Cases Of Subclinical Hypothyroidism Research Articles

Influence of hypothyroidism on pregnancy outcome and fetus during pregnancy

To investigate the influence of hypothyroidism on pregnancy outcome and fetus in pregnant women. A total of 4 286 pregnant women, who received prenatal examination in our hospital from January 2013 to October 2015, were selected as study subjects. The incidence of hypothyroidism and the influence on pregnancy outcomes and fetus were investigated. In 4 286 pregnant women surveyed, 209 hypothyroidism cases were detected(4.9%), including 85 clinical hypothyroidism cases and 124 subclinical hypothyroidism cases. In health group, the premature delivery rate was 1.0%, significantly lower than that in clinical hypothyroidism group(10.6%)and in subclinical hypothyroidism group(6.5%), the differences were significant(χ(2)= 38.884, P<0.001; χ(2)=17.722, P<0.001). In healthy group, the incidence of anemia was 3.8%, significantly lower than that in clinical hypothyroidism group(18.8%)and in subclinical hypothyroidism group(9.7%), the differences were significant(χ(2)=30.949, P<0.001; χ(2)=23.275, P<0.001). In health group, the incidence of low birth weight was 1.1%, significantly lower than that in clinical hypothyroidism group(14.1%)and in subclinical hypothyroidism group(4.8%), the differences were significant(χ(2)=50.593, P<0.001; χ(2)=15.637, P<0.001). In health group, the fetal distress incidence was 1.9%, significantly lower than that in clinical hypothyroidism group(10.6%)and in subclinical hypothyroidism group(5.6%), the differences were significant(χ(2)=19.257, P< 0.001; χ(2)=12.357, P<0.001). In health group, the fetal Apgar score(9.69 ± 0.32)was significantly higher than those in clinical hypothyroidism group(9.25 ± 0.45)and in subclinical hypothyroidism group(9.28 ± 0.44), the differences were significant(t=8.823, P<0.001; t=15.175, P<0.001). Hypothyroidism during pregnancy has adverse influences on pregnancy outcome and fetus, and it is necessary to strengthen the hypothyroidism detection in pregnant women for the early treatment.

Evaluation of thyroid antibodies and benign disease prevalence among young adults exposed to (131)I more than 25 years after the accident at the Chernobyl Nuclear Power Plant.

Background. The Chernobyl Nuclear Power Plant (CNPP) accident exposed a large number of inhabitants to internal 131I radiation. The associations between internal 131I exposure and thyroid autoimmunity and benign thyroid diseases remain controversial in the population living in the contaminated area around the CNNP. In this study, we evaluate the association of 131I with benign thyroid diseases. Methods. We compared the prevalence of Anti-Thyroid Autoantibodies (ATAs), thyroid function, and prevalence of thyroid ultrasound finding outcomes in 300 residents of the contaminated area of Ukraine who were 0–5 years of age at the time of the CNPP accident (group 1) and 300 sex-matched residents who were born after the accident (group 2). Results. We did not find any differences of the prevalence of Antithyroglobulin Antibodies (TGAb) positive, Antithyroid Peroxidase Antibodies (TPOAb) positive, and TGAb and/or TPOAb positive between the study groups. (11.7% vs 10.3%; p = 0.602, 17.3% vs 13.0%; p = 0.136, 21.0% vs 17.3%; p = 0.254, respectively); after adjusting for age and sex, the prevalence was not associated with the 131I exposure status in the study groups. The prevalence of subclinical and overt hypothyroidism cases was not significantly different (p = 0.093 and p = 0.320) in the two groups, nor was the prevalence of goiter (p = 0.482). On the other hand, the prevalence of nodules was significantly higher in group 1 (p = 0.003), though not significantly so after adjustment for age and sex. Discussion. Working 26–27 years after the CNNP accident, we found no increased prevalence of ATAs or benign thyroid diseases in young adults exposed to 131I fallout during early childhood in the contaminated area of Ukraine. Long-term follow-up is needed to clarify the effects of radiation exposure on autoimmunity reaction in the thyroid.

Individualized Follow-up of Pregnant Women with Asymptomatic Autoimmune Thyroid Disease.

Maternal hormones are essential for the normal fetal development during pregnancy. Autoimmune thyroid disease is a frequent pathology in our iodine replete region. The aim of this study is to evaluate the occurrence of subclinical hypothyroidism (SCH) in cases with known autoimmune thyroid disease, which were in a euthyroid state prior to pregnancy, and to assess the association between supplemental treatments administered and the outcome of the pregnancy. The study is a prospective interventional controlled study. The two cohorts comprise the interventional group, consisting of 109 pregnant women with known autoimmune asymptomatic thyroid disease, without any levothyroxine (LT4) treatment and an aged-matched control group, with an unknown thyroid disease. After the pregnancy, a monthly evaluation of TSH, FT3, and FT4 was performed. Offspring evaluation was made at birth time. 88.8% of the women developed SCH in the first four weeks of pregnancy. Average LT4 doses increased as the pregnancy progressed. The monthly adjustment was 12.5 or 25 μg. All SCH cases developed in the first trimester of pregnancy. There was no significant difference regarding the gestational week, weight, or length at birth between the interventional group and controls, when TSH values were in the optimal range, during the whole pregnancy. Premature birth was described in one case in the interventional group.

Coronary artery calcium scoring is a better predictor of cardiac risk in subclinical hypothyroidism patients with low-risk Framingham score.

Context:Overt hypothyroidism accelerates the cardiovascular disease. Subclinical hypothyroidism (SCH), being considered as a preclinical state, impacts on cardiovascular status is not clear.Aims:This study was aimed at assessing cardiac risk stratification by Framingham risk scoring (FRS) and coronary coronary artery calcium score (CACS) by noncontrast cardiac computed tomography in SCH.Study Design:Observational study.Subjects and Methods:We enrolled thirty treatment-naive SCH patients (aged 30–60 years with no serious concurrent medical conditions), thirty euthyroid (age, sex, and body mass index-matched) controls, and ten healthy controls. All cases were evaluated for coronary artery calcium scoring and Framingham risk score.Statistical Analysis:Qualitative data were analyzed using the Chi-square test. In addition, demographics and CACS are summarized graphically or in a table.Results:SCH cases had higher thyroglobulin, while there was a trend toward an increase in total cholesterol, low-density lipoprotein (LDL), very LDL, and decrease in HDL levels. All participants had low-risk FRS (10-year FRS < 10%). The mean CACS in SCH was significantly higher than simple obese and healthy controls (47.17 vs. 2.67 vs. 0.00).Conclusion:This study suggests that SCH is an independent risk factor for coronary artery disease in apparently healthy controls. The risk of occult coronary artery disease is increased in SCH cases.

Urinary iodine excretion and thyroid function status in school age children of hilly and plain regions of Eastern Nepal.

BackgroundIodine deficiency is a major public health problem in many developing countries including Nepal. The present study was designed to investigate the urinary iodine excretion (UIE), thyroid function status and household salt iodine content (SIC) in school-aged children (SAC) and to establish the relationships between these factors.MethodsA community-based cross sectional study was conducted in selected schools of two districts, Tehrathum and Morang, lying in the hill and plain region of eastern Nepal respectively. A total of 640 SAC, (Tehrathum n = 274 and Morang n = 366) aged 6–11 years, were assessed for UIE and household SIC. Among the 640 children, 155 consented to blood samples (Tehrathum n = 78 and Morang n = 77) to test for serum thyroglobulin (Tg), thyroid stimulating hormone (TSH), free triiodothyronine (fT3) and free thyroxine (fT4). UIE was measured by ammonium persulfate digestion method. SIC was measured by iodometric titration method and Tg, TSH, fT4 and fT3 were measured by immunoassay based kit method.ResultsIn Tehrathum and Morang, 9.5 and 7.7 % of SAC had UIE values of UIE <100 µg/L while 59.5 and 41 % had iodine nutrition values of >299 µg/L, with median UIE of 345.65 and 270.36 µg/L respectively. The overall medians were as follows, Tg 14.29 µg/L, fT3 3.94 pmol/L, fT4 16.25 pmol/L and TSH 3.61 mIU/L. There was a negative correlation between UIE and Tg (r = −0.236, p = 0.003) and a positive correlation between UIE and SIC (r = 0.349, p < 0.0001). We found 19.5 %, n = 15 and 16.7 %, n = 13 subclinical hypothyroid cases in Morang and Tehrathum respectively. Iodometric titration showed only 6.4% (n = 41) of the samples had household SIC <15 ppm. Multivariate analysis revealed that use of packaged salt by SAC of Tehrathum district correlated with higher UIE values.ConclusionsOur focused data suggests that collaborative universal salt iodization (USI) programs are improving the health of children in the Tehrathum and Morang districts of Nepal. We also found that excessive iodine in a large portion of the study groups is a substantial concern and iodine intervention programs need to deal with both deficient and excessive iodine scenarios that can both be present simultaneously in study populations.

Cost-effectiveness analysis of universal screening for thyroid disease in pregnant women in Spain

Objective To assess the cost-effectiveness of universal screening for thyroid disease in pregnant women in Spain as compared to high risk screening and no screening. Methodology A decision-analytic model comparing the incremental cost per quality-adjusted life year (QALY) of universal screening versus high risk screening and versus no screening. was used for the pregnancy and postpartum period. Probabilities from randomized controlled trials were considered for adverse obstetrical outcomes. A Markov model was used to assess the lifetime period after the first postpartum year and account for development of overt hypothyroidism. The main assumptions in the model and use of resources were assessed by local clinical experts. The analysis considered direct healthcare costs only. Results Universal screening gained .011 QALYs over high risk screening and .014 QALYS over no screening. Total direct costs per patient were €5,786 for universal screening, €5,791 for high risk screening, and €5,781 for no screening. Universal screening was dominant compared to risk-based screening and a very cost-effective alternative as compared to no screening. Use of universal screening instead of high risk screening would result in €2,653,854 annual savings for the Spanish National Health System. Conclusions Universal screening for thyroid disease in pregnant women in the first trimester is dominant in Spain as compared to risk-based screening, and is cost-effective as compared to no screening (incremental cost-effectiveness ratio of €374 per QALY). Moreover, it allows diagnosing and treating cases of clinical and subclinical hypothyroidism that may not be detected when only high-risk women are screened.

Subclinical Hypothyroidism Might Increase the Risk of Postoperative Atrial Fibrillation after Aortic Valve Replacement.

Background To evaluate the influence of subclinical hypothyroidism (SCH) on the development of postoperative atrial fibrillation (AF) in patients undergoing aortic valve replacement surgery with extracorporeal circulation. Methods A prospective study in a tertiary hospital between July 2005 and December 2013 in which all patients undergoing aortic valve replacement with no other valve surgery were consecutively included. Patients who were in preoperative sinus rhythm were selected and they underwent thyroxine (T4) and thyroid-stimulating hormone determination in the month before surgery. Postoperative AF was defined as the development of AF during hospital admittance. Descriptive analysis and binary logistic regression were performed for the target variable. Results A total of 467 patients were studied, with 35 cases of SCH. The incidence of postoperative AF was 57% in the group with SCH versus 30.3% (p = 0.001) in the group without hypothyroidism, without significant differences in other postoperative complications. In the logistic regression analysis, the independent predictors of postoperative AF were SCH, age, and aortic clamping time. SCH multiplies the odds ratio of postoperative AF by 3.14 (95% confidence interval: 1.24-7.96). Conclusion SCH behaves like a risk factor for the development of postoperative AF in patients undergoing aortic valve replacement with extracorporeal circulation. Other studies are needed to determine whether preoperative T4 replacement therapy and/or more aggressive AF prophylaxis can prevent this complication in patients undergoing aortic valve replacement.

Análisis coste-efectividad del cribado universal de la enfermedad tiroidea en mujeres embarazadas en España

ObjectiveTo assess the cost-effectiveness of universal screening for thyroid disease in pregnant women in Spain as compared to high risk screening and no screening. MethodologyA decision-analytic model comparing the incremental cost per quality-adjusted life year (QALY) of universal screening versus high risk screening and versus no screening. was used for the pregnancy and postpartum period. Probabilities from randomized controlled trials were considered for adverse obstetrical outcomes. A Markov model was used to assess the lifetime period after the first postpartum year and account for development of overt hypothyroidism. The main assumptions in the model and use of resources were assessed by local clinical experts. The analysis considered direct healthcare costs only. ResultsUniversal screening gained .011 QALYs over high risk screening and .014 QALYS over no screening. Total direct costs per patient were €5,786 for universal screening, €5,791 for high risk screening, and €5,781 for no screening. Universal screening was dominant compared to risk-based screening and a very cost-effective alternative as compared to no screening. Use of universal screening instead of high risk screening would result in €2,653,854 annual savings for the Spanish National Health System. ConclusionsUniversal screening for thyroid disease in pregnant women in the first trimester is dominant in Spain as compared to risk-based screening, and is cost-effective as compared to no screening (incremental cost-effectiveness ratio of €374 per QALY). Moreover, it allows diagnosing and treating cases of clinical and subclinical hypothyroidism that may not be detected when only high-risk women are screened.

Serum Lipid Profile in Hypothyroid Patients in Nepal

INTRODUCTION: Hypothyroidism is non-curable common endocrine disorder in which the thyroid gland is unable to produce enough thyroid hormone. Present with a number of symptoms, Having a low level of thyroid hormone affects our whole body. Untreated hypothyroidism can be the cause of raised cholesterol levels. Many study have shown association between hypothyroidism and lipid profile. In this study, we evaluate the mean lipid profile status in subclinical hypothyroidism and hypothyroid patients. MATERIAL AND METHODS: A hospital based retrospective study done from the record card maintained in Alka Hospital, Jawalakhel. Total number of participants were 215. Out of which 73 had overt hypothyroidism, 92 had subclinical hypothyroidism and 50 were taken as control. SPSS version 20 was used for data analysis. RESULTS: The level of LDL, TG and TC was significantly higher in case of overt hypothyroidism as compared to control group, but no significant difference was found in subclinical hypothyroidism and control group. TG level was significantly lower in subclinical hypothyroidism cases. CONCLUSION: Elevated HDL, LDL &amp; TC is seen in overt hypothyroid patients. It is important to screen for lipid profile in hypothyroid patients.DOI: http://dx.doi.org/10.3126/jucms.v2i4.12065Journal of Universal College of Medical Sciences (2014) Vol.02 No.04 Issue 08Page: 33-36

Comparison of pre- and post-levothyroxine high-sensitivity c-reactive protein and fetuin-a levels in subclinical hypothyroidism

OBJECTIVE:The objective of this trial was to determine the levels of inflammatory markers, high-sensitivity C-reactive protein and fetuin-A pre- and post-levothyroxine treatment in cases of subclinical hypothyroidism.MATERIALS AND METHODS:A total of 32 patients with a diagnosis of subclinical hypothyroidism and a control group of 30 healthy individuals were tested for high-sensitivity C-reactive protein and fetuin-A, followed by the administration of 50 µg of levothyroxine in the patient group for 3 months. During the post-treatment stage, high-sensitivity C-reactive protein and fetuin-A levels in the patient group were re-assessed and compared with pre-treatment values.RESULTS:Pre-treatment levels of both high-sensitivity C-reactive protein and fetuin-A were observed to be higher in the patient group than in the control group. The decrease in high-sensitivity C-reactive protein levels during the post-treatment stage was not statistically significant. However, the decrease observed in post-treatment fetuin-A levels was found to be statistically significant.CONCLUSION:The decrease in fetuin-A levels in subclinical hypothyroidism cases indicates that levothyroxine treatment exerts anti-inflammatory and anti-apoptotic effects. Although the decrease in high-sensitivity C-reactive protein levels was statistically non-significant, it is predicted to reach significance with sustained treatment.

Prevalence of Hypogonadotropic Hypogonadism in Type 2 Diabetes Male Patients

Background: Erectile dysfunction is common in patients with diabetes mellitus. In addition, reduced testosterone itself is considered as a risk factor for diabetes; therefore hypogonadism was studied in diabetes. Objective: This study was done to determine the prevalence of hypo- and hypergonadotropic hypogonadism in the type 2 diabetes male patients in Mashhad in north-east of Iran. Methods: This study was done on type 2 diabetic men aged 40 - 60 years in the endocrine clinic, Endocrinology Research Center, Mashhad University of Medical Sciences, Iran. Fasting blood samples were collected at 8 am for measurement of fasting blood sugar (FBS), HbA1C, total serum testosterone, FSH, Sex Hormone Binding Globulin (SHBG), LH, prolactin, thyroxin-stimulating hormone (TSH), and immediately was sent to laboratory. Results: Out of total 96 type 2 diabetic males (mean age of 51.4 ± 11.26 years, range of 40 - 60 years), 11 (12.94%) patients were excluded because of inadequate samples, insufficient information and fulfillment of the exclusion criteria of the study. Hypogonadism based on Testosterone, Calculated free testosterone (CFT), and boiavailable testosterone (BT) were observed in 10 (11.8%), 31 (36.6%), and 30 (35.3%) of the patients, respectively. Libido was decreased in 55 (64.7%) of the patients. Based on the obtained SHBG values there were 7 (8.2%), 52 (61.2%), and 26 (30.6%) cases of low, normal and high values, respectively. According to TSH observed values there were 6 (7.1%) patients and 1 case of sub-clinical hypothyroidism and hyperthyroidism, respectively, and the rest 78 (91.8%) cases were euthyroid. Prolactin level was normal in all cases. Conclusion: Hypogonadotropic hypogonadism is common in type 2 diabetic men, and whether its treatment is useful for erectile dysfunction or not, needed additional investigation.

Improvement in subclinical cognitive dysfunction with thyroxine therapy in hypothyroidism: A study from tertiary care center.

Aim:To evaluate the effect of hypothyroidism (both overt and subclinical) on cognitive function using latencies of P300 auditory evoked potentials (AEPs). P300 latency suggests that shorter latency times are related to better cognitive performance. P300 latencies were also done after thyroxine replacement to see the effect of treatment on cognitive function.Materials and Methods:Biochemically proven new onset cases with hypothyroidism (overt and subclinical) were enrolled into the study, AEPs of these two groups when compared with matched controls. After detailed history and physical examination, P300 potentials were recorded at two points Cz and Pz (Cz: On the midline of the head at the vertex, Pz: On the midline of the head between the vertex and occipital protuberance) using a Nicolet Viking Select neuro diagnostic system version 10.0. The study was done in electrophysiology lab in Osmania Medical College.Results:A patient characteristics of both cases and controls were comparable. The cases consisted of two groups, overt hypothyroid cases 24, mean thyroid stimulating hormone (TSH) values in them was 94, subclinical cases 21 in whom mean TSH value was 12.3. Mean P300 latencies of all cases at Cz was 342.42 ± 29.5 ms, and at Pz was 345.4 ± 30 ms. Mean P300 latencies of controls at Cz was 296.4 ± 34 ms and at Pz was 297.9 ± 33 ms (difference in P < 0.001). Mean P300 values in overt cases were 362.6 ± 32.9 ms at Cz, and at Pz it was 362.5 ± 33.9 ms. Mean P300 values in subclinical cases were 319.3 ± 30.9 ms at Cz, and at Pz it was 316.4 ± 27.9 ms. P300 values in overt cases were highly significant as compared to controls, and P300 values in the subclinical cases versus controls were also significant (P < 0.001).Conclusion:P300 latency prolongation in both clinical and subclinical hypothyroid cases shows that cognitive function is affected adversely in hypothyroidism including the subclinical hypothyroid cases. Larger studies evaluating the effect of subclinical hypothyroidism on cognitive function are needed with objective means such as the AEPs P300.

PO-0155 Evaluation Of Growth Hormone Deficiency (ghd) In Children With Acute Lymphoblastic Leukemia (all) And Non-hodgkin’s Lymphoma (nhl)

Introduction Acute lymphoblastic leukaemia (ALL) is the most common childhood cancer and non-Hodgkin’s lymphoma (NHL) is the most common childhood cancer.these children may suffer from some late effects of treatments such as endocrinopathies like thyroid, pituitary, metabolism disfunctions. Growth Hormone Deficiency (GHD) is one of the causes of short stature. Material and methods During a 3 years cross-sectional research in Dr Sheikh children hospital in Mashhad, we studied on 50 children with ALL (n = 25), NHL (n = 25) who received chemotherapy alone (n = 25) or plus radiation (n = 25). Patients with height less than 5th percentile, were evaluated for GHD via insulin stimulating test. Also for short stature workup in all patients thyroid function test were done. Results We found 6 (12%) children with height less than 5th percentile who 5(83.33% of them or 10% of total) had GHD. There was no statistical correlation between type of disease also type of treatment and GHD (respectively p-value = 0. 667, 0.189) due to small sample size. Among these 6 patients, 5 children (83.33% of them) undergone radiation and 4 patients (66.66% of them) had ALL. There was 2(4% total) cases of subclinical hypothyroidism but with normal height. According to BMI (body mass index) access 2(4% total) patients had overweight. Conclusion In our study ALL patients who received radiation had unfavourable state for height and endocrine side effects. So it seems more attention to radiotherapy complications in children with cancer especially ALLs is needed to improve their quality of life.

Echocardiographic Evaluation of Diastolic Dysfunction in Patients with Subclinical Hypothyroidism &amp; the effect of L-Thyroxine treatment: A hospital based study

Background &amp; Aims: Diastolic dysfunction is the common condition with Subclinical Hypothyroidism and is reversible in many cases after treatment. We aimed to investigate the response of diastolic dysfunction to thyroid hormone replacement therapy in patients of Subclinical Hypothyroidism. Methods: Forty newly diagnosed cases of Subclinical Hypothyroidism (38 females and 2 males) and age more than 18 years were included. Diagnosis was made on the basis of history, clinical examination and thyroid function tests. Echocardiography was performed in all and was repeated after 4-6 months in those who had diastolic dysfunction. Distribution of Diastolic dysfunction among the involved cases and their response to treatment with L-thyroxine were studied. Results: The diastolic dysfunction was found in 15 (37.5%) and pericardial effusion (PE) in five (12.5%) patients. Fourteen of them had impaired relaxation abnormality and only one patient had pseudonormal pattern. With replacement therapy, 13 reverted back to the normal whereas one having grade 2 diastolic dysfunction (pseudonormal pattern) reverted to grade 1. One patient who had grade 1 diastolic dysfunction (impaired relaxation) did not improve. Pericardial effusion subsided in all 5 cases. Conclusions: Echocardiography may be a useful tool for monitoring the response of diastolic dysfunction to thyroid hormone replacement therapy in patients with Subclinical Hypothyroidism. Our findings suggest that Thyroid Hormone Replacement Therapy may reverse diastolic dysfunction in Subclinical Hypothyroidism. DOI: http://dx.doi.org/10.3126/njh.v11i1.10979 Nepalese Heart Journal 2014;11(1): 33-38

Hypothyroidism in type 2 diabetic patients: a tertiary care hospital experience

Background Hypothyroidism is one of the most common endocrine disorders encountered in endocrine practice worldwide which is more prevalent in elderly and women and its prevalence varies according to population studied. Both type 1 and type 2 Diabetic patients have higher prevalence of hypothyroidism than normal population not for direct etiology rather due to autoimmune association and increasing age. Co-existing hypothyroidism may impose co-morbid effects of dyslipidemia, atherosclerosis, hypertension and renal impairment on diabetic patients.&#x0D; Objective This study was designed to find out frequency and association of clinical and sub-clinical hypothyroidism in adult type 2 diabetic subjects.&#x0D; Method This was a cross sectional study conducted during the period of December 2009 to November 2010 in a tertiary care specialized hospital, (BIRDEM). Thyroid hormone (FT4 and TSH) was studied among 227 adult type 2 diabetic subjects.&#x0D; Results Among 227 study subjects, female respondents were 67%. Age (in years) was as mean± SD (SE) and (95% CI): 53.95±11.6 (.77) and (52.44-55.47). Thyroid hormone (FT4 and TSH) was assayed. FT4 (in pmol/L) of this population was as mean± SD (SE) and (95% CI): 13.05±2.66 (.18) and (12.71-13.4) and TSH was (in μIU/ml) as mean± SD(SE) and (95% CI): 4.12±7.03(.47) and (3.2-5.04). Sixty nine (30.4%) of them were hypothyroid and rest 158 (69.6%) were euthyroid. Among the hypothyroid cases, 17.6% were cases of sub-clinical hypothyroidism and 12.8% were of clinical hypothyroidism.&#x0D; Conclusion Diabetic population have higher prevalence of hypothyroidism. While planning therapeutic approaches for diabetic patients, clinical and sub clinical hypothyroidism always should be taken into consideration. Diabetic patients with or without complication particularly with poor glycemic control, should be routinely screened for hypothyroidism.&#x0D; JBSA 2012; 25(1): 14-20

Dyslipidemia associated with subclinical hypothyroidism in Eastern Nepal

Objectives: The present study was conducted aiming to investigate lipid profile in patients with subclinical hypothyroidism as compared to age and sex matched controls.Methods: The study population consisted of total 80 subjects; 40 patients (cases) and 40 controls. Serum free tri-iodothyronine (fT3) and free thyroxine (fT4) were estimated by microplate competitive enzyme immunoassay, and thyroid stimulating hormone (TSH) measured by sandwich enzyme immunoassay. Lipid profile tests: Total Cholesterol, triglycerides, high density lipoprotein (HDL) cholesterol were estimated by enzymatic methods and low density lipoprotein cholesterol (LDL) was calculated by Friedewald’s formula.Results: Significant differences were observed between lipid parameters in case Vs controls: total cholesterol (4.9±1.1 Vs 4.3±1.0 mmol/L, P=0.03), triglycerides (1.9±0.7 Vs 1.6±0.6 mmol/L, P=0.02) and LDL cholesterol levels (3.5±1.1 Vs 2.9±0.9 mmol/L, P=0.02). In case Vs controls no significant differences were observed between HDL Cholesterol (1.1±0.2 Vs 1.1±0.7 mmol/L, P=0.07), VLDL (0.9±0.4 Vs 0.8±0.3 mmol/L, P=0.1) and Cholesterol/HDL ratio (4.48±1.40 Vs 4.06±0.89, P=0.118). Elevated TSH level were found in cases Vs controls (12.42±7.08 Vs 2.69±0.20 mIU/L, P=0.01) which was statistically significant. The subjects on control group were euthyroid, however increased fT3 (3.9±0.8Vs 4.6±0.8 pmol/L, P=&lt;0.01) and fT4 (17.1±3.9Vs 21.2±.3.7 pmol/L, P=&lt;0.01) values were observed in controls than cases, which was statistically significant.Conclusion: The results of the present study suggest that cases of subclinical hypothyroidism are at risk of dyslipidemia as compared to controls. Large population based studies are needed to generalize these findings and establish the therapeutic guidelines for implementing lipid lowering agents in subclinical hypothyroidism.Asian Journal of Medical Science, Volume-5(3) 2014: 22-25http://dx.doi.org/10.3126/ajms.v5i3.9251

Pregnancy in Overt and Subclinical Hypothyroidism and its Feto-Maternal Outcome

This prospective study was done to find out the maternal and fetal complications of pregnancy in patients with subclinical and overt (TSH level higher than subclinical hypothyroidism) hypothyroidism. Chronic hypertension, anemia with GDM, GDM with preeclampsia and thalassemia with GDM were observed only in patients with overt hypothyroidism. PPH, fetal distress, abortion and IUD were significantly higher (p&lt;0.05) in patients with overt hypothyroidism. Fetal distress was found to be more in patients with overt than subclinical hypothyroidism. This study included 50 admitted patients who were pregnant. Among which, 29 were diagnosed as cases of subclinical hypothyroidism and 21 as that of overt hypothyroidism. Duration of marriage was almost identical between two groups. Multipara was predominant in both groups, however abortions were significantly higher (p&lt;0.05) in overt hypothyroidism. Duration between first conception and marriage was somewhat longer (3-5 years) in patients with overt hypothyroidism than that ( 2 years) in patients with subclinical hypothyroidism. The commonest problem in both groups was anemia. 17.2% of patients with subclinical hypothyroidism were anemic whereas 42.9% patients with overt hypothyroidism suffered anemia. Preeclampsia (23.8%) and diabetes mellitus (38.1%) were also predominant in patients with overt hypothyroidism than in patients with subclinical hypothyroidism (Preeclampsia-3.4% and DM-10.3%). Low Birth Weight (LBW) babies were also common in patients with overt hypothyroidism (80%) than in patients with subclinical hypothyroidism (27.6%). 62.1% of babies from mothers having subclinical hypothyroidism had APGAR score of 7 whereas 73.3% of babies from mothers having overt hypothyroidism had APGAR score of 6 in the first minute. None of the babies were hypothyroid as tested from cord blood. Majority of patients underwent C-section in both groups. DOI: http://dx.doi.org/10.3329/medtoday.v25i2.17924 Medicine Today 2013 Vol.25(2): 69-71

Study of cognitive functions in newly diagnosed cases of subclinical and clinical hypothyroidism.

Introduction:Hypothyroidism is associated with significant neurocognitive deficits because hypothyroidism prevents the brain from adequately sustaining the energy consuming processes needed for neurotransmission, memory, and other higher brain functions. Hence, the study was done to assess the cognitive functions of newly diagnosed subclinical and clinical hypothyroid patients by evoked response potential P300.Materials and Methods:75 patients each of newly diagnosed subclinical and clinical hypothyroid patients attending endocrinology clinic and 75 healthy age and sex matched euthyroid controls were considered for the study. P300 was recorded with Record Medicare System Polyrite, Chandigarh using auditory “oddball paradigm”. The data was analyzed using ANOVA followed by post Tukey's test.Results:Newly diagnosed clinical hypothyroid patients showed a significant increase in P300 latency compared to control (P < 0.05) and subclinical cases (P < 0.01) while there was no significant difference between the P300 latency of subclinical cases and control group. Also, there was no significant difference in P300 amplitude among the three groups.Conclusion:P300 latency in case of newly diagnosed hypothyroid clinical cases is significantly increased compared to newly diagnosed subclinical cases and control.

Prevalance and fetomaternal outcome of thyroid disorder in pregnanacy

Background: Thyroid diseases are the commonest endocrine disorders affecting women of reproductive age group and hence constitute the commonest endocrine disorder in pregnancy also. It has long been recognized that maternal thyroid hormone excess or deficiency can influence the outcome for mother and fetus at all stages of pregnancy as well as interfere with ovulation and fertility. Thyroid dysfunction is often overlooked in pregnant women because of the nonspecific symptoms and the hyper metabolic state of pregnancy. Hence thyroid function test becomes essential to know the thyroid status in pregnancy and also to detect the subclinical disease. Aims & Objective: To establish the prevalence and effect of thyroid disorder on pregnancy outcome. Materials and Methods: The study is an observational study carried on 100 women coming for antenatal check-up in Private hospital, Ahmedabad from January 2011 to January 2012. All women who were included in this study were followed from 11-14 weeks of pregnancy up to delivery. Results: It was observed that the maximum numbers of patients were in 21– 25 years (52%) age group. Euthyroid (87%), hyperthyroid (1%), subclinical hyperthyroid (2%), hypothyroid (2%), and subclinical hypothyroid (8%) cases were detected. Neonatal jaundice developed in all Hyperthyroid patient, 50% (1/2) of patients with Subclinical hyperthyroidism, 50% (1/2) of patients with Hypothyroidism, 75% (6/8) of patients with Subclinical Hypothyroidism and 48.27% (42/87) of patients with Euthyroid. Conclusion: Gestational age specific reference intervals are of utmost importance by which clinicians can reliably evaluate thyroid function and monitor thyroxine replacement therapy in pregnant women. TPOAb (Thyroid peroxidase Antibody) positive patients are associated with an increased risk of abortion and these infants are more often born preterm. TSH is the hallmark in detection of hypothyroid as well hyperthyroid so TSH should be included in the list of routine investigations done in all antenatal women in first trimester. If TSH values are abnormal then FT3, FT4 and TPOAb need to be checked.

Cognitive function in subclinical hypothyroidism in elderly.

Aim:To study the association of cognitive function with subclinical hypothyroidism in elderly.Materials and Methods:It's a cross-sectional, case-control study of 103 patients (≥65 years) who met the criteria for subclinical hypothyroidism. Similarly 103 age, sex and education-matched healthy controls were taken. Serum TSH, free T3 and free T4 were measured. Cognitive functions were assessed by using Folstein Mini Mental Examination (MMSE) and clock drawing test.Results:Out of the 103 diagnosed subclinical hypothyroidism cases, cognitive impairment (by MMSE) was found in 33 (30.9%) while it was present in only 15 (14.54%) out of 103 controls (P = 0.003), cognitive impairment (by CDT) was present in 32 patients (31.06%) out of 103 cases while it was present in 26 patients (25.24%) out of 103 controls (P > 0.05, insignificant). Mean TSH of subclinical hypothyroidism with cognitive impairment was 7.67 ± 1.22 mIU/liter and without cognitive impairment was 6.47 ± 0.98 mIU/liter (P value = 0.0001, significant)Conclusions:Prevalence of cognitive impairment was significantly higher in subclinical hypothyroidism as compared to controls. Presence of cognitive impairment correlated with the level of TSH; as TSH increased cognitive function declined.