Thyroid Hormone Deficiency Research Articles

Insights into Central Congenital Hypothyroidism: A Multicenter Retrospective Analysis.

Central congenital hypothyroidism (CCH) is a thyroid hormone deficiency at birth caused by inadequate pituitary stimulation of the thyroid gland. Although primary CH has been studied extensively, studies on CCH are sparse. To assess the prevalence of CCH in Israel and describe its clinical features, neonatal screening results, and outcomes. Multicenter cross-sectional retrospective chart review. Nine pediatric endocrine units throughout Israel. Patients diagnosed with CCH in 1987-2021 were categorized into early (within 14 days of life) and late (after 14 days) diagnosis groups. Newborn screening (NBS) results were retrospectively retrieved from the national NBS program dataset. CCH prevalence in Israel was about 1:42,800 live births. Subjects were 94 patients (54 males), of these, 84% had multiple pituitary hormone deficiencies and 16% had isolated CCH. The median age at diagnosis was 50 days (range, 1-8760), with 66% having moderate to severe hypothyroidism. NBS detected only three infants. Early diagnosis occurred in 34% due to hypopituitarism, while 66% were diagnosed later due to growth and developmental delays. Neurodevelopmental sequelae included mental retardation (12%), learning difficulties (18%), delayed speech (27%), and motor clumsiness (19%), with no significant differences in outcomes between early and late diagnosis. Despite high rates of neurodevelopmental sequelae, no differences were found between early and late diagnosis groups. Further research is needed to assess the impact of delayed diagnosis on neurological outcomes in newborns with CCH. Improved strategies for detecting CHH in newborns are also necessary.

The association between hypothyroidism, mental disorders and physical activity: a comprehensive review

Hypothyroidism refers to the common pathological condition of thyroid hormone deficiency. Multiple studies have concluded that undiagnosed and undertreated patients with hypothyroidism are at increased risk of developing mental disorders. Moreover, there are proven cases of symptom remission with or without antidepressants after a euthyroid state was established. Studies suggest that exercise can have positive effects on thyroid function as well as improving mental state. However, patients with untreated hypothyroidism often experience decreased exercise tolerance, weakness, fatigue, and feelings of low energy, which often prevent them from engaging in physical activities. This review strengthens the link between hypothyroidism, mental health issues and struggles that come with thyroid hormone deficiency and physical activity. It also demonstrates how treating the underlying hypothyroidism, as well as promoting regular physical activity, can be significant ways to improve health outcomes in these patients.

Hypothalamic hormone deficiency enables physiological anorexia in ground squirrels during hibernation

Mammalian hibernators survive prolonged periods of cold and resource scarcity by temporarily modulating normal physiological functions, but the mechanisms underlying these adaptations are poorly understood. The hibernation cycle of thirteen-lined ground squirrels (Ictidomys tridecemlineatus) lasts for 5–7 months and comprises weeks of hypometabolic, hypothermic torpor interspersed with 24–48-h periods of an active-like interbout arousal (IBA) state. We show that ground squirrels, who endure the entire hibernation season without food, have negligible hunger during IBAs. These squirrels exhibit reversible inhibition of the hypothalamic feeding center, such that hypothalamic arcuate nucleus neurons exhibit reduced sensitivity to the orexigenic and anorexigenic effects of ghrelin and leptin, respectively. However, hypothalamic infusion of thyroid hormone during an IBA is sufficient to rescue hibernation anorexia. Our results reveal that thyroid hormone deficiency underlies hibernation anorexia and demonstrate the functional flexibility of the hypothalamic feeding center.

A study of the association of lipid ratios with thyroid dysfunction in a tertiary medical college in Eastern India

Background: Thyroid hormones play a crucial role in major metabolic pathways in the body and dyslipidemia is a major metabolic abnormality seen in thyroid disorders. Cardiovascular diseases (CVDs) are now emerging as the leading cause of morbidity and mortality worldwide and the most important risk factor for CVDs is dyslipidemia. The lipid ratios that have a positive association with CVD risk are atherogenic index of plasma (AIP), Castelli’s risk index (CRI)-I and II, and atherogenic coefficient (AC). Clinically, both an excess and deficiency of thyroid hormones can exacerbate or induce CVDs and lipid ratio can be used as an inexpensive marker for predicting CVD risk. Aims and Objectives: This study aims to evaluate the lipid ratios (AIP, CRI-I, CRI-II, AC) in patients with thyroid dysfunction and compare the results with lipid ratios in euthyroid individuals. This study also aims to find any correlation, if exists, between lipid ratios and serum thyroid-stimulating hormone (TSH) levels in thyroid dysfunction. Materials and Methods: The serum TSH and lipid profile were evaluated in fifty euthyroid, fifty hypothyroid, fifty subclinical hypothyroid, and fifty hyperthyroid patients. The lipid ratios (AIP, CRI-I, CRI-II, AC) were calculated from the lipid profile. Results: The mean lipid ratios were higher in hypothyroid, followed by subclinical hypothyroid cases when compared to euthyroid controls and hyperthyroid patients. A positive correlation was observed between the TSH and lipid ratios in euthyroid, hypothyroid, and subclinical hypothyroid subjects. There was no significant correlation between TSH and lipid ratios in hyperthyroid patients. Conclusion: This study demonstrates that the evaluation of lipid ratios along with TSH can provide an effective screening tool to assess the cardiovascular risk in patients with subclinical and overt hypothyroidism, especially in the absence of imaging techniques in resource-limited centers.

Development of an animal model of hypothyroxinemia during pregnancy in Wistar rats

AbstractBackgroundHypothyroxinemia is a subclinical thyroid hormone deficiency in which the mother has inadequate levels of T4 during pregnancy. The fetus relies entirely on the mother's T4 hormone level for early neurodevelopment. Isolated maternal hypothyroxinemia (IMH) in the first trimester of pregnancy can lead to lower intelligence, lower motor scores, and a higher risk of mental illness in descendants. Here, we focus on the autism‐like behavior of IMH offspring.MethodsThe animals were administered 1 ppm of propylthiouracil (PTU) for 9 weeks. Then, the concentrations of T3, T4, and thyroid‐stimulating hormone (TSH) were detected using enzyme‐linked immunosorbent assay (ELISA) to verify the developed animal model of IMH. We performed four behavioral experiments, including the marble burying test, open‐field test, three‐chamber sociability test, and Morris water maze, to explore the autistic‐like behavior of 40‐day‐old offspring rats.ResultsThe ELISA test showed that the serum T3 and TSH concentrations in the model group were normal compared with the negative control group, whereas the T4 concentration decreased. In the behavioral experiments, the number of hidden marbles in the offspring of IMH increased significantly, the frequency of entering the central compartment decreased, and the social ratio decreased significantly.ConclusionThe animal model of IMH was developed by the administration of 1 ppm of PTU for 9 weeks, and there were autistic‐like behavior changes such as anxiety, weakened social ability, and repeated stereotyping in the IMH offspring by 40 days.

Impact of hormone replacement therapy on cardiovascular risk in patients with hypothyroidism: a systematic review

Hypothyroidism, which is developed in 4-10 % of the population, and subclinical hypothyroidism found in more than 10 % of people which are highly associated with cardiovascular pathophysiology at some level. Hypothyroidism, which is the most frequent endocrine disorder with a lack of enough thyroid hormones, presents a wide range of cardiovascular complications, including coronary artery disease, heart failure, and dyslipidemia. Thyroid hormone replacement therapy, particularly levothyroxine (LT4), continues to be the central management of hypothyroidism, which aims to restore euthyroidism and other cardiac comorbidities as well as relieving symptoms. Nonetheless, the complex interworking of thyroid function and cardiovascular health requires a detailed clarification of the processes associated with disease development and drug therapy. Hypothyroidism triggers a chain of cardiovascular alterations such as aberrant lipid metabolism, endothelial dysfunction, and lessened cardiac contractility primarily by lowering the thyroid hormone level. Besides, these modifications eventually lead to raised rates of atherosclerosis, myocardial infarction, and heart failure. LT4 replacement therapy achieves normalization of hyperthyroidism with the replacement of thyroid hormone deficiency, which restores the cardiovascular system to normal by doing so. LT4 modulates lipid metabolism, improves endothelial function, and stimulates myocardial contractility via several different mechanisms. LT4 therapy acts on systemic inflammation and oxidation to accentuate the protective effects of the cardiovascular system. Apart from this, there is an increasing awareness about the use of new thyroid hormone formulations, like LH4, in the therapy of hypothyroidism. LH4, the thyromimetic compound, demonstrated a similar binding affinity at the thyroid hormone receptor as T3 (triiodothyronine) but with better tissue selectivity and more metabolic stability. Clinical trials have proven the potency of LH4 in lowering symptoms of hypothyroidism, for example, fatigue, weight gain which are leading cause of cardiovascular disorders. LH4 administration has been safe for up to six months, and only mild adverse effects have been reported when it is used more than a year.

Hydropericardium in hypothyroidism. Features of the clinic, diagnosis and treatment

Thyroid hormone deficiency negatively affects the state of the cardiovascular system, causing the formation of a «myxedematous heart». The frequency and clinical features of primary hypothyroidism in 84 patients discharged from the endocrinology department of the RCH in 2017-2022 were retrospectively analyzed. Pericardial effusion was registered in 9 people (10.7%). Massive effusion with separation of pericardial leaflets from 30 to 50 mm and the threat of tamponade was in 4 out of 9 patients. Even with a large volume of pericardial effusion, classic symptoms such as shortness of breath, orthopnea, chest pain, and a feeling of fullness were absent or poorly expressed. Differential diagnosis with diseases accompanied by accumulation of fluid in the pericardial cavity was required. Indicators of thyroid status made it possible to associate the hydropericardium with decompensation or hypothyroidism for the first time. Thyroid hormone replacement therapy led to the disappearance of hypothyroidism symptoms and a decrease in the hydropericardium. With a high risk of tamponade in 3 patients, therapy was supplemented with pericardiocentesis. A clinical observation of successful treatment with thyroid hormones in combination with pericardiocentesis of severe newly diagnosed hypothyroidism against the background of autoimmune thyroiditis with massive pericardial effusion is presented.

Cutaneous manifestations of hypothyroidism: An observational study in a tertiary care center of Eastern India

Cutaneous manifestations of hypothyroidism: An observational study in a tertiary care center of Eastern India

Functional variants in a TTTG microsatellite on 15q26.1 cause familial nonautoimmune thyroid abnormalities

Insufficient thyroid hormone production in newborns is referred to as congenital hypothyroidism. Multinodular goiter (MNG), characterized by an enlarged thyroid gland with multiple nodules, is usually seen in adults and is recognized as a separate disorder from congenital hypothyroidism. Here we performed a linkage analysis of a family with both nongoitrous congenital hypothyroidism and MNG and identified a signal at 15q26.1. Follow-up analyses with whole-genome sequencing and genetic screening in congenital hypothyroidism and MNG cohorts showed that changes in a noncoding TTTG microsatellite on 15q26.1 were frequently observed in congenital hypothyroidism (137 in 989) and MNG (3 in 33) compared with controls (3 in 38,722). Characterization of the noncoding variants with epigenomic data and in vitro experiments suggested that the microsatellite is located in a thyroid-specific transcriptional repressor, and its activity is disrupted by the variants. Collectively, we presented genetic evidence linking nongoitrous congenital hypothyroidism and MNG, providing unique insights into thyroid abnormalities.

Knowledge of thyroid disorder and preventive practice among pregnant women attending selected maternal and child health clinic of Bhaktapur, Nepal

Background: Thyroid is the second most common endocrine illness after diabetes. Both hyperthyroidism and hypothyroidism can cause serious complications such as hypertension, coronary artery disease, infertility, arrhythmia, and more. This study aimed to determine the level of awareness among a group of people in the central region of Nepal. Objectives: The overall objective of this study was to assess the knowledge of thyroid disorder and its preventive practices among pregnant women attending MCH clinic. Methods: A cross-sectional analytical study was conducted among 207 pregnant women of age 18-29 years attending maternal and child health clinic of Siddhi Memorial Hospital, Bhaktapur through a pre-tested structured questionnaire. Quantitative research method was applied through face-to-face interview and the collected data were entered and analysed using SPSS v.25. Results: Around 86% of 207 respondents had heard about thyroid disorder. Thyroid illness was defined by more than a third of respondents (38.76%) as the presence of Goiter, followed by disease caused by insufficient thyroid hormone (18.54%) and disease caused by excess thyroid hormone (12.92 %). 68.54% of those surveyed were uninformed about various thyroid issues, while 31.46% did. Only 62.92% of respondents were aware of the thyroid test, and the majority (81.15%) were not familiar with preventive practices. Overall, 65.2% of respondents had inadequate knowledge about thyroid disorders, whereas 34.80% had acceptable level of knowledge. Ethnicity, occupation, and education level were statistically significantly associated with knowledge on Thyroid disorder (p-value < 0.05). Adequate knowledge was found to be associated with good in preventive practice (p-value <0.06). Conclusion: The respondents had a low level of awareness about thyroid problem and its preventive measures. This study highlights the necessity of comprehensive health education and accessible, affordable health services covering wide range of issues regarding thyroid.

Challenging diagnosis of resistance to thyroid hormone in a patient with COVID-19, pituitary microadenoma and unusual response to octreotide long-acting release test.

The resistance to thyroid hormone syndrome (RTHβ) occurs uncommonly and requires a high level of clinical suspicion and specific investigations to reach a precise diagnosis and to avoid unnecessary and potentially harmful therapies. We report a case of a young male patient referred to our unit for SARS-CoV-2 infection and atrial fibrillation with elevated thyroid hormones and non-suppressed thyroid-stimulating hormone (TSH), for which antithyroid therapy was prescribed. A mood disorder was reported in the medical history. The family history was unknown as the patient was adopted. Thyroid-specific antibodies were undetectable, and thyroid ultrasound revealed a normal thyroid gland without nodules. After the resolution of SARS-CoV-2 infection, the diagnostic workup continued, and the pituitary MRI revealed a small area ascribable to a microadenoma. Due to atrial fibrillation, the execution of the T3 test was contraindicated. The octreotide long-acting release (LAR) test showed an initial reduction of free thyroid hormones levels at first administration, which was consistent with the presence of a TSH-secreting pituitary tumour, although an escape from the response was observed after the following two injections of octreotide LAR. Indeed, the genetic investigation revealed a variant in heterozygosity of the THRβ gene (Pro453Ser), thus leading to an RTHβ diagnosis, and, therefore, medical treatment with triiodothyroacetic acid was initiated. After 2 years from the SARS-CoV-2 infection, the patient continues the follow-up at our outpatient clinic, and no other medical interventions are needed. RTHβ is a rare genetic syndrome characterised by discrepant thyroid function tests and by a dissociation between the observed hormone levels and the expected patient signs and symptoms. Features of thyroid hormone deficiency in TR-ß dependent tissues (pituitary gland, hypothalamus, liver and neurosensitive epithelia), as well as thyroid hormone excess in TR-α-dependent tissues (heart, bone, skeletal muscle and brain), may coexist in the same individual. Clinical pictures can be different even when the same variant occurs, suggesting that other genetic and/or epigenetic factors may play a role in determining the patient's phenotype. Differentiating RTHβ from a TSH-secreting pituitary tumour is very difficult, especially when a concomitant pituitary adenoma is detected during diagnostic workup. The injection of long-acting somatostatin analogues can help differentiate the two conditions, but it is important to detect any interference in the dosage of thyroid hormones to avoid an incorrect diagnosis. Genetic testing is fundamental to prevent unnecessary and potentially harmful therapies. Medical treatment with triiodothyroacetic acid was demonstrated to be effective in reducing thyroid hormone excess and controlling symptoms.

Synaptic Plasticity and Cognitive Ability in Experimental Adult-Onset Hypothyroidism.

Adult-onset hypothyroidism impairs normal brain function. Research on animal models of hypothyroidism has revealed critical information on how deficiency of thyroid hormones impacts the electrophysiological and molecular functions of the brain, which leads to the well known cognitive impairment in untreated hypothyroid patients. Currently, such information can only be obtained from experiments on animal models of hypothyroidism. This review summarizes important research findings that pertain to understanding the clinical cognitive consequences of hypothyroidism, which will provide a better guiding path for therapy of hypothyroidism. SIGNIFICANCE STATEMENT: Cognitive impairment occurs during adult-onset hypothyroidism in both humans and animal models. Findings from animal studies validate clinical findings showing impaired long-term potentiation, decreased CaMKII, and increased calcineurin. Such findings can only be gleaned from animal experiments to show how hypothyroidism produces clinical symptoms.

Brain hypothyroidism silences the immune response of microglia in Alzheimer's disease animal model.

Thyroid hormone (TH) imbalance is linked to the pathophysiology of reversible dementia and Alzheimer's disease (AD). It is unclear whether tissue hypothyroidism occurs in the AD brain and how it affects on AD pathology. We find that decreased iodothyronine deiodinase 2 is correlated with hippocampal hypothyroidism in early AD model mice before TH alterations in the blood. TH deficiency leads to spontaneous activation of microglia in wild-type mice under nonstimulated conditions, resulting in lowered innate immune responses of microglia in response to inflammatory stimuli or amyloid-β. In AD model mice, TH deficiency aggravates AD pathology by reducing the disease-associated microglia population and microglial phagocytosis. We find that TH deficiency reduces microglial ecto-5'-nucleotidase (CD73) and inhibition of CD73 leads to impaired innate immune responses in microglia. Our findings reveal that TH shapes microglial responses to inflammatory stimuli including amyloid-β, and brain hypothyroidism in early AD model mice aggravates AD pathology by microglial dysfunction.

TO EVALUATE THE RELATIONSHIP BETWEEN THYROID PROFILE AND IRON STATUS AMONG HYPOTHYROID PATIENTS

Objective: Iron deficiency is very commonly seen among hypothyroidism patients. The study aimed to find out the relationship between thyroid profile and iron status among hypothyroidism patients, whether it is interdependent or not. Methods: This retrospective study was conducted among hypothyroidism patients at the Department of Biochemistry, Government Medical College, Amritsar. One hundred study participants were included in this study. The study participants were divided into two groups. Fifty hypothyroidism patients served as cases and 50 normal healthy individuals as control. Serum thyroid-stimulating hormone (TSH), T3, and T4 levels and serum ferritin, iron, and TIBC levels were estimated and then compared between the two groups. Results: In our findings, 70% of the females were hypothyroidism patients. Hypothyroidism patients’ mean age±SD value was 37±15.1 whereas the healthy control group was 39±12.5. Most of the middle-aged people suffer from this disease, i.e., 52%. In this study, the levels of ferritin, and iron were found to decrease whereas that of TIBC increased in patients suffering from hypothyroidism as compared to healthy controls. Serum TSH levels were inversely correlated with ferritin. The levels of ferritin were found to be significantly decreased in patients as compared to controls. Conclusion: Thyroid hormone insufficiency may lead to a deficiency of iron and vice versa. Other factors such as oxidative stress may also play a role. Thus, iron the estimation using the above parameters may be useful during diagnosing and treating hypothyroid patients.

Clinical Features and Outcomes of Myxedema Coma in Patients Hospitalized for Hypothyroidism: Analysis of the United States National Inpatient Sample.

Background: Hypothyroidism is a common endocrine condition and chronic thyroid hormone deficiency is associated with adverse effects across multiple organ systems. In compensated hypothyroidism, however, patients remain clinically stable due to gradual physiological adaptation. In contrast, the clinical syndrome of decompensated hypothyroidism referred to as myxedema coma (MC) is an endocrine emergency with high risk of mortality. Because of its rarity, there are currently limited data regarding MC. This study analyzes the clinical features and hospital outcomes of MC compared with hypothyroid patients without MC (nonMChypo) in national United States hospital data. Methods: A retrospective analysis of the National Inpatient Sample, a public database of inpatient admissions to nonfederal hospitals in the United States, 2016-2018, including adult patients with primary diagnosis of MC (International Classification of Diseases 10th Revision [ICD-10]: E03.5) or nonMChypo (E03.0-E03.9, E89.0). Patient demographics, relevant clinical features, mortality, length of stay (LOS), and hospital costs were compared. Results: Of 18,635 patients hospitalized for hypothyroidism, 2495 (13.4%) had a diagnosis of MC. Sex distribution and race/ethnicity were similar between patients with MC and nonMChypo, whereas MC was associated with older patient age (p = 0.02), public insurance (p = 0.01), and unhoused status (p = 0.04). More admissions with MC occurred in winter compared with other seasons (p = 0.01). The overall mortality rate for MC was 6.8% versus 0.7% for nonMChypo (p < 0.001), and MC was independently associated with in-hospital mortality after adjusted regression analysis (adjusted odds ratio = 9.92 [CI 5.69-17.28], p < 0.001). Mean LOS ± standard error was 9.64 ± 0.73 days for MC versus 4.62 ± 0.12 days for nonMChypo (p < 0.001), and total hospital cost for MC was $21,768 ± $1759 versus $8941 ± $276 for nonMChypo (p = 0.07). In linear regression analyses, MC was an independent predictor of both increased LOS and total hospital cost. Conclusions: In summary, MC remains a clinically significant diagnosis in the modern era, independently associated with high mortality and health care costs. This continued burden demonstrates a need for further efforts to prevent, identify, and optimize treatment for patients with MC.

EVALUATION OF ADVERSE EFFECTS OF HYPOTHYROIDISM DURING ANTENATAL PERIOD WITH MATERNAL AND FETAL OUTCOMES IN SUBJECTS WITH SUBCLINICAL AND OVERT HYPOTHYROIDISM

Objectives: Maternal thyroid hormone excess or deficiency can influence the outcome of the mother and fetus at all stages of pregnancy as well as interfere with ovulation and infertility. In females who suffer from thyroid diseases before pregnancy or during pregnancy, these hormonal changes are magnified leading to adverse maternal and fetal outcomes. This study is done to evaluate the adverse effects of hypothyroidism during the antenatal period, maternal and fetal outcomes in patients with subclinical and overt hypothyroidism (OH). Methods: The present prospective case–control study was conducted in the Department of Obstetrics and Gynaecology, Government Medical College and Rajindra Hospital Patiala, Punjab, from August 2018 to July 2019. The study was conducted among 150 antenatal patients, who had singleton pregnancy irrespective of age and parity. A complete thyroid profile was done to segregate them into euthyroid, subclinical hypothyroidism, and OH. Patients were divided into two groups, In group I, there were 75 antenatal patients who were euthyroid, and in group II, there were 75 antenatal patients with subclinical or OH diagnosed in pregnancy or already on treatment. The adverse maternal and fetal complications were noted in two groups. Data were compared using t-test for parametric data and Chi-square test for non-parametric data. Data presented as mean and standard deviation with p≤0.05 was considered statistically significant. Results: In the current study, 4 (5.33%) patients in group II, 0 patient in group I had abortions giving p=0.011. 7 (9.3%) patients of group II, 0 patient in group I had intra uterine death giving a p=0.001. In group I, 1 (1.33%) patient, 8 (10.6%) patients in group II developed pregnancy-induced hypertension giving p=0.025. In group I, 6 (8%) patients, 25 (33.3%) in group II had preterm delivery giving p=0.018. In group I, 7 (9.33%) patients underwent induction of labor, and in group II, 19 (25.3%) patients were induced giving p=0.009. In group I, 2 (2.67%) patients, 10 (13.3%) patients in group II had undergone C-section giving p=0.006. In group I, 2 (2.67%) patients had fetal growth restriction babies as compared to 10 (13.3%) in group II giving p=0.006. In group I, 1 (1.33%) baby had an APGAR score &lt;9 at 5 min and 15 (20%) in group II patients giving p=0.001. Neonatal intensive care unit admissions were 7 (9.33%) in group I as compared to 19 (25.33%) in group II giving p=0.018. Conclusion: In the present study, it was observed that the prevalence of thyroid disorder in pregnant women is considerably high with subclinical hypothyroidism being most common followed by OH. A simple screening test of thyroid profile, if used to timely diagnose hypothyroidism a large number of maternal and fetal complications can be prevented.

The effects of choline supplementation in mothers with hypothyroidism on the alteration of cognitive-behavioral, long-term potentiation, morphology, and apoptosis in the hippocampus of pre-pubertal offspring rats.

The mother's thyroid hormone status during gestation and the first few months after delivery can play a crucial role in maturation during the brain development of the child. Transient abnormalities in thyroid function at birth indicate developmental and cognitive disorders in adulthood. Choline supplementation during gestation and the perinatal period in rats causes long-lasting memory improvement in the offspring. However, it remains unclear whether choline is able to restore the deficits in rats with maternal hypothyroidism. The aim of this study was to evaluate the effects of choline supplementation on the alteration of cognitive-behavioral function, long-term potentiation (LTP), and morphological changes as well as apoptosis in pre-pubertal offspring rats. To induce hypothyroidism, 6-propyl-2-thiouracil was added to the drinking water from the 6th day of gestation to the 21st postnatal day (PND). Choline treatment was started twice a day on the first day of the gestation until PND 21 via gavage. LTP recording and Morris water maze (MWM) test were conducted at PND 28. Then, the rats were sacrificed to assess their brains. The results revealed that developmental thyroid hormone deficiency impaired spatial learning and memory and reduced LTP (both: P < 0.001). Choline treatment alleviated LTP (P < 0.001), as well as learning and memory deficits (P < 0.01) in both male and female hypothyroid rats. However, no significant changes were observed in the number of caspase-3 stained cells in choline-receiving hypothyroid groups. The results revealed that developmental thyroid hormone deficiency impaired spatial learning and memory and reduced LTP. Choline treatment alleviated LTP, as well as learning and memory deficits in both male and female hypothyroid rats.

Evaluation of the reliability and readability of ChatGPT-4 responses regarding hypothyroidism during pregnancy

Hypothyroidism is characterized by thyroid hormone deficiency and has adverse effects on both pregnancy and fetal health. Chat Generative Pre-trained Transformer (ChatGPT) is a large language model trained with a very large database from many sources. Our study was aimed to evaluate the reliability and readability of ChatGPT-4 answers about hypothyroidism in pregnancy. A total of 19 questions were created in line with the recommendations in the latest guideline of the American Thyroid Association (ATA) on hypothyroidism in pregnancy and were asked to ChatGPT-4. The reliability and quality of the responses were scored by two independent researchers using the global quality scale (GQS) and modified DISCERN tools. The readability of ChatGPT was assessed used Flesch Reading Ease (FRE) Score, Flesch-Kincaid grade level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), and Simple Measure of Gobbledygook (SMOG) tools. No misleading information was found in any of the answers. The mean mDISCERN score of the responses was 30.26 ± 3.14; the median GQS score was 4 (2–4). In terms of reliability, most of the answers showed moderate (78.9%) followed by good (21.1%) reliability. In the readability analysis, the median FRE was 32.20 (13.00–37.10). The years of education required to read the answers were mostly found at the university level [9 (47.3%)]. Although ChatGPT-4 has significant potential, it can be used as an auxiliary information source for counseling by creating a bridge between patients and clinicians about hypothyroidism in pregnancy. Efforts should be made to improve the reliability and readability of ChatGPT.

Association between maternal hypothyroidism, baby birth weight, and adult cardiovascular disease risk: insights from ECG measurements.

Thyroid hormone (TH) deficiency during pregnancy may affect cardiovascular function in offspring rats. This study aimed to evaluate the effect of TH deficiency during gestation, on the electrocardiogram indices of young and middle-aged offspring of male rats. Eight female rats were equally divided into hypothyroid and control groups. The hypothyroid mothers received 0.025% 6-propyl-2-thiouracil (PTU) in drinking water throughout pregnancy, while control mothers consumed only tap water. Following birth, male rats from each group were observed for 4 months (young age) and 12 months (middle-aged). The group known as fetal hypothyroid (FH) consisted of rats born from hypothyroid mothers. The serum T4 and TSH concentrations from mothers and newborn male rats were assayed at the end of gestation. Lead II electrocardiogram (ECG) was recorded for 5 minutes using Power Lab, AD Instruments. There was a significant rise in the P wave voltage in young FH rats, whereas, it was decreased in middle-aged control and FH rats. The voltage of QRS decreased and its duration increased in the young and middle-aged FH rats compared to the corresponding control groups. Duration and voltage of the T wave were significantly altered in the young and middle-aged FH groups. PR and QT intervals significantly increased in the young and middle-aged FH groups compared to their controls. Maternal hypothyroidism affected the electrocardiogram indices of offspring rats, possibly signaling cardiovascular problems later in life.

Co-Morbid Hypothyroidism and Liver Dysfunction: A Review.

The liver and thyroid hormones interact at multiple levels to maintain homoeostasis. The liver requires large adequate amounts of thyroid hormones to execute its metabolic functions optimally, and deficiency of thyroid hormones may lead to liver dysfunction. Hypothyroidism has been associated with abnormal lipid metabolism, non-alcoholic fatty liver disease (NAFLD), hypothyroidism-induced myopathy, hypothyroidism-associated gallstones and occasionally, interferon-induced thyroid dysfunction. NAFLD remain an important association with hypothyroidism and further studies are needed that specifically compare the natural course of NAFLD secondary to hypothyroidism and primary NAFLD. Hepatic dysfunction associated with hypothyroidism is usually reverted by normalizing thyroid status. Large scale studies geared towards finding new and effective therapies, especially for NAFLD are needed. The clinician must be aware that there exists overlapping symptomatology between liver dysfunction and severe hypothyroidism which may make delay the diagnosis and treatment of hypothyroidism; this requires a high index of suspicion.