Serum Thyroid-stimulating Hormone Research Articles

Recurrence patterns in differentiated thyroid cancer (DTC) following adjuvant radioiodine therapy.

With an increasing incidence of differentiated thyroid cancer (DTC) diagnosis, questions emerge about the optimal duration of follow-up for detecting recurrent disease and its outcomes. The objective of this retrospective research was to assess the clinical course of differentiated thyroid cancer after radioiodine adjuvant treatment in patients monitored over an extended period. Special attention was paid to the analysis of the time from treatment to recurrence. We also assessed patient outcomes after recurrence. A total of 650 patients with DTC after total/near-total thyroidectomy and adjuvant radioiodine post-recombinant human thyrotropin (post-rhTSH) stimulation were evaluated. All patients were followed up with neck ultrasound, serum thyroid-stimulating hormone (TSH), thyroglobulin (Tg), and antithyroglobulin antibody (anti-Tg) measurements at intervals of 6 to 18 months. Only structural recurrences were considered. They were defined as locoregional recurrence confirmed by biopsy or distant metastases [confirmed by computed tomography (CT) or magnetic resonance imaging (MRI), or abnormal foci on radioiodine scintigraphy or 18F-gluorodeoxyglucose positron emission tomography [18 F] FDG-PET scan], regardless of thyroglobulin (Tg) or anti-Tg levels. The median follow-up was 12 years (5-15.5). Structural recurrence was observed in 47 out of 650 patients (7%). All but 3 locoregional recurrences were suitable for surgery. The median time to structural recurrence was 16 months, with only 9 (1.4%) patients presenting with recurrence after more than 60 months. At the time of the database closure, 601 patients (92%) had an excellent response, including 20 out of 47 (42%) patients with structural recurrence. Eighty-one out of 650 patients had died (12.5%) before the database closure. The median age at the last follow-up of the patients who died was 72 years (range 20-88). A second recurrence was diagnosed in 10 out of 650 patients (1.5%), corresponding to 21% (10 out of 47) of patients who had already experienced a recurrence. The median time from radioiodine (RAI) therapy to the second structural recurrence was 108 months. Structural recurrences in DTC are uncommon, with most patients showing a favourable response to treatment. Improved understanding of recurrence timing may define the duration of patient surveillance at reference centres that can be safely discontinued after 5 years in low- and intermediate-risk groups, as indicated in our study.

Estimating the Prevalence of Primary Hypothyroidism in Karbala City, and Modulation of Clinical Manifestations Among Patients Receiving Levothyroxine; A Single Center Study

Background: Hypothyroidism has a wide range of clinical manifestations and general symptoms, including but not limited to obesity, tiredness, poor concentration, depression, widespread muscle soreness, menstruation abnormalities, and constipation. The administration of a daily dosage of levothyroxine is sufficient for the successful management of hypothyroidism, as it facilitates the restoration of serum thyroid stimulating hormone (TSH) levels to their normal range. Several factors can influence the absorption of levothyroxine in the human body, including age, weight, the presence of other medical problems, and dietary intake. The aim of this study was to assess the prevalence of primary hypothyroidism and alteration in clinical presentation associated with replacement therapy. Methods: This was a cross-sectional, observational study conducted over at Al Hassan Metabolism, Endocrine, and Diabetes Center (HMEDC) in Karbala city. The study team created a questionnaire, and data was collected from face-to-face patient interviews, which included various sociodemographic variables, TSH and ferritin levels, drug interactions, as well as signs and symptoms exhibited both prior to and following treatment. Additionally, the patient treatment regimen and the specific doses of levothyroxine administered are also recorded. Results: the total number of cases visited Al Hassan Metabolism, Endocrine, and Diabetes Center (HMEDC) during the study period was (10800). The prevalence of thyroid diseases was 300 (2.8%). The rate of primary hypothyroidism out of the total number of hypothyroid cases was 85.1%. (61%) of the patients had normal levels of TSH whereas (42%) of the patients were found to be undertreatment. A total of (84%) of the patients exhibited normal levels of ferritin. The patients exhibited a reduction in their signs and symptoms following the administration of therapy. Conclusion: treatment with levothyroxine improved sluggish speech, constipation, lack of appetite, cold sensitivity, weight gain, and weariness. There is no observed correlation between the dosage of levothyroxine and the manifestation of signs and symptoms.

Combined LT3 and LT4 therapy for precision medicine: easier with TTCombo system.

Hypothyroidism is typically treated with levothyroxine monotherapy. However, despite normalized serum thyroid-stimulating hormone levels, 5-10% of patients continue to experience persistent symptoms, raising concerns about the adequacy of thyroxine monotherapy. Combination therapy with levothyroxine and liothyronine has been proposed as an alternative, but it presents practical challenges, including dosing complexity, the short half-life of triiodothyronine, increased monitoring requirements, and potential adverse effects. Moreover, there is no clear consensus within the medical community regarding the superiority of combination therapy over levothyroxine monotherapy, although some studies indicate potential benefits in specific patient populations. Genetic factors, such as polymorphisms in the DIO2 gene, may influence individual responses to therapy, further complicating treatment. To address the limitations of combination therapy, we propose a novel approach: TTCombo. This digital health technology delivers personalized doses of levothyroxine and liothyronine, improving treatment adherence and optimizing outcomes. By providing individualized, physiologically tailored hormone replacement, TTCombo has the potential to revolutionize hypothyroidism management and enhance patient quality of life.

Hyperthyroidism, hypothyroidism, thyroid stimulating hormone, and dementia risk: results from the NHANES 2011-2012 and Mendelian randomization analysis.

As the world ages, dementia places a heavy burden on society and the economy, but current methods of diagnosing dementia are still limited and there are no better therapies that target the causes of dementia. The purpose of this work is to explore the relationship between thyroid disease, thyroid stimulating hormone (TSH) concentrations, free tetraiodothyronine (FT4) concentrations and cognitive function. This study utilized cognitive function and thyroid data from the 2011-2012 National Health and Nutrition Examination Survey (NHANES) to assess the relationship between different groups of TSH and FT4 concentrations and cognitive function using weighted logistic regression and restricted cubic spline (RCS), and then used two-sample Mendelian Randomization (MR) to assess the causal relationship between hyperthyroidism, hypothyroidism, TSH and FT4 concentrations with dementia. Our analysis of the 2011-2012 NHANES data showed that the individuals with low TSH concentrations had higher Alzheimer's Disease Word List Registry Consortium1 (CERAD1) and CERAD.delay.recall scores than individuals with high TSH concentrations, and individuals with low FT4 concentrations had higher CERAD3 and Animal Fluency Test scores than individuals with high FT4 concentrations. Our results also showed a non-linear relationship between serum TSH and FT4 concentrations and the Animal Fluency Test. The TSH concentrations within the range of 1.703 to 3.145 mIU/L exhibit a positive correlation with Animal Fluency Test, whereas concentrations outside this range are negatively correlated with Animal Fluency Test. The FT4 concentrations exhibited a positive correlation with Animal Fluency Test to the left of the FT4 concentrations inflection point (0.849 ng/L), whereas to the right of this inflection point, correlation was negative. MR analysis results further indicate that genetic predisposition to hyperthyroidism may be associated with a reduced risk of dementia and vascular dementia(VaD). Conversely, genetic predisposition to hypothyroidism appears to be linked with an increased risk of dementia and VaD. Additionally, genetic predisposition to elevated TSH concentrations may be correlated with a heightened risk of risk of Alzheimer's disease (AD). This study provides evidence of a nonlinear relationship between TSH and FT4 concentrations and cognitive function, with hyperthyroidism decreasing the risk of dementia and VaD, hypothyroidism increasing the risk of dementia and VaD, and elevated serum TSH concentrations increasing the risk of AD. Furthermore, prioritizing early detection, diagnosis, and treatment through the assessment of thyroid function in individuals at high risk for developing dementia is of paramount importance. This strategy has the potential to significantly contribute to the prevention and deceleration of dementia progression.

Evaluation of anterior pituitary hormone levels in patients with atrial fibrillation

Aim: The risk of ischemic stroke is increased 5-fold in patients with atrial fibrillation (the most common reason for cardiac arrhythmia). The aim is to investigate whether insufficiency in anterior pituitary hormones develops in patients diagnosed with atrial fibrillation and no history of cerebrovascular accident. Method: A group of 65 patients with chronic /paroxysmal atrial fibrillation without a history of cerebrovascular accident and a group of 65 healthy controls without arrhythmia were included in this study. Atrial fibrillation was diagnosed by electrocardiography or 24-hour rhythm holter. Demographic data, biochemical tests, echocardiography findings were compared between the groups. P<0.05 was considered statistically significant. Results: There was no statistical difference in gender and age distribution between groups (p<0.05). (Patient group: Mean age 68 ± 7 years (16 (24.6%) male and 49 (75.4%) female) / Control group: Mean age 67 ± 6 years (18 (27.7%) male and 47 (72.3%) female). Serum insulin-like growth factor-1, adrenocorticotropic hormone and cortisol levels were significantly lower in the patient group compared to the control group (p=0.048, p=0.005, p=0.023). There was no significant difference in serum thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, and prolactin levels between groups. Left atrial diameter and left ventricular end-diastolic diameter were higher in the patient group (p<0.0001). The left ventricular ejection fraction value was lower in the patient group (p<0.0001). Conclusion: It was thought that the reason for the low level of insulin-like growth factor-1 in the setting of normal liver and kidney functions and simultaneous cortisol and adrenocorticotropic hormone deficiency, in patients with atrial fibrillation with no history of cerebrovascular accident might be due to silent cerebral ischemia leading to pituitary dysfunction.

Understanding Hypothyroidism: Causes, Symptoms, Diagnosis, and Treatment Options for Optimal Thyroid Health

Hypothyroidism is a condition where your thyroid gland doesn’t produce enough thyroid hormone leading to symptoms like fatigue, weight gain, and feeling cold. Globally, the lack of iodine in the environment is the leading cause of hypothyroidism. However, in regions where there is enough iodine, Hashimoto’s thyroiditis, an autoimmune disorder is the most common cause. Risk factors include having a family history of thyroid disease, being over 6o years and being female. Diagnosis done with a simple blood test that measures the levels of serum free thyroxine (FT4) and thyroid-stimulating hormone (TSH). High TSH and FT4 levels usually indicate Hypothyroidism. Even daily medication with synthetic thyroid hormone (levothyroxine), regular follow up with your doctor is important to monitor your TSH level and adjust the dosage of medication as needed.

12602 The Effect of Three-Month Semaglutide Treatment on Serum TSH and Thyroid Hormones in Individuals with Obesity

Abstract Disclosure: P. Konopka: None. A. Janucik: None. A. Citko: None. A. Paszko: None. A.J. Kretowski: None. L. Szczerbinski: None. Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) play a crucial role in managing obesity and diabetes, significantly influencing glycemic control and weight management. Previous studies showed that GLP-1 RAs therapy affects thyroid-stimulating hormone (TSH) levels; however, they were limited by small sample sizes and did not extensively cover newer agents like semaglutide. Thus, the aim of this study was to assess the impact of a three-month semaglutide treatment on thyroid hormones and TSH levels in individuals with obesity, without diabetes, and examine the relationship of these changes with weight loss. Methods: We analyzed data from 290 patients participating in the GAROS study, excluding those on medications affecting thyroid function or with a known history of thyroid disease. All participants underwent a three-month treatment with oral semaglutide, followed by a three-month discontinuation phase. Measurements of TSH, free triiodothyronine (fT3), free thyroxine (fT4), and body weight were taken at baseline, at the end of the treatment period, and three months post-treatment discontinuation. To compare changes in TSH, fT3, and fT4 levels, as well as weight, across the study timelines we used non-parametric tests due to the non-normal distribution of the data. We also employed multiple linear regression models to evaluate the association between thyroid hormone changes and weight loss, both in the aggregate and stratified by sex. Results: Initial fT3, fT4, and TSH levels were 3.13 pg/ml (SD=0.38), 0.94 ng/dl (SD=0.10), and 1.64 mIU/l (SD=0.82), respectively. Post-treatment, fT3 decreased on average by 0.33 pg/ml (p<0.001), TSH by 0.32 mIU/l (p<0.001), and fT4 increased by 0.06 ng/dl (p<0.001). Upon discontinuation, fT3 and fT4 levels did not fully return to baseline values but showed a significant shift in that direction (p<0.001 for fT3 and p=0.006 for fT4, compared to baseline). Conversely, TSH levels adjusted back to their baseline values (p=0.26). Notably, changes in fT4 levels, unlike fT3 and TSH, were significantly negatively associated with weight changes during (p=0.030) and post-treatment (p=0.008), across sex-stratified analyses. Conclusions: Semaglutide treatment significantly alters thyroid hormones and TSH levels in patients with obesity, with some effects reversible post-discontinuation. Except for fT4, these hormonal changes appear to be independent of the weight loss effects of semaglutide. Although the magnitude of these alterations might not be clinically significant, they do imply that GLP-1 RAs may have additional physiological effects. The exact nature of the interaction between semaglutide and thyroid function, however, remains to be fully elucidated, highlighting the need for further research to clarify these mechanisms. Presentation: 6/2/2024

7350 Association between thyroid function and insulin resistance indices in Korean adolescents: Findings from the 2014-2015 KNHANES

Abstract Disclosure: E. Mun: None. H. Lee: None. J. Choi: None. R. Lee: None. K. Kim: None. H. Kim: None. Purpose: Obesity and diabetes are rising concerns among adolescents. There are several studies regarding to the association between thyroid function and IR. However, there are limited studies focus on adolescents. Furthermore, there is a lack of studies evaluating various IR indices. We investigated the association between thyroid function and insulin resistance indices in adolescents with normal thyroid function. Methods: This cross-sectional study included 465 adolescents (aged 12-18, 255 boys, 210 girls) based on data from the Korea National Health and Nutritional Examination Survey2014-2015. Thyroid function was assessed using serum thyrotropin (TSH) and free thyroxine (fT4), while IR was estimated using the homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), glucose/insulin ratio (GIR), TyG (triglyceride-glucose index), and TG/HDL. Multiple linear regression analyzed the relationship between thyroid function and IR, stratified by sex. Nonlinearity was assessed through a restricted cubic spline model. Results: The mean TSH (uIU/mL) and fT4 (ng/dL) were 2.70 and 1.29, respectively. Boys had higher TSH (2.86 vs. 2.52, p = 0.013) and fT4 (1.33 vs. 1.24, p < 0.001) than girls, with significant gender differences. In girls, fT4 negatively correlated with HOMA-IR and positively with GIR. No significant relationship was found between thyroid function and IR in boys. When analyzed stratified by level of obesity, the association between IR and thyroid function was clear in the overweight/obese group in both sexes. Overweight and obese groups showed relationships between fT4 and HOMA-IR (β = 0.08, p = 0.04 in boys; β = -0.12, p < 0.01 in girls) and QUICKI (β = -4.14, p = 0.03 in boys; β = 6.60, p < 0.01 in girls). TSH correlated with TyG (β = 1.01, p = 0.04 in boys; β = 1.38, p = 0.01 in girls). In girls, fT4 was also related to TG/HDL (β = -0.06, p < 0.05) and GIR (β = 0.14, p < 0.01). Nonlinear analysis found no significant relationship between thyroid function and IR. Conclusion: The relationship between thyroid function and IR was more pronounced in the overweight and obese groups. Our study suggests that the correlation between thyroid function and insulin resistance in adolescents may vary based on gender and IR indices. Presentation: 6/1/2024

Study of the relationship between thyroid autoimmunity, obesity and serum leptin level in a sample of Egyptian individuals

Obesity is a worldwide health problem, and its prevalence is increasing steadily all over the globe. Leptin, mainly produced by adipocytes, was identified to modulate the immune system, as well as contributing to increased production of thyroid peroxidase antibodies (TPO-Ab) and thyroglobulin antibody (TG-Ab). Autoimmune thyroiditis, mainly Hashimoto's thyroiditis, is believed to be the main cause of hypothyroidism in iodine sufficient regions, (TPO-Ab) and (TG-Ab) are the hallmarks of this disease. This study aimed to assess the relationship between thyroid autoimmunity, obesity and serum leptin level in a sample of Egyptian individuals. This study was a case control study which included 60 participants, recruited from the outpatient of the Internal Medicine Clinic at Ain Shams University Hospitals, during the period from February 2022 to October 2022. They were divided into two groups: Group 1 included 30 participants, have Residual hematopoiesis is an important prognostic factor of immunosuppressive therapy in severe aplastic anemia (BMI) >30 kg/m2, and Group 2 included 30 participants, have BMI (18.5-25 kg/m2). We detected serum leptin, thyroid profile and thyroid antibodies using the enzyme linked immunosorbent assay and other immunoassays. Serum levels of leptin, thyroid-stimulating hormone (TSH) and glycated hemoglobin (HbA1c) were statistically significantly higher in group 1 than in group 2 (p=0.0001 for all). Also, there was a statistically significant positive correlation between leptin level and Anti-TPO in group 1 (p=0.002). In addition, in group 1, there was a statistically significant positive correlation between serum leptin level and TSH (p=0.0001). In conclusion, there is a relationship between thyroid autoimmunity and serum leptin level in obese subjects.

Meta-Analytical and Meta-Regression Evaluation of Subclinical Hyperthyroidism's Effect on Male Reproductive Health: Hormonal and Seminal Perspectives.

Subclinical hyperthyroidism (SCH) is a subtle thyroid dysfunction marked by decreased serum thyroid-stimulating hormone (TSH) levels while maintaining a normal thyroid hormone profile. Despite its mild nature, SCH can significantly impact various physiological functions, including male reproductive health. However, the effects of SCH on reproductive hormones and semen quality are less understood compared to overt thyroid disorders. This study employed extensive search methods across various databases from January 2000 to February 2024 to explore the relationship between SCH and Hormonal and Seminal Perspectives. Effect sizes, estimated using the standardized mean difference (SMD) and pooled with a Random-effect model, provided significant insights from 748 participants. Included studies adhered to the following criteria: Patients (male individuals with SCH), Intervention (assessment of reproductive hormones and semen quality), Comparison (SCH patients versus healthy controls), and Outcome (changes in reproductive factors). Significant alterations in reproductive hormones were observed in SCH patients, including reduced LH levels (SMD = - 0.20; p = 0.007), elevated FSH levels (SMD = 0.25; p = 0.002), and stable testosterone levels (SMD = - 0.05; p = 0.50). Regarding thyroid profile, SCH was associated with increased FT3 (SMD = 0.15; p < 0.001) and FT4 (SMD = 0.08; p = 0.002) levels, along with decreased TSH levels (SMD = - 2.00; p < 0.001). Adverse effects on semen quality were also observed. These findings underscore the need to incorporate thyroid health assessments in the evaluation of male infertility, recognizing the impact of minor thyroid hormone deviations on reproductive outcomes.

Prognostic Implications of Maintaining the Target Thyroid-Stimulating Hormone Status Based on the 2015 American Thyroid Association Guidelines in Patients with Low-Risk Papillary Thyroid Carcinoma after Lobectomy: A 5-Year Landmark Analysis

Background: The 2015 American Thyroid Association guidelines recommend the maintenance of serum thyroid stimulating hormone (TSH) levels ≤2 mIU/L in patients with low-risk papillary thyroid carcinoma (PTC) who underwent lobectomy; however, the evidence is insufficient. We investigated the association between maintaining the TSH status at ≤2 mIU/L and tumor recurrence in patients with low-risk PTC who underwent lobectomy through a 5-year landmark analysis. Methods: Between 2010 and 2016, 662 patients with low-risk PTC were included. The postoperative TSH status was determined using the ‘TSH &gt; 2 ratio’, which was calculated using the TSH test results during the 5-year follow-up. The optimal cutoff value of ‘TSH &gt; 2 ratio’ for tumor recurrence was determined using a receiver operating characteristic curve analysis. Recurrence-free survival (RFS) was compared between the groups using Kaplan–Meier and Cox proportional hazard regression analyses. Results: Patients with ‘TSH &gt; 2 ratio’ &gt; 0.1833 (n = 498) had a worse RFS outcome compared to patients with ‘TSH &gt; 2 ratio’ ≤ 0.1833 (n = 164; p &lt; 0.001). ‘TSH &gt; 2 ratio’ &gt; 0.1833 was a significant risk factor for tumor recurrence after the 5-year landmark (hazard ratio: 4.795, 95% confidence interval: 2.102–10.937, p &lt; 0.001). Conclusions: Maintaining TSH levels ≤ 2 mIU/L below a certain percentage among the total TSH tests during the 5-year follow-up period has a negative impact on tumor recurrence.

Evaluation of Comparative Efficacy of Levothyroxine Versus Kshar Basti and Kanchanar Guggul in the Treatment of Hypothyroidism: Protocol for a Randomized Controlled Trial.

The thyroid gland is an endocrine gland that has an impact on the body's general metabolism. Thus, the secretions of the thyroid gland can modify the overall metabolism of the entire body. The prevalence of hypothyroidism is increasing quickly, with rates of 2%-5% in affluent countries and 11% in India. Individuals diagnosed with hypothyroidism need to take medication for the rest of their lives, resulting in significant stress. Therefore, conducting a study in this area is imperative. This study aims to assess the effectiveness of the therapeutic enema (Kshar Basti) and oral Kanchanar Guggul in the treatment of hypothyroidism. The trial group (n=45) will receive a therapeutic enema (Kshar Basti) followed by oral Ayurvedic drugs for 180 days. The control group (n=45) will be given levothyroxine tablets at a dosage of 1.6 µg/kg/day for the same duration. The objective is to examine the alterations in thyroid stimulating hormone (TSH) levels before and after the treatment. Any deviation of the serum TSH by more than 20% from the initial values, while keeping triiodothyronine (T3), and thyroxine (T4) levels within the normal range, will be deemed statistically significant. Consequently, we anticipate a statistically significant variation in serum TSH levels between the therapeutic enema and Kanchanar Guggul treatments. Presently, the drug preparation operations are in progress. We expect to start enrolling patients in June 2024, do data analysis in December 2025, and acquire results by early 2026, marking the end of this trial. This study will evaluate the efficacy of the therapeutic enema, specifically Kshar Basti, in treating hypothyroidism. Furthermore, more research can determine the efficacy of a therapeutic enema (Kshar Basti) in treating overt hypothyroidism and hypothyroidism during pregnancy. Clinical Trials Registry India CTRI/2023/05/052389; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=Nzk1NjY=&Enc=&userName=052389. PRR1-10.2196/57287.

Demographic and Clinical Characteristics of Patients with Primary Hypothyroidism and Adequacy of Levothyroxine Replacement Therapy in Them: A Nationwide Study in Bangladesh

ABSTRACT Background: Despite the huge burden of primary hypothyroidism in Bangladesh, no nationwide study has been conducted describing the demographic and clinical characteristics of these patients; data on the adequacy of levothyroxine (L-T4) replacement are also lacking. This study aimed to fill the knowledge gap. Materials and Methods: This cross-sectional study was conducted among patients with primary hypothyroidism attending the endocrinology outpatient clinics of several hospitals throughout Bangladesh from July 2023 to December 2023. Adults with primary hypothyroidism who had been on L-T4 replacement for at least 1 year were included. Data on their demographic and disease-related characteristics were collected. Serum thyroid-stimulating hormone (TSH) was measured; TSH 0.4–4.0 μIU/mL was considered the therapeutic target for nonmalignant thyroid cases. Results: Two thousand six hundred and forty-one patients (median age 37 years, 86.4% female, and median disease duration 5 years) were included. Hashimoto’s thyroiditis was the most common (40.9%) cause of hypothyroidism; 1.9% had differentiated thyroid cancer (DTC), and the etiology was not established in many (40.2%). Only 26.8% of patients had high adherence to L-T4. Among the non-DTC cases (n = 2590), over half (53.9%) had TSH within the target range, whether the disease was uncontrolled in the remaining 46.1% (TSH was below the target range in 5.6% and above the target range in 40.5%). Among the DTC cases (n = 51), only a few (9.8%) had a TSH within the target range; TSH was below and above the range in 2% and 88.2% of these patients, respectively. In the nonmalignant hypothyroid cases, vegetarian diet, smokeless tobacco use, disease duration &gt;5 years, iron or calcium supplements consumption within 4 h of L-T4 intake, and low or medium adherence to L-T4 were associated with uncontrolled hypothyroidism. Conclusion: For nearly half of Bangladeshi patients with primary hypothyroidism, L-T4 replacement is not optimal. Physicians should address the barriers to reaching the therapeutic goal for these patients.

The alternative value of thyroid stimulating hormone instead of thyroglobulin in differentiation of follicular thyroid neoplasm in Hashimoto's thyroiditis.

To provide novel aspects for the preoperative diagnosis and appropriate differentiation strategies for follicular thyroid carcinoma (FTC) and follicular thyroid adenoma (FTA). Among 25,765 cases, a total of 326 patients with follicular thyroid neoplasms between 2013 and 2019 were enrolled. Patient demographics, perioperative parameters, surgical profiles and oncologic outcomes were collected and analyzed. There were no significant differences in preoperative ultrasound findings between FTA and FTC patients. The true positive rate (sensitivity) and true negative rate (specificity) of fine needle aspiration (FNA) for FTA patients were 0.6956 and 0.5000, respectively, and those for FTC patients were 0.0714 and 0.9348, respectively. Patients with FTC presented significantly higher serum thyroglobulin (TG) levels than patients with FTA. Preoperative TG level was positively related to tumor invasiveness and recurrence or distant metastases in FTC patients. There were 55 patients with Hashimoto's thyroiditis (HT), accounting for 16.87% of enrolled patients. HT patients had significantly lower serum TG concentrations than antibody-negative patients. Among HT patients, no significant differences were observed in TG levels between the FTA and FTC groups. Instead, FTA patients had significantly higher serum thyroid stimulating hormone (TSH) levels and lower serum T3 (Triiodothyronine) levels compared to FTC patients. Serum TSH level >1.736U/L was associated with benign follicular neoplasms in HT patients according to the receiver operating characteristic (ROC) curve. Distinguishing FTC from FTA remains a challenge for ultrasonography and FNA. Serum TG should be measured as a risk factor of FTC. However, in HT patients, serum TSH levels can serve as a more reliable indicator for differentiating FTC from FTA preoperatively.

Association of Serum Uric Acid Level and Thyroid Function in Chronic Kidney Disease: A Hospital-Based Cross-Sectional Study From Northeast India.

Although the prevalence of thyroid dysfunction and hyperuricemia are independently high in patients with chronic kidney disease (CKD), there are limited data showing the association of serum uric acid and thyroid function in those with CKD. The aim of this study was to observe the alteration of both the serum uric acid level and thyroid function in CKD patients and to find the association between both. This observational cross-sectional study was conducted in a tertiary care hospital over a period of one year in Northeast India. A total of 50 CKD patients were enrolled. Their demographic profiles were studied. Serum urea, creatinine, thyroid-stimulating hormone (TSH), total triiodothyronine (TT3), free triiodothyronine (FT3), total tetraiodothyronine (TT4), and free tetraiodothyronine (FT4) levels were measured to establish the correlation of serum uric acid along with each of the parameters separately. A p-value of <0.05 was considered statistically significant. In the CKD patients studied, serum uric acid exhibited positive correlations with serum creatinine (p = 0.001, r = 0.67), serum urea (p = 0.001, r = 0.69), and serum TSH levels (p = 0.001, r = 0.5). Conversely, serum uric acid showed negative correlations with serum TT4 (p = 0.001, r = -0.74), TT3 (p = 0.001, r = -0.6), FT4 (p = 0.001, r = -0.53), and FT3 (p = 0.001, r = -0.58) levels. There was a significant positive correlation between uric acid and TSH levels in CKD patients. Thus, early estimation of both parameters should be considered in CKD patients.

TSH is independently associated with remnant cholesterol in euthyroid adults: a cross-sectional study based on 29,708 individuals.

The study aims to investigate the relationship between thyroid-stimulating hormone (TSH) and remnant cholesterol (RC) in euthyroid adults. The adults who were recruited for the study had undergone physical examination at Beijing Chao-Yang Hospital. High RC levels were defined as the upper quartile of RC levels in males and females, respectively. The relationship between TSH and RC was assessed using the logistic and linear regression models. A total of 29,708 adults (14,347 males and 15,361 females) were enrolled in this study. RC ≥ 0.77 mmol/L in males and RC ≥ 0.60 mmol/L in females were defined as high RC levels. With increasing serum TSH levels, the percentage of adults with high RC levels increased. The odds ratios (ORs (95% confidence intervals (CIs)) for high RC levels increased as TSH quartiles (Q) rose after full adjustments [males: Q2 1.11 (1.00-1.24), P < 0.05; Q3 1.03 (0.92-1.15), P > 0.05; Q4 1.25 (1.12-1.40), P < 0.001; and females: Q2 1.07 (0.96-1.20), P > 0.05; Q3 1.17 (1.05-1.31), P < 0.01, Q4 1.33 (1.20-1.48), P < 0.001, all P for trend < 0.001], using Q1 as the reference. Higher TSH levels were independently associated with higher RC levels in euthyroid adults, this underscoring the significance of regulating TSH levels appropriately.

Iodine supply and thyroid function in women with gestational diabetes mellitus: a cohort study.

Maternal urinary iodine concentration and blood neonatal thyroid-stimulating hormone (TSH) concentration reflect iodine status in pregnancy and serve as markers of iodine deficiency. As dietary measures in gestational diabetes mellitus (GDM) could affect iodine intake, our study aimed to investigate iodine supply in women with GDM compared to healthy pregnant women and to evaluate its relationship to maternal and neonatal thyroid function. Urinary iodine concentration (UIC) and serum TSH, free thyroxine (FT4), and autoantibodies against thyroid peroxidase (TPOAb) were analyzed in 195 women with GDM and 88 healthy pregnant women in the second trimester. Subsequently, neonatal TSH concentrations measured 72 h after delivery in a subgroup of 154 newborns (115 of mothers with GDM and 39 controls) from the national register were analyzed. Median UIC was significantly lower in women with GDM compared to controls (89.50 µg/L vs. 150.05 µg/L; P < 0.001). Optimal iodine intake was found only in nine women with GDM (4.6%) and 33 healthy pregnant women (37.5%) (P < 0.001). Most pregnant women with GDM (88.7%) compared to one half of controls (50%) had iodine deficiency (P < 0.001). Although serum TSH and the prevalence of hypothyroidism (TSH > 4.0 mIU/L) were not different in both groups, hypothyroxinaemia was more prevalent in GDM compared to controls (12.3% vs 3.4%, P = 0.032). Consistently, neonatal TSH > 5.0 mIU/L indicating iodine deficiency, was found in 6 (5.2%) newborns of women with GDM as compared to none in controls. In women with GDM, the prevalence of perinatal complications was significantly lower in those who were taking dietary iodine supplements compared to those who were not (3/39 (7.69%) vs 46/156 (28.85%), P <0.001). In the multiple logistic and linear regression models in women with GDM, hypothyroxinaemia was associated with preterm births, and a negative association of serum FT4 and HbA1c was found. Iodine deficiency in pregnancy was more prevalent among women with GDM compared to healthy pregnant controls. Serum FT4 negatively correlated with HbA1c, and hypothyroxinaemia was associated with preterm births in women with GDM. Conversely, women with GDM who used dietary iodine supplements had a lower risk of perinatal complications.

Correlation of serum thyrotropin and thyroid hormone levels with diabetic kidney disease: a cross-sectional study

ObjectiveThe relationship between thyrotropin (TSH), free triiodothyronine (FT3), free thyroxine (FT4) and diabetic kidney disease (DKD) is still controversial, and this study analyzed the correlation between TSH, FT3, FT4 and DKD in patients with type 2 diabetes mellitus (T2DM).MethodsT2DM patients (1216) were divided into five groups based on serum TSH, FT3, and FT4 levels, differences in urinary albumin excretion rate (UACR), estimated glomerular filtration rate (eGFR) were compared. Binary logistic regression verified independent correlations among TSH, FT3, FT4 and UACR, eGFR. TSH and FT3 predictive values for DKD were analyzed using receiver operating characteristic (ROC) curves.ResultsThe prevalence of albuminuria with decreased eGFR was higher in T2DM patients with subclinical hypothyroidism and overt hypothyroidism than that in patients with normal thyroid function. TSH positively correlated with UACR (r = 0.133, p < 0.001) and positively correlated with eGFR (r = -0.218, p < 0.001), FT3 negatively correlated with UACR (r = -0.260, p < 0.001) and positively correlated with eGFR (r = 0.324, p < 0.001). With the change from the lower normal level to the increased level of TSH and the change from the higher normal level to the reduced level of FT3, the prevalence of albuminuria gradually increased, the prevalence of decreased eGFR gradually increased in TSH groups and FT3 groups. After adjusting for age, BMI, duration of diabetes, TPOAb, TGAb, smoking, drinking, hypertension, the use of anti-diabetic medications (metformin, sodium–glucose cotransporter 2 inhibitors), HbA1c, CRP, TC, TG, LDL-C, and HDL-C, both TSH and FT3 correlated with increased UACR (TSH: OR 1.253, p = 0.001; FT3: OR 0.166, p < 0.001) and decreased eGFR (TSH: OR 1.245, p < 0.001, FT3: OR 0.579, p < 0.001), but this correlation of TSH with eGFR < 60 mL/min/1.73 m2 was not found in male. The area under the ROC curve (AUC) for FT3 was greater than that for TSH (FT3: 0.64; TSH: 0.61).ConclusionsIncreased TSH and reduced FT3 levels were associated with DKD in T2DM patients, but in a sex-dependent manner. FT3 had a higher predictive value for DKD.

A Cross-Sectional Study on the Prevalence of Subclinical Hypothyroidism in Metabolic Syndrome Patients at a Tertiary Care Hospital.

Metabolic syndrome (MetS) is defined as a "constellation" of cardiometabolic risk factors, characterized by hypertension, atherogenic dyslipidemia, hyperglycemia, prothrombotic and proinflammatory conditions which, jointly, increase the risk of suffering cardiovascular diseases (CVD) and type 2 diabetes mellitus.Thyroid dysfunction is also believed to affect parameters such as high-density lipoprotein (HDL) cholesterol, triglycerides, plasma glucose, and blood pressure, in turn increasing the risk of CVD. Subclinical hypothyroidism (SCH), which independently raises the risk of CVDs and their associated complications, is more frequently detected in patients with MetS compared to the general population. When both conditions coexist, the risk of CVD and its complications is significantly heightened. The objective of the study was to find out the prevalence of SCH in patients with MetS. A prospective cross-sectional study was conducted in the Department of General Medicine, New Civil Hospital, Surat, Gujarat, India. Eighty patients who fulfilled the criteria for MetS by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), were taken into the study. A detailed history, anthropometric measurements, blood pressure, fasting blood glucose, lipid profile, and thyroid profile (Free T3, Free T4, and serum thyroid-stimulating hormone (TSH)) were undertaken. The thyroid profile was done by chemiluminescence immunoassay (CLIA) method. Out of 80 patients with MetS, 48 were female and 32 were male, with the overall mean age of the study population being 46.5±9.5 years. Among them, 23.7% of the population was found to be having thyroid dysfunction. Among the thyroid dysfunction, SCH was highly prevalent (18.8%), 3.8% patients had overt hypothyroidism and 1.3% patients had subclinical hyperthyroidism. There were no overt hyperthyroid patients in our study.HDL (mg/dl) and TSH (mIU/L) were significantly higher in the SCH group as compared to other types of hypothyroidism group (p-value < 0.05). There is a statistically significant prevalence of SCH (18.8%) in MetS patients. It is clear from the study that one-fifth of MetS patients or every fifth patient with MetS had SCH. Thus, looking proactively for SCH in MetS and treating it would prevent conversion to overt hypothyroidism and complications of MetS.

Medium-Chain Chlorinated Paraffins Trigger Thyroid Hormone Synthesis and Interfere with Mitochondrial Function in the Thyroid Gland.

Medium-chain chlorinated paraffins (MCCPs, C14-C17) are frequently detected in diverse environmental media. It has been proposed to be listed in Annex A of the Convention on Persistent Organic Pollutants in 2023. Although MCCPs are a crucial health concern, their toxicity remains unclear. This study investigated the toxic effects of MCCPs (0.1-50 mg/kg body weight/day) on the thyroid gland of female Sprague-Dawley rats and characterized the potential toxic pathways via transcriptomics and metabolomics approaches. MCCPs exposure caused histopathological changes to the endoplasmic reticula and mitochondria in thyroid follicular cells at a dose of 50 mg/kg bw/d and increased serum thyrotropin-releasing hormone, thyroid-stimulating hormones, and thyroxine when exposed to a higher dose of MCCPs. Transcriptomic analysis indicated the excessive expression of key genes related to thyroid hormone synthesis induced by MCCPs. Integrating the dual-omics analysis revealed mitochondrial dysfunction of the thyroid by mediating fatty acid oxidation, Kreb's cycle, and oxidative phosphorylation. Significant metabolic toxicity on the thyroid might be linked to the characteristics of the chlorine content of MCCPs. This study revealed the toxicity of MCCPs to the thyroid gland via triggering thyroid hormone synthesis and interfering with mitochondrial function, which can provide new insights into the modes of action and mechanism-based risk assessment of MCCPs.