Free Thyroxine Research Articles

Contingent negative variation for assessment of neurological deficits in children with hypothyroidism

Objectives: Hypothyroidism is one of the most common endocrine disorders. Its effect on the central nervous system is more pronounced, especially in the pediatric age group. Despite receiving adequate thyroid hormone replacement therapy, several patients continue to suffer from neurological impairments including cognitive dysfunction. Contingent negative variation (CNV) is an event-related potential (ERP) that is considered as an indicator of cognitive function. In this study, CNV was recorded in children with hypothyroidism. To the best of our knowledge to date, there have been no studies of CNV in hypothyroidism. Materials and Methods: This prospective study included 52 children between 8 and 15 years of age who were newly diagnosed with hypothyroidism. Diagnosis of hypothyroidism was based on laboratory thyroid function tests. CNV ERP was recorded in the enrolled children at the time of diagnosis, 1-month, and 6-month follow-up. Initial CNV (iCNV) and late CNV (lCNV) amplitudes and latencies were recorded each time. Results: Although the amplitudes of iCNV and lCNV appeared to increase during follow-ups, the changes were not statistically significant (P > 0.05). Similarly, there appeared to be a modest reduction in latencies of iCNV or lCNV during follow-up; however, these changes were not statistically significant either. Conclusion: Our study did not show any significant changes in neurophysiological parameters. This may be attributed to a shorter time period of follow-up of six months and a smaller sample size. There is a possibility that CNV parameters may show more pronounced changes after a prolonged duration of treatment.

What is the impact of acute endocrine and metabolic alterations on long-term ischemic stroke prognosis: a prospective study

BackgroundPost-stroke stress can trigger instant survival but its influence on long-term ischemic stroke outcomes remains controversial. Thus, we sought to explore the associations of acute post-stroke stress evidenced by endocrine and metabolic changes, with long-term ischemic stroke outcomes.MethodsAdmissions for acute ischemic stroke within seven days of onset were prospectively recruited to determine acute endocrine and metabolic variations measured by thyroid parameters and the stress hyperglycemia ratio (SHR). Long-term ischemic stroke prognoses were followed up for one year, with the primary outcome being a modified Rankin Scale score of 3 to 6.ResultsA total of 887 patients were enrolled, of which 535 reached the final one-year followed up at a poor prognosis rate of 29.3%. Patients with poor outcomes were observed to have lower levels of free triiodothyronine (fT3) and higher levels of SHR on admission. Medium values (fT3, 4.4 mmol/L; SHR, 8 nmol/L) were used to divide patients into four gradient stress degrees. Larger acute endocrine and metabolic variations (fT3 < 4.4 mmol/L and SHR ≥ 8 nmol/L) were independently associated with a poor one-year prognosis (adjusted OR = 4.231, P = 0.001).ConclusionsHigh degrees of acute post-stroke stress may aggravate long-term ischemic stroke prognosis and timely stress-reduced interventions may help promote post-stroke living quality is equally important as survival.

Anticonvulsants impacting bone metabolism: interim results from a cross-sectional study

Background. Despite a wide range of antiepileptic drugs (AEDs) with an improved pharmacological profile, patients often experience a variety of side effects during long-trem anticonvulsant therapy, among which are osteoporotic disorders. Currently, the mechanisms of AED effect on bone metabolism remain poorly understood, which creates certain difficulties in prevention and treatment of AED-induced osteoporosis.Objective: to study bone mineral density and laboratory parameters of bone metabolism in patients with epilepsy and longterm AED administration.Material and methods. A cross-sectional study included two comparison groups: 100 adult patients with epilepsy receiving AEDs for more than 12 months and 58 healthy volunteers without taking AEDs. All participants underwent general clinical examination, computed tomography (CT) densitometry at three time points (L1, L2 and femoral neck) and laboratory tests of mineral metabolism.Results. According to CT-densitometry results, a decrease in bone mineral density was detected in the majority of participants from both study groups. While assessing an impact of osteoporosis risk factors on bone tissue in epileptic patients, low motor activity and duration of AED therapy were the most significant, which was associated with lower bone mineral density indices. The study of laboratory mineral metabolism indicators revealed significant inter-group differences in indicators such as ionized calcium, 25-hydroxy-calciferol, free thyroxine and prolactin (p(U)=0.044, p(U)=0.040, p(U)=0.001, p(U)=0.003, respectively).Conclusion. The intermediate study results showed that long-term anticonvulsant use negatively affected bone metabolism in patients suffering from epilepsy. The data obtained point at need for further in-depth study of AED therapy effect on mineral metabolism.

Central Hypothyroidism Associated With Empty Sella: Literature Review and Case Report

Empty Sella Syndrome (ESS) is a rare case of sella turcica malformation, resulting in pituitary gland decrease. It may reveal itself through neurological symptoms, endocrine disorders, visual disturbances or incidental findings during imaging. The urgency of this problem has increased with the widespread use in the diagnosis of the non-invasive method of magnetic resonance imaging (MRI). It can be discovered as part of the investigation of the pituitary disorders, or as an incidental finding when imaging the brain. Practice shows that such patients rarely come with typical complaints thus an extended review of this case is needed to prompt suspicion and aid in the diagnosis of ESS. Few cases of empty sella associated with isolated thyroid-stimulating hormone (TSH) deficiency were published. We report a case of a 46 year-old woman with complaints: edema, dizziness, low blood pressure, hair loss, dry skin. Examinations were performed: ultrasound of the thyroid gland, TSH, FT4 (free thyroxine), FT3 (free triiodothyronine), anti TPO (Antibodies to thyroid peroxidase). Conclusion: patients with TSH, FT4, and FT3 deficiency, should undergo examinations to exclude empty sella as one of the reason of central hypothyroidism. According to the above mentioned the recommendation is to examine all the tropic hormones of the pituitary gland after diagnosing empty sella. Diagnosing central hypothyroidism associated with empty sella helps improving the knowledge and points to different clinical manifestation of empty sella syndrome.

Comparison of orexigenic and anorexigenic neuropeptide levels in hyperemesis gravidarum patients with normal pregnant women: A prospective cohort study.

The aim of this study was to determine whether orexigenic neuropeptides, orexin and galanin, and anorexigenic neuropeptides, alpha-melanocyte-stimulating hormone (α-MSH) and cocaine- and amphetamine-regulated transcript (CART), are implicated in hyperemesis gravidarum (HG). Fifty pregnant women who had been diagnosed with HG between April 2022 and February 2023 at the Siirt University Faculty of Medicine Training and Research Hospital (tertiary center) were recruited for this study. An equal number of pregnant women without an HG diagnosis were included in the study as the control group. Participants' age, pregnancy history, medical history, thyroid function test results, complete blood count results, and electrolyte levels were recorded, and their orexin, galanin, α-MSH, and CART serum levels were analyzed using an enzyme-linked immunosorbent assay. No statistically significant differences in orexigenic neuropeptides (orexin and galanin) were observed between the HG and control groups. A statistical difference was found between an anorexigenic neuropeptide (α-MSH) and the control group (P = .012). Based on a receiver operating characteristic analysis, the α-MSH parameter was statistically significant for distinguishing between participants with an HG diagnosis and those without, with a sensitivity of 63.6%, specificity of 65.9%, and cutoff value of 11769.3 pg/mL (P = .012, area under curve: 0.655). Based on the severity classification of ketonuria (ketonuria levels of +1 or +2 were classified as mild, whereas levels of +3 or +4 were classified as moderate to severe), the anorexigenic CART neuropeptide was found to be a statistically significant diagnostic indicator of severe ketonuria (P = .020). α-MSH and CART levels were found to be related in HG patients and in HG patients with severe ketonuria.

Lower Free Thyroxine Levels Are Associated with Diabetic Kidney Disease in Males with Type 2 Diabetes Mellitus: An Observational Cross-Sectional Study.

Objectives: We aimed to explore the correlation between thyroid function and diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM). Methods: A total of 7516 T2DM patients were enrolled and grouped according to DKD status. Clinical parameters, including blood glucose parameters, thyroid function, and indicators of renal impairment, were collected and compared between the DKD and Non-DKD groups. Correlation analysis and univariate/multivariate logistic regression analyses were performed. Results: Age, T2DM duration, the use of insulin and lipid-lowering drugs, systolic and diastolic blood pressure, body mass index, and fasting blood glucose levels were greater in the DKD group than in the Non-DKD group (p < 0.001). Notably, compared with those in the Non-DKD group, patients in the DKD group had lower triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3), and free thyroxine (FT4) levels and higher thyrotropin levels (p < 0.001). Univariate logistic regression analysis revealed that T3, T4, FT3, and FT4 levels were negatively correlated with the risk of DKD. Spearman correlation analysis confirmed that T3, T4, FT3, and FT4 levels were negatively correlated with blood urea nitrogen levels, blood creatinine levels, and the urinary albumin-to-creatinine ratio (p < 0.05). Multivariate logistic regression analysis revealed that a greater FT4 level was a protective factor against DKD in T2DM patients, especially in males, with a cut-off value of 13.35 pmol/L (area under the curve = 0.604). Conclusions: Thyroid hormone levels, especially FT4 levels, were significantly negatively correlated with DKD in T2DM patients.

Effects of repetitive transcranial magnetic stimulation on cognitive function and hormone levels in early stroke patients with low thyroid hormone levels.

This study aimed to observe the effects of repetitive transcranial magnetic stimulation (rTMS) on cognitive function and thyroid hormone levels in early older stroke patients with low thyroid hormone levels, and to investigate the correlation between the changes in thyroid hormone levels and the improvements in cognitive function after stroke. Forty older stroke patients who met the inclusion criteria were recruited and randomized into a magnetic-stimulation group (rTMS group) and a sham-stimulation group (Sham group). The rTMS group received low-frequency true stimulation and the Sham group received low-frequency sham stimulation. Patients' cognitive scores, activity of daily living(ADL) scores, and their levels of triiodothyronine (T3), free triiodothyronine (FT3), thyroxin (T4), free thyroxine (FT4), and thyroid stimulating hormone (TSH) were assessed before the intervention, after the 4-week intervention, and after an additional 4 weeks of follow-up; Repeated measurement analysis of variance was used to compare the changes of each index in the two groups at different times and the correlations between patiens' cognitive function scores and their changing hormone levels were subsequently investigated. Thirty-one patients were included in this study: 16 patients in rTMS group and 15 patients in the Sham group. Repeated-measures ANOVA showed that patients' T3,FT3 and TSH levels tended to increase at 4-week intervention and at the follow up (p < 0.05), and that the rTMS group had a better effect on improving T3 than the Sham group (Fgroup = 5.319, p = 0.028); The cognitive scale at different time points in both groups showed an upward trend (p < 0.05), and the MoCA, DSF, DSB scores in the rTMS group were statistically higher than those in the Sham group at the end of the 4-week intervention and at the follow-up (p < 0.05); The changes in the levels of T3 before and after 4-week intervention were positively correlated with the changes in the MoCA scores (r = 0.638, p < 0.05). And the difference in T3 level change was positively correlated with the difference in delayed recall, attention and naming score change (r = 0.562, p < 0.05; r = 0.562, p < 0.05; r = 0.531, p < 0.05); and the difference in FT3 level change was positively correlated with the visuospatial and executive function (r = 0.514, p < 0.05). Repetitive transcranial magnetic stimulation improved cognitive function and elevated T3 levels in older patients with post-stroke cognitive dysfunction who had low thyroid hormone levels. Within the normal range, increases in T3 levels are positively correlated with changes in cognitive function.

Successful management of megaoesophagus associated with hypothyroidism in a dog: A case report

A seven-year-old male Dachshund was presented with a history of chronic regurgitation and weight loss for two months. On clinical examination, dry and rough hair coat with alopecia on nose bridge and rat tail appearance were observed. Elevated rectal temperature and increased respiratory rate were noticed. Auscultation of lung field revealed mild crackles. Leucocytosis and mild anaemia were evident on complete blood count. Hypercholesterolaemia, hypertriglyceridaemia and elevation of Lactate dehydrogenase (LDH) and Alkaline phosphatase (ALP) were observed in serum biochemistry. The total T4 (TT4) value was low and canine-specific thyroid stimulating hormone (cTSH) was elevated. Megaoesophagus was confirmed by plain radiography. Barium contrast radiograph revealed generalised dilatation with pooling of barium in the oesophagus. The animal was treated with levothyroxine sodium at 0.02 mg/kg BW PO BID and bethanechol at 10 mg PO TID. Supportive therapy included antibiotics, antacids and antiemetics. Elevated feeding was advised. The animal had no episodes of regurgitation even after one month Keywords: Megaoesophagus, hypothyroidism, bethanechol, elevated feeding

Increased thyroid hormone sensitivity is correlated with visceral obesity in patients with type 2 diabetes

ObjectiveThe study aimed to assess whether thyroid hormone (TH) sensitivity is related to visceral fat area (VFA) and visceral obesity in euthyroid subjects with type 2 diabetes (T2D).Methods750 euthyroid patients with T2D were enrolled. A VFA of 80 cm2 or more was considered visceral obesity. Central TH sensitivity was conducted using thyrotrophic thyroxine resistance index (TT4RI), thyrotropin index (TSHI), and thyroid feedback quantile-based index (TFQI). Free triiodothyronine to free thyroxine (FT3/FT4) was utilized for assessing peripheral TH sensitivity.ResultsThe subjects had a mean age of 51.5 ± 11.1 years, and 540 (72.0%) of them were men. In multivariable regression analyses, there was a positive correlation of FT3/FT4 tertile with visceral obesity, after full adjustment for confounding variables (P < 0.05). The middle and highest FT3/FT4 tertiles were correlated with a 134% [95% CI (1.24, 4.44)] and 98% [95% CI (1.04, 3.78)] higher prevalence of visceral obesity than the lowest tertile, respectively. Conversely, elevated TFQI levels were linked to a decreased prevalence of visceral obesity. Stratified analysis revealed that these associations were particularly pronounced in participants who are neither overweight nor obese and those aged less than 60 years (all P < 0.05).ConclusionsHigher TH sensitivity is correlated with visceral obesity and elevated VFA in euthyroid patients with T2D, particularly among those younger than 60 years and individuals who are neither overweight nor obese.

Prevalence of thyroid dysfunction in namakkal district -A hospital based study

Thyroid disorders are most common endocrine disorder in India but the prevalence studies on these dysfunction is limited. All subjects who visited the hospital for a period of four months to have thyroid function tests (TFTs) on their first outpatient visit were included in the study. Thyroid disordrs were present in 22.11 % of the total 2510 subjects . The prevalence rate was higher in females (64.8%) than males (35.2%) with (p=0.0003).The prevalence of hypothyroidism in the study population was 64.32 % (n = 357). In our study those with primary hypothyroidism were predominant (55.18 %, 197 out of 357) and 43.1 % (154 out of 357) were having sub clinical hypothyroidism and 6 of 357 were having secondary hypothyroidism. The prevalence rate of hyperthyroidism was 52.6 % (n-188) . The majority were subclinical hyperthyroidism (65.90 % , 124 out of 188) ,30.8 % (58 out of 188) had primary hyperthyroidism and3% ( 6 out of 188) had secondary hyperthyroidism. In our study thyroid function abnormalities were noted in 15.73 % of all subjects. Thyroid disorders were common in age of &amp;#62;20 years than 20-40 ,40-60 and and &amp;#62;60 year categories. The prevalence of primary hypothyroidism was found to be higher than subclinical hypothyroidism, while in hyperthyroidism subclinical condition was predominant compared to primary hyperthyroidism.

Association between sensitivity to thyroid hormones and non-high-density lipoprotein cholesterol levels in patients with type 2 diabetes mellitus

BACKGROUND Dyslipidemia and type 2 diabetes mellitus (T2DM) are chronic conditions with substantial public health implications. Effective management of lipid metabolism in patients with T2DM is critical. However, there has been insufficient attention given to the relationship between thyroid hormone sensitivity and dyslipidemia in the T2DM population, particularly concerning non-high-density lipoprotein cholesterol (non-HDL-C). AIM To clarify the association between thyroid hormone sensitivity and dyslipidemia in patients with T2DM. METHODS In this cross-sectional study, thyroid hormone sensitivity indices, the thyroid feedback quantile-based index (TFQI), the thyroid-stimulating hormone index (TSHI), the thyrotrophic T4 resistance index (TT4RI), and the free triiodothyronine (FT3)/free thyroxine (FT4) ratio were calculated. Logistic regression analysis was performed to determine the associations between those composite indices and non-HDL-C levels. Random forest variable importance and Shapley Additive Explanations (SHAP) summary plots were used to identify the strength and direction of the association between hyper-non-HDL-C and its major predictor. RESULTS Among the 994 participants, 389 (39.13%) had high non-HDL-C levels. Logistic regression analysis revealed that the risk of hyper-non-HDL-C was positively correlated with the TFQI (OR: 1.584; 95%CI: 1.088-2.304; P = 0.016), TSHI (OR: 1.238; 95%CI: 1.034-1.482; P = 0.02), and TT4RI (OR: 1.075; 95%CI: 1.006-1.149; P = 0.032) but was not significantly correlated with the FT3/FT4 ratio. The relationships between composite indices of the thyroid system and non-HDL-C levels differed according to sex. An increased risk of hyper-non-HDL-C was associated with elevated TSHI levels in men (OR: 1.331; 95%CI: 1.003-1.766; P = 0.048) but elevated TFQI levels in women (OR: 2.337; 95%CI: 1.4-3.901; P = 0.001). Among the analyzed variables, the average SHAP values were highest for TSHI, followed by TT4RI. CONCLUSION Impaired sensitivity to thyroid hormones was associated with high non-HDL-C levels in patients with T2DM.

Thyroid gland dysfunction and keratoconus.

The association between keratoconus and thyroid gland dysfunction (TGD) remains controversial. We aimed to determine the frequency of keratoconus among patients with laboratory-confirmed, treatment-naive TGD compared with that of age- and sex-matched healthy controls. Moreover, we investigated the potential relationship between TGD and corneal topographic and tomographic parameters. This multicenter, cross-sectional study recruited individuals with treatment-naive, laboratory-confirmed TGD and sex- and age-matched healthy controls. Demographic and ophthalmic data of all participants were recorded. All participants underwent comprehensive ocular examinations and corneal tomography. Patterns of symmetric bowtie, asymmetric bowtie, asymmetric bowtie/superior steep, asymmetric bowtie/inferior steep, or asymmetric bowtie pattern with a skewed radial axis were documented if present. Furthermore, the maximum simulated keratometry value (Kmax), corneal thinnest thickness (CTT), and back elevation (BE) values were recorded. We measured the serum concentrations of thyroid-stimulating hormone (TSH) and thyroid hormones (free thyroxine [FT4] and free tri-iodothyronine [FT3]) using an immunoassay method. We included 200 eyes of 200 individuals with TGD and 200 eyes of 200 healthy age- and sex-matched controls, with female predominance in both groups. The mean FT4 concentration was significantly higher and the TSH concentration was significantly lower in the TGD group than in the control group (both P < 0.0001), whereas the FT3 level was comparable between groups (P > 0.05). In the TGD group, the frequencies of hyperthyroidism and hypothyroidism were 190 (95%) and 10 (5%), respectively. We found significantly lower mean CTT, higher Kmax, and greater BE values with a significantly higher frequency of abnormal topographic patterns among eyes in the TGD group than in controls (all P < 0.05). The frequency of eyes with keratoconus was significantly higher in the TGD (7.5%) group than in the control (0.5%) group (P < 0.0001). Except for a statistically significant correlation of Kmax (r = - 0.23, P < 0.05) and CTT (r = + 0.15, P < 0.05) with TSH level in the TGD group, no significant correlation was found between corneal characteristics and thyroid profile in either group (all P > 0.05). We observed a higher frequency of keratoconus, with female predominance, in the TGD group. TGD was associated with significant changes in certain corneal topographic and tomographic parameters. Compared with healthy controls, individuals with TGD demonstrated increased Kmax and BE values with more corneal thinning, highlighting the potential association between keratoconus and TGD. However, further large-scale longitudinal studies are essential to confirm our findings.

Surgical Outcomes in Thyroidectomy for Patients with Graves’ Disease: A Randomized Controlled Trial

Background: Thyroidectomy is a preferred protocol for patients with Graves’ disease. However, it may be a challenging option in post-surgical management of various factors. There, this study aims to compare the surgical outcomes of total thyroidectomy and subtotal thyroidectomy in patients with Graves’ disease to provide evidence-based surgical decision-making. Methods: This randomized controlled trial was conducted at Sheikh Zaid Hospital, Rahim Yar Khan, October 2023 to April 2024; enrolled 120 patients diagnosed with Graves’ disease using a simple random sampling technique were assigned to Group A (n=60) and B (n=60) who underwent total thyroidectomy, and subtotal thyroidectomy respectively. Preoperative assessments and surgeries were performed while postoperative outcomes, complications, and thyroid function tests were also monitored and represented using independent t-tests while a p&lt;0.05 was considered significant. Results: It was revealed that operative time was significantly higher for total thyroidectomy than subtotal thyroidectomy 125.60±14.56 and 97.54±12.56 respectively, suggesting significantly lower time consumption in subtotal thyroidectomy procedure (p=0.001). Patients who underwent subtotal thyroidectomy had a significantly shorter hospital stay compared to those who underwent total thyroidectomy (p=0.02). Moreover, levels of triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) were significantly different between the two groups. Patients who underwent subtotal thyroidectomy had significantly lower T3 and T4 levels and higher TSH levels compared to those who underwent total thyroidectomy (p&lt;0.05). Conclusion: Subtotal thyroidectomy demonstrated favorable outcomes, including shorter operative time, lower rates of postoperative complications, and thyroid function tests compared to total thyroidectomy. These findings help and support the consideration of subtotal thyroidectomy as a viable surgical approach for patients with Graves' disease. Keywords: Grave Disease, Thyroidectomy, Thyroxine, Triiodothyronine.

Blood levels of zearalenone, thyroid-stimulating hormone, and thyroid hormones in patients with colorectal cancer

Mycotoxins are secondary metabolites produced by various species of mold fungi commonly found in plant materials. Zearalenone (ZEN) adversely affects the endocrine system. This study aimed to determine whether thyroid-stimulating hormone (TSH), procalcitonin (PCT), free triiodothyronine (fT3), and free thyroxine (fT4) levels are altered during natural zearalenone mycotoxicosis in patients diagnosed with sigmoid colon cancer (SCC) or colorectal cancer (CRC). A study was conducted on women and men diagnosed with SCC or CRC accompanied by the presence or absence (Patients Without ZEN – PWZ group) of ZEN in the blood. The PWZ group consisted of 17 patients with symptoms of SCC and CRC in whom ZEN and its metabolites were not detected in peripheral blood. The experimental (empirical) groups included a total of 16 SCC and CRC patients who tested positive for ZEN, but not its metabolites. TSH values in both sexes were within the upper limit of the reference range (0.27 – 4.2 μIU/mL) adopted by the hospital laboratory and corresponded to the upper second tertile and the lower third tertile. PCT values demonstrated that SCC and CRC were accompanied by a systemic or local bacterial infection. All mean values of fT3 were in the middle of the reference range, and the mean values of fT4 were within the upper reference limit. The fT3/fT4 prognostic marker was somewhat above the cut-off point of 0.22. These results indicate that in postmenopausal women and andropausal men who were diagnosed with SCC and CRC and were exposed to food-borne ZEN, higher values of the prognostic marker (fT3/fT4) were associated with an unfavorable prognosis. The study also revealed that the more distal the neoplastic lesions in the colon, the higher the percentage of both thyroid hormones, regardless of the patient's sex. The presence of ZEN in the diet alters thyroid activity in patients diagnosed with SCC and CRC.

Investigating thyroid function and iodine status in adolescents with and without paediatric major depressive disorder.

Depression has been associated with subclinical hypothyroidism and altered hypothalamic-pituitary-thyroid axis functioning. Adequate iodine nutrition is essential for healthy thyroid functioning. We therefore determined associations of iodine and thyroid status with paediatric major depressive disorder (pMDD) among Swiss adolescents and explored whether associations are sex-specific and mediated by stress. We conducted a matched case-control study in 95 adolescents with diagnosed pMDD and 95 healthy controls. We assessed depression severity using the Children's Depression Rating Scale-Revised and stress using the perceived stress scale (PSS) and measuring hair cortisol levels. We determined iodine status by measuring urinary iodine concentrations (UIC) and thyroid status by thyroid-stimulating hormone (TSH) and free thyroxine (FT4) in serum. Median (IQR) UIC did not differ between cases (121 (87, 174) µg/l) and controls (114 (66, 183) μg/l, P = 0·3). Median TSH and FT4 were lower in cases than controls (TSH: 1·36 (0·91, 2·00) mlU/l v. 1·50 (1·18, 2·06) mlU/l, P = 0·039; FT4: 14·7 (12·9, 16·9) pmol/l v. 15·7 (14·3, 17·2) pmol/l, P = 0·004). The prevalence of hypothyroxinaemia (normal TSH; low FT4) was higher among female cases than controls (21 % v. 4%, P = 0·006). PSS scores were higher while hair cortisol was lower in cases than controls (PSS: 25 (20, 28) v. 11 (7, 15), P < 0·001; cortisol: 2·50 (1·34, 3·57) pg/mg v. 3·23 (1·79, 4·43) pg/mg, P = 0·044). After adjusting for confounders, the associations of TSH and hair cortisol with pMDD were no longer significant. Furthermore, TSH and FT4 were not associated with PSS scores and hair cortisol levels. Summarising, iodine nutrition was adequate for adolescents with and without pMDD. However, FT4 concentrations were lower in those with pMDD, and 1 in 5 female adolescents with pMDD were hypothyroxinaemic.

Understanding Hypothyroidism: Causes, Symptoms, Diagnosis, and Treatment Options for Optimal Thyroid Health

Hypothyroidism is a condition where your thyroid gland doesn’t produce enough thyroid hormone leading to symptoms like fatigue, weight gain, and feeling cold. Globally, the lack of iodine in the environment is the leading cause of hypothyroidism. However, in regions where there is enough iodine, Hashimoto’s thyroiditis, an autoimmune disorder is the most common cause. Risk factors include having a family history of thyroid disease, being over 6o years and being female. Diagnosis done with a simple blood test that measures the levels of serum free thyroxine (FT4) and thyroid-stimulating hormone (TSH). High TSH and FT4 levels usually indicate Hypothyroidism. Even daily medication with synthetic thyroid hormone (levothyroxine), regular follow up with your doctor is important to monitor your TSH level and adjust the dosage of medication as needed.

Biomarker role of thyroid irAE and PD-L1 positivity in predicting PD-1 blockade efficacy in patients with non-small cell lung cancer

Thyroid immune-related adverse events (irAEs) are associated with programmed cell death protein 1 (PD-1) blockade efficacy in non-small cell lung cancer (NSCLC). However, their independence from PD-L1 expression and quantitative impact on predicting PD-1 blockade efficacy remain unexplored. This multicenter, retrospective, longitudinal study from Korea included 71 metastatic NSCLC patients who underwent PD-L1 expression and thyroid function testing during PD-1 blockade. Disease progression by the Response Evaluation Criteria for Solid Tumors was the main outcome. Three-stage analyses were performed: (1) multivariate Cox regression models adjusted for PD-L1 expression according to thyroid irAEs; (2) subgroup analyses; (3) regrouping and comparing predictivity of current and alternative staging. Patients with thyroid irAE + exhibited a longer progression-free survival [7/20 vs. 34/51, adjusted HR 0.19 (0.07–0.47); P < 0.001] than those with thyroid irAE-, independent of PD-L1 expression; the results remained across most subgroups without interaction. The three groups showed different adjusted HR for disease progression (Group 1: PD L1 + and thyroid irAE + ; Group 2: PD-L1 + or thyroid irAE + : 5.08 [1.48–17.34]; Group 3: PD-L1− and thyroid irAE− : 30.49 [6.60–140.78]). Alternative staging (Group 1 in stage IVB → stage IVA; Group 3 in stage IVA → stage IVB) improved the prognostic value (PVE: 21.7% vs. 6.44%; C-index: 0.706 vs. 0.617) compared with the 8th Tumor–Node–Metastasis staging. Our study suggests thyroid irAEs and PD-L1 expression are independent biomarkers that improve predicting PD-1 blockade efficacy in NSCLC. Thyroid irAEs would be helpful to identify NSCLC patients who benefit from PD-1 blockade in early course of treatment.

Early life air pollution exposures and thyroid function in children: A prospective cohort study

Studies on early life ambient air pollution exposures and childhood thyroid function are scarce. This study aimed to evaluate the relationships between early life fine particulate matter (≤2.5 μm; PM2.5) and nitrogen dioxide (NO2) exposures and thyroid function in children. We measured the levels of thyrotropin, triiodothyronine, and free thyroxine in children (n = 684) residing in a rural Korean area at age 2, 4, 6, or 8 years from 2012 to 2020 in the Environment and Development of Children cohort. The relationship between residential average exposure levels of PM2.5 and NO2 during pregnancy and 1-year average levels before visit and thyroid function during childhood were analyzed. Inverse association between increases of 10 μg/m3 in PM2.5 during the first trimester and thyrotropin levels at aged 4 (β, −0.12; 95% CI: −0.22, −0.02) and 6 years (β, −0.16; 95% CI: −0.26, −0.06) were observed. No association was found between PM2.5 exposure during the second and third trimester and childhood TSH levels. Childhood PM2.5 exposure was positively associated with thyrotropin rise at aged 4 (β, 0.2; 95% CI: 0.06, 0.35) and 6 years (β, 0.16; 95% CI: 0.02, 0.29) and inversely related with free thyroxine levels at aged 8 years (β, −0.04; 95% CI: −0.07, −0.01). No relationship between NO2 exposure and thyroid function was found. In conclusion, association between PM2.5 exposure and childhood thyrotropin levels varied depending on exposure timing. Early gestational exposure showed an inverse relationship, whereas childhood exposure were positively associated with childhood thyrotropin levels. The long-term effects of early life air pollution exposure and underlying mechanisms should be investigated in future studies.

Systemic iodine levels increase with povidone-iodine irrigation, but does this affect thyroid functions? A case-control study.

Intraoperative irrigation with diluted povidone iodine (PI) can be used to reduce the incidence of infection-related complications in arthroplasty surgeries. Since PI is associated with many interventions, especially skin antisepsis, its systemic effects are being studied. The aim of our study is to evaluate the systemic effects of PI, which we use as an irrigation solution, by means of urine iodine and thyroid function tests. In this case-control study, 96 patients who underwent knee or hip arthroplasty were included and divided into two groups according to the irrigation solution. In the first group, PI was added to the standard irrigation. The second group was considered as the control group and only standard irrigation was applied. Urine iodine, thyroid stimulating hormone, free T3 and free T4 values were compared in the preoperative and postoperative periods of these two groups. In this way, the effect of absorbed iodine on thyroid functions was investigated. In the diluted PI group, urinary iodine levels were measured at maximum levels (450µg/L) in the early postoperative period in most of the patients. The statistically significant difference in urinary iodine levels between the PI group and the control group, which started in the early postoperative period, continued until the last follow-up on the 14th postoperative day. In terms of thyroid functions, the observed differences were not statistically significant. Studies to reduce periprosthetic infection show that PI can be preferred for irrigation before the closure of the joint area in total joint arthroplasty. Although the success of this treatment in periprosthetic infection has been investigated, its systemic examination has not been demonstrated. It was determined that PI treatment, which was seen to decrease in the systemic circulation within 14 days, did not show a statistically significant change in terms of thyroid functions when used at the determined concentration and duration. These results should be evaluated with larger and longer-term studies. Clinical trials ID no. NCT05599841.

Correlation analysis of FT3/FT4 and frailty in elderly patients with coronary heart disease.

In previous studies on thyroid hormones and frailty, most of the target population were elderly, and there were relatively few studies on elderly patients with coronary heart disease (CHD). Inflammation, oxidative stress, and haemodynamic instability in cardiovascular disease (CVD) can influence fluctuations in thyroid hormone (TH) levels and increase the incidence of frailty. The purpose of the present study was to explore the effect of TH on the risk of frailty in elderly patients with CHD. The Fried scale was used to assess the frailty of participants. The predictive value of TH for frailty was determined using the patient's operating characteristic curve. Multivariate logistic regression model was utilised to analyse the relationship between TH and frailty. A total of 277 elderly patients with CHD were included in the study, of whom 29.96% were in a state of frailty. Free triiodothyronine (FT3)/free thyroxine (FT4) predicted frailty with the largest area under the curve of 0.634. Unordered multinomial logistic regression analysis showed that a lower T3 level was a risk factor for pre-frailty (p < 0.05). Lower levels of T3, FT3, and FT3/FT4 were risk factors for frailty (p < 0.05) after adjusting for demographic variables and blood indexes. The predictive value of FT3/FT4 for frailty was more accurate than that of a single index. Moreover, T3 ≤ 1.095 nmol/L, FT3 ≤ 4.085 pmol/L, and FT3/FT4 ≤ 0.336 were shown to be the influencing factors of frailty, while T3 ≤ 1.095 nmol/L is an independent risk factor pre-frailty. Clinicians should focus on timely identification of the risk of frailty in order to improve patient quality of life and to reduce the risk of complications.