Thyroid Peroxidase Antibody Levels Research Articles

Effect of oral isotretinoin therapy on thyroid function in patients with moderate-to-severe acne vulgaris: A prospective study

Introduction: Despite its growing use, the side effects of isotretinoin therapy are not fully understood. Studies have suggested that isotretinoin can cause thyroid dysfunction, suggesting the need to investigate thyroid dysfunction as a possible side effect of oral isotretinoin therapy. Purpose: The main objective of the study is to investigate the association between isotretinoin therapy and thyroid dysfunction. Methods: In all, 51 patients (male, 21; female, 30; aged 18–25 years) with moderate-to-severe acne vulgaris were treated with 0.5 mg/kg/day oral isotretinoin (cumulative dose: 120–150 mg/kg). Serum-free thyroxine (T4), thyroid-stimulating hormone (TSH), and thyroglobulin (TGA) and thyroid peroxidase (TPO) antibody levels were measured. Results: TSH levels at baseline and at the 2nd, 4th, 6th, and 8th months of treatment were 2.3307 ± 1.097, 2.5824 ± 1.34, 2.678 ± 1.133, 2.3 ± 1.17, and 2.7 ± 2.17 IU·mL, respectively, with no significant change from baseline (P = 0.526, P = 0.552, P = 0.530, and P = 0.910 at 2, 4, 6, and 8 months, respectively). Serum levels of free T4, TGA, and TPO antibodies were unchanged. Conclusions: Follow-up screening for thyroid dysfunction may not be necessary for patients receiving oral isotretinoin.

Неразвивающаяся беременность и гиперпролактинемия. Есть ли место растительным препаратам в терапии?

Aim: to analyze whether hyperprolactinemia contributes to missed miscarriage and to assess the efficacy of the treatment with plant-derived dopamine agonists.Patients and Methods: 375 women with anamnestic missed miscarriage before 14 weeks of pregnancy were enrolled. Women with the first and the only missed miscarriage (n=218) were included in group 1. Women with the first and subsequent pregnancies that resulted in intrauterine fetal death (n=157) were included in group 2. The levels of prolactin, thyroid-stimulating hormone (TSH), and thyroid peroxidase antibodies (TPO Abs) were measured. MRI with contrast was performed as needed. Cyclodynon® (1 tablet daily for 3 months) was prescribed for hyperprolactinemia.Results: elevated prolactin levels were revealed in 45 women (significant differences between group 1 and group 2 were demonstrated). All women with hyperprolactinemia underwent pituitary MRI with contrast. Pituitary microadenoma was identified in 16 women (group 1, n=5, 2.3%; group 2, n=11, 7.0%). In a total of 16 women, pituitary adenoma was identified for the first time. Gynecological examination has demonstrated that 20 women are infertile, i.e., 7 women in group 1 (3.2%) and 13 women in group 2 (8.3%). Elevated TSH was revealed in 23 women with missed miscarriage (6.1%), one in two woman (n=13) had hyperprolactinemia. Elevated TPO Abs were revealed in 59 women (15.7%), 17 out of 59 women (28.9%) had hyperprolactinemia, 17 out of 59 women (28.9%) had elevated THS, and 9 out of 59 women (15.3%) had hyperprolactinemia and elevated TSH.Conclusions: hyperprolactinemia was identified in every ten woman with anamnestic missed miscarriage. Significant differences between women with the only pregnancy loss and women with subsequent pregnancy loss were revealed. 35.6% of women with hyperprolactinemia were diagnosed with microadenoma. Treatment efficacy for both organic and functional hyperprolactinemia was 91.1%.Keywords: infertility, miscarriage, missed miscarriage, hyperprolactinemia, pituitary microadenoma, dopamine agonist.For citation: Olina A.A. Missed miscarriage and hyperprolactinemia. Is there a place for plant-derived medicines? Russian Journal of Woman and Child Health. 2020;3(2):64–69. DOI: 10.32364/2618-8430-2020-3-2-64-69.

Hashimoto's Encephalopathy in A 30 Years Old Healthy Male: Case Report and Literature Review

Context: Hashimoto's encephalopathy is a rare neurological disorder associated with autoimmune thyroiditis. It occurs primarily in the fifth decade of life. However, different age groups may also develop the disease, with serious consequences if unrecognized and untreated. Clinically, it comprises two forms: a sudden vasculitic, and progressive subacute type with wide neuropsychiatric manifestations including confusion, seizures, short term memory impairment, depressed mood and psychosis. Objective: The objective of this report is to present an unusual case of Hashimoto's encephalopathy presented with the acute confusional state. Case presentation: We report the case of a 30-year-old male medically free presented with acute behavioral changes and confusion. Serological studies revealed elevated thyroid peroxidase antibodies levels. In addition, EEG findings of slow background. He was diagnosed as a case of Hashimoto's encephalopathy and he was improved after initiation of intravenous Methylprednisolone therapy. Conclusion: Hashimoto's encephalopathy can present with a challenging clinical picture that may go unrecognized for a long time. Therefore, one should keep in mind the importance of evaluating thyroid function and thyroid antibodies levels in patients presented with unexplained neurocognitive and psychiatric manifestations.

The association between cigarette smoking and serum thyroid stimulating hormone, thyroid peroxidase antibodies and thyroglobulin antibodies levels in Chinese residents: A cross-sectional study in 10 cities.

ObjectivesAlthough several studies have shown that cigarette smoking is associated with thyroid stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb), the exact relationship between smoking and thyroid function is controversial. As little is known about the effects of smoking on TSH, TPOAb and TgAb in Chinese residents. This study aimed to evaluate the association between cigarette smoking and TSH, TPOAb and TgAb in ten-city residents of China.Study designThis was a population-based cross-sectional study.MethodsIn this cross-sectional study, 15,181 subjects from ten major cities of China were investigated. Data regarding demographic characteristics, smoking status and consumption of iodine status were collected using in-person interviews based on a self-designed structured questionnaire. Serum concentrations of TSH, TPOAb and TgAb were measured using electrochemiluminescence immunoassays. Univariate analysis and multivariate linear stepwise regression analyses were used to analyze the data.ResultsThe regular smokers had lower concentrations of TSH, TPOAb and TgAb than occasional smokers, former smokers and never smokers. Multivariate analysis demonstrated that regular smoking was associated with the decreased concentrations of TSH (β = -0.178), TPOAb (β = -0.287) and TGAb (β = -0.453) after adjusting other factors. Furthermore, daily smoking number was significantly associated with the decreased level of TSH (β = -0.045) and TPOAb(β = -0.080), and smoking duration was associated with the decreased TSH level (β = -0.030).ConclusionsOur findings suggest that cigarette smoking is related to a significant decline in the concentrations of TSH, TPOAb and TgAb. In addition, daily smoking number and long-term smoking decrease serum TSH and TPOAb levels. Cigarette smoking plays a significant role in the development of thyroid dysfunction.

The Relationship between High Iodine Consumption and Levels of Autoimmune Thyroiditis-Related Biomarkers in a Chinese Population: a Meta-Analysis.

To comprehensively evaluate the relationship between high iodine concentration and biomarker abnormalities related to autoimmune thyroiditis in a Chinese population. Medline, PubMed, and Embase electronic databases were searched for articles published domestically and internationally on the relationship between high iodine concentrations and thyroid hormone antibodies and thyroid-stimulating hormone in China before March 2019. Articles published in Chinese were searched in the China Biology Medicine (CBM) disc, Wanfang Database, and China National Knowledge Infrastructure (CNKI). A total of 16 cross-sectional articles were included in this study, including 9061 participants. A meta-analysis was conducted in Stata 14.0. The binary categorical and continuous variables used odds ratios (ORs) and standardized mean differences (SMDs) with the corresponding 95% confidence intervals (CIs) as the effect statistics, respectively. The results showed that high iodine concentrations had a minimal association with the abnormal rates of thyroid peroxidase antibody (TPOAb) (OR = 1.274, 95% CI (0.957, 1.695), P > 0.05) and thyroglobulin antibody (TGAb) (OR = 1.217, 95% CI (0.911, 1.626), P > 0.05) in the entire population. The thyroid-stimulating hormone (TSH) level in the high iodine group was greater than that in the adaptive iodine group (SMD = 0.202, 95% CI (0.096, 0.309), P < 0.05). The results of the subgroup analysis showed that the abnormal TPOAb rate in pregnant women (OR = 1.519, 95% CI (1.007, 2.291), P < 0.05) and children (OR = 3.365, 95% CI (1.966, 5.672), P < 0.05) in the high iodine group was greater than that in the adaptive iodine group, and the abnormal TGAb rate of children in the high iodine group was greater than that in the adaptive iodine group. The TSH levels of lactating women (SMD = 0.24, 95% CI (0.053, 0.427), P < 0.05), pregnant women (SMD = 0.301, 95% CI (0.176, 0.426), P < 0.05), and children (SMD = 0.25, 95% CI(0.096, 0.309), P < 0.05) in the high iodine group were higher than those in the adaptive iodine group. Egger's and Begg's tests showed no significant (P > 0.1) publication bias. High iodine can increase the risk of abnormal levels of TPOAb, TGAb, and TSH related to autoimmune thyroiditis in pregnant women, lactating women, and children in China.

Serum and follicular fluid thyroid hormone levels and assisted reproductive technology outcomes

ObjectiveThe objective ofthis study was to assess the association between thyroid hormone (TH) levels in follicular fluid (FF) and serum and to determine whether THs impact assisted reproductive technology (ART) outcomes.MethodsThis study enrolled 299 women undergoing ART. Blood samples were drawn on the day of human chorionic gonadotrophin (HCG) administrationand analysed for thyroid-stimulating hormone (TSH), thyroxine(T4), triiodothyronine(T3),free T4 (fT4),free T3(fT3), thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) levels. FF was obtained on the oocyte pick up (OPU) day and analysed forTSH, T4, T3, fT4, fT3, TPOAb, TgAb and estradiol levels.Results(1) There were significant positive correlations between serum and FF TH and thyroid autoantibody levels. Statistically significant differences were discovered in serum and FF levels of TSH (p ≤ 0.001), T4 (p ≤ 0.001), T3 (p ≤ 0.001), TPOAbs (p ≤ 0.001) and TGAbs (p = 0.021).(2) Serum T4 levels [121.9(104.8,140.8) vs 114.1(98.6,130.6) nmol/l, p = 0.026], serum fT4 levels[(19.0(17.7,21.8) vs 18.6(17.0,20.1) pmol/l, p = 0.026], serum T4/T3 ratios [62.5 (55.7, 66.2) vs 59.4 (53.4, 64.9), p = 0.029], FF fT4 levels [19.0(17.5,21.3) vs 18.1(16.8,19.9) pmol/l, p = 0.009] and FF T4/T3 ratios [52.6 (46.4, 57.3) vs 50.0 (43.7, 53.1), p = 0.004] were significantly higher in the successful pregnancy group than the implantation failure group.(3) Spearman’s rank correlation analysis revealed positive associations of both the FF T4/T3 ratio and serum TSH levels with the numbers of retrieved oocytes (total or MII) and embryos (fertilized, cleavage, and good quality).ConclusionsTH levels in FF are strongly correlated with those in serum on the HCG day, and THs on the HCG day may affect ART outcomes.

Seguimiento del hijo de madre con patología tiroidea autoinmune. ¿Qué no debemos cribar?

IntroductionThyroid dysfunction is a common problem in pregnant women. It is usually of an autoimmune origin, with Hashimotós thyroiditis and Graveś disease being the most common conditions. Although hormonal changes and transplacental antibody transfer may occur, specific neonatal screening has not been shown to be useful. Patients and methodA prospective study of newborns of women with autoimmune thyroid disease born at a level III university hospital (November 2013-December 2016). Neonates were selected during their stay at the maternity. Babies with perinatal asphyxia were excluded. Data were collected from the clinical histories of mothers and newborns. ResultsA total of 191 neonates were included. Ninety percent of mothers had been diagnosed with autoimmune hypothyroidism. Only 5.8% of newborns had some laboratory disorder, consisting of slightly increased thyroid-stimulating hormone levels, which returned to normal at the age of one month and did not correlate to thyroid peroxidase antibody levels. Transient hyperthyrotropinemia was diagnosed in one newborn and required thyroxin treatment during the first year of life. Among newborns from mothers with Graveś disease, 36.8% had some abnormal laboratory value during the first 7 days of life, but there were no cases of hyperthyroidism and only one of transient hyperthyrotropinemia. ConclusionsExperience at our hospital in screening of newborns from hypothyroid mothers reveals a high number of laboratory controls with a poor diagnostic yield. No relationship was found between thyroid peroxidase antibody levels and thyroid dysfunction. We support the recommendations to continue testing serum thyroid-stimulating hormone and FT4 levels at 48h of life in newborns of mothers with autoimmune hypothyroidism.

Association of Exposure to Ambient Air Pollution With Thyroid Function During Pregnancy

Air pollutants interact with estrogen nuclear receptors, but their effect on thyroid signaling is less clear. Thyroid function is of particular importance for pregnant women because of the thyroid's role in fetal brain development. To determine the short-term association of exposure to air pollution in the first trimester with thyroid function throughout pregnancy. In this cohort study, 9931 pregnant women from 4 European cohorts (the Amsterdam Born Children and Their Development Study, the Generation R Study, Infancia y Medio Ambiente, and Rhea) and 1 US cohort (Project Viva) with data on air pollution exposure and thyroid function during pregnancy were included. The recruitment period for the Amsterdam Born Children and Their Development Study was January 2003 to March 2004; for Generation R, April 2002 to January 2006; for Infancia y Medio Ambiente, November 2003 to January 2008; for Rhea, February 2007 to February 2008; and for Project Viva, April 1999 to November 2002. Statistical analyses were conducted from January 2018 to April 2019. Residential air pollution concentrations (ie, nitrogen oxide and particulate matter [PM]) during the first trimester of pregnancy were estimated using land-use regression and satellite-derived aerosol optical depth models. Free thyroxine, thyrotropin, and thyroid peroxidase antibody levels were measured across gestation. Hypothyroxinemia was defined as free thyroxine below the fifth percentile of the cohort distribution with normal thyrotropin levels, following the American Thyroid Association guidelines. Among 9931 participants, the mean (SD) age was 31.2 (4.8) years, 4853 (48.9%) had more than secondary educational levels, 5616 (56.6%) were nulliparous, 404 (4.2%) had hypothyroxinemia, and 506 (6.7%) tested positive for thyroid peroxidase antibodies. Concentrations of nitrogen dioxide and PM with an aerodynamic diameter of 2.5 μm or less (PM2.5) were lower and had less variation in women in the US cohort than those in European cohorts. No associations of nitrogen oxide with thyroid function were found. Higher exposures to PM2.5 were associated with higher odds of hypothyroxinemia in pregnant women (odds ratio per 5-μg/m3 change, 1.21; 95% CI, 1.00-1.47). Although exposure to PM with an aerodynamic diameter of 10 μm or less was not significantly associated with hypothyroxinemia, the coefficient was similar to that for the association of PM2.5 with hypothyroxinemia (odds ratio per 10-μg/m3 change, 1.18; 95% CI, 0.93-1.48). Absorbances of PM2.5 and PM with aerodynamic diameter from 2.5 to 10 μg and were not associated with hypothyroxinemia. There was substantial heterogeneity among cohorts with respect to thyroid peroxidase antibodies (P for heterogeneity, <.001), showing associations of nitrogen oxide and PM with thyroid autoimmunity only in the women in the Generation R Study. The findings of this study suggest that first-trimester exposures to PM2.5 were associated with mild thyroid dysfunction throughout pregnancy. The association of PM2.5 exposure with thyroid function during pregnancy is of global health importance because air pollution exposure is widespread and hypothyroxinemia may adversely influence the brain development of offspring.

Maternal Thyroid-Stimulating Hormone Level and Thyroid Peroxidase Antibody Status in the First and Second Trimester of Pregnancy and Their Relationship with the Risk of Gestational Diabetes Mellitus

Abstract Objective: To investigate thyroid-stimulating hormone (TSH) levels and thyroid peroxidase antibody (TPOAb) in early pregnancy and to estimate the risk of development of gestational diabetes mellitus (GDM). Methods: The levels of TSH, free thyroxine, free triiodothyronine, and TPOAb were retrospectively evaluated in 2333 pregnant women. All women recruited were divided into groups of TSH high (H), TSH low (L), TSH (H) TPOAb positive (+), TSH (H)TPOAb negative (−), TSH normal (N)TPOAb (+), TSH (L)TPOAb (+), TSH (L)TPOAb (−), and estimated the risk of GDM. Results: TSH level (X 2 = 13.0024, P = 0.0015) and TSH combined TPOAb (X 2 = 20.0038, P = 0.0012) were correlated to development of GDM. The level of TSH in 95 women was increased, and in 216 women were decreased. Of the 2333 pregnant women, 546 patients were diagnosed with GDM, with a prevalence of 23.40%. The prevalence of GDM was 35.78% and 28.70% for the TSH high (H) and TSH low (L) pregnant women, respectively. The increased TSH (P = 0.0013, odds ratio: 2.09, confidence interval:1.34–3.28) was correlated to increase GDM incidence. TSH (H) TPOAb (+) (n = 29), TSH (H) TPOAb (−) (n = 58), TSH normal (N) TPOAb (+) (n = 265), TSH (L) TPOAb (+) (n = 30), TSH (L) TPOAb (−) (n = 154) were in this study. The prevalence of GDM was 51.72%, 29.31%, 23.02%, 26.67%, and 29.87% for the TSH (H) TPOAb (+), TSH (H) TPOAb (−), TSH (N) TPOAb (+), TSH (L) TPOAb (+), and TSH (L) TPOAb (−) pregnant women, respectively. Only the TSH (H) TPOAb (+) pregnant women had a significant higher incidence of GDM (P = 0.0018, odds ratio: 3.63, confidence interval: 1.62–8.16). Trimester specific results showed that only second trimester had higher GDM risk either analyze TSH or the combination of TSH and TPOAb. Conclusion: Elevated TSH level and TPOAb positive in the second trimester of pregnancy were correlated to an increased risk of GDM.

SEVERE HYPOTHYROIDISM LEADING TO RESPIRATORY FAILURE AND BULBAR WEAKNESS: A RARE CASE REPORT

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Hypothyroidism is a rare cause of respiratory muscle dysfunction leading to respiratory failure secondary to hypoventilation. It can also cause decreased central ventilatory response to hypoxia and hypercapnia and obstructive sleep apnea syndrome (1). Dysarthria has also been seen as a presenting symptom of hypothyroidism (2). Here, we report a case of an elderly female who developed signs of bulbar weakness along with respiratory failure attributed to severe hypothyroidism. CASE PRESENTATION: A 73-year old Caucasian female with a past medical history of hypothyroidism presented to the emergency department with complaints of progressive generalized weakness. She experienced ambulatory dysfunction due to motor weakness along with dysphagia, hoarseness of voice and drooling. She was hemodynamically stable. Proximal muscle weakness was noted in bilateral upper and lower extremities. Thyroid examination was within normal limits. Arterial blood gas analysis revealed hypercapnia (partial pressure of CO2 81 mm Hg). Thyroid stimulating hormone (TSH) level was 39.299 IU/mL and free thyroxine 4 level was 0.56 ng/dL. Thyroid peroxidase antibody and thyroglobulin antibody levels were elevated (107 IU/mL and 6 IU/mL, respectively). Inflammatory and connective tissue disease workup was negative. Muscle biopsy was performed which showed non-specific muscle atrophy and did not reveal any pathological features consistent with any neuromuscular disorder. Antibodies for myasthenia gravis were negative. Diagnosis of acute hypercapnic respiratory failure associated with autoimmune hypothyroidism was established. She was placed on non-invasive positive pressure ventilation (NIPPV) with constant monitoring of negative inspiratory force and vital capacity. She was given 125 g of intravenous levothyroxine daily for 5 days which was then transitioned to oral 150 mg levothyroxine. The patient showed significant improvement in her symptoms evident by a decreased requirement of NIPPV and improved ambulation. DISCUSSION: Hypothyroidism can manifest as a severe respiratory failure along with symptoms of bulbar weakness. The severity of the condition demands early NIPPV, like in our case. Recovery in severe hypothyroidism may take a protracted course, sometimes taking weeks to months of hormone replacement therapy (3). An early multidisciplinary approach towards this case is essential for optimal management planning. CONCLUSIONS: To conclude, hypothyroidism should always be considered as a rare cause of respiratory failure with hypoventilation and bulbar weakness. Our case reinforces the importance of early recognition of this condition in order to prevent any patient mortality. Reference #1: Behnia M, Clay AS, Farber MO. Management of myxedematous respiratory failure: review of ventilation and weaning principles. Am J Med Sci. 2000;320(6):368-73. Reference #2: El-Shafie KT. Hypothyroidism presenting with dysarthria. J Family Community Med. 2003;10(2):55-7. Reference #3: Khaleeli AA, Edwards RH. Effect of treatment on skeletal muscle dysfunction in hypothyroidism. Clin Sci (Lond). 1984;66(1):63-8. DISCLOSURES: No relevant relationships by Ankit Agrawal, source=Web Response No relevant relationships by Mehak Bassi, source=Web Response No relevant relationships by Amina Saqib, source=Web Response

Association between perfluoroalkyl substance exposure and thyroid hormone/thyroid antibody levels in maternal and cord blood: The Hokkaido Study

BackgroundThyroid antibodies (TAs) are the most common cause of hypothyroidism during gestation. Although previous studies found that prenatal exposure to perfluoroalkyl substances (PFASs) disrupts thyroid hormones (THs) in humans, their effects on TAs during the perinatal period have not been investigated. ObjectiveTo explore the associations between prenatal exposure to eleven different PFASs from two different groups (carboxylates and sulfonates) and the expression of THs and TAs in maternal and cord blood while considering maternal TA status. MethodsIn a prospective birth cohort (the Hokkaido Study), we included 701 mother‑neonate pairs recruited in 2002–2005 for whom both prenatal maternal and cord blood samples were available. Eleven PFASs were measured in maternal plasma obtained at 28–32 weeks of gestation using ultra-performance liquid chromatography coupled with triple quadrupole tandem mass spectrometry. THs and TAs including thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb) were measured in maternal blood during early pregnancy (median 11 gestational weeks), and in cord blood at birth. ResultsThe median levels of TgAb and TPOAb in maternal serum were 15.0 and 6.0 IU/mL, respectively. The median TgAb level in neonates was 38.0 IU/mL, and TPOAb were detected in only 12.3% of samples. Maternal FT3 level was positively associated with PFAS levels in both TA-positive and TA-negative mothers. Maternal perfluorooctanoate was inversely associated with maternal TPOAb. Among boys, some maternal PFASs were associated with higher TSH and lower FT3 levels in maternal TA-negative group, while perfluorodecanoic acid was associated with lower TSH in maternal TA-positive group. Among girls, some PFAS of mothers showed associations with lower TSH and higher FT3 in maternal TA-negative group, while perfluorododecanoic acid was associated with lower FT4 in maternal TA-positive. Maternal PFASs showed associations with boy's TgAb inversely in maternal TA-negative group and with girl's TgAb positively in maternal TA-positive group. ConclusionsOur results suggest thyroid disrupting effects of PFAS exposure and susceptibility vary depending on maternal TA levels.

Establishing thresholds and effects of gender, age, and season for thyroglobulin and thyroid peroxidase antibodies by mining real-world big data

BackgroundThyroglobulin antibody (TG-Ab) and thyroid peroxidase antibody (TPO-Ab) are cornerstone biomarkers for autoimmune thyroid diseases, and establishment of appropriate thresholds is crucial for physicians to appropriately interpret test results. Therefore, we established the thresholds of TG-Ab and TPO-Ab in the Chinese population through analysis of real-world big data, and explored the influence of age, gender, and seasonal factors on their levels. MethodsThe data of 35,869 subjects downloaded from electronic health records were analyzed after filtering based on exclusion criteria and outliers. The influence of each factor on antibody levels was analyzed by stratification. Thresholds of TG-Ab and TPO-Ab were established through Clinical Laboratory Standards Institute document C28-A3 and National Academy of Clinical Biochemistry (NACB) guidelines, respectively. ResultsThere were significant differences according to gender after age stratification; the level of TG-Ab gradually increased with age in females. There were significant differences in TG-Ab and TPO-Ab distributions with respect to age after gender stratification. Moreover, differences were observed between seasons for TG-Ab and TPO-Ab. The thresholds of TG-Ab and TPO-Ab were 107 [90% confidence interval (CI):101–115] IU/mL and 29 (90% CI: 28–30) IU/mL, respectively, using C28-A3 guidelines, but were 84 (90% l CI: 50–126) IU/mL and 29 (90% CI: 27–34) IU/mL, respectively, using NACB guidelines. ConclusionThe levels of TG-Ab and TPO-Ab were significantly affected by gender, age, and season. The thresholds for TG-Ab and TPO-Ab for the Chinese population were established by big data analysis.

Association between serum TSH levels and metabolic components in euthyroid subjects: a nationwide population-based study.

BackgroundWhether a relationship exists between various metabolic factors and thyroid-stimulating hormone (TSH) levels in euthyroid persons remains unknown. This study aims to explore the relationship between TSH levels and metabolic factors in euthyroid individuals.MethodsA total of 2,663 subjects were enrolled from a nationwide population-based cross-sectional survey of iodine nutrition, thyroid disease and diabetes in China (2014–2017). Euthyroid individuals were divided into four groups according to quartiles of TSH levels: group A (n=305, 0.3–1.3 mIU/L), group B (n=829, 1.3–2.2 mIU/L), group C (n=673, 2.2–3.2 mIU/L) and group D (n=349, 3.2–4.2 mIU/L). Anthropometric parameters, biochemical indicators and TSH levels were determined.ResultsA total of 2,156 euthyroid subjects with serum TSH levels within the normal range accounted for 86.8% of the sample. The systolic blood pressure (SBP) in group D was significantly higher than that in the other three groups. Group C displayed significantly lower thyroid peroxidase antibody (TPOAb) levels than the other three groups. Group C also had lower anti-thyroglobulin antibody (TgAb) levels than groups A and D, whereas the TgAb levels in group B were only lower than those in group A. Spearman’s or Pearson’s linear regression analysis showed that SBP (r=0.054; P=0.013) was positively correlated with TSH, but cholesterol (TC) (r=−0.043, P=0.047) was negatively correlated with TSH. Multiple stepwise regression analysis revealed that SBP, the urinary iodine concentration (UIC), waist circumference (WC), body mass index (BMI), TC, triglycerides (TGs) and low-density lipoprotein cholesterol (LDL-C) were independent predictors of serum TSH levels.ConclusionThis large population-based study demonstrates a significant interaction between metabolic factors and TSH levels. An adverse weight status, high blood pressure levels, blood lipid metabolism disorder and excessive iodine intake may be early manifestations of thyroid disease in euthyroid subjects.

Evaluation of Maternal Exposure to PM2.5 and Its Components on Maternal and Neonatal Thyroid Function and Birth Weight: A Cohort Study.

Background: Particulate matter (PM) air pollution is an environmental risk to public health. The prevalence of thyroid disease during pregnancy has increased rapidly in recent decades, but the available data on the relationships among air pollution, thyroid function, and birth outcomes in pregnant women, particularly in China, are scarce. We aimed to evaluate the association between maternal exposure to PM2.5 and its components and maternal and neonatal thyroid function and to investigate whether thyroid function acts as a mediator between air pollution and birth weight. Methods: In this prospective birth cohort study, the levels of maternal exposure to PM2.5 and its components during the first trimester were assessed in 433 pregnant women in Nanjing, China, enrolled during 2014-2015. We evaluated the levels of maternal exposure to PM2.5 and its six main constituents-organic matter (OM), black carbon (BC), sulfate (SO42-), nitrate (NO3-), ammonium (NH4+), and soil dust-using the V4.CH.02 product of the Dalhousie University Atmospheric Composition Analysis Group. The maternal serum-free thyroxine (fT4), thyrotropin (TSH), and thyroid peroxidase antibody (TPOAb) levels during the second trimester were measured through electrochemiluminescent microparticle immunoassays. The neonatal TSH levels were detected using an AutoDELFIA Neonatal TSH kit within 72 hours after birth, and the birth weight Z-score of each newborn was estimated. Results: Higher exposure to maternal PM2.5 and some components (BC and NH4+) decreased the maternal fT4 level (p < 0.05), and the birth weight Z-score was decreased (p < 0.05) by higher exposure to maternal PM2.5 and some components (OM, BC, NO3-, and NH4+). A mediation analysis clarified that the maternal fT4 levels explained 15.9%, 18.4%, and 20.9% of the associations of maternal PM2.5, BC, and NH4+ exposure with the birth weight Z-score, respectively (p < 0.05). After additional sensitivity analyses including only nonpreterm participants (n = 418) and non-TPOAb-positive participants (n = 415), the models remained stable. Conclusions: Our results suggest an inverse association between maternal exposure to PM2.5 and its components and the maternal fT4 levels. Maternal fT4 might act as a mediator between exposure to PM2.5 and its components and birth weight.

TRAbs at diagnosis may better predict disease severity and relapse in younger patients with Graves′ disease

Thyrotropin receptor antibodies (TRAbs) are pathognomonic for Graves′ disease. Previous studies have linked serum titers of TRAbs to severity of Graves′ disease and likelihood of Graves′ disease relapse. However, we know little about factors that may be involved in the impact of TRAbs on Graves′ disease patients. In December 2018, The Journal of Clinical Endocrinology & Metabolism online published an article [Bano A, Gan E, Addison C, et al. Age may influence the impact of TRAbs on thyroid function and relapse-risk in patients with Graves′ disease. J Clin Endocrinol Metab, 2019, 104(5): 1378-1385. DOI: 10.1210/jc.2018-01738]. With the permission of the original journal, we translated the article into Chinese. This article aimed to investigate the association of TRAbs at diagnosis with thyroid hormones and risk of relapse, and to study the influencing factors on these associations. The results showed that TRAbs at diagnosis were positively associated with circulating thyroid hormone levels and risk of relapse, and these associations were influenced by age, but not by sex, race, smoking or thyroid peroxidase antibody levels. This study indicates TRAbs at diagnosis can better predict severity of elevated thyroid hormone levels and risk of relapse in younger patients with Graves′ disease. Key words: TSH receptor antibody; Graves′ disease; Age; Relapse; Predictive value

Long-Term Variations of Antithyroperoxidase Antibodies and its Clinical Significance.

Various cut-offs have been proposed for thyroid peroxidase antibodies (TPOAb) positivity. Considering that the long-term trend of TPOAb levels and its positivity incidence is not clearly understood, we conducted the current study to determine the longitudinal variations of TPOAb in a population-based cohort study. We followed 5783 individuals of Tehran Thyroid cohort Study (TTS) for 10 years (4 phases). After exclusions, data of 3493 euthyroid participants remained for analyses. The baseline prevalence rates of TPOAb positivity were 19.8, 17, and 11.4% and the annual incidence rates (95% CI) of TPOAb positivity were 8.53 (8.29-8.77), 7.59 (7.37-7.80) and 6.79 (6.60-6.98) per 1000 persons for the 3 proposed cut-offs of 14.77, 18.38, and 40 U/l; respectively. Although a slightly increasing trend was observed for TPOAb levels (p=0.001) and its conventional positivity (TPOAb>40U/l), the recently proposed cut-offs of 14.77 and 18.38 U/l showed constant TPOAb positivity over 10 years. The time trends of the TPOAb levels among younger participants were significantly different from older participants (time×age effect p=0.004), with the former having an increasing trend and the latter, a relatively decreasing trend. Although the prevalence of TPOAb positivity was significantly (p<0.001) higher among women as compared to men, the longitudinal changes of TPOAb were similar in men and women. TPOAb positivity along with TSH values between 2.5 and 5.0 mU/l or free T4 values between 0.93 and 1.7 ng/dl exerted a significantly increased risk of subclinical or overt hypothyroidism. In an iodine sufficient population, an increasing trend in TPOAb levels was observed in line with the increasing incidence of subclinical and overt hypothyroidism.

High Levels of Serum Thyroid Peroxidase and/or Thyroglobulin Antibodies Are Associated with Impaired Thyroidal Response to hCG in Pregnancy

High Levels of Serum Thyroid Peroxidase and/or Thyroglobulin Antibodies Are Associated with Impaired Thyroidal Response to hCG in Pregnancy

Thyroid Peroxidase Antibody among Hypothyroid Patients and Clinical and Biochemical Response to L-Thyroxine Replacement Therapy

This study was carried out in the Department of Medicine, Rajshahi Medical College, in 2006-2007 to study the thyroid peroxidase (TPO) antibody level among hypothyroid patients and to find out the effects of L-thyroxine therapy in TPO-antibody titer. After thorough physical examination and relevant investigations, 100 patients of hypothyroidism were enrolled in this study. The selected patients were given L-thyroxine replacement therapy at a dose of 50-150 microgram/d. Before starting L-thyroxine, serum was collected from all patients to estimate anti TPO-antibody level. All patients were followed-up after 12-28 weeks of full dose of L-thyroxine therapy. Patients with high TPO-Abs at baseline, only 17.6% turned into euthyroid (based on composite clinical score), whereas about 42% of the patients who did not have high TPO-Abs became euthyroid suggesting that patients with high TPO Abs may show significantly poor response to treatment compared to the patients without high TPO Abs (p &lt; 0.001). Patients with high TPO-Ab titers also showed a decreased biochemical response (TSH values) compared to the patients without high TPO-Ab positive patients. So, TPO-Ab plays a significant role in causation of the disease and is also associated with poor treatment response with L-thyroxine replacement therapy.&#x0D; TAJ 2018; 31(2): 45-49

Thyroid-stimulating hormone (TSH) serum levels and risk of spontaneous abortion: A prospective population-based cohort study.

Thyroid dysfunction, a common complication of pregnancy, is associated with adverse obstetric and neonatal consequences. This study aimed to determine the effect of TSH levels on early pregnancy outcome in a prospective population-based cohort study. The serum TSH, free thyroxine, free triiodothyronine, thyroid peroxidase antibody levels and urinary iodine concentration of 418 pregnant women in their first trimester of pregnancy were measured. According to the American Thyroid Association (ATA) and the local reference ranges for TSH, women were divided into two groups of 0.1-2.5, >2.5mIU/L and 0.2-4.6, >4.6mIU/L. The risk of spontaneous abortion (SA) was calculated for each group. Spontaneous abortion was detected in 7.2% (n=30) of total 418 pregnancies. Women with TSH levels>2.5mIU/L had an increased risk of SA, compared to women with TSH levels of 0.1-2.5mIU/L (relative risk [RR] 3.719, 95% confidence interval [CI]:1.713-8.074). The risk of SA was increased in women with TSH levels>4.6mIU/L (RR 5.939, 95% CI: 1.711-20.620). The rate of SA was increased by 78% for every unit increase in standard deviation of TSH concentration (RR 1.35, 95% CI: 1.09-1.70). The rate of miscarriages in the treated group by levothyroxine was 9.8% (n=6) compared to 28.6% (n=8) in the untreated group (P=0.024). Our finding suggests that the upper limit for the TSH normal range should be redefined to <2.5mIU/L during the first trimester of gestation. The local upper limit was 4.6mIU/L, consistent with 4.0mIU/L cut-off value recommended by the ATA.

SAT-586 Primary Fallopian Tube Carcinoma Metastasizing to the Thyroid Gland: A Rare Cause of Hypothyroidism

Background: Primary fallopian tube carcinoma (PFTC) has been considered to account for only about 0.1-0.5% of all gynecologic cancers. It is notorious for metastasis to the ovaries, omentum, and uterus but has never been reported to present with hypothyroidism as a metastatic thyroid nodule. Case: A 53-year-old female presented with fatigue, generalized weakness and constipation for the last 4 months. Her past medical history was significant for stage IV poorly differentiated PFTC status post total abdominal hysterectomy, omentectomy and tumor debulking due to the local spread of the PFTC. She also underwent multiple cycles of chemotherapy with paclitaxel, cisplatin, doxorubicin and bevacizumab and was declared in remission by her oncologist. On examination, her vital signs were stable. Thyroid examination showed palpable nodules in the right and left lobes. Her laboratory investigation revealed normal liver and renal function tests, but the blood chemistry was significant for raised TSH levels of 68.8 mcIU/ml and decreased T3 and T4 levels of 45 ng/dL and 0.54 ng/dL respectively. Thyroid Peroxidase Antibody level was less than 3 IU/ml (reference range <6 IU/ML). Thyroid ultrasound showed a 2.3 x 0.7 x 2 cm solid nodule in the medial lower pole of the right lobe with and a 1.9 x 0.8 x 1.1 cm solid nodule in the medial lower pole of left lobe with increased vascularity. The fine needle aspiration cytology revealed groups of highly atypical cells showing enlarged, irregular, crowded nuclei which were intermixed with scattered bland follicular cells and macrophages. These atypical cells were identical to the serous carcinoma cells seen on previous PFTC specimens, confirming the hematogenous spread of PFTC to the thyroid gland. This diagnosis was further substantiated by immunohistochemical staining, which showed two different populations of cells, thyroid cells stained positive for TTF-1 (Thyroid transcription factor-1) while other cells were positive for WT-1 immunohistochemical stain strongly suggestive of metastatic serous carcinoma. Her serum cancer antigen 125 (CA 125) was also found to be elevated at 395 U/ml (normal range 0-35 U/ML) suggesting recurrence of PFTC. Niraparib chemotherapy was initiated. She was also started on 75 mcg of Levothyroxine per day. TSH levels after two months were 4.2 mcIU/ml. Conclusion: PFTC can be diagnosed early in its course using transvaginal Doppler ultrasound to detect areas of neovascularization within the fallopian tube. PFTC has histological and clinical resemblance with ovarian and uterine primaries and hence can be challenging to diagnose. It is incredibly uncommon to suspect thyroid metastasis from the residuals of PFTC as a possible etiology of hypothyroidism. Thus, physicians should keep a very high index of suspicion in appropriate clinical settings. Prognosis remains poor as most patients present with metastatic disease.