Assessment Of Thyroid Function Research Articles

Assessment of thyroid and parathyroid function in patients treated for laryngeal carcinoma

Background The close proximity of both thyroid and parathyroid glands to the larynx puts them at high risk to develop hypofunction from the treatment of cancer larynx. Aim Thyroid and parathyroid function evaluation after treatment modalities of cancer larynx. Patients and methods Thyroid and parathyroid function was evaluated in 60 patients treated from laryngeal carcinoma. Patients were classified into three groups based on treatment type. Group 1 included patients with primary radiotherapy while group 2 included patients with total laryngectomy and group 3 involved patients with combined total laryngectomy and postoperative radiotherapy. Laboratory assessment of thyroid function included thyroid-stimulating hormone (TSH), free T4, while parathyroid function included corrected serum calcium and parathormone levels. The association of gland hypofunction was studied against tumor and treatment characteristics. Results Among the 60 patients; group 1 included 27 patients, group 2 included 21 patients, and group 3 included 12 patients. Twenty-five (41.7%) patients showed high TSH level and low FT4 level indicating clinical hypothyroidism while 12 (20%) patients showed high TSH level with normal FT4 level indicating subclinical hypothyroidism. Twenty-three (38.3%) patients showed normal levels of both TSH and FT4 being euthyroid. Concerning parathyroid function; 19 (31.7%) showed hypoparathyroidism diagnosed by low corrected serum calcium level and confirmed by low parathyroid hormone level. Conclusion The study detects the occurrence of hypothyroidism with or without hypoparathyroidism after treatment modalities of cancer larynx emphasizing the need of high clinical suspicion and routine evaluation for early detection of any post treatment thyroid or parathyroid gland hypofunction.

Correlation between Thyroid Radiation Dose and Thyroid Function after Adjuvant Hypofractionated Locoregional Radiotherapy in Breast Cancer Patients

Radiotherapy (RT) is used quite often among breast cancer patients, and because these patients now live longer than they used to, long-term treatment-related adverse effects, such as hypothyroidism, are becoming increasingly relevant. Radiation-induced hypothyroidism is a late side effect of radiation to the thyroid gland, which could develop months to years after radiotherapy. However, there is no sufficient data on hypothyroidism in patients with breast cancer who receive locoregional RT, which usually affects a portion of the thyroid gland. In this prospective study, we tried to correlate between the radiation dose received by the thyroid gland and the incidence of thyroid dysfunction in breast cancer patients treated with hypofractionated locoregional radiotherapy, as well as establishing potential planning objectives that could help in sparing the thyroid gland. Our study included 109 women who received 3-D conformal loco-regional breast radiotherapy, these patients had normal thyroid function prior to start of radiotherapy. Patients had follow-up thyroid function tests 6 months after finishing radiotherapy. Based on dose volume histograms (DVH), the percentages of the thyroid volume, and ipsilateral thyroid lobe, receiving 5, 10, 15, 20, 25, 30, 35, and 40 Gy (V5, V10, V15, V20, V25, V30, V35, and V40 respectively), in addition to the mean and maximum thyroid doses, were estimated. Follow-up assessment of thyroid function and statistical analysis unveiled incidence of radiotherapy induced hypothyroidism to be 8.3%. Possible risk factors included high maximum radiation dose and V40 to the thyroid gland and the ipsilateral thyroid lobe, as well as high mean dose and smaller volume of the ipsilateral thyroid lobe. The likelihood of hypothyroidism was significantly increased with V40 of >5% of the thyroid gland, and V40 of >11% of the ipsilateral thyroid lobe. Further study is recommended for larger populations and longer follow-up periods.

B-125 Artificial Intelligence Application to Improve the Algorithm for Autoverification of Results of Biochemical Markers that Assess Thyroid Function

Abstract Background The results verification process is the most important control step of the post-analytical phase. It can be done in two ways, manually by a professional, or using autoverification systems. Appropriate results are verified and submitted to the Laboratory Information System (LIS). Corrective actions are initiated for discordant results prior to their submission to the LIS. Autoverification is a process where the laboratory tests results are published without any professional’s intervention. It is recommended that each laboratory creates the necessary cut-off values for autoverification, according to its population and its biochemical-medical criteria. In our laboratory, an autoverification algorithm is applied to evaluate thyroid function, which involves the measurement of 2 parameters: Thyrotropin (TSH) and Free Thyroxine (FT4). These parameters were chosen because they are the most used for characterizing thyroid function. The autoverification algorithm was defined for euthyroid, hypothyroid and hyperthyroid patients. Our professionals proposed a “safe range” for both parameters and we relate those parameters results for autoverification. We study the usefulness of artificial intelligence models by clustering non-supervised machine learning algorithms, to find behavioral patterns of not autoverified sample results, to support and even broaden the “safe ranges” established by our professionals. The goal was to improve the current autoverification algorithm by using artificial intelligence for thyroid function test results and to increase the autoverification percentage. Methods The autoverification process was carried out at TURNER Laboratories, Rosario, Argentina. The autoverification algorithm was designed according to the Laboratory and Clinical Standards Institute Guide AUTO10-A. The Atellica Data Manager (ADM) middleware was used to provide the connection between the Atellica Solution Immunoassay & Clinical Chemistry Analyzers and the LIS. ADM receives the results from the analyzers and processes them in consideration of the pre-analytical (age, sex, etc.), analytical (QC, flags, etc.) and post-analytical (Delta Check, etc.) conditions. It then applies the autoverification algorithm to send the results to the LIS. In the first semester of 2022, we used the autoverification algorithm with the existing “safe ranges” in 18 626 samples of outpatients between the ages of 16 and 60. On the other hand, we applied different Clustering algorithms to the samples that were not autoverified, to find behavior patterns. The ones we used are: KMeans, Fuzzy C-Means, DBSCAN, Agglomerative Clustering, Dendrogram and Affinity Propagation. We chose KMeans with k = 4. Our professionals thoroughly analyzed each of the clusters and defined “new safe ranges” for autoverification. In the second semester of 2022, 18 947 samples were analyzed and the autoverification algorithm was applied with the “safe ranges” and the “new safe ranges”. Results In the first semester of 2022, by applying the existing “safe ranges” we obtained an autoverification of 19.0%. We then simulated an autoverification with “safe ranges” and “new safe ranges” and obtained an autoverification of 71.5%. In the second semester, we applied autoverification with “safe ranges” and “new safe ranges” obtaining an autoverification of 72.7%. Conclusion The application of machine learning algorithms has significantly improved the level of autoverification of biochemical markers that evaluate thyroid function.

A-338 TSH Reference Range in the First Trimester in a Iodine Sufficient Population of Pregnant Women Attended by the Public Health System in Curitiba South of Brazil

Abstract Background Thyroid diseases are common among women of reproductive age, and the serum concentration of thyroid-stimulating hormone (TSH) is the most used index to assess thyroid function during pregnancy. Changes in thyroid function during pregnancy can have a clinical impact on a woman's health and pregnancy outcome, as well as interfere with fetal health and child development. An adequate thyroid function is essential for normal intrauterine development. When comparing the levels of TSH between pregnant and non-pregnant women, TSH levels are lower in pregnancy, mainly in the first trimester, with gradual increase during pregnancy. Although some guidelines propose fixed TSH reference values in pregnancy according to the gestational trimester, the main recommendation is to carry out a study of their local population due to the significant variation in TSH reference range levels in different populations and different assays. Therefore, it is necessary to determine values of a reference interval for TSH for the local population of pregnant women. This study aims to determine the normal reference range of TSH in the first trimester of gestation in the public health system pregnant women from Curitiba. Methods This is an ongoing prospective cohort study, with the population sample from the pregnant women using the public health system, with age >18 years old in Curitiba, South of Brazil. 383 pregnant women were invited to participate. After evaluate the exclusion criteria (gestational age more than 13 weeks, twin pregnancy, thyroid disease, iodine ingestion, identification of the samples in the laboratory), 225 pregnant women had the TSH measured by chemiluminescent immunoassay on Atellica IM Analyzer (Siemens Healthineers), as well as the TPO-ab presence, FreeT4 and Total T4. The 2.5, 50 end 97,5 TSH percentiles were estimated for the normal pregnant population. Results The mean gestational age was 8,6 weeks (standard deviation 2.33). From 225 pregnant women, 22 (9.8%) had TPO-ab positive. The 2.5 and 97.5 percentiles of TSH were 0.12 and 5.28 μIU/mL after using de exclusion criteria. The populational iodine status was sufficient. In the TPO-ab positive population was found a higher level of TSH. The proportion of TPO-ab positive was significantly higher in the population with TSH >2.5 μIU/mL. Conclusions This preliminary data shows the TSH reference range with levels higher than other regions, reinforcing to do not use fixed values of TSH from other populations to evaluate the thyroid function in pregnancy. Comparing to the laboratory reference for non-pregnant adult (0.48 to 5.60 μIU/mL), the recommended reduction of 0.5 μIU/mL on upper limit and 0.4 μIU/mL on the lower limit found similar values to our findings.

Mutuality of thyroid hormones and psychiatric disorders

Abnormalities in thyroid function may induce affective, anxious, psychotic, and cognitive disorders and are a potential marker for assessing suicidal risk in patients suffering from psychiatric disorders. This retrospective, cross-sectional, electronic, and data-based study, comprising 118 adult psychiatric patients, aimed to establish differences in the concentrations of total T3, T4, and thyroid-stimulating hormone among patients diagnosed with common psychiatric disorders. The analysis encompassed the levels of these hormones in patients who had attempted suicide and those who had not. Lower values of total T3 were observed in patients with depressive disorder compared to patients with psychotic and bipolar disorder, as well as the control group. Furthermore, lower total T3 values were observed in patients who had reported a suicide attempt in their lives compared to participants who had not attempted suicide. These findings suggest a potential link between thyroid hormones and the regulation of central serotonin activity. The study underscores the importance of routinely assessing thyroid function in clinical practice to facilitate early detection of suicidality and the prevention of suicide.

The influence of Epstein–Barr-associated infection upon pituitary-thyroid system in children at different periods of the disease

BACKGROUND: The interest in infectious mononucleosis caused by the EpsteinBarr virus (EBV) is currently apparent. EpsteinBarr virus reaches tropism for reticular and lymphoid tissues, does not eliminate from the body and causes an immunopathological process in which the endocrine system develops. Thyroxine (T4), triiodothyronine (T3), and thyroid-stimulating hormone determinations are the most widely used diagnostic tests to assess thyroid function.
 AIM: To study changes in T3, T4, thyroid-stimulating hormone in children of older sex and age at the height and convalescence of infectious mononucleosis, the period of EpsteinBarr virus.
 MATERIALS AND METHODS: Under the supervision of the child were 94 aged from 1 to 17 years, among them from 1 to 5 years 22%, from 5 to 10 years 39%, from 10 to 15 years 27%, from 15 to 17 years 12% , diagnosed with EpsteinBarr virus mononucleosis, moderate severity. The diagnosis was made on the basis of clinical, anamnestic and laboratory data. The studies leading to the diagnosis were carried out in the laboratory of the Saint Petersburg State Pediatric Medical University. In addition to routine settings (clinical minimum), detection of M- and G- antibodies to EpsteinBarr virus, detection of the genome in the blood by PCR, determination of the levels of T3, T4, thyroid-stimulating hormone by enzyme-linked immunosorbent assay in blood serum.
 RESULTS: Regular changes in T3 concentrations were registered in both girls and boys of all three age groups: the concentration of T3, T4 in the period of the peak of the disease was reduced compared to the period of convalescence. Significant changes in thyroid-stimulating hormone were registered in girls and boys of all three age groups: the concentration of thyroid-stimulating hormone during the peak of the disease slightly decreased compared to the period of convalescence in boys and increased compared to the period of convalescence in girls.
 CONCLUSIONS: The changes in the levels of T3, T4, thyroid-stimulating hormone in children during the peak of infectious mononucleosis depends on the severity of the disease, the presence and nature of complications.

Thyroid Function in patients with nephrotic syndrome

Nephrotic syndrome is a common pediatric kidney disease characterized by leakage of protein from the blood to the urine through damaged glomeruli. It is classically defined as nephrotic range proteinuria, hypoalbuminemia and edema. In children with nephrotic syndrome, it is probable to determine a hypothyroid state because of significant loss of thyroxine (T4) and triiodothyronine (T3) in the presence of proteinuria. This study aimed to evaluate the thyroid function in children with nephrotic syndrome and its correlation with the state of patients ( relapse or remission ). Methods: A comparative study was carried out on total of 60 patients with nephrotic syndrome (divided into two equal groups of 30 with remission and 30 with relapse ) in the age group from 1-18 years who admitted to department of nephrology in Babylon teaching hospital for Maternity and children from November 2020 to May 2021, serum albumin, serum cholesterol, thyroid stimulating hormone (TSH) and thyroxine( T4 )were done to all patients and the result compared. Result: The mean age of patients was (5.74 ± 3.77) years; most patients (N=42, 70.0%) were male. Hypothyroidism represents (N=19, 31.7%) of patients with nephrotic syndrome, while patients with normal thyroid function (euthyroid) represented (N=41, 68.3%). Significant differences existed between the means of TSH and T4 according to the patient's state (remission or relapse). There was a significant association between the state of patients and thyroid function tests. Among patients with relapse (N=19, 63.3%) presented with hypothyroidism and (N=11, 36.7%) of patients presented with normal thyroid function (euthyroid state), while among those with remission, all patients (N=30, 100%) presented with normal thyroid function (euthyroid state). In conclusion, hypothyroidism is more common in nephrotic syndrome patients during relapse, so it's important to assess thyroid function during relapse. Keywords: Thyroid, nephrotic syndrome, Nephrotic syndrome

Clinical and thyroid profile in patients with COVID-19 hospitalized in an intensive care unit.

This study aimed to summarize the epidemiological and clinical features of thyroid function in COVID-19 patients in the intensive care unit (ICU) of Civil Fray Antonio Alcalde Hospital in Mexico. This is a cross-sectional study that included 63 ICU patients with COVID-19 from August 2021 to December 2021. Thyroid function was evaluated through the TSH, T4, T3, and FT3 measures. Comorbidities such as diabetes mellitus type 2 (T2DM), arterial hypertension (HT), body mass index (BMI), and biochemical biomarkers, including procalcitonin (PCT) and C reactive protein (CRP), were also analyzed. A total of 63 patients with COVID-19 were hospitalized in the ICU; 42 (67%) were male, and 21 (33%) were female, with a mean age of 47 (range of 26-76 years). A total of 49 (78%) patients were non-vaccinated, 5 (8%) had an incomplete vaccination schedule, and 4 (6%) had completed the vaccination schedule. Regarding BMI, 10 (16%) were overweight, and 26 (40%) reported obesity. When assessing thyroid function, 8 (13%) patients were euthyroid, and 55 (87%) showed alterations on the thyroid hormonal axis, mainly a low concentration of TSH (0.56±0.79; p=0.0001) and FT3 (2.34±0.52; p=0.0006). In addition, increased PCT concentrations were associated with a higher risk to decease (1.22 vs. 8.21; p=0.0001) in this group of patients. Based on our findings, it appears that COVID-19 patients with low TSH and FT3 levels, who have not been vaccinated against SARS-CoV-2, are overweight or obese, and exhibit high levels of PCT are more likely to experience a poor prognosis and even mortality.

Assessment of Thyroid Functions in Multiple Sclerosis Patients Treated with Disease Modifying Therapies

Background:
 Multiple sclerosis is a chronic disease believed to be the result of autoimmune disorders of the central nervous system, characterised by inflammation, demyelination, and axonal transection, affecting primarily young adults. Disease modifying therapies have become widely used, and the rapid development of these drugs highlighted the need to update our knowledge on their short- and long-term safety profile.
 Objective:
 The study aim is to evaluate the impact of disease-modifying treatments on thyroid functions and thyroid autoantibodies with subsequent effects on the outcome of the disease.
 Materials and Methods:
 A retro prospective study enrolled 45 patients who were registered and diagnosed in the Multiple Sclerosis Clinic according to the revised McDonald criteria (2017). Blood samples for thyroid functions and thyroid autoantibody tests were taken before, 3 months and after 6 months from the start of disease modifying therapy. The Expanded Disability Status Scale was used to assess the severity of the disease before and after 6 months of receiving treatment.
 Results:
 45 patients with the mean age of 33.3 years, a standard deviation (SD) of ± 9.5 years were enrolled in this study. (64.4%) patients’ age was between 20 - 39 years.
 The mean free T3 decreased significantly, while the mean anti-TPO and anti-TG increased after three months compared to its baseline level.
 After six months of treatment, the mean free T4 decreased significantly, while the mean TSH increased compared to its baseline level. There were no statistically significant correlations between the baseline (EDSS) score and after 6 months of therapy.
 Conclusion
 Thyroid hormone dysfunction and thyroid autoimmune antibody levels that changed in response to interferon beta therapy in patients with multiple sclerosis may be temporary and not associated with poor outcomes.

Thyroid function and urinary concentrations of iodine, selenium, and arsenic in vegans, lacto-ovo vegetarians and pescatarians

PurposePopulations following a plant-based diet may be at particular risk of thyroid dysfunction due to low iodine and selenium intakes. The main purpose was to assess thyroid function and urinary concentration of iodine, selenium, and arsenic, in subjects following a vegan, lacto-ovo vegetarian, or pescatarian diet.MethodsIn Norway, a country without mandatory dietary iodine fortification, 205 adults, following vegan (n = 115), lacto-ovo vegetarian (n = 55) and pescatarian diet (n = 35) were included. Thyroglobulin (Tg), thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), and serum anti-TPO (S-anti-TPO) were measured in a venous blood sample and concentrations of iodine (UIC), creatinine (UCC), selenium, and arsenic were measured from single spot urine samples.ResultsSubclinical hypothyroidism (TSH > 4.0 mU/L) was observed in 3% of subjects. The overall median (p25, p75) Tg was 17 (9, 30) µg/L and vegans had higher Tg compared to pescatarians. Vegans not consuming iodine-containing supplements (n = 43) had higher Tg, than supplement users (n = 72), 27 (11, 44) vs. 16 (8, 25) µg/L and higher fT4, 16 (15, 17) vs. 15 (14, 17) pmol/L, respectively. The overall median UIC was 57 (28, 130) µg/L, all dietary groups had median UIC below WHO thresholds. Median urinary selenium and arsenic concentration was 13 (6, 22) and 3 (2, 8) µg/L, respectively.ConclusionThe prevalence of subclinical hypothyroidism was low and fT4 and fT3 were within the normal range for all dietary groups. Vegans had significantly increased Tg compared to pescatarians.

Assessment of thyroid function in patients with rheumatoid arthritis in Kunming, China: A case-control study.

The present study aimed to analyze the prevalence of hypothyroidism in patients with rheumatoid arthritis (RA). In addition, the study aimed to elucidate the correlation of hypothyroidism with RA activity and to investigate the relationship between RA and thyroid dysfunction. A total of 314 patients were categorized into two groups according to thyroid stimulating hormone (TSH) level: RA without hypothyroidism and RA with hypothyroidism. All patients underwent routine laboratory investigation, including thyroid function testing, and complete clinical assessment. These included the determination of the erythrocyte sedimentation rate as well as the level of TSH, free triiodothyronine, free thyroxine, total triiodothyronine level, total thyroxine level, C-reactive protein, rheumatoid factor immunoglobulin (RF-Ig), RF-IgA, RF-IgG, RF-IgM, cyclic citrullinated peptide immunoglobulin G (CCP IgG), complement component 3, and complement component 4. Based on these data, thyroid function, and rheumatoid factor levels were analyzed. Curve estimation using linear regression revealed that CCP Ig level was significantly correlated with the TSH level (r=0.122, P=0.031). TSH level may be used as an auxiliary test to assess disease severity in patients with RA and to evaluate thyroid function. This evaluation parameter may be considered for determining clinical prognosis in patients with RA.

Folic acid supplementation improved cognitive deficits associated with lithium administration during pregnancy in rat offspring.

The present study aimed to analyse both neurobehavioural and biochemical results of neonates born of mothers exposed to different doses of lithium along with the groups that received lithium at the highest dose with folic acid as a preventive treatment. Male and female rats were mated in separate cages, and pregnant rats were divided into eight first group as (1) vehicle; (2) propylthiouracil (PTU)-induced hypothyroidism; (3-4) received two different doses of lithium carbonate (15 and 30 mg/kg); (5-7) the highest doses of lithium (30 mg/kg) plus three different doses of folic acid (5, 10 and 15 mg/kg); and (8) received just folic acid (15 mg/kg). All treatments were dissolved in drinking water and continued until delivery, followed by returning to a regular diet without treatment. Lithium (30 mg/kg) disrupts both behavioural and biochemical markers, including TSH, T3 and T4 as measuring indicators to assess thyroid function, IL-10 and TNF-α as anti-inflammatory and inflammatory agents, respectively, malondialdehyde as an oxidative stress marker, alongside SOD, and catalase activity as antioxidant indicators. Besides, folic acid, almost at the highest dose (15 mg/kg), attenuated memory impairement and anxiety-like behaviour caused by lithium. Moreover, the groups treated with folic acid alone in comparison with vehicles demonstrated higher levels of antioxidant and anti-inflammatory indicators. According to the results, prenatal exposure to a high dose of lithium (30 mg/kg) leads to foetal neurodevelopmental disorder and growth restriction through various mechanisms more likely attributed to hypothyroidism, which means it should be either prohibited or prescribed cautiously during pregnancy.

Frequency of Hypothyroidism in Patients with Beta-Thalassemia Major

Objective: To determine the frequency of hypothyroidism in patients with beta-thalassemia major in Paediatric department of Pak Emirates Military Hospital, Rawalpindi Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Paediatric Medicine Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Nov 2018 to Oct 2019. Methodology: All transfusion dependant beta-thalassemia major (BTM) patient sir respective of age and gender were consecutively enrolled. For the assessment of thyroid function, a random sample of 3 ml venous blood was drawn. The presence of increased thyroid stimulating hormone and normal T4, T3 were labelled as compensated, increased thyroid stimulating hormone, decreased T4 and/or T3 as uncompensated. Results: Of 73 patients, the mean age of the patients was 7.0±3.87 years. All the patients were getting iron chelation therapy. The mean serum ferritin level was 3911.68±2017.36 ng/mL. Twenty-eight (38.4%) cases were hypothyroid. Subclinical hypothyroidism was documented in 25(89.3%) while clinical hypothyroidism in 3(10.7%) patients. Patients with age >8 years (p=<0.001), >2 years of age at the time of 1st blood transfusion (p<0.001)>8 numbers of blood transfusion (p<0.001) and >4000ng/dl serum ferritin levels (p<0.007) were noted as factors significantly associated with hypothyroidism. Conclusion: A considerable number of patients were affected with hypothyroidism. Moreover, high serum ferritin level and a high number of blood transfusions were found to be significant determinants.

Dyslipidemia and Thyroid Dysfunction Associated with Psoriasis.

Psoriasis is a T-cell mediated inflammatory skin disorder which causes considerable psychosocial disability resulting in major impact on patient's quality of life. The dominant response of Th1 cells and the high expression of related inflammatory factors appears in both psoriasis and thyroid dysfunction. Psoriasis can lead to increased risk of incidence of cardiovascular events for which dyslipidemia is an important risk factor. This study aims to evaluate thyroid function and lipid profile and its association in patients with psoriasis. This was a prospective case-control study conducted at the Department of Biochemistry, Nobel Medical College Teaching Hospital from November 2021 to October 2022. Seventy six clinically diagnosed psoriatic patients were taken as case and eighty non-psoriatic patients coming for other skin lesions were included in the study as control. Thyroid function test (serum free T3, T4, TSH) and lipid profile (total cholesterol, low density lipoprotein, high density lipoprotein and triglyceride) were done. Hypothyroidism was most common thyroid abnormalities in our study population which was 13.15% (n=10). The lipid profile parameters were significantly higher in the psoriatic patients than in the controls (p<0.001). The odds of psoriatic patient having thyroid dysfunction was 2.8 times higher compared to other non-psoriatic patients and the odds of psoriatic patient having dyslipidemia was 8.7 times higher compared to other non-psoriatic patients. It is thus useful to assess thyroid function test and lipid profile in patients with psoriasis considering their role in etiopathogenesis and co-morbidity of psoriasis.

Recurrent MiscarriageGreen-top Guideline No. 17.

In this guideline, recurrent miscarriage has been defined as three or more first trimester miscarriages. However, clinicians are encouraged to use their clinical discretion to recommend extensive evaluation after two first trimester miscarriages, if there is a suspicion that the miscarriages are of pathological and not of sporadic nature. Women with recurrent miscarriage should be offered testing for acquired thrombophilia, particularly for lupus anticoagulant and anticardiolipin antibodies, prior to pregnancy. [Grade C] Women with second trimester miscarriage may be offered testing for Factor V Leiden, prothrombin gene mutation and protein S deficiency, ideally within a research context. [Grade C] Inherited thrombophilias have a weak association with recurrent miscarriage. Routine testing for protein C, antithrombin deficiency and methylenetetrahydrofolate reductase mutation is not recommended. [Grade C] Cytogenetic analysis should be offered on pregnancy tissue of the third and subsequent miscarriage(s) and in any second trimester miscarriage. [Grade D] Parental peripheral blood karyotyping should be offered for couples in whom testing of pregnancy tissue reports an unbalanced structural chromosomal abnormality [Grade D] or there is unsuccessful or no pregnancy tissue available for testing. [GPP] Women with recurrent miscarriage should be offered assessment for congenital uterine anomalies, ideally with 3D ultrasound. [Grade B] Women with recurrent miscarriage should be offered thyroid function tests and assessment for thyroid peroxidase (TPO) antibodies. [Grade C] Women with recurrent miscarriage should not be routinely offered immunological screening (such as HLA, cytokine and natural killer cell tests), infection screening or sperm DNA testing outside a research context. [Grade C] Women with recurrent miscarriage should be advised to maintain a BMI between 19 and 25 kg/m2 , smoking cessation, limit alcohol consumption and limit caffeine to less than 200 mg/day. [Grade D] For women diagnosed with antiphospholipid syndrome, aspirin and heparin should be offered from a positive test until at least 34 weeks of gestation, following discussion of potential benefits versus risks. [Grade B] Aspirin and/or heparin should not be given to women with unexplained recurrent miscarriage. [Grade B] There are currently insufficient data to support the routine use of PGT-A for couples with unexplained recurrent miscarriage, while the treatment may carry a significant cost and potential risk. [Grade C] Resection of a uterine septum should be considered for women with recurrent first or second trimester miscarriage, ideally within an appropriate audit or research context. [Grade C] Thyroxine supplementation is not routinely recommended for euthyroid women with TPO who have a history of miscarriage. [Grade A] Progestogen supplementation should be considered in women with recurrent miscarriage who present with bleeding in early pregnancy (for example 400 mg micronised vaginal progesterone twice daily at the time of bleeding until 16 weeks of gestation). [Grade B] Women with unexplained recurrent miscarriage should be offered supportive care, ideally in the setting of a dedicated recurrent miscarriage clinic. [Grade C].

Adequacy of equine thyroid function testing in mares

The gold standard for thyroid function in horses is a thyroid releasing hormone (TRH) response test. We hypothesized that published reference values for thyroxine (T4), triiodothyronine (T3) would apply to mares in an iodine deficient zone. Our objective was to evaluate basal thyroid hormone levels and TRH responses in twenty-seven healthy Quarter Horse type mares fed grass hay, oats, with free access to cobalt iodine salt blocks and mean ± SD age of 9.2 ± 4.4 years, and weight of 527 ± 65.1 kg. Four mares were 10 to 35 days pregnant. Physical examinations were within normal limits including palpation and ultrasound of the thyroid gland. TRH response tests were performed mornings from July to September. A basal jugular blood sample (0 h) was obtained, TRH (1 mg IV, Sigma) was administered, and additional samples obtained at 2 h for T3 and 4 h for T4. Definitions: Fold change (FC) post-TRH level / basal level; Euthyroid basal T4 (12.87-38.6 nmol/L) and T3 (0.41-1.1 nmol/L) within reference ranges of Animal Health Diagnostic Lab, Ithaca, NY and TRH T4 and T3 responses with a FC >2. The Post TRH FC reference ranges for T4 and T3 reported by Breuhaus (2018) were also evaluated (T4 FC 1.3-3.8; T3 FC 1.1-10). Serum was separated and stored at -20C. A single assay was performed to measure T3 and T4 using the Siemen's Immulite method (PDS, Saskatoon, SK). Data were evaluated using Shapiro Wilk, Kruskal Wallis and Spearman Rank Correlation at P < .05. Low basal levels were measured in three mares for T3 (11%), and two for T4 (7.4%). Ten mares had T3 levels with a FC<2 (37%), and two had FC<1.1 (7.4%). Regarding T4 twenty-two mares (81%) had a FC<2 and ten had a FC <1.3 (37%). The FC was below the reference range for both T3 and T4 in two mares. There were significant correlations between basal T3 and T4 (R=0.47 P=.012) and between T3 FC and T4 FC (R=0.64, P=.0001), and no effect of pregnancy. We concluded that basal T3 and T4 values were too variable to assess thyroid function, as mares with low basal values usually had a FC>2. Using FC >2 as an adequate TRH response is problematic as a FC<2 was identified in 37% of T3 and 81% of T4 mares. There were 7.4% and 37% of mares below the low end of the FC reference for T3 and T4 respectively. These low values may indicate that the mares were hypothyroid, which is often due to underlying iodine insufficiency. Iodine status and its relationship to the thyroid response to TRH should be further evaluated due to iodine's central role in equine health.

Delayed puberty: How to approach?

Disorders of puberty can profoundly impact physical and psychosocial well-being. Delayed puberty is the absence of breast development in girls by 13 years of age and absence of testicular growth to at least 4 mL in volume or 2.5 cm in length in boys by 14 years of age. Hypogonadism occurs when there is a disruption in the hypothalamic-pituitary-gonadal axis. Two categories of delayed puberty are: hypergonadotropic (primary) hypogonadism and hypogonadotropic (secondary) hypogonadism. The etiology of delayed puberty varies from relatively benign to life threatening conditions, which may be either congenital or acquired. Constitutional delay of growth and puberty is the commonest cause of delayed puberty, which is a diagnosis of exclusion. There is a notable delay in puberty but eventually progress through normal stages of puberty. History concerns about stature are often present and a familial pattern of inheritance is usually present. Delayed bone age but corresponding to height age helps in diagnosis. Reversible hypogonadotropic hypogonadism may be observed due to associated conditions including chronic malnutrition, systemic disease, untreated hypothyroidism, hyperprolactinemia, anorexia nervosa. Permanent causes include structural damage either to hypothalamic-pituitary axis or linked to the sexual organs of the individual. Complete physical examination should include proper anthropometry, pubertal staging and assessment to look for any signs of chronic illness or stigmata of syndromes. In laboratory analysis, hypogonadotropichypogonadism (pHH) showing low serum testosterone or estradiol and blunted follicle-stimulating hormones (FSH) and luteinizing hormones (LH) levels may be due to abnormalities in the central nervous system. Magnetic resonance imaging is necessary to exclude morphological abnormalities and neoplasia. Low serum testosterone in male patients and low estradiol values in female patients, associated with high serum FSH and LH levels, suggest a diagnosis of hypergonadotropic hypogonadism due to dysfunction of peripheral sex organs. Abnormal growth velocity necessitates assessment of serum thyroid function, prolactin, and insulin like growth factor-1. Karyotyping can reveal a chromosomal abnormality like Turner syndrome or Klinefelter syndrome. Beside reassurance, in cases where the adolescent with CDGP is experiencing psychological difficulties, short courses of sex hormones may be used to allow individuals to catch up with their peers. Definitive treatment for underlying cause is worthy where possible. Long-term hormone replacement therapy is recommended for permanent causes of delayed puberty. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 192

Challenging Thyroid Cases in Clinical Practice

Thyroid disorders are prevalent, and their manifestations are divergent and sometimes it is very challenging to diagnose and deal with some Thyroid cases in clinical practice. Here seven different challenging cases will be discussed that will help clinicians to diagnose and treat such cases in dayto- day clinical practice. First case enlightened us that Thyroid function should not be assessed in seriously ill patients unless there is a strong suspicion of thyroid dysfunction, since there are many other factors in acutely or chronically ill euthyroid patients that influence thyroid function tests. The second case taught us that there is assay interference with Biotin ingestion and patients taking Biotin should hold the supplement for two days prior to assessing thyroid function. Subacute thyroiditis is a self-limiting inflammatory condition of the thyroid gland and COVID-19 virus infection may be associated with subacute thyroiditis as a complication that may occur in patients without any previous thyroid disorder that is revealed in third case. In Secondary hypothyroidism/Hypopituitarism, TSH may be low, normal, or even slightly elevated due to inactive TSH isoform in blood. The fourth case shows us that only TSH testing in clinical practice leads to missing Secondary hypothyroidism/Hypopituitarism. Learning from fifth case is that during monitoring of thyrotoxic patients taking ATDs, serum TSH may remain suppressed for several months after starting therapy and it is therefore not a good parameter for monitoring therapy early during treatment, rather we should rely on FT4 and FT3. The sixth case enlightened us that in case of low TSH in early pregnancy, Gestational transient Thyrotoxicosis should be excluded which is commonly associated with hyperemesis gravidarum with no prior history of thyroid disease, no stigmata of Graves’ disease (Goiter, ophthalmopathy) and a self-limited mild disorder. In poorly compliant patients, there may be a combination of high FT4 and high TSH that is revealed in the seventh case. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 189

A STUDY OF PREVALENCE OF SUBCLINICAL HYPOTHYROIDISM AND OVERT HYPOTHYROIDISM IN BIDAR DISTRICT, KARNATAKA

Background: Subclinical hypothyroidism and overt hypothyroidism are often overlooked afictions. The aim of the present study was to estimate the prevalence of overt and subclinical hypothyroidism among the adult population of Bidar District. Materials &amp; Methods: A prospective hospital study of 1485 subjects who were referred to Department of Biochemistry, Bidar Institute of Medical Sciences, Bidar was undertaken for assessment of thyroid functions investigated between November 2022 to April 2023. Statistical analysis was done in terms of percentage and chi-square test (x2). Results: Of the 1485 subjects (198 men and 1287 women); 593 subjects (~40%) were euthyroid, 362 subjects (27 men and 335 women) had subclinical hypothyroidism; 331 subjects (56 men and 275 women) had overt hypothyroidism; 30 subjects (6 men and 24 women) had subclinical hyperthyroidism; 162 subjects (3 men and 159 women) had overt hyperthyroidism; and 7 subjects (02 men and 5 women) had Euthyroid sick syndrome. Conclusion: Hypothyroidism appears to be common in Bidar, Karnataka. Community based mass screening for Sub clinical and overt hypothyroidism in high risk group is suggested to identify these patients and treat them.

The utility of salivary thyroid hormones in assessment of thyroid function

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