Altered Thyroid Function Research Articles

Increased thyroxine levels of patients with allergic rhinitis

Allergic rhinitis and asthma are common respiratory conditions with complex etiologies involving genetic, environmental, and physiological factors. In these conditions, the role of thyroid function remains underexplored. This study enrolled 116 participants with a mean age of 29.55 years: 66 with allergic rhinitis, 20 with concomitant asthma, and 30 healthy controls. BMI and serum IgE, T3, T4, and TSH levels were measured. A significant familial history of atopy was reported by 66.4% of participants. Skin prick tests revealed predominant sensitivity to house dust mites (55.2%). BMI was within normal ranges across all groups, serum IgE levels were significantly elevated in patients with respiratory allergies compared to controls (Mean = 36.85 IU/mL), especially those with allergic rhinitis and concomitant asthma (Mean = 218 IU/mL). Significant differences in serum T4 levels were observed, particularly among those with allergic rhinitis (p < 0.001 and p < 0.05). Pearson correlation analysis revealed significant associations between age, BMI, and thyroid hormones, with notable sex-specific differences (p < 0.05 and p < 0.01). The study highlights the complex interplay between metabolic, endocrine, and immune responses in respiratory allergies. Elevated serum IgE levels and alterations in thyroid function, particularly among males, suggest potential pathways for targeted therapeutic interventions. Further research is needed to elucidate these relationships and their underlying mechanisms.

Thyroid Function and Brain Structure: Insight from a Mendelian Randomization Study

Introduction: Thyroid hormones play a critical role in brain development. However, the precise causal associations between thyroid function and structural changes in specific brain regions remain uncertain. Methods: We applied the univariate Mendelian randomization (UVMR) method to assess the causal effects of thyroid function on brain structure. Genome-wide association study (GWAS) data on thyroid-related traits from the ThyroidOmics Consortium including free thyroxine (FT4), free tri-iodothyronine (FT3), thyroid-stimulating hormone (TSH), FT3/FT4 ratio, as well as dichotomized high and low TSH levels were used as exposures. GWAS data on cortical thickness, surface area, and volume of subcortical structures served as outcomes. Inverse variance weighted was the main estimate method. Subsequently, multivariable MR (MVMR) was conducted to validate significant causal associations identified in UVMR. Results: UVMR analysis demonstrated a statistically significant inverse association between genetically predicted FT4 and putamen volume (β = −71.91 mm3, 95% confidence interval: −112.11 mm3 to −31.71 mm3, p = 4.54 × 10−4). The findings were robust in sensitivity analysis. MVMR analysis further confirmed a persistent causal relationship between FT4 and putamen volume after adjusting for FT3, TSH, and neuropsychiatric disorders. Functional enrichment analyses indicated the pathways by which FT4 influences putamen volume may be related to the thyroid hormone signaling pathway, sodium-independent organic anion transport, and Rap1 signaling pathway. Conclusion: MR analysis provides evidence for causal relationships between thyroid function and brain structural alterations, particularly highlighting the impact of FT4 on putamen volume. Further research is warranted to elucidate the underlying mechanisms by which thyroid hormones modulate brain structure.

Fluoride exposure and risk of fractures: a systematic review and dose-response meta-analysis

Abstract Introduction Fluoride (F) is a widespread natural element, whose exposure occurs mostly through drinking water, fluoridated foods and use of toothpastes. At high levels, it may adversely affect human health by altering thyroid and cognitive function in children, and inducing dental and skeletal fluorosis. Since bone health significantly impacts quality of life, we performed a systematic review and meta-analysis to evaluate the effect of F exposure on risk of bone fractures. Methods We conducted a literature search in online databases and selected studies that were carried out in humans and reported risk estimates with 95% confidence intervals for bone fractures according to F exposure. We eventually performed a meta-analysis using a random effects model, comparing the highest versus the lowest exposure, and one-stage dose-response model, to explore the shape of the association. Results Of the 1052 potentially eligible articles, 28 were included in the quantitative analyses. Most studies were conducted in adults (n = 26) and in Western countries (North America=16, Europe=11) and assessed fluoride exposure in drinking water, urine, serum, toenail or diet. The preliminary dose-response curve showed a positive non-linear relation between F exposure through drinking water and bone fracture risk, regardless of site, starting at 1.5 mg/L. Sex-stratified analyses, based on a lower number of studies, showed similar trends, with an indication of higher susceptibility in males compared with females. Conclusions Overall, risk of bone fractures appears to non-linearly increase along with exposure to fluoride in drinking water, regardless of bone site and sex, at levels of exposure above the WHO standard and similar to those that have associated to altered thyroid and cognitive function. Under a public health perspective, fluoride in drinking water should be kept below 1.5 mg/L to prevent bone fractures. Key messages • Our analysis revealed a positive non-linear association between fluoride in drinking water and bone fracture risk. • Public Health actions should be oriented in keeping fluoride in drinking water below 1.5 mg/L to prevent bone fractures.

Evaluation of Thyroid Function and Its Relation to Glycemic Status in Pregnant Women With Gestational Diabetes Mellitus.

Background Gestational diabetes mellitus (GDM) is a prevalent complication during pregnancy that can lead to adverse outcomes for both the mother and the fetus. It also increases the likelihood of developing type 2 diabetes mellitus (T2DM) later in life. Thyroid hormones play an essential role in regulating growth and metabolism and often coexist with diabetes mellitus (DM), affecting glucose metabolism. Pregnant women with GDM frequently exhibit thyroid issues, impacting insulin secretion and beta-cell function. Aim This study aims to assess thyroid function and glycemic status in pregnant women with and without GDM and to evaluate the correlation between thyroid function and glycemic status in pregnant women with GDM. Methods This prospective case-control study was conducted over two months at a tertiary care hospital in Puducherry, India. It included 60 cases (pregnant women with GDM, blood glucose > 140 mg/dL per DIPSI guidelines) and 60 age- and parity-matched controls. Blood samples were collected, centrifuged, and analyzed for blood glucose and serum thyroid levels (FT3, FT4, thyroid-stimulating hormone (TSH)) using the Cobas e-411 autoanalyzer through an electrochemiluminescence assay. Results Serum plasma glucose levels were significantly higher in cases (159.25 ± 16.22 mg/dL) compared to controls (101.6 ± 17.30 mg/dL) (p < 0.05). FT3 levels were higher in cases (3.98 ± 4.18) compared to controls (2.87 ± 0.54) (p = 0.04). The FT3/FT4 ratio was also higher in cases (3.99 ± 4.927) than in controls (2.70 ± 0.58) (p = 0.04). No significant differences were found in FT4 or TSH levels between the groups. Correlation analysis revealed no significant correlations between plasma glucose levels and thyroid function parameters. Conclusion Pregnant women with GDM showed significantly higher plasma glucose levels, FT3 levels, and FT3/FT4 ratio compared to normal pregnant women. These findings suggest an association between altered thyroid function, particularly higher FT3 levels and the FT3/FT4 ratio, and GDM.

PFAS-mediated disruptions on thyroid histology

Abstract Introduction/Objective Per-and polyfluroalkyl substances (PFAS), are environmental contaminants of emerging concern due to their abundance in the environment and potential adverse health impacts. PFAS are used in waterproof clothing, makeup, carpets, upholstery, cookware, and fast-food containers. These organic pollutants have been found in the blood of 98% of Americans and have been linked to disruption in thyroid hormones. During fetal life, thyroid hormones are crucial for brain development and alterations in these hormones can induce long-term impacts on intellectual and brain impairments. T3 and T4 are known to be altered by PFAS exposure, but the mechanism by which this is done remains unclear. Methods/Case Report Normal thyroid cells were treated for 72 hours with 1000 nM solution containing either GEnX, PFOA, PFOS, or 1% DMSO control. Immunofluorescence for actin, tubulin, and DAPI was performed using a Nikon spinning disk. In vivo studies where 8-week-old mice are gavaged with 7.5 mg/kg of PFOS, PFOA, and GenX or PBS control for 8 weeks. Results (if a Case Study enter NA) We hypothesized the PFAS treatment alters thyroid cells morphology and histology. Immunofluorescence staining of normal thyroid cells treated with PFAS show a decrease in actin stress fibers compared to control cells. PFAS treated mice show a decrease in follicle size compared to control (average 1017 um2 size, p=0.0483). Conclusion This is the first study to show changes in thyroid histology after 8 weeks of PFAS exposure. As structure and function are closely linked, it is likely that this reduction in follicle size and actin reorganization contribute to alterations in thyroid function. Future studies are needed to illuminate the mechanism by which PFAS alter thyroid function in vivo. Understanding the role of PFAS-mediated thyroid dysregulation will have far reaching implications on environmental regulations and considerations for limiting PFAS in our environment.

7410 Bevacizumab Induced Hypothyroidism

Abstract Disclosure: A.L. McKenna: None. S. Thota-Kammili: None. K. Grennan: None. S. Rao: None. It is known that thyroid dysfunction is an adverse effect of tyrosine kinase inhibitors (TKIs) via inhibition of the vascular endothelial growth factor receptor (VEGFR). The VEGF signaling pathway is important in regulating angiogenesis in tumors and normal tissue. As a highly vascularized gland, it is expected the thyroid may be compromised because of VEGFR inhibitors. Proposed mechanisms of thyroid dysfunction include capillary regression and constriction leading to reduced vascular perfusion to the gland. Bevacizumab is a monoclonal antibody that targets VEGF and inhibits activation of VEGFR, reducing angiogenesis; interestingly, this is not commonly reported in the literature. Here we present a case where bevacizumab altered thyroid function in a patient with pre-existing primary hypothyroidism. A 60-year-old woman presented with worsening hypothyroidism. She reported a history of nonautoimmune primary hypothyroidism diagnosed in her early 20s; she still had an intact thyroid with no history of head/neck radiation. In the months leading to the presentation, she had been receiving maintenance chemotherapy with 5 fluorouracil and bevacizumab every 2 weeks for metastatic duodenal carcinoma. Prior to starting chemotherapy, she had been on a steady dose of 112 mcg of levothyroxine (LT4) daily. After 6 months on chemotherapy, she reported symptoms of fatigue and hair loss. Workup revealed an elevated TSH of 41 mIU/L (reference 0.3-4.2 mIU/L). She denied any significant changes in weight or malabsorption issues. Aside from the chemotherapy, no other new medications were introduced. Her LT4 dose was increased to 137 mcg daily, and 3 months later, there was improvement in TSH to 6.5 mIU/L as well as her symptoms. At this point, bevacizumab was briefly on hold for 2 months due to an upcoming procedure, hence there was no change to LT4 to avoid over correction. Her TSH normalized and was trending lower while bevacizumab was on hold. Once bevacizumab resumed, LT4 was preemptively increased to 150 mcg daily. Four months after resuming bevacizumab, her TSH remains within the normal reference range on 150 mcg LT4. It is hypothesized that this VEGF blocker led to worsening of her underlying hypothyroidism.Given the shared down regulation in the VEGF signaling pathway, it would be expected that TKIs and monoclonal antibodies against VEGF would share similar adverse reactions to the thyroid. However, to our knowledge, there have been limited reports of bevacizumab induced thyroid dysfunction in the literature. Explanations to this may include the more targeted VEGF inhibition with bevacizumab versus the inhibition of multiple kinase receptors from the TKIs. Further research into this will be needed. This case demonstrates that bevacizumab can impact thyroid function and thyroid labs may need to be monitored at the onset and during VEGF inhibitor therapies. Presentation: 6/3/2024

Relation between Helicobacter pylori Infection and Autoimmune Thyroid Disease in a Sample of Pediatric Patients

Abstract Background Autoimmune thyroid diseases (ATDs) are heterogeneous group of acquired disorders that are characterized by the presence of circulating anti-thyroid antibodies, infiltration of the thyroid gland by reactive B and T lymphocytes in addition to altered thyroid function. This study aimed to explore the thyroid function profile and H. pylori infection in a sample of pediatric patients with autoimmune thyroid disease. Methods This case control study included 31 pediatric patients diagnosed with ATDs proven by positive thyroid autoantibodies and 31 healthy age and sex matched children were included as control group. Detailed history including clinical manifestations and treatment modalities were taken. Free T4, free T3, TSH, anti-thyroglobulin and anti-tissue peroxidase, H. Pylori stool antigen and thyroid ultrasound were done. None of our included children have received treatment for H. pylori infection. Results Out of the 31 patients, 11 were diagnosed with Graves’ disease (35.48%) while 20 were diagnosed with Hashimoto thyroiditis (64.52%) with mean age of 13.515 ± 3.176 and 14.081 ± 2.715 years respectively. There is no statistically significantly difference in thyroid ultrasound findings in children with GD and HT. H. pylori infection was significantly higher in children with ATDs (51.6%) in comparison to healthy children (25.8%). 17 of the 31 children with ATDs had dyspeptic symptoms with insignificant difference between H. pylori positive and negative children. Regarding treatment modalities, 18 of children with ATDs (58.1%) were controlled on medications while 13 were uncontrolled (41.9%) and needed frequent adjustment of doses or surgical intervention. 19 children with HT (95%) and 7 children with GD (63.6%) received medical treatment only, while 1 patient with HT (5%) and 4 children with GD (36.4%) underwent thyroidectomy after a duration ranged from 3 to 6 years of medical treatment. In Conclusion Hashimoto thyroiditis was the most prevalent ATD in pediatric age group. H. Pylori infection is more frequent in children with ATDs. Medications alone may be insufficient to achieve symptoms control in children with AUTs and surgical intervention may be required. Further studies are required to evaluate the impact of H. pylori infection eradication on thyroid function in children with ATDs.

Zinc and Ferritin Levels and Their Associations with Functional Disorders and/or Thyroid Autoimmunity: A Population-Based Case-Control Study.

Population zinc and iron status appear to be associated with an increased risk of thyroid function abnormalities and thyroid autoimmunity (AITD). In the present study, we aimed to determine whether zinc and/or iron levels (assessed by ferritin levels) were associated with the presence of AITD and with alterations in thyroid function. A population-based case-control study (n = 1048) was conducted (cases: n = 524; controls: n = 524). Participants were measured for blood concentrations of zinc and ferritin, TSH, FT4, FT3, and thyroid autoantibodies. No significant differences were found in relation to ferritin levels between cases and controls. Among cases, the prevalence of low zinc levels in those with hypothyroidism (both subclinical and overt) was 49.1% [odds ratio (OR) of low zinc levels: 5.926; 95% CI: 3.756-9.351]. The prevalence of low zinc levels in participants with hyperthyroidism (both subclinical and overt) was 37.5% [OR of low zinc levels: 3.683; 95% CI: 1.628-8.33]. The zinc value that best discriminated the highest frequency of AITD was 70.4 µg/dL [sensitivity: 0.947, 1-specificity: 0.655, specificity: 0.345]. The highest frequency of AITD was calculated based on a zinc value <70 µg/dL (relative to a normal value), with this frequency being significantly higher in cases than in controls [OR: 9.3; 95% CI: 6.1-14.3 (p = 0.001)]. In conclusion, the results of our study suggest that zinc deficiency is associated with an increased frequency of functional thyroid disorders and thyroid autoimmunity.

Perinatal exposure to Aroclor 1254 disrupts thyrotropin-releasing hormone mRNA expression in the paraventricular nucleus of male and female rats

Polychlorinated biphenyls (PCBs) are industrial pollutants that act as endocrine disruptors and alter thyroid function. However, it is still unclear whether PCBs can affect hypothalamic thyrotropin releasing hormone (Trh) mRNA expression through TH signaling disruption. As salt-loading dehydration induces tertiary hypothyroidism in the hypothalamic parvocellular paraventricular nuclei (paPVN), and perinatal exposure to Aroclor 1254 (A1254) disrupts the hydric balance in rats, we hypothesized that TRH synthesis could be altered during dehydration in TRH neurons that control the hypothalamic–pituitary–thyroid (HPT) axis activity in rats perinatally exposed to A1254. We examined Trh mRNA expression in the paPVN and the response to salt-loading dehydration (hyperosmotic (hyper) stress) in the progeny of Wistar pregnant rats receiving 0 mg/kg BW (control) or 30 mg/kg BW A1254 daily from gestational days 10–19. Three-month-old offspring were subjected to normosmotic or hyper conditions and Trh mRNA, glucocorticoid receptor (GR) mRNA expression were measured in the PVN by RT-PCR. TRH mRNA and TRH+ neurons were measured in the paPVN by fluorescent in situ hybridization (FISH). As expected, Trh mRNA levels were decreased in the paPVN of male and female rats in the hyper group. Basal Trh mRNA expression and serum TSH were decreased in male rats in the A1254 group. Notably, Trh mRNA levels were further decreased in the paPVN of male and female A1254 + hyper rats, in which the GR mRNA expression was significantly decreased. These results support the hypothesis that perinatal exposure to A1254 results in inadequate adaptive response of the HPT axis in adulthood and contributes to dysregulation of the HPT axis response to salt-loading dehydration.

The impact of environmental factors and contaminants on thyroid function and disease from fetal to adult life: current evidence and future directions.

The thyroid gland regulates most of the physiological processes. Environmental factors, including climate change, pollution, nutritional changes, and exposure to chemicals, have been recognized to impact thyroid function and health. Thyroid disorders and cancer have increased in the last decade, the latter increasing by 1.1% annually, suggesting that environmental contaminants must play a role. This narrative review explores current knowledge on the relationships among environmental factors and thyroid gland anatomy and function, reporting recent data, mechanisms, and gaps through which environmental factors act. Global warming changes thyroid function, and living in both iodine-poor areas and volcanic regions can represent a threat to thyroid function and can favor cancers because of low iodine intake and exposure to heavy metals and radon. Areas with high nitrate and nitrite concentrations in water and soil also negatively affect thyroid function. Air pollution, particularly particulate matter in outdoor air, can worsen thyroid function and can be carcinogenic. Environmental exposure to endocrine-disrupting chemicals can alter thyroid function in many ways, as some chemicals can mimic and/or disrupt thyroid hormone synthesis, release, and action on target tissues, such as bisphenols, phthalates, perchlorate, and per- and poly-fluoroalkyl substances. When discussing diet and nutrition, there is recent evidence of microbiome-associated changes, and an elevated consumption of animal fat would be associated with an increased production of thyroid autoantibodies. There is some evidence of negative effects of microplastics. Finally, infectious diseases can significantly affect thyroid function; recently, lessons have been learned from the SARS-CoV-2 pandemic. Understanding how environmental factors and contaminants influence thyroid function is crucial for developing preventive strategies and policies to guarantee appropriate development and healthy metabolism in the new generations and for preventing thyroid disease and cancer in adults and the elderly. However, there are many gaps in understanding that warrant further research.

Clinicopathological Evaluation of Thyroid Dysfunction in Women with Abnormal Uterine Bleeding

Introduction: Abnormal uterine bleeding describes any variation from normal bleeding patterns in nonpregnant, reproductive-aged women beyond menarche lasting for at least 6 months. Regular cyclic menstruation results the choreographed relationship between the endometrium and its regulating factors. Any type of disturbance between the regulatory mechanism of pituitary ovarian axis or pelvic diseases results in abnormal uterine bleeding. Thyroid hormones play a key role in the menstrual and reproductive function of women. It is recognized universally that menstrual disturbances may accompany clinical alterations in thyroid function. Objectives: To evaluate the thyroid dysfunction in patients with abnormal uterine bleeding. Materials and Methods: This cross sectional study was conducted in Department of obstetrics &amp; gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from April 2023 to December 2023. Women with abnormal uterine bleeding were included in the study. Sample was selected by purposive sampling. Sample size was 100. Detail demographic data were collected from the informant and recorded in structured case report form. Clinical examination and relevant investigation were done meticulously. Data was collected by using a semi-structured questionnaire. Data was processed and analysed with the help of computer program SPSS and Microsoft excel. Quantitative data expressed as mean and standard deviation and qualitative data as frequency and percentage. Result was presented in the form of tables, pie chart, graphs, bar diagrams, histogram &amp; charts etc. Results: In this study, the maximum numbers of cases (43.0%) were between 26-35 years age group. Mean age was 29.57 ± 8.27 years. Large numbers of respondents came from urban area (58%). On evaluation of types &amp; causes of AUB, maximum patient belongs to AUB-L (leiomyoma) group (53%) followed by AUB-A (adenomyosis) (28%); AUB-P (polyp) (8%); AUB-O (ovulatory) (9%) and AUB-M (malignancy) (2%). Present study showed that prevalence of thyroid disorders is 26% in AUB patients. The prevalence of Hypothyroidism was 18% and Hyperthyroidism was 8%. Thyroid dysfunction is associated with menstrual abnormalities in females of all age groups. Conclusion: Abnormal uterine bleeding has a strong association with thyroid disorders. The most common type of disorder is subclinical hypothyroidism. Thus, all patient of AUB must be evaluated for thyroid dysfunction. Medicine Today 2023 Vol.36 (1): 1-6

Thyroid Hormone Status in Children Taking Antiepileptic Drugs (AEDs): An Experience in a Tertiary Care Hospital of Bangladesh.

Introduction: Antiepileptic drugs (AEDs) may alter thyroid hormone homeostasis at the level of biosynthesis, release, transport, metabolism and excretion of thyroid hormones. The purpose of the study was to see the thyroid hormone status in children with epilepsy treating with common antiepileptic drugs. Materials &amp; Method: The cross-sectional study was carried out in department of pediatric neurology, National Institute of Neurosciences and Hospital (NINS), Dhaka. One hundred and sixty epileptic children aged 1 year to 14 years who were on monotherapy or polytherapy with the most commonly used Antiepileptic drugs (AEDs) for at least 6 months or more were enrolled. Serum TSH and FT4 were measured in all selected patients with early morning serum sample. Result: Nearly one third of study subjects had thyroid dysfunction, most of which were Subclinical hypothyroidism (SCH). The frequency of SCH was 29.2% in carbamazepine(CBZ), 50% in oxcabazepine (OXC), 28.6% in phenobarbitone(PHB) and 13% in valproic acid (VPA) treated epileptic children. No child was found to have subclinical hypothyroidism with topiramate and ethosuximide monotherapy. Antiepileptic drugs (AEDs) monotherapy or polytherapy had no significant difference in alteration on thyroid hormone level. Use of CBZ for long duration significantly altered thyroid function. Doses of Antiepileptic drugs (AEDs) didn’t show any significant thyroid dysfunction. Conclusion: Commonly used Antiepileptic drugs (AEDs) in children with epilepsy were associated with alteration of thyroid hormones, most commonly subclinical hypothyroidism. BANGLADESH J CHILD HEALTH 2022; VOL 46 (2) : 58-64

Long-Term Effects of 0.1 mg Recombinant-Human-Thyrotropin-Stimulated Fixed-Dose Radioiodine Therapy in Patients with Recurrent Multinodular Goiter after Surgery.

(1) Background: After thyroid malignancy is ruled out, treatment options for multinodular goiter patients include surgery, levothyroxine suppressive therapy, and 131-I therapy. Surgery effectively reduces goiter size but carries risks of surgical and anesthetic complications. 131-I therapy is the only nonsurgical alternative, but its effectiveness diminishes with goiter size and depends on iodine sufficiency. This study aimed to assess the efficacy and safety of 0.1 mg rhTSH as an adjuvant to a fixed dose of 131-I therapy in patients with a recurrence of large multinodular goiter, several years after the initial thyroidectomy. (2) Methods: 14 patients (13 females and 1 male), aged 59.14 ± 15.44 (range, 35-78 years) received 11mciu of 131-I, 24 h after the administration of 0.1 mg rhTSH. The primary endpoint was the change in thyroid volume (by ultrasound measurements) as well as in the diameter of the predominant nodule during a follow-up period of 10 years. Secondary endpoints were the alterations in thyroid function and potential adverse effects. (3) Results: A significant decrease in the volume of initial thyroid remnants (32.16 ± 16.66 mL) was observed from the first reevaluation (at 4 months, 23.12 ± 11.59 mL) as well as at the end of the follow-up period (10 years, 12.62 ± 8.76 mL), p < 0.01. A significant reduction in the dominant nodule was also observed (from 31.71 ± 10.46 mm in the beginning to 26.67 ± 11.05 mm). (4) Conclusions: Further investigation is needed since this approach could be attractive in terms of minimizing the potential risks of reoperation in these patients.

Thyroid dysfunction and semen quality among males investigated for infertility in Southern Nigeria

The relationship between thyroid and testis is well understood, and the association between changes in thyroid function and male infertility has been reported. However, the contribution of thyroid dysfunction to male infertility is not sufficiently addressed in our setting. This study aims to assess the thyroid hormones level among males undergoing investigation for infertility and to establish correlations between thyroid hormones and sperm indices. Thyroid hormones were determined in 150 infertile males and 50 fertile male controls. Semen analysis was done according to the World Health Organization criteria while thyroid hormones were determined using Enzyme linked Immunosorbent assay technique. The measured anthropometric data, sperm indices and thyroid hormone levels were compared using appropriate statistical tools. Serum triiodothyronine, and thyroxine levels were significantly lower (p &lt; 0.001), while thyroid stimulating hormone was higher among infertile males than control subjects. The body mass index of the infertile subjects was significantly higher (p &lt; 0.011) than control subjects. Of the 150 subjects, 41.33% (62/150) were euthyroid, 7.33% (11/150) had subclinical hypothyroidism while 51.34% (77/150) had overt hypothyroidism. Among the 88 altered thyroid function, 6.82% (6/88) had normozoospermia, 44.32% (39/88) had oligozoospermia while 48.86% (43/88) were azoospermia. The area Under the Curve of T3 (0.858), T4 (0.765) and sperm count (0.875) were able to differentiate fertile men from infertile subjects. Thyroid disorders are prevalent among infertile men and should be considered in the laboratory assessment of male infertility cases. Including thyroid function tests in the investigative panel can help identify and manage potential thyroid-related factors contributing to infertility. This comprehensive approach ensures thorough evaluation and targeted treatment for better reproductive outcomes in affected individuals.

A Cross-Sectional Study of Acute Coronary Syndrome and Thyroid Profile: Dissecting the Relationship to Improve Patient Care.

Thyroid-releasing hormones are pivotal in regulating cardiovascular (CVS) function and maintaining its hemodynamics and homeostasis. Even a minor alteration in thyroid function has an enormous implication on CVS morbidity and mortality. Moreover, hypothyroidism was found to be a potential menace for coronary artery disease (CAD).The objective of this study was to determine the role of thyroid-releasing hormones in patients suffering from acute coronary syndrome (ACS). Among a cohort of 100 patients suffering with ACS, a complete history and clinical information followed by physical examinationand electrocardiography were recorded. Blood samples were also collected to record the blood sugar levels i.e., fasting blood sugar (FBS), postprandial blood sugar (PPBS), and thyroid profile, including free thyroid stimulating hormone (TSH), free thyroxine (fT4), free triiodothyronine (fT3), and reverse triiodothyronine (rT3). The data was analyzed using SPSS version 26 software (IBM Corp., Armonk, NY, USA). The study identified alterations in the thyroid hormone levelsin 27% of patients suffering from ACS. The prevalence of euthyroid sick syndrome was found to be 59.3%, while subclinical hypothyroidism and subclinical hyperthyroidism were reported among 18.5% and 14.8% of patientsrespectively. Therewas no significant difference found between males and females. The study illustrated a greater occurrence of aberrant thyroid hormone profiles among those aged 40-60 years. The ST-elevated myocardial infarction (STEMI) group had a statistically significant higher prevalence of an aberrant thyroid hormone profile compared to the non-ST-elevated myocardial infarction (NSTEMI) and unstable angina (UA)groups (p=0.02). A total of nine patients died with ACS and all of those had statistically significant low fT3 and TSH values while higher rT3 values (p<0.05). An atypical thyroid status has been found to elevate the likelihood of developing CAD and experiencing CVS mortality. This condition can impact ventricular function and serum cholesterol levelsas well as heart rate and rhythm. Therefore, understanding this relationship could potentially lead to improved treatment strategies for individuals with ACS which will further prevent major CVS complications.

Effect of Hypothalamic Adrenal Axis and Thyroid Function Alterations on Prognosis of Critically Ill COVID-19 Patients

Effect of Hypothalamic Adrenal Axis and Thyroid Function Alterations on Prognosis of Critically Ill COVID-19 Patients

Evaluation of the Thyroid Hormone Status among Normal New Born Preterm Infants

Introduction: Thyroid dysfunction poses a greater risk in preterm newborns (PN) compared to term newborns (TN), often eluding detection in neonatal screening due to delayed thyrotropin (TSH) elevation in these cases. Objective: To assess thyroid function during the second week of life in PN born before 32 weeks gestation and identify factors associated with its alteration. Methods: A retrospective study examined thyroid function in &lt; 32 weeks gestation neonates, analyzing thyroxine (T4L) and TSH levels in relation to perinatal and neonatal outcomes. The study included 358 patients with a mean gestational age of 29.3 weeks and a mean birth weight of 1127 grams. Results: Linear correlations were observed between T4L and birth weight (BW) (R=0.356; p&lt;0.001) and gestational age (GA) (R=0.442; p&lt;0.001). TSH values were associated with small for gestational age (SGA) (5.3 mU/L [1.5-37] for SGA vs. 2.89 mU/L [0.2-19.5] for non-SGA; p&lt;0.001), inotropic support (3.98 mU/L [0.6-22.9] for Yes vs. 3.16 mU/L [0.2-37] for No; p=0.019), and BW (R=-0.249; p&lt;0.001). Levothyroxine treatment was administered to 2.5% of patients, with six being SGA. Conclusions: Analyzing thyroid function in the second week aids in identifying asymptomatic newborns at risk of thyroid dysfunction, particularly in the case of SGA newborns who exhibit a higher susceptibility to thyroid function alterations.

Screening for Delayed Thyroid Stimulation Hormone Rise and Atypical Congenital Hypothyroidism in Infants Born Very Preterm and Infants with Very Low Birth Weight

ObjectiveTo determine among infants born very preterm (VPT) or with very low birth weight (VLBW) the incidence of alterations in thyroid function and associated co-morbidities; the incidence of atypical congenital hypothyroidism (CH) requiring thyroxine therapy; and 3) reference ranges for re-screening at one month of age. Study designA retrospective review of infants born VPT or with VLBW and admitted to UCI Medical Center between 1/1/2012 and 12/31/2020. Repeat thyroid screening was obtained at 1 month of life (+ 10 days). Infants with TSH >5 μIU/mL or FT4 <0.8 ng/dL underwent follow-up testing and endocrinology consultation. Initial newborn screening (NBS) and repeat thyroid screening data were collected via chart review. Demographic data and short-term outcomes were abstracted from the California Perinatal Quality Care Collaborative database. Results430 patients were included. 64 out of 429 patients (14.9%) had TSH >5 μIU/mL and 20 of 421 patients (4.8%) had FT4 <0.8 ng/dL. Logistic regression analysis identified small for gestational age (p = 0.044), patent ductus arteriosus (p = 0.013), and late-onset sepsis (p = 0.026) as risk factors associated with delayed TSH rise. Atypical CH requiring treatment through neonatal intensive care unit (NICU) discharge was diagnosed in 6 patients (incidence of 1.4%); none were identified by NBS. The 90th percentile TSH for extremely low birth weight (ELBW) infants (<1000 g) was 7.2 μIU/mL, and the 95th percentile for those with birth weight of 1000-1500g was 6.1 μIU/ml; using these cutoff values identified all infants diagnosed with atypical CH with 100% sensitivity and 90 to 95% specificity.ConclusionAbnormal thyroid function is common in preterm infants. Those infants, including some with atypical CH, are missed by NBS. We recommend repeat thyroid screening with TSH at one month of age in infants born VPT or VLBW infants to identify CH that may require therapy.

Long-Term Complications after Allogeneic Hematopoietic Stem Cell Transplantation with Treosulfan- or Busulfan-Based Conditioning in Pediatric Patients with Acute Leukemia or Myelodysplastic Syndrome: Results of an Associazione Italiana Ematologia Oncologia Pediatrica Retrospective Study

Patients undergoing hematopoietic stem cell transplantation (HSCT) for hematologic malignancies during childhood have an increased risk of developing long-term sequelae that are in part attributable to the conditioning regimen. The present study aimed to assess the occurrence of long-term toxicities in a population of children who underwent HSCT for hematologic malignancies using either treosulfan or busulfan in the conditioning regimen. The cumulative incidences of growth impairment, altered gonadal function, altered thyroid function, cataracts, secondary malignant neoplasia, and altered pulmonary function were evaluated retrospectively by univariable and multivariable analyses in a population of 521 pediatric patients with acute leukemias or myelodysplastic syndromes treated in 20 Italian transplant centers affiliated with the Associazione Italiana Ematologia ed Oncologia Pediatrica (AIEOP). The median duration of follow-up for the entire study population was 7.1 years (range, 1 to 16 years). Overall, a larger proportion of patients given busulfan developed long-term toxicities compared to patients treated with treosulfan (34% versus 20%; P = .01). In univariable analysis, gonadal toxicity developed in 10% of patients who received treosulfan (95% confidence interval [CI], 3% to 15%), compared with 38% (95% CI, 24% to 39%) of busulfan-treated patients (P = .02), and this finding was confirmed by multivariable analysis (relative risk, .51; 95% CI, .34 to .76; P = .0009). We did not find any statistically significant associations between the occurrence of other long-term toxicities and the use of either busulfan or treosulfan. This study provides evidence that the use of treosulfan is correlated with a reduced incidence of gonadal toxicity in children undergoing HSCT for hematologic malignancies.

Total weight loss induces the alteration in thyroid function after bariatric surgery.

Bariatric surgery is an effective approach to weight loss, which may also affect thyroid function. However, alteration in thyroid-stimulating hormone (ΔTSH) and thyroid hormones after bariatric surgery and the relationship between thyroid function and postoperative weight loss still remains controversial. Data were collected from euthyroid patients with obesity who underwent sleeve gastrectomy and Roux-en-Y gastric bypass from 2017 to 2022. The alterations of free thyroxine (FT4), free triiodothyronine (FT3), total thyroxine (TT4), total triiodothyronine (TT3), and TSH were calculated 1 year after surgery. Pearson correlation analysis was used to assess the correlation between the percentage of total weight loss (%TWL) and ΔTSH. Multivariable linear regression was utilized to determine the association between %TWL and ΔTSH. A total of 256 patients were included in our study. The mean %TWL was 28.29% after 1 year. TSH decreased from 2.33 (1.67, 3.04) uIU/mL to 1.82 (1.21, 2.50) uIU/mL (P < 0.001), FT3 decreased from 3.23 ± 0.42 pg/mL to 2.89 ± 0.41 pg/mL (P < 0.001), FT4 decreased from 1.11 ± 0.25 ng/dL to 1.02 ± 0.25 ng/dL (P < 0.001), TT3 decreased from 1.13 (1.00, 1.25) ng/mL to 0.89 (0.78, 1.00) ng/mL (P < 0.001), and TT4 decreased from 8.28 ± 1.69 ug/mL to 7.82 ± 1.68 ug/mL 1 year postoperatively (P < 0.001). %TWL was found to be significantly correlated to ΔTSH by Pearson correlation analysis (Pearson correlation coefficient = 0.184, P = 0.003), indicating that the more weight loss, the more TSH declined. After adjusting for covariates in multivariable linear regression, %TWL was found to be independently associated with ΔTSH (β = 0.180 [95% confidence interval (CI), 0.048 - 0.312], P = 0.008). Moreover, %TWL was divided into 3 categorical groups (%TWL ≤ 25%, 25% < %TWL ≤ 35%, and %TWL > 35%) for further exploration, and was also found to be an independent predictor for ΔTSH after adjusting for covariates in multivariable linear regression (β = 0.153 [95% CI, 0.019 - 0.287], P = 0.025). TSH, FT4, FT3, TT4, and TT3 decrease significantly 1 year after bariatric surgery. The decline in TSH is independently mediated by postoperative weight loss; the more the weight loss, the more the TSH decrease.