Subclinical Hyperthyroidism Research Articles

Survey on the prevalence and related factors of thyroid disorders in different iodine intake regions in China in 2015-2017

Objective: To observe the prevalence and related factors of thyroid diseases in different iodine intake areas from 2015 to 2017 after the implementation of national salt iodization policy in China for 20 years. Methods: A cross-sectional survey. Multi-stage stratified cluster random sampling was used to randomly select subjects meeting the inclusion criteria from 31 provinces, municipalities and autonomous regions in China from January 2015 to December 2017, and stratified by age and sex. The survey included questionnaire, physical examination and thyroid ultrasonography. At the same time, the concentrations of serum thyrotropin, thyroxine, thyroid peroxidase antibody (TPOAb), thyroid globulin antibody (TgAb) and urinary iodine were measured.To determine whether the patient has a certain thyroid disease according to the above results. Different iodine nutrition areas were defined according to urinary iodine concentration, and the influence of iodine nutrition status in different iodine intake areas on thyroid diseases was analyzed. Results: A total of 78 470 adults were included, including 39 893 in the area of moderate iodine, 28 779 in the area of adequate iodine, and 9 798 in the area of excessive iodine.In the above three regions, the prevalence of subclinical hyperthyroidism (hyperthyroidism) was 0.45% (95%CI: 0.39%-0.52%), 0.50%(95%CI: 0.35%-0.70%)and 0.27%(95%CI: 0.20%-0.35%), respectively, with statistical significance(χ²=6.92, P=0.003). The prevalence of subclinical hypothyroidism (hypothyroidism) was 11.36% (95%CI: 10.73%-12.02%), 13.57%(95%CI: 11.70%-15.69%) and 16.18%(95%CI: 12.41%-20.82%), respectively, with statistical significance(χ²=5.08, P=0.009). The prevalence rates of Graves' disease, TPOAb, goiter and thyroid nodule among the three regions were statistically significant (all P<0.05). There were no significant differences in the prevalence of clinical hyperthyroidism and clinical hypothyroidism and the positive rate of TgAb among the three regions (all P>0.05). Multivariate logistic regression model analysis showed that excess iodine was a risk factor for subclinical hypothyroidism (OR=1.24, 95%CI: 1.06-1.44), and a protective factor for thyroid nodules (OR=0.73, 95%CI: 0.57-0.94). Iodine overdose was a risk factor for subclinical hypothyroidism (OR=1.47, 95%CI: 1.08-2.01), while it was a protective factor for subclinical hyperthyroidism (OR=0.56, 95%CI: 0.41-0.77), and TPOAb positive (OR=0.93, 95%CI: 0.87-0.99), goiter (OR=0.33, 95%CI: 0.17-0.66) and thyroid nodule (OR=0.77, 95%CI: 0.61-0.97). Conclusions: There are significant differences in the prevalence of subclinical hyperthyroidism, subclinical hypothyroidism, positive TPOAb, thyroid nodule and goiter in different iodine intake regions. Different iodine intake levels have an effect on the incidence of thyroid diseases.

Clinical characteristics and risk factors of programmed death-1 inhibitors associated with thyroid gland injury

Objective: To investigate the clinical characteristics and related risk factors of thyroid gland injury (TGI) in patients with a malignant tumor treated with a programmed death-1 (PD-1) inhibitor. Methods: A Retrospective case-control study. Data from 198 patients with a malignant tumor who received treatment with a PD-1 inhibitor in Chinese PLA General Hospital from October 2019 to October 2021 were collected and analyzed retrospectively. According to the TGI incurred after receiving treatment with a PD-1 inhibitor, patients were divided into a thyroid gland normal (TGN) group and TGI group. The prevalence, type, time of occurrence, and outcome of TGI were analyzed. The risk factors that may contribute to TGI were analyzed further by logistic regression. Results: TGI prevalence was 29.8% (59/198 cases) after treatment with a PD-1 inhibitor. There were significant differences with respect to previous radiotherapy and targeted therapy between the TGN group and TGI group (P<0.01 for both), but there were no significant differences with regard to sex, age, tumor type, previous surgery, previous chemotherapy, tumor metastasis, or type of PD-1 inhibitor (P>0.05 for all). Patients in the TGI group included those with subclinical hypothyroidism (32.2%, n=19), hypothyroidism (27.1%, n=16), thyrotoxicosis (23.7%, n=14), subclinical thyrotoxicosis (10.2%, n=6), and thyroiditis with normal thyroid function (6.8%, n=4), and the median time of occurrence (months) was 3.00, 3.00, 1.50, 1.50, and 0.80 after treatment with a PD-1 inhibitor, respectively. Among 20 patients who presented initially with thyrotoxicosis or subclinical thyrotoxicosis, 12 cases developed hypothyroidism or subclinical hypothyroidism subsequently. Logistic regression analysis suggested that previous radiotherapy (OR=3.737, 95%CI 1.390-10.046), targeted therapy (OR=3.763, 95%CI 1.553-9.117), thyroglobulin antibodies at baseline (OR=12.082, 95%CI 1.199-121.775), and thyroid-peroxidase antibodies at baseline (OR=10.874, 95%CI 1.010-117.047) were risk factors associated with the TGI caused by treatment with a PD-1 inhibitor. Conclusions: After treatment with a PD-1 inhibitor, TGI prevalence was high, especially in those with hypothyroidism or subclinical hypothyroidism. Some patients had a transition from thyrotoxicosis to hypothyroidism. Patients who underwent radiotherapy previously, had targeted therapy, or were thyroid autoantibody-positive at baseline may carry an increased risk of TGI following treatment with a PD-1 inhibitor.

Thyroid dysfunction as a long-term post-COVID-19 complication in mild-to-moderate COVID-19

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), may lead to thyroid disorders, including both thyrotoxicosis and suppression of thyroid function. The aim of the present study was to assess the post-COVID-19 effects on thyroid function in patients without history of thyroid disease after complete recovery from mild-to-moderate COVID-19. Thyroid function tests [thyroid-stimulating hormone (TSH), free thyroxine (fT4), antithyroid antibodies] were performed on 113 patients (median age of 43.0 years; 31.0% male) two months after initial SARS-CoV-2 infection. TSH and fT4 were determined again one month later in this observational, prospective study. Thyroid dysfunction was registered in 61.1% of the patients (78.3% subclinical hypothyroidism, 13% subclinical hyperthyroidism and 8.7% overt hypothyroidism) two months after COVID-19. Moderate rather than mild manifestation of COVID-19 was significantly associated with a higher risk of thyroid dysfunction (OR 5.33; 95% CI: 1.70–16.69, p = 0.002), presence of thyroglobulin antibodies and need for levothyroxine therapy. At the follow-up, the subclinical hypothyroidism persisted in 28.3% of the subjects. Moreover, the TSH level was significantly reduced in comparison to the second month after the initial COVID-19 infection in all the patients (p < 0.001), but not in those with subclinical hypothyroidism and without hormone replacement therapy. Our findings indicate that COVID-19 could have long-term, negative effects on thyroid function. Therefore, thyroid function testing should be included in the follow-up algorithm of COVID-19 survivors.

Neuropsychiatric Manifestations of Thyroid Diseases.

Thyroid disorders are known to cause neuropsychiatric manifestations. Variousneuropsychiatric manifestations are depression, dementia, mania, and autoimmune Hashimoto encephalopathy. Numerous investigations carried out in the previous 50-60 years have been evaluated critically.The pathophysiology of neuropsychiatric symptoms of thyroid diseases is described in the current studyand its link with autoimmune Hashimoto encephalopathy is also discussed. Furthermore, this paper also describes the association between thyroid-stimulating hormones and cognitive impairment. Hypothyroidism is associated with depression and mania, and hyperthyroidism is linked with dementia and mania. The association between Graves' disease and various mental disorders such as depressive and anxiety disorders is also discussed. The aim of this study is to review the relationship between various neuropsychiatric disorders and thyroid diseases. A literature search from the PubMed database to find various neuropsychiatric manifestations of thyroid disorders in the adult population was conducted. According to the review of the studies, cognitive impairment can result from thyroid disease. It has not been possible to demonstrate how hyperthyroidism can hasten the process of developing dementia. However, subclinical hyperthyroidism, thyroid-stimulating hormone (TSH) levels below the normal range, and high free thyroxine (T4) levels all raise the risk of dementia in the elderly. Additionally, the potential mechanisms underlying this associationhave been examined. A quick summary of the research on mania as a clinical symptom of hypothyroidism and its likely causes and pathogenesis is also reviewed. There is no dearth of evidence that describes variousneuropsychiatric manifestation in thyroid disorders.

Impact of Thyroid Function on the Prevalence and Mortality of Metabolic Dysfunction-Associated Fatty Liver Disease.

Thyroid function variation within the thyroxine reference range has negative metabolic effects. Metabolic dysfunction-associated fatty liver disease (MAFLD) is a recently proposed definition. We aim to explore the effects of thyroid function status on prevalence and mortality of MAFLD. Data of 10 666 participants from the Third National Health and Nutrition Examination Survey (NHANES III) were used. MAFLD was diagnosed based on the new definition. Thyroid function variation within the thyroxine reference range was defined based on thyroid-stimulating hormone (TSH) levels: subclinical hyperthyroidism, <0.39 mIU/L; strict-normal thyroid function, 0.39-2.5 mIU/L; and low thyroid function, >2.5 mIU/L, which comprised low-normal thyroid function (2.5-4.5 mIU/L) and subclinical hypothyroidism (> 4.5 mIU/L). Logistic and Cox regression were used in multivariate analysis. Low thyroid function is independently associated with MAFLD (odds ratio: 1.27). Compared with strict-normal thyroid function, subclinical hypothyroidism was significantly associated with increased risk for all-cause and cardiovascular mortality in the total population (hazard ratio [HR] for all-cause: 1.23; cardiovascular: 1.65) and MAFLD population (HR for all-cause: 1.32; cardiovascular: 1.99); meanwhile, in the low-normal thyroid function group, an increasing trend in mortality risk was observed. Furthermore, low thyroid function also showed significant negative impact on mortality in the total and MAFLD population. Among thyroid function spectrum, mild subclinical hypothyroidism showed the highest HRs on mortality. Low thyroid function is independent risk factor of MAFLD and is associated with increased risk for all-cause and cardiovascular mortality in the MAFLD population. Reevaluation of TSH reference range should be considered.

Study of thyroid dysfunction in people living with HIV in Nepalese population undergoing antiretroviral therapy: a cross-sectional study.

Thyroid dysfunction is one of the most common endocrine disorders in people living with HIV (PLHIV). The abnormality in thyroid function has been linked with the adverse effects of prolonged antiretroviral therapy (ART) in PLHIV, but its prevalence remains obscure. The present study aimed to determine the prevalence of impaired thyroid function and its relationship to ART duration in Nepalese people living with HIV. This cross-sectional clinical laboratory based study was conducted at SRL Diagnostics Nepal, Pvt. Ltd. from October 2021 to May 2022. Two hundred and three HIV-seropositive patients enrolled at Tribhuvan University Teaching Hospital (TUTH) in Kathmandu, Nepal were examined for their thyroid function test (TFT) by analyzing the serum T3, T4, and TSH concentrations using a fully automated COBAS e411 analyzer (Roche Diagnostics, USA) based on the electrochemiluminescence assay (ECLIA). Out of 203 PLHIV, 22 (10.83%) had a thyroid disorder, with subclinical hypothyroidism (n = 16, 72.73%) being the most common, followed by subclinical hyperthyroidism (n = 3, 13.63%). Thyroid dysfunction had no significant correlation with HIV/ART duration (p = 0.304) and sex (p = 0.419), whereas, the risk of thyroid dysfunction was induced with the rise in the age of the PLHIV (p = 0.002, ϕ = 0.274). There were no significant differences in the mean serum T3, T4 and TSH values among different sexes and the HIV/ART duration, however a significant difference in the mean values of TSH (F (3, 199) = 3.231, p = 0.023) and T3 (F (3, 199) = 4.587, p = 0.004) among the different age-groups were shown. The mean T3 values also indicated a gradual decrease with increasing age. The study revealed subclinical hypothyroidism as the prevailing thyroid disorder associated with PLHIV. The risk of thyroid dysfunction in PLHIV was neither gender specific nor being attributed by the ART duration in Nepalese population; however, elderly PLHIV were highly susceptible to the risk of thyroid disorder.

Estimation of Prevalence and Patterns of Thyroid Dysfunction in a Tertiary Care Centre in Uttarakhand, India: A Cross-sectional Study

Introduction: Thyroid dysfunction is a common endocrine disorder, defined as the altered serum Thyroid Stimulating Hormone (TSH) levels with normal or altered FT3 and FT4 (triiodothyronine and thyroxine) levels. The spectrum of thyroid disorders includes hypothyroidism, hyperthyroidism, goiter/ iodine deficiency disorders, autoimmune thyroiditis, thyroid cancer, as well as subclinical hypothyroidism or hyperthyroidism. However, further research is required on the spectrum of thyroid disorders, apart from goiter/iodine deficiency disorders in the study population mentioned. Aim: To investigate the prevalence and patterns of thyroid disorders in the clinical biochemistry laboratory of a tertiary care hospital in the hilly region of Uttarakhand, India. Materials and Methods: Present cross-sectional study was conducted in the clinical biochemistry laboratory of Veer Chandra Singh Garhwali (VCSG) Govt. Institute of Medical Science and Research Centre, Srinagar Garhwal, Uttarakhand, India. The study population consisted of 950 subjects who underwent Thyroid Function Test (TFT) panel investigation from January 1, 2018 to December 31, 2020. The collected data were analysed using descriptive statistical tools (mean, frequency, percentage) and correlation analysis of thyroid disorder with age and gender using Spearman’s rank correlation test. Results: Among 950 TFT panel reports, thyroid dysfunction was prevalent in 386 (40.63%) patients, of which 307 (79.53%) were females and 79 (20.47%) were males. The mean age±SD of the 386 patients with thyroid dysfunction was 32.24±8.77 years. Among these 386 thyroid dysfunction patients, the majority, 264 (68.39%) were in the 19-39 years age group. A very weak statistical correlation was observed between thyroid dysfunction with age and with gender among the 386 patients. Out of the total number of patients (950), 156 patients had euthyroid hyperthyroxinaemia (16.42%), 101 had subclinical hypothyroidism (10.63%), 74 had euthyroid sick syndrome (7.78%), 42 had subclinical hyperthyroidism (4.42%), 10 had primary (overt) hypothyroidism (1.05%), one had primary (overt) hyperthyroidism (0.11%), and two had secondary hyperthyroidism (0.21%). Conclusion: The prevalence of thyroid dysfunction in the present study was high, with a greater proportion in females and the 19- 39 years age group. The most common disorders observed were euthyroid hyperthyroxinaemia, subclinical hypothyroidism, and euthyroid sick syndrome.

Thyroid function screening and follow-up of children with abdominal distension in Nanjing, China: a cross-sectional study

ObjectiveTo describe the thyroid function test among children with abdominal distention and to follow up the treatment received by children with abnormal thyroid function.DesignCross-sectional study.Setting and participantsA total of 1089...

A STUDY ON THYROID DYSFUNCTION IN ELDERLY TYPE 2 DIABETES MELLITUS

Introduction: Type 2 diabetes mellitus (T2DM) and thyroid dysfunction (TD) are common endocrine disorders usually encountered in clinical practice. Diabetes and thyroid disorders have been shown to mutually inuence each other, and association between both conditions has long been reported. Aims: To evaluate the thyroid dysfunction in elderly type 2 diabetes mellitus. Materials and Methods: This cross sectional, observational and hospital-based study was conducted in the Dept. of General Medicine [both OPD and IPD], Midnapore Medical College &amp; Hospital, Paschim Medinipur, West Bengal from March 2020 to February 2021. Total 110 patients were present in this study. Result: Our study showed that in Clinical hyperthyroid, 3(100.0%) patients had Type 2 Diabetes Mellitus. In Clinical hypothyroid, 12(100.0%) patients had T2Diabetes Mellitus. In Euthyroid, 82(100.0%) patients had Type 2 Diabetes Mellitus. In Subclinical Hyper thyroid, 2(100.0%) patients had Type2 Diabetes Mellitus. In Subclinical hypothyroid, 11(100.0%) patients had Type 2 Diabetes Mellitus. Conclusion: Early detection of thyroid dysfunction in patients with type 2 diabetes mellitus should be performed routinely, given the high rate of newly diagnosed cases, and increased cardiovascular risk associated with undiagnosed thyroid dysfunction

Mendelian randomization study of thyroid function and anti-Müllerian hormone levels.

Although previous studies have reported an association between thyroid function and anti-Müllerian hormone (AMH) levels, which is considered a reliable marker of ovarian reserve, the causal relationship between them remains uncertain. This study aims to investigate whether thyrotropin (TSH), free thyroxine (fT4), hypo- and hyperthyroidism are causally linked to AMH levels. We obtained summary statistics from three sources: the ThyroidOmics Consortium (N = 54,288), HUNT + MGI + ThyroidOmics meta-analysis (N = 119,715), and the most recent AMH genome-wide association meta-analysis (N = 7,049). Two-sample MR analyses were conducted using instrumental variables representing TSH and fT4 levels within the normal range. Additionally, we conducted secondary analyses to explore the effects of hypo- and hyperthyroidism. Subgroup analyses for TSH were also performed. MR analyses did not show any causality relationship between thyroid function and AMH levels, using normal range TSH, normal range fT4, subclinical hypothyroidism, subclinical hyperthyroidism and overt hypothyroidism as exposure, respectively. In addition, neither full range TSH nor TSH with individuals <50 years old was causally associated with AMH levels. MR sensitivity analyses guaranteed the robustness of all MR results, except for the association between fT4 and AMH in the no-DIO1+DIO2 group. Our findings suggest that there was no causal association between genetically predicted thyroid function and AMH levels in the European population.

Challenges in Thyroid Function Testing: Interferences and Clinical Implications

In recent decades, significant advancements have been made in the methodologies used for evaluating thyroid dysfunctions. These advancements include the development of radioimmunoassays, immunometric assays, and liquid chromatography coupled with mass spectrometry. The main thyroid function tests include thyroid-stimulating hormone (TSH) and the measurement of triiodothyronine (T3) and thyroxine (T4), including their total and free fractions. Over time, different generations of TSH tests have been developed, starting from radioimmunoassays to immunometric assays, and more recently, tests utilizing fluorophores and chemiluminescent molecules. The third-generation tests are currently the most widely used due to their high sensitivity and specificity. Thyroid-stimulating hormone is preferred as the initial test for evaluating thyroid function since it has a log-linear relationship with free T4 levels, enabling the identification of subclinical hypothyroidism and subclinical hyperthyroidism. The reference range for normal TSH levels is typically between 0.45 and 4.5 mIU/L. However, there can be variations in TSH levels based on factors such as sex, age, and ethnicity. Specific reference values may be required for certain populations, such as the elderly, pregnancy, and neonates. In the elderly, an increase in TSH levels is expected. In the neonatal period, TSH levels are high after birth and take a few weeks to normalize. During pregnancy, various physiological changes occur, leading to alterations in thyroid hormones to meet fetal demands. Laboratory interferences in thyroid hormone assays must be considered to ensure accurate results. Biotin interference can lead to falsely low TSH and falsely high free T3 and T4 levels. Macro-thyrotropin can cause elevated TSH levels with normal thyroid hormone levels. Heterophilic antibodies can also cause false results. Additionally, the evaluation of autoantibodies and markers used in thyroid cancer follow-up needs special attention. Patients experiencing conditions like trauma, particularly in severe cases, may undergo changes in thyroid hormone levels, even without having a specific thyroid disease, which is called low triiodothyronine syndrome. In conclusion, it is essential to be aware of potential laboratory interferences and consider individual variations to ensure accurate interpretation and appropriate management of patients.

Coagulation Profile in Patients with Autoimmune Thyroiditis: A Cross-sectional Exploratory Study

Abstract Background: The association between the hemostatic system and thyroid diseases is a subject of investigation that can shed light on various abnormalities ranging from subclinical laboratory findings to thromboembolic events. Aim: The aim of this study was to evaluate the potential association between various thyroid disorders and coagulation profiles in patients with no apparent bleeding abnormalities. Materials and Methods: An analytical case–control study was carried out between April 2020 and November 2021. Adults presenting with symptoms suggestive of thyroid dysfunction/palpable goiter without any apparent bleeding disorder were included in the study. Thyroid function tests were categorized as euthyroid, hyperthyroid, and hypothyroid. Antithyroid antibodies, prothrombin time, activated partial thromboplastin time, fibrinogen, factor VIII, and D-dimer were assessed. Comparison of cases and controls and between various subgroups of cases was carried out by Student’ t-test and P ≤ 0.05 was considered significant. Results: We recruited 20 controls and 46 cases, including 18 with overt hypothyroidism, 13 with overt hyperthyroidism, 3 with subclinical hyperthyroidism, and 12 with subclinical hypothyroidism. On comparison with controls, those with overt hypothyroidism showed a hypocoagulable state with decreased fibrinogen, factor VIII, and raised D-dimer values. The converse was true in patients with hyperthyroidism and subclinical hypothyroidism, both, showing a hypercoagulable state. Only factor VIII and fibrinogen values showed statistically significant differences (P ≤ 0.05 for both) between the subgroups of cases and between those who were antibody-positive versus negative. Conclusion: Our findings support the assertion that there is a deranged coagulation profile in autoimmune thyroiditis.

Prevalence of Thyroid Disorders in and around Nalgonda District, Telangana, India: A Cross-sectional Study

Introduction: Among the endocrine disorders, thyroid disorders are the most common. Long term and excessive intake of fluoride plays a significant role in the development of thyroid disorders. Nalgonda is one of the highly drought-prone districts in Southern India and its groundwater has 10 to 15 parts per million (ppm) of fluoride in contrast to a maximum permitted level of just 1.5 ppm. The entire Nalgonda division is under the threat of fluorosis due to high concentration of fluoride in the drinking water. Aim: To assess the prevalence of thyroid disorders in and around areas of Nalgonda district, Telangana, India. Materials and Methods: A cross-sectional study was conducted in Department of Biochemistry, Government Medical College, Nalgonda, Telangana, India, from December 2021 to May 2022. Total 391 subjects attending Outpatient Department (OPD) of General Medicine, Nalgonda were included in the study. Samples were analysed for thyroid function tests (total T3,T4, thyroid stimulating hormone) by chemiluminiscence immuno assay method in an Abbott architect ci4100 automated analyser. Statistical analysis was done by using Microsoft Excel spreadsheets and results were expressed as prevalence percentages, mean±Standard Deviation (SD). Results: In the present study, the mean age was 39.5±20.506 years. Out of the total participants, 273 (69.8%) subjects were found to be euthyroid and 118 (30.2%) had thyroid disorders. Among 30.2% subjects with thyroid disorders, 32 (8.2%) were hypothyroid, 19 (4.9%) were hyperthyroid, 54 (13.8%) were having subclinical hypothyroidism, 13 (3.3%) were having subclinical hyperthyroidism. The prevalence of thyroid disorders was higher in females compared with males, with the ratio of 3:1 and females contributing to major disease burden. Conclusion: According to this study, prevalence of thyroid disorders was 30.2% with more disease burden in females. Subclinical hypothyroidism contributes to the major disease burden.

CARDIOVASCULAR CHANGES IN SUBCLINICAL HYPOTHYROIDISM: DESCRIPTIVE OBSERVATIONAL STUDY

Thyroid disorders are the most common endocrine disorders in India. Reduced production of thyroid hormone is central feature of clinical state termed as “hypothyroidism”. Iodine deciency remains a common cause of hypothyroidism worldwide. In areas of iodine sufciency, autoimmune disease (Hashimoto's thyroiditis) and iatrogenic causes (treatment of hyperthyroidism) are most common. By denition, subclinical hypothyroidism refers to biochemical evidence of thyroid hormone deciency in patients who have few or no apparent clinical features of hypothyroidism. Subclinical Hypothyroidism is an asymptomatic state in which reduction in thyroid activity is compensated by elevated thyroid stimulating hormone to maintain euthyroid state. Evidence seems to indicate subclinical hypothyroidism is quite prevalent in presumably normal population. Subclinical hypothyroidism is found in 6–8% of women (10% over the age of 60) and 3% of men8. Prevalence increases with age. Methods- This was an observational study done in medical college and hospital. The study was carried out in the duration of 2 years. All OPD and IPD patients of Hospital, diagnosed with subclinical hypothyroidism, during this period, who fullled the inclusion criteria, were included in this study. This study included 54 newly diagnosed patients with subclinical hypothyroidism attending Hospital. Results- In this study maximum patients belong to age group ranging from 18-30 (33.33%). Next to it is age group involving 31-40 (31.48%). While least number of patients comes in age group ranging from 61-70 (9.26%) . Female (74.07%) preponderance compared to males (25.93%). With male having (25.93%). Male to Female ratio is 1:3. Showing female predominance in hypothyroidism. Conclusion- Quite a signicant number of patients were in the prehypertension group. Various life style modications can be advised to prevent them from going to stage I hypertension. Skin changes, Facial pufness, Hoarseness of Voice, cold intolerance, limbs swelling and weight gain these are the symptoms in decreasing order in patients with subclinical hyperthyroidism

A study of thyroid function in polycystic ovary syndrome

ABSTRACT Background and Objectives: Polycystic ovary syndrome (PCOS) is a complex endocrine disorder of multifactorial etiology. PCOS is associated with thyroid dysfunctions ranging from subclinical hypothyroidism, autoimmune thyroiditis, hyperthyroidism, and multinodular goiter. This study evaluated thyroid function in patients with PCOS. Methods: This comparative case-control study was done among 186 patients attending the outpatient services of a tertiary care hospital. Patients aged between 18 and 30 years were evaluated; 93 candidates with PCOS were diagnosed using the Rotterdam 2003 criteria and 93 candidates without symptoms or signs of PCOS were selected as controls. Details of symptoms and clinical examination were obtained and their serum thyroid-stimulating hormone and serum-free thyroxine were estimated. Data were statistically analyzed for differences in clinical profile and thyroid function which were compared among the groups. Results: The mean age of the participants was 23.65 and 24.83 years in the case and control groups, respectively. The most common features in the PCOS group were hyperandrogenism (79, 85.9%) and oligomenorrhea (66, 71.7%). The mean body mass index in the PCOS group (23.76 kg/m2) was found to be significantly higher as compared to the controls. Thirty-three (34.4%) patients with PCOS were found to have thyroid dysfunction as compared to 7 (7.5%) in the control group. Among PCOS patients, hypothyroidism was more common than subclinical hypothyroidism. Conclusion: The occurrence of hypothyroidism and subclinical hypothyroidism was found to be higher in patients with PCOS. Hypothyroidism was more frequent among patients in the PCOS group than in the control group.

CORRELATION OF SERUM ELECTROLYTES IN PATIENTS WITH THYROID DYSFUNCTION

Background: The thyroid hormone is a central regulator of body functions; disorder of thyroid functions is considered to cause electrolytic disorders. Thus the main objective of this study is to assess the correlation of thyroid dysfunction with serum electrolyte levels. Methods: In this prospective cross-sectional study,100 patients who attended Manipal Teaching Hospital having thyroid hormones disarrangement were included. Estimation of serum electrolytes were also done in those patients. Patients with subclinical hypothyroidism and subclinical hyperthyroidism were excluded. Thyroid hormones were estimated by electrochemiluminiscence immunoassay (eCLIA) and Serum sodium and potassium was estimated by ion selective electrode (ISE) method. Data was entered and analyzed using SPSS 23 by Spearman’s correlation test and Chi square test. A p-value of &lt; 0.05 was considered as statistical significance. Results: The 75% of total patients were found to be having hypothyroidism and 25% to have hyperthyroidism. Spearman’s correlation coefficient for Na+ and K+ vs fT3, fT4 showed positive correlation (p-value&lt;0.001) and Na+ and K+ vs TSH showed negative correlation. There was significant association between Na+ and thyroid hormones (p-value&lt;0.001) but no association between K+ and thyroid hormones. (p-value&gt;0.001). Conclusions: The current study reveals that decrease in thyroid hormones may lead to hyponatremia. Knowledge of this significant association will be worthwhile value for clinicians, to manage their patients optimally.

Risk of carotid plaques according to triglyceride-glucose index stratified by thyroid function: A cross-sectional study.

Recent studies have indicated that the triglyceride-glucose (TyG) index or subclinical thyroid dysfunction is associated with carotid plaques, a predictor of cardiovascular disease risk. However, evidence for this association is limited and inconsistent. This study aimed to evaluate the risk of carotid plaques according to TyG index and thyroid function status in the general population. A total of 2,931 individuals who underwent carotid ultrasound as part of a comprehensive health examination at the Health Promotion Center of Soonchunhyang University Hospital were retrospectively reviewed. Based on the TyG index and thyroid function status, the participants were divided into six groups: LoTyG-SHyper (low TyG index with subclinical hyperthyroidism), LoTyG-Eu (low TyG index with euthyroidism), LoTyG-SHypo (low TyG index with subclinical hypothyroidism), HiTyG-SHyper (high TyG index with subclinical hyperthyroidism), HiTyG-Eu (high TyG index with euthyroidism), and HiTyG-SHypo (high TyG index with subclinical hypothyroidism). A multivariate logistic regression analysis was conducted to determine the risk of carotid plaques. The proportion of participants with significant carotid plaques was significantly different among the six groups (p<0.001, p for trend<0.001). The odds ratio (OR) and 95% confidence interval (CI) for significant carotid plaques were significantly higher in the HiTyG-SHypo group than in the LoTyG-Eu group, even after adjusting for confounding variables including sex, age, smoking, obesity, hypertension and diabetes mellitus (OR 1.506, 95% CI 1.045-2.170, p = 0.028). The OR of significant carotid plaques was higher in the HiTyG-Eu group than in the LoTyG-Eu group; however no associations were observed after additional adjustment for confounding variables. The TyG index and thyroid function status are important predictors of the risk of carotid plaques in healthy individuals. Early evaluation of carotid plaques may be necessary for subjects with high insulin resistance and subclinical hypothyroidism.

The effect of subclinic thyroid pathologies on erythropoietine dose in hemodialysis patients.

The effect of subclinical thyroid pathologies on erythropoietin (EPO) treatment has not been well defined. The aim of the study is to compare the frequency and dose of EPO administration in patients with subclinical thyroid pathology and euthyroid hemodialysis patients. A cross-sectional and retrospective study was conducted with 210 patients. Special conditions were excluded, a total of 191 patients were included. Patients were divided into three groups. The incidences of subclinical hypothyroidism, subclinical hyperthyroidism and euthyroidism were 10.5%, 3.1%, and 86.4%, respectively. Statistically significant difference was found between subclinical hypothyroid and euthyroid patients in terms of the number of patients using EPO (p=0.0207), monthly total EPO doses (p=0.003), and total monthly EPO doses per weight (p=0.001). The EPO dose required to achieve similar hemoglobin levels in hemodialysis patients was significantly higher in subclinical hypothyroid patients than in euthyroid patients.

Anomalies cardiaques associées à l'hyperthyroïdie : étude clinique, structurelle et rythmique

IntroductionThe prevalence and nature of cardiac complications associated with hyperthyroidism vary considerably in the literature depending on the population studied and the means of investigation used to detect them. The aim of this study was to determine the structural, functional, and rhythmic cardiac abnormalities associated with hyperthyroidism and to identify their risk factors. MethodsIt is a cross-sectional study conducted in thirty adult patients with overt or subclinical hyperthyroidism. Each patient underwent a clinical cardiovascular examination, a cardiac Doppler ultrasound, a pulmonary ultrasound and a 24-hours rhythm holter. The diagnosis of cardiothyreosis (thyrotoxic heart disease) was retained if an arrhythmia, heart failure (HF) and/or pulmonary arterial hypertension (PAH) were noted following the investigations carried out. ResultsThe mean age of the patients was 44.8 ± 14.4 years. The sex ratio (M/F) was 0.3. Five patients (17%) had subclinical hyperthyroidism and 25 (83%) had overt hyperthyroidism. Thirteen patients (43%) had cardiothyreosis. It consisted of a rhythm disorder in three patients (10%), PAH in twelve patients (40%) and HF in eight patients (27%). An age over 50 years and toxic nodular etiology were associated with atrial fibrillation (AF), p = 0.041 and p = 0.004 respectively. Tachycardia and a higher number of atrial extrasystoles were associated with HF, p = 0.039 and p = 0.007 respectively. A lower TSH, tachycardia and a higher number of atrial extrasystoles were associated with the presence of PAH, p = 0.004, p = 0.011 and p = 0.007 respectively. ConclusionCardiac complications should be sought in all patients with hyperthyroidism, especially in elderly and tachycardic patients. Specialized investigations such as echocardiography or 24 hours rhythmic holter should be requested in these cases.

Evaluation of Adrenal Reserve in Patients with Differentiated Thyroid Cancer Receiving Thyroid Hormone Suppression Therapy- case-control Comparative Study

ABSTRACT Background Patients with differentiated thyroid cancer (DTC) are exposed to subclinical exogenous hyperthyroidism for the suppression of thyroid-stimulating hormone (TSH). In this study, we aimed to evaluate the adrenal reserve in DTC patients receiving suppression therapy. Materials and Methods The study included 55 DTC patients on suppression therapy and 32 healthy volunteers. Basal serum cortisol of all participants and adrenocorticotropic hormone (ACTH) of the patient group were measured. A standard-dose ACTH test (0.25 mg) was performed in patients with a basal cortisol <14.5 mcg/dL. Results In the patient group, TSH was lower, free thyroxine (fT4) was higher, and free triiodothyronine (fT3) was similar to those of the control group (p < .01, p < .01, p = .140, respectively). The serum cortisol of the patient group was significantly lower than the control group (12.14 ± 5.12 mcg/dL vs 18.00 ± 5.56 mcg/dL, p < .001). A total of 34 (61.8%) patients with DTC had a basal cortisol <14.5 mcg/dL. Prolonged TSH suppression (≥5 years vs <5 years) was associated with lower basal cortisol (7.46 ± 2.63 mcg/dL vs 9.48 ± 2.65 mcg/dL, p = .022). The ACTH stimulation test showed that 2 (5.8%) patients had a cortisol response <18 mcg/dL. The rate of adrenal insufficiency was 3.6% in DTC patients. A moderate negative correlation was found between ACTH and fT3 of patients with low basal cortisol (r = −0.358, p = .038) Conclusion Patients with DTC receiving TSH suppression therapy are at risk for adrenal insufficiency. The duration and severity of suppression might increase this possibility. Dynamic testing with synthetic ACTH can be used to reveal insufficient cortisol response in case of clinical suspicion.