Thyroid Disease In Patients Research Articles

Nutritional Status among patients with Heart Failure and Thyroid Diseases - Result of Nutritional Status Heart Study (NSHS)

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Wroclaw Medical University Background Nutritional status is related to the prognosis and the length of hospitalization of individuals with heart failure. The effects of thyroid dysfunction in patients with pre-existing heart failure and nutritional status have not been adequately studied. Purpose This study aims to assess how nutritional status affects thyroid disease in patients with heart failure. Methods We performed a retrospective study and analysis of medical records of 1056 patients admitted to the cardiology department of our University Clinical Hospital between September 2017 and September 2020 due to acute heart failure (HF) (ICD10: I50). We analyzed all the patients who met the inclusion criteria (diagnosis of HF, age ≥18 years old). A final group of 1056 patients’ medical records was analyzed. The analysis included data such as age, gender, patients’ body mass index (BMI), and laboratory results such as total data on past and comorbid disease units and assessment of the nutritional status of the patient via the NRS-2002. Our study was approved by the independent Bioethics Committee of the Wroclaw Medical University (decision no. KB–590/2020). Statistical analysis was performed using Statistica 13.1 (StatSoft, Inc., Tulsa, OK, USA). The results were considered statistically significant at p<0.05 Results A total of 1056 individuals were included in the analysis. It included more men than women (66,7%) Due to a lack of data for some parameters, those numbers are smaller and are provided for each variable. More than 76% of participants were overweight or obese. 4.3% of patients were in risk of malnutrition. Thyroid disease registered in 15.1% of patients (Hyperthyroidism – 5.3% and Hypothyroidism 9.8%) Based on BMI, four groups were distinguished: <18.5, 18.5–24.9, 25.0–29.9, and ≥30 The occurrence of Hyperthyroidism was more frequently observed in the group of overweight patients (p=0,02) (table 1). Based on NRS2002, two groups were distinguished: <3 and ≥3. In the group with risk of malnutrition (NRS ≥3) patients had a mean statistically significant higher FT4 (<0.001) than the group with no risk of malnutrition (NRS <3) ( x̅ : 2,02 ng/dl vs x̅ : 1.35 ng/dl, p<0.001). Additionally, lower scores of FT3 were observed in the group NRS ≥3 (x̅ : 1.91 ng/dl, p<0.001) (table2). Conclusion This study shows that patients with thyroid disease and heart failure were often overweight and obese. The risk of malnutrition status correlates with a lower result of FT3 and the highest FT4. Undoubtedly, those phenomena require further research.

Autoimmune Thyroid Disease in Patients with Hypovitaminosis D in Department of Biochemistry of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Autoimmune thyroid disease is characterised by the generation of autoantibodies against self-antigens such as thyroid peroxidase, thyroglobulin, and thyroid-stimulating hormone receptor. Recent studies have implicated the role of hypovitaminosis D to immune dysfunction, failure of self-tolerance and generation of autoantibodies. This study aimed to find out the prevalence of autoimmune thyroid disease among hypovitaminosis D patients in a tertiary care centre. A descriptive cross-sectional study was conducted among participants between the ages of 18 years to 65 years who visited the Department of Biochemistry of a tertiary care centre between the periods of July 2018 to December 2019. The study was initiated after receiving ethical approval from the Institutional Review Committee (Reference number: 42,8/074/075-IRC). Data was collected using a self-administered questionnaire followed by anthropometric measurement and blood collection. Thyroid hormone, thyroid peroxidase antibody and 25-hydroxy vitamin D were measured by chemiluminescence technique. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated. Among 83 patients, 39 (46.98%) (42.32-51.63, 95% Confidence Interval) had autoimmune thyroid disease. The prevalence of autoimmune thyroid disease among patients with hypovitaminosis D was similar to studies conducted in comparable settings. autoimmune diseases; prevalence; thyroid; vitamin D.

Conducting Hormonal, Biochemical and Serological Tests in Autoimmune Thyroid Patients

Background: One of the most frequent autoimmune illnesses affecting the thyroid gland is immunological thyroid disease. Antibodies against the enzyme thyroglobulin and thyroid-stimulating hormone receptors are produced by the immune system. Hashimoto's disease and Graves' disease are the two primary forms of autoimmune diseases.
 Methods: 91 blood samples were taken, including 71 for thyroid disease patients and 20 for healthy persons as control samples, from both sexes and of various ages. The tests were performed using a variety of methodologies.
 Results: Some of autoantibodies were found in varying quantities in 44 individuals. While TPO antibodies were found in 75% of 33 individuals, Anti-TG Ab was found in 72.72% of the patients, 15.90% in seven patients, and anti-TSHR Ab and antinuclear antibodies were found in 22.72% of the patients compared to the control samples. Any type of autoantibody, as well as the results of hormonal testing, revealed disease in a variety of individuals at varying rates. Because the patients were on therapy, the highest rate was 59.09% for thyroid-stimulating hormones. Chemical analyses revealed a sugar and fat imbalance with no discernible link. Interleukin 4 was detected in 4 individuals (9.09%), including one patient with autoimmune hypothyroidism (2.27%) and three patients in C3 18 with immunological hyperthyroidism (6.82%). The findings revealed an increase in complement molecule concentration in 40.90% of patients, including 15 patients with autoimmune hypothyroidism (34.09%) and 3 patients with immune thyroid gland C3 hyperactivity (6.71%). The statistical study revealed a P < 0.01 level of significance correlation between the presence of sugar and triglycerides and the complement molecule. Interleukin 4 and antibodies to receptors have a substantial correlation at the P < 0.01TSHR Ab level TSH.
 Conclusions: The C3 gland patients for thyroid peroxidase had the largest amount of antibodies, lipids, and sugar, according to the study. Interleukin-4 occurred in certain individuals who had antibodies to thyroid-stimulating hormone receptors, according to the research.

Incidence and Risk Factors of Thyroid Malignancy in Patients with Toxic Nodular Goiter.

Background Although hyperfunctioning thyroid disorders were thought to be protective against malignancy, some recent studies reported a high incidence of incidentally discovered cancer in patients with hyperfunctioning benign thyroid disorders. We performed this study to estimate the incidence and predictors of malignant thyroid disease in patients with toxic nodular goiter (TNG). Patients and Methods. The data of 98 patients diagnosed with TNG were reviewed (including toxic multinodular goiter SMNG and single toxic nodule STN). The collected data included patients age, gender, systemic comorbidities, family history of thyroid malignancy, previous neck radiation, type of disease (multinodular or single), size of the dominant nodule by the US, operative time, and detection of significant lymph nodes during operation. Based on the histopathological analysis, the cases were allocated into benign and malignant groups. Results Malignancy was detected in 21 patients (21.43%). Although age distribution was comparable between the two groups, males showed a significant increase in association with malignancy. Medical comorbidities and family history of cancer did not differ between the two groups. However, TMNG showed a statistically higher prevalence in the malignant group. Operative data, including operative time and lymph node detection, were comparable between the two groups. On regression analysis, both male gender and TMNG were significant predictors of malignancy. Conclusion The presence of thyroid hyperfunction is not a protective factor against malignancy, as malignancy was detected in about 1/5 of cases. Male gender and TMNG were significant risk factors of malignancy in such patients.

Thyroid disease in patients with type 1 diabetes

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

IDF21-0216 Prevalence of Hypothyroidism in Diabetes and its association with comorbidities

Background: The prevalence of thyroid disease in patients with Type 2 Diabetes Mellitus (T2DM) appears to be more than in the general population. In addition, there appears to be a relationship between the presence of thyroid dysfunction and comorbidities of diabetes.

Health care access of thyroid disease patients in Serbia during the COVID-19 pandemic.

PurposeThe aim of this study was to assess the impact of repurposing health care facilities in response to COVID-19 on the access of patients with thyroid disease to health care.MethodsThis study consisted of a web-based survey. The survey was anonymous and consisted of forty questions.ResultsThis survey included 206 respondents. 91.3% of the respondents had health insurance through the Republic Fund of Health Insurance, 9.7% had private or both health insurances, and 3.4% did not have any health insurance. A significant proportion of respondents (60.4%) had to switch from public to private health care to reach a physician and 73.8% had to switch from public to private laboratories. For the 91.9%, this was perceived as a financial burden. Before the pandemic, 83.1% of respondents reported regular follow-up by physicians, which decreased to 44.9% during the pandemic (p < 0.01). 76.3% of the respondents regarded that their thyroid disease was managed optimally before the pandemic, while this figure declined to only 48% during the pandemic (p < 0.01).ConclusionsThe COVID-19 pandemic disrupted the medical care of thyroid patients in Serbia. For the patients treated in the public health care system, access to general practice was hindered, while access to specialist care was disrupted. It led to a switch from public to private health care, which was perceived as a financial burden for almost all the respondents. However, private health care proved to be an important safety net when the public system was overwhelmed.

Mortality after benign thyroid surgery in patients aged 80 years or older

IntroductionA recent report from the United Nations showed that aged people are increasing worldwide. Few data exist on overall survival for patients 80 years or older undergoing benign thyroid surgery. Short- and long-term survival and risk factors for death in patients undergoing thyroid surgery for benign disease were evaluated, using a nationwide, population-based quality register.MethodsPatients operated for benign thyroid disease, 2004 to 2017, were collected from the national quality register for thyroid surgery. Mortality data were retrieved from the Swedish National Board of Health and Welfare. Mortality at 30 days, 90 days, and 1 year after surgery, for patients 80 years or older, was calculated. Overall survival was calculated using the Kaplan–Meier estimate. Risk factors for mortality were assessed with Cox’s multiple regression analysis. The standardized mortality ratio was calculated.ResultsThere were 17,969 patients. Among them, 483 patients were 80 years or older, and of these, 397 (82.2%) were women. The mortality rate at 0–30 days, 31–90 days, and at 91–365 days after surgery was 0.4%, 0.2%, and 2.5%, respectively. The median (IQR) follow-up time was 4.5 (2.9–7.2) and the median (IQR) survival time was 8.0 (4.1–12.5) years. Apart from age, there was no other risk factor for death. The standardized mortality ratio (SMR) was 0.67 (0.49–0.91) for men and 0.76 (0.65–0.89) for women.ConclusionMortality after surgery for benign thyroid disease in patients 80 years or older was lower than the general population with no specific risk factors for death except for age.

THE INFLUENCE OF THE THYROID GLAND ON THE DEVELOPMENT OF THE SCLEROSING HULL OF THE VULVA IN WOMEN OF REPRODUCTIVE AGE

Sclerosing lichen (SL) of the external genitalia is a chronic slowly progressive disease with pronounced focal atrophy of the skin of the perineum and visible mucous membranes of the vulva and has two main peaks of clinical manifestations: childhood and perimenopausal age. It is associated with an increased risk of developing vulvar cancer, even though it is not a malignancy in itself. The true precursor of SL-associated cancer is intraepithelial vulvar neoplasia (VIN). The diagnosis is usually clinical, but in some cases a biopsy may be performed, especially to rule out VIN or cancer. In this study, 180 patients with SL vulva were examined on the basis of two clinical bases (National Cancer Institute, MC "Verum"). After examining the patients, the diagnosis was made on the basis of examination, complaints, advanced biochemical blood test, detailed blood test, hormonal examination and ultrasound. In most cases, the diagnosis of SL vulva is clinical. As a result of a number of examinations of patients of reproductive age in patients with SL vulva, it was found that SL vulva is a consequence of thyroid disease (82.2%) of different types compared with patients in the control group (32.7%). The diagnosis of SL vulva was established in young patients mainly with AIT (48.6%) and with AIT accompanied by hypothyroidism or nodular thyroid disease (27%). When comparing the diagnostic findings of thyroid disease in patients with SL vulva and the control group, no significant differences were found. Therefore, timely detection of latent forms of AIT, hypothyroidism, nodular goiter, adequate treatment of thyroid dysfunction will allow to normalize changes in the reproductive system and prevent the formation of pathological lesions of the reproductive organs of women.

The detection of up-regulated anti-thyroid antibodies and autoimmune thyroid diseases in patients with autoimmune encephalitis: a retrospective study of 221 patients.

ObjectiveTo investigate the potential detection rate of anti-thyroid antibodies’ (ATAbs) positivity, thyroid dysfunctions, and autoimmune thyroid diseases (AITDs) in autoimmune encephalitis (AE) and to analyze whether thyroid autoimmunity/dysfunction can affect the clinical course of AE.MethodsTwo hundred twenty-one AE patients and 229 age- and sex-matched controls were included in this study. We measured the levels of ATAbs (anti-thyroglobulin antibodies [TgAb], anti-thyroid peroxidase anti-bodies [TPOAb]) and thyroid hormones in all the individuals. In addition, the association of thyroid autoimmunity/dysfunctions with functional outcomes of AE was identified by using logistic regression and Kaplan–Meier analyses.ResultsThe prevalence of TPOAb-positive and TgAb-positive was significantly higher in AE patients (16.3% and 16.7%, respectively) as compared with controls (9.6% and 7.4%, respectively; P = 0.034 and P = 0.002, respectively). In addition, the free triiodothyronine (fT3) level was significantly lower in AE patients as compared to the controls (P < 0.001). However, the frequency of AITDs (Hashimoto’s thyroiditis and Graves’ disease) did not significantly differ between AE patients and control subjects. Importantly, low fT3 was found to be associated with poor functional outcomes at the 3-month follow-up in AE. Adjustment of potential confounders did not change the association. However, the presence of ATAbs did not significantly alert the disease course of AE.ConclusionsATAbs-positive and/or AITD patients with symptomatic encephalopathy should undergo proper surveillance for AE. Moreover, low fT3 could serve as a possible predictor of poor short-term outcome in AE, thereby suggesting that monitoring of thyroid function in AE may be necessary.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10072-022-05932-0.

Impact of thyroid disease in patients with atrial fibrillation: Analysis from the JoFib registry

BackgroundThyroid disease is a well-established risk factor for atrial fibrillation (AF). However, only a handful of studies examined its impact on treatment. This study aims to report the prevalence rate of thyroid disease in patients with AF and to demonstrate the effect of thyroid disease on AF treatment. Materials and methodsWe retrospectively analyzed the Jordanian Atrial Fibrillation Study (JoFib). Among Jordan and Palestine, patients with AF were evaluated for their sociodemographic, clinical, and pharmacological characteristics. ResultsA total of 2000 patients with AF (53.3% males, mean age 67.6 ± 13.1 years) were enrolled in the JoFib registry from May 2019 to November 2020. Thyroid disease was present in 210 (10.5%) patients. Hypertension, diabetes mellitus, and dyslipidemia were the most common comorbidities among patients with thyroid history (75.2%, 51.0%, and 45.7%, respectively). Diabetes mellitus (p = .04), pulmonary hypertension (p = .01), and chronic kidney disease (p = .01) were significantly higher in this particular subgroup. Patients with thyroid disease demonstrated significantly higher usage of anticoagulants (p = .02). ConclusionDespite having similar stroke and bleeding risks, patients with thyroid disease demonstrated meaningful differences in their baseline characteristics. Prospective studies are required to assess the influence of thyroid hormone fluctuations on the progression of AF.

Prevalence of autoimmune thyroid disease in patients with psoriasis: a meta-analysis

ObjectivePsoriasis is a chronic inflammatory disease with autoimmune aetiology. A possible link between psoriasis and autoimmune thyroid disease (AITD) has been suggested in some studies with inconsistent findings. This meta-analysis...

Diltiazem-Induced Reversible Cardiogenic Shock in Thyroid Storm

Early recognition of underlying thyroid disease in patients presenting with new-onset tachyarrhythmia is central to management, as usual rate-control strategies can result in significant mortality and morbidity. Hyperthyroidism-induced cardiomyopathy complicated by cardiogenic shock is a life-threatening condition. Thyroid storm can lead to irreversible cardiovascular collapse and death if proper treatment is not initiated as soon as possible. In this case, we report a 44-year-old female who presented to the emergency department (ED) with the chief complaints of anxiety and palpitations. Her past medical history was significant for anxiety, but she was otherwise healthy. An electrocardiogram (ECG) in the ED demonstrated atrial fibrillation (A. fib) with rapid ventricular response (RVR) felt to be secondary to thyroid storm based on the Burch-Wartofsky point scale (BWPS), which is a quantitative diagnostic tool that uses clinical manifestation in diagnosing thyroid storm. The patient was initially managed with a continuous infusion of diltiazem to achieve rate control with a goal heart rate <115 beats per minute (bpm). Shortly after initiating the infusion, the patient developed signs and symptoms consistent with cardiogenic shock. Bedside echocardiogram revealed an estimated ejection fraction (EF) <10% with concomitant pulmonary edema. Repeat echocardiogram within 72 hours after stopping diltiazem and starting appropriate treatment for thyroid storm showed improvement of EF to 35%.

Correlation between fine needle aspiration and intraoperative frozen section findings for thyroid patients; a single center study

Introduction: Thyroid nodules are one of the most common diseases. Objectives: The aim of this study was to evaluate the correlation between fine needle aspiration (FNA) and intraoperative frozen section findings for thyroid disease patients. Patients and Methods: In this study, the FNA and intraoperative frozen section findings of 143 patients who were admitted to an educational hospital, Isfahan, Iran were collected and classified using these diagnostic methods during 2015. To find the correlation between FNA and intraoperative frozen section findings, statistical analysis was conducted using SPSS software version 16.0 (Chicago, IL). Results: Sensitivity and specificity of the positive FNA findings were 71% and 86.8%, respectively (P&lt;0.001). The maximum concordance between FNA and intraoperative frozen section for papillary thyroid cancer was seen (P&lt;0.001). Conclusion: In this study, a significant association between FNA and intraoperative frozen section of thyroid cancers, among our patients, however this finding requires further investigation by larger studies.

A STUDY OF EVALUATION OF THYROID FUNCTION STATUS IN CONTINOUS AMBULATORY PERITONEAL DIALYSIS PATIENTS

Background/Aim: End-stage-renal-disease (ESRD) patients/CAPD have a high rate of abnormal thyroid hormone (include subclinical hypothyroidism and non-thyroidal illness syndrome) compared with those without kidney disease. These thyroid dysfunctions are associated with higher death risk due to cardiovascular disease in the general population, little is known about the effect of thyroid disease in patients received peritoneal dialysis. Methods: Cross-sectional research, 118 participants (59 healthy people, 57 CAPD patients) were enrolled. We examined the association of thyroid status, assessed by serum TSH, free T3, free T4 levels which were measured by immunoassay method. Results: Mean serum TSH level of patients were higher than those of control group, p&lt;0.05 (3.15±2.28 μUI/mL versus 1.65±0.82 μUI/mL); mean FT3 level of patients were lower than those of control group, p&lt;0.05 (2.42±0.46 pg/mL versus 3.01±0.41 pg/mL); mean FT4 level of patients were lower than those of control group, p&gt;0.05(1.26±0.24 ng/dL vs 1.18±0.18 ng/dL). Among 57 CAPD patients, 35.1% abnormal thyroid function; 19.3% subclinical hypothyroidism; 15.8% low FT3; 1 patient has low FT4. Mean serum TSH level of patients were higher than those of control group, p&lt;0.05 (3.15±2.28 μUI/mL versus 1.65±0.82 μUI/mL); mean FT3 level of patients were lower than those of control group, p&lt;0.05 (2.42±0.46 pg/mL versus 3.01±0.41 pg/mL); mean FT4 level of patients were lower than those of control group, (p&gt;0.05, 1.26±0.24 ng/dL vs 1.18±0.18 ng/dL). Conclusion: Subclinical hypothyroidism and low FT3syndrome are high in CAPD patients. Additionally, FT4 serum concentration is associated with PD duration and serum creatinine; FT3 is dependent risk factor of rate Kt/V Urea weekly, also cardiovascular disease. Key words: ambulatory peritoneal dialysis, continous ambulatory peritoneal dialysis patients (CAPD), abnormal thyroid function, subclinical hypothyroidism

IMPENDING PERICARDIAL TAMPONADE AS THE INITIAL PRESENTATION OF AUTOIMMUNE POLYGLANDULAR SYNDROME 3B

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Autoimmune polyglandular syndromes (APS) are rare polyendocrinopathies characterized by loss of immune tolerance to self-antigens leading to autoimmune destruction of endocrine glands and other tissues. APS is classified into APS types 1, 2, 3 and 4. APS Type 3 is recognized by absence of adrenal insufficiency. APS type 3b (APS3b) specifically comprises of the association of autoimmune thyroid disease with pernicious anemia. CASE PRESENTATION: A 66-year-old female with history of pernicious anemia presented to the emergency department with shortness of breath and lethargy which started on day of arrival. She was diagnosed with pernicious anemia 2 years ago and was receiving intramuscular cyanocobalamin injections. In the emergency department, she was found to be hypoxic with oxygen saturation of 90%. Her physical exam was notable for muffled heart sounds. Her labs on admission were: Hb 11.8 g/dl, HCT 35.8 %, WBC 6.3 K/ul, PLT 166 K/ul, Glucose 106 mg/dl, Sodium 143 mmol/l, BUN 13 mg/dl, Creatinine 1.13 mg/dl, pro-BNP 171 pg/ml, TSH 44.6 UIU/ml, Free T4 0.2 ng/dl, Free T3 0.5 pg/ml and positive thyroid peroxidase antibody >1300 u/ml. Serial troponins were unremarkable. Chest x-ray showed an enlarged cardiac silhouette concerning for pericardial effusion. EKG showed normal sinus rhythm with low voltage QRS complexes. 2D Echo showed a large circumferential pericardial effusion with end diastolic RV collapse suggestive of impending pericardial tamponade. LV ejection fraction was 60%. Pericardiocentesis drained 1700 cc of fluid with relief of patient's symptoms. This was followed by placement of pericardial drain. Her pericardial effusion was attributed to her new diagnosis of hypothyroidism. She was started on low dose levothyroxine given her age above 60 with plan for slowly increasing her dose with close outpatient follow up. DISCUSSION: Pernicious anemia is the most common association with thyroid autoimmune disease in APS type 3 seen in 39% of cases. APS3 is more commonly seen in females. The diagnosis of this condition requires the presence of multiple autoimmune diseases in the same individual, diagnosed in any order and at any age. CONCLUSIONS: A high index of suspicion is required whenever one autoimmune disease is diagnosed to prevent morbidity and mortality from other associated conditions. Here, we describe a patient with known history of pernicious anemia presenting with impending tamponade who was subsequently diagnosed with Hashimoto's thyroiditis. The constellation of these findings represent APS Type 3b. REFERENCE #1: Betterle, Corrado et al. "A rare combination of type 3 autoimmune polyendocrine syndrome (APS-3) or multiple autoimmune syndrome (MAS-3)." Auto- immunity highlights vol. 5,1 27-31. 11 Feb. 2014, doi:10.1007/s13317-013-0055-6 REFERENCE #2: Lahner E, Centanni M, Agnello G, et al. Occurrence and risk factors for autoimmune thyroid disease in patients with atrophic body gastritis. Am J Med. 2008;121(2):136-141. doi:10.1016/j.amjmed.2007.09.025 DISCLOSURES: No relevant relationships by Sana Fatima, source=Web Response No relevant relationships by Shumail Syed, source=Web Response

A case of thyroid storm caused by Graves\u2019 disease misdiagnosed as panic attack due to panic disorder

BackgroundGraves’ disease is characterized by hyperthyroidism and its symptoms often overlap with those of panic disorder, which may make it difficult to distinguish between the two conditions. In this report, we describe how proper diagnosis of thyroid disease in patients with mental illness can lead to appropriate treatment.Case presentationWe encountered a 34-year-old woman in whom thyroid crisis from Graves’ disease was misdiagnosed as panic attack. The patient was being managed as a case of panic disorder and bipolar disorder in a psychiatric outpatient setting. About 6 months before presentation she had lost about 16 kg in weight, and a month before presentation she developed several unpleasant symptoms as her condition worsened. Several weeks before she had had severe palpitations, tachycardia, and discomfort in her throat. She became unable to eat solids, ate only yogurt and gelatin, and felt it difficult to take psychiatric drugs.She visited our emergency outpatient department on a Sunday morning, presenting with nausea, severe tachycardia, fever, and restlessness with anxiety. We treated her as panic disorder with fever, but noted proptosis and considered the possibility of Graves’ disease. Thyroid function tests were performed even though data from her clinic was not available because it was a weekend.Because there was no improvement in her condition after her first visit, she returned to our hospital early the next morning. We had misdiagnosed her as having severe panic attacks due to panic disorder, and after a diazepam injection had allowed her to go home.Later that day, the thyroid function test results became available, and her symptoms and the results strongly indicated a thyroid storm. The endocrinology department was consulted immediately, and she was referred for hospitalization the next day. During hospitalization, she was treated with steroid and radioactive iodine therapy and was discharged from hospital in 3 weeks.ConclusionPsychiatrists and doctors engaged in psychosomatic medicine need to consider the possibility of severe hyperthyroidism as a differential diagnosis of panic disorder.

Prevalence of autoimmune thyroid diseases in patients with prolactinomas and non-functioning pituitary adenomas

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Postpartum Thyroid Abnormalities and Systemic Lupus Erythematosus: Is There a Link?

Abstract Introduction: Postpartum Thyroiditis (PPT) is an autoimmune disorder characterized by destruction of the thyroid gland within the first year after delivery. Systemic Lupus Erythematosus (SLE), another autoimmune disease, has been associated with a spectrum of thyroid disorders. While the prevalence of thyroid diseases in patients with SLE is increased, the association between SLE and PPT is not well known. The infrequency of encountering SLE and PPT makes abnormal thyroid tests in the postpartum period a diagnostic challenge. Clinical Case: A 27-year-old G1P1001 who was five months postpartum and not breast feeding was referred to Endocrinology clinic for evaluation of abnormal thyroid function tests. Past medical history was significant for SLE with renal and pericardial involvement. SLE was well controlled, treated with hydroxychloroquine. Family history was significant for hypothyroidism in her mother. She was asymptomatic and appeared clinically euthyroid. Vitals were stable and physical exam was negative for goiter, nodule or orbitopathy. Lab results at two months postpartum showed an elevated TSH of 3.87 UIU/mL (Normal 0.40-3.8 UIU/mL) and at four months postpartum TSH was low at 0.012 UIU/mL. Repeat labs at five months postpartum continued to show a low TSH at 0.007 UIU/mL with mildly elevated Free T4 at 1.7 ng/dL (Normal 0.6-1.6 ng/dL) and elevated Free T3 of 6.0 pg/mL (Normal 2.1-3.8 pg/mL). Anti-thyroid peroxidase antibodies (TPO), thyroid stimulating antibodies (TSI) and TSH receptor antibodies (TRAb) were negative. Thyroid Ultrasound with Doppler was within normal limits. Radioactive Iodine Uptake and Scan, obtained at 6 months postpartum, showed high normal uptake (17% and 32% at 4 hours and 24 hours respectively), suggestive of recovery phase of PPT. The most recent TSH was elevated at 8.5 UIU/mL and Free T4 was low at 0.7 ng/dL. Disease course was consistent with PPT. Conclusion: The Th1 (T-helper) lymphocyte immune predominance in autoimmune thyroid disease and SLE is the immune-pathogenetic base of the association between both diseases. Postpartum thyroiditis is a variant of chronic autoimmune thyroiditis. Serum anti-TPO antibodies vary during pregnancy and tend to increase early and may decline later. Immunologic tolerance increases during pregnancy, fades in the postpartum period and makes interpretation of thyroid function tests and disease process challenging. Pregnant and postpartum patients who have SLE have increased prevalence of thyroid disease. Causes are multifactorial with a higher prevalence of hypothyroidism and thyroid autoantibodies. Hyperthyroidism is much less likely. One comparable study found 6 of 43 (14%) women with SLE developed PPT and only one of these patients had positive thyroid antibodies. These reports and our patient illustrate the variability of thyroid function tests in patients with SLE.

COVID-19 Infection Causing Atypical Thyroiditis

Introduction: Coronavirus disease 2019 (COVID-19) has caused significant health burden across the world. Identification of factors contributing to severe disease is important to enable stratification of risk, optimize the reallocation of hospital resources, and guide public health recommendations and interventions. Subacute thyroiditis is an inflammatory thyroid disease characterized by neck pain and is usually preceded by an upper respiratory tract infection. It may be caused by a viral infection or a post-viral inflammatory reaction, and many viruses have been linked to the disease. We present case of atypical thyroiditis associated with COVID-19 infection. Case Report: 27-year-old female with no significant past medical history apart from recent COVID-19 infection is referred to endocrinology for evaluation of abnormal thyroid function test. Patient states around three months ago she was experiencing the symptoms like unintentional weight loss, nausea, palpitation, insomnia, anxiety, fatigue similar to symptoms she experienced 9 years ago while she was pregnant with her daughter so she thought she is pregnant again and visited her gynecologist. But patient had pregnancy test was done and she was found to be negative but her thyroid function test showed low TSH 0.32mIU/ml (0.47-4.68mIU/ml). Patient states around same time she was diagnosed with COVID-19 infection and she lost 5 pounds during that time but even after recovery from the infection she continued to lose weight and lost a total of 18 pounds in 3 months. Patient states during the time of COVID-19 infection she was having difficulty swallowing and painful swallowing but following infection patient denied any current difficulty swallowing or breathing, headache, vision changes, cold or heat intolerance, diarrhea or constipation, tremors, proximal muscle weakness, bulging of her eyes. Patient continue to have regular monthly menstrual cycles. Three months following infection patients repeat thyroid function tests were done and it showed normal TSH 0.56mIU/ml(0.47-4.68mIU/ml),free T4 1.05ng/dL(0.78-2.19ng/dL) and negative thyroid antibodies like TSI index<1.0, Thyroid peroxidase Antibodies 1.4 IU/mL, Thyrotropin Receptor Ab <1.00 IU/L. Patient also had normal thyroid ultrasound. Patient had complete resolution of hyperthyroid symptoms and did not require any medications. Conclusion: In conclusion, physicians should be engaged in close monitoring of thyroid disease in patients with suspected COVID-19, for timely detecting signs of disease progression. Finally, the presence of thyroid disease shall be regarded as an important factor in future risk stratification models for COVID-19.