Subclinical Hypothyroidism Patients Research Articles

Subclinical Hypothyroidism in Patients with Diabetic Retinopathy: Role of Vascular Endothelial Growth Factor.

This study was conducted by considering the vital role of Vascular Endothelial Growth Factor (VEGF) in the development of Diabetic Retinopathy (DR) on the one hand and the frequent association between Subclinical Hypothyroidism (SCH) and DR on the other hand. The present study was proposed to explore the possible role of VEGF in the relation between SCH and DR; thus, we investigated the relationship between SCH and VEGF levels in patients with DR. Two hundred patients with DR were recruited in this study [100 patients with Proliferative Diabetic Retinopathy (PDR) and 100 patients with Non-Proliferative Diabetic Retinopathy (NPDR)]. Patients with DR were divided into 2 groups according to thyroid function, patients with SCH or those with euthyroidism. Patients were subjected to careful history taking and underwent clinical and ophthalmological examination. Fasting blood glucose, glycosylated hemoglobin, fasting insulin, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), TSH, FT4, FT3, VEGF, and thyroid volume were assessed. Among all the studied patients, 21.5% (43/200) had SCH. DR patients with SCH had older age, longer diabetes duration, and higher HbA1c, HOMA-IR, and VEGF than those with euthyroidism. The frequency of PDR in patients with SCH was 72.1% (31/43) and 43.9% (69/157) in those with euthyroidism, whereas the frequency of NPDR in patients with SCH was 27.9 (12/43) and 56.1% (88/157) in those with euthyroidism (P 0.003). In multivariate analysis, PDR, HOMA- IR, and VEGF levels were the significant predictor variables of SCH. Increased VEGF levels may be implicated in the relationship between SCH and DR.

Systematic review and meta-analysis of the efficacy and pregnancy outcomes of levothyroxine sodium tablet administration in pregnant women complicated with hypothyroidism.

In recent years, the detection rate of pregnancy complicated with hypothyroidism [subclinical hypothyroidism (SCH) during pregnancy] has increased significantly. Levothyroxine sodium tablet is the main drug for the treatment of SCH during pregnancy, but its effect on the treatment of SCH during pregnancy and the effect of pregnancy outcome are still controversial. PubMed, Web of Science, Medline, and Embase databases were screened to retrieve clinical studies on levothyroxine sodium tablets in the treatment of pregnancy complicated with hypothyroidism from the date of establishment to June 2021. Meta-analysis was performed with RevMan5.3 software. The differences in the incidence of preterm birth, miscarriage, gestational hypertension, postpartum hemorrhage, placental abruption, and abnormal neonatal weight were compared between the observation group and the control group. Heterogeneity of results was assessed with chi-square test and I2 in RevMan5.3 software. Nine articles with a total of 2,873 pregnant women were included. The Cochrane assessments were all grade B and above, and the Jadad scale scores were all >3 points. The incidences of preterm birth, abortion, postpartum hemorrhage, and low birth weight infants in the pregnant women treated with levothyroxine sodium were lower than those in the control group [odds ratio (OR) =0.42, 0.34, 0.40, and 0.08, respectively; 95% confidence interval (CI): 0.30-0.58, 0.23-0.52, 0.22-0.74, and 0.01-0.51, respectively; Z=5.23, 5.08, 2.97, and 2.70, respectively; P<0.00001, <0.00001, =0.003, and =0.007, respectively]. Levothyroxine sodium in the treatment of SCH can significantly reduce the incidence of premature birth, miscarriage, postpartum hemorrhage, and low birth weight infants. Due to the limited number of included studies, it remained to be further verified whether levothyroxine sodium treatment in SCH patients would affect the incidence of gestational hypertension.

Relation Between URIC Acid Levels and Subclinical Hypothyroidism in Diabetic Patients.

Subclinical hypothyroidism (SCH) is frequently seen in diabetic patients. Elevated levels of uric acid (UA) were also reported in diabetic patients. No study assessed the relation between SCH and UA levels in diabetic patients. We aimed to evaluate this relation and the association of both conditions with other clinical and laboratory parameters in diabetic patients. This cross-sectional study included 100 T2DM patients in addition to 50 age and sex matched healthy controls. Diabetic patients comprised 50 patients with SCH and 50 euthyroid patients. All participants were subjected to careful history taking, thorough clinical examination and standard laboratory work up. The performed investigations included fasting and postprandial blood sugar, fasting insulin levels, HbA1c levels, thyroid hormones (FT3, FT4 and TSH), renal profile and serum UA. Comparison between the studied groups regarding serum UA levels revealed significantly higher levels in the diabetic group (5.4 ± 1.9 versus 4.2 ± 1.0 mg/dl, p<0.001). SCH + DM patients had significantly higher UA levels in comparison to DM group (6.1 ± 1.8 versus 4.8 ± 1.7 mg/dl, p<0.001) and control group (6.1 ± 1.8 versus 4.2 ± 1.0 mg/dl, p<0.001). SCH + DM patients had significantly higher HbA1c levels (8.9 ± 1.1 versus 7.6 ± 1.3%, p<0.001), HOMA-IR (3.9 ± 0.8 versus 2.8 ± 1.0, p<0.001) and UA levels (6.1 ± 1.8 versus 4.8 ± 1.7, p<0.001). Correlation analysis identified a significant direct correlation between serum UA and HOMA-IR in DM + SCH patients (r=0.4,p=0.004). In univariate analysis, presence of SCH [OR (95% CI): 2.57 (1.07-6.15), p=0.034] and nephropathy [OR (95% CI): 4.57 (1.77-11.8), p=0.002] was significant predictors of higher (upper tertile) UA in the studied patients. However, in multivariate analysis, only nephropathy [OR (95% CI): 4.25 (1.62-11.17), p=0.003] continued to be significant while SCH showed a marginal trend [OR (95% CI): 0.43 (0.17-1.08), p=0.073]. The present study suggests an association between SCH and increased UA levels in diabetic patients.

The relationship between thyroid hormone levels, insulin resistance and body mass index, in patients with subclinical hypothyroidism andeuthyroid patients

Background. Hypothyroidism is a common thyroid disorder with female predominance. In general population its prevalance is 2–5% while 10 times higher in female than in men. Insulin resistance, one of the most discussed issues recently, is an inadequate response to insulin in peripheral tissues despite the normal secretory function of pancreatic islet cells. In this study, we analyzed relationship between thyroid hormone levels, body mass index and insulin resistance calculated with Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), Quantitative Insulin Sensitivity Check Index (QUICKI) and Atherogenic Index of Plasma (AIP) in SCH and euthyroid patients under levothyroxine treatment. Materials and methods. The clinical and laboratory data of approximately 14000 patients between the ages of 18–60 were retrospectively evaluated. After these exclusion criteria were applied, 371 eligible individuals were included in the study. All 371 individuals divided into three groups according to TSH levels. Group 1 is eutyhroid patients under levothyroxine treatment with TSH levels between 0.27–4.2μIU/mL. Group 2 is subclinical hypothyroid patients with TSH levels between 4.2–10 μIU/mL. Group 3 is healthy control group with TSH levels between 0.27–4.2 μIU/mL. Results. The euthyroid patient group has the highest (25.66±3.36 kg/m2) mean BMI. On the other hand the mean BMI was higher in SCH (24.0400±3.8436kg/m2) group than in control group (22.48±2.74 kg/m2) (p&lt;0.05). Fasting plasma glucose (FPG), serum triglyserid, low density lipoprotein (LDL), anti-thyroid peroxidase (TPO) and insulin levels were significantly higher in euthyroid patient and SCH groups (p&lt;0.05). Notably, total cholesterol, LDL and TPO levels were higher in euthyroid patient group (p&lt;0.05). On the other hand, there were no difference between euthyroid patients and SCH group. Conclusions. This study found significantly elevated insulin resistance and cholesterol levels in SCH patients, so we hypothesized that SCH is also a risk factor for insulin resistance disorders such as cardiovascular diseases and metabolic syndrome. As a consequence, lipid metabolism defects and insulin resistance should be screened and treated in SCH patients. Thanks to the strong and significant correlation between HOMA and QUICKI in our study, we suggest the combined use of HOMA and QUICKI in these patients. Further and large-scale studies are needed to evaluate the relationship of HOMA, QUICKI, AIP, and BMI in detecting insulin resistance in SCH patients.

PREVALENCE OF DYSLIPIDEMIA IN PATIENTS OF SUB CLINICAL HYPOTHYROIDISM AND THE EFFECTS OF THYROXINE REPLACEMENT THERAPY ON LIPID PROFILE IN NORTH INDIAN POPULATION

Subclinical hypothyroidism is a very common entity in Indian middle aged population with a prevalence of around 6-15%, dened as increase in thyroid stimulating hormone (TSH) level without obvious rise in free triiodothyronine (FT3) and free thyroxine (FT4) level. However most of the patients have an annual conversion of 5% into overt hypothyroidism. Replacement of thyroxine in these patients is always a controversial issue, deranged lipid prole is an important indication of thyroxine replacement in these patients. In present study which is a case control study, we have observed improvement in lipid prole after thyroxine replacement in patients of subclinical hypothyroidism with deranged lipid prole. In our study there is a signicant improvement in total cholesterol, triglyceride, and LDL level without signicant improvement in HDL level after thyroxine replacement.

A STUDY OF CAROTID INTIMA MEDIA THICKNESS AS A MARKER OF ATHEROSCLEROSIS IN CLINICAL VS SUBCLINICAL HYPOTHYROIDISM

Introduction:Hypothyroidism increases the risk of atherosclerosis, which in turn increases the cardiovascular disease risk. Carotid intima media thickness (CIMT)&gt;1 mm is used as a non invasive marker of atherosclerosis. Aim:To nd the prevalence of atherosclerosis in patients with clinical vs subclinical hypothyroidism using CIMT as a marker for atherosclerosis Methods: Type of study: Prospective observational study. 100 patients of clinical or subclinical hypothyroidism of age more than 12 years, were included in the study. Theyunderwent laboratory and radiological investigations (CIMT-Carotid Intima Media thickness).Data analysis was carried out using statistical package for social sciences. Result:54.55% of clinical hypothyroid patients had CIMT&gt;1 mm as compared to 17.86% of subclinical hypothyroidism. Elevated total cholesterol, triglycerides and LDL in clinical hypothyroid patients were 45.46%,68.18% and 40.90% respectively, As compared to subclinical hypothyroidism which had 3.58%, 39.29%, 21.43% respectively. Markers of inammation CRP&gt;3.0 mg/dl, ESR&gt;30 mm and TLC&gt;10,000 were also signicantly higher in patients with clinical as compared to subclinical hypothyroid patients.(40.91%,50% and 40.91% respectively)suggesting possibility of active atherogenesis being signicantly higher in clinical hypothyroidism as compared to subclinical hypothyroidism.

Metabolic Syndrome in Overt and Subclinical Hypothyroidism Syrian Patients

Thyroid hormones have important functions in many metabolic pathways, including glucose and lipid metabolism, and may cause metabolic syndrome. Both hypothyroidism and metabolic syndrome are common in the Syrian population. This research was carried out to evaluate the incidence of the metabolic syndrome in two types of hypothyroidism and the effect of TSH levels on its occurrence. A retrospective cross-sectional study was performed of 91 overt hypothyroidism patients, 31 subclinical hypothyroidism patients without clinical symptoms, and 53 controls without thyroid disorders. We used the criteria for metabolic syndrome as per International Diabetes Federation (IDF) which are defined as central obesity depending on race- and gender-specific WC cutoffs(Waist circumference (WC)≥94 cm for male, WC≥80 cm for female) in addition to any two of the following four parameters: (Triglycerides level: ≥150 mg/dl (1.7 mmol/l) or history of treatment for TG abnormality, HDL cholesterol level: &lt;40 mg/dl (1.03 mmol/l) in males and &lt;50 mg/dl (1.29 mmol/l) in females or history of treatment for HDL cholesterol abnormality, high blood pressure: systolic BP ≥130 mm Hg or diastolic BP≥85mm Hg or on treatment for previously diagnosed hypertension and high FPG: ≥100 mg/dl or previously diagnosed type 2 Diabetes mellitus. In conclusion, our study showed a significant correlation between overt hypothyroidism and metabolic syndrome. It also revealed that a TSH level over 2.5 uIU‎/ml significantly increases the risk of metabolic syndrome.

The Association Between Anti-Thyroid Peroxidase Antibody and Dyslipidemia in Subclinical Hypothyroidism Among the Rural Population of Central India.

ObjectiveIn this study, we aimed to determine the association between anti-thyroid peroxidase (anti-TPO) antibody and dyslipidemia in subclinical hypothyroidism (SCH).Materials and methodsWe conducted a cross-sectional case-control study in the department of medicine at a tertiary care teaching hospital in central India. The study consisted of 150 patients (75 cases and 75 controls) who fulfilled the inclusion and exclusion criteria.ResultsThe study showed that serum cholesterol was high in 23.1% of cases in the negative anti-TPO antibody SCH sub-group and 88.7% of cases in the positive anti-TPO antibody SCH sub-group (p<0.001). Serum triglyceride (TG) levels were high in 61.5% of cases in the negative anti-TPO antibody SCH sub-group and 90.3% of cases in the positive anti-TPO antibody SCH sub-group (p=0.008). Serum high-density lipoproteins (HDL) were low in 15.4% of cases in the negative anti-TPO antibody SCH sub-group and 24.2% of cases in the positive anti-TPO antibody SCH sub-group (p=0.490). Serum low-density lipoproteins (LDL) were high in 61.5% of cases in the negative anti-TPO antibody SCH sub-group and 90.3% of cases in the positive anti-TPO antibody SCH sub-group (p=0.008). Serum very-low-density lipoproteins (VLDL) were high in 84.6% of cases in the negative anti-TPO antibody SCH sub-group and 83.9% of cases in the positive anti-TPO antibody SCH sub-group (p=0.947). Based on our findings, 82.8% of participants with negative anti-TPO antibodies had normal serum LDL levels, while 11.1% of participants with positive anti-TPO antibodies had normal LDL levels (p<0.001). The study also showed that elevated serum LDL was present in 17.2% of participants with negative anti-TPO antibody levels and 88.9% of participants with positive anti-TPO antibodies (p<0.001). The study showed a correlation coefficient of 0.0432 between serum TG and anti-TPO antibody levels (p<0.001).ConclusionOur findings showed an increased incidence of dyslipidemia in SCH patients with positive anti-TPO antibodies. SCH with positive anti-TPO antibody is significantly associated with elevated serum total cholesterol (TC) levels, serum TG levels, and serum LDL levels. Hence, early screening and diagnosis of dyslipidemia are crucial to prevent cardiovascular morbidity and mortality in SCH patients with positive anti-TPO antibodies.

Aging-related Characteristics of Subclinical Hypothyroidism Detected in General Practice.

Subclinical hypothyroidism (SCH) is diagnosed when serum thyrotropin (TSH) is elevated despite a normal thyroxine level and is known to increase the risk of metabolic disorders. This study was conducted to identify potential laboratory markers suspicious for latent SCH. We retrospectively reviewed 958 outpatients in whom thyroid functions had been examined. Eighty-five (9.1%) of the 939 analyzed subjects had SCH (73% females). In the SCH group, median serum TSH and FT4 levels were 5.04 μU/ml and 1.19 ng/dl, respectively, and auto-thyroid antibodies were detected in 53.8% of patients. SCH group patients were significantly older than patients in the euthyroid group, while there was no intergroup difference in BMI. However, 56.5% of the SCH patients were asymptomatic. In the SCH group, serum aspartate aminotransferase and low-density lipoprotein cholesterol (LDL-C) levels were significantly higher, and the estimated glomerular filtration rate (eGFR) was significantly lower than in the euthyroid group. Among patients less than 65 years of age, SCH patients tended to have lower eGFR and higher LDL-C than euthyroid patients. Age-dependent reductions of red blood cells and serum albumin were more prominent in the SCH than the euthyroid group. Biochemical changes with aging are useful as potential clues for suspecting latent SCH.

A systematic review on the prevalence and management of subclinical hypothyroidism in patients with Type 2 Diabetes Mellitus

Background: Subclinical hypothyroidism (SCH) remains one of the most common biochemical manifestations of thyroid dysfunction.1 Similarly, type 2 diabetes mellitus (T2DM) is considered the most common metabolic disorder in clinical practice.2Methods: This is a systematic review to ascertain the prevalence and optimum management approach for thyroid dysfunction in patients with T2DM. We conducted a search on PubMed and Google scholar (Figure 1) for articles published between 2010-2020 using the following keywords: subclinical hypothyroidism, type 2 diabetes mellitus, thyroid diseases, diabetic retinopathy, diabetic nephropathy, and diabetic complications. Results: The prevalence of SCH in T2DM patients ranges from 7.8% to 23 % (average around 13.4%). In comparison, the prevalence of SCH in the general population ranges from 6% to 10%. SCH has a higher prevalence in females, older age &gt;60 years old, long duration of T2DM, positive thyroid autoantibodies, glycated hemoglobin (Hba1c) 8%, and obese patients (risk factors).3 The prevalence of SCH in patients with diabetic retinopathy (DR) ranges from 17.3% to 43.3%. Also, the prevalence of SCH among patients with diabetic nephropathy (DN) ranges from 18.1% to 36%. Screening for thyroid dysfunction in T2DM at diagnosis is recommended and justified (Table 1). If patients with SCH have a risk of cardiovascular disease (CVD), DR, DN, symptomatic, presence of goiter, pregnant women, and continuous sustained increases of thyroid-stimulating hormone (TSH) on follow-up, it is recommended to start low dose levothyroxine which improves morbidity. Conclusion: The prevalence of SCH is relatively high in T2DM patients. This supports routine screening of such patients for thyroid dysfunction especially in patients with risk factors and diabetic complications (DR, DN), and consideration of thyroxine replacement wherever warranted although more evidence from randomized controlled trials is needed to explore the possible causal relationships.

Thyroid disorders and cardiovascular manifestations: an update.

Cardiovascular disease (CVD) remains the leading cause of death worldwide, representing a major health, social, and economic issue. Thyroid disorders are very common and affect >10% of the adult population in total. The aim of this review is to describe the physiologic role of thyroid hormones on cardiovascular system, to present cardiovascular manifestations in patients with thyroid disorders, emphasizing in molecular mechanisms and biochemical pathways, and to summarize current knowledge of treatment options. Thyroid hormone receptors are located both in myocardium and vessels, and changes in their concentrations affect cardiovascular function. Hyperthyroidism or hypothyroidism, both clinical and subclinical, without the indicated therapeutical management, may contribute to the progression of CVD. According to recent studies, even middle changes in thyroid hormones levels increase cardiovascular mortality from 20% to 80%. In more details, thyroid disorders seem to have serious effects on the cardiovascular system via plenty mechanisms, including dyslipidemia, hypertension, systolic and diastolic myocardial dysfunction, as well endothelial dysfunction. On top of clinical thyroid disorders management, current therapeutics focus on younger patients with subclinical hypothyroidism and elderly patients with subclinical hyperthyroidism.

Relationship between Vitamin D Level and Subclinical Hypothyroidism in Patients with Gestational Diabetes Mellitus.

The aim was to investigate the relationship between the vitamin D (VitD) level and the incidence rate of subclinical hypothyroidism in patients with gestational diabetes mellitus (GDM) in early pregnancy. Ninety eligible patients who underwent physical examination from March 2015 to September 2017 were selected. The levels of serum 25-hydroxyvitamin D (25-OH-VD), free thyroxine (FT4), free triiodothyronine (FT3), thyroid stimulating hormone (TSH), and thyroid peroxidase antibody (TPOAb) were measured. The correlations of VitD level with those of thyroid function-related indices were analyzed. The serum 25-OH-VD level was (17.82 ± 3.45) ng/mL in the 90 GDM patients in early pregnancy, including 64.44% patients in VitD deficiency group, 22.22% patients in VitD insufficiency group, and 13.33% in VitD sufficiency group. No significant differences in the levels of serum FT4, FT3, and TSH were found among different VitD groups (p > 0.05), but the level of TPOAb gradually decreased (p < 0.05). There was no significant difference in the incidence rate of subclinical hypothyroidism among different VitD groups (p > 0.05). VitD level was not correlated with those of FT4, FT3, and TSH (p > 0.05), but negatively correlated with that of TPOAb (p < 0.05). An increase of TPOAb level raised the risk of VitD deficiency in pregnant women (p < 0.05). Patients suffered from significant 25-OH-VD deficiency in spring and winter (p < 0.05). GDM patients in early pregnancy display VitD deficiency, and their serum 25-OH-VD level is affected by seasons and not significantly related to subclinical hypothyroidism. However, the increased level of TPOAb may raise the risk of VitD deficiency in pregnant women.

Free Papers Compiled

BACKGROUNDStudies conducted in various parts of world as well as in India have revealed that Subclinical Hypothyroidism (SCH) is one of the risk factors for Depression. Several studies have found depression symptoms as a prevalent finding in patients with SCH. SCH has been found to have a negative effect in treatment of depression as well.AIMTo study the prevalence of SCH in patients with diagnosis of depressive episode, attending tertiary medical careMETHODSCross sectional Study conducted on 78 patients (selected by consecutive sampling) with a diagnosis of Depressive episode visited Govt Hospital for Mental Care, Visakhapatnam from March 2021 to September 2021. Hamilton Scale for Depression (HAM-D) and Montgomery-Asberg Depression Rating Scale (MADRS) were applied and blood levels of TSH, T4 and T3 were evaluated.RESULTSIn our study 6.78% of study population were found to have SCH with mildly elevated TSH level and T3, T4 level WNL. HAMD and MADRS Scale scores revealed mild to moderate depression in 73.8% of patients.CONCLUSIONSimilar to studies conducted elsewhere, our study also revealed SCH to be an important associated finding in patients with depression. Treating subclinical hypothyroidism may be a game changer in treating depressive episodes in such patients.

ОСОБЕННОСТИ ЛИПИДЕМИИ И АТЕРОСКЛЕРОТИЧЕСКОГО ПОРАЖЕНИЯ КОРОНАРНОГО РУСЛА У ЛИЦ С ОСТРЫМ КОРОНАРНЫМ СИНДРОМОМ И СУБКЛИНИЧЕСКИМ ГИПОТИРЕОЗОМ

Objective: To assess the derangements in lipid metabolism and the severity of atherosclerotic disease of the coronary arteries in patients with the acute coronary syndrome (ACS) and subclinical hypothyroidism (SHT). Methods: 146 medical records of inpatients of working age with newly developed ACS and various thyroid hormonal statuses were analysed. The lipid profile, high-sensitivity C-reactive protein (hs-CRP), thyroid-stimulating hormone (TSH), and free thyroid hormones (free thyroxine, FT4, and free triiodothyronine, FT3) levels were investigated. Coronary angiography results were used to assess coronary atherosclerotic plaque burden. The study group comprised 67 patients with ACS and SHT (TSH level &gt;4.0 mIU/l with normal thyroid hormone levels), and the control group included 79 ACS patients without thyroid hormonal abnormalities. The groups were matched for the presence of unhealthy habits, gender, age, and severity of arterial hypertension. Before admission to the hospital, patients did not receive preventive therapy for coronary artery disease (CAD) or hormone replacement therapy. Results: In SHT patients, in comparison with the group of patients with normal thyroid function, the proportion of individuals with type IIa hyperlipidemia was higher – 82.0% (n=55) and 46.8% (n=37), respectively (χ2=19.33; p&lt;0.001). A medium strength direct correlation was established between laboratory confirmed SHT and atherogenic dyslipidemia (r=0.62; p&lt;0.01), an increase in the level of hs-CRP (r=0.74; p&lt;0.01), and multivessel CAD (r=0.58; p&lt;0.05). Conclusion: In patients with CHT, the proportion of individuals with multivessel coronary artery stenosis is higher, and CAD occurs in the presence of hs-CRP and atherogenic dyslipidemia. Keywords: Acute coronary syndrome, coronary artery disease, atherosclerosis, hyperlipidemia, subclinical hypothyroidism, thyroid gland.

Study of fatigue in hypothyroid patients

ObjectivesTo assess the association between the severity of chronic fatigue and hypothyroidism.BackgroundFatigue is often described as mainly physical and cognitive and emotional discomfort. Persistent tiredness and fatigue-related symptoms are common in many hypothyroidism individuals.Patients and methodsThis case–control study was carried out on overt hypothyroid and subclinical hypothyroid patients attending outpatient clinics and inpatient endocrinology clinics in Menoufia University Hospital. The participants were classified into two groups: group I (control): 48 patients with normal thyroid-function tests (euthyroid) and group II (cases): 45 patients with overt hypothyroid and subclinical hypothyroid patients (autoimmune hypothyroidism). Patients were subjected to full clinical examination such as weight, height, BMI, and waist and hip circumference, and laboratory investigations such as complete blood count, renal-function test, liver-function test, lipid profile, and thyroid profile. Their fatigue level was assessed by Fatigue Severity Scale (FSS) and Multidimensional Fatigue Inventory.ResultsThe cases had significantly higher body weight, BMI, and waist: hip ratio (P ≤ 0.001). There was a significant positive correlation between FSS and each of thyroglobulin antibodies and thyroid peroxidase (TPO) (P = 0.005, P < 0.001, and P < 0.001, respectively). The univariate linear-regression analysis showed that TPO, free thyroxin, and duration of illness were independently associated with the FSS.ConclusionFatigue is prominent in patients with hypothyroidism. However, TPO, free thyroxin, and duration of illness were independently associated with higher FSS.

The Prevalence of Subclinical Hypothyroidism in the Obese Population and Effect Following Bariatric Surgery

Background: The purpose of our study was to analyze the clinical and biochemical characteristics of obese patients with subclinical hypothyroidism (SCH). The study pertains (shown) to the clinical efficacy of bariatric surgery on sub-clinical thyroid function in obese patients. Methods: A total of 130 obese patients (M=24, F=106) who underwent bariatric surgery in our hospital between June 2018 and December 2019 were considered for the study. These patients were further divided into two sub-groups: SCH (22 cases) & NSCH (108 cases). The thyroid hormones and their relevant metabolic indexes were then subsequently compared using a t-test. The effect of the bariatric surgery on the SCH group was then analyzed. Results: Among 130 cases, the prevalence of the SCH group was in 22 patients accounting for 16.92%. The prevalence of SCH with metabolic syndrome (MS) was in 13 patients accounting for 59.09%. The prevalence of NSCH with metabolic syndrome was seen in 30 cases accounting for 27.77%. Consequently, this indicates a significant disparity between these two groups (P<0.05). The SCH group patients were followed up for 12 months of surgery. The study showed that post-bariatric surgery the average TSH level (6.07±1.68IU/mL) had drastically dropped (2.88±0.56 IU/mL) indicating a staggering statistical improvement amongst the SCH group (P<0.05). Conclusion: The study showed that the obese patients associated with Subclinical hypothyroidism who underwent bariatric surgery saw a significant reduction and improvement in their TSH levels. The prevalence of subclinical hypothyroidism in the SCH group of obese patients was 16.92%. There was a higher MS occurrence rate amongst SCH patients. SCH could is a type of metabolic syndrome. Post-bariatric surgery has shown a significant decrease in TSH levels and acts as an effective treatment for SCH in obese patients.

Utility of Epicardial Fat Thickness in Subclinical Hypothyroid Children to Determine Existence of Subclinical Atherosclerosis in Them.

Adult studies have shown the association of subclinical hypothyroid (SCH) with various cardiovascular dysfunction, which indicates SCH may be a potentially modifiable risk factor of CV disease and mortality. However, there is still controversy about the association of cardiovascular dysfunction in children with SCH. Epicardial fat thickness (EFT) is a reliable and sensitive marker of cardiovascular risk and has become an emerging modality to predict CV risks. To measure the EFT in children with subclinical hypothyroidism and compare with healthy children. To find its correlation with subclinical atherosclerosis. To compare EFT between TPO positive and TPO negative subclinical hypothyroid patients. Children of subclinical hypothyroidism (TSH >5 mIU/ml with normal FT3, FT4, and age and sex matched control were included as per inclusion and exclusion criteria. Clinical data was collected from all study subjects. Thyroid function tests including FT3, FT4 and TSH, TPO antibody, fasting insulin, hsCRP, Lp(a), USG neck for carotid intima media thickness (CIMT), USG brachial artery for flow mediated dilation (FMD) and echocardiography for epicardial fat thickness (EFT) were done in all patients. A total 42 number of SCH and 50 age and sex matched controls were recruited and screened for various parameters of subclinical atherosclerosis. EFT was significantly higher in the cases than in the controls (6.27 mm vs 4.54 mm) with P value < 0.001. Brachial FMD was significantly lower in cases than the cohort (4.5% vs 8.93%, P < 0.001). Difference in CIMT was not significant amongst the cases and controls. EFT failed to correlate with the level of TSH though it had significant positive correlation with hsCRP. The patients who were TPO positive, had higher fasting insulin, HOMAIR, hsCRP, Lp(a) than those who were TPO negative. Results of this study show the presence of subclinical atherosclerosis in children with SCH regardless of the aetiologies. The patients of Hashimoto thyroiditis had significantly high insulin resistance and inflammation than the SCH patients of other aetiologies.

Vitamin B12 (Cobalamin) Deficiency in Overt and Subclinical Primary Hypothyroidism.

Background:B12 (cobalamin) deficiency has been reported in hypothyroid patients with variable prevalence rates thus routine screening of hypothyroid patients was recommended by some and discouraged by others. We aimed to assess the prevalence of B12 deficiency among hypothyroid patients and to evaluate for pernicious anemia and celiac disease as etiologies.Methods:A total 133 patients were included. Thyroid hormones and thyroid peroxidase (TPO) autoantibodies were measured. Serum B12 was measured and if deficient, intrinsic factor antibodies (IFAB) and tissue transglutaminase (tTG) antibodies were evaluated.Results:Our study included 45 patients with overt hypothyroidism (OH), 48 patients with subclinical hypothyroidism (SCH), and 40 patients as controls. Mean age was 34.3 years and 82% were females. TPO antibodies were positive in 73.5% of OH and 51.1% of SCH patients. B12 deficiency was detected in 33.3%, 47.9%, and 37.5% of OH, SCH, and controls, respectively with no significant difference (P = .334). Borderline-to-low B12 level was more prevalent in the OH and the SCH groups compared to controls (68.9%, 85.4%, and 57.5%, respectively; P = .014). Among B12-deficient hypothyroid patients, 7.5% had positive IFAB and 13.3% had positive tTG antibodies. We did not find a significant association of TPO positivity and B12 deficiency (OR, 0.69; 95% CI 0.3-1.57; P = .147).Conclusion:We did not find a higher prevalence of B12 deficiency among hypothyroid patients nor an association with TPO positivity. Borderline B12 levels were more prevalent among hypothyroid patients.

Comparison of triglyceride-glucose index and HOMA-IR as indicators of insulin resistance in obese women with subclinical hypothyroidism

Introduction and aim. Thyroid hormones play an important role in glucose metabolism as in many metabolic events. The aim of our study is to evaluate the relationship between subclinical hypothyroidism (SCH) and insulin resistance, especially in obese women. Material and methods. Newly diagnosed SCH patients with body mass index (BMI) ≥30 who applied to our outpatient clinic between March 2021 and October 2021, and euthyroid obese women who applied for routine control were included in the study. In this study, we used homeostasis model assessment of insulin resistance (HOMA-IR) and triglyceride glucose (TyG) indexes, which are noninvasive, simple and useful methods for evaluating insulin sensitivity. Results. The study included 78 female patients between the ages of 19 and 64. A correlational analysis was performed between thyroid stimulating hormone (TSH) and HOMA-IR, TyG, and BMI. The results showed that TSH levels were positively correlated with HOMA-IR (R=0.297, p=0.008), TyG (R=0.316, p=0.005) and BMI (R=0.307, p=0.006). This relationship was stronger for TyG compared to the other variables. As another finding, BMI was positively correlated with HOMA-IR (R=0.359, p=0.001) and TyG (R=0.404, p&lt;0.001). This relationship was stronger for TyG than HOMA-IR. Conclusion. These results show that patients with SCH are at risk of developing diseases that accompany insulin resistance, such as metabolic syndrome and cardiovascular disorders. The most important finding of our study is that the TyG index gives more significant results than HOMA-IR, especially in obese women.

Prevalence of undiagnosed hypothyroidism in patients with gall bladder stones in Belagavi

Background: Contribution of hypothyroidism to gallstone formation is debated over years. With this background, the study intended to analyze the prevalence of undiagnosed hypothyroidism in patients with cholelithiasis. The aim is to understand the prevalence of hypothyroidism in patients with gallstones.Methods: A prospective, hospital-based study was done on 100 patients admitted for the management of gall stone disease in Belagavi. After initial screening, a detailed history was obtained with special reference to symptomatology and the risk factors as per proforma from patients meeting selection criteria. Thyroid function test was done on all eligible patients. Patients were divided into three groups of Euthyroid, Subclinical hypothyroid and clinical hypothyroidism. Statistical analysis used. Percentage of gall stones in different age groups and gender of the study population was calculated followed by prevalence of hypothyroidism and subclinical hypothyroidism in all the patients included.Results: Among the study population, 40% were male and 60% were female. 23 of them have subclinical hypothyroidism and 6 of them were diagnosed with hypothyroidism. Majority of subclinical hypothyroid patients (39.13%) were aged 41-60 years. Hypothyroid symptoms were shown by the study population with unknown thyroid status.Conclusions: The prevalence of hypothyroidism in cholelithiasis is 29% in the study and is significant. The study demands further studies to consider hypothyroidism as a cause /risk factor for biliary calculus.