. Especially in girls with AD, decreased estradiol and IGF-1 levels were observed compared to the controls during minipuberty. In the logistic regression model, decreased levels of serum estradiol, dehydroepiandrosterone sulfate, FT4, and IGF-1, and increased levels of IGFBP3 were associated with an increased likelihood of exhibiting atopic dermatitis.

Impact of Thyroid Status on Incident Kidney Dysfunction and Chronic Kidney Disease Progression in a Nationally Representative Cohort

ObjectiveTo examine the relationship between thyroid status and incident kidney dysfunction/chronic kidney disease (CKD) progression. Patients and MethodsWe examined incident thyroid status, ascertained by serum thyrotropin (TSH) levels measured from January 1, 2007, through December 31, 2018, among 4,152,830 patients from the Optum Labs Data Warehouse, containing deidentified retrospective administrative claims data from a large national health insurance plan and electronic health record data from a nationwide network of provider groups. Associations of thyroid status, categorized as hypothyroidism, euthyroidism, or hyperthyroidism (TSH levels >5.0, 0.5-5.0, and <0.5 mIU/L, respectively), with the composite end point of incident kidney dysfunction in patients without baseline kidney dysfunction and CKD progression in those with baseline CKD were examined using Cox models. ResultsPatients with hypothyroidism and hyperthyroidism had higher risk of incident kidney dysfunction/CKD progression in expanded case-mix analyses (reference: euthyroidism): adjusted hazard ratios (aHRs) (95% CIs) were 1.37 (1.34 to 1.40) and 1.42 (1.39 to 1.45), respectively. Incrementally higher TSH levels in the upper reference range and TSH ranges for subclinical, mild overt, and overt hypothyroidism (≥3.0-5.0, >5.0-10.0, >10.0-20.0, and >20.0 mIU/L, respectively) were associated with increasingly higher risk of the composite end point (reference: TSH level, 0.5 to <3.0 mIU/L): aHRs (95% CIs) were 1.10 (1.09 to 1.11), 1.37 (1.34 to 1.40), 1.70 (1.59 to 1.83), and 1.70 (1.50 to 1.93), respectively. Incrementally lower TSH levels in the subclinical (<0.5 mIU/L) and overt (<0.1 mIU/L) hyperthyroid ranges were also associated with the composite end point: aHRs (95% CIs) were 1.44 (1.41 to 1.47) and 1.48 (1.39 to 1.59), respectively. ConclusionIn a national cohort, TSH levels in the upper reference range or higher (≥3.0 mIU/L) and below the reference range (<0.5 mIU/L) were associated with incident kidney dysfunction/CKD progression.

A Japanese Boy with Dysmorphic Syndrome with Multiple Pituitary Hormone Deficiency and Gingival Fibromatosis Due to a Pathogenic KCNQ1 Variant.

A six-year-old boy presented with short stature and gingival fibromatosis (GF). Dysmorphic features included slant optic fissures, a high-arched palate, thick earlobes, and an edematous face. Laboratory tests showed low levels of serum insulin-like growth factor-1 and serum free thyroxine but normal serum thyrotropin levels. Provocative tests suggested growth hormone deficiency, central hypocortisolemia, and hypothalamic hypothyroidism. At 12 years old, hypogonadotropic hypogonadism was observed. Next-generation sequencing revealed a heterozygous missense variant, KCNQ1 p. (P369L), in the proband and mother. The coexistence of multiple pituitary hormone deficiencies and GF helps diagnose KCNQ1-variant dysmorphic syndrome through genetic testing.

Thyroid disease-related sleep disorders and its diagnostic and therapeutic recommendations: A literature review

As perioperative medicine evolves, more hospitals are offering comfort sleep clinics. Thyroid disorders (e.g., hypothyroidism, hyperthyroidism, and thyroid cancer) affect the peripheral circadian clock. Elevated serum thyroid-stimulating hormone levels have been found to associate with the incidence of thyroid cancer in humans, but the relationship between circadian disruption and thyroid disease requires further investigation. Malignant transformation of thyroid nodules is characterized by disruption of the expression of biological clock genes. Sleep clinics often see patients complaining of sleepiness and tinnitus. These patients often have comorbid thyroid disorders and are therefore highly susceptible to misdiagnosis or underdiagnosis. In this article, we first summarize this category of disorders, which we propose to classify as insomnia secondary to somatic disease and define as thyroid disease-related sleep disorder (TSD). The primary and common clinical complaints of TSD patients are different types of sleep disorders. In addition, we attempt to provide some preliminary diagnostic and therapeutic recommendations for TSD in the hope that it may assist healthcare professionals in the early diagnosis and management of this disorder.

Correlation between serum thyroid stimulating hormone level and glycolipid metabolism in patients with polycystic ovary syndrome

To investigate the correlation between serum thyroid-stimulating hormone (TSH) levels and glycolipid metabolism in patients with polycystic ovary syndrome (PCOS). From January 2021 to November 2022, 105 patients with PCOS were selected for this retrospective study. All patients were administered drug-induced ovulation treatment and were divided into 2 groups according to ovulation status. There were 67 and 38 patients in the ovulation and non-ovulation groups, respectively. Venous blood (5 mL) was collected on the day after admission from the non-ovulation group and on the day of physical examination from the ovulation group. Several indicators were measured, including TSH, fasting plasma glucose (FPG), glycosylated hemoglobin, total cholesterol (TC), high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride (TG), albumin (ALB), prealbumin (PA), and transferrin (TF). Weight, BMI, waistline, and hipline in the non-ovulation group were significantly higher than those in the ovulation group (P &lt; .05). There were no significant differences in glycosylated hemoglobin, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol levels between the non-ovulation and ovulation groups (P &gt; .05). Compared with the ovulation group, the levels of TSH, FPG, TC, and TG in the non-ovulation group were significantly higher (P &lt; .05). Serum ALB, PA, and TF the non-ovulation group were significantly higher than those in the ovulation group (P &lt; .05). Correlation analysis showed that TSH was negatively correlated with weight, BMI, waistline, hipline, waist-hip ratio, FPG, ALB, PA, and TF in the non-ovulation group (P &lt; .05) and had no significant correlation with TC and TG (P &gt; .05). Our findings demonstrate TSH levels may be associated with weight, BMI, waistline, hipline, waist-hip ratio, FPG, ALB, PA, and TF in patients with PCOS.

Association between thyroid hormone levels in the acute stage of stroke and risk of poststroke depression: A meta-analysis.

Thyroid hormones have been indicated to be associated with depression, but their relationship with poststroke depression (PSD) remains controversial. Therefore, we performed a meta-analysis to explore the correlation between thyroid hormone levels in acute stroke and PSD. We searched databases for eligible studies. Standard mean differences (SMD) and 95% confidence intervals (CI) were applied to evaluate the association among levels of thyroid hormones, including thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4), in acute stroke patients and the risk of PSD. A total of 13 studies were included in the analysis. Compared to non-PSD patients, PSD patients had remarkably lower serum TSH and FT3 levels (TSH: SMD=-0.59, 95%CI=-1.04 to -.15, p=.009; FT3: SMD=-0.40, 95%CI=-.51 to -.30, p=.000) and higher serum FT4 levels (SMD=0.33, 95%CI=.07-.59, p=.013). Subgroup analysis showed that there may be a more statistically significant association between FT3 and the risk of PSD compared to TSH and FT4. Our results suggested that patients with lower serum TSH and FT3 levels as well as higher serum FT4 levels in the acute stage of stroke may be more susceptible to PSD.

A COMPREHENSIVE COMPOSITE FOR ALLOSTATIC LOAD SCORING AND RISK CATEGORIZATION FOR PREDICTIVE COMPARISONS

Abstract Introduced three decades ago, the concept of Allostatic Load (AL) describes the wear and tear of the physiological response to chronic stress, and how sustained demand overloads the systems involved, deplete their resources, and leads them to fail. Current evidence shows positive relationship between AL and risk of developing conditions such as depression, fibromyalgia, cardiovascular disease, diabetes, cancer, early cognitive decline, and dementia. However, there is only partial consensus regarding which biomarkers can compose an AL index or how to accurately score them. Current proposals debate between purely statistical cut-off points, inclusion of gender and ethnicity differences, use of clinical reference values, and scoring ongoing medication. The result is a considerable heterogeneity of methods for AL calculation and a lack of universally agreed values, leaving researchers to subjectively choose which framework suits better to their aims. Using data from the PREVENT-Dementia study (cognitively normal mid-life participants, n=700), we developed a comprehensive composite for AL scoring to generate a more accurate and biologically relevant index, that considers both previous and recent clinical evidence. By including gender and age differences, high quartile approach, and up-to-date clinical reference values, individuals were categorized as no-risk, at-risk and high-risk of AL, which will be associated with MRI brain volume measurements. Comparison to serum Thyroid-stimulating hormone (TSH) levels will serve as proxy of the neuroendocrine biomarkers originally proposed as AL primary mediators, due to its association to increased cortisol. Additional stress-related biomarkers, such as sleep quality and the neutrophil-to-lymphocyte ratio will also be assessed for associations.

Thyroid Hormone Status in Severely Malnourished Children between 6 Months to 5 Years Admitted to Nutritional Rehabilitation Centre of a Tertiary Care Hospital

Introduction: Severe malnutrition poses a significant risk to the thyroid gland's function and hormonal balance, which can lead to numerous physiological and developmental complications. Understanding the relationship between severe malnutrition and thyroid hormone status is crucial for the effective management of these children.&#x0D; Aim and Objective: To investigate the prevalence and patterns of thyroid hormone abnormalities in severely malnourished patients with subgroup analysis in Marasmus, Kwashiorkor, and edematous malnourished patients.&#x0D; Methodology: We conducted a cross-sectional study involving 116 children diagnosed with severe acute malnutrition (SAM). The study protocol was approved by the Institution Ethics Committee. Well-informed written consent in the local language was taken from parents. SAM was diagnosed and managed according to WHO criteria (1). Comprehensive laboratory investigations were conducted to assess serum levels of thyroid-stimulating hormone (TSH), free thyroxine (T4), and triiodothyronine (T3). Statistical analysis was performed to examine the associations between these variables and SAM.&#x0D; Results: Most of the 116 subjects included in the study were male (53.4%) and had a lower socioeconomic status (43.9%). The age distribution of the children aged below 5 years revealed that 46.5% were between 12 and 36 months old. In the present study, Marasmus was 55.2%, Kwashiorkor was 12.1%, and edematous malnutrition was 32.7%. Among 116 participants, 94.8% were discharged, while 5.2% were expired during treatment. The mean levels of fT3, fT4, and TSH were 1.88±1.06 pg/ml, 0.99±0.84 ng/dl, and 3.22±0.87 µIU/ml, respectively. Most SAM patients had low fT3, fT4, and TSH levels relative to the normal range.&#x0D; Conclusion: Monitoring of thyroid hormone status in SAM patients is mandatory for this vulnerable population.