Thyroid Profile Research Articles

FACTORS ASSOCIATED WITH THYROID ASSOCIATED ORBITOPATHY DUE TO GRAVES’ DISEASE

Background: Thyroid associated orbitopathy (TAO) is the principal extrathyroidal manifestation of Graves’ disease (GD). TAO is described as chronic inflammation of orbital and periorbital tissue. Environmental risk factors variably influence development of TAO and risk factors vary with ethnicity and geographical region. Aims: To evaluate the clinical factors for TAO in patients with GD. Setting and Design: This was a hospital-based cross-sectional study done on consecutive 76 newly diagnosed patients of GD documented by thyroid 99mTechnetium-pertechnetate scan. Materials and Methods: Patients were subjected to complete clinical workup and thyroid profile. The diagnosis of TAO was based on the criteria of Bartley and Gorman. Fifty two TAO patients were compared with twenty four non TAO patients (controls) for risk. Statistical Analysis Used: All analyses were performed with SPSS software (version 21.0). Results: TAO was present in 52 (68%) of patients with GD. TAO was bilateral in 50 (96%) of patients. Majority of patients had mild orbitopathy 34 (65.4%) and none of the patients showed any signs of sight-threatening disease. Clinical activity score (CAS) was active in 13.5% of the study group. There was significant female preponderance in TAO. Current smoking increased the risk of TAO (P = 0.023). Total triiodothyronine (T3) and mean intraocular pressure (IOP) in primary and upward gaze was significantly elevated at baseline in TAO patients. Braley’s sign was seen in 30.7% of patients with TAO and in 8.3% of patients in the control group (P = 0.033). Current smoking, total T3 > 4ng/dl and differential IOP > 6 mmHg were found to be associated with risk of TAO. Conclusion: TAO was clinically inactive and of mild severity in most cases. This study identified current smoking, total T3 > 4 ng/dl and differential IOP > 6 mmHg as risk factors for TAO.

Impaired Sensitivity to Thyroid Hormones Is Associated With Decreased Vitamin D Levels in the Euthyroid Population.

The relationship between vitamin D and thyroid profiles lacks consensus despite extensive investigations. Whether vitamin D levels correlate with thyroid hormone sensitivity remains largely unexplored. To explore the relationship between vitamin D levels and thyroid hormone sensitivity among euthyroid individuals. This study involved 6452 euthyroid participants. Clinical parameters, including TSH, free thyroxine, 25-hydroxyvitamin D [25(OH)D], and other relevant indicators were extracted from the National Health and Nutrition Examination Survey 2007-2012. To quantify thyroid hormone sensitivity, we calculated the Thyroid Feedback Quantile-based Index (TFQI), the TSH index (TSHI), and the thyrotropin thyroxine resistance index (TT4RI). Subjects with impaired thyroid hormone sensitivity have decreased 25(OH)D levels (TFQI, TT4RI: P < 0.05; TSHI: P = .05574) following adjustment of confounding variables. Age-specific analysis found negative correlations between thyroid hormone sensitivity indices and 25(OH)D within the 20 to 60 years subgroup, turning positive in the 60 to 80 years subgroup. In females, thyroid hormone sensitivity indices and vitamin D levels were negatively linked, while in males, vitamin D's relationships with TFQI, TT4RI, and TSHI shifted from negative to positive when 25(OH)D levels exceeded 63.5 nmol/L, 56.7 nmol/L, and 56.7 nmol/L, respectively. Stratification by race revealed U-shaped curvilinear patterns resembling those found in the males. In body mass index (BMI) subanalysis, vitamin D had differing associations with thyroid hormone sensitivity indices: negative in the <25 kg/m2 and ≥30 kg/m2 subgroups and U-shaped in the 25-30 kg/m2 subgroup. Impaired thyroid hormone sensitivity correlates with decreased vitamin D levels among euthyroid subjects, with associations varying by age, sex, race, and BMI.

Determination of Serum Zinc and Phosphorus Levels in Patients with Hypothyroidism.

Various studies reported that serum zinc (Zn) and phosphorus (P) levels altered in patients with hypothyroidism and vice versa, but results were found inconsistent. It was aimed to find the association between serum Zn and P in patients with hypothyroidism. In this case-control study, a total of 100 subjects (50 newly diagnosed patients of hypothyroidism and 50 controls) were enrolled aged between 25 and 60years. Biochemical parameters such as thyroid profile, serum Zn, and P were estimated in each subject. A p < 0.05 was considered statistically significant. The mean level of body mass index (BMI), thyroid-stimulating hormone (TSH), and serum P was found significantly elevated in cases compared to controls (p < 0.001). However, the mean level of total triiodothyronine (T3), thyroxine (T4), and serum Zn was found significantly reduced in cases compared to controls (p < 0.001). The serum Zn has shown a significant negative correlation with T3 and BMI among cases (r = - 0.313 p < 0.05, r = - 0.338 p < 0.05, respectively). However, serum P has shown a significant positive correlation with TSH and BMI among cases (r = 0.310 p < 0.05, r = 0.449 p < 0.01, respectively). Regression analysis indicated that serum Zn significantly predicted hypothyroidism (p < 0.00). Similarly, serum P significantly predicted hypothyroidism (p < 0.007). Results showed that serum Zn levels were significantly reduced and serum P levels were significantly elevated in cases compared to controls. The serum Zn and serum P both significantly associated with hypothyroidism.

Autoimmune thyroid status in subclinical thyroid disorders in patients attending a tertiary care center in Nepal: a hospital-based cross-sectional study

BackgroundThyroid dysfunction is the leading endocrine disorder worldwide. Iodine deficiency disorders, which were once the major etiology of thyroid dysfunctions, now have been succeeded by autoimmune thyroid diseases with the rise in aberrant salt ionization protocols. This study endeavors to access the level of thyroid autoantibodies viz. anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (TGA), and anti-thyroid stimulating hormone receptor (TRAb) in individuals with subnormal thyroid profiles.MethodsThis hospital-based cross-sectional study was conducted at the Department of Clinical Biochemistry, Tribhuvan University for a period of six months. Using non-probability (purposive) sampling method, a total of 60 patients were enrolled with subnormal thyroid profiles to include the population who have not yet started medication. Thyroid hormones (free T3, free T4, TSH) and thyroid antibodies (anti-TPO, TGA, and TRAb) were measured. For non-parametric data, Chi-square test and Kruskal-Wallis test were used. Spearman’s correlation was done to determine the association between variables.ResultsOut of 60 participants, the majority of the population between 25 and 44 years were diagnosed with thyroid dysfunction with female preponderance. Among all, 40% (n = 24) had subclinical hyperthyroid states while, 60% (n = 36) had subclinical hypothyroid states, and 75% (n = 45) of the total exhibited positive thyroid antibodies. In subclinical hypothyroid patients with TSH above 10 µIU/ml, anti TPO (58.5%) and TGA (66.7%) positivity were highly prevalent. On the other hand, TRAb was exclusively positive in hyperthyroid condition (50% among the group) which is by far the first of its kind reported in Nepal.ConclusionThe rise in autoimmune thyroid disease among the Nepalese population infers that addressing iodine deficiency simply through salt iodinization may not be adequate to deal with the rising burden of thyroid disorders, especially in iodine-depleted areas. Also, the increasing prevalence of thyroid autoantibodies positivity in subclinical hypothyroidism in the Nepalese population accounts for the arduous screening and monitoring of autoimmune thyroid disorders in Nepal.

FRI527 Timing Of Thyroxine Dose During Ramadan: A Randomized Controlled Trial

Abstract Disclosure: R.M. Alamoudi: None. S.M. Nawar: None. H.S. Alharbi: None. A.A. Al Qarni: None. A. Alzahrani: None. A.K. Almulla: None. W.T. Busaad: None. N.F. Alahmari: None. N.D. Alshamrani: None. L. Alkhalifa: None. Y.M. Saleh: None. M. Ramadan: None. A. Borai: None. Background: The effect of Ramadan fasting on the thyroid profile, and the best time for L-thyroxine (LT4) intake in relation to fasting during Ramadan remains undetermined. Objectives: To compare two different time points of taking LT4 therapy during fasting the month of Ramadan in regards to thyroid profile and patient satisfaction. Methods: A multicenter open-label randomized controlled trial. Patients with primary hypothyroidism were recruited from three centers in three cities in Saudi Arabia (Jeddah, Riyadh, and Alhasa). Patients with thyroid cancer were excluded. TSH and FreeT4 (FT4) were measured two weeks before Ramadan, and four to six weeks after Ramadan. Results: 303 patients with primary hypothyroidism were randomized; 156 to take the LT4 dose at sunset with sips of water at the time of breaking fast and wait 30-60 minutes to eat the main Iftar meal (pre-Iftar), and 147 to take the LT4 dose just before the start of fasting (pre-dawn) regardless of their last meal intake. There were no significant differences between the two groups in demographics or comorbidities. The mean age was 49 ±12 years, 87% were female, and the average duration of hypothyroidism was 9.7 ±8.25 years. The mean weekly LT4 dose in the pre-Iftar vs. pre-dawn group was 753.3 ±349.4 vs. 733.2 ±265.6 mcg, p=0.001, and the Pre-Ramadan thyroid profile was: TSH 2.56 ±2.16 vs. 2.46 ±1.72 mIU/L, p=0.3, FT4 13.45 ±2.1 vs 13.08 ±2.4 pmol/L, p=0.16. Post-Ramadan thyroid profile values were: TSH 3.64 ± 4.1 vs. 4.07 ±4.17 mIU/L, p=0.78, FT4 12.96 ±0.1 vs. 12.64 ±0.22 pmol/L, p=0.003. The estimated difference within the group means post-Ramadan was - 0.41 ±0.51 mIU/L, p=0.43 for TSH, and 0.32 ±0.28 pmol/L, p=0.24 for FT4. Generalized linear model repeated measures analysis of variance showed no significant difference over time in TSH or FT4 within or between groups (p = 0.47 vs. 0.81). Patient compliance and satisfaction with the regimens were similar between groups. Conclusion: There is no significant change nor difference in thyroid profile between the two regimens related to the change in LT4 intake during the fasting months of Ramadan. Both regimens can be utilized depending on patient preferences. ClinicalTrials.gov: NCT05421468. Saudi FDA: SCTR # 22041002 Presentation: Friday, June 16, 2023

THU227 Isosexual Peudo-precocious Puberty Due To Leydig Cell Tumor In A Prepubertal Child

Abstract Disclosure: M. Baby: None. A. Xu: None. N. Shacham: None. E. Shapiro: None. B.C. Shah: None. Background: Testicular tumors account for 2-4% of all childhood cancers. Leydig cell tumors are the most common form of sex cord stromal tumors and represent 1-3% of all testicular tumors. In the pediatric population, testicular Leydig cell tumors present with signs of precocious puberty. Workup reveals low gonadotropins with elevated testosterone and testicular mass on ultrasound. Treatment involves surgical enucleation (partial orchiectomy) in most cases. Clinical case: We present the case of a 4 year 10 month old male who presented to endocrine clinic for precocious puberty. He developed pubic hair three months prior with body odor. He did not have any CNS symptoms including headaches or visual changes. There was no use of exogenous androgens at home. He was born full term, small for gestational age with an uncomplicated postnatal course. There was no family history of precocious puberty. Height was at the 99th percentile (z-score 2.7), weight 98th percentile (z-score 2.07), and BMI 86th percentile (z-score 1.09). On exam, he was lean and appeared muscular. His testes were asymmetrical with the right testicle measuring 3 ml and the left testicle 2 ml. Scrotal hair was curly and sparse, Tanner III. Stretched penile length was 7 cm (90th percentile), width was 3.2 cm. Results: Bone age was advanced to 10 year 0 months with height age of 7 year 3 months. Serum gonadotropins were low, testosterone was pubertal at 115 ng/dl (Electrochemiluminescence Immunoassay). Serum 17-hydroxyprogesterone (221 ng/dl, ref range 0-90 ng/dl) androstenedione (163 ng/dl, ref range = &amp;lt; 51 ng/dl), and IGF-1 (368 ng/ml, ref range 108 – 293 ng/ml) were elevated. ACTH, cortisol, thyroid profile, and prolactin were normal. Beta-HCG and AFP were negative. ACTH stimulation test showed normal response. Testicular ultrasound with doppler was performed; right testicle measured 1.82 x 1.06 x 1.36 cm, volume of 1.4 ml, while left measured 1.27 x 0.72 x 0.87 cm, 0.4 ml. Within the right testicle, there was a mass that was hypoechoic, vascular (with a testicular artery feeding branch in the periphery), multinodular and measured 1.2 x 0.8 x 1.10 cm (0.53 ml). He was referred to urology and underwent enucleation of the right testicular mass through an inguinal approach. Grossly, the mass appeared tan and lobulated and surgical pathology confirmed a benign Leydig cell tumor. The patient recovered well and post-operative serum testosterone level at 2 weeks was &amp;lt;2.5 ng/dl. Conclusion: We present a case of a testicular Leydig cell tumor that presented as peripheral precocious puberty marked by low gonadotropins and elevated testosterone with ultrasound findings of a vascular mass with testicular artery feeding branch in the periphery. Early detection of a Leydig cell tumor is crucial as it can be treated by enucleation thus salvaging the testes. Presentation: Thursday, June 15, 2023

Role of Kanchanara Twaka Kwatha with Shunthi Churna in Hypothyroidism (Dhatuwagni Vikriti)

The thyroid is an important part of human endocrine system which are responsible for regulation of oxygen use, BMR, cellular metabolism and growth and development. Hypofunctioning of Jatharagni which in turn effect Dhatwagni eventually brings out Pathological sequence and ultimately the disease condition develop. In hypothyroidsim etiological factors mainly vitiate Tridosha (Kapha predominance along with Pitta vitiation and Margavarana leading to provoking of Vata). The line of treatment with specific target to Rasavaha, Mamsavaha, Medovaha, Manovaha Srotas as well as Vata-Kapha Nashaka, Agnideepan, Sroto Shodhana, Vatanuloman, Amapachan treatment should be administered in hypothyroidism. Keeping the same in mind, present study was carried out to assess the role of Kanchanara Twaka Kwatha with Shunthi Churna in hypothyroidism (Dhatuwagni Vikriti). For this study 40 patients were selected and are divided into two groups with 20 patients in each group on the basis of inclusion and exclusion criteria and were assessed on the basis of subjective and objective parameters by applying appropriate statistical test. Most of the patients in group 1 (Kanchanaradi Kwatha) shows marked improvement in their symptoms as well as in objective parameters (thyroid profile) as compared to group 2 (Tab. Levothyroxine 50 mcg) which was taken as control group. From this study it can be concluded that hypothyroidism can be managed effectively with Kanchanara Twaka Kwatha with Shunthi Churna mention in Sharangdhar Samhita Madhyam Khanda Adhyaya 2 Shloka no.126.

FRI487 Oral Liquid L- Thyroxine (L-T4) Is More Effective In Controlling Hypothyroidism, Than L-T4 Tablet, In Patients Submitted To Total Thyroidectomy

Abstract Disclosure: P. Fallahi: None. S. Ferrari: None. F. Ragusa: None. G. Elia: None. G. Materazzi: None. S. Paparo: None. A. Patrizio: None. V. Mazzi: None. P. Miccoli: None. A. Antonelli: None. Objectives: Our aim is to investigate the efficacy of levothyroxine (L-T4) in liquid formulation in patients recently subjected to total thyroidectomy (without malabsorption or drug interference), with respect to L-T4 tablets. Methods: We enrolled two hundred and twenty-five patients of whom 75 received L-T4 in tablets, and 150 were treated with liquid L-T4 at the same dosage (1.5 mcg/kg/day). The therapy started the day after thyroidectomy, and the drugs were assumed every day 30 min before breakfast. The thyroid profile was assessed by evaluating serum thyrotropic hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) in a first control after 6 weeks, then in a second control after 12 weeks. Results: Our results showed that the prevalence of patients in the hypothyroid range (TSH&amp;gt;3.6 mcU/ml) was significantly higher in the L-T4 tablet group. Moreover, TSH values were significantly lower in the liquid L-T4 group, than in the tablet L-T4 group both at the first (P &amp;lt; 0.05), and at the second control (P &amp;lt; 0.01), while FT4 and FT3 levels were not significantly different. Conclusions: Our data showes that thyroidectomized patients, not reporting issues of malabsorption, gastric disorders, or drug interference, have a better control of TSH levels under a liquid L-T4 therapy. Presentation: Friday, June 16, 2023

FRI515 GRADE-Adolopment Of Hyperthyroidism Treatment Guidelines For A Pakistani Context

Abstract Disclosure: A. Pervez: None. R. Martins: None. A. Aziz: None. S. Raja: None. N. Islam: None. A. Ahmed: None. A. Sheikh: None. S. Furqan: None. N. Ram: None. A. Rizwan: None. N. Rizvi: None. M. Mustafa: None. S. Aamdani: None. B. Ayub: None. M.Q. Masood: None. A. Haider: None. S. Nadeem: None. Background: Hyperthyroidism is a common endocrinological disorder in Pakistan. The prevalence of hyperthyroidism here is four times higher than the United States. Most high-quality hyperthyroidism clinical practice guidelines (CPGs) originate from high-income countries. Due to resource constraints, de novo local guideline creation is restricted in lower-middle income countries which adopt internationally created CPGs lacking a local context. Thus, we aimed to produce a comprehensive evidence-based CPG for the management of adult outpatient hyperthyroidism patients in Pakistan. Methods: An adaptation of the GRADE-ADOLOPMENT process was followed in collaboration with the GRADE working group. Adolopment describes a combination of adoption (verbatim use), adaptation (contextual modifications), and de novo development, thus leveraging the benefits of pre-existing high-quality CPGs while ensuring local appropriateness. The 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis was selected as the source CPG by a panel of local endocrinology experts. Recommendations from the source CPG were either adopted, excluded, or adapted. Adaptation was done using the evidence-to-decision framework. Results: The source CPG included a total of 124 recommendations, of which 71 were adopted as is. 49 recommendations were excluded due to reasons including but not limited to unavailability of drugs, inapplicability to the existing health-care system of Pakistan or different target audience. 4 recommendations were carried forward for adaptation, 2 of these remained unchanged after collection of local contextual data and consensus between the local endocrinologists. 2 recommendations were modified from the source CPG. The first recommended using ALT only instead of a full liver function test amongst patients experiencing symptoms of hepatotoxicity while being treated with anti-thyroid drugs. The second pertained to thyroid status testing post-treatment by radioactive iodine therapy for Graves’ Disease with only FT4 instead of a full thyroid profile. Both adaptations centered around the judicious use of laboratory investigations to reduce costs of hyperthyroidism management. Conclusion: Our CPG for the management of hyperthyroidism in Pakistan consists of 75 recommendations, of which two recommendations have context-specific adaptations that prioritize patients’ finances during hyperthyroidism management and limit the overuse of laboratory testing in a resource-constrained setting. Our revised methodology is a resource-efficient method for developing CPGs with a local context. We aim to publish and disseminate this CPG to improve hyperthyroidism care provision in Pakistan. Future research must investigate the cost-effectiveness and risk-benefit ratio of these modified recommendations. Presentation: Friday, June 16, 2023

FRI514 Treatment Of Hypothyroidism By Age And Sex In The United States: A National Health And Nutrition Examination Survey (NHANES) And Optum Claims Data Analysis

Abstract Disclosure: A. Tessnow: None. K.L. Wyne: None. C.P. Schneiderman: Employee; Self; Abbvie. Stock Owner; Self; Abbvie. B. Pinsky: Employee; Self; Abbvie. Stock Owner; Self; Abbvie. D. Guo: Employee; Self; Abbvie. Stock Owner; Self; Abbvie. B. Barger: Employee; Self; Abbvie. Stock Owner; Self; Abbvie. O. Antunez Flores: Employee; Self; Abbvie. Stock Owner; Self; Abbvie. Background: Recently updated hypothyroidism (HT) prevalence in the United States (US) using NHANES and Optum Claims data (OCD) showed an increasing prevalence of overall HT from 9.6% in 2012 to 11.7% in 2019. Objectives: Characterize treatment pattern of overt HT (OHT) in the US with NHANES 2009-12 cycles and OCD during 2019. Methods: Combined NHANES Survey data from the 2009-12 cycles and OCD for 2019 were utilized. Patients age ≥12 years old were included in the NHANES thyroid profile sub-sample; for Optum patients ≥18 were included and women who were pregnant were excluded. Disease status was determined from blood samples (NHANES), labs (OCD) or evidence of HT Tx. OHT was defined as presence of elevated thyroid-stimulating hormone (TSH &amp;gt;4.0 mIU/L) and a subnormal or low level of free thyroxine (FT4 &amp;lt; 0.8 ng/dL); patients with a documented prescription (Rx) for HT Tx with levothyroxine or liothyronine were also categorized with OHT regardless of lab values. The results were stratified by age (12/18-44, 45-59, 60+) and sex, concurrently. NHANES data was further stratified by insurance status (private or Medicare vs neither) and excluded sub-clinical HT to parallel OCD estimates. Results: Among both the OCD and matched NHANES cohorts, overall Tx of OHT was 83.6% &amp; 79.5% respectively. The OCD cohort showed both males and females having similar Tx patterns across age and sex strata, ranging from 78.6% of males aged 60+ with evidence of Rx, to 91.3% of females aged 45-59. Among NHANES strata, overall Tx rates increased as age increases (ages 12-44 = 62% to 60+ = 87.5%) and higher in females than in males, especially among those aged 60+ years (ages 12-44 F:M; 66.2% - 53.2%, ages 45-59; 81.3% - 71.1%, and 60+; 93.7% - 67.0%). Sex differences were less pronounced, and the Tx rates tend to be lower among those aged 60+ years in OCD analysis (ages 18-44 F:M; 90.1% - 85.7%, ages 45-59; 91.3% - 87.8%, and 60+; 82.0% - 78.6%). Among the NHANES strata not privately or Medicare insured, OHT Tx rates overall were 55.9%, with younger females and males &amp;lt; 60 years old showing the lowest treatment rates (M 12-44 - 0% F 12-44 - 30%). Study Limitations: Claims data may incompletely capture the conditions and outcomes documented in the medical records and prevalence may be overestimated due to miss or rule out coding. The active surveillance of thyroid function conducted in NHANES might also have contributed to the differences. Likewise, NHANES may overestimate OHT as no re-testing occurs for thyroid function. Conclusions: This study provides important updates to the treatment of HT by age-groups and sex using both total and insured population estimates. Differences between NHANES and OCD Tx patterns may be due to the population-based approach of NHANES compared to care-seeking behavior as observed in claims data. Further analyses to delineate treatment patterns by age &amp; sex will be completed to better understand the treated and untreated population. Presentation: Friday, June 16, 2023

Comparative Study of Intravenous Methylprednisolone Pulse Therapy versus Oral Prednisolone Minipulse Therapy in Progressive Vitiligo

Abstract Background: Vitiligo is an idiopathic acquired illness characterized by limited depigmented macules and patches. We aim to compare intravenous (IV) methylprednisolone pulse therapy with oral prednisolone minipulse therapy in the treatment of progressive vitiligo. Objective: The assessment of the efficacy of both treatment methods in the arrest of the progression of vitiligo and repigmentation of the existing lesions. Materials and Methods: A total of 60 patients, 30 in each group, were enrolled for the study. Each patient underwent a detailed clinical, general physical, systemic, and thorough dermatological examination. A set of routine investigations, consisting of hemoglobin%, total leukocyte count, differential leukocyte count, urine routine examination, blood sugar (fasting and postprandial), liver function tests, renal function test, serum electrolytes, Montoux test, chest X-ray posteroanterior view, and thyroid profile were carried out before the analysis. Clinical photographs were taken before the start of therapy and after each month thereafter were used for the analysis after taking written consent. Results: The age of vitiligo patients considered for the study ranged from 13 to 70 years. The ratio of male-to-female patients considered for the study was 22:38 (36.6%: 63.3%). The duration of instability in vitiligo cases studied varied from 6 months to 2 years. In both Group A and Group B, the maximum number of patients (66.7% and 86.7%, respectively) had unstable vitiligo for 6 months to 1 year. Percentage repigmentation was better in Group A (IV) than Group B (OMP). In Group A, 17 out of 20 (85%) patients had shown different degrees of repigmentation, while 20 out of 30 (66.7%) patients of Group B had shown the same. This was statistically insignificant. Types of repigmentation observed in patients were of the following types: perifollicular, marginal, and combined. In both groups, all patients showed perifollicular regimentation. Conclusions: In progressive vitiligo, it was observed that oral mini pulse with prednisolone is superior to IV methylprednisolone pulse therapy for the arrest of progression. Considering the cost, mode of administration, hospital admission, loss of man-hours, and patients’ compliance, OMP was considered simpler and cost-effective.

Thyroid Profile and Serum Lipid Level in Women with Normal Pregnancy

Objective: To evaluate the changes in thyroid profile and serum lipid level in normal pregnancy.Methods: This observational study was conducted at the Department of Biochemistry of Santosh Medical College, Ghaziabad, UP, India, from June 2021 to February 2022. In this study, 200 average pregnant women were enrolled. The thyroid profile was estimated using the ELISA method, and the lipid profile was measured using the enzymatic kit method. All data were expressed as means and standard deviations, and SPSS version 17 was used for statistical analysis.Results: This observational study observed that the mean T3, T4, and TSH levels increased significantly in the second trimester compared to the first trimester. In contrast, the mean value of T3, T4, and TSH decreased in the third trimester as compared to the second trimester. The mean levels of total cholesterol, triglyceride, and LDL-cholesterol increased significantly, while the mean value of HDL-cholesterol decreased significantly in the second and third trimesters when compared to the first trimester.Conclusion: This study demonstrated abnormal lipid and thyroid metabolism. Changes in thyroid profile may be associated with adverse obstetric outcomes. The altered lipid parameters, mainly High TG and low HDL-C concentrations, may promote vascular dysfunction and oxidative stress.

Ultrasound characteristics of Hashimoto’s thyroiditis in the subclinical stages of the disease

ObjectiveTo investigate the prognostic value of indicators from b-mode ultrasound, color Doppler ultrasound, and strain elastography of the thyroid gland in the diagnosis of Hashimoto's thyroiditis (HT). MethodsIn 70 euthyroidal patients with HT, demographic characteristics, serum thyroid profile and ultrasound parameters, including thyroid gland size, vascularity and stiffness (elastography strain index) of the parenchyma, and flow indices of the superior and inferior thyroid artery were recorded. The control group consisted of 70 age and weight matched euthyroid individuals with negative anti-thyroid antibodies (anti-TPO and anti-Tg). ResultsA significant difference was observed between the two groups in total thyroid size (ml, median ± standard deviation, SD) 7.86 ± 2.9 in HT vs. 6.35 ± 2.7 ml in controls, p = 0.003) and parenchymal vascularity which was increased in patients with HT (p < 0.001). Tissue strain index was higher in the HT group but without reaching statistical significance In logistic regression, thyroid size (odds ratio 1.20, 95% confidence interval: 1.02–1.41, p = 0.022) demonstrated significant prognostic value for the presence of HT. No differences were found between the two groups, regarding the peak systolic velocity (PSV), end-diastolic volume (EDV), pulsatility index (PI) and resistive index (RI) values of the thyroid arteries. In the ROC analysis (AUC 0.653, p = 0.002), a thyroid size >7.3 ml exhibited sensitivity of 61.43% and specificity of 72.6% for the diagnosis of HT. ConclusionPatients with HT exhibit larger thyroid size and increased intrathyroidal vascularity on ultrasound prior to the manifestation of hypothyroidism compared to the healthy population. Flow indices of the superior thyroid artery do not have prognostic value in the diagnosis of HT.

Evaluation of Role of Prognostic Factors on Hearing Outcome in Unilateral Idiopathic Sudden Onset Sensorineural Hearing Loss

Introduction: Owing to its uncertain and multiple possible etiologies, use of multiple empirical treatment regimens and possibility of spontaneous recovery, it becomes important to look for the possible prognostic factors affecting the outcome of sudden sensorineural hearing loss (SSNHL). Material and methods: This prospective observational study was conducted with the primary aim of analyzing the role of various possible prognostic factors on the outcome of idiopathic SSNHL including demographic (Age, gender), audio-vestibular (Pre-treatment hearing loss in the affected ear, hearing in the contralateral ear, time elapse between onset of hearing loss and start of treatment, type of hearing loss in term of frequencies affected), presence of tinnitus / vertigo and Comorbidities (Diabetes, Hypothyroidism &amp; Deranged lipid profile/ dyslipidemia). Result: The absence of vertigo and tinnitus led to better hearing outcomes while raised HbA1c levels, deranged lipids and thyroid profiles adversely affected the outcome. Conclusion: Vertigo, tinnitus, raised HbA1c levels, deranged lipids and thyroid profiles are possible negative prognostic factors. Better pretreatment hearing levels in the affected and unaffected ears prompted improved recovery.

Systematic Review to Gauge the Effect of Levothyroxine Substitution on Progression of Diabetic Nephropathy in Patients With Hypothyroidism and Type 2 Diabetes Mellitus.

Diabetes mellitus (DM) and thyroid dysfunction are two disorders that are closely related. This systematic review aimed to investigate the effect of levothyroxine supplementation on diabetic nephropathy in type 2 diabetic patients with co-existing thyroid dysfunction. We explored medical databases such as PubMed, Medline, Multidisciplinary Digital Publishing Institute (MDPI), and Cochrane Library for relevant medical literature. The papers were screened, and 12 research papers involving 10,371 patients were identified after applying eligibility criteria and quality assessment using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The included papers analyzed the effect of aberrant thyroid profile on kidney disease in diabetic individuals and the role that achieving euthyroid status with levothyroxine supplementation could play in diabetic nephropathy. Reduced free triiodothyronine (FT3) was the most common independent factor associated with diabetic microvascular and macrovascular complications. Levothyroxine (LT4) regimen was more effective than the placebo in lowering urinary albumin excretion rate (UAER), low-density lipoprotein cholesterol, and uric acid and decreasing oxidative stress overall. However, replacement therapy's effect may differ in the short and long terms. Thyroid hormone replacement therapy (THRT) may reduce the risk of diabetic nephropathy and cardiovascular disease (CVD) development in hypothyroid patients, but more randomized trials are needed to confirm the effect of THRT.

Thyroid profile prognostic value on disease severity and mortality in COVID-19

Background: Precise accurate triage of Coronavirus disease 2019 (COVID-19) patients during hospitalization for early identification of individuals at risk of developing severe disease is essential as Intensive Care Units (ICUs) are overwhelmed by the pandemic burden. The aim of this study was to evaluate thyroid function in patients with COVID-19. Methods: 60 healthy controls and 180 patients were admitted to a cardiothoracic hospital, Minia University, Egypt, between March 2020 and September 2021 without a history of thyroid disease. Patients divided as 60 non-COVID pneumonia patients with a similar degree of severity were included as another control group to find any unique effects of COVID-19 on thyroid function, 120 positive COVID-19 divided according to clinical classifications into moderate (n = 58), severe (n = 21), and critical (n = 41), Critical group were admitted to ICU and classified to survivors (n = 33) and non-survivors (n = 8). COVID patients also were divided into tertiles according to their FT3 levels. Lowes tertile (n = 45), middle tertile (n = 37) and highest tertile (n = 38). All participants underwent routine physical checkups, acute physiology, and chronic health evaluation (APACHE-II) scores. The outcome measure was death during hospitalization; intensive care admission, mechanical ventilation, and length of hospitalization. We analyzed the ability of each parameter to predict mortality in participants. Further, we also evaluated whether the combination of free triiodothyronine (FT3) level with APACHE-II score could improve the mortality prediction. Results: Thyroid Stimulating Hormone (TSH) was lower than normal range in 56.7% (68/120) of patients with COVID-19. TSH and serum-free triiodothyronine (FT3) were significantly lower in COVID-19 patients than healthy control and non-COVID-19 pneumonia patients. TSH and FT3 were lower in severe COVID-19 with statistical significance (p &lt; 0.001) and both positively correlated with the severity. The free thyroxine (FT4) in COVID-19 patients was not significantly different from the control group. Patients in the lowest FT3 tertile had significantly higher rates of mortality (18/40), mechanical ventilation (24/53.3), and intensive care unit admission (20/44.4). In univariate analyses, FT3 remained the most significant independent predictor of death. Conclusion: The changes in serum TSH and FT3 levels may be important manifestations of COVID-19 courses.FT3 levels can serve as a prognostic tool for disease severity in early presentation of COVID-19.

Thyroid Profile and Serum Lipid Level in Women with Normal Pregnancy

Objective: To evaluate the changes in thyroid profile and serum lipid level in normal pregnancy. Methods: This observational study was conducted at the Department of Biochemistry of Santosh Medical College, Ghaziabad, UP, India, from June 2021 to February 2022. In this study, 200 average pregnant women were enrolled. The thyroid profile was estimated using the ELISA method, and the lipid profile was measured using the enzymatic kit method. All data were expressed as means and standard deviations, and SPSS version 17 was used for statistical analysis. Results: This observational study observed that the mean T3, T4, and TSH levels increased significantly in the second trimester compared to the first trimester. In contrast, the mean value of T3, T4, and TSH decreased in the third trimester as compared to the second trimester. The mean levels of total cholesterol, triglyceride, and LDL-cholesterol increased significantly, while the mean value of HDL-cholesterol decreased significantly in the second and third trimesters when compared to the first trimester. Conclusion: This study demonstrated abnormal lipid and thyroid metabolism. Changes in thyroid profile may be associated with adverse obstetric outcomes. The altered lipid parameters, mainly High TG and low HDL-C concentrations, may promote vascular dysfunction and oxidative stress.

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

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

Correlation of sdLDL-C with cardiometabolic risk indices in women with subclinical hypothyroidism– A cross-sectional study

Introduction and Aim: Subclinical hypothyroidism (SCH) characterised by normal free thyroxine (FT4)­­, “free triiodothyronine (FT3)”, and raised serum TSH, is an early stage of mild thyroid hormone deficiency. A change in the lipid profile most often observed in SCH is mainly caused by increased serum levels of Triglycerides (TG), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C), whereas high-density lipoprotein cholesterol (HDL-C) levels can be normal or elevated. Studies on small dense Low Density Lipoprotein – Cholesterol (sdLDL-C), associated with CVD risk are few. The aim of this study was to estimate serum sdLDL-C and find its correlation with thyroid profile (FT4 and TSH) and cardiometabolic risk indicators in female subjects with subclinical hypothyroidism. Materials and Methods: The study had 112 female participants in total. After screening, subjects were divided into two groups. Control group (euthyroid) and study group (SCH). Age, TSH, FT4, TC, TG, HDL-C, LDL-C, sdLDL-C &amp; Lipid ratios “(TC/HDL-C, LDL-C/HDL-C”, “Log TG/ HDL-C)” were examined and compared between the two groups. Results: The correlation of sdLDL-C with TSH, FT4, lipid parameters &amp; lipid ratios were studied. TG, TC, HDL-C, and LDL-C were not clinically significant. While sdLDL-C and lipid ratios had a statistical decrease, it was not clinically significant. A highly significant negative association between sdLDL-C, other lipid parameters, except HDL-C, lipid ratios are observed in the study group. Conclusion: As anticipated, the current investigation did not demonstrate any statistically significant improvement in the sdLDL-C as a better predictor of CVD risk. No apparent lipid abnormalities were also seen in women, in the age group of 20-40 years as observed in the correlation studies. However, measurement of AIP along with FT4 would make a better assessment of CVD risk.

Oxidative Stress Mediates the Association between Thyroid Dysfunction and Breast Cancer

BACKGROUND: Breast Cancer (BC) and thyroid dysfunction are commonly observed ailments in females, and two may occur synchronously. The present study was conducted to find the role of oxidative stress and its association with thyroid dysfunction and BC.METHODS: In this cross-sectional study, 288 and 100 subjects were included in case and control groups, respectively. Serum samples were obtained from consented subjects. Thyroid profile, thyroid antibodies, antioxidant and oxidant profiles, as well as cathepsin S (CTSS), prolactin, and estradiol levels were estimated using specific enzyme-linked immunosorbent assay kits. The data was analyzed using independent Student's t-test and Pearson correlation test.RESULTS: BC cases had higher levels of thyroid antibodies and thyroid stimulating hormone than controls. Prolactin and estradiol levels were also deranged in the case group. Higher oxidative stress biomarkers were evident in the case group; 8-hydroxy-2'-deoxyguanosine (8-OHdG), a DNA damage marker, increased concomitantly. Correlation analysis showed a positive correlation between the antioxidant (catalase) and the oxidant (8-OHdG) levels. Furthermore, the higher level of CTSS in BC cases than in the controls is the hallmark of this study, demonstrating the pathogenesis and progression of the disease.CONCLUSION: Results suggest the mediating role of oxidative stress in the association between thyroid dysfunction and BC. It concludes that the parameters assessed in this study could be indicative of disease progression and metastasis in BC as well as thyroid dysfunction.KEYWORDS: breast cancer, thyroid, oxidant, antioxidant, ROS