Subclinical Hypothyroidism Patients Research Articles

The Importance of Treating Subclinical Hypothyroidism in Patients With Immune Thrombocytopenia: A Case Report

The Importance of Treating Subclinical Hypothyroidism in Patients With Immune Thrombocytopenia: A Case Report

Association of apolipoproteins A1 & B100 in subclinical hypothyroidism in patients attending endocrinology clinic at tribhuvan university teaching hospital

Association of apolipoproteins A1 & B100 in subclinical hypothyroidism in patients attending endocrinology clinic at tribhuvan university teaching hospital

The state of central and peripheral hemodynamics in patients with out-of-hospital pneumonia associated with subclinical hypothyroidism

Objective: to investigate the state of сеntral and peripheral hemodynamics in patients with out-of–hospital pneumonia (OHP) combined with subclinical hypothyroidism (SH). Materials and methods: the study was conducted in 132 patients with OHP of clinical groups II-III, including 64 with OHP combined with SН — the main group, and 68 with OHP without SН (comparison group). The average age of the patients was 37.4±3.3 years, including 74 women among the studied, 58 men. The state of microcirculation in patients was studied by biomicroscopy of the bulbar conjunctiva using a slit lamp with the calculation of conjunctival indices, intravascular aggregation of shaped blood elements was observed in the presence of a sludge phenomenon according to N. Knisely (1965), and central cardiohemodynamics parameters were determined. Results: in patients with OHP, along with small clinical signs of hypertension, laboratory data were revealed: TSH — (6,4±0,6) мIU/ml, free T4 — (13,2±1,1) pmol/L, the level of ATP — 53,7±2,3 IU/ml — microcirculatory disorders with changes in the microvascular wall, sludge in them, perivascular changes, as well as dysfunction of the right and left ventricles of the heart. Conclusions: the combination of OHP and SH in patients is accompanied by significant microvascular shifts, which are associated with disorders of central cardiohemodynamics in the form of dysfunction of the right and left ventricles of the heart. The found correlations between the parameters of cardiohemodynamics and microcirculation in patients with OHP combined with SH and TSH levels confirm the negative effect of subclinical hypothyroidism on the state of central and peripheral hemodynamics in patients.

Effects of levothyroxine in subclinical hypothyroidism and heart failure with reduced ejection fraction: An open-label randomized trial

We report a randomized, multicenter, open-label trial (ClinicalTrials.gov: NCT03096613) to investigate the clinical benefits of levothyroxine (L-T4) administration in subclinical hypothyroidism (SCH) patients with heart failure with reduced ejection fraction (HFrEF). Overall, 117 patients were enrolled and received L-T4 plus standard HFrEF treatment (experimental group, N= 57) or standard HFrEF therapy alone (control group, N= 60). The change of 6-min walk test distance in the experimental group was significantly higher than that in the control group at 24weeks (70.08± 85.76m vs. 27.73± 82.00 m, mean difference [95% confidence interval (CI)] 46.90 [12.90, 80.90], p<0.001). Improvements in New York Heart Association (NYHA) classification (p= 0.033) and thyroid function were significant. Adverse event incidence was similar between groups (risk ratio [95% CI]: 0.942 1.053 (0.424, 2.616); p= 0.628). L-T4 addition to HFrEF treatment improved activity tolerance, NYHA class, and thyroid function within 6months, suggesting its potential for combined therapy in HFrEF patients with SCH. Future double-blind, placebo-controlled trials should be performed to confirm these results.

Circulating miR-206, miR-181b, and miR-21 as promising biomarkers in hypothyroidism and their relationship to related hyperlipidemia and hepatic steatosis.

Background: Thyroid hormones (THs) signaling has profound effects on many physiological processes. The regulation of THs signaling in various tissues involves the action of microRNAs (miRNAs) on thyroid deiodinases and receptors. THs regulate the expression of certain miRNAs and their target messenger RNAs (mRNAs) in various tissues and cells. The modulation of miRNA levels by THs affects their functions in processes such as liver lipid metabolism, skin physiology, and muscle and heart performance. Aim: This research aimed to investigate miR-181b, miR-206, and miR-21 in the serum of patients with subclinical and overt hypothyroidism to determine their possible role in the diagnosis of the disease and their relationship to clinical disorders related to hypothyroidism. Methods: This study included ninety participants, divided evenly into three groups as follows: patients with overt hypothyroidism diagnosed clinically, radiologically, and by investigation, subclinical hypothyroid patients, and healthy volunteers. The patients had a thorough medical history and underwent a clinical examination. Laboratory tests included plasma cholesterol, LDL, HDL, TGs, liver and renal function tests, CBC, fasting insulin, HOMA-IR, HbA1c, TSH, and free T4. The serum levels of miR-21, miR-206, and miR-181b were measured using qRT-PCR. Results: miR-206 and miR-181b levels were higher in the subclinical group, followed by the hypothyroid and control groups. For miR-21, there was a significantly lower mean value in both the hypothyroid and subclinical groups than in the control group, with no difference between the two groups. Both miR-206 and miR-181b showed a significant negative association with albumin and free T4 levels and a significant direct association with GGT, ALT, AST, creatinine, uric acid, TGs, TC, LDL, TSH, thyroid volume, and CAP score. The same correlation pattern was observed for miR-181b, except that it was not significantly correlated with the TGs. For miR-21 levels, there was a significant positive correlation with albumin, free T4 level, and kPa score and a negative correlation with GGT, ALT, AST, creatinine, uric acid, HOMA-IR, HbA1c, TC, LDL, TSH, and CAP score. Cases with F1 kPa score and S2 CAP scores had significantly higher averages for miR-206 and miR-181b, with a p-value of 0.05. Moreover, miR-21 levels were significantly lower in the S2 CAP score group. Conclusion: These miRNAs (miR-206, miR-181b, and miR-21) may be used as diagnostic biomarkers for hypothyroidism. They may be used as therapeutic targets to control dyslipidemia and hepatic steatosis during hypothyroid disease.

Prevalence of Subclinical Hypothyroidism among Pregnant Women

Background: Some studies have associated subclinical hypothyroidism with obstetric complications such as preeclampsia, preterm birth, and placental abruption. Objective: To investigate the prevalence of subclinical hypothyroidism in patients with preeclampsia and normotensive pregnant women ending their pregnancy at Enrique Garces Hospital. Methods: This is a descriptive cross-sectional study conducted between February 2020 and 2022. The study included pregnant women between 20 and 35 years of age, with singleton pregnancies in the third trimester. The women were in labor and diagnosed with subclinical hypothyroidism and preeclampsia in the current pregnancy. The women underwent blood sampling. Also, the thyroid stimulating hormone (TSH) and free thyroxine (fT4) levels were measured by chemiluminescence. Results: A total of 639 women were evaluated; Among these women 509 (79.66%) were normotensive, 137 (26.92%) had subclinical hypothyroidism, and 372 (73.08%) did not have subclinical hypothyroidism, 130 (20.34%) had preeclampsia, 34 (26.15%) of them with subclinical hypothyroidism and 96 (73.85%) not having subclinical hypothyroidism. The overall prevalence of subclinical hypothyroidism was 26.76%. In the normotensive group the prevalence of subclinical hypothyroidism was 0.2691 with a 95 % CI (0.2306, 0.3076) and in the preeclampsia group it was 0.2615 with a 95 % CI (0.1859, 0.3370). Conclusions: A high prevalence of subclinical hypothyroidism was identified among pregnant women, which often goes undiagnosed in the early stages of pregnancy due to the lack of thyroid profile screening protocols for all pregnant women. Regarding the TSH cut-off levels 3mIUI/L there was no statistically significant difference of subclinical hypothyroidism among normotensive pregnant women and preeclampsia women, as literature suggests that TSH levels above 4mIU/L are associated with hypertensive diseases

Prevalence of Subclinical Hypothyroidism in Patients with Recurrent Miscarriages

Background: Subclinical hypothyroidism poses a concealed threat to reproductive health. With evidence hinting at its prevalence in recurrent miscarriages, this study delves into unraveling the intricacies of this relationship for comprehensive understanding and improved clinical outcomes. Objective: To determine prevalence of subclinical hypothyroidism in patients with recurrent miscarriages. Study Design: Descriptive cross-sectional study. Settings: This study was conducted at the Department of Medicine, DHQ Teaching Hospital, KMU Institute of Medical Sciences, Kohat Pakistan. Duration: 6 months period from Jan-Jun, 2023. Methods: A total of 224 women meeting inclusion criteria were included in the study after taking informed written consent. Blood samples were taken as per standard hygiene protocol and send hospital lab for thyroid profile. Subclinical hypothyroidism was labeled when serum TSH level was ≥4.0 mIU/L and the patients didn’t have clinical symptoms of hypothyroidism. All the data was collected in a predesigned format and data analysis was done using SPSS 27.0. Results: Mean age of the patients in this study was 29.01±6.61 years wherein 58.0% (n=130) patients were in the age group of 18-30 years while remaining 42% (n=94) were in the age group of 31-40 years. As regards parity, 50.9% (n=114) patients were nulliparas, 28.1% (n=63) were primiparas and 21.0% (n=47) were multiparas. Mean BMI of the study sample was 24.87±3.7 kg/m2 wherein 52.7% (n=118) participants were normal weight, 37.9% (n=85) were overweight and only 9.4% (n=21) were obese. Previous number of miscarriages were almost same amount all the three groups as 3 miscarriages (33.5%), 4 miscarriages (35.7%) and 5 miscarriages (30.8%). Subclinical hypothyroidism was observed in 18.3% (n=41) patients. Frequency of mischarge was stratified on the basis of age, parity, BMI and previous number of miscarriage, it produced insignificant different for all the subgroups (p-value=0.05). Conclusion: In conclusion, our study highlights a consistent prevalence of subclinical hypothyroidism (18.3%) in women with recurrent miscarriage. This aligns with global findings, emphasizing the significance of thyroid dysfunction. These insights underscore the importance of routine thyroid screening in the management of recurrent miscarriage, guiding targeted interventions for improved reproductive outcomes.

Subclinical Hypothyroidism in Patients with Obesity and Metabolic Syndrome: A Narrative Review.

The literature on the connection between obesity, metabolic syndrome, and subclinical hypothyroidism is critically analyzed in this narrative review. These conditions are frequently observed among adult populations and various studies and meta-analyses have assessed their association. The prevalence of subclinical hypothyroidism in obese individuals is higher than in non-obese subjects and this trend is more pronounced in unhealthy obesity phenotypes. However, the diagnosis and treatment of subclinical hypothyroidism can be difficult in obese patients. Exaggerated body fat is linked to thyroid hypoechogenicity as evident through ultrasonography and euthyroid obese people have greater TSH, FT3, and FT3/FT4 ratios than non-obese individuals in a euthyroid condition. Moreover, a reduced expression of the TSH receptor and altered function of deiodinases has been found in the adipose tissue of obese patients. Current data do not support the necessity of a pharmacological correction of the isolated hyperthyrotropinemia in euthyroid obese patients because treatment with thyroid hormone does not significantly improve weight loss and the increase in serum TSH can be reversible after hypocaloric diet or bariatric surgery. On the other hand, obesity is linked to elevated leptin levels. Inflammation can raise the risk of Hashimoto thyroiditis, which increases the likelihood that obese patients will experience overt or subclinical hypothyroidism. Both metabolic syndrome and subclinical hypothyroidism are associated with atherosclerosis, liver and kidney disease. Hence, the association of these two illnesses may potentiate the adverse effects noted in each of them. Subclinical hypothyroidism should be identified in patients with obesity and treated with appropriate doses of L-thyroxine according to the lean body mass and body weight. Randomized controlled trials are necessary to verify whether treatment of thyroid deficiency could counteract the expected risks.

Estimation of left ventricular functions in patients with subclinical hypothyroidism: a meta-analysis.

To evaluate left ventricular (LV) function in patients with subclinical hypothyroidism (ScH) compared to healthy individuals and to provide clinical hints for practitioners. PubMed, Embase, Cochrane Library, and Web of Science were systematically searched in this meta-analysis. Studies evaluating LV function in ScH patients were included. Standardized mean difference (SMD) and the 95% confidence intervals (CIs) were calculated as effect size. Heterogeneity and risks of bias of included studies were assessed. A total of 9 studies were identified as eligible. The SMD for fractional shortening (FS, %) was -0.21 (95% CI: -0.60, 0.17; z = -1.08, p = 0.2788). The pooled SMD for systemic vascular resistance (SVR, dynes/sec·cm-5) was -0.41 (95% CI: -1.31, 0.49; z = -0.89, p = 0.3744). The pooled SMD for early diastolic mitral flow velocity/late diastolic mitral flow velocity (E/A) ratio was -0.74 (95% CI: -1.09, -0.39; z = -4.13, p < 0.001). The pooled SMD for ejection fraction (EF, %) was -0.35 (95% CI: -0.59, -0.12; z = -2.95, p = 0.0032). ScH patients had significantly worse LV function parameters than healthy controls. These changes in LV function may be involved in the management of ScH.

Subclinical hypothyroidism and anti-thyroid peroxidase antibodies in primary open-angle glaucoma: A case-control study.

To evaluate the association among subclinical hypothyroidism, anti-thyroid peroxidase (anti-TPO) antibody, and primary open-angle glaucoma (POAG). Case-control study. The cases consisted of patients with POAG and controls were age- and sex-matched patients from the general eye clinic with no history of glaucoma. Blood samples were taken from the participants' antecubital veins and sent for measurement of thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), and anti-thyroid peroxidase (anti-TPO) antibody. Data was analyzed using the Mann-Whitney U test and the Chi-square test. Odds ratio with 95% confidence interval (CI) was calculated. A two-tailed P value less than 0.05 was considered for statistical significance. There were a total of 63 cases and 63 controls. Subclinical hypothyroidism was present in 20.6% of patients in the glaucoma group and 4.8% of patients in the control group ( P < 0.01). The odds of subclinical hypothyroidism in patients with POAG compared to controls was 5.2 (95% CI 1.7-22). Anti-TPO antibody positivity was higher in the glaucoma group (22.2%) than in the control group (14.3%), but this did not reach statistical significance ( P = 0.25). This study suggests an association between POAG and subclinical hypothyroidism. Further research is needed to establish the cause-and-effect relationship between these two conditions.

Association of vitamin D with triglyceride-glucose index and cardiometabolic risk factors in subclinical hypothyroidism

BackgroundThe present study aimed to explore the association of vitamin D with triglyceride-glucose (TyG) index and cardiometabolic risk factors in subclinical hypothyroidism (SCH). MethodsWe recruited 75 individuals diagnosed with SCH and 75 healthy controls of both genders aged 20 to 65 years. Triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH) and 25-hydroxyvitamin D [25(OH)D] were measured using chemiluminescent immunoassay. Fasting plasma glucose and lipid profile were analyzed by standard methods. The TyG index was calculated as Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)]/2. ResultsThere were significant decreases in 25(OH)D levels and changes in cardiometabolic risk factors among individuals with SCH compared to healthy controls. Additionally, there was a significant increase in the TyG index among the SCH group. Correlation and regression analysis revealed that 25(OH)D was significantly and negatively associated with TyG index, diastolic blood pressure (DBP), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C). However, it was positively associated with high-density lipoprotein cholesterol (HDL-C). ConclusionPresent study shows that SCH patients have lower vitamin D levels and higher TyG index, increasing cardiovascular disease risk. Screening and managing vitamin D deficiency is crucial in these subjects. In addition, TyG index could be used as an indicator for identifying vitamin D deficiency.

Assessing the cardiovascular effects of levothyroxine use in an ageing United Kingdom population (ACEL-UK) protocol: a cohort and target trial emulation study

BackgroundSubclinical hypothyroidism is diagnosed when serum thyroid stimulating hormone levels are higher whilst free thyroxine levels remain within their respective reference ranges. These reference ranges are uniformly applied in all adults, despite serum thyroid stimulating hormone levels naturally increasing with age. Research has found that mildly elevated thyroid stimulating hormone levels may be associated with some benefits in ageing patients, including reduced mortality and better cardiorespiratory fitness. Levothyroxine is typically prescribed to patients with hypothyroidism, but no conclusive evidence exists on whether levothyroxine therapy is beneficial or detrimental in older subclinical hypothyroid patients. Despite this, prescriptions for levothyroxine are increasing year-on-year. This study aims to determine if receiving levothyroxine affects the cardiovascular and bone health outcomes of subclinical patients in primary care aged 50 years and over.MethodsThis project includes a retrospective cohort analysis and a target trial emulation study using electronic patient records collected between 2006 and 2021 and recorded in The Health Improvement Network database. The primary outcome of this study is to compare the cardiovascular outcomes of subclinical hypothyroid patients aged over 50 years treated with levothyroxine compared to those untreated. Secondary outcomes are bone health and all-cause mortality outcomes. Descriptive and inferential statistics will both be employed to analyse the data. Secondary analysis will explore confounding factors, including age, sex, smoking status, body mass index, co-morbidities, and levothyroxine dosage.DiscussionThere needs to be a greater understanding of the potential risks of the current treatment for older patients with subclinical hypothyroidism in a primary care setting. We will investigate the clinical importance of this issue and whether older subclinical hypothyroid patients have poorer outcomes when treated. Clarifying this concern may help address the healthcare resource implications of ageing patients being misclassified as having mild hypothyroidism, as these patients are more likely to repeat their blood tests. This could reduce prescription wastage and improve patient outcomes and quality of life in the ageing population.Trial registrationNot applicable.

Frequency of Subclinical Hypothyroidism in Patients with First-Trimester Pregnancy Loss

Objectives: To determine the frequency of subclinical Hypothyroidism in women with first-trimester pregnancy loss. Study Design: Cross-sectional study. Place and Duration of Study: Gynaecology &amp; Obstetrics Department, Combined Military Hospital, Rawalpindi Pakistan,from Jun 2018 to Dec 2018. Methodology: The study included 130 women aged 18-40 years who had first-trimester pregnancy loss. Patients withchronic renal failure, known thyroid disorders and taking medication that can affect thyroid functions were excluded. Venous blood samples were taken to analyse thyroid function tests, and subclinical Hypothyroidism was noted. Results: The mean age of the women was 28.68±4.80 years. Most patients 77(59.23%), were between 18 and 30 years old. The mean BMI was 29.42±2.50 kg/m2. 16(12.31%) women with first-trimester miscarriage had subclinical Hypothyroidism. Conclusion: This study concluded that the frequency of subclinical Hypothyroidism in women with first-trimester pregnancy loss was significant. Proper management protocol for early recognition and management of subclinical Hypothyroidism in women can improve pregnancy outcomes.

The Role of Global Longitudinal Strain in Subclinical Hypothyroid Patients With Heart Failure.

Introduction There is considerable evidence to suggest the role of thyroid hormone in acute coronary syndrome (ACS), but less is known about its prognostic role in heart failure (HF). We aimed to assess the role of global longitudinal strain (GLS) in patients hospitalized with HF and underlying subclinical hypothyroidism (SCHS). Methods A retrospective analysis of 161 subjects was conducted by dichotomizing them into HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) subgroups. SCHS was defined as a thyroid stimulating hormone level >4.50 mIU/L with a normal thyroxine level based on the evaluation of limits for lab markers from prior studies. HFpEF and HFrEF were defined as left ventricular ejection fraction (LVEF)>40% and LVEF≤40%, respectively, based on American College of Cardiology (ACC) guidelines. An abnormal speckled transthoracic echocardiographic (TTE) strain was defined as a left ventricular global longitudinal strain (LVGLS) value of >-15%. Results The mean age of the population was 62±8 years, and 55% were female. LVGLS was present in 121 patients with underlying SCHS (p<0.05). The patients with SCHS andabnormal LVGLS were found to have deranged left ventricular echocardiographic parameters (p<0.05). The derangements were greater for SCHS patients with HFrEF and abnormal LVGLS (p<0.05). Readmission rates at 30 days and in-hospital mortality were higher in SCHS patients with abnormal LVGLS (p<0.05). Conclusion The SCHS is associated with abnormal GLS in HF patients (either HFpEF or HFrEF) that results in remodeling and adverse outcomes, including mortality and readmission rates. Further studies are warranted to validate these findings in a larger population data pool.

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 relationship between serum superoxide dismutase and thyroid function in obese patients after Laparoscopic sleeve gastrectomy

To investigate the cross-sectional and longitudinal correlation between serum superoxide dismutase (SOD) levels and thyroid function with obesity before and after laparoscopic sleeve gastrectomy (LSG). Patients with morbid obesity (n = 219, 112 males and 107 females) who underwent LSG were selected and they were subdivided into normal levels of SOD (NSOD, n = 112) and high levels of SOD (HSOD, n = 107) according to the median value of SOD levels (183 U/mL). SOD and thyroid hormones were measured and compared at baseline, 3, 6, and 12 months after LSG. The HSOD group had lower body mass index (BMI), total thyroxine (TT4), and thyroid-stimulating hormone (TSH) than the NSOD group (p < 0.001, p = 0.031, p < 0.001, respectively). However, they had higher free triiodothyronine (FT3) and free thyroxine (FT4) (p = 0.019 and p = 0.017, respectively). SOD was significantly negatively associated with TSH and positively associated with FT4. Of all the patients, 22.31% (NSOD: 66.67%; HSOD: 33.33%) had subclinical hypothyroidism (SH), and there were lower SOD levels in the SH group. Preoperative SOD was a protective factor for SH. After LSG, SOD and FT4 levels were increased at 12 months after LSG, however, TSH, FT3, total triiodothyronine (TT3) and TT4 levels decreased compared to the preoperative levels at 3, 6, and 12 months in the SH group. Postoperative changes in FT4 and TT4 levels correlated with changes in SOD levels. SOD, which is correlated with thyroid hormones, protects against SH in patients with obesity. The improvement in thyroid function with SH after LSG may be related to increased SOD levels.

FRI543 Effect Of Vitamin D Replacement On Thyroid Autoimmunity And thyroid Functions In Subclinical Hypothyroid And Vitamin D Deficient Patients: A Randomized Controlled Trial

Abstract Disclosure: N.J. Aljohani: None. Background: Vitamin D status has been implicated to influence several non-skeletal diseases including diabetes, cardiovascular diseases, and auto-immunity. Several observations have also associated vitamin D deficiency with thyroid disorders, but prospective data is lacking. In this randomized clinical trial, we aimed to determine whether vitamin D correction improves subclinical hypothyroid status of Arab adult patients. Subjects and Methods: A total of 84 subjects with subclinical hypothyroidism were recruited and allocated (1:1) to receive either vitamin D 50,000 IU weekly in first four months (cases) or placebo (Vitamin D 5000 IU weekly). Thyroid function and thyroid autoantibodies was repeated after 3 and 6 months with vitamin D level to see sufficient vitamin D replacement status. Results: Post-intervention, 31 cases and 37 controls completed the intervention. Cases had a significant increase in 25(OH)D levels after 3 and 6 months of intervention. In both cases, and controls, there was a significant decrease in TSH over time (p&amp;lt;0.05), with no significant changes in both circulating FT4 and FT3 levels. A significant decrease in TPO ab and anti-TG ab levels after 6 months (p&amp;lt;0.05) were observed only in cases. In conclusion, vitamin D correction modestly improves thyroid status of Arab patients with known subclinical hypothyroidism. Further investigations are needed as to whether vitamin D supplementation is more beneficial among subclinical hypothyroid patients who were deficient at baseline. Presentation: Friday, June 16, 2023

FRI568 Hashimoto’s Thyroiditis With Negative Antibodies In Association With Common Variable Immunodeficiency

Abstract Disclosure: I.C. Ebrahim: None. K.F. Brown: None. N.O. Vietor: None. T.D. Hoang: None. M.K. Shakir: None. Introduction: Common variable immunodeficiency (CVID) is associated with several autoimmune manifestations including Hashimoto’s thyroiditis (HT). We report a 47-year-old male with CVID and HT with negative thyroid antibodies (Abs). Case Report: A 47-year-old male, while undergoing coronary calcium scan in 2021, was found to have scattered lung nodules. Follow-up Ct scans showed interval increase in size of lung nodules and a PET scan confirmed bilateral lung nodules which demonstrated hypermetabolic activity and scattered hypermetabolic lymph nodes, suggesting infectious or inflammatory processes. PET scan also revealed thyromegaly with diffusely increased uptake, suggesting thyroiditis. Serum immunoglobulins were measured: IgA &amp;lt; 5 mg/dL (normal 70-400), IgG 334 mg/dL (normal 700-1600), and IgM &amp;lt; 25 mg/dL (normal 40-230). Serum immunoglobulins levels from depository serum samples collected in 2005 also showed similarly low values. CBC was normal, excluding any bone marrow disorders. There was no family history of immunodeficiency or thyroid disorders. On review of systems patients did not have any symptoms of hypothyroidism. Exam: thyroid 50-gms diffusely enlarged with no palpable nodules; heart and lung exam was normal. Laboratory tests including comprehensive metabolic panel, serum complement CH 50, leukemia/lymphoma panel, T/B - lymphocyte/Natkiller, CRP were all normal. Thyroid functions: TSH 5.6 mc1U/mL (0.27-4.2), Free T4 1.20 ng/dL (0.93-1.71), TPO Ab &amp;lt; 9 IU/mL (0-34), TG Ab &amp;lt; 1.0 1U/mL (0.0-0.9), thyrotropin receptor Ab &amp;lt; 0.3 IU/L (&amp;lt;1.0), thyroid stimulating immunoglobulin &amp;lt; 0.10 1U/L (0.06-0.55). Serum thyroid Ab levels from depository samples collected in 2005 also showed normal values. FNA of thyroid showed atypical lymphoid infiltrates and an excision biopsy of the thyroid isthmus confirmed lymphocytic thyroiditis. A PET avid right inguinal lymph node biopsy showed a reactive lymph node. Additional lab evaluation also showed low post vaccination pneumococcal titers. With pan-hypoglobulinemia and low vaccine response, a diagnosis of CVID was made. Patient preferred watchful waiting than iv immunoglobulin therapy. Additionally, the patient has HT with negative thyroid Abs and although patient had mild subclinical hypothyroidism patient elected no treatment. Common variable immunodeficiency (CVID) is the most frequent symptomatic primary immunodeficiency in adults. Autoimmune manifestations occur in 22% of CVID patients and these include autoimmune cytopenia, pernicious anemia, rheumatoid arthritis, vitiligo, and/or HT. Interestingly, our patient did not manifest any thyroid Abs thus it may be postulated that thyroid follicles destruction in HT is mediated predominantly by thyroid-specific B and T cells rather than by thyroid antibodies. Presentation: Friday, June 16, 2023

Prevalence and Factors Associated with Subclinical Hypothyroidism in Major Depressive Disorder Patients with Dyslipidemia.

Major depressive disorder (MDD) is a common psychiatric disorder with a high prevalence of comorbidity with subclinical hypothyroidism. The aim of this study was to investigate the prevalence and factors influencing the comorbidity of subclinical hypothyroidism in patients with dyslipidemic MDD who were hospitalized for the first time in a Chinese population. The study incorporated 708 first-time hospitalized MDD patients, all with dyslipidemia. Data collection encompassed socio-demographic information, blood pressure, fasting blood glucose (FBG), lipid, and thyroid hormone levels. Participants were evaluated using the Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and Positive Symptom Subscale (PSS). The prevalence of subclinical hypothyroidism in dyslipidemic MDD patients with the first hospitalization was 39.97%. The course of the disease, age at onset, HAMA score, and low-density lipoprotein cholesterol (LDL-C) were risk factors for subclinical hypothyroidism in dyslipidemic MDD patients. The course of disease, age at onset, HAMA score, HAMD score, FBG, and systolic blood pressure (SBP) levels were observed to influence serum Thyroid Stimulating Hormone (TSH) levels. MDD patients with dyslipidemia have a high prevalence of subclinical hypothyroidism, and the outcome is associated with anxiety, fasting glucose, and lipids. This study provides a potential biomarker for the identification of co-morbid subclinical hypothyroidism in MDD patients with dyslipidaemia.

Studying of Thyroid Dysfunction on Patients with Metabolic Syndrome

A retrospective study was conducted several studies aimed at knowing the relationship between the level of thyroid hormone and the metabolic syndrome and according to the results of the study, it is recommended to determine the level of tsh hormone in the pituitary gland in all patients as well as in all patients with risks of developing cardiovascular diseases: in patients who they suffer from obesity, dyslipidemia, arterial hypertension, hyperhomocysteinemia, and tobacco smoking., hereditary factor, diabetes mellitus type 2. No less important is the issue of treatment tactics in patients and in accordance with current recommendations, the appointment of thyroid hormone preparations is indicated for patients with an increase in the level of tsh more than 10 μm / l. The assignment of thyroxine to the boundary level of tsh is still a matter of debate. Most authors consider surgical myocardial revascularization, continuous statin therapy, and correction of subclinical hypothyroidism with small doses of thyroxine to normal tsh values as ideal. The most appropriate is the early detection of subclinical hypothyroidism in patients and correction of disorders identified with thyroid hormone preparations. The study showed that subclinical hypothyroidism is an additional independent risk factor.