Thyroid Disturbances Research Articles

Subclinical hypothyroidism and plasma levels of commonly prescribed anti-seizure medications

Background: Epilepsy remains the most common neurological problem worldwide. Most commonly prescribed antiseizure medications (ASMs) like phenytoin, sodium valproate, and carbamazepine show high inter-individual variability in bioavailability due to genetic and epigenetic factors resulting in either therapeutic failure or toxicity. In our study, we aim to determine the association between subclinical hypothyroidism and the plasma levels of these commonly prescribed ASMs, leading to either therapeutic failure or adverse drug reactions. Methods: We collected demographic data, details about the antiepileptic medication, and plasma levels of ASMs (phenytoin, carbamazepine, and sodium valproate) from patients on antiseizure medications who came for routine therapeutic drug monitoring (TDM). High-performance liquid chromatography (HPLC) estimated plasma levels of the antiseizure medications as per the TDM laboratory standard operating procedure (SOP) and thyroid function test (TSH) by a standard enzyme-linked immune-sorbent assay (ELISA) kit. Results: Of the 158 patients who had TDM, 75.31% were taking sodium valproate, 15.18% were on phenytoin, and 9.49% were on carbamazepine monotherapy. In our study, we found that 12 patients (7.59%) had TSH levels between 4 to 10 mIU/l, indicating subclinical hypothyroidism (SCH). The plasma drug levels of all 12 patients who had SCH were found to be below the therapeutic range. Conclusions: This study has established a significant association between ASMs, particularly sodium valproate, and thyroid dysfunction, specifically SCH, in patients with epilepsy. Our findings suggest that prolonged ASM therapy can lead to thyroid disturbances, warranting careful monitoring of thyroid function in these patients.

Prevalence of Thyroiditis Following Either COVID-19 Infection or Vaccination in a Group of Egyptian Hashimoto Cases

Abstract Background Hashimoto's thyroiditis (HT), the most frequent autoimmune thyroid disorders (AITDs), is the leading cause of hypothyroidism in the iodine-sufficient areas of the world. COVID-19 is a highly transmissible infectious disease caused by the Severe Acute Respiratory Syndrome Virus 2 (SARS-CoV- 2), belong to the family of beta-coronaviruses. The disease rapidly spread, leading to COVID-19 pandemic on March 11, 2020. Aim of the Work The aim of this study was to evaluate the thyroid function consequences following either (COVID-19) infection or vaccination, in relation to their clinical features, biochemical, immunological, and inflammatory markers. Patients and Methods This study was a pilot study, conducted on 80 subjects attending COVID vaccination center and Emergency isolation in Ain Shams university hospital during the period from August to October 2022 14 males, 66 females, age>18 years old and <70 years’ old to evaluate the thyroid function consequences following either (COVID-19) infection or vaccination, in relation to their clinical features, biochemical, immunological, and inflammatory markers. Results Our study showed significant increase in the level of TSH and decrease in the level of free T3, Free T4 in Hashimoto’s patients who exposed to COVID19 infection. Also it showed significant increase in the level of free T3, Free T4 and decrease level of TSH in normal subjects after exposure to COVID19 infection. Additionally, our study showed increase level of free T3, Free T4 in normal subjects after being exposed to COVID19 vaccine (AstraZeneca) in contrast to TSH being decreased in them. Furthermore, we found significant increase in the level of free T3, Free T4 in Hashimoto’s subjects after their exposure to AstraZeneca vaccine, with non significant difference regarding –anti- TPO, Antithyroglobulin. Conclusion COVID19 infection and vaccination against COVID might be followed by an attack of thyroiditis (disturbed thyroid function test) in Hashimoto patient and even in normal person.

Experimental Study of Thyroid Disturbances and Interplay with Growth Hormone on Body Development and Lipid Profile in Immature Male Rats

Experimental Study of Thyroid Disturbances and Interplay with Growth Hormone on Body Development and Lipid Profile in Immature Male Rats

Protective effect of curcumin against microplastic and nanoplastics toxicity.

Microplastics and nanoplastics (MNPs) are present in urban dust and the aquatic environments of industrialized cities. MNPs in the human body accumulate in the lymphoid follicles, Peyer's patches of the gastrointestinal tract, and pulmonary vascular endothelial cells, which slowly result in toxicity. Since previous studies introduced curcumin as a natural protective agent against environmental toxins, we reviewed preclinical studies that had used curcumin to protect organs or cells from toxicity secondary to exposure to MNPs. It was found that exposure to MNPs resulted in osteolysis, immunotoxicity, thyroid disturbances, nephrotoxicity, neurotoxicity, hepatotoxicity, pulmonary toxicity, gastrointestinal toxicity, cardiovascular toxicity, and especially endocrine, and reproductive toxicity. Nevertheless, except for one study reviewed, curcumin restored all oxidative and histopathological damages induced by MNPs to normal due to curcumin's inherent antioxidant, antiapoptotic, anti-inflammatory, and anti-proliferative properties.

Effect of thyroid disruption on ovarian development following maternal exposure to Bisphenol S.

Thyroid hormones play a crucial role in numerous physiological processes, including reproduction. Bisphenol S (BPS) is a structural analog of Bisphenol A known for its toxic effects. Interference of this substitute with normal thyroid function has been described. To investigate the effect of thyroid disruption on ovarian development following maternal exposure to BPS, female rats were exposed, daily, to either AT 1-850 (a thyroid hormone receptor antagonist) (10 nmol/rat) or BPS (0.2 mg/kg) during gestation and lactation. The effects on reproductive outcome, offspring development, histological structures, hormone levels, oxidative status, cytoskeleton proteins expression, and oocyte development gene expression were examined. Our results are in favor of offspring ovarian development disruption due to thyroid disturbance in adult pregnant females. During both fetal and postnatal stages, BPS considerably altered the histological structure of the thyroid tissue as well as oocyte and follicular development, which led to premature ovarian failure and stimulation of oocyte atresia, being accompanied with oxidative stress, hypothalamic-pituitary-ovarian axis disorders, and cytoskeletal dynamic disturbance. Crucially, our study underscores that BPS may induce reproductive toxicity by blocking nuclear thyroid hormone receptors, evidenced by the parallelism and the perfect meshing between the data obtained following exposure to AT 1-850 and those after the treatment by this substitute.

Effects of Insecticide and Herbicides on Thyroid Disturbances in Zebrafish.

Thyroid cancer usually begins with thyroid dysfunction and nodules and has become the most common cancer globally, especially in women. Although the causes of thyroid dysfunction are complex, the presence of environmental pollutants, especially certain pesticides as established mutagens, has been widely accepted. Zebrafish (Danio rerio) have similar toxic reactions and signal transduction pathways to humans and are very similar to humans in physiology, development, and metabolic function. Here, the direct toxicity effects and mechanisms of different insecticides and herbicides on zebrafish thyroid functions and indirect toxicity effects originating from thyroid dysfunction were summarized and compared. The overall toxicity of insecticides on the zebrafish thyroid was greater than that of herbicides based on effective concentrations. Penpropathrin and atrazine were more typical thyroid disruptors than other pesticides. Meanwhile, chiral pesticides showed more sophisticated single/combined toxicity effects on both parental and offspring zebrafish. Besides thyroid hormone levels and HPT axis-related gene expression alteration, developmental toxicity, immunotoxicity, and oxidative damage effects were all observed. These data are necessary for understanding the thyroid interference effect of pesticides on humans and for screening for thyroid disruptors in surface water with zebrafish models for the pre-assessment of human health risks and ecological risk control in the future.

Patterns and outcomes of late onset thyroid disturbances after COVID-19 vaccination: A report of 75 cases.

Isolated cases of subacute thyroiditis exist in the early period of COVID-19 vaccination, largely after mRNA vaccines. Here we report late onset thyroid disturbances and persistent health issues in patients of thyroid disorders after COVID-19 vaccination. Seventy-five patients with post COVID-19 vaccination thyroid disturbances were identified. Among these, 41 had flare of underlying thyroid illness, majority occurring at a median time lag of 28.4 weeks since 2nd dose. Thirty-one cases of new onset hypothyroidism and three of new onset hyperthyroidism were reported, with a median time lag respectively of 17.2 and 22.6 weeks since 2nd dose. Most cases occurred after ChAdOx1-nCoV-19, which was the commonest vaccine employed in mass roll out in India. Significant improvement was observed in majority, after a median follow up of 22-26 weeks. New onset health issues persisting for ≥4 weeks were reported in 37.3% and were common in individuals with history of COVID-19 before vaccine. New onset metabolic, musculoskeletal, and reproductive disorders were the common health complaints. Active monitoring is warranted for late onset adverse events after COVID-19 vaccines of all types. Larger studies with involvement of unvaccinated individuals are required to understand the incidence and causality of late onset thyroid disturbances after COVID-19 vaccines.

Relationship between Lipid Profile and Thyroid Disturbance and Ischemic Heart Disease in Iraqi Patients

The current study is a case-control study conducted in Baghdad city between 1st of January to the end of, 2023. The study focused on patients admitted to the Coronary Care Unit of Ibn Al Nafees Hospital and Ibn Al Bitar Hospital in Baghdad. And Alyarmok Hospital in Baghdad. The study included 60 Iraqi patients with coronary heart disease, ranging in age from 37 to 66 years. A control group of 30 apparently healthy individuals (15 men and 15 women) was included in the study. The control group was matched with the patients in terms of gender and age to improve the accuracy of the results. Blood samples were collected from both patients and control individuals after 12 hours of fasting. Biochemical colorimetric methods by spectrophotometer were used to determine total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein (LDL), and Immunofluorescence technique by Afias was used to determine triiodothyronine (T3), thyroxine (T4), and TSH levels and HbA1C levels in the blood. The study analyzed the demographic characteristics of patients with ischemic heart disease (IHD) and the control group, including age groups, sex distribution, and BMI. The majority of IHD patients were non-smokers, with 26.67% being smokers and the majority being non-smokers. The majority of IHD patients had hypertension, while 58.33% had diabetes. The cholesterol levels in IHD patients were significantly higher than the control group, with a p-value of 0.001. The triglyceride levels were also significantly elevated in IHD patients, with a p-value of 0.001. LDL-c levels were significantly elevated in IHD patients, while very low-density lipoprotein cholesterol (VLDLc) levels were significantly elevated in IHD patients. IHD patients had significantly higher T3 levels (1.701 ± 1.21) than the control group (0.87 ± 0.16), suggesting potential differences. T4 levels were also significantly higher in IHD patients with thyroid dysfunction (106.7 ±86.5) compared to the control group (78.5 ±13.65). On the other hand, TSH levels did not show a significant difference between IHD patients with thyroid dysfunction (3.29 ± 2.55) and the control group (3.18 ±2.078). The study found no significant differences in thyroid function parameters among the different age groups of individuals with hypothyroidism. The mean T3 level in the 40-49 age group was 0.49±0.02, the mean T4 level was 43.5±0.7, and the mean TSH level was 4.88±0.38. For the 50-59 age group, the mean T3 level was 0.36±0.17, the mean T4 level was 44.6±0.54, and the mean TSH level was 5.41±1.07. In the >59 age group, the mean T3 level was 0.51±0.03, the mean T4 level was 45.8±6.9, and the mean TSH level was 5.24±0.66. The study showed that hypothyroidism IHD patients tend to be associated with higher levels of cholesterol, triglycerides, LDL-c, and VLDL-c. The highest prevalence of hyperthyroidism among individuals with hypertension was 72.73%, while the highest spread was seen in hypothyroidism among individuals with diabetes. The highest mean value for HbA1c was observed in patients with hypothyroidism (6.99±0.82%), followed by patients with hyperthyroidism (6.46±0.51), and the lowest mean value was seen in patients with normal thyroid function (4.36±0.56%). These differences in mean HbA1c levels among the three groups are statistically significant, as indicated by the p-value: of 0.017.

Assessment of Thyroid Dysfunction Among Pregnant Women With Pre-Existing Diabetes Mellitus or Gestational Diabetes Mellitus.

Objective This study investigates the prevalence and risk of thyroid disturbances in pregnant women with pre-existing diabetes mellitus (DM) or gestational diabetes mellitus (GDM) in a tertiary hospital setting in Riyadh, SA. This research's findings may help identify potential risk factors associated with thyroid disturbances during pregnancy and facilitate early diagnosis for at-risk pregnant women. Subjects and methods A retrospective cross-sectional study was conducted at an endocrinology clinic between October 2018 and December 2021 to evaluate the electronic records of pregnant women with DM or GDM who had documented normal thyroid function before pregnancy. Results Three hundred ninety-six files that met the selection criteria were deeply investigated and analyzed. The analysis showed that 378 (95.5%) patients were of Saudi nationality, and the mean age in years ± SD for the selected patients was 34.23 ± 5.468. The prevalence of obesity was 63.7%, with a mean body mass index (BMI) of 32.78 ± 6.78 kg/m2. The patients in this study were categorized into three groups based on their type of DM: 57 were diagnosed with type 1 DM (14.4%), 120 with type 2 DM (30.3%), and 219 with GDM (55.3%). The study identified 43 patients (10.85%) with subclinical hypothyroidism and 74 (18.69%) with hypothyroidism. Among the remaining patients, thyroid function was within the normal range for 264 (66.67%). The study also identified eight patients (2.02%) with subclinical hyperthyroidism and seven (1.77%) with hyperthyroidism. The prevalence of thyroid dysfunction was reported at 33.4%, with most of the dysfunction observed in the GDM group (20.7%). By comparison, the type 1 DM and type 2 DM groups presented a lower prevalence of thyroid dysfunction, accounting for only 4.1% and 8.6%, respectively. Conclusions Hypothyroidism, both clinical and subclinical, is more prevalent among patients with GDM than individuals with type 1 and type 2 DM. Research suggests a greater risk of developing hypothyroidism in patients with an increased BMI and among those older during pregnancy.

Thyroid disturbances after COVID-19 and the effect of vaccination in children: a prospective tri-center registry analysis

Rapidly evolving clinical data suggest that the novel coronavirus (SARS-CoV-2) and vaccination against COVID-19 might be associated with thyroid disturbances. However, studies remain limited among the pediatric population. Our aim was to assess the prevalence and permanence of thyroid autoimmunity (TA) and dysfunction in children after an acute infection and its potential association with vaccination. A prospective, multicenter registry analysis was performed among 458 children (mean age: 12.4 ± 3,8 years, 45.4% male) with preceding COVID-19. Patient inclusion lasted from 24th March, 2021 to 23rd March, 2022 at three pediatric outpatient facilities at Semmelweis University, Budapest. Primary outcomes were the rate of thyroid disturbances assessed by laboratory parameters (thyroid function tests, antithyroglobulin [ATG] and anti-thyroid peroxidase [ATPO] antibodies) and thyroid ultrasound. TA rate among vaccinated and unvaccinated children was determined. Children with newly diagnosed thyroid alterations were followed up for 12.7 ± 4.3 months. Six children had previous thyroid disease. Out of 452 children, 30 cases (6.6%) of newly diagnosed TA (six of them had abnormal thyroid-stimulating hormone [TSH] levels) and eight cases (1.8%) of isolated TSH elevation were observed. Ultrasound-proven autoimmune thyroiditis (AIT) was 4.0%. No association was found between COVID-19 vaccination and thyroid autoimmunity (χ2(1,N = 452) = 0.138, p = 0.815). Among children with TA, 73.3% had long-lasting alterations. Conclusion: Vaccination had no effect on the prevalence of TA. Until further controlled studies state otherwise, children with preceding COVID-19 might benefit from thyroid screening.What is Known:• Numerous case reports implicate that coronavirus disease-2019 (COVID-19) and vaccination against SARS-CoV-2 can be responsible for thyroid disturbances.• Thyroid alterations discovered during acute COVID-19 tend to cease by time and only incidental thyroid autoimmunity (TA) is diagnosed after COVID-19. In adults, no increase in vaccine-related hyper- or hypothyroidism was found.What is New:• TA rate after COVID-19 vaccination among children was not increased. TA had no role in long COVID syndrome.• We discovered a considerable rate of TA (6.6%) and ultrasound-proven autoimmune thyroiditis (AIT) (4.0%) after SARS-CoV-2 infection, and the majority of these alterations remained positive after 6 months.

Selenium, Iodine and Iron–Essential Trace Elements for Thyroid Hormone Synthesis and Metabolism

The adequate availability and metabolism of three essential trace elements, iodine, selenium and iron, provide the basic requirements for the function and action of the thyroid hormone system in humans, vertebrate animals and their evolutionary precursors. Selenocysteine-containing proteins convey both cellular protection along with H2O2-dependent biosynthesis and the deiodinase-mediated (in-)activation of thyroid hormones, which is critical for their receptor-mediated mechanism of cellular action. Disbalances between the thyroidal content of these elements challenge the negative feedback regulation of the hypothalamus-pituitary-thyroid periphery axis, causing or facilitating common diseases related to disturbed thyroid hormone status such as autoimmune thyroid disease and metabolic disorders. Iodide is accumulated by the sodium-iodide-symporter NIS, and oxidized and incorporated into thyroglobulin by the hemoprotein thyroperoxidase, which requires local H2O2 as cofactor. The latter is generated by the dual oxidase system organized as 'thyroxisome' at the surface of the apical membrane facing the colloidal lumen of the thyroid follicles. Various selenoproteins expressed in thyrocytes defend the follicular structure and function against life-long exposure to H2O2 and reactive oxygen species derived therefrom. The pituitary hormone thyrotropin (TSH) stimulates all processes required for thyroid hormone synthesis and secretion and regulates thyrocyte growth, differentiation and function. Worldwide deficiencies of nutritional iodine, selenium and iron supply and the resulting endemic diseases are preventable with educational, societal and political measures.

A detailed pituitary profile always matters

Abstract 29-year-old female with known hypothyroidism and positive thyroid auto antibodies, followed up throughout pregnancy for adjusted doses of thyroid replacement therapy, presented 2 months post-partum with gradually increasing fatigue, repeated pre-syncope experience, inability to cope with daily home and family needs and headache. Adequacy of thyroid replacement therapy was questioned, TSH has been performed: 0.18 mIU/ml. Checking the blood pressure in lying and standing position has showed Postural hypotension. An urgent measurement of Cortisol (am) showed a result of1.06 ug/dl. Preliminary Differential Diagnoses have been suggested; Pituitary apoplexy, Pituitary adenoma, Autoimmune adrenalitis (Autoimmune Polyglandular Syndrome) or Others. On further detailed history, the patient affirmed dizziness and fainting liability on standing from lying position, bitemporal headache more in the morning. However, she denied frequent urination throughout the day, neither repeated times at night. In addition, she confirmed efficient breast feeding. Continued Lab investigations: ACTH (am) (Low); FT4 (Low; on replacement therapy); IGF1 (Normal) Serum osmolality (Normal); Urine osmolality (Normal); E2 / LH / FSH (normal physiological levels) Prolactin (normal for breast feeding) MRI pituitary and sella: Diffuse isointense enlargement of anterior pituitary gland. Homogenous and strong diffuse pituitary enhancement with gadolinium contrast. History and investigations were not fully matching with any of the previously proposed differential diagnoses, especially in regards of selective corticotroph and thyrotroph affection, sparing other pituitary cell types. Moreover, the autoimmune predisposition, the nature of the clinical presentation and its timing during early postpartum period, together with the laboratory and imaging investigations were all matching with the diagnosis of Lymphocytic Hypophysitis. The Patient got pregnant again 14 months post-partum, reflecting spared gonadotroph function and highlighting the importance to identify this uncommon diagnosis and to notify the patient about normal gonadal function and the normal possibility of pregnancy. However, she remained on hydrocortisone and thyroxine replacement. Finally, it is important that this condition should not be misdiagnosed in the first place as postpartum thyroid disturbance and TSH results, especially during and after pregnancy, shall always be interpreted in the clinical context and with the overall thyroid profile.

Management of fetal hyperthyroidism caused by persistent autoimmune antibodies in a case of previously treated maternal Graves' disease.

Maternal Graves' autoantibodies are well known to cause fetal and neonatal thyroid disturbances. Despite radioiodine therapy, Graves' autoantibodies are known to persist, which can cross the placenta and cause hyperthyroidism in the fetus. We present the case of a 26-year-old woman in her first pregnancy, clinically and biochemically euthyroid with history of treated Graves' disease, where the fetus showed signs of hyperthyroidism on antenatal scans. This was confirmed by amniotic fluid testing as fetal blood sampling was not feasible and successfully treated with maternal carbimazole whilst continuing thyroxine for the mother (block-replacement). We discuss the challenges in the diagnosis of fetal hyperthyroidism and treatment whilst maternal thyroid status is maintained on thyroxine.

SARS-CoV-2 infection may enhance the adverse effect of thyroid disturbance on climacteric symptoms.

SARS-CoV-2 infection may enhance the adverse effect of thyroid disturbance on climacteric symptoms.

Abnormal thalamocortical connectivity of preterm infants with elevated thyroid stimulating hormone identified with diffusion tensor imaging

While thyroid disturbances during perinatal and postnatal periods in preterm infants with congenital hypothyroidism reportedly disrupt neuronal development, no study has considered the effect of thyroid disturbances in premature infants with subclinical hypothyroidism with elevations of thyroid stimulating hormone. We aimed to identify altered fiber integrity from the thalamus to cortices in preterm infants with subclinical hypothyroidism. All preterm infants born were categorized according to thyroid stimulating hormone levels through serial thyroid function tests (36 preterm controls and 29 preterm infants with subclinical hypothyroidism). Diffusion tensor images were acquired to determine differences in thalamocortical fiber lengths between the groups, and cerebral asymmetries were investigated to observe neurodevelopmental changes. Thalamocortical fiber lengths in the subclinical hypothyroidism group were significantly reduced in the bilateral superior temporal gyrus, heschl’s gyrus, lingual gyrus, and calcarine cortex (all p < 0.05). According to the asymmetric value in the orbitofrontal regions, there is a left dominance in the subclinical hypothyroidism group contrary to the controls (p = 0.012), and that of the cuneus areas showed significant decreases in the subclinical hypothyroidism group (p = 0.035). These findings could reflect altered neurodevelopment, which could help treatment plans using biomarkers for subclinical hypothyroidism.

GLIS3 mediated by the Rap1/PI3K/AKT signal pathway facilitates real-ambient PM2.5 exposure disturbed thyroid hormone homeostasis regulation

Exposure to fine particulate matter (PM2.5) could damage multiple organs and systems. Recent epidemiological studies have shown that PM2.5 can disrupt dynamic balance of thyroid hormone (TH). However, the underlying mechanism by which PM2.5 interferes with TH remains unclear. This study evaluated the role of Gli-similar3 (GLIS3) in the effect of PM2.5 on TH synthesis in mice using a real-ambient exposure system, in Shijiazhuang City, Hebei Province. The PM2.5exposure group (PM) and filtered air group (FA) were placed in the exposure device for four and eight weeks. The results showed that the PM2.5 exposure altered the structure of the thyroid gland. Moreover, after PM2.5 exposure for eight weeks, the exposure level of free thyroxine (FT4) increased and the expression level of thyroid stimulating hormone (TSH) decreased in serum of mice. In addition, PM2.5 exposure significantly increased the expression of proteins related to thyroid hormone synthesis, such as sodium iodide transporter (NIS), thyroid peroxidase (TPO) and thyroglobulin (TG). Next, we found that GLIS3 and thyroid transcription factor Paired box 8 (PAX8) also increased after PM2.5 exposure. In order to further explore the potential molecular mechanism, we carried out transcriptome sequencing. KEGG analysis of the top 10 pathways revealed that the Ras-associated protein 1 (Rap1) signaling pathway could activate transcription factors and is related to thyroid cell survival. Additionally, PM2.5 exposure significantly increased the protein levels of Rap1 and its active form (Rap1 +GTP). We speculate that the active state of Rap1 is believed to be involved in activating the expression of transcription factor GLIS3. In conclusion, PM2.5 exposure induces histological changes in the thyroid gland and thyroid dysfunction in mice. The exposure activates GLIS3 through the Rap1/PI3K/AKT pathway to promote the expression of proteins related to thyroid hormone synthesis, leading to increased dysregulating TH homeostasis.

Association of Primary Subfertility in Polycystic Ovarian Syndrome with BMI and Waist Circumference

Background: To determine the association of primary subfertility in Polycystic Ovaries with BMI and waist circumference. Methods: This cross-sectional study was performed from 01-08-2018 to 01-08-2019 at the Department of Obstetrics &amp; Gynecology, Indus Medical College, Tando Muhammad Khan on (n=245) diagnosed with polycystic ovaries in the age group of 18 to 49 years. The study population, having diabetes mellitus, increased prolactin levels, disturbed thyroid function, congenital adrenal hyperplasia, and the couples with contraceptive measures were not included. Mean ± SD was computed for numerical data, frequencies and percentages were computed for qualitative data. Chi-square was used as a test of significance with a P-value &lt;0.05 as significant. Results: The mean ± SD age of these women was 33.46±6.71 years with a range from 18 to 45 years. The proportion of subfertility in PCOS was 40.41%. The frequency of subfertility in PCO increases from normal weight to obesity significantly. (P-value &lt;0.01) Additionally; women presenting with PCOS and increased waist circumference had a higher frequency of subfertility. (P-value &lt;0.01). Conclusion: A much higher proportion of women with PCOS who present with obesity, overweight, and higher waist circumference were subfertile. With early screening and treatment for PCOS, weight control also is necessary to prevent the big issue of subfertility. Keywords: Obesity, Polycystic Ovarian Syndrome. Subfertility.

Arrythmic storm in patients with and without a myocardial infarction

Abstract Introduction Available data on arrhythmic storm (AS) is frequently obtained from retrospective observational series of patients who carry an implantable cardioverter defibrillator or who undergo ablation, and typically, patients with ST-elevation myocardial infarction (STEMI) as the cause of the AS are excluded. Therefore, this selection bias limits the evidence regarding mortality and prognosis of patients with AS due to STEMI. Purpose Describe and compare the epidemiological and clinical characteristics, treatment, and outcomes of patients admitted for AS in the Acute Coronary Care Unit due to STEMI and other causes. Methods Between 2006 and 2020, 187 episodes of AS in 165 patients were identified in two third level hospitals. There were 40 patients with STEMI and 147 patients with other causes of AS. Clinical characteristics, treatment and outcome were analysed. Results Baseline characteristics are depicted in Figure 1. Risk profile of patients without STEMI was worse (they were older, had more often hypertension, and thyroid disturbances, and had worse NYHA class). Patients with STEMI were more frequently smokers. Ejection fraction was higher among STEMI patients. Predisposing features for AS (apart from myocardial ischemia) were also different. Ion disturbances were more common among STEMI patients (37.4% vs 67.5%, p=0.001). Heart failure or cardiogenic shock (27.9% vs 40.0%, p=0.140), infection (12.2% vs 7.5%, p=0.399) and bradycardia with acquired long QT syndrome (10.2% vs 10.0%, p=0.695) were similar in both groups. There were two episodes of myocarditis in patients without STEMI. The predominant arrythmia was also different. Ventricular fibrillation was more common in STEMI patients (4.8% vs 72.5%) while monomorphic ventricular tachycardia was more frequent patients without STEMI (80.3% vs 7.5%, p&amp;lt;0.001). STEMI patients had worse levels of pH (7.40 vs 7.25, p&amp;lt;0.001) and lactate (2.25mmol/L vs 5.56mmol/L, p&amp;gt;0.001) and required inotropics and vasopressors more frequently due to haemodynamic instability (15.0% vs 77.5%, p&amp;lt;0.001), mechanical support with intra-aortic balloon pump (5.4 vs 57.5%, p&amp;lt;0.001), ECMO (2.0% vs 7.5%, p=0.082), and other mechanical assist devices (0 vs 10.0%, p&amp;lt;0.001), and oral intubation (23.8% vs 90.0%, p&amp;lt;0.001). Pharmacologic treatment is described in Figure 2. Obviously, STEMI patients required more often percutaneous coronary intervention (8.2% vs 87.5%, p&amp;lt;0.001) and less frequently ventricular ablation (50.3% vs 0, p&amp;lt;0.001). Therapeutic hypothermia was more commonly used in STEMI patients due to out of hospital cardiac arrest (2.0% vs 52.5%, p&amp;lt;0.001). In-hospital mortality was higher in STEMI patients (11.6% vs 42.5%, p&amp;lt;0.001). Conclusion Despite a worse cardiovascular profile in patients without STEMI, AS is associated with a worse haemodynamic situation and mortality in STEMI patients. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Beca para la Formaciόn e Investigaciόn en Cuidados Críticos Cardiolόgicos concedida por la Asociaciόn de Cardiopatía Isquémica y Cuidados Críticos Cardiolόgicosde la SEC Figure 1. Baseline CharacteristicsFigure 2. Pharmacological treatment

Arrythmic storm in patients with and without an implantable cardioverter defibrillator

Abstract Introduction Available data on arrhythmic storm (AS) is frequently obtained from retrospective observational series of patients who carry an implantable cardioverter defibrillator (ICD). Therefore, this selection bias limits the evidence regarding mortality and prognosis of patients with AS who do not have an ICD. Purpose Describe and compare the epidemiological and clinical characteristics, treatment, and outcomes of patients with and without an ICD, admitted for AS in the Acute Coronary Care Unit. Methods Between 2006 and 2020, 187 episodes of AS in 165 patients were identified in two third level hospitals. There were 71 patients without ICD and 116 patients with ICD. Clinical characteristics, treatment and outcome were analysed. Results Baseline characteristics are depicted in Figure 1. Risk profile of ICD carriers was worse (they were older, more frequently smokers, had more often hypertension, dyslipidemia, chronic kidney disease and thyroid disturbances, and had worse NYHA class). Known ejection fraction was also worse. AS aetiology was also different. Myocardial infarction was present only in non ICD carriers (56.3% vs 0, p&amp;lt;0.001) and was the most frequent cause of AS in this group. Ion disturbances were also more common among ICD carriers (60.3% vs 33.6%, p&amp;lt;0.001), but it was the most frequent aetiology of AS in non ICD carriers. Heart failure or cardiogenic shock (36.6% vs 26.7%, p=0.154), infection (7% vs 13.8%, p=0.156) and bradycardia with acquired long QT syndrome (11.3% vs 9.5%, p=0.695) were similar in both groups. There were two episodes of myocarditis among non ICD carriers. The predominant arrythmia was also different. Ventricular fibrillation was more common in non ICD carriers (43.7% vs 4.3%) while monomorphic ventricular tachycardia was more frequent in ICD carriers (38.8% vs 83.6%, p&amp;lt;0.001). Non ICD carriers had worse levels of pH (7.30 vs 7.42, p&amp;lt;0.001) and lactate (4.4mmol/L vs 2.0mmol/L, p&amp;gt;0.001) and required inotropic and vasopressor drugs more frequently due to haemodynamic instability (57.7% vs 10.3%, p&amp;lt;0.001), mechanical support with intra-aortic balloon pump (40.8% vs 1.7%, p&amp;lt;0.001), ECMO (8.5% vs 0%, p&amp;lt;0.001), and other mechanical assist devices (5.6% vs 0%, p=0.010), and oral intubation (71.8% vs 17.2%, p&amp;lt;0.001). Pharmacologic treatment is described in Figure 2. Non ICD carriers required more frequently percutaneous coronary intervention (59.2% vs 4.3%, p&amp;lt;0.001) and less frequently ventricular ablation (28.2 vs 46.6%, p=0.013). Therapeutic hypothermia was used only in non ICD patients due to out of hospital cardiac arrest (33.8% vs 0%, p&amp;lt;0.001). In-hospital mortality was higher in non ICD carriers (28.2% vs 11.2%, p=0.003). Conclusion Despite a worse cardiovascular profile in ICD carriers, AS is associated with a worse haemodynamic situation and mortality in non ICD carriers, due to different aetiology of the AS and to the absence of protection against sustained arrythmias. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Beca para la Formaciόn e Investigaciόn en Cuidados Críticos Cardiolόgicos concedida por la Asociaciόn de Cardiopatía Isquémica y Cuidados Críticos Cardiolόgicosde la SEC Figure 1. Baseline CharacteristicsFigure 2. Pharmacological treatment

Differential lipids in pregnant women with subclinical hypothyroidism and their correlation to the pregnancy outcomes

Subclinical hypothyroidism (SCH) has become a prevalent complication in pregnancy. Recent research links SCH to disturbed thyroid lipid profile; however, it is unclear how lipid metabolism disorders contribute to the pathogenesis of SCH during pregnancy. Thus, we used nontargeted lipidomics to identify and compare the lipids and metabolites expressed by pregnant women with SCH and healthy pregnant women. Multivariate analysis revealed 143 lipid molecules differentially expressed between the SCH group and the control group. Based on fold change, 30 differentially expressed lipid metabolites are potential biomarkers. KEGG pathway enrichment analysis showed that the differentially expressed metabolites participate in several pathways, including response to pathogenic Escherichia coli infection, regulation of lipolysis in adipocytes, metabolic pathways, glycerophospholipid metabolism, and fat digestion and absorption pathways. Correlation analyses revealed sphingomyelin (SM) and phosphatidylcholine (PC) positively correlate to tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and interleukin-6 (IL-6), while phosphatidylglycerol (PG), and phosphatidylinositol (PI) negatively correlate with them. In addition, PG positively correlates to birth weight. Thus, the lipid profile of pregnant women with SCH is significantly different from that of healthy pregnant women. Lipid molecules associated with the differential lipid metabolism, such as SM, phosphatidylethanolamine (PE), and PI, should be further investigated for their roles in the pathogenesis of SCH in pregnancy, as they might be targets for reducing the incidence of adverse pregnancy outcomes.