Thyroid-stimulating Hormone Levels Research Articles

Occult Thyroid Cancer in Autoimmune Thyroiditis: Lymph Node Ultrasound as the Sole Diagnostic Indicator of Malignancy in a Pediatric Case of Papillary Thyroid Carcinoma

Background: Autoimmune thyroiditis (AIT) is a common thyroid disorder in children, linked to an increased risk of papillary thyroid carcinoma (PTC). Characteristic ultrasonographic features of AIT can obscure PTC, delaying diagnosis. Case Presentation: An 11-year-old girl with a two-year history of AIT presented with persistently elevated thyroid-stimulating hormone (TSH) levels despite levothyroxine therapy. Examination revealed a firm, slightly enlarged right thyroid lobe. Serial thyroid ultrasounds showed typical AIT features, with no apparent tumor. However, a cervical lymph node ultrasound detected a suspicious lymph node with pathological vascularization. Fine-needle aspiration suggested possible PTC metastasis. The patient underwent total thyroidectomy with central and right lateral neck dissection. Histopathology confirmed multifocal PTC with cervical lymph node metastases (pT3aN1bM0). Postoperative radioactive iodine therapy resulted in undetectable thyroglobulin levels, indicating a biochemical response. Conclusions: Children with AIT may harbor occult PTC even without thyroid gland abnormalities suggestive of malignancy. Comprehensive ultrasound evaluation, including cervical lymph nodes, is vital for early detection and timely treatment.

Correlation analysis of Hashimoto’s thyroiditis with papillary thyroid carcinoma occurrence and its central lymph node metastasis: a single center experience

PurposeThis study investigates the clinicopathological characteristics of papillary thyroid carcinoma (PTC) with coexisting Hashimoto’s thyroiditis (HT) and further explores the risk factors for central lymph node metastasis (CLNM) in PTC.MethodA retrospective analysis was conducted on 415 PTC patients who underwent surgical treatment for thyroid cancer at the First Affiliated Hospital of Anhui University of Chinese Medicine from 2016 to 2022. Clinicopathological features were compared between PTC patients with and without HT. Univariate and multivariate logistic regression were used to analyze the risk factors of CLNM.ResultThe PTC+HT group had a higher proportion of female patients (85.5%) than the PTC group (P<0.05). Univariate analysis revealed no statistically significant difference between the two groups in eight aspects (all P>0.05). Multivariate analysis showed that HT was positively associated with the total number of central lymph node (CLN) dissected, Thyroid-stimulating hormone (TSH), Thyroid peroxidase antibody (TPOAb), and Thyroglobulin antibodies (TgAb), while identified as a protective factor against invasion with an odds ratio of 0.422 (95%CI 0.209-0.853, P=0.016). Through univariate and multivariate logistic regression, we proved that tumor position, Capsule + Extrathyroidal extension (ETE), multifocal tumors, and the total number of CLN dissected were independent risk factors for CLNM. Multiple linear regression analysis told us that invasion (β= 0.093, p=0.048) had a positively predictive impact on CLN positive rate.ConclusionFemale PTC patients are more prone to concurrent HT, which elevates the levels of TSH, TPOAb, and TgAb. HT not only promotes the longitudinal growth of nodules and PTC development, but also reduces the risk of invasion and CLNM. Therefore, we posit that the impact of HT on PTC patients is a “double-edged sword”. Isthmus, Capsule + ETE, multifocality, age < 55 years old, and male are high-risk factors for CLNM in PTC, while HT is regarded as a protective factor. Capsule + ETE is the primary risk factor affecting the CLN positive rate.

Association between Helicobacter pylori infection, serum thyroid-stimulating hormone, and thyroxine in the National Health and Nutrition Examination Survey 1999–2000

BackgroundHelicobacter pylori has been increasingly implicated in extra-gastric diseases. Current evidence regarding the association between serum thyroid-stimulating hormone (TSH), thyroxine (T4), and H. pylori infection remains inconclusive. Consequently, this study aimed to explore the correlation between TSH and T4 levels and H. pylori infection in a US-based population sample.MethodsData from the US National Health and Nutrition Examination Survey (NHANES), comprising 971 participants aged 30–85 years from 1999 to 2000, were analyzed. Binary logistic regression was employed to analyze the correlation between H. pylori and TSH and T4 levels. The impact of TSH and T4 on H. pylori infection was further assessed using restricted cubic spline (RCS) analysis. In addition, subgroup analyses stratified by sex and age were conducted.ResultsSubjects with H. pylori seropositivity demonstrated lower serum TSH levels and higher serum T4 levels compared to those with H. pylori seronegativity. A significant positive correlation was identified between H. pylori seropositivity and T4 levels with increasing quartiles of hormonal levels in both univariate regression models (Q4 vs. Q1: OR = 1.483; 95% CI, 1.033–2.129) and multivariate regression models (Q4 vs. Q1: OR = 1.004; 95% CI, 0.981–1.026). Conversely, a negative correlation was observed between H. pylori seropositivity and TSH levels with increasing quartiles of hormonal levels in univariate regression models (Q4 vs. Q1: OR = 0.579; 95% CI, 0.403–0.831) and in multivariate regression models (Q4 vs. Q1: OR = 0.580; 95% CI, 0.389–0.866). In stratified analyses, the adjusted association of serum T4 levels with H. pylori seropositivity was statistically significant among men (T4: Q4 vs. Q1: OR = 2.253; 95% CI, 1.311–3.873), age over 68 years in TSH levels (Q4 vs. Q1: OR = 0.434; 95% CI, 0.206–0.911), and age 41–54 years in T4 levels (Q4 vs. Q1: OR = 4.965; 95% CI, 2.071–11.903). RCS analysis revealed a non-linear relationship between TSH levels and H. pylori infection. Notably, when TSH < 0.98 IU/ml, the likelihood of H. pylori infection significantly increased.ConclusionsLower TSH and higher T4 levels were associated with H. pylori infection, particularly among men and elderly individuals.

Thyroxine overuse and clinical indices guiding successful treatment withdrawal.

Levothyroxine (LT4) is commonly prescribed, but there is evidence strongly suggesting that a significant proportion of these patients are on treatment without solid evidence of hypothyroidism.Small trials on treatment discontinuation, did not detect any predictors of success. Therefore, we conducted this study in an attempt to identify predicting factors for successful LT4 withdrawal. In 802 consecutive patients (83% females, mean age 48 ± 16 years) on LT4 treatment for 8.8 ± 7.3 years without a solid diagnosis of hypothyroidism, therapy was abruptly discontinued. A total of 387 persons were followed up for up to 4 months (group A) and 415 individuals who were euthyroid at 4 months post LT4 discontinuation, were followed up for up to 60 months (group B). Recurrent hypothyroidism was defined if thyrotropin (TSH) level exceeded 4.5mIU/L. Among the entire cohort, 182 patients (23%) became hypothyroid, 40% of group A and 7% of group B (p < 0.001). The Τhyroid treatment Discrimination Index (T4RxDI), the product of TSH levels multiplied by the daily LT4 dose divided by BMI, was calculated. In group A, successful LT4 withdrawal was strongly indicated by a T4RxDI value < 2.78 (72% sensitivity, 66% specificity), while in group B, the corresponding value was 3.75 (100% sensitivity, 48% specificity). Our findings reveal considerable overuse of LT4 and propose a T4RxDI product of < 3 as a valuable predictive factor of recurrent hypothyroidism, justifying a treatment discontinuation trial. If hypothyroidism does not resume within 4 months, the risk of developing long-term hypothyroidism is likely to be minimal.

Abstract TP332: Assessing the Role of Thyroid Function in Ischemic Stroke: A Retrospective Analysis Across TOAST Classification

Introduction: Subclinical hyperthyroidism has been linked to an increased risk of atrial fibrillation, which elevates the likelihood of cardioembolism, cryptogenic stroke (CS), and embolic stroke of undetermined source (ESUS). However, the broader relationship between thyroid function abnormalities and acute ischemic stroke remains uncertain. This study aims to investigate whether patients with acute ischemic stroke due to cardioembolism, CS, or ESUS are more likely to have abnormal thyroid-stimulating hormone (TSH) levels compared to those with ischemic strokes from other etiologies, as classified by the TOAST criteria. Methods: Utilizing data from the Get With The Guidelines Database, we conducted a retrospective chart review of patients admitted to our single comprehensive stroke center, diagnosed with an acute ischemic stroke between August 2022 and January 2023. The Kruskal-Wallis rank sum test was employed to assess differences in TSH, Free T4, and, if available, one year follow-up TSH levels among patients with ischemic stroke etiologies of small vessel disease, large artery atherosclerosis, cardioembolism, CS, and ESUS. Results: A total of 211 patients were included in the analysis, the distribution of stroke etiologies included 33 (16%) with small vessel disease, 51 (24%) with large artery atherosclerosis, 77 (36%) with cardioembolism, 13 (6.2%) with an undetermined/cryptogenic etiology, and 25 (12%) with ESUS. The majority of patients had normal TSH levels, accounting for 82% of the total cohort, the overall mean TSH level was 2.52 (reference range 0.27-4.2uIU/mL). No significant differences were observed in the mean TSH (p = 0.066), Free T4 (p = 0.13), or follow-up TSH (p = 0.79) levels across each stroke subtype. Conclusions: Our findings suggest that thyroid function does not significantly differ across the various etiologies of acute ischemic stroke, as classified by TOAST criteria. While further large-scale studies are warranted, our results indicate that routine evaluation of thyroid function may not be essential in the determination of stroke etiology.

Modifying effects of prenatal exposure to rare earth elements on birth outcomes through maternal thyroid function in early pregnancy.

The potential health effects of exposure to rare earth elements (REEs) remain largely unexplored. This prospective cohort study aimed to elucidate the association between early pregnancy REE exposure and maternal thyroid function, as well as neonatal birth outcomes, in a cohort of pregnant women in Beijing, China. Additionally, the study explored the mediating role of thyroid homeostasis in the effects of REE exposure. Serum concentrations of fifteen REEs, along with Free Thyroxine (FT4), Thyroid Stimulating Hormone (TSH), and Thyroid Peroxidase Antibodies (TPOAb), were measured in 195 pregnant women. Multivariable linear regression analyses identified significant correlations between REE exposure and disruptions in maternal thyroid homeostasis. Specifically, Praseodymium (Pr) and Lutetium (Lu) were positively associated with FT4 levels, while Gadolinium (Gd) showed a positive correlation with TSH levels. Conversely, Thulium (Tm) was negatively associated with FT4 levels, and Yttrium (Y) was negatively correlated with TSH levels, indicating distinct interactions of specific REEs with thyroid regulation. Notably, Lu remained positively correlated with FT4 levels (β=1.39, 95% CI=0.55, 2.22) after adjusting for multiple comparisons. Regarding neonatal birth outcomes, Dysprosium (Dy) was found to be negatively associated with infant birth weight (β=-0.09, 95% CI=-0.170, -0.002). Furthermore, gender-specific analyses revealed significant associations between REE exposure and TPOAb levels among female neonates. Mediation analyses indicated that TSH significantly mediated the relationships between Terbium (Tb) and Y exposure and neonatal birth outcomes. The study suggests that REEs may disrupt endocrine function, particularly thyroid hormones, which could adversely affect neonatal growth, highlighting the need for further research on their impact in vulnerable populations.

Immunohistochemical examination of PNAd, α4β1 integrin and MUC-2 expressions in the secretary phase endometrium of women diagnosed with recurrent implantation failure.

Successful embryo implantation is contingent upon the intricate interaction between the endometrium and the blastocyst. Recurrent implantation failure (RIF) signifies the clinical challenge of failing pregnancy post-transfer of high-quality embryos, fresh or frozen, in at least three in vitro fertilization (IVF) cycles, often in women under 40 years. Recent studies identify impaired blastocyst maternal tissue communication among recurrent implantation failure causes. Despite successful embryo transfer in vitro fertilization cycles, endometrial factors persist in women with recurrent implantation failure history, underscoring implantation's complexity. The implantation window, during which the endometrium becomes receptive to the blastocyst, involves the expression of key molecules that facilitate the implantation process. When the literature was examined, it was observed that comparative immunohistochemical studies on key molecules such as α4β1 integrin, MUC-2 and PNAd, which are thought to play a critical role in the endometrium before and during implantation, were limited. In this study, we aimed to investigate, through immunohistochemical and histological analyses, the roles of adhesion molecules in the secretory phase endometrium of patients diagnosed with RIF. Twenty-one patients diagnosed with recurrent implantation failure and 21 patients with a history of previous pregnancy at the Gynecology and Obstetrics Clinic of Balcalı Hospital, Faculty of Medicine, Çukurova University were clinically evaluated between days 19-21 of the menstrual cycle and included in the study. Endometrial biopsies, prepared for light and electron microscopy, received Hematoxylin and Eosin staining and anti-α4β1 integrin, anti-MUC-2, and anti-PNAd antibodies for immunohistochemistry. Blood samples were collected on the 2nd and 3rd days of the menstrual cycle to assess serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and thyroid-stimulating hormone (TSH). While FSH, LH, and E2 levels showed no significant difference, TSH was elevated in the recurrent implantation failure group. Structural differences in the endometrium included increased microvilli cells and reduced pinopod counts in infertile women compared to controls. In women with recurrent implantation failure MUC-2 expression were found to be elevated in the endometrial surface epithelium, while PNAd expression was reduced compared to the control group. These findings suggest structural and molecular disparities during the endometrial receptivity window in recurrent implantation failure women may underlie infertility by hindering blastocyst adherence. Molecular studies are needed to elucidate the pathophysiology of the biomarkers whose presence in the endometrium we examined immunohistochemically and to discover new molecules. Changing expressions of adhesion molecules (PNAd, α4β1 and MUC-2) under the influence of steroid hormones, remodeling of intercellular connections and stromal epithelial communication play an important role in endometrial receptivity.

Impact of Covid-19 infection on thyroid functions

BackgroundThe 2019 coronavirus illness (COVID-19) has caused significant disruption on a worldwide scale. With several recent studies observing the rise of thyroid problems in afflicted individuals, the influence of COVID-19 on thyroid function is receiving more attention.This study aims to determine the prevalence of thyroid dysfunction in COVID patients.MethodsWe evaluated thyroid function tests (TFTs) in 129 patients who were hospitalized to Zagazig University Hospitals with confirmed COVID-19 infection. Patients with pre-existing thyroid conditions or those on medications influencing (TFTs) were excluded. Serum levels of free thyroxine (FT4), thyrotropin (TSH), and free triiodothyronine (FT3) were measured on the first day of admission, followed by follow-up TFTs within the first six months, one year, and two years after discharge.ResultsWe included 129 patients aged between 22 and 70 years, with 38 (29.5%) identified as male and 91 (70.5%) as female. Upon admission, (TFTs) were normal in 14.9% of patients. The findings also revealed 13.2% with subclinical hypothyroidism, 32.6% with subclinical hyperthyroidism, 6.2% with hypothyroidism, and 37.2% with hyperthyroidism. Two years after discharge, only 43.4% had normal TFTs, while 10.1% were being treated for hypothyroidism and 46.5% for hyperthyroidism.ConclusionThis study emphasizes the complex interplay between COVID-19, thyroid function, and vaccination status. The results indicate that thyroid dysfunction specifically hyperthyroidism, subclinical hyperthyroidism, hypothyroidism, or subclinical hypothyroidism might be a frequent outcome for patients recovering from COVID-19, particularly in those who experienced more severe cases.

Serum Levels of Thyroid Hormones and Thyroid Peroxidase Antibodies in Different Types of Glaucoma

Abstract Aim of this study is to analyze connection between thyroid hormones disbalance and thyroid peroxidase antibodies in serum and different types of glaucoma. This was a hospital-based, retrospective case-control study. Eighty-seven patients were recruited for outdoor department of Clinic of ophthalmology for the routine ophthalmological examination from an endocrinologist, with laboratory analysis of serum levels of thyroid hormones and thyroid peroxidase antibodies test. We specifically included patients with primary open-angle glaucoma and pseudoexfoliation glaucoma, since these two types of glaucoma are highly reported clinically. Based on laboratory analysis, we divided patients into three groups: primary open-angle glaucoma patients with hypothyroidism, pseudoexfoliation glaucoma patients with hypothyroidism and control group that included healthy subjects. In our research, we found that there were discrete differences between glaucoma patients and control subjects in serum levels of free triiodothyronine and free thyroxine. In other words, these differences were insignificant. Patients with primary open-angle glaucoma and pseudoexfoliation glaucoma had increased serum levels of thyroid stimulating hormone, when compared to patients in control group. This study highlights the interaction between thyroid hormones and glaucoma development. Laboratory analysis of glaucoma patients confirmed thyroid peroxidase antibodies levels greater than normal. Control group had physiological range of thyroid peroxidase antibodies. These findings support autoimmune theory of glaucoma development.

Evaluation of the association between thyroid-stimulating hormone with handgrip strength and dynapenia in euthyroid postmenopausal women.

To examine the association between serum thyroid-stimulating hormone (TSH) levels with handgrip strength (HGS) and dynapenia in euthyroid postmenopausal women. This was an exploratory cross-sectional study among 385 participants from the Department of Obstetrics, Gynecology, and Reproduction of the Dexeus Women's University Hospital, Barcelona, Spain. Age, age at menopause, adiposity, alcohol consumption, body mass index (BMI), and smoking status were recorded. TSH was determined by electrochemiluminescence immunoassay. HGS was measured using a digital dynamometer, and physical activity was assessed by the International Physical Activity Questionnaire. Dynapenia was considered when HGS was <20 kg. A directed acyclic graph was designed to identify confounding variables. Multivariable linear and logistic regression models were adjusted by age, age at menopause, adiposity, BMI, glomerular filtration rate, glycated hemoglobin, physical activity, and smoking status. Multivariable linear regression model showed that age ( β = -0.22; 95% CI, -0.28 to -0.16), adiposity ( β = -0.15; 95% CI, -0.22 to -0.07), BMI ( β = 0.15; 95% CI, 0.04-0.25), glomerular filtration rate ( β = -0.04; 95% CI, -0.07 to -0.01), and physical activity ( β = 0.79; 95% CI, 0.07-1.5) were significantly associated with HGS. Instead, serum TSH levels were not significantly associated ( β = 0.21; 95% CI, -0.10 to 0.51). Multivariable logistic regression model showed that dynapenia was associated with age (OR, 1.20; 95% CI, 1.12-1.31) and glomerular filtration rate (OR, 1.03; 95% CI, 1.00-1.05). No significant association between TSH and dynapenia was observed (OR, 0.98; 95% CI, 0.78-1.23). In this study of postmenopausal women, normal TSH levels were not associated with low HGS or dynapenia.

A novel X-linked variant c.1772delG (p.G591fs*20) in IRS4 in two related patients with central hypothyroidism

Introduction: Central hypothyroidism (CeH) is characterized by thyroid hormone deficiency due to impairment of pituitary thyroid stimulating hormone (TSH) or hypothalamic TRH biosynthesis. It is extremely rare and affects approximately 1:16,000-100,000 individuals. Diagnosis, especially of isolated CeH, may be challenging. CeH is often seen as a part of multiple pituitary hormone deficiencies, but it can also be seen as isolated CeH. To date, some variants that can cause CeH have been identified; although in a number of patients the cause has not been clarified. Recently, variants of the insulin receptor substrate 4 (IRS4) gene have been reported to be the cause of isolated CeH. Herein, we report two related patients and their family with carriers with a novel X-linked frameshift variant in the IRS4 gene. It has also been shown that thyroid function may be slightly affected in the heterozygous female carriers in our study. Case Presentation: Herein, we reported two Turkish male patients with CeH due to a hemizygous variant in IRS4. The index case was a 15-year-and-2-month male who presented with a low serum free thyroxin level, which was incidentally detected. Conclusion: Isolated CeH should kept in mind in insistent low fT4 levels without an increase in TSH levels. Genetic testing can aid in identifying the underlying cause of CeH in such cases. This report demonstrates the significance of providing comprehensive laboratory and molecular features of the patients and carriers with the IRS4 variants.

Comparative Study of Subclinical Hypothyroidism in Patients with and Without Metabolic Syndrome

Background: A group of metabolic abnormalities known as metabolic syndrome (MetS) greatly raises the risk of type 2 diabetes mellitus and cardiovascular illnesses. People with MetS frequently have subclinical hypothyroidism (SCH), which is defined by high levels of thyroid-stimulating hormone (TSH) with normal free thyroxine (T4). The research examined the relationship between thyroid function and metabolic parameters, as well as to assess the incidence of subclinical hypothyroidism in individuals with and without MetS. Methods: There were 960 participants in all, 480 of whom had a diagnosis of MetS and 480 of whom were healthy controls. Blood pressure and waist circumference were measured clinically. After an overnight fast, blood samples were taken utilising fully automated clinical chemistry and hormone analyzers to assay lipid profile, fasting blood glucose (FBG), and thyroid function tests (T3, T4, and TSH). The Pearson correlation coefficient and Student's t-test were used to analyse the data. Results: Statistically, there was a significant variation in the prevalence of subclinical hypothyroidism between the MetS group (16.3%) and the control group (5%; p &lt; 0.001). In addition to having decreased HDL cholesterol, MetS patients also had higher FBG, blood pressure, triglycerides, and waist circumference. TSH levels and the elements of MetS, such as waist circumference (r = 0.41, p &lt; 0.001), systolic blood pressure (r = 0.38, p &lt; 0.001), FBG(r = 0.44, p &lt; 0.001), triglycerides (r = 0.39, p &lt; 0.001), and HDL cholesterol (r = -0.32, p &lt; 0.001), were found to be significantly correlated with each other. Conclusion: The results of the study indicate that people with metabolic syndrome have a higher incidence of subclinical hypothyroidism, which may indicate a relationship between thyroid function and metabolic health. Regular thyroid function testing could help improve clinical outcomes by enabling early detection and management of SCH in MetS patients. Recommendations: When treating patients with metabolic syndrome, healthcare professionals should think about doing routine thyroid function tests. To manage thyroid dysfunction in patients with metabolic syndrome (MetS), further research is required to investigate the underlying mechanisms and create tailored therapies. Keywords: Metabolic Syndrome, Subclinical Hypothyroidism, Thyroid Function, Cardiovascular Risk, Metabolic Health

The Prevalence of Left Ventricular Diastolic Dysfunction in Subclinical Hypothyroidism Patients

Background: Elevated serum thyroid-stimulating hormone (TSH) levels together with normal blood levels of free thyroxine (FT4) and free triiodothyronine (FT3) are the hallmarks of subclinical hypothyroidism (SCH). SCH is common, especially in older persons and women, and it has been linked to a number of harmful cardiovascular consequences, such as left ventricular diastolic dysfunction (LVDD). The study investigated the incidence of LVDD in females with SCH and identify key predictors of this condition. Methods: A total of 1,248 female patients aged 20 to 50 years with SCH were included. Inclusion criteria were elevated TSH (5-10 micro unit/L) with normal FT3 (2.77-5.27 pg/ml) and FT4 (0.78-2.19 ng/dl) levels. Patients underwent 2D Echocardiography to assess LVDD. Descriptive statistics, chi-square testing, and logistic regression analysis were used to analyse the data. Result: LVDD was identified in 25% of the patients. The prevalence increased with age, being highest (28.2%) in the 40-50 age group. Significant associations were found between thyroid function and LVDD, with higher TSH and lower FT3 and FT4 levels linked to increased LVDD risk (p&lt;0.001). Echocardiographic parameters showed higher LV mass and wall thickness in LVDD patients. Doppler echocardiographic parameters indicated impaired diastolic function. Logistic regression identified age, serum FT3, serum FT4, serum TSH levels, LV mass index, and E/A ratio as independent predictors of LVDD. Conclusion: Female SCH patients have high rates of LVDD, which is linked to thyroid function. Older age and greater TSH were risk factors for LVDD, but higher FT3 and FT4 were protective. SCH individuals with LVDD had significant heart structural and functional abnormalities on echocardiography. Recommendations: Regular cardiovascular screening and proactive management of thyroid function are recommended for patients with SCH to prevent the progression of cardiac dysfunction. Further research should explore the benefits of early intervention and the potential role of thyroid hormone replacement therapy in reducing cardiovascular risks. Keywords: Subclinical hypothyroidism, Left ventricular diastolic dysfunction, Thyroid function, Echocardiography, Cardiovascular risk

The Effects of Maternal Subclinical Hypothyroidism on Fetal Thymus Size: A Prospective Study

Objective: This study investigated the impact of maternal subclinical hypothyroidism on fetal thymus size and development and explored how inadequate thyroid hormone production in pregnant women affects the fetal thymus. Methods: Conducted at the Giresun Obstetrics, Gynecology, and Pediatrics Training and Research Hospital, this case–control study involved 86 pregnant women, 43 with hypothyroidism and 43 without. Maternal thyroid function was assessed using TSH and free T4 levels, and fetal thymus size and thymus–thorax ratio were measured using ultrasound. Exclusion criteria were chronic hypertension, gestational hypertension or eclampsia, multiple pregnancies, infectious diseases, renovascular diseases, diagnosed with hypothyroidism prior to pregnancy and other endocrine disorders, fetal cardiac diseases, and morbid obesity. Data collected included maternal age, gestational week, number of pregnancies, parity, number of living children, thyroid-stimulating hormone (TSH) and Free thyroxine 4 (T4) levels, and fetal thymus measurements (transverse diameter and thymus/thorax ratio). Statistical analyses were performed using the Mann–Whitney U test and logistic regression analysis. The relationships between TSH, thymus diameters, thorax diameters, and the thymus–thorax ratio were evaluated using Spearman’s correlation coefficient. Results: The thymus–thorax ratio was significantly reduced in the hypothyroid group (p = 0.003). Logistic regression analysis identified TSH as an independent risk factor for a low thymus–thorax ratio, with each unit increase in TSH associated with a 1.345-fold higher likelihood of having a low thymus–thorax ratio. A significant negative correlation was found between TSH levels and the TTR ratio (Spearman’s correlation coefficient r = −0.338, p = 0.001). Conclusions: An association was identified between maternal TSH levels and the thymus–thorax ratio, with increasing TSH levels correlating with a decrease in the thymus–thorax ratio. Regular monitoring of thyroid hormone levels during pregnancy and appropriate replacement treatment in cases of deficiency are crucial for optimal fetal thymus development. Further multicenter studies are needed to confirm these findings and investigate the long-term implications of altered fetal thymus development.

Impact of Experimental Congenital Toxoplasmosis on the Thyroid Gland: Histopathological and Immunobiochemical Indices Assessment

PurposeThe thyroid gland is one of the most vital endocrine organs. It is responsible for the synthesis and secretion of hormones principally triiodothyronine (T3) and thyroxine (T4). These hormones play a significant role in the functions and the metabolism of the body. The thyroid gland could be affected by several infections, among them Toxoplasma gondii. Congenital toxoplasmosis took place when the parasite reached the developing fetus and infected any nucleated cells within it. This study assessed the effect of experimental congenital toxoplasmosis on the thyroid gland structure and function.MethodsWe used 34 Wistar rats and allocated them into two groups: normal control group (17 rats) and congenital toxoplasmosis group (17 rats). After euthanasia, the brain and the thyroid gland was assessed through histopathological examination. Thyroid functions examination was performed through measuring the serum levels of T3, thyroxine T4, and thyroid stimulating hormone (TSH). Moreover, serum levels of thyroid antibodies [thyroid-peroxidase antibody (TPO-Ab) and anti-thyroglobulin (TG-Ab)] were examined.ResultsThe examination of thyroid tissues of the congenital toxoplasmosis group showed decreased or absent colloid secretion. About 47.1% of follicles showed degeneration with different grades. Parafollicular cells hyperplasia were observed in 23.6% of specimens. The serum concentrations of T3, T4, and TSH were significantly higher in congenital toxoplasmosis group than the control group. The congenital toxoplasmosis group had lower serum concentrations of TPO-Abs than the control group.ConclusionThese results indicated that congenital Toxoplasma infection could result in a central hyperthyroidism state with alteration of thyroid gland structure in offspring.

Determining the Association between Preeclampsia and the Thyroid Hormone Status in Pregnant Women

Background: Preeclampsia is a significant multisystem disorder in pregnancy care that hormonal, environmental, and genetic factors can cause. Aim: This study aimed to investigate the relationship between preeclampsia and thyroid hormone levels in pregnant women. Method: This case-control study was conducted in 2022 with 200 pregnant women in southeast Iran, utilizing a convenience sampling method. The participants included 100 women in the preeclampsia group and 100 in the normal pregnancy group. Data related to preeclampsia were obtained from the Integrated Health System (SIB) at the health center in Jiroft city, while information about the thyroid hormones was extracted from the Ministry of Health's SIB system. The data were analyzed using SPSS-26 software, employing both descriptive and inferential statistical tests Results: Systolic pressure was significantly higher in the preeclampsia group (149.14 mm Hg) than in the control group (105.33 mm Hg), and diastolic pressure also showed a significant difference (94.57 mm Hg in preeclampsia vs. 64.33 mm Hg in normal pregnancies). Thyroid-stimulating hormone (TSH) levels were significantly higher in the preeclampsia group (3.7) compared to the normal pregnancy group (2.5), indicating a notable difference (P&lt;0.005). Thyroid thyroxine (TT4) levels were significantly lower in the preeclampsia group (10.78) compared to the control group (12.5) (P&lt;0.005). Conclusion: Thyroid function significantly impacts the risk and severity of preeclampsia, with elevated TSH and reduced TT4 levels indicating potential complications. Monitoring these hormone levels is crucial for managing affected pregnancies. It is recommended that health policymakers include thyroid function screening in prenatal care protocols.

Gender, FT4 levels, T stage, and BMI as predictors of TSH levels in thyroid cancer patients

BackgroundAfter initial treatment, levothyroxine (LT4) administration is necessary for thyroid cancer patients to achieve target thyroid-stimulating hormone (TSH) levels. However, the clinical efficacy of weight-based LT4 dosing has been suboptimal, highlighting the need to identify factors influencing the attainment of desired TSH levels and guide personalized treatment.MethodsWe constructed a retrospective cohort comprising 215 patients diagnosed with thyroid cancer. The identification of factors influencing the attainment of expected TSH levels was accomplished through univariate and multivariate logistic regression analyses. Subsequently, we developed a nomogram based on these prognostic factors and performed internal validation using the bootstrap resampling method.ResultsUnivariate and multivariate logistic regression analyses were conducted to analyze the clinical and demographic parameters. A nomogram was constructed using bootstrap resampling to predict the risk of TSH suppression failure, which was validated. The nomogram demonstrated moderate discrimination in estimating the risk of TSH suppression failure, with a Hosmer-Lemeshow test p-value of 0.393 and a bootstrapped calibrated C-index of 0.757 (95% CI 0.687-0.814). The calibration curve indicated good consistency of the model, and decision curve analysis suggested that the nomogram had clinical utility.ConclusionGender, preoperative serum free thyroxine (FT4) levels, T stage, and body mass index exhibit independent associations with the expected level of TSH. The established nomogram effectively predicts the risk of TSH suppression failure. Further research is warranted to investigate how these factors can be utilized in developing a personalized LT4 dosage calculator.

Disrupting effects of neonicotinoids and their interaction with metals on thyroid hormone, an evidence of children in a rural area, South China.

Neonicotinoids exposure was found to induce thyroid dysfunction. However, there lack of direct evidence between neonicotinoids exposure and thyroid hormone (TH) disruption in population study, especially in children, which limits the understanding on their health hazard. To fill this knowledge gap, we conducted a cross-sectional study on children of a rural area in South China (n = 88), and analyzed urinary ten neonicotinoids (including metabolites), serum TH, thyroxine-binding globulin (TBG), and thyroid stimulating hormone (TSH) levels. Based on linear regression, generalized additive model, and Bayesian kernel machine regression, neonicotinoids levels were found to be correlated with TH, TBG, and TSH levels, with stronger effects for metabolites than parent compounds in most cases. Mixture exposure of neonicotinoids had significantly positive effect on free triiodothyronine (T3). N-desmethyl-acetamiprid (N-dm-ACE) was negatively associated with T3 for female, which corresponded to much lower T3 levels for female than for male. Also, N-dm-ACE was found to non-monotonic associated with free thyroxine for male. Some neonicotinoids had interactive effects with lead and cadmium on TH disruption. The results provide an evidence on TH disruption of neonicotinoids in children, and highlight the need to explore TH disruption of neonicotinoids and safeguard the health of children.

Associations of combined exposure to selected metal mixtures with thyroid hormones in children: a cross-sectional study in China.

Exposure to several metal elements has been found to be associated with thyroid hormone homeostasis. However, evidence for combined exposure is inconclusive, especially for children. To examine the individual and joint effects of blood metal elements on thyroid hormones in children. A total of 12,470 children aged 0-14 were collected from January 2018 to December 2021 in Hunan Children's Hospital. The concentrations of lead (Pb), iron (Fe), calcium (Ca), copper (Cu), zinc (Zn) and magnesium (Mg) in blood were detected via atomic absorption spectrometry (AAS). The levels of thyroid stimulating hormone (TSH), triiodothyronine (TT3, FT3) and total and free thyroxine (TT4, FT4) were measured by electrochemiluminescence immunoassay (ECLIA). Generalized linear regression (GLR) model and Quantile-based g-computation (QGC) were employed to estimate the association between metal exposure and thyroid hormone homeostasis. GLR model showed that a unit increase in ln-transformed Fe was associated with increases in TT3 (β = 0.163; P FDR < 0.001), TT4 (β = 12.255; P FDR < 0.001) and FT3 (β = 0.615; P FDR < 0.001), as well as decreases in TSH (β = -0.471; P FDR = 0.005) and FT4 (β = -1.938; P FDR < 0.001). The result of QGC analysis indicated a positive relationship of the ln-transformed concentration of metal mixture with the levels of TT3 (β = 0.018; P = 0.012), TT4 (β = 2.251; P < 0.001) and FT3 (β = 0.074; P < 0.001) in children. Fe was the predominant contributor among the metal mixture with positive contributions to TT3 (weight = 0.439), TT4 (weight = 0.502) and FT3 (weight = 0.450). The combined metal exposure was associated with increased levels of TT3, TT4, and FT3 in children and Fe appeared to be the major contributor. Further studies are warranted to confirm our findings and elucidate the underlying mechanisms.

Association between clinical activity score and serum sPD-1 and sPD-L1 levels during systemic glucocorticoid treatment for active moderate-to-severe thyroid eye disease.

CD4+ T lymphocytes are key immune cells involved in orbital inflammation in thyroid eye disease (TED). Inhibition of their activity is important in treatment of TED, but effective drugs targeting these cells are lacking. The programmed cell death-1/programmed cell death ligand-1 pathway has been implicated in several T-cell-mediated diseases. Manipulation of this pathway with antagonists or agonists is an attractive therapeutic option. The role of soluble programmed cell death-1 (sPD-1) and soluble programmed cell death ligand-1 (sPD-L1) in regulation of this pathway is debated. This study aimed to investigate the involvement of sPD-1 and sPD-L1 in the pathogenesis of TED, focusing on their utility as novel biomarkers to evaluate disease severity and treatment response. Thirty patients diagnosed with moderate-to-severe TED associated with Graves' disease were included. Blood samples were collected from patients before and 12weeks after initiation of intravenous glucocorticosteroid (IVGC) treatment. Disease severity was assessed using the Clinical Activity Score (CAS) before and after IVGC treatment. Thyroid-stimulating hormone, free thyroxine, free triiodothyronine, thyroid-stimulating immunoglobulin, interleukin-6, sPD-1, and sPD-L1 levels were measured. Correlations between sPD-1, sPD-L1, and CAS before and after IVGC treatment were investigated. Serum concentrations of sPD-1 and sPD-L1 before and after IVGC treatment in patients with TED were compared with those in healthy controls (HCs). The changes in the tested protein concentrations upon IVGC treatment and their associations with clinical characteristics were investigated. Enzyme-linked immunosorbent assays were used to measure sPD-1 and sPD-L1 concentrations in peripheral blood serum. There was a positive correlation of moderate Spearman's rank strength between sPD-L1 and CAS before and after treatment, and a positive correlation between sPD-1 and sPD-L1. However, no correlation was observed between sPD-1 and CAS. Baseline serum levels of sPD-1 and sPD-L1 did not significantly differ between patients with TED and HCs. There were no correlations between changes in the levels of the tested molecules upon IVGC treatment and the analyzed clinical features. The decreases of sPD-1 and sPD-L1 levels after 12weeks of IVGC treatment were not significant. The positive correlation of moderate Spearman's rank strength between sPD-L1 and CAS before and after 12weeks of treatment indicates that sPD-L1 is involved in the pathogenesis of TED. sPD-L1 may become an additional immunological biomarker to assess the disease activity and monitor the respond to treatment. Although sPD-1 is reported in the literature to have an activating effect on lymphocytes, our study shows that sPD-1 may not play a significant role in the pathogenesis of TED, as its level does not differ significantly between the TED and HC groups and does not correlate with disease activity. Understanding the clinical value of sPD-1 and sPD-L1 is of great practical importance.