Thyroid Hormone Levels In Patients Research Articles

Association of kisspeptin with thyroid hormone levels in patients with hyperthyroidism in Erbil city

Association of kisspeptin with thyroid hormone levels in patients with hyperthyroidism in Erbil city

Comparative and Predictive Analysis of Clinical and Metabolic Features of Anorexia Nervosa and Bulimia Nervosa.

Eating disorders have become increasingly prevalent over the years; the age at which they appear has decreased, and they can lead to serious illness or death. Therefore, the number of studies on the matter has increased. Eating disorders like anorexia nervosa (AN) and bulimia nervosa (BN) are affected by many factors including mental illnesses that can have serious physical and psychological consequences. Accordingly, the present study aimed to compare the clinical and metabolic features of patients with AN and BN and identify potential biomarkers for distinguishing between the two disorders. Clinical data of 41 participants who sought treatment for eating disorders between 2012 and 2022, including 29 AN patients and 12 BN patients, were obtained from NPIstanbul Brain Hospital in Istanbul, Turkey. The study included the clinical variables of both outpatient and inpatient treatments. Principal component analysis (PCA) was utilized to gain insights into differentiating AN and BN patients based on clinical characteristics, while machine learning techniques were applied to identify eating disorders. The study found that thyroid hormone levels in patients with AN and BN were influenced by non-thyroidal illness syndrome (NTIS), which could be attributed to various factors, including psychiatric disorders, substance abuse, and medication use. Lipid profile comparisons revealed higher triglyceride levels in the BN group (P<0.05), indicating increased triglyceride synthesis and storage as an energy source. Liver function tests showed lower levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in BN patients (P<0.05), while higher prolactin levels (P<0.05) suggested an altered hypothalamic-pituitary-gonadal axis. Imbalances in minerals such as calcium and magnesium (P<0.05) were observed in individuals with eating disorders. PCA effectively differentiated AN and BN patients based on clinical features, and the Naïve Bayes (NB) model showed promising results in identifying eating disorders. The findings of the study provide important insights into AN and BN patients' clinical features and may help guide future research and treatment strategies for these conditions.

The effect of preoperative short-term octreotide treatment to surgery in thyrotropin-secreting pituitary adenomas: a retrospective cohort study

BackgroundTo prevent thyroid storm and ensure surgical safety, it is imperative to regulate excessive thyroid hormone levels in patients with thyrotropin-secreting pituitary adenomas (TSHoma) prior to surgery. Somatostatin analogues (SSAs), such as octreotide, have showed efficacy in shrinking tumors, which may facilitate surgical resection. This retrospective study aimed to investigate the effect of shortterm preoperative octreotide treatment on the surgical outcome of TSHoma.MethodsA total of 65 TSHoma patients from January 2010 to July 2019 were included in the study. Of these,41 patients received short-term preoperative octreotide (Sandostatin, intermittent subcutaneous injection) treatment and all patients subsequently underwent surgery. The following data were recorded: clinical manifestations, laboratory examinations, sellar region MRI, postoperative pathological and electron microscopy data, intraoperative situation, and follow-up (> 3 months) regarding hormone levels and tumor recurrence.ResultsThere was no significant difference in the consistency and blood supply of the tumor between patients who received short-term preoperative octreotide treatment and those who did not. Additionally, preoperative short-term octreotide treatment (median of 10 days with a range of 6–18 days) did not significantly improve the rates of gross total resection (GTR) or biochemical remission. Moreover, electron microscopy revealed subcellular level impairments and cell apoptotic in the octreotide treated TSHoma specimens.ConclusionPreoperative octreotide treatment for the purpose of reducing excessive thyroid hormones may not enhance surgical outcomes, and the duration of octreotide treatment needs to be extended to fully benefit from the tumor-shrinking effects of SSAs.

Advance in the Correlation between Diabetic Nephropathy and Abnormal Serum Thyroid Hormone Levels in Patients.

This study was developed to explore the correlation between diabetic nephropathy (DN) and abnormal serum thyroid hormone (TH) levels in patients, which can provide a reference for disease prevention and control in patients with DN. DN is the most serious complication of diabetes. The mortality rate of diabetic patients with DN is approximately 30 times higher than that of diabetic patients without DN. DN leads to high blood sugar, which causes vascular dysfunction in patients, causes cardiovascular disease, aggravates the disease and disease complexity, and thus increases the mortality of patients. DN patients often have oxidative stress and even fibrosis in severe cases. TH has a potential renal protective effect and can also regulate glucose metabolism and improve abnormal glucose tolerance and insulin resistance. Abnormal serum TH levels increase the risk of DN. Normal thyroid function plays an important role in regulating the physiological functions of the human body. Hormonal disorders promote the development of diabetes mellitus (DM) into DN. The pathogenesis, clinical manifestations, detection, and treatment methods of DN were reviewed in this study. The research progress of the influence of TH on DN was analyzed. This study is conducive to clinical research on DN and provides a reference.

Abstract #1406373: A Rare Case of Hyperthyroidism in a Patient with Metastatic Thyroid Cancer Presenting as Flaccid Paralysis

Hyperthyroidism in patients with thyroid cancer is rare although increasingly reported. We describe an unusual case of hyperthyroidism associated with metastatic thyroid cancer presenting as flaccid paralysis. A 53-year-old man with a history of a goiter presented to our hospital with severe low back pain for 1 month and inability to walk. He experienced loss of sensation and motor strength in his legs a few days prior to admission. Of note, he was informed about a neck mass years ago, but elected not to follow-up with any medical providers. MRI and CT imaging revealed a large mediastinal mass with cervical lymphadenopathy and multiple lytic lesions in the spine (T11, L1, L5), right ilium, lung, and liver. Initial labs showed mild hyperthyroidism. Biopsy of a right cervical lymph node revealed metastatic thyroid carcinoma, favoring follicular variant of papillary thyroid carcinoma. His hospital course was further complicated by bowel perforation and atrial fibrillation, requiring amiodarone to control his tachyarrhythmia. Subsequent labs revealed worsening thyrotoxicosis with free T4 of 7.62 ng/dL, free T3 of 14.55 pmol/L, and negative thyroid antibodies. He was a poor surgical candidate and unable to receive radioiodine for diagnosis or treatment due to his recent iodine exposure. Methimazole and PTU were not administered as he was strict NPO due to concerns of worsening his bowel perforation. Instead, he received high-dose dexamethasone for both his spinal cord compression and hyperthyroidism. After extensive goals of care discussion, he was eventually transitioned to hospice care. Hyperthyroidism associated with thyroid cancer is rare, as these cancers are typically hypo-functioning and suppression of thyrotropin helps decrease cancer progression. However, these cases are increasingly described in the literature, with a recent systematic review reporting 28 cases of hyperthyroidism in metastatic thyroid cancer patients. Among patients with thyroid cancers, hyperthyroidism can arise from the primary lesion, metastatic lesions, underlying Graves’ disease, toxic nodules, or even precipitated by a large iodine load. The etiology of hyperthyroidism in our patient is unconfirmed, but given the degree of his thyrotoxicosis, we suspect it was primarily from his metastatic disease and worsened by iodinated contrast and/or amiodarone. Our case highlights the importance of monitoring thyroid hormone levels in patients with thyroid cancers and the consequence of using iodine-containing medications, which can precipitate thyroid hormone dysfunction and delay appropriate treatments such as radioiodine ablation.

Clinical Study of Liver Cirrhosis with Special Reference to Thyroid Function: A Cross Sectional Study

Objective: The objective of this study was to assess liver cirrhosis with special reference to thyroid function. Study Design: The study was a cross-sectional one. Setting: Research was conducted at Department of Medicine, Shaikh Zayed Hospital, Lahore from August 2022 to January 2023. Material and Methods: In this study, 115 patients with cirrhosis who were both male and female and between the ages of 20 and 70 were included. These patients underwent thyroid function tests. Each patient provided written informed consent. Results: The average patient's age was 51.78±9.17 years old, and their ages ranged from 35 to 70. The vast majority of patients (n=119, or 55.6%) were between the ages of 53 and 70. Patients included 71 males (61.73% of the total) and 44 females (38.8%). The average duration of illness was 23.78 ±10.05 months, although it may be as little as 8 months. A total of 34 patients (29.56%) were classified as Child Class-B, while 81 patients (70.43%) were classified as Child Class-C. The range of serum TSH was from 3.5 to 5.8 uIU/ml (mean 4.32±0.43 uIU/ml), while the range of serum fT3 was from 1.2 to 2.9 pg/ml (mean 1.87± 0.38 pg/ml). The average serum fT4 concentration was 1.68 pg/ml (standard deviation = 0.47). Practical Implication: Especially in low and middle income countries, there is a lack of consistent data on the impact of cirrhosis on thyroid function and the association of thyroid hormone levels in patients with cirrhosis. In order to better understand the medical picture of cirrhosis of the liver and its relationship to thyroid function, the current investigation was carried out at a tertiary care center. Conclusion: Liver cirrhosis patients had lower mean blood levels of fT3 and fT4. However, the mean serum TSH level was higher in this group of individuals. It was shown to be significantly higher in patients with more advanced liver disease, but not to differ significantly by age, gender, or disease duration. Keywords: Thyroid Function, Liver Cirrhosis, Child-Pugh Classification

THYROID FUNCTION ABNORMALITIES IN PATIENTS ADMITTED IN MEDICAL INTENSIVE CARE UNIT

Aims and Objectives: The aim of the study was to assess the thyroid hormone levels in patients admitted in intensive care unit (ICU) for various critical medical conditions. Methods: This was a prospective and observational study conducted in the department of medicine of a tertiary care medical college. One hundred and twenty patients admitted in medical ICU for various medical conditions were included in this study on the basis of a predefined inclusion and exclusion criteria. A detailed history with respect to demographic details such as age, gender, and body mass index was noted. APACHE II score of the patients were noted with an objective to assess the severity of the illness. The incidence of thyroid function abnormalities as well as the analysis of patients’ outcome in terms of thyroid function abnormalities was determined. p&lt;0.05 was taken as statistically significant. Results: Out of these 120 patients, there were 78 (65%) were males and 42 (35%) were females with a M: F ratio of 1:1.0.53. The mean age of patients was found to be 44.52±11.27 years. The most common indication for admission was diabetic ketoacidosis (23.33%) followed by stroke (15.00%) and renal failure (11.67%). Thyroid function abnormalities were seen in 26 (21.67%) patients. These abnormalities were seen in patients with diabetic ketoacidosis (4.17%), congestive cardiac failure (4.17%), stroke (3.33%), renal failure (2.50%), hypertensive crisis, and multiorgan dysfunction (2.50%). Mortality was found to be significantly high in patients having thyroid function abnormalities as compared to those who had normal thyroid function. Conclusion: Thyroid function abnormalities are common in patients admitted in ICU and are associated with adverse outcome.

Obezitenin Tiroid Hormon Düzeyleri Üzerine Etkileri: Retrospektif Kesitsel Çalışma

Objective: The incidence of obesity is increasing. Thyroid dysfunction has been extensively studied in obesity. The aim of this study is to determine thyroid hormone levels in patients with obesity (Class I and II obesity) and morbid obesity, and to determine the correlation between body mass index (BMI) and thyroid hormones. Material and Methods: Data from one hundred fifty-seven patients with obesity, including 71 patients with a BMI of 30-39.9 kg/m2 (Group 1) and 86 patients with morbid obesity with a BMI≥40 kg/m2 (Group 2), and 60 control subjects with a BMI of 18.5-24.9 kg/m2 were retrospectively reviewed. Thyroid hormone levels were compared. Consent was obtained from the patients and, if necessary, their legal representatives. The study was a retrospective cross-sectional study. Ethics committee approval was obtained for our study. Results: The mean age of obese and normal-weight individuals was similar (p=0.94). Thyroidstimulating hormone (TSH) levels were higher in patients than in controls (3.7±1.8 μIU/mL and 2.5±1.7, respectively; p=0.01). The prevalence of subclinical hypothyroidism (SCH) was higher in patients than in controls (p=0.003). There was a positive correlation between TSH and BMI (r=0.44, p=0.001). In subgroup analysis, TSH level was similar in Group 1 and Group 2 (p=0.07). TSH was higher in Group 1 (p=0.03) and Group 2 (p=0.01) than in the control group. The frequency of SCH was similar in Group 1 and Group 2 (p=0.06). The frequency of SCH was higher in Group 1 (p=0.006) and Group 2 (p=0.002) than in the control group. Conclusion: TSH level was higher in patients with obesity than in healthy controls. There was a positive correlation between BMI and TSH. Thyroid hormone levels were similar in patients with a BMI of 30-39.9 kg/m2 and morbid obesity. We recommend thyroid hormone screening in obesity.

Abstract 15293: Predictive Value of Thyroid Hormone Levels in Patients Suffering From Cardiogenic Shock Complicating Acute Myocardial Infarction

Hypothesis: Introduction. Acute critically ill patients experience a rapid decline in plasma free thyroid hormone levels (free triiodothyronine (FT3) and free levothyroxine (FT4)), with a marked elevation of reverse T3, recognized as the euthyroid sick syndrome (ESS) or low-T3 syndrome. The ESS is also often associated with depressed myocardial function, sometimes referred to as the 'stunned myocardium. The role of thyroid hormone levels in patients with cardiogenic shock complicated myocardial infarction has not been shown Methods: The purpose of the study was to assess the impact of thyroid hormone levels on hospital mortality in patients with infarction related cardiogenic shock. Thyroid hormone levels were measured from routine blood specimens and analyzed initial and up to 96 hours. Results: We identified 40 patients with infarction related cardiogenic shock treated at our university hospital. Majority of the CS-patients had on admission reduced TSH levels of 1,42 ± 0,22mU/l. Nevertheless, in-hospital mortality rate was higher in patients with lower admission TSH levels and levels over time. In addition, FT3 in CS-survivors showed a flat slope from normal levels. Non-survivor had a trend towards lower levels after 72 and 96 hours. When we analyzed for low T3 syndrome (i.e. FT3 &gt;3,1pmol/l) we saw a 3x times higher mortality rate compared to CS patients with normal levels. In contrast, FT4 levels of non survivors were significantly elevated compared to surviving CS patients. After 96 hours both groups had similar levels. Predictors of hospital death in CS patients were low TSH levels, low T3 syndrome and elevated FT4. Conclusions: Thyroid hormone level on admission and over time (i.e. low TSH, low T3 and elevated FT4) are predictors of in-hospital death in patients with infarction related cardiogenic shock. Interestingly TSH stays almost stable over time whereas FT3 and FT4 declines over time. Further studies have to show if administration of thyroid hormone might be beneficial in patients with infarction related cardiogenic shock.

Research progress on the relationship between liver cirrhosis and thyroid hormones

There exists a complex relationship between liver and thyroid hormones. Liver plays an important role in the activation, inactivation, transportation, and metabolism of thyroid hormones. At the same time, thyroid hormones also affect hepatocytes activity and liver metabolism, such as lipid and bilirubin metabolism. Importantly, thyroid hormone levels often change abnormally in patients with liver cirrhosis. Therefore, studying the change of thyroid hormone levels in patients with liver cirrhosis has a certain clinical value for assessing the severity, prognosis, diagnosis and treatment. This paper reviews the research progress on the relationship between liver cirrhosis and thyroid hormone.

Comparison of thyroid function in different emotional states of drug-na\xefve patients with bipolar disorder

BackgroundPrevious studies have shown that bipolar disorder is closely related to thyroid dysfunction. Psychiatric drugs have a large or small effect on thyroid function, and thyroid hormone levels can also affect the effect of drug treatment. Therefore, the purpose of this study is assessment the thyroid function of drug-naive bipolar disorder across different mood states, with the expectation of providing support for treatment options.MethodsThe present study is a cross-sectional study. Patients diagnosed with bipolar disorder according to the International Classification of Diseases diagnostic Criteria, Edition 10 (ICD 10) and who had never received medication were included in the study. The Montgomery Depression Scale (MADRS) was used to assess depressive symptoms and the Young Mania Rating Scale (YMRS) for manic symptoms. Thyroid function indicators include thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), total triiodothyronine (TT3), free thyroxine (FT4), and total thyroxine (TT4). Levels of TSH, TT4, FT4, TT3, and FT3 were measured within 48 h of hospitalization, between 06:00 and 08:00.ResultsThe data analysis finally covered the data of 291 subjects (136 in a bipolar manic group, 128 in a bipolar depressive group, and 27 in a bipolar mixed group), including 140 males and 151 females, with an average age of 27.38 ± 8.01. There was no significant difference in age, sex, marital status, work status, family history, and course of illness among the manic group, depressive group, and mixed group. The level of FT3, the rate of thyroid hormone increased secretion, and the total abnormality rate of thyroid hormone secretion in the manic group were significantly higher than those in the depressive group.ConclusionThese findings indicate that thyroid functions were significantly different between depressive and manic episodes in BD patients. In clinical practice, it is necessary to take into account the differences in thyroid hormone levels in patients with BD across different emotional states in choosing drug.

Multivariate NTCP Model of Hypothyroidism After Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma.

ObjectiveTo evaluate the incidence of hypothyroidism in patients with nasopharyngeal carcinoma after intensity-modulated radiotherapy (IMRT), analyze its correlation with multiple influencing factors such as thyroid exposure dose, thyroid volume, and gender, and construct a multivariate-based normal tissue complication probability (NTCP) model for the occurrence of hypothyroidism after IMRT.Materials and MethodsThe thyroid hormone levels of patients at different points in time before and after radiotherapy were tested, and statistics on the incidence of hypothyroidism after treatment were obtained. The dose-volume data of patients’ thyroids were converted into EQD2 equivalent dose values. The correlation between hypothyroidism after radiotherapy and thyroid exposure dose, thyroid volume, gender, and other factors was analyzed, and an NTCP model was constructed.ResultsA total of 69 patients with nasopharyngeal carcinoma were enrolled in this study. Twelve months after radiotherapy, a total of 24 patients (34.8%) developed hypothyroidism. Univariate analysis and multivariate analysis revealed that the average thyroid dose and thyroid volume are the most important factors affecting hypothyroidism after radiotherapy. The NTCP model constructed based on the average dose and thyroid volume has a good degree of fit.ConclusionThe volume and average dose of the thyroid gland are the key factors affecting the occurrence of hypothyroidism in patients with nasopharyngeal carcinoma after radiotherapy. The NTCP model constructed based on multivariate construction suggests that reducing the average dose of the thyroid to the greatest extent is an effective way to protect thyroid functions.

Association of Thyroid Function With Suicide Ideation/Attempt -A Systematic Review and Meta-analysis

Background: Thyroid disorders are very prevalent and could affect virtually the entire human body, including cognitive and psychiatric domains. However, the relationship between thyroid dysfunction and suicide is still controversial. Material and Methods: A systematic review and meta-analysis was conducted to describe the association of thyroid function with suicide ideation/attempt in adults. A comprehensive search from databases’ inception (MEDLINE, EMBASE, Cochrane, PsycINFO, PsycArticles, PSYNDEX and Scopus) to July 20, 2018 was conducted with no language restrictions. We included studies that reported mean values and standard deviation (SD) of thyroid hormone levels [Thyroid-stimulant hormone (TSH), free T4 (FT4), free T3 (FT3), total T4 (TT4), and total T3 (TT3)] in patients with suicide ideation/attempt compared with controls. Four reviewers worked independently and in duplicate for assessment of inclusion criteria, data extraction, and assessment of risk of bias. The mean value and SD of the thyroid function tests were used to calculate the mean difference for each subgroup. Random-effects models for meta-analyses were applied. Results: Overall, 2278 articles were identified, and 13 observational studies met the inclusion criteria. These studies involved 2651 participants, including 817 participants diagnosed with suicidal ideation/attempt. Group sizes of patients with suicide ideation/attempt ranged from 7 to 122 participants with mean age ranging from 23 to 49 years. Control group sizes ranged from 8 to 464 participants with mean age ranging from 24 to 50 years. Two studies included only women, two studies included only men, and 9 studies included both (% female range: 29 to 78%). Patients with suicide ideation/attempt had lower levels of FT3 (-0.19 pg/mL; P=0.04) and TT4 (-0.23 µg/dL; P=0.05) compared to controls. There were no differences in TSH, TT3 or FT4 levels between groups. In a subgroup analysis comparing current suicidal ideation vs current suicidal attempt vs history of suicidal ideation/attempt with the control group, there were no differences in any of the thyroid function tests. None of the included studies compared rates of overt/subclinical thyroid disease among groups. The overall risk of bias of the included studies was low-to-moderate. Conclusions: There is scarce evidence regarding the association of thyroid disorders and suicide. We found statistically significant lower thyroid hormone levels in patients with suicidal ideation/attempt. The clinical implications of this finding remain unknown and further research is needed to evaluate the association of thyroid disorders with suicide.

Microwave ablation of autonomously functioning thyroid nodules: a comparative study with radioactive iodine therapy on the functional treatment success.

The objective of this study was to compare the efficiency of microwave ablation (MWA) and radioactive iodine (RAI) in the treatment of toxic adenoma (TA), and to investigate the functional treatment success of the used modalities for its remission. Treatment outcomes- thyroid hormone levels and nodule characteristics- of 30 patients (23:7 F:M; 52.77 ± 11.13 years) treated by MWA were compared with the those of 35 patients (24:11 F:M; 61.43 ± 12.60 years) treated by RAI. The baseline characteristics of TAs, which are gender and pre volume, were analogous and did not show any statistical significance (p > 0.05). Thyroid hormone levels of patients treated with two different methods were measured after 9 months, and the obtained results were compared. Although there was no statistically significant difference in the nodule volume (p > 0.05), there was a greater volume reduction rate (VRR%) in the group treated with MWA rather than RAI (p < 0.05) at the end of the follow-up. In the MWA group, there was a higher increase in FT3 than in the RAI group (p < 0.05). Furthermore, no statistically significant difference in TSH (p = 0.124) and FT4 (p = 0.144) levels of the patients as treatment outcomes was observed. The therapeutic success was accomplished in 18/30 (60%) of the MWA group and in 24/35 (68.6%) of the RAI group. Therapeutic success of MWA and RAI did not show any statistically significant difference (p = 0.471). However, the development of hypothyroidism in 7 of 35 patients treated with RAI was observed. On the other hand, no case of post-treatment hypothyroidism was observed in patients treated with MWA. In this regard, MWA could be a great alternative to RAI due to its advantages in terms of non-exposure to radiation and lower risk of post-treatment hypothyroidism.

Evaluation of Thyroid Hormones Levels in Libyan Patients with Chronic Renal Failure Before and AFTER Maintenance Hemodialysis

Data from recent studies revealed that kidney diseases might affect the thyroid function in various ways. A variety of alterations in thyroid hormone levels and metabolism have also been reported in patients with chronic renal failure (CRF) in some studied population. In addition, it was reported that serum levels of both T3 and T4 might altered immediately after a hemodialysis (HD) treatment than before. Therefore, this study was aimed to investigate the level of triiodothyronine (T3) and thyroxine (T4) in CRF Libyan patients before and after HD. This study was carried out on 46 CRF patients (30 male and 16 female) with a mean age of 47.46 ±15.75 years. These patients were treated at the hemodialysis unit of Educational Central Zelitin Hospital, Zelitin, Libya. None of these patients apparently have any thyroid problems and no history of drug intake that may affect thyroid function. Blood samples were taken from each patient to measure serum levels of T3 and T4, before and after HD. In addition, the effect of several variables include age, gender, body mass index (BMI), presence of both hypertension and, diabetes mellitus and duration of kidney dialysis on serum levels of T3and T4 before and after HD were also studied. After HD, there was a statistically significant increase in the serum levels of T3, T4. The age, gender, BMI, duration of kidney dialysis and the presence of hypertension and diabetes mellitus did not have any significant effect on the serum level of T3 and T4 before and after HD. However, the serum levels of T3 and T4 were still in the normal range in these examined patients either before or after HD. From these findings, it can be concluded that these CRF patients may be in a euthyroid state, because the serum levels of T3 and T4 were in the normal range. In addition, HD was seem to improve the T3 and T4 thyroid hormone concentrations, suggesting that HD might activate the secretion of thyroid glandand catabolism. The other variables did not play any role in thyroid hormone levels in these patients either before or after HD. It is highly recommended that large scale evaluation of thyroid hormone levels in Libyan CRF patients is performed more patients, especially elderly patients.

Significant Association of Antiepileptic Drug Polytherapy with Decreased FT4 Levels in Epileptic Patients.

Epileptic patients have to continue anti-epileptic drugs (AED) over a long period of time which can have deleterious effects on the endocrine system including the thyroid hormones with rare check. Risk factors for the development of thyroid dysfunction are still unclear. Therefore the aim of study was to evaluate thyroid functions in epileptic patients receiving anti-epileptic drugs (AED) as monotherapy and polytherapy and to determine potential risk of low thyroid function in epileptic patients receiving treatment. This cross-sectional study included 100 epilepsy patients more than 12years of age. Serum levels of free thyroxin (FT4), free triiodothyronine (FT3), and thyroid stimulating hormone (TSH) were evaluated in all subjects in addition to serum AED levels. TSH levels were found to be significantly higher in the polytherapy subgroup (p < 0.05) in comparison to the monotherapy group. 44% of the patients in the VPA monotherapy group had raised TSH levels and 41.2% of the patients on CBZ had low FT4. A significant negative correlation was observed between CBZ and FT4 (p < 0.05). Female sex and old age were additional risk factors detected for deranged thyroid function. Female patients with epilepsy, an older age and AED polytherapy were found to be associated with a higher risk of thyroid dysfunction. Thus, Thyroid function in these patients should be monitored closely. In conclusion, we observed significant changes in thyroid hormone levels in patients receiving antiepileptic treatment in both monotherapy and polytherapy. Elevated CBZ levels were significantly associated with decreased FT4 levels.

Association Between Thyroid Function and Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

PurposeChronic obstructive pulmonary disease (COPD) was the fourth leading cause of death in the world. Many studies have shown that COPD often exists with thyroid dysfunction; however, the relationship between thyroid function and COPD is often ignored in clinical. We retrospectively analyze the serum thyroid hormone levels in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and explore the association between thyroid function and AECOPD.MethodsThe study included patients hospitalized for AECOPD in our institution between January 2018 and September 2020. Patients with AECOPD were divided into moderate-to-severe and very severe groups based on lung function, and into normal and abnormal thyroid function groups based on thyroid hormone levels. Collected data and compared data between groups to identify risk factors for thyroid dysfunction in patients with AECOPD.ResultsThe cohort included 97 in the moderate-to-severe group (72.39%) and 37 in the very severe group (27.61%). Compared with the very severe group, the moderate-to-severe group had higher triglyceride (P=0.017), high-density lipoprotein (P<0.05), partial pressure of carbon dioxide (PaCO2; P<0.05), and serum thyroid-stimulating hormone (TSH; P<0.001). FEV1 as a percentage of the predicted value (FEV1%pred) was positively correlated with TSH and FT3 (r=0.329, r=0.192, respectively, both P<0.05). Duration of hospitalization was negatively correlated with TSH (r=−0.256, P=0.003). Among the 134 subjects, 98 (73.13%) had normal thyroid function and 36 (26.87%) had abnormal thyroid function. The two groups significantly differed regarding forced vital capacity (FVC), forced expiratory volume in 1 second, FEV1%pred, and albumin level. Logistic regression analysis showed that high FVC correlated with a low risk of thyroid dysfunction in AECOPD.ConclusionIn patients with AECOPD, TSH is related to lung function and duration of hospitalization, and high FVC reduces the risk of thyroid dysfunction.

Evaluation of Thyroid Hormones Levels in Libyan Patients with Chronic Renal Failure before and after Maintenance Hemodialy

Data from recent studies revealed that kidney diseases might affect the thyroid function in various ways. A variety of alterations in thyroid hormone levels and metabolism have also been reported in patients with chronic renal failure (CRF) in some studied population. In addition, it was reported that serum levels of both T3 and T4 might alter immediately after a hemodialysis (HD) treatment than before. Therefore, this study was aimed to investigate the level of triiodothyronine (T3) and thyroxine (T4) in CRF Libyan patients before and after HD. This study was carried out on 46 CRF patients (30 males and 16 females) with a mean age of 47.46 ± 15.75 years. These patients were treated at the hemodialysis unit of Educational Central Zelitin Hospital, Zelitin, Libya. None of these patients apparently have any thyroid problems and no history of drug intake that may affect thyroid function. Blood samples were taken from each patient to measure serum levels of T3 and T4, before and after HD. In addition, the effects of several variables including age, gender, body mass index (BMI), presence of both hypertension and, diabetes mellitus and duration of kidney dialysis on serum levels of T3 and T4 before and after HD were also studied. After HD, there was a statistically significant increase in the serum levels of T3, T4. The age, gender, BMI, duration of kidney dialysis and the presence of hypertension and diabetes mellitus did not have any significant effect on the serum level of T3 and T4 before and after HD. However, the serum levels of T3 and T4 were still in the normal range in these examined patients either before or after HD. From these findings, it can be concluded that these CRF patients may be in a euthyroid state, because the serum levels of T3 and T4 were in the normal range. In addition, HD was seemed to improve the T3 and T4 thyroid hormone concentrations, suggesting that HD might activate the secretion of thyroid gland and catabolism. The other variables did not play any role in thyroid hormone levels in these patients either before or after HD. It is highly recommended that large scale evaluation of thyroid hormone levels in Libyan CRF patients is performed by more patients, especially elderly patients.

Thyroid hormone concentrations in severely or critically ill patients with COVID-19.

ObjectiveCOVID-19 is a new coronavirus infectious disease. We aimed to study the characteristics of thyroid hormone levels in patients with COVID-19 and to explore whether thyroid hormone predicts all-cause mortality of severely or critically ill patients.MethodsThe clinical data of 100 patients with COVID-19, who were admitted to Wuhan Tongji Hospital from February 8 to March 8, 2020, were analyzed in this retrospective study. The patients were followed up for 6–41 days. Patients were grouped into non-severe illness and severe or critical illness, which included survivors and non-survivors. Multivariate Cox proportional hazards analysis was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality in association with continuous and the lower two quartiles of thyroid hormone concentrations in severely or critically ill patients.ResultsThe means of free T3 (FT3) were 4.40, 3.73 and 2.76 pmol/L in non-severely ill patients, survivors and non-survivors, respectively. The lower (versus upper) two quartiles of FT3 was associated with all-cause mortality HR (95% CI) of 9.23 (2.01, 42.28). The HR (95% CI) for all-cause mortality in association with continuous FT3 concentration was 0.41 (0.21, 0.81). In the multivariate-adjusted models, free T4 (FT4), TSH and FT3/FT4 were not significantly related to all-cause mortality. Patients with FT3 less than 3.10 pmol/L had increased all-cause mortality.ConclusionFT3 concentration was significantly lower in patients with severe COVID-19 than in non-severely ill patients. Reduced FT3 independently predicted all-cause mortality of patients with severe COVID-19.

Effect of Ramadan Fasting on Thyroid Hormone Levels in Patients on Levothyroxine Treatment.

To evaluate the changes in thyroid functions in Ramadan, and compare late evening and pre-seheri use of levothyroxine in patients with hypothyroidism. Cross-sectional study. Department of Endocrinology, Ankara Ataturk Education and Research Hospital and Ankara Yildirim Beyazit University, Turkey, from May to June 2018. Patients who were on levothyroxine treatment and having normal thyroid functions were recruited for the study in the last one week before Ramadan. Patients were offered to take levothyroxine at 22.30-23.00 pm before sleep or between 01:30-03:00 am at least 30 min pre-seheri. There were 53 (85.5%) female and 9 (14.5%) male patients. Basal thyrotrophin (TSH) was 2.02 μIU/mL (0.27-4.14) and insignificantly increased at the end of Ramadan [2.18 μIU/mL (0.04-19.69), p=0.167]. Free-triiodothyronine (fT3) decreased while free-thyroxine (fT4) increased (p<0.001 for both). Eighteen patients preferred to take levothyroxine in late evening and 44 preferred to take at pre-seheri. There were insignificant increases in TSH in both groups (p=0.401 and p=0.276, respectively). At the end of Ramadan, TSH increased in 39 (63.9%), decreased in 22 (36.1%), and did not change in one patient. Increase in TSH was not significant after Ramadan. While there was an insignificant increase in median TSH, about one-third of patients had lower TSH, indicating for the need to evaluate every patient individually and follow closely during Ramadan. Clinical studies with larger sample sizes will be helpful to determine the optimal time for levothyroxine use during Ramadan. Key Words: Thyroid functions, Ramadan fasting, Hypothyroidism, Levotyhroxine.