Subclinical Hypothyroid State Research Articles

Correlation Between Hypothyroidism and Gallstone Disease in Central India.

Introduction The decreased thyroid-stimulating hormone (TSH) levels affect almost every nucleated cell in our body, which directly affects the basal metabolic rate (BMR). It tends to affect multiple organ systems in the human body. In recent times, there have been changes inlifestyle and the consumption ofprocessed foods has increased. Thus, cholelithiasis and hypothyroidism are being encountered frequently, even in rural populations. In recent times, the overt clinical presentation of hypothyroidism is rare due to early diagnosis and treatment of the subclinical hypothyroidism state itself. Aim The aim is to determine the correlation betweencholelithiasis and hypothyroidism. Methods This was a cross-sectional study done on the patients presenting to the surgical department at Acharya Vinoba Bhave Rural Hospital affiliated to Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India between the duration from December 2020 to December 2022, having gallstone disease or with symptoms suggestive of gall bladder stones. The admitted patients were then evaluated for hypothyroidism by thyroid profile tests, and the results were documented. Using the collected data, factors such as clinical spectrum, correlation between cholelithiasis and hypothyroidism, relation with the demographic data, and body mass index (BMI) were studied. Results A total of 52 gallstone patients were included in the study. A greater number of patients were found to be above the age of 40 years (82.7%), with female preponderance (61.5%).More patientswith cholelithiasis were from the group with having BMImore than normal (57.6%).More patients having both cholelithiasis and hypothyroidism were also from the group with having BMI more than normal. Mostsymptomatic patients complained ofpain in the right hypochondriac region (88.5%). Of these 52 patients, nine (17.3%) were found to have hypothyroidism (seven were subclinical, two patients had overt clinical symptomsand signs)and theremaining 43 patients were euthyroid. Conclusions Our study supports that there is a correlation between cholelithiasis and hypothyroidism. Out of all the 52 patients, nine had hypothyroidism, seven were subclinical, and two had overt symptoms. Thus, we conclude that there is a correlation between cholelithiasis and hypothyroidism.

Autoimmune Thyroid Disease in Psoriasis Patients: A Case-Control Study.

Psoriasis is a common immunologically mediated inflammatory disease characterized by skin inflammation, epidermal hyperplasia, an increased risk of painful and destructive arthritis, cardiovascular morbidity, and psychosocial challenges. Some autoimmune diseases are mediated by stimulating or blocking auto-antibodies. Auto-antibodies may act as antagonists and bind to hormone receptors, blocking receptor function. It may result in impaired secretion of mediators and gradual dysfunction of the affected organ, e.g., Graves disease and myasthenia gravis. This study was planned to evaluate the association between anti-thyroid peroxidase antibody (anti-TPO Ab) and anti-thyroglobulin antibody (anti-TG Ab) as biochemical markers in 30 clinically diagnosed psoriasis patients. This hospital-based, epidemiological case-control study was conducted in the Department of Biochemistry in collaboration with the Department of Dermatology, Venereology, and Leprology at Bhagat Phool Singh Government Medical College for Women, Khanpur Kalan, Sonepat, Haryana, India. Thirty subjects diagnosed clinically with psoriasis and an equal number of age-matched controls with no known autoimmune disease from the outpatient department were also enrolled. The following hormonal tests, i.e., thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), and antibodies, anti-TPOAb and anti-TG Ab, were performed. The study period was one year. The data thus obtained was analyzed using SPSS Statistics version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp). The significance level (p-value) was taken as <0.05. The mean age of psoriasis subjects was 37.83±12.89 years compared to 36.91±12.32 years in the control group and was found to be non-significant (p=0.432), reflecting a similar age distribution. A male preponderance was observed in the present study, where the psoriasis group consisted of 80% males and 20% females, while the control group had 60% males and 40% females. All six psoriasis patients diagnosed with autoimmune thyroid disease (AITD) were euthyroid at the time of enrollment, compared to only one control subject in a subclinical hypothyroid state. The mean values of anti-TPO Ab were 30.93±41.26 IU/mL in psoriasis patients and 11.39±28.42 IU/mL in the control group (p=0.001), while the mean values of anti-TG Ab were 11.21±27.69 IU/mL in psoriatic subjects and 2.49±9.05 IU/mL in the control group (p=0.004). No significant correlation between AITD and psoriasis was found when both parameters were analyzed statistically for correlation; even when one marker was considered, no significant correlation was found. The odds ratio was calculated to find an association between the disease and thyroid autoimmunity. The odds ratio was estimated to be 2.25 for psoriasis and the control group, with a confidence interval of 95% (0.77-6.59) and a p-value of 0.139, which was not statistically significant. Psoriasis, a dermatological disorder, has been seen as related to AITD. The role of early detection of anti-thyroid antibodies, i.e., anti-TPO Ab and anti-TG Ab, can be of prognostic value in AITD and psoriasis.

Autoimmune thyroid status in subclinical thyroid disorders in patients attending a tertiary care center in Nepal: a hospital-based cross-sectional study

BackgroundThyroid dysfunction is the leading endocrine disorder worldwide. Iodine deficiency disorders, which were once the major etiology of thyroid dysfunctions, now have been succeeded by autoimmune thyroid diseases with the rise in aberrant salt ionization protocols. This study endeavors to access the level of thyroid autoantibodies viz. anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (TGA), and anti-thyroid stimulating hormone receptor (TRAb) in individuals with subnormal thyroid profiles.MethodsThis hospital-based cross-sectional study was conducted at the Department of Clinical Biochemistry, Tribhuvan University for a period of six months. Using non-probability (purposive) sampling method, a total of 60 patients were enrolled with subnormal thyroid profiles to include the population who have not yet started medication. Thyroid hormones (free T3, free T4, TSH) and thyroid antibodies (anti-TPO, TGA, and TRAb) were measured. For non-parametric data, Chi-square test and Kruskal-Wallis test were used. Spearman’s correlation was done to determine the association between variables.ResultsOut of 60 participants, the majority of the population between 25 and 44 years were diagnosed with thyroid dysfunction with female preponderance. Among all, 40% (n = 24) had subclinical hyperthyroid states while, 60% (n = 36) had subclinical hypothyroid states, and 75% (n = 45) of the total exhibited positive thyroid antibodies. In subclinical hypothyroid patients with TSH above 10 µIU/ml, anti TPO (58.5%) and TGA (66.7%) positivity were highly prevalent. On the other hand, TRAb was exclusively positive in hyperthyroid condition (50% among the group) which is by far the first of its kind reported in Nepal.ConclusionThe rise in autoimmune thyroid disease among the Nepalese population infers that addressing iodine deficiency simply through salt iodinization may not be adequate to deal with the rising burden of thyroid disorders, especially in iodine-depleted areas. Also, the increasing prevalence of thyroid autoantibodies positivity in subclinical hypothyroidism in the Nepalese population accounts for the arduous screening and monitoring of autoimmune thyroid disorders in Nepal.

The Role Of Speckled Tracked Transthoracic Echocardiography And Global Longitudinal Strain In Heart Failure Patients With Subclinical Hypothyroid State

The Role Of Speckled Tracked Transthoracic Echocardiography And Global Longitudinal Strain In Heart Failure Patients With Subclinical Hypothyroid State

LEVELS OF SERUM TSH AND ITS IMPLICATIONS IN DEVELOPMENT OF METABOLIC SYNDROME – TIP OF THE ICEBERG: IN YOUNG ADULTS OF GUWAHATI CITY.

Thyroid Stimulating Hormone (TSH) is a hormone secreted by the anterior pituitary that plays an important role in regulating the function of the thyroid gland. Levels of TSH in the blood - is a reliable index of the functional status of the thyroid gland. At present, TSH levels in serum are estimated by microparticle enzyme immuno assays (MEIA), which are very sensitive. In the current study, serum TSH levels were measured in 100 clinically euthyroid subjects, consisting of 50 males and 50 females. The study found that 12% of the subjects (5 males and 7 females) had TSH values above the normal, the normal range of the TSH assay being 0.35-4.50 m IU/ml. This nding is signicant in light of the recent focus on subclinical hypothyroidism being in limelight, particularly the risk of development of overt thyroid dysfunction in persons with high normal values of serum TSH. Furthermore, such kind of studies in general population among young population was done rarely previously, as a reection of their serum TSH levels in this part of the India who are considered euthyroid till the time they were tested. Moreover, detection of subclinical or overt hypothyroid state helps in the preventive aspects as well as to nd out other parameters of metabolic syndrome- which is considered now as just the tip of the iceberg. In the study, serum TSH levels were measured in 100 eut Materials and methods: hyroid subjects (50 males and 50 females) by microparticle enzyme immune assay. After analyzing the values of TSH i Results: t was detected that 12% of the subjects (5 males and 7 females) had TSH levels &gt;4.50 m IU/ml (Upper limit of the normal range). This nding is Conclusion: signicant in light of the recent focus on subclinical hypothyroidism being particularly at the risk of development of overt thyroid dysfunction in young age leading to a gamut of metabolic disorders and mortality &amp; morbidity occuring among such populace at a young age Further, it is of importance that such type of lifestyle modiable disorders can be prevented or reverted to normal if detected early.

Assessment of the relationship between subclinical hypothyroidism and blood lipid profile: reliable or not?

BackgroundThe relationship between subclinical hypothyroidism (SCH) and blood lipid metabolism is controversial. This study is intended to evaluate the relationship between SCH and blood lipid profiles using well defined diagnostic criteria.MethodsData from 11,512 physical examinees in our hospital who had finished two tests with an interval of at least 3 months were analyzed, including 685 cases of SCH as stipulated in this study. In addition to common physical examination indicators, other parameters such as thyroid function indices and blood lipids were measured twice with an interval of at least 3 months. Subjects were diagnosed with SCH only when their levels of TT3, TT4, FT3 and FT4 were normal and TSH levels were increased on both tests, which meant these subjects were in a state of SCH for at least 3 months. The results of blood lipids for the second time were analyzed.ResultsStatistically significant differences were found in age, sex, BMI, hemoglobin, total cholesterol (TC), low density lipoprotein (LDL-C), high density lipoprotein (HDL-C), and BFP between the SCH and control groups (P < 0.001). However, there were no statistically significant differences in age, sex, blood pressure, blood lipids, blood glucose or BMI between patients with mild SCH and those with severe SCH (P > 0.05). After balancing the age and sex ratio, no factors were confirmed to be statistically significant independent factors of SCH. None of the parameters showed statistically significant differences between patients with mild SCH and those with severe SCH (P > 0.05).ConclusionAfter defining rigorous criteria for the diagnosis of SCH, no definite association between SCH and TC, LDL-C or HDL-C was confirmed in this study. SCH may have no relationship to the most concerning blood lipid profile.

Analysis of thyroid stimulating hormone (thyrotrophin) level as a gold standard marker for assessing frequency of subclinical hypothyroidism in the first fifteen weeks of gestation.

Objective: To find out the frequency of subclinical hypothyroidism in the first trimester of pregnancy. Study Design: Cross-Sectional study. Setting: Bacha Khan Medical Complex Swabi. Period: May 2019 to October 2019. Material &amp; Methods: Total ninety (90) subjects visiting antenatal unit were taken for the study by using non-probability sampling technique. The sample size was calculated by Andrew Fisher’s formula. After the informed consent 5ml of blood was collected in EDTA tube from the enrolled patient. The blood was centrifuged and their serum was preserved in cuvets for forthcoming TSH analysis. The cut-off value for TSH was 4.0 mIU/L as per new American guidelines 2017. Results: The cases were described according to their thyroid function tests. There were eleven (11) cases in which TSH value was more than 4.0 mIU/L. To rule out hypothyroid state we also do Ft4 for these cases whose results were normal. This interpretation identifies subclinical hypothyroid state in these cases. We did not perform ft4 for cases whose TSH was in normal range. The p-value &lt; 0.5 was considered significant. Pearson correlation values were given in the Table-III. Conclusion: it has been concluded from the results that pregnant women are associated with subclinical hypothyroidism (TSH &gt; 4.0 mIU/L and Free T4 within normal range) which requires proper assessment during pregnancy to avoid from any further risk.

Interpretation of TSH and T4 for diagnosing minor alterations in thyroid function: a comparative analysis of two separate longitudinal cohorts

BackgroundMinor alterations in thyroid function are frequent, and interpretation of thyroid function tests in the individual patient can be challenging. Furthermore, the choice of thyroid function test is debatable. To inform the debate, we performed a comparative evaluation of the variation in thyrotropin (TSH) and thyroxine (T4) in two different cohorts to illustrate the precision of TSH and T4 in the diagnosis and monitoring of thyroid dysfunction.MethodsA comparative analysis of two separate longitudinal studies previously surveyed with monthly blood sampling for one year among 35 subjects. Participants were included based on T4 within the reference range and TSH either within (euthyroid; n = 15) or above (subclinical hypothyroidism; n = 20) the laboratory reference range on two independent blood samplings before inclusion. Exclusion criteria were known thyroid disease or use of thyroid interfering medication. TSH and T4 in individual samples were measured in a single batch to prevent between-batch variation. The distributions TSH and T4 were compared among euthyroid and subclinical hypothyroid individuals, and bootstrap estimates were used to calculate area under the curve (AUC).ResultsCollection of twelve, monthly blood samples in the 35 participants provided 420 samples, and data completeness was 100%. The mean TSH was 1.27/7.19 mIU/L and the mean total T4 was 106/85 nmol/L in euthyroid/subclinical hypothyroid participants. The subclinical hypothyroidism state deviated from the euthyroid by 20% for total T4 and by 466% for TSH. The overlap between the euthyroid and subclinical hypothyroid groups was 92.6% (389/420) for total T4 and 9.0% (38/420) of test results for TSH. The estimated AUC was 0.999 (95%-CI: 0.995; 1.00) for TSH and 0.853 (0.736; 0.935) for total T4. There was no confidence interval overlap between participant groups for TSH while there was a considerable overlap for total T4 (p < 0.001).ConclusionThe distributions of thyroid function tests illustrated how TSH outperforms T4 for detecting delicate differences in thyroid function in an individual. Thus, TSH was markedly better than T4 to discriminate between the subtle differences in thyroid function corroborating that TSH is the more sensitive and accurate index of thyroid function status in the individual patient.

Subclinical Hypothyroidism and Cognitive Impairment.

Although thyroid dysfunction has been considered as a cause of reversible cognitive impairment, association between subclinical hypothyroidism and cognitive impairment is controversial. We compared cognitive profiles of patients in an euthyroid or subclinical hypothyroid (sHypo) state, as well as their disease progression from mild cognitive impairment (MCI) to dementia within 3 years. We included 2,181 patients in a euthyroid and 284 in a sHypo state over 60 years of age who underwent an extensive cognitive assessment at Seoul National University Bundang Hospital but were not prescribed levothyroxine, methimazole, carbimazole, or propylthiouracil. After propensity score matching for age, sex, and education level, 1,118 patients in a euthyroid and 283 patients in a sHypo state were included. Attention, language, memory, visuocontructive, and executive functions were compared between the groups using Student's t-test or the Mann-Whitney U test. To investigate the association between disease progression and subclinical hypothyroidism, a Cox regression analyses was performed in 379 patients with MCI. Patients with thyroid-stimulating hormone levels over 10 mlU/L was classified as the "sHypo10", and hazard ratios for sHypo or sHypo10 were assessed. There was no difference in attention, language, memory, visuoconstructive, and executive functions between the patient groups. Progression from MCI to dementia was not associated with sHypo or sHypo10. There was no difference in cognitive profile between euthyroid and sHypo patients, and no association between subclinical hypothyroidism and disease progression. This might suggest a clue of strategies regarding hormone therapy in subclinical hypothyroidism with cognitive impairment.

Fine needle aspiration cytology of thyroid lesions and thyroid profile – a correlative study

Introduction The Fine Needle Aspiration Cytology (FNAC) is a simple, safe, cost-effective minimally invasive procedure for diagnosing thyroid nodules/swelling. Clinicians usually evaluate thyroid function by estimating T3, T4 and TSH level for therapeutic planning. In this study the importance of FNAC in the diagnosis of thyroid diseases was evaluated and FNAC findings were correlated with clinical features and thyroid profile. Materials and Methods The study was designed as prospective cross-sectional hospital based (laboratory investigation) study for 2 months duration (from 17th July, 2017 to 16th September, 2017). Fifty cases of thyroid swelling attending Pathology Department for FNAC were included in the study. For Each case thyroid profile was done. Result Total 50 patients of thyroid swelling were included in the study, out of which 46 were female (92%) and 4 were male (8%). Male to female ratio was 1:12.5. Mean age was 45.44 ±16.02 years. Out of 50 patients 35 (70%) had diffuse thyroid swelling, 9 (18%) had left lobe and 6 (12%) had right lobe involvement. All the 50 patients with thyroid lesion had a common complaint of neck swelling. Some had associated dysphagia (12 cases, 24%) and/ or dyspnoea (6 cases, 12%), and only 2 had hoarseness of voice. Among 38 cases of non-neoplastic lesions colloid goitre was the commonest comprising 20 cases (52.63%), followed by 11 cases ( 28.95%) lymphocytic thyroiditis, 4 cases (10.53%) of granulomatous thyroiditis and 3 cases (7.89%) of follicular hyperplasia. Among 12 cases of neoplastic lesions papillary carcinoma was the commonest consisting of 7 cases (58.33%), followed by follicular neoplasm (4 cases, 33.33%) and 1 case of Hurthle cell neoplasm. Most of the colloid goitre cases were euthyroid (60%), lymphocytic thyroiditis was commonly associated with hypothyroidism (45.5% cases), and most cases of granulomatous thyroiditis were euthyroid (50%). All the patients with follicular hyperplasia had hyperthyroidism. Most of the cases with papillary carcinoma were in euthyroid (3 of 7, 42.86%) and followed by subclinical hypothyroid state (2cases, 28.57%) and one case of each hypothyroidism and subclinical hyperthyroidism. Follicular neoplasm was commonly associated with euthyroid state (75% cases). One case of Hurthle cell neoplasm had hyperthyroidism. Conclusion Thyroid gland being superficial, it is easy to perform fine needle aspiration. Similar thyroid disease shows variable hormone profile in different patient and different stages of the disease. Hence, FNAC of thyroid lesions in conjunction thyroid hormonal analysis helps in proper assessment and management of patients with thyroid lesion.

Abstract 13197: Increased Cardiac and All-Cause Mortality After Percutaneous Coronary Intervention in Subclinical Hypothyroidism: A Meta-Analysis

Background: Subclinical hypothyroidism (elevated TSH with normal thyroid hormone levels), is associated with an increased risk of cardiovascular diseases like atherosclerosis and coronary artery disease. However, its impact on long-term outcomes after percutaneous coronary intervention (PCI) remains understudied. Methods: PubMed, EMBASE, and Web of Science databases were screened through June 2021 for studies reporting long-term PCI outcomes in patients with subclinical hypothyroid state vs. Euthyroid state. Random effects models were used for the meta-analysis. I2 statistics were used to interpret heterogeneity with I 2 &gt;75% indicating substantial inter-study variation. A sensitivity analysis was performed using the leave one out method. A p-value &lt;0.05 was considered statistically significant. Results: A total of 6 studies including 11,664 patients who had undergone PCI were identified with a median follow-up period of 3.75 years. There were 987 patients identified with subclinical hypothyroidism and the mean age of the cohort was 67.15 ± 9.9 years. It consisted of 48% males, the most common comorbidities were hypertension (70%) followed by diabetes mellitus (33%). In-hospital outcomes were reported only in one study while long-term outcomes were reported in all 6 studies. Pooled analysis for long-term adverse events showed that subclinical hypothyroidism was associated with increased all-cause (OR 1.78, 95%CI: 1.16-2.72, p&lt;0.01, I 2 =50.67%) and cardiac mortality (OR 1.41, 95%CI: 1.09=1.81, p&lt;0.01, I 2 =0%) over long-term follow-up following PCI Conclusions: Subclinical hypothyroidism at times remains undiagnosed or underdiagnosed, however, it predicts significantly higher all-cause and cardiac mortality in the long term following PCI compared to controls. Therefore, it is recommended to regularly screen and manage high-risk patients undergoing PCI with underlying subclinical hypothyroidism.

Аналіз впливу субклінічного гіпертиреозу на параметри кісткового метаболізму

Стан субклінічного гіпертиреозу можна розглядати як оптимальну модель для оцінки значення тиреотропного гормона (ТТГ) для кісткової тканини у клінічній практиці. Мета дослідження: здійснити порівняльний аналіз впливу субклінічного гіпертиреозу різного генезу на показники мінеральної щільності кісткової тканини (МЩКТ) і параметри кісткового обміну. Матеріали і методи. У дослідження в амбулаторних умовах було включено 112 жінок з діагнозом «субклінічний гіпертиреоз» і тривалістю менопаузи принаймні 5 років. Із числа обстежених ендогенний субклінічний гіпертиреоз спостерігався у 78 жінок (група I), екзогенний субклінічний гіпертиреоз на тлі супресивної терапії левотироксином (група II) — у 34. До контрольної групи (група III) увійшло 20 жінок без порушення функції щитоподібної залози. Результати. У дослідженні вперше проведений порівняльний аналіз стану кісткового метаболізму, показників МЩКТ, а також показників фосфору і кальцію, ліпідного спектру крові у жінок із субклінічним гіпертиреозом різної етіології. Позитивна кореляція маркерів кісткового метаболізму і вільного трийодтироніну (вТ3) як гормонів, необхідних для розвитку скелета і підтримки його гомеостазу, вказує на фізіологічний вплив паратгормона і вТ3 на кісткову тканину. Показано, що стан кісткового метаболізму і МЩКТ залежить не лише від вмісту ТТГ, але й від причин розвитку субклінічного гіпертиреозу. Висновки. У жінок постменопаузального періоду з ендогенним субклінічним гіпертиреозом спостерігається вірогідне зниження показників МЩКТ, більш виражене в кістках із кортикальною будовою. Виявлена негативна кореляційна залежність між маркерами кісткового метаболізму і ТТГ серед усіх пацієнтів, включених у дослідження.

The subclinical hypothyroid state might predict 30-day readmission in patients admitted with acute heart failure syndrome and reduced left ventricular ejection fraction.

Introduction:Thyroid hormone (TH) has an essential role on the functional capability of cardiac muscle with its gene modulation and induction of vasodilatory effects. There is considerable evidence to suggest the role of TH in patients with acute coronary syndrome, but less is known about its prognostic role in heart failure (HF) patients. We aim to evaluate the association between subclinical hypothyroid state (SCHS) and event rates including 30-day all-cause and HF readmission in patients with an index hospitalization for acute HF syndrome (AHFS).Methodology:A retrospective chart review analysis of 2335 patients admitted with the diagnosis of AHFS between 1 January 2007 and 31 December 2017 was conducted. SCHS was defined as thyroid-stimulating hormone (TSH) level >4.50 mIU/L with a normal thyroxine (T4) level. Patients with pre-existing thyroid disease or receiving thyroid replacement therapy were excluded. HF with preserved ejection fraction (HFpEF) was defined as left ventricular ejection fraction (LVEF) >40% and HF with reduced ejection fraction (HFrEF) was defined as having LVEF ⩽40%. Percentage of 30-day, 3-month and 6-month all-cause readmission and mortality rates were calculated in both cohorts of AHFS (HFpEF and HFrEF) with and without SCHS.Results:The mean age of the 2335 AHFS population was 65 (±14.8) years. Of the 2335 patients admitted with AHFS, 1228 (52.6%) patients were found to have HFrEF and 1107 (47.4%) with HFpEF. There were 170 (7.3%) patients with AHFS found to have SCHS. There were more males than females (54% versus 46%). The percentage of hospital readmission within 30 days was higher for patients with SCHS compared with those without SCHS in the HFrEF group (42% versus 30%, p = 0.001). Hospital readmission within 30 days for patients with SCHS compared with those without SCHS in the HFpEF group did not differ (36.5% versus 31%, p = 0.47). Additionally, all-cause mortality was higher among patients with SCHS compared with patients without SCHS in the HFrEF group (18.7% versus 7.0%, p < 0.001). All-cause mortality was found similar in both arms of the HFpEF group (9.5% versus 7.7%, p = 0.73).Conclusion:During an index hospital admission for AHFS, SCHS was an independent predictor of readmission in 30 days in patients with HFrEF but not in patients with HFpEF. Additionally, it was related to adverse outcome such as all-cause mortality in HFrEF patients but not in HFpEF patients. Further studies regarding the concept of tissue thyroid and the potential for a therapeutic target are warranted.

Sample Timing, Diagnosis of Subclinical Thyroid Dysfunction and Mortality in Acute Myocardial Infarction: ThyrAMI1 Study.

The objective of this study was to determine the impact of blood sample timing on the diagnosis of subclinical thyroid dysfunction (SCTD) and mortality in patients with acute myocardial infarction (AMI). Patients with AMI had thyroid function evaluated on admission between December 2014 and December 2016 and those with abnormal serum thyrotropin (TSH) had repeat thyroid function assessed at least a week later. The association between sample timing and SCTD was evaluated by logistic regression analysis. Secondary outcomes were confirmation of SCTD on repeat testing and all-cause mortality up to June 2018. Of the 1806 patients [29.2% women, mean (± standard deviation) age of 64.2 (±12.1) years] analyzed, the prevalence of subclinical hypothyroidism (SCH) was 17.2% (n = 311) and subclinical hyperthyroidism (SHyper) was 1.2% (n = 22) using a uniform TSH reference interval. The risk of being diagnosed with SCTD varied by sample timing in fully-adjusted models. The risk of SCH was highest between 00.01 and 06.00 hours and lowest between 12.01 and 18.00 hours, P for trend <.001, and risk of SHyper was highest between 12.01 hours and 18.00 hours and lowest between 00.01 hours and 06.00 hours. Furthermore, time of the initial sample was associated with the risk of remaining in a SCH state subsequently. Mortality in SCH patients was not elevated when a uniform TSH reference interval was utilized. However, when time period-specific TSH reference ranges were utilized, the mortality risk was significantly higher in SCH patients with HR (95% CI) of 2.26 (1.01-5.19), P = .04. Sample timing impacts on the diagnosis and prognosis of SCH in AMI patients. If sample timing is not accounted for, SCH is systemically misclassified, and its measurable influence on mortality is lost.

Correlation of Biochemical Parameters with Cytomorphological grading in Hashimoto’s Thyroiditis

Background: Hashimoto’s thyroiditis (HT) is one of the most common cause of hypothyroidism in iodine sufficient areas. Diagnosis of HT is based on clinical, cytomorphological and biochemical parameters. Fine Needle Aspiration Cytology (FNAC) of thyroid provides a safe and accurate method for diagnosis of HT. Cytological grading of HT helps in assessing the severity of the disease and can predict the thyroid functional status. Methods: Retrospectively, 50 diagnosed cases of HT on FNAC were studied over a period of 6 months in a tertiary care hospital. Clinical, biochemical parameters such as T3, T4 and TSH values were collected. Cytological grading of FNAC smears was done based on Bhatia et al cytological grading system into three grades. These grades were compared with the clinical and biochemical parameters of HT. Result: Of 50 patients, 47 were females. Maximum number of cases were seen between 36 -45 years. Most of the patients presented with goiter. 31 out of 50 (62%) cases were grade II thyroiditis, of them most cases were hypothyroid. 17 out of 50 cases (34%) were grade I thyroiditis, of which most cases were euthyroid biochemically. Conclusion: Higher the grades of HT in cytology the more abnormal are the biochemical parameters. A combined approach of cytological grading along with clinical and biochemical parameters can detect subclinical hypothyroid state which provides a guide to therapy.

Abnormal Glucose Metabolism and Insulin Resistance Are Induced via the IRE1α/XBP-1 Pathway in Subclinical Hypothyroidism.

Subclinical hypothyroidism (SCH) and diabetes mellitus are closely related and often occur together in individuals. However, the underlying mechanism of this association is still uncertain. In this study we re-analyzed the data of a mature database (NHANES, 1999 ~ 2002) and found that both fasting plasma glucose levels and the proportion of hyperglycemic subjects among SCH patients were higher than that found in euthyroid controls. SCH was also associated with a 2.29-fold increased risk for diabetes. Subsequently, we established an SCH mouse model and subjected it to an oral glucose tolerance test (OGTT) and an insulin tolerance test (ITT). SCH mice exhibited impaired glucose and insulin tolerance. Increased HOMA-IR and decreased ISI indexes, indicating insulin resistance (IR), were also observed in the SCH state. Hepatic ERp29 and Bip, as well as IRE1α and XBP-1s, were induced significantly in SCH mice, suggesting the induction of endoplasmic reticulum (ER) stress, particularly involving the IRE1α/XBP-1s pathway. Interestingly, when we relieved ER stress using 4-phenyl butyric acid, abnormal glucose metabolism, and IR status in SCH mice were improved. Our findings suggest that ER stress, predominantly involving the IRE1α/XBP-1s pathway, may play a pivotal role in abnormal glucose metabolism and IR in SCH that may help develop potential strategies for the prevention and treatment of diabetes.

THE SUBCLINICAL HYPOTHYROID STATE MIGHT PREDICT 30-DAY READMISSION IN PATIENTS WITH AN ACUTE HEART FAILURE SYNDROME AND REDUCED LEFT VENTRICULAR EJECTION FRACTION

Thyroid hormone has an essential role on the functional capability of cardiac muscle with its gene modulation and induction of vasodilatory effects. We aim to evaluate the association between the subclinical hypothyroid(SCH) state and event rates including 30 day all-cause and heart failure(HF)

High Thyrotropin Is Associated with Reduced Hippocampal Volume in a Population-Based Study from Germany.

Previous patient studies suggest that thyroid dysfunction affects volumes of particular regions of the brain. So far, population-based data related to this topic are lacking. The aim of this study was to investigate associations of serum levels of thyrotropin (TSH), free triiodothyronine, and free thyroxine (fT4) with total brain volume, gray matter volume, white matter volume (WMV), and hippocampal volume (HV) in a population-based study. Data on 2557 individuals were pooled from two independent population-based surveys of the Study of Health in Pomerania conducted in Northeast Germany. Brain volumes were determined from images derived from 1.5 T magnetic resonance imaging. Low and high TSH were defined using the cutoffs 0.40 and 3.29 mIU/L, respectively. Associations between thyroid hormone levels and segmented brain volumes were analyzed by linear regression models. Further, voxel-based morphometry was conducted to search for associations with thyroid hormone levels in a hypothesis-free way throughout the whole brain. All models were adjusted for confounders. Only 9/70 individuals with high TSH had low free triiodothyronine or fT4 levels. Individuals with high TSH had significantly lower total brain volume (β = -26.9 [confidence interval (CI) -49.0 to -4.8]; p = 0.017), WMV (β = -16.1 [CI -29.4 to -2.7]; p = 0.018), and HV (β = -223 [CI -395 to -50]; p = 0.011) than individuals with TSH within the reference range, while low TSH was not significantly associated with any of the brain volumes. Voxel-based morphometry analyses revealed a significant positive association with serum fT4 levels in the left middle frontal gyrus. In conclusion, the results of this study indicate that the subclinical hypothyroid state may lead to a reduced brain volume affecting particularly HV in younger subjects and WMV, which might correspond to subtle microstructural changes in white matter fiber tracts or myelination of the axones. Gray matter seems not to be affected by subclinical hypothyroid states.

The Subclinical Hypothyroid State might Predict 30 Day Readmission in Patients with an Acute Heart Failure Syndrome and Reduced Left Ventricular Ejection Fraction.

Introduction Thyroid hormone has an essential role on the functional capability of cardiac muscle with its gene modulation and induction of vasodilatory effects. There is a considerable evidence to suggest the role of thyroid hormone in acute coronary syndrome (ACS) patients but less is known about its prognostic role in heart failure (HF) patients. We aim to evaluate the association between the subclinical hypothyroid state and event rates including 30-day all-cause and HF readmission in patients with an index hospitalization for an acute HF syndrome (AHFS). Methods A retrospective chart review analysis of 1,020 patients, who were admitted to Bronx-Care Hospital Center with the diagnosis of an AHFS was conducted. We reviewed cases from January 1, 2012 to December 31, 2017. The subclinical hypothyroid state was defined as thyroid stimulating hormone (TSH) level>4.50 mIU/L with a normal thyroxine (T4) level. Subjects with preexisting thyroid disease or receiving thyroid replacement therapy were excluded. HF with preserved ejection fraction (HFpEF) was defined as left ventricular ejection fraction (LVEF)>40% and HF with reduced ejection fraction (HFrEF) was defined as having LVEF≤40%. Percentage of 30-day all-cause readmission and mortality was calculated in both cohorts of AHFS (HFpEF and HFrEF) with and without subclinical hypothyroidism. Results The mean age of our 1,020 AHFS population was 66 ± 15.1 years. Of 1,020 patients admitted with AHFS, 635 (63%) patients were found to have HFrEF and 385 with HFpEF(37%). There were 64 (6.27%) patients with AHFS found to have subclinical hypothyroidism. There were more males than females (52% versus 48%). The percentage of hospital readmission within 30 days was higher for patients with subclinical hypothyroidism compared to those without subclinical hypothyroidism in the HFrEF group (42.9% versus 27.2%, P = 0.029). Hospital readmission within 30 days for patients with subclinical hypothyroidism compared to those without subclinical hypothyroidism in HFpEF group did not differ (30% versus 22%, P = 0.675). Additionally, all-cause mortality was higher among patients with subclinical hypothyroidism compared to patients without subclinical hypothyroidism in the HFrEF group (20% versus 6.0%, P Conclusion Subclinical hypothyroidism during an index hospital admission for an AHFS was an independent predictor of readmission in 30 days in patients with HFrEF but not in patients with HFpEF. It is also related to an adverse outcome such as all-cause mortality. Further studies regarding the concept of tissue thyroid and the potential for a therapeutic target are warranted.

Importance of combined approach of investigations for detection of asymptomatic Hashimoto Thyroiditis in early stage.

INTRODUCTION:Hashimoto's thyroiditis (HT) is the most common cause of goitrous hypothyroidism in iodine sufficient areas. The diagnosis of HT is important because it progresses to hypothyroidism, and also, it is associated with thyroid lymphoma and papillary thyroid carcinoma. Apart from thyroid antibodies, assessment of thyroid function test (TFT) levels, ultrasonography (USG), and cytological analysis can help in early diagnosis and management of HT.AIMS AND OBJECTIVES OF THIS STUDY:To know the age incidence and clinical presentation of HT, its association with thyroid hormone levels and with thyroid antibodies and its correlation with the cytologic grade of HT.MATERIALS AND METHODS:Consecutive convenient method of sampling was adopted at the cytology clinic. Fine-needle aspiration cytology of patients presenting with thyroid enlargement was done using standard technique and aseptic precautions.RESULTS:Out of 875 cases of thyroid cytology, 134 cases were diagnosed as HT over a 4-year period. A strong female preponderance was observed. A significant proportion of them (103/134) presented in the first four decades of life. Majority of cases (60.63%) were hypothyroid, while 15.74% were hyperthyroid and 23.62% were euthyroid. Apart from thyroid enlargement, although a majority of patients presented with symptoms related to the thyroid, a significant number of patients (38.80%) were asymptomatic.CONCLUSIONS:A combined approach of cytological grading of HT along with USG, TFT levels, and thyroid antibodies can detect hypothyroid and subclinical hypothyroid or euthyroid state of HT and provide an appropriate guide to therapy.