Subclinical Thyroid Disorders Research Articles

Abstract P199: Small HDL-C is Associated to Subclinical Hypothyroidism. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Introduction: Although epidemiologic studies have associated subclinical thyroid disorders with coronary heart disease, the role of lipoprotein levels are not well defined as a mediator or moderator of this association. Purpose: To test the association of lipoprotein particle concentration and size measured by nuclear magnetic resonance with subclinical hyperthyroidism and subclinical hypothyroidism using baseline data from the Brazilian Longitudinal Study of Health (ELSA-Brasil) of apparently healthy 5024 men and women aged 35 to 74 years old. Methods: We measured lipids and lipoproteins subfractions using a new nuclear magnetic resonance spectroscopy (NMR LipoProfile® test spectra, LabCorp, Raleigh, NC): triglyceride-rich lipoprotein particles (TRLP, containing IDL-P and VLDL-P), 3 LDL-P subclasses (large, medium and small) and 3 HDL-P subclasses (large, medium and small). Subclinical thyroid disorders were defined as TSH >4 IU/ml and TSH <0.4 IU/ml for people with normal free-thyroxine levels. We excluded from the sample participants reporting previous cardiovascular disease, those who used lipid-lowering medications and/or other drugs that interfere with thyroid function remaining 3,947 subjects. The cross-sectional relationship between subclinical thyroid diseases (independent variable) and lipids and lipoproteins (dependent variable) were evaluated by linear regression models using euthyroid subjects as the reference. Models were presented as crude and after adjustment for sociodemographic (age, sex, race, and education), cardiovascular risk factors (body-mass index, hypertension, diabetes, smoking habit, alcohol use, and physical activity) and LDL-C, HDL-C and triglycerides measured by enzymatic methods. Results: After exclusions, we detected 47 persons with subclinical hyperthyroidism (mean age 53.1 (±9.4 years; 61.7% women), 258 with subclinical hypothyroidism (mean age 52.3 (±8.9); 58.1% women) and 3,642 participants with normal thyroid function (mean age: 50.1 (±8.6); 52% women). After multivariate adjustment, subclinical hyperthyroidism was associated with a decrease in triglyceride-rich lipoprotein particles (Beta coefficient (B) -15.2; P=0.04) and with the very small triglyceride-rich lipoprotein subclass (B, -16.9; P=0.04). Subclinical hypothyroidism was associated with a decrease in small HDL-P subclass (B, 0.42; P=0.03). No association was found for any subclinical conditions with LDL-C. Conclusions: Subclinical hyperthyroidism does not show any possible association with an atherogenic profile, and subclinical hypothyroidism revealed an association with lower small HDL-cholesterol levels.

Abstract P357: Subclinical Hypothyroidism Alters Autonomous Nervous System. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Introduction: Lifetime stressful conditions have been related to a higher risk of coronary heart diseases events. One recognized way is related to the disbalance of a parasympathetic and sympathetic system that can be mediated by several humoral factors, including thyroid hormones. Although the role of thyroid hormones on cardiovascular system regulation on the autonomous nervous system was very well-defined decades ago for normal conditions and there is scarce information concern to the association between subclinical thyroid disorders and the autonomous nervous system. Hypothesis: Subclinical thyroid dysfunctions are associated with autonomic disturbances assessed by the heart rate variability evaluated by linear and nonlinear variables following postural changes. Methods: At baseline of the ELSA-Brasil study (15105 adults aged 35-74 years old), we evaluated the heart variability rate at the supine position for everyone, and sampled 855 participants to repeat a standing measure of the heart rate variability. Subclinical hypothyroidism was defined as thyroid-stimulating hormone >4 IU/ml for people with normal free-thyroxine levels. The cardiac autonomic nervous function was evaluated by linear time and frequency domain analyses (standard deviation of consecutive RRi - SDNN; root mean square of successive differences between adjacent regular R-R intervals - RMSSD; low frequency - LF; high frequency - HF; LF/HF ratio) as well as by nonlinear symbolic dynamics (patterns with no variation - “0V”; patterns with one variation - “1V”; patterns with two variations - 2V). Results: After exclusions, 666 (93.8%) euthyroid and 44 (6.2%) participants with subclinical hypothyroidism were eligible for analyses. At the baseline, supine rest measurement, the “0V” symbolic pattern, which reflects sympathetic modulation, was higher (31.8 vs. 24.2; P= .01) and “2V”, representing parasympathetic activity, was lower than in the euthyroid group (18.0 vs. 25.3; P= .02). Comparing the variation between positions, the “0V” pattern showed a lower delta in subclinical hypothyroidism than in euthyroid subjects (6.8 vs. 14.2%; P= .04). Additionally, it is suggested that a symbolic analysis of heart rate dynamics is an alternative and, possibly, a more sensitive method for cardiac autonomic assessment following standing position in this population. Conclusion: Subclinical hypothyroidism presented lower sympathetic and parasympathetic tonus at rest and a blunted sympathetic response to active postural change, marked by reduced variation in the “0V” of symbolic analysis.

Thyroid disorders in Brazil: the contribution of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Thyroid disorders are common diseases, both in Brazil and worldwide. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a prospective cohort study that investigates cardiovascular diseases, diabetes, and associated factors, including non-classical cardiovascular risk factors such as thyroid function. Thyroid function was classified according to thyrotropin stimulating hormone (TSH), free thyroxine (FT4), and use of medication to treat thyroid disorders, after excluding participants who reported use of any medication that could alter the results of the TSH and FT4 tests. All analyses included in this review are cross-sectional using baseline data (2008 to 2010). The results showed an association of subclinical thyroid disorders with biomarkers of subclinical atherosclerosis, measured by carotid intima-media thickness and coronary artery calcium, insulin resistance, metabolic syndrome, and some psychiatric disorders. No association was found with the biomarker of inflammation high-sensitivity C-reactive protein, or changes in pulse wave velocity or heart rate variability.

Hypothyroidism in pregnancy

Thyroid hormones of the fetus exclusively comes from mothers in early pregnancy, indicating that maternal hypothyroidism has a close-knit relationship with fetal growth and neuropsychological development. Hypothyroidism is one of the most common endocrinopathies during pregnancy with an estimated prevalence of 3–5% among pregnant women. Emerging evidence suggests that maternal overt hypothyroidism is associated with adverse maternal, obstetrical and neonatal outcomes, but, although there is still no consensus on the association of subclinical thyroid disorders or increasing thyroid antibodies with complications of pregnancy and childhood cognition. Data available are inconclusive regarding the benefits of treatment of subclinical hypothyroid pregnant women for both feto-maternal outcomes and even neurocognitive development of the children of affected women. In this review we aimed to address pregnancy outcomes of mothers affected by overt and subclinical hypothyroidism, psychosocial development of neonates affected by overt and subclinical maternal hypothyroidism and the beneficial effects of treatment.

Thyroid function in elderly people: The role of subclinical thyroid disorders in cognitive function and mood alterations.

International Journal of Clinical PracticeVolume 72, Issue 10 e13254 PERSPECTIVE Thyroid function in elderly people: The role of subclinical thyroid disorders in cognitive function and mood alterations Alessandro P. Delitala, Corresponding Author Alessandro P. Delitala aledelitala@tiscali.it orcid.org/0000-0003-1729-8969 U.O.C. di Medicina Interna 2 (Clinica Medica), Azienda Ospedaliero-Universitaria di Sassari, Sassari, ItalyCorrespondenceAlessandro P. Delitala, Azienda Ospedaliero-Universitaria (AOU) di Sassari, Clinica Medica, Viale San Pietro 8 Sassari 07100, Italy. Email: aledelitala@tiscali.itSearch for more papers by this authorMarta Manzocco, Marta Manzocco Department of Clinical and Experimental Medicine, University of Sassari, Sassari, ItalySearch for more papers by this authorFederico G. Sinibaldi, Federico G. Sinibaldi Department of Clinical and Experimental Medicine, University of Sassari, Sassari, ItalySearch for more papers by this authorGiuseppe Fanciulli, Giuseppe Fanciulli Department of Clinical and Experimental Medicine, University of Sassari, Sassari, ItalySearch for more papers by this author Alessandro P. Delitala, Corresponding Author Alessandro P. Delitala aledelitala@tiscali.it orcid.org/0000-0003-1729-8969 U.O.C. di Medicina Interna 2 (Clinica Medica), Azienda Ospedaliero-Universitaria di Sassari, Sassari, ItalyCorrespondenceAlessandro P. Delitala, Azienda Ospedaliero-Universitaria (AOU) di Sassari, Clinica Medica, Viale San Pietro 8 Sassari 07100, Italy. Email: aledelitala@tiscali.itSearch for more papers by this authorMarta Manzocco, Marta Manzocco Department of Clinical and Experimental Medicine, University of Sassari, Sassari, ItalySearch for more papers by this authorFederico G. Sinibaldi, Federico G. Sinibaldi Department of Clinical and Experimental Medicine, University of Sassari, Sassari, ItalySearch for more papers by this authorGiuseppe Fanciulli, Giuseppe Fanciulli Department of Clinical and Experimental Medicine, University of Sassari, Sassari, ItalySearch for more papers by this author First published: 14 September 2018 https://doi.org/10.1111/ijcp.13254Citations: 4Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume72, Issue10October 2018e13254 RelatedInformation

Is Subclinical Thyroid Dysfunction Associated With with Coronary Heart Disease

Introduction: Previous cohort studies reported contradictory data on the association between subclinical thyroid dysfunction and coronary heart disease (CHD). Regarding this, the present study was conducted to illuminate this relationship. Materials and Methods: For the purpose of the study, 3,066 participants employed in a study conducted by Azizi et al. aged ≥ 20 years were subjected to thyroid function tests every 3 years over a mean follow-up of 10 years. After the exclusion of the subjects with CHD and those consumed thyroid, anti-thyroid, or corticosteroid preparations, 2,144 subjects remained for analysis and followed up for CHD events in the next 10 years. Results: At the baseline, 1929, 139, and 76 subjects had euthyroid, subclinical hyperthyroid, and subclinical hypothyroid, respectively. No CHD event occurred in the subclinical hypothyroid group. After the adjustment of all confounders, the subclinical hyperthyroid group had the hazard ratio of 1.01 for CHD with a 95% confidence interval of 0.36-2.85. Conclusions: The 10 year follow-up of subjects with subclinical thyroid disease revealed no relationship between CHD and subclinical thyroid disorders.

Assessment of Thyroid Function in Early Pregnancy

<p><strong>Objectives: </strong>Thyroid disorders are commonly observed in pregnancy. Thyroid hormones play an important role in embryogenesis and fetal development. The fetus is completely dependent on the mother for thyroid hormone in first trimester. About 10% of all pregnant women can be affected by thyroid disorders during pregnancy. Thyroid function abnormalities in pregnancy are a challenge for the concerned physicians. The objective of this study was to assess the maternal thyroid function in first trimester of pregnancy.</p><p><strong>Patients and Methods: </strong>A descriptive cross sectional study was carried out at the Combined Military Hospital (CMH), Dhaka over a period of one year from January 2013 to December 2013 to see the serum FT<sub>3</sub>, FT<sub>4</sub>, TSH, thyroid antibodies level and common thyroid disorders in pregnancy. A total of 138 pregnant women in their first trimester (up to 12 weeks) of pregnancy with an age range of 18-35 years were enrolled in this study. Pregnant women with known thyroid disorder and on treatment and pregnancy more than three months were excluded. Measurement of serum FT<sub>3</sub>, FT<sub>4</sub>, TSH, Anti TPO-Ab and Anti TG-Ab were done in each patient at the time of enrolment. Ultrasonography of each patient was done for confirmation of pregnancy and correlation of gestational age.</p><p><strong>Results: </strong>Among 138 pregnant women, subclinical hypothyroidism was detected in 10 (7.2%) patients and subclinical hyperthyroidism was detected in 3 (2.2%) patients. Mean difference of the investigation findings were not statistically significant among primi and multi gravida. TPO-Ab and TG-Ab difference were statistically significant between two age groups.</p><p><strong>Conclusion: </strong>Subclinical thyroid disorders are fairly high among pregnant women. Correct diagnosis in early pregnancy and prompt treatment will bring an excellent prognosis for both mother and offspring.</p><p>Bangladesh J. Nuclear Med. 19(2): 98-102, July 2016</p>

Relationship between heart rate variability and subclinical thyroid disorders of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

The association between subclinical thyroid dysfunctions and autonomic modulation changes has been described by many studies with conflicting results. We aimed to analyze the association between subclinical hyperthyroidism (SCHyper), subclinical hypothyroidism (SCHypo), and heart rate variability (HRV) using the baseline from ELSA-Brasil. SCHyper and SCHypo were classified by use of medication to treat thyroid disorders, thyrotropin levels respectively above and under the reference range, and normal free thyroxine levels. For HRV, the participants underwent 10 min in supine position and the R-R intervals of the final 5 min were selected for analysis. We first used linear regression models to report crude data and then, multivariate adjustment for sociodemographic (age, sex, and race) and cardiovascular risk factors (hypertension, dyslipidemia, diabetes, smoking, body mass index, use of alcohol, and leisure physical activity) using the euthyroid group as reference. From 9270 subjects (median age, 50; interquartile range: 44–56), 8623 (93.0%) were classified as euthyroid, 136 (1.5%) as SCHyper, and 511 (5.5%) as SCHypo. Compared to euthyroid subjects, SCHyper participants presented significantly higher heart rate (68.8 vs 66.5 for euthyroidism, P=0.007) and shorter R-R intervals (871.4 vs 901.6, P=0.007). Although SCHyper was associated with lower standard deviation of NN interval (SDNN) (β: –0.070; 95% confidence interval (95%CI): –0.014 to –0.009) and low-frequency (LF) (β: –0.242, 95%CI: –0.426 to –0.058) compared to the euthyroid group, these differences lost significance after multivariate adjustment for confounders. No significant differences were found for HRV in SCHypo. No association was found between HRV and SCHyper or SCHypo compared to euthyroid subjects in this sample of apparently healthy subjects.

P6382Electrocardiographic changes in overt and subclinical thyroid disorders

P6382Electrocardiographic changes in overt and subclinical thyroid disorders

Thyrotrophin levels and coronary artery calcification: Cross-sectional results of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

There is little information about the association between thyrotrophin (TSH) levels and coronary artery calcification (CAC). Our aim was to analyse the association between TSH quintiles and subclinical atherosclerosis measured by CAC, using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Cross-sectional study. We excluded individuals using medications that affect thyroid function and who self-reported cardiovascular disease. We included euthyroid subjects and individuals with subclinical hypothyroidism (SCHypo) and subclinical hyperthyroidism (SCHyper). Logistic regression models evaluated CAC >100 Agatston units as the dependent variable, and increasing quintiles of TSH as the independent variable, adjusted for demographic and cardiovascular risk factors. Our sample included 3836 subjects, mean age 49years (interquartile range 44-56); 1999 (52.1%) were female, 3551 (92.6%) were euthyroid, 239 (6.2%) had SCHypo and 46 (1.2%) had SCHyper. The frequency of women, White people and never smokers as well as body mass index and insulin resistance increased according to quintiles. The 1st quintile for TSH (0-0.99mIU/L) was associated with CAC >100, using the 3rd quintile (1.39-1.85mIU/L) as reference (adjusted OR=1.57, 95% CI: 1.05-2.35, P=.027), but no association was shown for the 5th quintile (2.68-35.5mIU/L) compared to the 3rd. Restricting the analysis to euthyroid subjects did not change the results. For women, but not for men, we observed a U-shaped curve with 1st and 5th TSH quintiles associated with CAC>100. Low and low-normal (1st quintile) TSH levels were associated with CAC>100Agatston units in a sample with subclinical thyroid disorders and euthyroid subjects.

Abstract P374: Thyroid-stimulating Hormone Levels and Coronary Artery Calcium Score. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Introduction: There is scarce information about the association between thyroid stimulating hormone (TSH) levels with subclinical atherosclerosis as the coronary artery calcium score (CAC). Hypothesis: we assessed the hypothesis that the extremes quintiles of TSH were associated with high values of CAC. Methods: We analyzed cross-sectionally baseline data of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort of civil servants aged 35-74 years-old, in 4549 participants with CAC information. We excluded individuals using medications that affect thyroid function, with overt thyroid disorders and who self-reported cardiovascular disease. We included in the analysis TSH levels of subjects with euthyroidism and with subclinical thyroid disorders (subclinical hypothyroidism and hyperthyroidism). Logistic regression models evaluated increasing quintiles of TSH as the independent variables and CAC greater than 100 Agatston units as the dependent variable. Multivariate models were adjusted for age (continuous), sex, race (white, mixed, black, Asian, indigenous), body-mass index (continuous), hypertension (yes/no), diabetes (yes/no), dyslipidemia(yes/no), smoking (never/former/current), glomerular filtration rate (continuous, CKD-Epi formula) and C-Reactive Protein (log transformed). Results: From 3,836 subjects included (median age = 49 years;52.1%, women), 3,551 (92.6%) had euthyroidism, 239 (6.2%) subclinical hypothyroidism, and 46 (1.2%) subclinical hyperthyroidism. Frequencies of women, whites, never smokers, overweight/obesity and of reduced glomerular filtration rate increased according to TSH quintiles, but the frequency of diabetes decreased. Quintiles of TSH were from 1 st to 5 th respectively: TSH:0-0.99; 1.00-1.38; 1.39-1.85 (reference); 1.86-2.67; and 2.68-35.5 mIU/L. Using the 3 rd quintile as reference, the odds ratio OR (95% Confidence Interval) for CAC greater than 100 Agatston units were 1.57 (1.05-2.35) for the 1 st ; 0.95 (0.62-1.46) for the 2 nd ; 1.25 (0.81-1.87) for the 4 th ; and 1.18 (0.77-1.80) for the 5 th quintiles. Restricting analysis to the 3,551 euthyroid participants, quintiles of TSH in normal range were from 1 st to 5 th respectively: 0.40-0.99; 1.00-1.35; 1.36-1.75 (reference); 1.76-2.43 and 2.44-4.0. Using 3 rd quintile as reference, we also observed a significant association of the 1 st quintile with CAC: 1.70 (1.11-2.59) but not with 2 nd 0.95 (0.60-1.50), 4 th 1.46 (0.95-1.70) or 5 th 1.08 (0.69-1.70) quintiles. Conclusion: contrasting with previous studies that did not find any association between subclinical hypothyroidism and prevalent CAC, our results point to an association of low and low-normal TSH levels with prevalent CAC. Although one previous study showed an association between low normal TSH levels with CAC, our results also extended this association to low TSH levels.

Sub-Clinical Thyroid Disorders in Patients With Hepatitis C Before and After Conventional Treatment

Objective: Thyroid dysfunction represents one of the commonest endocrine manifestations of chronic hepatitis C infection, exaggerated by interferon based treatment. The purpose of this study was to assess the frequency of hepatitis C virus and sub-clinical thyroid disorder in patients with hepatitis C before and after treatment. Methods: This is an observational, cross sectional analysis conducted in Lyari general hospital and Abbasi Shaheed hospital from January 2009 to December 2015. Patients with a positive rt-PCR and genotype 3 were included in the study. After a positive rt-PCR, patients were screened by thyroid stimulating hormone before starting the treatment. All patients were given therapy of conventional interferons (3 million units thrice weekly) and ribavirin (800 mg per day in two divided doses) for a period of 6 months. Patient with normal TSH level was included and patients with a co-existing hepatitis B or D were excluded from the study. After 6 months of therapy all patients had a repeat rt-PCR to see the end treatment response to therapy and a thyroid stimulating hormone to screen for thyroid disorders. Results: A total of 129,430 patients have visited the medical outpatient department of which, 4069 were HCV RNA PCR positive. The prevalence of unrecognized hepatitis C Virus was 13.4% in the study population. The prevalence of sub-clinical thyroid disorders was 9%. Of which 6.5% had sub-clinical hypothyroidism and 2.5% had overt or subclinical hyperthyroidism. A total of 2196 patients were included in the analysis. Mean age was 36.22 ±10.01 years range from 16 to 63 years. Among all 36.9% were male and 5.1% were known diabetics. On the whole 14.8% were non-responders, 80.9% achieved an end treatment response and 4.3% lost to follow up. We observed an association between the post treatment TSH level and the ETR of HCV (p=0.015). A statistically significant difference (p<0.001; 95% CI -3.008-1.577) was observed in the thyroid stimulating hormone at the baseline and following the conventional interferon and ribavirin therapy for a period of 6 months. 388 (17.6%) patients had abnormal thyroid function tests after conventional interferon treatment. These 388 patients were further followed up for 6 months. Conclusion: In conclusion, this study results shows 13.4% prevalence of HCV in Karachi and the prevalence of sub-clinical thyroid disorders was 9%, of which 6.5% and 2.5% had overt hypothyroidism and hyperthyroidism respectively.

Assessment of thyroid function among the young asymptomatic male members of the Indian armed forces

Background: Thyroid Disorders are often underdiagnosed. This is probably due to the fact that most of the clinicians are unaware of that fact that clinical entities like Subclinical Hypothyroidism & Subclinical Hyperthyroidism do exist. Overt Hypothyroidism & Hyperthyroidism form only the tip of the iceberg of Thyroid Disorders. It has been shown in previous studies that unchecked subclinical hypothyroidism (SCH) in young individuals poses a risk for cardiovascular events in the future. This study attempts to assess the extent of Subclinical Hypothyroidism & Autoimmune Sub Clinical Hypothyroidism in the male members of the Indian Armed Forces. Through this study, the authors endeavour to bring to the notice that Subclinical Thyroid Disorders are an emerging health problem among the young individuals. It is also evident that clinical parameters alone are insufficient in establishing a diagnosis of hypothyroidism and are often misleading, thus biochemical confirmation is a must. Aims & Objectives: 1) To assess the thyroid function among asymptomatic male members of the Indian Armed Forces. 2) To study the distribution of non neoplastic thyroid disorders, if any, among the asymptomatic male members of the Armed Forces. 3) To detect the levels of Anti TPO antibodies among the members of the Armed Forces. 4) To correlate the variation in the T3, T4, TSH levels with the presence of Anti TPO antibodies. 5) To ascertain correlation, if any, between age of the subjects & presence of Anti thyroid antibodies. Materials & Methods: This is an Observation Crossectional Study performed at a Tertiary Care Naval Hospital over a period of 15 months.100 Male volunteers meeting the Inclusion & Exclusion criteria were enrolled using simple random sampling. The samples were tested for Serum T3, T4, TSH & Anti TPO Antibody levels using the STRATEC SR 300 Analyser on the day of collection. The data was analysed using the SPSS software & depicted in figures. Results: The prevalent non neoplastic Thyroid Disorders in the study population were Subclincal Hypothyroidism, Autoimmune Subclinical Hypothyroidism, Overt Hypothyroidism & High Anti TPO Antibody levels with normal Thyroid Function.The Mean Age of Presentation of Subclinical Hypothyroidism, Positive Anti TPO Antibodies & Autoimmune Subclinical Hypothyroidism were 27 ± 8.36 years (p>0.05), 26.12 ± 9.0 years (p>0.05) & 26.5 ± 7.0 years (p>0.05) respectively .The prevalence of Autoimmune Subclinical Hypothyroidism (p=0.0004), Overt Hypothyroidism (p value 0.042) & Anti TPO Antibody positivity (p=0.017) in the study population was significantly lower compared to the results of the prevalence of these disorders in General Population Based Studies. The Serum T4 levels and Age in the study population were found to have a statistically significant inverse correlation (p=0.041) Conclusion: Subclinical Autoimmune Hypothyroidism & Overt Hypothyroidism are the most prevalent non neoplastic thyroid disorders in the Male members of the Indian Armed with their prevalence in the study population being significantly less than the General population. Anti TPO antibody positivity precedes thyroid symptoms & deranged Thyroid Profile. Serum T4 has a significant inverse correlation with age & serum TSH levels. However, the correlation serum Anti TPO Antibody levels & age of the individuals is insignificant.

No evidence of association between subclinical thyroid disorders and common carotid intima medial thickness or atherosclerotic plaque

Background and aimsIncreased carotid artery intima-media thickness (IMT) and the presence of plaques have been shown to be predictors of cardiovascular disease. The cardiovascular risk in patients with overt thyroid diseases is related to increased risk of atherosclerosis, but there has been no clear evidence about subclinical disorders. We have assessed whether subclinical thyroid dysfunction is associated with arterial thickening and plaque. Methods and resultsThe SardiNIA study is a population-based survey on the Italian island of Sardinia. We reviewed data from 5815 subjects (aged 14–102 years), none of whom had overt hyperthyroidism or hypothyroidism or was taking thyroid medication. Serum thyrotropin (TSH), free thyroxine, together with carotid ultrasound IMT and the presence of common carotid plaques were analysed in all subjects. Possible association of IMT and carotid plaques with thyroid parameters was evaluated by univariate and multivariate analyses. IMT was significantly associated with age, sex, smoking, low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol, pulse pressure (PP), history of arterial hypertension, diabetes, and previous cardiovascular events (p = 0.001 or lower, R2 = 0.47). Carotid plaques were predicted by age, sex, LDL, PP, history of diabetes, previous cardiovascular events, and the use of statins (p = 0.029 or lower). Thyroid hormone was not predictive of carotid atherosclerosis when adjusted for confounders. ConclusionThyroid hormone is not associated with increased IMT or with the presence of carotid artery plaque. Our data do not support the idea that treating subclinical disorders might help to prevent arterial remodelling or carotid atherosclerosis.

Subclinical thyroid dysfunction and psychiatric disorders: cross‐sectional results from the Brazilian Study of Adult Health (ELSA‐Brasil)

To evaluate the association between subclinical thyroid dysfunction and psychiatric disorders using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Cross-sectional study. The study included 12437 participants from the ELSA-Brasil with normal thyroid function (92·8%), 193 (1·4%) with subclinical hyperthyroidism and 784 (5·8%) with subclinical hypothyroidism, totalling 13414 participants (50·6% of women). The mental health diagnoses of participants were assessed by trained raters using the Clinical Interview Schedule - Revised (CIS-R) and grouped according to the International Classification of Diseases 10 (ICD-10). Thyroid dysfunction was assessed using TSH and FT4 as well as routine use of thyroid hormones or antithyroid medications. Logistic models were presented using psychiatric disorders as the dependent variable and subclinical thyroid disorders as the independent variable. All logistic models were corrected for multiple comparisons using Bonferroni correction. After multivariate adjustment for possible confounders, we found a direct association between subclinical hyperthyroidism and panic disorder odds ratio [OR], 2·55; 95% confidence Interval (95% CI), 1·09-5·94; and an inverse association between subclinical hypothyroidism and generalized anxiety disorder (OR, 0·75; 95% CI, 0·59-0·96). However, both lost significance after correction for multiple comparisons. Subclinical hyperthyroidism was positively associated with panic disorder and negatively associated with anxiety disorder, although not significant after adjustment for multiple comparisons.

Subclinical thyroid disorders.

Symptoms of the menopause transition-altered cycle length, change in amount of bleeding, sleep disruption, fatigue, mood swings, forgetfulness, heat intolerance, and palpitations-can also reflect thyroid dysfunction, common in midlife women. Although many clinicians are familiar with diagnosis and management of overt thyroid disorders, subclinical thyroid disease adds an entirely new dimension to this arena.

Gender impact on the correlations between subclinical thyroid dysfunction and hyperuricemia in Chinese.

Overt hypothyroidism and hyperthyroidism can lead to hyperuricemia. However, few data are available regarding the association between subclinical thyroid dysfunction and hyperuricemia, especially from the perspective of gender impact. This study aimed to investigate the association between subclinical thyroid disorders and hyperuricemia with emphasized focuses on differences resulting from different gender. Eleven thousand four hundred forty-six healthy subjects (6870 male, 4576 female) were enrolled in this cross-sectional study, with exclusions of known thyroid, renal, hepatic, gastrointestinal, or oncological diseases. Clinical data including anthropometric measurements, thyroid function, uric acid, renal and liver function were collected. The associations between thyroid function and hyperuricemia of males and females were analyzed separately. Prevalence of hyperuricemia was substantially higher in male (23.17%) than that in female (9.11%). Serum uric acid was correlated well with various factors, especially with creatinine, whose coefficients were 0.283 and 0.386 for males and females. The significantly elevated risk for hyperuricemia was observed in mild hypothyroidism male participants with an odd ratio of 1.49 (1.10-2.02), whereas no statistical risk was found in female. No meaningful risk was found in mild hyperthyroidism participants. Estimated glomerular filtration rate was significantly depressed in both genders with mild hypothyroidism, while obviously increased in both genders with mild hyperthyroidism. For hyperuricemia, mild hypothyroidism is a risk factor in males while it is not in females. This difference could be caused by the protective effect of estrogen in females. Monitoring serum uric acid in subclinical hypothyroidism is more necessary in males.

171-POS

Objectives Subclinical thyroid disorders are common in pregnant women, which are associated with adverse pregnancy outcomes. Physiological changes in pregnancy and the lack of pregnancy-specific reference ranges pose great challenge for the managements of subclinical thyroid disorders in pregnancy. We aimed to establish trimester-specific thyroid hormone reference intervals throughout pregnancy in southern Chinese population. Methods we measured the serum thyroid hormone (TSH, FT4, TPO-AB) using Abbott electrochemiluminescence immunoassay in 5589 pregnant women during 2012–2013. Patients with known thyroid disorders, autoimmune disease, recurrent miscarriage, hyperemesis gravidarum and pre-eclampsia were excluded. Trimester-specific reference ranges (2.5th, 97.5th centiles) were calculated. Results TSH median T1: 1.19 ± 0.99 mIU/L ( N = 3532), T2: 1.40 ± 1.02 mIU/L ( N = 1623), T3: 1.48 ± 1.30 mIU/L ( N = 434). FT4 median T1: 15.7 ± 3.12 pmol/L ( N = 3532), T2: 13.81 ± 2.99 pmol/L ( N = 1623), T3: 12.92 ± 2.98 pmol/L ( N = 434). TSH reference range T1: 0.01–3.55 mIU/L, T2: 0.01–4.13 mIU/L, T3: 0–4.67 mIU/L. FT4 reference range T1: 12–21.44pmol/L, T2: 10.01–19.36 pmol/L, T3: 9.29–20.31 pmol/L. TSH slightly increased throughout gestation. FT4 decreased throughout gestation. Conclusions We established pregnancy-specific thyroid function reference intervals of southern Chinese population, which is beneficial in clinical practice. Disclosures L. Liu: None. X. Zhang: None. J. Yang: None. X. Qian: None. Z. Zheng: None. X. Tang: None. H. Liu: None.

Subclinical Thyroid Disorders: Clinical Significance and When to Treat?

Subclinical thyroid disorders are commonly encountered in the primary care setting. This article aims to review the latest evidence and guidelines pertaining to the management of subclinical hypo- and hyperthyroidism, in particular the important decision of when treatment should be considered.

Thyroid screening in pregnancy

The adverse impact of overt hypothyroidism that complicates pregnancy outcomes is well-established and not debated. For more than a decade, however, endocrinologists and obstetricians have been debating whether screening for subclinical thyroid disorders during pregnancy should be routine or should continue to be based on symptoms and risk factors. Several observational studies have suggested that offspring of women with asymptomatic thyroid dysfunction were at increased risk for impaired neurodevelopment. Other studies have suggested that pregnant women with subclinical thyroid disease, particularly those identified with an elevated thyroid-stimulating hormone (TSH) level may be at increased risk for pregnancy complications such as fetal death, preterm birth, or placental abruption. These data have prompted both obstetric and endocrinologic professional societies to draft recommendations regarding screening for thyroid disease during pregnancy, some of which are not entirely based on available evidence. The prevalence of overt thyroid disease is estimated to be 1-2 per 1000 pregnancies and historically has not been considered high enough to justify routine screening. Lower TSH thresholds (>2.5 mU/L) for the diagnosis of hypothyroidism have been promoted, and women with subclinical thyroid dysfunction commonly are included in estimates of thyroid disease during pregnancy, both of which exaggerate prevalence rates. The most compelling recent evidence on this issue has come from the Controlled Antenatal Thyroid Screening trial. After almost 22,000 pregnant women were screened for either isolated high TSH or isolated low free thyroxine level, 390 children of treated women with either diagnosis were compared with 404 children of similar women who were not treated during pregnancy. Treatment had no effect on mean offspring IQ at age 3 years or the number of children with an IQ <85. Authors of this landmark study concluded that antenatal screening and maternal treatment for women with subclinical thyroid dysfunction did not result in improved cognitive function. An ongoing intervention trial conducted by the Eunice Kennedy-Shriver National Institute of Child Health and Human Development's Maternal-Fetal Medicine Units Network will provide further clarity to this important question. In the interim, the debating authors have concluded, after careful review of the currently published literature, that routine screening for subclinical thyroid dysfunction during pregnancy is not currently warranted at this time.