Thyroid Function Abnormalities In Patients Research Articles

SAT594 Thyroid Dysfunction Is Very Common In Patients With Pheochromocytoma And Paraganglioma: A Cross-sectional Study

Abstract Disclosure: C. Ramirez-Renteria: Speaker; Self; Ipsen. M. Garcia-Saenz: None. N. Morin-Martinez: None. A. Albarran-Sanchez: None. Background: Thyroid function abnormalities are reported in 8-9% of the general population, but the prevalence may change according to different ages, populations, iodine intake, etc. Preoperatory evaluations for pheochromocytoma (Pheo) and paragangliomas (PGN) don’t include routine thyroid function tests, but uncontrolled hypo- or hyperthyroidism may result in adverse effects outcomes during surgery. Aim: to describe the frequency of thyroid function abnormalities in patients evaluated for Pheo and PGN in a referral center. Materials and Methods: All the medical files of adult patients evaluated for Pheo or PGN between January 2018 and December 2022 were reviewed. The available clinical, biochemical, imaging, and pathology data confirming the diagnosis were retrieved. We determined the frequency of patients with a previous diagnosis of thyroid disease, type of disease, and date of diagnosis and recorded the data of patients without a diagnosis but that had their thyroid function tested during the perioperative evaluation. Results: 359 patients with Pheo/PGN were evaluated, 72.7% had a neck PGN, 88% were women and the median age at diagnosis was 56.5 years (IQR 45-66), thyroid function tests were performed in 51.3%, and only 22.8% were normal, 20.9% had primary hypothyroidism, 3.9% had hypothyroidism after a procedure, 2.5% had hyperthyroidism, and 1.1% had thyroiditis. The patients with neck PGN were the most likely to present with hypothyroidism (p=0.006) and they were also the most likely to have hypothyroidism during follow-up, Abnormal thyroid images were found in 19.2%. Thyroid dysfunction was detected before the tumor in 21.5%, during the evaluation of the tumor in 25.8%, and after in 52.7%. Hypertensive cardiomyopathy was more common in patients with abnormal thyroid function (OR 1.969, CI 95% 1.052-3.685, p=0.032), as well as cardiomegaly (OR 2.145, CI 95% 1.200-3.835) and hypertension (OR 1.937, CI95% 1.269-2.956). Conclusions: Pheo/PGN are frequently associated with thyroid dysfunction. Heart disease and hypertension are more common in patients with both comorbidities. Thyroid function tests are suggested during perioperative evaluation in patients with a history of thyroid disease, thyroid abnormalities in imaging, poor blood pressure control, or heart disease. Thyroid function may require an additional evaluation in some cases during the follow-up of Pheo/Para. Presentation: Saturday, June 17, 2023

Biochemical Assessments of Thyroid Profile and Renal Function Test in Chronic Kidney Disease

Introduction: CKD is a clinical syndrome which occurs due to irreversible loss of renal function leading to metabolic, endocrine, excretory and synthetic function resulting in accumulation of non – protein nitrogenous substances which leads to metabolic derangements and ends up with distinct clinical manifestations. Aim: To study thyroid function abnormalities in patients with chronic kidney disease. To correlate the thyroid function abnormalities with severity of renal failure. To differentiate primary hypothyroidism from thyroid dysfunction due to chronic kidney disease. Methodology: After selection of patients, fulfilling the above criteria, about 5 ml of blood sample is collected in non-heparinised serum bottle and sent for thyroid profile test. Components of thyroid profile included in our study and Quantitative determination of T3, T4 and TSH is done by Enzyme Linked Immunosorbent Assay. Result: In our study out of 50 patients, 33 patients had low serum T3 levels . 4 patients among low serum T3 value, they also had low T4 and high TSH suggesting primary hypothyroidism. So excluding 4 patients of hypothyroidism 29 patients had low T3 syndrome in our study. Low T4 levels in our study, out of which 4 patients had low T3 and high TSH suggesting primary hypothyroidism. Conclusion: In my study population, 50 CKD patients who were on conservative management were studied. Among them 66% of the patients had low T3 values. The change in the serum levels of T3 and T4 in patients with CKD can be considered as being protective, promoting conservation of protein. There is increase in incidence of hypothyroidism in patients with chronic kidney disease.

Thyroid Function Abnormalities in Patients with Different Stages of Chronic Kidney Disease

Introduction: Thyroid hormones are crucial for renal development and physiology. Thyroidal hormones affect the cardiovascular system through their influence on renal blood flow as it modulates the glomerular function, the tubular secretory and absorptive capacities as well as the electrolyte pumps and the kidney structure. Objective: To assess the thyroid function abnormalities in patients with different stages of chronic kidney disease. Materials and Methods: The cross sectional observation study was conducted in Department of Medicine, 250 Bed District Hospital, Habiganj, Bangladesh from January to April 2021. Included 54 CKD patients not on dialysis, who are only on conservative management. Results: In our study the age matched graph shows that maximum number of patients in the category of 40-49 years with 8 males and 6 females, 50- 59 years had 8 males and 6 females, whereas between 60 to 69 years there were 6 males and 6 females. The extreme age groups had few patients chronic kidney disease above 70 there were 2 females and 2 males between 18-29 years there were 3 males and 3 females and 30-39 years had 1 male and 3 females. In our study the number of chronic kidney patients having low T3 were 39 which constitutes 72.2%,the patients with normal T3 were 12 constituting 22.2% and those with high T3 were 3, suggesting primary hyperthyroidism, so excluding them 75% of our patients had low T3 syndrome. In our study 39 patients had low T3, 26 had low T4 with 49 patients being normal TSH, only 4 had high high TSH. Excluding patients with primary hypothyroidism. Patients with low T3 low T4 were clustered in more towards end stage renal disease with 60%. Patients also were in moderate number with low T3 and low T4 in stage 4 chronic kidney disease. 20% in stage 3 chronic kidney disease T4 and TSH were almost normal with only 10% patients had low T3 syndrome. In stage 2 chronic kidney disease 10% had low T3, low T4 with rest being normal TSH. In our study patients .....

Thyroid Function Abnormalities in Patients with Chronic Kidney Disease

The function of the thyroid gland is one of the most important in the human body as it regulates the majority of the body's physiological actions. The thyroid produces hormones (T3 and T4) that have many actions including metabolism, development, protein synthesis, and the regulation of many other important hormones. There is a lot of interaction between the kidney and thyroid gland during the disease States thyroid hormones have a major role in regulating the glomerular filtration rate through its hormonal actions in normal physiology. But these things are altered in the disease States such as chronic kidney disease. It is a well-known fact that hypothyroidism causes decreased Glomerular filtration rate whereas hyperthyroidism causes increased Glomerular filtration rate leading to renin-angiotensin-aldosterone system activation. In our study we aim to see the prevalence of low T3 syndrome in different stages of CKD which is a state of physiological benefit in preserving the proteins lost through the Kidneys in CKD patients and since CKD is progressed in hyperthyroidism state it is a protective mechanism in restoring the CKD status. Other subclinical hypothyroidism hyperthyroidism. Autoimmune hypothyroidism. Glomerulonephritis are all part of a dynamic endocrine and nephrology sequence. Thorough knowledge of these is required for optimum treatment of thyroid in CKD patients.

Prevalence of Thyroid Function Abnormalities in Patients with Chronic Renal Failure under Regular Hemodialysis

Background: There are various changes in the thyroid gland and its function in end stage renal disease (ESRD). It is not surprising that impairment of kidney function leads to disturbed thyroid physiology. Objective: Is to detect thyroid function abnormalities in hemodialysis patients. Patients and Methods: 100 patients on maintenance hemodialysis (HD) were enrolled, they were excluded if they had the following criteria: history of thyroid disease, thyroid and parathyroid surgery, under interferon therapy, exposed to radiation, antithyroid drugs or thyroid replacement therapy, and those under 30 years. They were subjected to history taking, clinical examination and laboratory investigations including hepatitis C virological state, renal functions and thyroid functions. Results: 92% of patients had normal thyroid-stimulating hormone (TSH) levels, 8% had abnormal TSH levels. Regarding fT3 levels, 67 % had normal fT3 while 33 % had abnormal fT3, and only 11 patients had abnormal fT4. In respect to the thyroid hormone status, only one was hyperthyroid, 92% were in euthyroid status, 2% were clinically hypothyroid, 5% were subclinically hypothyroid, and 1% was hyperthyroid. There was significant negative correlation between TSH levels and dialysis duration, 8 patients having abnormal thyroid functions ere females, and 60% had HCV positive status. No significant associations were found between HCV infection and the thyroid hormones levels. However, HCV positive patients experienced lower levels of T4 and TSH. Conclusion: The average percentage of patients under regular hemodialysis with abnormal thyroid state is 8% with females having abnormal fT4 and TSH levels compared to males. TSH levels were inversely correlated with dialysis duration.

Study of Thyroid Function Abnormalities in Patients with Different Stages of Chronic Kidney Disease

Study of Thyroid Function Abnormalities in Patients with Different Stages of Chronic Kidney Disease

Thyroid Function Abnormalities in patients with Diabetes Mellitus Type II: A comparative Study

Thyroid Function Abnormalities in patients with Diabetes Mellitus Type II: A comparative Study

Silent thyroid function abnormalities in patients undergoing coronary angiography

Background: Iodine is an essential element in the formation of thyroid hormones, the body may encounter situations in which high iodine load occur in the body like doing the contrast studies using the iodine-containing contrast media. In most people, this iodine load is well-tolerable; however, in some others, this may result in derangements in the thyroid function, from which hyperthyroidism is the most common. Objective: The objective of the study is to determine the subclinical changes in the thyroid functions in a cohort of patients with coronary artery disease (CAD) undergoing coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). Materials and Methods: In this pilot study, a total of 101 patients with CAD undergoing CAG and/or PCI were recruited during the year 2018. All cases had normal thyroid function tests including (thyroid-stimulating hormone [TSH], free T4, and free T3) preprocedural. Six weeks after CAG/PCI serum TSH, free T4 and T3 were assessed again. Results: No significant differences were observed in levels of TSH, free T4, and free T3 between preprocedures (CAG/PCI) and after 6 weeks with P values (0.645, 0.135, and 0.807), respectively. In addition, no difference was found between the subgroup of CAG versus PCI. Conclusion: In euthyroid patients undergoing CAG/PCI minimal changes could occur in thyroid function. However, these changes are of limited significance in the short term.

Characterization of the onset of thyroid function (TF) abnormalities in patients receiving immune checkpoint inhibitor (CPI) therapy.

e22082 Background: Nivolumab (N), Pembrolizumab (P) and ipilimumab (I) are active cancer therapies, however; endocrinopathies are common immune-related adverse events (irAEs). The estimated incidence of TF abnormalities in patients receiving these agents is 10%. Methods: We performed a retrospective review of cancer patients who received CPI therapy with N, P, or I between July 2012 and November 2016 – for various indications- through our integrated community-based health system. The primary aim was to characterize the onset of TF abnormalities and the potential predictors of their development. Patients with pre-existing TF abnormalities, prior head and neck radiation, or prior thyroid surgery were excluded. TF abnormalities were classified as thyrotoxicosis (defined as low TSH, or an elevation of FT4 or FT3) or hypothyroidism (defined as an elevation in TSH, or a reduced level of FT4 or FT3). Patient demographics, diagnosis, treatment type, associated symptoms, and number of days before detection (NDBD) of TF abnormality were reviewed. Results: Of 361 eligible patients reviewed, 50 patients (13.85%) developed new onset of TF abnormalities. Among those with TF abnormalities, the median age at the time of receiving immunotherapy was 64. 29 patients (58%) received N, 12 received P (24%), 4 patients received I (8%), and 5 patients received N + I (10%). Thyrotoxicosis was the most commonly noted initial abnormality (n = 27, 54%), compared to hypothyroidism (n = 23,46%). Only 58% of patients had clinically evident symptoms. No significant difference was found between the mean of NDBD of TF abnormality between hypothyroidism and thyrotoxicosis (89 versus 78 days, P = 0.57). The time frame for TF abnormality detection was not significantly different between males and females receiving CPI therapy (71 versus 97 days, P = 0.17). Conclusions: The incidence of CPI related TF abnormalities at our center is similar to clinical trial findings. CPI therapy is associated with different patterns of TF abnormalities. The majority of patients who developed laboratory evidence of abnormal thyroid function were asymptomatic. Ongoing research is exploring the impact of these irAE on patient outcome.

Thyroid dysfunction in patients on antiretroviral therapy: A perspective from southern India.

Thyroid dysfunction in patients with human retroviral infection has been reported but the prevalence of thyroid function abnormalities in patients on highly active antiretroviral therapy (HAART) has not been studied. We aimed to assess the prevalence of thyroid dysfunction and autoimmunity (antithyroid peroxidase auto-antibodies [TPO-Ab]) in patients on first-line HAART, identify risk factors for thyroid dysfunction and determine any association of thyroid dysfunction with HAART. We screened and enrolled consecutive patients from the outpatient department if they were (i) diagnosed with HIV infection (enzyme-linked immunosorbent assay); (ii) aged more than 18 years; (iii) on HAART for 1 year or more; and (iv) clinically stable with no evidence of any acute illness in the past 2 months. We excluded patients who were on drugs that affect thyroid function. Thyroid function tests and CD4 counts were done. A total of 159 patients on firstline HAART were included in the study. Their mean (SD) age was 43.3 (10) years and duration of HAART was 44.4 (33.54) months. The mean CD4 count was 502.8 (274.45). Forty-seven patients (29.6%) had thyroid dysfunction. TPO-Ab positivity was noted in 6 patients. No association was seen between thyroid dysfunction and any type of regimen or drug. There was a significant negative correlation between CD4 counts and thyroid-stimulating harmone (TSH) suggesting that thyroid dysfunction may be more prevalent when immunity is low. There is a high prevalence of thyroid dysfunction, predominantly subclinical hypothyroidism, in patients on HAART. Thyroid autoimmunity is low in this subset of patients. Lower immunity is associated with higher TSH levels. Larger longitudinal studies are required to determine the course of hypothyroidism in patients on HAART.

“A Study of Thyroid Function Abnormalities in Patients with Chronic Kidney Disease”

BACKGROUND AND OBJECTIVES : Chronic Kidney Disease is a worldwide health problem with an increasing incidence and prevalence. Abnormalities in the structure and function of the thyroid gland and in the metabolism and plasma concentration of thyroid hormones are common in patients with Chronic Kidney Disease. In view of variability of thyroid profile in CKD patients in previous studies, a prospective study of various thyroid function has been undertaken to establish a correlation if any between thyroid dysfunction and severity of renal diseases. METHOD : Total number of 50 patients with Chronic Kidney Disease on conservative management fulfilling the criteria for CKD who were admitted in Department of Medicine, Coimbatore medical college & hospital, Coimbatore during the period of July 2014-July 2015 were selected in this prospective study. RESULTS : Out of the 50 patients with CKD 29 patients had low T3 syndrome (0.2-2.0ng/ml, mean 0.67) which accounts for 58% of the patients, 12 patients had low T4 syndrome (0.5-8.5μg/ml, mean 5.65) which accounts for 24% of the patients and 4 patients had primary hypothyroidism TSH >20μIU/ml. Excluding Primary Hypothyroidism, analysis of serum T3, T4 and TSH in the study subjects shows very high significance χ2 = 12.715, p < 0.001. Distribution of Thyroid Dysfunction in this study among various creatinine clearance levels showed that as glomerular filtration rate declines, number of patients with low T3 syndrome increased. In patients with low T3 syndrome, the mean values of TSH in various stages of renal disease are within normal range, values of TSH did not show any linear correlation with GFR. Number of patients with low T4 syndrome did not correlate with severity of renal disease. CONCLUSION : Thyroid Dysfunction occurred in 66%% of the patients with chronic kidney disease in our study, it does not indicate a state of hypothyroidism, but a reflection of the state of chronic illness/malnutrition. The low T3 state of CKD can be viewed as being protective, promoting conservation of protein. The number of patients with low T3 syndrome progressively increases with the severity of renal failure.

Peri-operative concerns in a patient with thyroid storm secondary to molar pregnancy.

Awareness of the presence of thyroid function abnormalities in patients with molar pregnancy is important for its prompt diagnosis and management. We report the development of thyroid storm in the immediate post-operative period in a 25-year-old female who underwent evacuation of her molar pregnancy under saddle spinal block after being controlled for her thyrotoxicosis with a combination of antithyroid drugs, iodine, steroids and adrenergic blocking agents. We advocate the use of esmolol infusions up to a maximum dose of 200 μg/kg/min for immediate haemodynamic management of the patient. Optimum time needed for stabilisation of the hyper metabolic state after initiation of antithyroid drugs is still not known and evacuation of molar pregnancy remains the only definitive management of the thyrotoxic state.

Evaluation of the profile of alopecia areata and the prevalence of thyroid function test abnormalities and serum autoantibodies in Iranian patients.

BackgroundThe study aimed at evaluating the prevalence of thyroid function abnormalities in patients with alopecia areata (AA) and its association with other autoimmune diseases and various autoimmune antibodies.MethodWe retrospectively analyzed medical records of 123 patients with AA. The main site of involvement, pattern, and extent of alopecia as well as presence of the similar disease in first-degree family members and serologic status of patients were recorded.ResultsParticipating in the study were 57 males and 66 females (6 to 59 years old). In the majority of patients (69.9%) the disease was manifested in the first two decades of life. Patients with family members having alopecia were recorded in 24.4%. Thyroid function abnormalities were found in 8.9% of patients. Positive autoimmune antibodies were associated with AA in 51.4% of patients with no significant association between the severity and duration of disease and presence of these antibodies.ConclusionThe incidence of positive auto-immune antibodies in Iranian patients is higher than previous reports. Concerning the female:male ratio, thyroid function tests and the prevalence of alopecia in first-degree relatives, our results are compatible with previous data obtained from different ethnic populations. Previous reports documented that a greater severity and longer duration of AA were seen in the early onset forms; however our result are relatively different which could be explained by differences in genetic factors.

The incidence of thyroid function abnormalities in patients attending an outpatient lipid clinic

The incidence of thyroid function abnormalities in patients attending an outpatient lipid clinic

The incidence of thyroid function abnormalities in patients attending an outpatient lipid clinic.

Thyroid disorders are known to influence lipoprotein metabolism. In the current study we examined the incidence of thyroid function abnormalities in patients attending our outpatient lipid clinic. During the last 2 years, 248 patients were admitted to our lipid clinic for the diagnosis and management of dyslipidemia. In all cases, a detailed medical history was obtained and a thorough physical examination was performed with emphasis on the presence of symptoms/signs indicative of underlying thyroid diseases. In addition to lipid parameters, thyrotropin (TSH) and free thyroxine (FT4) levels were measured in a fasting blood sample. Seven female asymptomatic patients (2.8%) had frank biochemical hypothyroidism, and 11 patients (9 female, 2 male) (4.4%) had subclinical hypothyroidism with TSH levels between 5.8-19 mU/L. After restoration of a euthyroid state with levothyroxine therapy, no significant changes in serum lipid parameters were observed in the whole group of patients with subclinical hypothyroidism. However, in 4 patients with TSH levels >12 mU/L relatively small doses of levothyroxine (75 microg/day) were followed by a significant improvement of serum lipid profile. Interestingly, 3 patients exhibited clinical or subclinical hyperthyroidism that influenced serum lipid parameters as well as the effectiveness of hypolipidemic treatment. It is concluded that thyroid function abnormalities are relatively common in dyslipidemic patients attending a lipid clinic and could significantly affect the patients' lipid profile as well as the patients' management.

Thyroid function in patients maintained on lithium

To determine the clinical significance of thyroid function abnormalities in patients maintained on lithium, the authors evaluated the relationships of thyroid function tests to clinical response to lithium and side effects from lithium in 20 outpatients meeting DSM-III criteria for major affective disorder. No significant relationships were found between baseline thyroid function test and clinical response. Thyroxine (T 4) and triiodothyronine uptake ratio (T 3UR) within the normal range were found to be associated with complaints of lethargy and cognitive impairment. Thirteen subjects were followed prospectively for 6 months with monthly evaluations of affective state, side effects, and occurrence of relapse. Thyroid function tests were repeated at the final visit. Final and mean T 3 levels within the normal range were found to be significantly lower in patients who relapsed, and mean T 3 level was inversely correlated with affective state as measured by mean scores on the Hamilton Rating Scale for Depression and the Young Mania Rating Scale.