Subclinical Hypothyroidism Research Articles

7583 Evaluation of The Consistency of Thyroid Indicators Tests in Minimally Invasive Peripheral Blood and Venous Blood

Abstract Disclosure: Z. Zhu: None. Y. Huang: None. Z. Cao: None. L. Zhang: None. D. Wang: None. S. Wang: None. J. Zhang: None. Y. Gao: None. Y. Zhang: None. Background: The detection of thyroid indicators is of high demand in clinical and epidemiological screenings. Compared with existing venous blood tests, peripheral fingertip blood tests are less invasive and have a lower blood collection volume, which is the basis for point-of-care tests of thyroid indicators. Objective To explore the feasibility of minimally invasive and micro blood collection tests for thyroid disease (TD) patients by evaluating the consistency of thyroid indicators and TD diagnostic efficiency between fingertip blood tests and venous blood tests. Method 63 subjects with or without thyroid dysfunction were consecutively recruited. All subjects underwent serum, plasma and fingertip blood (same day collection) measurements for TSH and TT4 detection via the chemiluminescence method and for TPOAb detection via the electrochemiluminescence immunoassay method. The fingertip blood was centrifuged and diluted after EDTA anticoagulation. Bland–Altman plot, Passing–Bablok regression, and weighted kappa test were used for consistency test; AUC of ROC curve, sensitivity and specificity were used for authenticity evaluation among the three collection and testing methods. Results 43 subjects with euthyroidism and 20 subjects with thyroid dysfunction were included; including 29 (46.03%) females, the average age was 50.98±14.76 years. Bland-Altman plots showed more than 90% of the subjects had TSH and TT4 differences within the 95% limits of agreement between peripheral blood (PB) and venous blood (including serum and plasma). Passing–Bablok regression analyses revealed strong correlations between TSH levels in PB and serum (r=0.888) and plasma (r=0.894) (p<0.05); for TT4, there was a strong correlation between PB and serum (r=0.746), and there was also a moderate correlation between PB and plasma (r=0.664) (p<0.05 for both). Weighted kappa tests were performed for low, normal and high TSH values, indicating strong consistency between PB and serum and between PB and plasma, with coefficients of 0.901 and 0.881, respectively (P<0.001); for TT4, the coefficients between PB and serum, PB and plasma were 0.541 and 0.585 (P<0.001), indicating moderate consistency. Regardless of TPOAb positivity or negativity, the consistency among three blood sample sources was 100%. For euthyroidism (n=43), hyperthyroidism (n=6), subclinical hyperthyroidism (n=9), hypothyroidism (n=1), and subclinical hypothyroidism (n=4), the diagnostic sensitivities of PB were 97.06%, 83.33%, 87.50%, 100%, and 75.00%, respectively; the specificities were 94.74%, 97.87%, 95.74%, 98.11%, and 100.00%, respectively. The AUC of PB ROC curve for determining thyroid dysfunction was 0.944 (95% CI 0.867-1.000). Conclusion PB tests of thyroid indicators has high consistency with venous blood tests, offers sufficient diagnostic efficiency for TD, and is a feasible minimally invasive detection method. Presentation: 6/1/2024

7982 Is there a Connection between Alpha Thalassemia and Thyroid Disorders

Abstract Disclosure: W. Akhter: None. V. Taqi: None. J.L. Gilden: None. IntroductionA number of case reports suggest an association between thalassemia and autoimmune diseases through specific mutations and molecular pathways. An example is thyroid disease in thalassemia patients. Due to factors such as age, ethnicity and treatment protocol differences, the frequency of hypothyroidism in thalassemia patients is a wide range of 4 to 29% based on free T4 and TSH levels. Subclinical hypothyroidism is more common in thalassemia patients as compared to overt hypothyroidism. 90% of morbidity and mortality in B-Thalassemia patients is attributed to iron overload, anemia and hypoxia. Understanding this possible mechanism helps guide treatment and monitoring. Case PresentationWe present the case of a 26-year-old African American with Haitian ethnicity female, who upon routine testing was found to have a very high TSH level of 79.084 uIU/ml (nl=0.550-4.780 uIU/ml) for which 125 mcg of Levothyroxine was started, and then she was referred to the endocrine clinic. Past history was notable for sickle cell trait and alpha thalassemia trait. Patient stated that at age 12, she developed fatigue and low energy and was found to have hyperthyroidism which was treated with RAI ablation. After that, no follow up or lab tests were done until recently. The patient denied symptoms of hypo or hyperthyroidism or enlargement of the thyroid gland. She denied any family history of thyroid disorders. After presenting to the endocrine clinic a few days later, she was diagnosed with postprocedural hypothyroidism and the same dose of levothyroxine was continued. Physical exam was unremarkable and no thyromegaly was appreciated on exam. Labs were notable for decreased Hemoglobin of 11.4 g/dL (nl=12-16 g/dL) and CMP was unremarkable except low glucose of 65 mg/dL (nl=70-99 mg/dL). The patient’s most recent labs after 8 weeks of taking Levothyroxine were notable for TSH of 14.65 uIU/ml (nl=0.550-4.780 uIU/ml) and free T4 of 1 ng/dL (nl= 0.89-1.76 ng/dL) and the patient admitted to having still no thyroid symptoms and a little more energy. ConclusionEndocrinopathies are common complications of thalassemia with hypothyroidism being the second most common endocrine disorder in thalassemia patients after hypogonadism, reported in 5.6-17% of patients. In thalassemia patients, endocrine disorders have to be managed as early as possible. Therefore, it is recommended that an endocrine evaluation be carried out in thalassemia patients at a young age.Monitoring for glucose homeostasis, hypothyroidism and hypoparathyroidism is also warranted. Physicians caring for thalassemia patients should perform routine screening for and treat thyroid dysfunction appropriately. Reference: De Sanctis V, Soliman AT, Canatan, et al.. Thyroid Disorders in Homozygous β-Thalassemia: Mediterr J Hematol Infect Dis. 2019 May 1;11(1):e2019029. doi: 10.4084/MJHID.2019.029. PMID: 31205633; PMCID: PMC6548211. Presentation: 6/2/2024

8242 A Case of Ayme Gripp Syndrome

Abstract Disclosure: P. Jaisinghani: Consulting Fee; Self; Novo Nordisk. J. Pappas: None. We present a 35 year old female with cataracts, generalized seizures and oligodontia, referred to us for hair loss and elevated TSH. For over 10 years, patient had a diffuse hair loss which progressed to a focal patch of hair loss in the setting of prior use of keppra and seborrheic dermatitis. Patient has regular menses, and no symptoms of hyper/hypothyroidism or family history of thyroid disease. Patient established care with dermatology and scalp biopsy noted early androgenetic alopecia. Physical exam was notable for short stature, height 4'11, 98 lbs, BMI 19.8 kg/m², progeric appearance, facial hyperpigmented spot, hair thinning, palpable thyroid R>L. Laboratory evaluation included TSH 6.150 (0.450 - 4.500 uIU/mL), DHEAS 263 (84.8 - 378.0 ug/dL), total testosterone 15 (10 - 55 ng/dL), FSH 6.6 (Follicular phase 3.5 - 12.5 mIU/mL), LH 7.6 (Follicular phase 2.4 - 12.5 mIU/mL), estradiol 83 (Follicular phase 12.5 - 166.0 pg/mL). Thyroid US demonstrated smaller than average size left lobe measuring 2.93 cm x 0.84 cm x 1.36cm vs right lobe measured 4.34 cm x 0.90 cm x 1.62. Labs noted TSH 5.690 (0.450 - 4.500 uIU/mL), establishing subclinical hypothyroidism and negative thyroid antibodies. Clinical genetics evaluation included trio exome sequencing which revealed a de novo pathogenic variant p.(Ser54Leu) (TCG>TTG): c.161 C>T in exon 1 of the MAF gene (NM_005360.4) which establishes the diagnosis of a Ayme- Gripp syndrome (AGS). AGS is characterized by a triad of cataract, sensorineural hearing loss, and characteristic facial features in combination with neurodevelopmental abnormalities. 21 affected individuals from 19 families have been reported with AGS. Clinical features in our case characteristic of AGS included short stature, brachycephaly, midface hypoplasia, long philtrum and premature hair loss. Hypothyroidism was identified in childhood in 3/15 identified individuals who responded to thyroid hormone replacement therapy. For this patient, we will monitor thyroid function tests every 3-6 months and monitor for symptoms of hypothyroidism. Patient has been referred to cardiology and nephrology, and will continue to follow with genetics and dermatology. Our case further establishes the association of hypothyroidism with AGS. Our case demonstrates the value of expanding the differential of endocrinopathies to rare genetic conditions which are currently identifiable by clinically available genomic tests. Presentation: 6/1/2024

6414 Refractory Hyperthyroidism Following COVID-19 Infection

Abstract Disclosure: A.T. Wahba: None. A.A. Shibli-Rahhal: None. A 40-year-old man presented with 2 weeks of palpitations, weight loss, decreased appetite and malaise. The symptoms were preceded by neck pain for 1-2 weeks that improved spontaneously. He was in atrial fibrillation at 126 bpm, but otherwise clinically stable. He had a mildly tender enlarged thyroid with no palpable nodules, and the rest of his exam was negative. A chest CT with IV contrast ruled out pulmonary embolism. His TSH was < 0.01 µIU/mL (N:0.27-4.20), free T4 > 7.77 ng/dL (N: 0.80-1.80) and free T3 of 29.7 (N: 2.6-4.4 pg/ml), obtained prior to contrast administration. TSI antibody was negative and thyroid ultrasound showed diffuse enlargement with heterogeneous echotexture and reduced vascularity on doppler images. Thyroid uptake and scan could not be obtained due to iodinated contrast exposure. The patient’s medical history was notable for nonischemic cardiomyopathy (EF 50%), cardiac arrest with implantable cardiac defibrillator, and paroxysmal atrial fibrillation. He was previously treated with amiodarone for 2 years, and it was stopped 2 months before presentation. Other relevant medical problems included subclinical hypothyroidism diagnosed within the previous year and an uncomplicated acute COVID-19 infection 1 month prior to presentation.Given his cardiac history and high Burch-Wartofsky score, he received PTU 200 mg Q4h, hydrocortisone 100mg Q8h and propranolol for 3 days. As his FT3 level declined to 9.8 pg/ml, he was transitioned to methimazole 40 mg daily, propranolol and prednisone 40 mg daily and discharged with outpatient follow up. The atrial fibrillation worsened again 1 week later, and his FT3 increased to 20.2 with a FT4 > 7.77. He was put back on PTU 200 mg TID, prednisone and propranolol were continued and cholestyramine 2g BID was added. 1 week later, his FT4 and FT3 were unchanged. The tests were performed using a different assay and the results were consistent. Two sessions of plasma exchange (PLEX) did not yield a significant response, so thyroidectomy was eventually performed. Pathology showed morphologic findings consistent with type 2 amiodarone-induced thyrotoxicosis. While pathology showed amiodarone-induced changes, the patient’s hyperthyroidism occurred after a COVID-19 infection and was associated with neck pain, pointing to severe viral thyroiditis. De novo thyroid hormone production has been reported following COVID-19 infection, but the minimal improvement in thyroid hormone levels with thionamide therapy suggests that de novo secretion had little contribution to this patient’s hyperthyroidism. Presentation: 6/3/2024

The P300-ARRDC3 axis participates in maternal subclinical hypothyroidism and is involved in abnormal hepatic insulin sensitivity in adult offspring

Numerous studies have suggested potential associations between maternal subclinical hypothyroidism (SCH) and adverse metabolic outcomes in offspring, however, the underlying mechanism remains unclear. In this study, we generated a maternal SCH mouse model by administering 50 ppm 6-propyl-2-thiouracil (PTU) in the drinking water of pregnant mice until delivery. This model was used to investigate the mechanisms influencing glucose metabolism in offspring. RNA sequencing (RNA-seq) revealed a substantial increase in ARRDC3 expression in the livers of the offspring of the SCH model mice, which may contribute to insulin resistance. Additionally, the phosphorylation levels of key proteins in the insulin signalling pathway, such as protein kinase B (Akt), glycogen synthase kinase 3 beta (GSK-3β), and Forkhead box protein O1 (FoxO1), were correspondingly reduced in the SCH offspring. Moreover, overexpression of ARRDC3 in Hepa1‒6 cells suppressed the Akt/GSK-3β/FoxO1 signalling pathway and increased the expression of glucose-6-phosphatase (G6Pase) and phosphoenolpyruvate carboxykinase (PEPCK), which was consistent with the molecular changes observed in SCH offspring. Our results also indicated that the upregulation of ARRDC3 in SCH offspring may result from increased H3K27 acetylation of the ARRDC3 promoter region, driven by elevated expression of P300. Importantly, adequate L-T4 supplementation during pregnancy improved insulin sensitivity and reversed the molecular alterations in the insulin signalling pathway observed in SCH offspring. In conclusion, exposure to intrauterine SCH resulted in altering the P300-ARRDC3 axis in offspring and impaired insulin sensitivity by disrupting the Akt/GSK-3β/FoxO1 signalling pathway. Timely L-T4 supplementation during pregnancy is an effective strategy to prevent insulin resistance in offspring of SCH mothers. This study elucidates potential molecular mechanisms behind insulin resistance in SCH offspring and suggests novel therapeutic targets for treating metabolic disorders related to maternal SCH.

The Natural Course of Newborns with Transient Congenital Hypothyroidism.

The incidence of congenital hypothyroidism (CH) has increased worldwide over the last decades mainly due to the lowering of screening thresholds, resulting in an increased identification of newborns with transient CH. Several studies reported the prevalence and the predictive parameters of transient CH but reports on the long-term outcome are rare. This study aimed to assess the long-term course of neonates with transient CH. Neonates diagnosed with transient and permanent CH between the years 1998 to 2018 at the Pediatric Endocrine Institute of Ha'Emek Medical Center were enrolled in the study. Data were retrieved retrospectively from medical files. Included in the study were 76 newborns (45M,59%) with transient CH and 53 (25M,47%) with permanent CH. The major cause of transient CH was prematurity (29%) and subclinical hypothyroidism (30%). During retrospective follow-ups of up to 23 years, reinitiation of LT4 therapy was not required apart from four patients with underlying syndromic etiologies. Neurodevelopmental impairment occurred in 16% of children with transient CH compared with 29.4% in the permanent CH group. Transient CH is frequent among preterm infants but is limited to infancy. SCH frequently presents as overt hypothyroidism at birth but in most cases the requirement for LT4 supplemental therapy is limited to the first years of life, suggesting that long-term follow-up of thyroid function tests may be unnecessary for non-syndromic children. The high rate of neurodevelopmental impairment in newborns with transient CH emphasizes the need for neurodevelopmental monitoring in these patients.

The impact of weight reduction following laparoscopic sleeve gastrectomy on thyroid-stimulating hormone level in obese patients with subclinical hypothyroidism: A 3-year retrospective study

The impact of weight reduction following laparoscopic sleeve gastrectomy on thyroid-stimulating hormone level in obese patients with subclinical hypothyroidism: A 3-year retrospective study

Prevalence of abnormal thyroid function test in adults attending primary care setting in the year 2022 in the Kingdom of Bahrain

ABSTRACT Background: Thyroid disease is known to be one of the most common endocrine diseases globally and has serious health implications if left untreated. Objective: This study aimed to gain a better understanding of common thyroid diseases and to explore the associated risk factors in the Kingdom of Bahrain. Methods: A case-control study was carried out after obtaining all thyroid stimulating hormone (TSH) results done in a primary healthcare setting from January 1, 2022 to December 31, 2022 from the Health Information Department. In total, 500 participants were randomly selected from each group: the abnormal thyroid test group (cases) and the normal thyroid test group (controls). Participants were interviewed using a structured list of associated risk factors with the following sections: sociodemographic characteristics, comorbidities, family history of thyroid disease, BMI, previous radiation therapy, and certain medications. Results: The prevalence of abnormal thyroid tests was found to be 11%. Cases were categorized into four groups: hyperthyroidism (26.4%), hypothyroidism (64.6%), hyperthyroidism (4.5%), and subclinical hypothyroidism 13 (4.5%). The results showed significant differences between case and control in the following risk factors: female sex, increasing age, BMI, dyslipidemia, family history of thyroid disease, and previous radiation therapy (P = <0.05). Conclusion: In summary, the high prevalence of abnormal thyroid results highlights the need for an organized national screening program for individuals at average risk for developing thyroid disease.

Effects of iodine contrast media on thyroid function - a prospective study.

When exposed to iodine contrast medium (ICM), thyroid dysfunction may develop, due to excess amounts of iodide. The incidence of contrast-induced thyroid dysfunction has been difficult to interpret, because of the observational and retrospective designs of most previous studies. With the Swedish CArdioPulmonary bioImage Study (SCAPIS), where randomly selected individuals aged 50-65 years, underwent contrast-enhanced coronary CT angiography (CCTA), we were able to prospectively assess the incidence, magnitude and clinical impact of contrast-induced thyroid dysfunction. In 422 individuals, thyroid hormone levels were analysed before and 4-12 weeks after CCTA. Thyroid-related patient-reported outcome questionnaires (ThyPRO) at the time of pre and post CCTA blood samplings were provided by 368 of those individuals. Thyroid peroxidase antibodies (TPOab) were analysed and ultrasound of the thyroid gland was performed to detect any thyroid nodules. There was a small statistically significant effect on thyroid hormone levels but no cases of overt hypo- or hyperthyroidism after ICM. Subclinical hypo- or hyperthyroidism or isolated low/high levels of free thyroxine (fT4) developed in 3.5% of the population with normal hormone levels pre-CCTA, but without any increased thyroid-related symptoms compared to the remaining cohort. Elevated TPOab and being born outside Sweden were risk factors of developing subclinical hypothyroidism. Presence of thyroid nodules was not associated with ICM-induced thyroid dysfunction. The results of this prospective study support the notion that in iodine-sufficient countries, ICM associated thyroid dysfunction is rare, usually mild, self-limiting and oligo/asymptomatic in subjects aged 50-65 years.

TO STUDY THYROID DYSFUNCTION IN PATIENTS WITH METABOLIC SYNDROME

Background: Metabolic syndrome (MetS) is a cluster of risk factors associated with increased cardiovascular disease and diabetes risk. Thyroid dysfunction (TD), especially hypothyroidism, has been observed more frequently in individuals with MetS. However, the relationship between thyroid function and metabolic syndrome components remains debated. This study aimed to explore the prevalence of thyroid dysfunction and its association with metabolic syndrome components in patients. Methods: A cross-sectional study was conducted at Sri Aurobindo Medical College & P.G. Institute, Indore. A total of 120 patients meeting the International Diabetes Federation (IDF) criteria for metabolic syndrome were included. Detailed history, anthropometric measurements, blood pressure recordings, fasting blood sugar, lipid profile, and thyroid assays were performed. Statistical analysis using SPSS22 and Excel was employed to assess thyroid dysfunction prevalence and its correlation with metabolic syndrome components. Results: Among 120 patients with metabolic syndrome, 28% had thyroid dysfunction. Hypothyroidism was predominant, with subclinical hypothyroidism being the most common type. Females and older individuals (>45 years) showed a higher prevalence of thyroid dysfunction. Patients with thyroid dysfunction exhibited altered metabolic syndrome components, including increased waist circumference, decreased HDL-C, elevated blood pressure, fasting glucose, and triglyceride levels. Conclusion: The study highlights a high prevalence of thyroid dysfunction, especially hypothyroidism, among patients with metabolic syndrome. These findings suggest a potential association between thyroid status and metabolic syndrome components. Screening for thyroid dysfunction in individuals with metabolic syndrome could aid in optimizing clinical management strategies. Further research with larger sample sizes and prospective designs is warranted to explore the impact of thyroid dysfunction management on metabolic syndrome outcomes.

Prevalence of Thyroid Dysfunction among Patients with Type II diabetes Mellitus in Tertiary Care Center: A Descriptive Cross-sectional Study

Introduction: Diabetes mellitus (DM) and thyroid dysfunction (TD) are two of the most prevalent endocrine disorders globally. Both conditions have significant effects on metabolism and are known to influence each other. Thyroid hormones play a crucial role in glucose homeostasis by affecting insulin secretion, sensitivity, and glucose metabolism.Conversely, altered glucose metabolism in diabetes can impact thyroid function, leading to a higher prevalence of thyroid disorders in diabetic patients. Understanding this relationship is important for improving the clinical management of patients with Type II DM. However, there is limited data on the prevalence of thyroid dysfunction in diabetic populations within specific regions. Methods: A cross-sectional descriptive study was conducted from February to September 2023 among 209 patients diagnosed with Type II DM at a tertiary care center after obtaining ethical approval from Institutional Review Committee(Reference No: 367 (6-11) E2). Thyroid function was assessed using thyroid-stimulating hormone (TSH), free T3 (FT3), and free T4 (FT4) levels. Thyroid dysfunction was classified into hypothyroidism and hyperthyroidism based on standard clinical and laboratory criteria. Data management involved entry into Microsoft Excel, verification for accuracy, and subsequent analysis using SPSS version 29.Results: The study included 209 patients (61% female, 39% male), with a mean age of 65.87 ± 13.7 years. The prevalence of thyroid disorders was 77(36.8%): 53(25.3%) hypothyroidism,24 (11.4%) hyperthyroidism among patient with type II diabetes mellitus.Conclusions: Our study shows a high prevalence of thyroid disorders, especially subclinical hypothyroidism, in individuals with type 2 diabetes. Poorly controlled blood glucose (HbA1c ≥ 7.5) significantly increases the risk, underscoring the need for routine thyroid screening in T2DM management

Predictive Factors and Prognostic Relevance of Sunitinib-induced Subclinical and Overt Hypothyroidism in Korean Patients with Metastatic Renal Cell Carcinoma

Predictive Factors and Prognostic Relevance of Sunitinib-induced Subclinical and Overt Hypothyroidism in Korean Patients with Metastatic Renal Cell Carcinoma

Features of early remodeling of the left heart in patients with acute myocardial infarction and concomitant hypothyroidism

Objective: to evaluate the features of structural and functional remodeling of the left heart during hospitalization in patients with ST-segment elevation myocardial infarction (STEMI) and concomitant newly diagnosed hypothyroidism. Materials and methods: the study included 133 patients with STEMI aged 40 to 88 years admitted to the Rostov Regional Clinical Hospital. All patients were divided into 3 groups depending on the newly diagnosed hypothyroidism: Group 1 (control) included patients with STEMI without hypothyroidism syndrome (n=57), Group 2A — patients with STEMI and subclinical hypothyroidism (n=42) and Group 2B — patients with STEMI and manifest hypothyroidism (n=34). Patient data, clinical symptoms, information on complications in the acute period of myocardial infarction, echocardiographic examination results were entered into a specially developed questionnaire. Results: patients with STEMI of all groups were found to have increased values of indexed LV ESV and LVM, decreased values ​​of indicators characterizing myocardial contractility, as well as the presence of stage I LVDD. Patients with subclinical hypothyroidism were found to have statistically significantly higher values ​​of the indexed LA volume than patients without hypothyroidism. The peculiarities of structural and functional remodeling of the heart in the presence of overt hypothyroidism include significantly higher linear and volumetric parameters of the LA (ILP and IOLP), a greater decrease in the contractility of the LV myocardium (lower values of SV, SI and IOC), a more pronounced impairment of diastolic properties of the myocardium (lower DT value) compared to the control group. Conclusion: in patients with STEMI and concomitant overt hypothyroidism, more pronounced remodeling of the left heart in conditions of acute myocardial injury (larger size and volume of the LA, more pronounced impairment of systolic and diastolic function of the LV).

Features of atherosclerotic lesions of the coronary arteries in patients with myocardial infarction and concomitant newly diagnosed hypothyroidism

Objective: to assess the incidence of newly diagnosed subclinical and manifest hypothyroidism in patients with ST-segment elevation myocardial infarction (STEMI) and to identify angiographic features of coronary artery lesions in this combined pathology.Materials and methods: in all patients with STEMI, the level of thyroid-stimulating hormone (TSH) was determined, and thyroid function was assessed if the TSH level deviated from the norm. Stage I of the study included 441 patients, stage II included 133 patients with STEMI. Depending on the presence of newly diagnosed hypothyroidism, patients were divided into 3 groups: 1st — patients without hypothyroidism (n = 57), 2A group — with subclinical hypothyroidism (n = 42) and 2B group — with manifest hypothyroidism (n = 34). All patients underwent coronary angiography and percutaneous coronary intervention.Results: newly diagnosed hypothyroidism occurred in 27.44% of patients with STEMI: subclinical — in 19.73%, manifest — in 7.7% of cases. Patients with concomitant overt hypothyroidism had significantly more severe atherosclerotic lesions of the coronary arteries compared to patients without hypothyroidism.Conclusion: a high incidence of newly diagnosed hypothyroidism in patients with STEMI was established (27.44% of cases). Multivessel coronary lesions were recorded more often in patients with overt hypothyroidism than in patients with subclinical hypothyroidism and without hypothyroidism.

Frequency and Determinants of Levothyroxine Therapy Initiation for Veterans with Subclinical Hypothyroidism.

Background/Objectives: There is evidence of overtreatment in patients with subclinical hypothyroidism (SCH). We aimed to identify the proportion of patients treated for SCH and the determinants of thyroid hormone therapy initiation. Methods: We included a random sample of adult Veterans diagnosed with SCH from 1 January 2016 to 31 December 2018 and conducted univariate and multivariable logistic regression to identify factors associated with levothyroxine initiation. Results: Out of 229 Veterans with SCH [90.0% male, 87.2% White, 99.1% non-Hispanic, median age (interquartile range; IQR) 68 (17) years], 27.5% were treated with levothyroxine. The treated group had a higher proportion of White patients (95.2% vs. 84.2%, p = 0.039), a higher thyrotropin level [median (IQR), 6.98 (2.06) mIU/L vs. 6.14 (1.10) mIU/L, p = 0.0002], a higher proportion of patients with thyrotropin level ≥ 10 mIU/L (11.1% vs. 3.0%, p = 0.021), a lower frequency of confirmatory thyroid testing before initiating levothyroxine (49.2% vs. 97.0%, p < 0.0001), and a similar frequency of thyroid autoimmunity testing (3.2% vs. 0.6%, p = 0.18) compared to the untreated group. In a multivariable logistic regression analysis, White race (OR = 4.50, 95% CI 1.19 to 17.08, p = 0.026) and index thyrotropin level [OR = 1.71, 95% CI 1.24 to 2.35, p = 0.001; for every SD increase (1.6 mIU/L)] were associated with higher odds of treatment. Conclusions: Three in 10 Veterans with SCH received levothyroxine, often based on a single abnormal thyroid test without autoimmunity assessment. White race and higher thyrotropin level were linked to increased odds of starting treatment, indicating potential disparities and the influence of SCH severity on decision-making.

Hyperthyroidism and hypothyroidism in patients with autoimmune pancreatitis.

The objective of this study is to clarify the clinical features of thyroid dysfunction observed in patients with autoimmune pancreatitis (AIP). We repeatedly examined thyroid function in 74 patients with type 1 AIP (58 males, 16 females; average onset age of AIP 67 years). Clinical and serological findings in patients with thyroid dysfunction were analyzed. During follow-up, clinical and subclinical hypothyroidism were observed in 3 and 17 patients, respectively. Clinical and subclinical hyperthyroidism were observed in 5 and 1 patients, respectively. One patient showed clinical hyperthyroidism followed by subclinical hypothyroidism. All patients with clinical and subclinical hypothyroidism were asymptomatic and required no medical treatment, whereas four patients with clinical hyperthyroidism were symptomatic and received treatment with thiamazole. Frequent hypothyroidism in AIP, which was previously reported, was confirmed. Moreover, in this study, the association between hyperthyroidism and AIP was demonstrated. Hyperthyroidism in AIP may be more clinically significant than hypothyroidism because patients frequently require medical treatment.

Prevalence of Hypothyroidism in Children with Transfusion Dependent Thalassemia Patient Attending in A Tertiary Care Hospital of Bangladesh

Background: Blood transfusions and iron chelation are standard treatments for β-thalassemia major and Hb E-Beta-Thalassemia. However, repeated transfusions raise body iron levels, leading to secondary hemosiderosis and complications in the heart, endocrine system, and liver. Thyroid dysfunction results from gland infiltration, chronic hypoxia, free radical damage, and iron overload. This study aimed to find out the prevalence of hypothyroidism in transfusion-dependent thalassemic children attending Bangladesh Shishu Hospital &amp; Institute. Methods: A descriptive cross-sectional study was conducted at the Thalassemia Centre, Department of Hematology and Oncology, Bangladesh Shishu Hospital &amp; Institute, from December 2019 to November 2020. The study included 140 children with thalassemia, aged 5 to 16 years, who were receiving blood transfusions. Data were collected using a structured questionnaire with participant consent. Statistical analysis was performed using SPSS version 23.0. Results: In this study, hypothyroidism was observed in 26.2% of patients, with 23.5% having subclinical and 2.9% overt hypothyroidism. In most of the patients (n=85), aged 11-16 years, 58.3% had normal thyroid function, 36.5% had subclinical, and 4.7% had overt hypothyroidism, which was statistically significant (p&lt;0.05). Of the 91 patients with hemoglobin levels below 11.5 g/dL, 85.7% had normal thyroid function, 13.2% had subclinical hypothyroidism, and 1.1% had overt hypothyroidism, also significant (p&lt;0.05). In the group with ferritin levels of 1200-2000 ng/mL, 78.1% had normal thyroid function, 18.8% had subclinical hypothyroidism, and 3.1% had overt hypothyroidism, which was not statistically significant (p&gt;0.05). Conclusion: Subclinical hypothyroidism is commonly seen in thalassemia patients aged 5 to 16 years who undergo regular blood transfusions. Regular physical exams and thyroid function assessments are crucial to detect overt hypothyroidism early. Timely hormone replacement can

Micronutrient homeostasis disturbances in women with gestational diabetes mellitus and subclinical hypothyroidism: effects on pregnancy and outcomes

Aim. To characterize micronutrient homeostasis in women with a combination of gestational diabetes mellitus (GDM) and subclinical hypothyroidism (SCH), and to determine the significance of micronutrient imbalance in complicated pregnancies.Material and Methods. The study analyzed 439 birth histories of patients with GDM and SCH, who underwent plasma micronutrient analysis at 12−13 weeks of gestation. The study examined the patients' anthropometric and medical history data, complications during the current pregnancy, the timing and method of delivery, and newborn conditions. Some of these indicators were compared with previously obtained plasma micronutrient levels (Al, Co, Cu, Fe and others) measured at 12−13 weeks of gestation.Results. The analysis of micronutrient concentrations in plasma at 12−13 weeks of gestation revealed iron deficiency in 250 patients (57%), iodine deficiency in 231 patients (52.6%), cobalt deficiency in 229 patients (52.2%), vitamin B12 deficiency in 285 patients (64.9%), and vitamin D deficiency in 280 patients (63.6%). Iron deficiency was significantly more common in pregnant women with overweight and obesity than in those with normal body weight (χ2 =.14 and 5.32, respectively). The risk of developing iron deficiency also increased with higher body weight (1.81-fold for overweight (95% CI 1.2–2.73) and 2.07-fold for obesity (95% CI 1.11–3.86). Around 50% of patients with threatened preterm birth had cobalt deficiency and 59% of patients with anemia had iron deficiency. Selenium, calcium, and vitamin B12 deficiencies were observed in 55%, 70%, and 73% of patients with preeclampsia (PE), respectively.Conclusion. The observed deficiency of certain micronutrients in specific pregnancy complications suggests that correcting micronutrient levels during pre-conception or early gestation may improve pregnancy outcomes.

A Randomized Clinical Trial Comparing 2 Levothyroxine Regimens During Ramadan Fasting in Thyroidectomized Patients.

For Muslim patients on levothyroxine (L-T4) therapy, the best approach for L-T4 intake during Ramadan fasting remains unclear. We compared 2 practical approaches for L-T4 intake during Ramadan. We randomly assigned 69 patients (21 males, 48 females, median age 44 years) with differentiated thyroid cancer (DTC) who underwent thyroidectomy in the past and are on stable LT4 doses to 2 arms. Arm A (33 patients) ingested their pre-Ramadan L-T4 dose at the evening meal and ate immediately. Arm B (36 patients) increased their pre-Ramadan dose by 25 µg if their regular L-T4 dose was ≤150 µg/day or by 50 µg if their pre-Ramadan dose was >150 µg/day and ate immediately. At the beginning of Ramadan (baseline), the median thyrotropin (TSH) level and the numbers of patients in euthyroidism, subclinical hyperthyroidism (Shyper), or subclinical hypothyroidism (Shypo) were comparable between the 2 arms (P = .69 and P = .65, respectively). At the end of Ramadan, in arm A there were 17 (51.5%), 3 (9.1%), and 13 (39.4%) patients in euthyroidism, Shyper, and Shypo compared with 17 (47.2%), 14 (38.9%), and 5 (13.9%) patients, respectively, in arm B (P = .005). The mean ± SD TSH levels in arms A and B at the end of Ramadan were 5.6 ± 6.0 mU/L and 1.67 ± 2.6 mU/L, respectively (P = .0001). No overt thyroid dysfunction developed but there were more cases of Shypo in arm A and Shyper in arm B. Arm B achieved desirable levels of TSH (normal or slightly suppressed) in 86% of cases and might be a preferable approach, especially for patients who need TSH suppression (eg, DTC).

Proportion and Covariates of Hypothyroidism Among Patients with Metabolic Syndrome Attending in Tertiary Care Hospital

Background: Hypothyroidism in patients with metabolic syndrome is associated with worse outcomes. However, this has not yet been adequately investigated in Bangladeshi people. Objective: To find out the proportion and covariates of hypothyroidism among patients with metabolic syndrome. Materials and methods: A hospital-based cross-sectional study was conducted with 323 patients from the Endocrinology and Allied Medicine Department at BIRDEM General Hospital. Patients with metabolic syndrome but no prior diagnosis of hypothyroidism were included. Detailed history, physical examinations, and thyroid function tests—Thyroid Stimulating Hormone (TSH), Free Thyroxine (FT4), and Anti-Thyroid Peroxidase Antibody (Anti-TPO Ab)—were performed. Subclinical hypothyroidism was defined as TSH &gt;4.12 mIU/L and &lt;10 mIU/L, while overt hypothyroidism was defined as TSH &gt;10 mIU/L. Statistical analyses, including Chi-square tests, ANOVA, Pearson's correlation, and multiple linear regression, were conducted to explore associations between components of metabolic syndrome and thyroid dysfunction. Results: Out of the 323 participants, 62.8% were euthyroid, 28.5% had subclinical hypothyroidism, and 8.7% had overt hypothyroidism. Autoimmune hypothyroidism was confirmed in 31.6% of hypothyroid patients through elevated Anti-TPO Ab levels, a statistically significant finding. Hypothyroidism was significantly more prevalent in females and obese individuals. Significant positive correlations were observed between TSH and waist circumference (r=0.153), systolic blood pressure (r=0.271), and triglycerides (r=0.128), while FT4 showed negative correlations. Multiple linear regression indicated significant associations between waist circumference, fasting plasma glucose, and thyroid dysfunction. Conclusion: It was concluded that a higher proportion of metabolic syndrome cases were suffering from hypothyroidism. This necessitates that all MetS patients be screened for thyroid profile and autoimmune status and managed accordingly.