Thyroid-stimulating Hormone Values Research Articles

The role of autoimmune thyroid disorders in patients with alopecia areata

Objective: The aim of this study was to investigate the association of thyroid autoimmunity with alopecia areata (AA) by examining thyroid stimulating hormone (TSH) and thyroid autoantibody levels. In addition, to compare the epidemiologic data obtained with the data of our country. Methods: Our study was organized as a cross-sectional, retrospective study. The study was performed on patients between the ages of 2-65 years who were admitted to our outpatient clinic between 01.01.2008 and 31.12.2011, who were clinically or histopathological diagnosed with AA, examined for etiology and thyroid autoantibodies were requested. Patients under two years of age and over 65 years of age, patients with no thyroid autoantibodies and pregnant patients were excluded. Results were expressed as mean±standard deviation and median values. Mann-Whitney U test was used to compare TSH, anti-TG antibody (Anti-TG) and anti-TPO (Anti-TPO) antibody values in the variables of nail involvement, psychiatry, comorbidity and family history. Spearman correlation analysis was used to examine the relationships between age and disease duration and TSH, Anti-TPO and Anti-TG variables. Results: In our study, 65 (42.8%) of 152 patients were female and 87 (57.2%) were male. The ages of the patients ranged between 2-65 years and the mean age was 26.5±14.6 years. The mean age of females was 27.5±14.4 and 25.7±14.9 in males. Elevated thyroid autoantibodies were found in a total of 29 patients, 21 of whom were female and 8 of whom were male. Of these 29 patients, 10 had hypothyroidism, 2 had chronic thyroiditis and 3 had toxic multinodular goiter. 14 patients did not return after the examination at the internal medicine outpatient clinic, so the diagnosis of thyroid disease could not be reached. The mean TSH, Anti-TG and Anti-TPO values were 2.27±1.57, 29.2±99 and 71.5±2.2, respectively. When these values were analyzed separately as men and women, they were found to be 2.6±2.02, 41.8±1.23 and 134±2.8 in women and 1.99±1.03, 19.8±75.6 and 24.5±1.32 in men. There was a significant difference between men and women in terms of Anti-TG and Anti-TPO values (p=0.011 and p=0.001, respectively). A significant correlation was found between disease duration and Anti-TPO positivity (p=0.045); however, a similar relationship was not found between disease duration and Anti-TG positivity (p=0.34). Conclusions: As a result of this study, although there was a significant correlation between anti-TPO and duration of AA, the association between thyroid autoimmunity and AA was not found to be statistically significant. This may be due to the fact that humoral autoimmunity plays a role in thyroid autoimmunity and primarily cellular autoimmunity plays a role in AA. In addition, the epidemiologic data of our study were similar to the data of studies conducted in our country.

Correlation Between Thyroid-Stimulating Hormone (TSH) and Liver Function Test Values in North Karnataka Patients Admitted to a Tertiary Care Hospital

Correlation Between Thyroid-Stimulating Hormone (TSH) and Liver Function Test Values in North Karnataka Patients Admitted to a Tertiary Care Hospital

Triiodothyronine/Thyroxine Ratio as a Marker of Clinical Response to Levothyroxine Replacement in Patients With Hypothyroidism.

Hypothyroidism is one of the most common endocrine disorders with a simple therapy, that is levothyroxine (LT4). A normal thyroid-stimulating hormone (TSH) measurement is used as a marker of optimal replacement. But, many patients still have symptoms. Triiodothyronine (T3), thyroxine (T4), and their ratio may correlate with clinical improvement. The study aims to assess the T3/T4 ratio as a marker of clinical response in patients with hypothyroidism. Method:A cross-sectional study was conducted from June to November 2022 at Faiha Specialized Diabetes, Endocrine, and Metabolism Center, in Basrah, southern Iraq. We included 48 adult patients with primary hypothyroidism on LT4 treatment only and TSH within the target reference range for at least within the last six months. Each patient was subjected to a questionnaire that was designed to capture hypothyroidism-related complaints in the form of a five-point Likert scale. Biochemical assessments were done with the measurement of TSH, T3, and T4. Despite having a normal TSH level, nearly all the patients had persistent and varying severity of clinical complaints of hypothyroidism. Tiredness, hair problems, weight gain, and cold intolerance were the most severely persistent symptoms. Patients with scores of two and more for weight gain, cold intolerance, and skin problems had significantly lower T3/T4 ratios (P = 0.04, 0.002, and 0.02, respectively), while in the remaining clinical symptoms, the T3/T4 ratio did not differ significantly. A low T3/T4 ratio was significantly associated with resistant symptoms of hypothyroidism and may be used as a marker for treatment efficacy with TSH rather than TSH value alone.

Five-Year Follow-Up of Health-Related Quality of Life in Differentiated Thyroid Cancer Patients Treated with Total Thyroidectomy and Radioiodine in Sweden: A Nationwide Prospective Cohort Study.

Background: Despite a good prognosis, survivors of differentiated thyroid cancer (DTC) may have reduced health-related quality of life (HRQOL) many years after treatment, and it is unclear how suppression of thyroid-stimulating hormone (TSH) may contribute to HRQOL. This study investigated changes in HRQOL in the 5 years following DTC treatment, the association between HRQOL and TSH suppression, and how HRQOL compares to the general population. Methods: In this nationwide prospective cohort study, 487 patients with DTC were identified between 2012 and 2017 from all Swedish hospitals treating patients with DTC. Patients treated with total thyroidectomy and planned for radioiodine answered the Swedish version of the Short Form-36 Health Survey (SF-36) and a study specific questionnaire at treatment and after 1, 3, and 5 years. Summary measures for physical and mental QOL were derived from the SF-36, and TSH values were collected from patient records. To study changes in HRQOL over time, linear mixed models were fitted on multiply imputed data, with all patients and measurement points included in the model. Results: In total, 351 patients consented to participate in the study. In the 5 years following DTC treatment, physical QOL did not change significantly with time, while mental QOL improved by on average 0.61 (p < 0.001) per year. TSH levels were not predictive of either physical or mental QOL, or their change over time. At 5 years, there was a significant difference in physical and mental QOL compared with the Swedish general population, but effect sizes were small (Cohen's d = 0.29 and -0.21, respectively). The SF-36 domains general health, vitality, social functioning, and mental health were lower at 5 years compared with the general population (difference 8.7-13.3), and these differences were clinically significant. Conclusions: The mental component of HRQOL improves over time following DTC treatment. HRQOL in patients with DTC is not explained by TSH suppression. Although overall differences in physical and mental HRQOL compared with the general population were small 5 years after treatment, several specific psychosocial HRQOL domains were clinically meaningfully reduced. Psychosocial health issues should be screened for during DTC follow-up.

A Cross-Sectional Study of Acute Coronary Syndrome and Thyroid Profile: Dissecting the Relationship to Improve Patient Care.

Thyroid-releasing hormones are pivotal in regulating cardiovascular (CVS) function and maintaining its hemodynamics and homeostasis. Even a minor alteration in thyroid function has an enormous implication on CVS morbidity and mortality. Moreover, hypothyroidism was found to be a potential menace for coronary artery disease (CAD).The objective of this study was to determine the role of thyroid-releasing hormones in patients suffering from acute coronary syndrome (ACS). Among a cohort of 100 patients suffering with ACS, a complete history and clinical information followed by physical examinationand electrocardiography were recorded. Blood samples were also collected to record the blood sugar levels i.e., fasting blood sugar (FBS), postprandial blood sugar (PPBS), and thyroid profile, including free thyroid stimulating hormone (TSH), free thyroxine (fT4), free triiodothyronine (fT3), and reverse triiodothyronine (rT3). The data was analyzed using SPSS version 26 software (IBM Corp., Armonk, NY, USA). The study identified alterations in the thyroid hormone levelsin 27% of patients suffering from ACS. The prevalence of euthyroid sick syndrome was found to be 59.3%, while subclinical hypothyroidism and subclinical hyperthyroidism were reported among 18.5% and 14.8% of patientsrespectively. Therewas no significant difference found between males and females. The study illustrated a greater occurrence of aberrant thyroid hormone profiles among those aged 40-60 years. The ST-elevated myocardial infarction (STEMI) group had a statistically significant higher prevalence of an aberrant thyroid hormone profile compared to the non-ST-elevated myocardial infarction (NSTEMI) and unstable angina (UA)groups (p=0.02). A total of nine patients died with ACS and all of those had statistically significant low fT3 and TSH values while higher rT3 values (p<0.05). An atypical thyroid status has been found to elevate the likelihood of developing CAD and experiencing CVS mortality. This condition can impact ventricular function and serum cholesterol levelsas well as heart rate and rhythm. Therefore, understanding this relationship could potentially lead to improved treatment strategies for individuals with ACS which will further prevent major CVS complications.

Serum levels of glucose, thyroid stimulating hormone, and free thyroxine in boys diagnosed with attention deficit hyperactivity disorder: a cross-sectional pilot study

BackgroundAlthough attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, its aetiology remains unclear. We aimed to establish a relationship between ADHD diagnosis and serum levels of glucose, free thyroxine (FT4), and thyroid stimulating hormone (TSH) in primary school aged boys.MethodsIn a cross-sectional study, we enrolled 133 participants aged 6.5–12.5 years, 67 of whom met DSM-5 criteria for ADHD and 66 healthy age-matched boys. The ADHDT test (ADHDT) was used to assess ADHD symptoms and the Wechsler Intelligence Scale for Children – Revised was used to exclude participants with cognitive deficits. The ADHD participants were tested using the Iowa Conners’ Teacher Rating Scale.ResultsThe ADHD participants had lower glucose levels, higher TSH values, and significantly lower FT4 values than the control group. The multiple logistic regression analysis showed that TSH is a parameter that is 2.7% more likely to occur in the ADHD group. We found a significant correlation between the TSH level and the symptoms of hyperactivity (r = 0.318, p = 0.009) and impulsivity (r = 0.275, p = 0.024) as well as between the glucose level and the symptoms of hyperactivity (r = 0.312, p = 0.010).ConclusionsCertain ADHD symptoms may correlate with certain hormonal patterns. Our results suggest that the likelihood of suffering from ADHD was lower when FT4 levels were elevated. One biochemical parameter that was significantly and independently associated with the diagnosis of ADHD was the serum TSH level.Trial registrationOn June 26, 2018, at its VI session in 2018, the Ethics Committee of the Institute for Mental Health in Belgrade, Serbia, has considered and unanimously approved the conduct of the research, under the number 1704/1.

ASSOCIATION OF POLYCYSTIC OVARY SYNDROME AND THYROID DYSFUNCTION AMONG REPRODUCTIVE WOMEN: A CROSS-SECTIONAL STUDY

Objective: Polycystic ovarian syndrome (PCOS) is became most common problem in the reproductive age group women who seem to be adversely affected by associated thyroid dysfunction. Ovarian failure and pregnancy-related complications leaded by both factors. The study helps to explore the incidence and etiology of diverse thyroid conditions among PCOS individuals. Methods: This prospective single‑center study with 40 female patients with hyperandrogenism, hirsutism, oligo‐anovulation, and polycystic ovaries patients were defined as having PCOS according to the revised 2003 Rotterdam criteria and Ferriman–Gallwey score with comprised the study population. Normal female subjects were studied as the control population who had normal thyroid function and without PCOS. By measuring of serum thyroid-stimulating hormone (TSH), free thyroxine levels (free T3 and free T4), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, progesterone, and testosterone can evaluate thyroid function. Along with ultrasound was performed to confirm the PCOS. By SPSS version 19 Chi-square test and t-test were determined. Results: This case–control study revealed that a statistically significant higher prevalence of PCOS patients was found to have higher mean TSH values that were 5.33±2.51 μIU/mL, the mean for T3 and T4 was 154±138 μg/dL and 11.27±8.47 μg/dL, respectively. The mean FSH values were 07.27±4.49 μIU/mL, the mean LH was 84.27±38.49 μIU/mL, the mean estrogen 342±202 pg/mL, the mean progesterone values were 14.2±8.9 ng/mL and the mean testosterone levels were 69.73±9.28 ng/mL. Conclusion: Thyroid dysfunction shows a high prevalence in PCOS patients. Dysfunction can be treated which helps to manage infertility associated with PCOS.

Hypothyroxinemia and weight velocity in preterm infants.

Hypothyroxinemia of prematurity (HOP) is characterized by low free thyroxine (FT4) associated with low or normal thyroid stimulating hormone (TSH). The objective of this study is to define FT4 and TSH values in very preterm infants (<32 weeks postmenstrual age, PMA) and correlate hypothyroxinemia and levothyroxine treatment with growth velocity at 28 days and 36 weeks PMA. Preterm neonates <32 weeks PMA admitted to the regional neonatal intensive care unit (NICU) at the Children's Hospital of Georgia (USA) between January 2010 and July 2022 were routinely screened for hypothyroxinemia. FT4 and TSH values were obtained on 589 eligible neonates between day of life (DOL) 4 and 14. Growth velocity (g/kg/day) from DOL 14 to DOL 28 and 36-weeks PMA were calculated for each neonate and potential explanatory variables (PMA, sex, and race) were incorporated into multivariate regression models to identify associations between HOP and growth velocity. In 589 preterm infants, PMA at birth was strongly associated inversely with FT4 (R=0.5845) and modestly with TSH (R=0.2740). Both FT4 and gestational age, but not TSH or levothyroxine treatment, were associated with growth velocity at 28 days of life and at 36 weeks PMA. We provide a large data set for identifying FT4 and TSH measurements and identify hypothyroxinemia of prematurity as a potential mediator of slow postnatal growth in very preterm infants.

Can Pre-Ablation Biomarkers Be Used to Predict Arrhythmia Recurrence after Ablation Index-Guided Atrial Fibrillation Ablation?

Ablation Index (AI) software has allowed better atrial fibrillation (AF) ablation results, but recurrence rates remain significant. Specific serum biomarkers have been associated with this recurrence. To evaluate whether certain biomarkers could be used (either individually or combined) to predict arrhythmia recurrence after AI-guided AF ablation. Prospective multicenter observational study of consecutive patients referred for AF ablation from January 2018 to March 2021. Hemoglobin, brain natriuretic peptide (BNP), C-reactive protein, high sensitivity cardiac troponin I, creatinine clearance, thyroid-stimulating hormone (TSH) and free thyroxine (FT4) were assessed for their ability to predict arrhythmia recurrence during follow-up. Statistical significance was accepted for p values of<0.05. A total of 593 patients were included - 412 patients with paroxysmal AF and 181 with persistent AF. After a mean follow-up of 24±6 months, overall single-procedure freedom from atrial arrhythmia was 76.4%. Individually, all biomarkers had no or only modest predictive power for recurrence. However, a TSH value >1.8 μUI/mL (HR=1.82 [95% CI, 1.89-2.80], p=0.006) was an independent predictor of arrhythmia recurrence. When assessing TSH, FT4 and BNP values in combination, each additional "abnormal" biomarker value was associated with a lower freedom from arrhythmia recurrence (87.1 % for no biomarker vs. 83.5% for one vs. 75.1% for two vs. 43.3% for three biomarkers, p<0.001). Patients with three "abnormal" biomarkers had a threefold higher risk of AF recurrence compared with no "abnormal" biomarker (HR=2.88 [95% CI, 1.39-5.17], p=0.003). When used in combination, abnormal TSH, FT4 and BNP values can be a useful tool for predicting arrhythmia recurrence after AI-guided AF ablation.

Деякі особливості ендокринного статусу у реконвалесцентів після COVID-19 та його зміни під впливом відновлювального лікування

Abstract. The aim — to study the thyroid hormones and cortisol levels in convalescents after COVID-19, including patients with chronic obstructive pulmonary disease (COPD) and their possible changes under the influence of recovery treatment. Materials and methods. 83 convalescents after COVID-19 (with manifestations of COVID pneumonia in the acute period) aged 32–67 years, who had no history of thyroid or adrenal glands lesions’ manifestations were examined. 29 of them had COPD (GOLD II-III). Patients began the course of rehabilitation within 1–3 weeks after inpatient treatment. Тhe levels of thyroid-stimulating hormone (TSH), total fractions of thyroid hormones (thyroxine — T4 , triiodothyronine — T3 ), cortisol as well as the level of interleukin-8 (IL-8) were determined in blood serum. Assessment was carried out by immunoenzymatic method at the beginning of recovery treatment and after it (within 21–22 days). Recovery treatment included the necessary basic anti-inflammatory and broncholytic therapy (for patients with COPD) and a physiotherapeutic complex, which included the use of haloaerosoltherapy (HAT) — dry aerosol media with certain concentration and dispersion (18-20 sessions per course) and singlet oxygen therapy (12 procedures per course). Results. Before treatment significantly higher levels of all studied indices compared to control were found in both groups of patients (without history of COPD and patients with COPD). Certain change of the inverse relationship between the values of TSH and T4 , T3 was noted, which probably indicates the presence of maladaptive thyroid syndrome. The obtained results can be interpreted as a consequence of systemic immune activation caused by SARS-CoV 2 infection and as a result of intensive treatment in the acute period. These changes took place on the background of a significant IL-8 level increase. A correlation between the levels of IL-8 and TSH (r=0.43) was revealed, which indicates a certain dependence between stimulation of thyroid gland function and the severity of the inflammatory process. Thyroid hormone levels in convalescents after COVID-19 without COPD (1st group) and convalescents after COVID-19 with COPD history (2nd group) were compared. Direction of changes in the thyroid hormones levels in both groups was similar, but the increase of TSH and T4 levels in the 2nd group was significantly higher and took place on the background of a higher IL-8 level. Studies of cortisol secretion in the examined groups showed a moderate, but reliable increase in its levels compared to the control by 1.2 and 1.4 times respectively. This may be related to both activation of the adrenal cortex during the convalescence and the consequences of therapy in the acute period of COVID-19. Taking into account received data, as well as the analysis of individual deviations of the studied indices, these changes should be considered as a non-thyroidal illness syndrome (NTIS) and dysfunctional adrenal disorders. The applied recovery treatment had a corrective effect on the thyroid and adrenal functions. Thus, by the end of treatment, the levels of cortisol and T3 reached the control level on the background of a significant decrease of IL-8 level in both groups of patients. Positive changes in thyroid function in convalescents after COVID-19 without COPD history were more pronounced. Conclusions. In convalescents after COVID-19 thyroid and adrenal dysfunctional disorders were observed, they were more pronounced in patients with COPD and directly correlated with an increase of pro-inflammatory IL-8 level. Rehabilitation treatment based on haloaerosoltherapy, which is aimed at bronchopulmonary system sanation and reduction of inflammatory process, contributes to the recovery of thyroid and adrenal function. Positive effect is more pronounced in patients without a history of chronic bronchopulmonary pathology.

Establishment of Reference Interval of Thyroid Hormones and Autoantibodies: A Cross-sectional Study

Introduction: The accurate diagnosis of thyroid disease relies on the sensitivity and specificity of laboratory tests, which require specific reference intervals. Thyroid hormone levels can be influenced by factors such as age, gender, iodine intake and geographical region. Therefore, it is recommended for clinical laboratories to establish their own reference intervals. Aim: To establish reference intervals for Thyroid Stimulating Hormone (TSH), Free Thyroxine (FT4), Anti-thyroglobulin antibody (anti-TG), and Anti-Thyroid Peroxidase Antibody (antiTPO) in males and and females. Materials and Methods: A cross-sectional study was conducted in the Department of Biochemistry, Amrita Institute of Medical Sciences (AIMS), Kochi, India, from December 2021 to July 2022. The study included 217 apparently healthy subjects aged between 18 years and 60 years. TSH, FT4, anti-TPO, and anti-TG levels were analysed to establish reference values for males and females in the two age groups: 18-40 years and 41-60 years. Reference intervals for thyroid parameters were expressed as mean±Standard Deviation (SD), median, 2.5th and 97.5th percentiles. The Mann-Whitney U test was used to assess the statistical significance of thyroid parameters between gender and age groups. Results: The mean age in the female population was 38.24±11.64 years, while in the male population, it was 39.24±10.98 years. The reference intervals and cut-offs for TSH, FT4, anti-TG and anti-TPO in females were determined as 0.80-4.12 μIU/mL, 0.99- 1.57 ngm/mL, &lt;85.33 IU/mL and &lt;45.13 IU/mL, respectively. In males, the reference intervals and cut-offs for TSH, FT4, anti-TG and anti-TPO were determined as 0.51-5.09 μIU/mL, 1.03-1.79 ng/mL, &lt;87.09 IU/mL and &lt;33.88 IU/mL, respectively. There was a significant difference in anti-TPO (p-value=0.017) in males between the two age groups. A significant difference was also observed in FT4 (p-value=0.010) and anti-TPO (p-value=0.034) between males and females. Conclusion: The study successfully established reference intervals and cut-off values for TSH, FT4, anti-TG, and antiTPO. It was found that anti-TPO levels decrease significantly with age progression. Additionally, the reference interval for TSH was wider in the 41-60 years age group compared to the younger age group.

Lack of Association Between Depression and Subclinical Hypothyroidism in Adolescents Presenting for Routine Physical Examinations.

There are conflicting results in the existing studies regarding the association between depression and subclinical hypothyroidism in adolescents. Subclinical hypothyroidism is defined as elevated thyroid stimulating hormone (TSH) levels above the reference range without signs or symptoms of hypothyroidism. The focus of this study is to determine whether there is any association between depression and subclinical hypothyroidism, (as defined by the serum TSH levels) in a population of healthy adolescents. Quantitative-based cross-sectional study of a representative subset of the adolescent population. We carried out a cross-sectional study to determine the association between major depressive disorder (MDD) and subclinical hypothyroidism, in adolescents presenting for annual physical examinations during the peak period of the COVID-19 pandemic in the USA, a period deemed high for adolescent depression. All the adolescents were screened for depression by the PHQ-9 screening tool and had their TSH measured. Of the 304 subjects analyzed, 179 (58.88%) were minimally or not depressed according to the Patient Health Questionnaire (PHQ-9) screening tool (mean PHQ 1.80 ± 1.49). 70 (23.03%) had mild depression (mean PHQ 6.59 ± 1.46), 50 (16.45%) had moderate depression (mean PHQ 13.70 ± 2.75), and 5 (1.64%) had severe depression (mean PHQ 21.40 ± 1.67). Mean TSH values were 1.93 ± 0.99, 1.77 ± 1.05, 2.10 ± 0.98, and 1.57 ± 0.32 mIU/L, respectively in the four groups. All values were within the recommended range of 0.50 to 4.30 mIU/L, without statistically significant inter-group differences. We conclude that there is no statistically significant association between depression and subclinical hypothyroidism, in a population of adolescents presenting for physical examinations, and if the screening for depression by the PHQ-9 tool indicates depression, a screening TSH test for subclinical hypothyroidism is not justified.

Comparison between transient and permanent congenital hypothyroidism on a thyroid function test after re-evaluation.

Congenital hypothyroidism (CH) is diagnosed with neonatal screening and is treated early in the neonatal period. Among these patients, transient CH (TCH) is included and requires re-evaluation. The purpose of this study was to find the best way to discontinue levothyroxine and to find trends in thyroid function tests (TFTs) after re-evaluation. We retrospectively reviewed 388 patients diagnosed with CH. They were classified as permanent CH (PCH) and TCH. The total number of the PCH and TCH groups was 83 (51 boys and 32 girls). We compared clinical parameters to predict TCH and to identify the trends of TFT. The first thyroid-stimulating hormone (TSH) value after discontinuation and the average TSH value for 1, 2, and 3 years were all significantly higher in the PCH group (P<0.01). The first fT4 value after discontinuation and the average fT4 value for 1, 2, and 3 years were all significantly higher in the TCH group (P<0.01). The optimal cutoff value on the receiver operating characteristic curve for PCH prediction with an average of 3 years of TSH was greater than 9.05 μIU/mL, which was predicted with a sensitivity of 100% and a specificity of 100%. When the TSH value ranges from 10 μIU/mL to 20 μIU/mL, clinicians can discontinue levothyroxine if the next result is around 10 μIU/mL or shows a decreasing trend.

Prevalence of Thyroid Disorders among Pregnant Women at Birat Medical College Teaching Hospital

Background: Thyroid disorders (TD) are the second most common endocrine disorders seen in pregnancy. TD is known to be associated with adverse maternal and fetal outcomes.&#x0D; Materials and Methods: This was a hospital based descriptive cross-sectional study. All the pregnant women attending the antenatal clinic at Birat Medical College Teaching Hospital from 1st July 2021 to 30th June 2022 were enrolled in the study, irrespective of their gestational age and gravida status. Pregnant women with diagnosed thyroid disorder and are on medication, multiple gestation, Diabetes mellitus, Hypertension and pregnant women with age more than 35 years were excluded from study. Thyroid function status of pregnant women was assessed by measuring serum levels of thyroid stimulating hormone (TSH) and if the TSH value was deranged then they underwent free T3 and free T4 level. Based on the TFT reports they will be classified as euthyroid, subclinical hypothyroidism and overt hypothyroidism, subclinical hyperthyroidism and overt hyperthyroidism.&#x0D; Results: A total of 395 pregnant women were enrolled in this study. The mean age and standard deviation of pregnant women was 25.25± 4.76 years. Among 395 pregnant women 93(23.6%) pregnant women have thyroid disorder. Subclinical hypothyroidism and Overt hypothyroidism were 19% and 1.8% respectively. Subclinical and Overt hyperthyroidism were 1.5% and 1.3% respectively.&#x0D; Conclusion: The prevalence of thyroid disorder in pregnancy was 23.6%. The most common thyroid disorder observed was Subclinical hypothyroidism comprising 19% cases followed by overt hypothyroidism comprising 1.8% cases followed by Subclinical and Overt hyperthyroidism 1.5% and 1.3% cases respectively.

Interaction between triglyceride-glucose index and thyroid hormones on coronary artery disease risk in patient with euthyroid.

Triglyceride-glucose (TyG) index is an effective indicator in indentifying in pre-diabetes, diabetes, and coronary artery disease (CAD). However, the value of TyG index combined with thyroid hormones (THs) to affect CAD has not been fully evaluated. Here, we investigated the association between TyG index and THs and further studied the impacts of TyG index and THs on CAD in euthyroid. Subjects (1,297) with euthyroid who underwent selective coronary angiography (CAG) were enrolled in the present study, including 893 patients with CAD and 404 controls. The association between TyG index and THs were analyzed by linear regression models. Multivariate logistic regression analysis was used to evaluate the interaction of TyG and THs with the risk of CAD. According to the cutoff value of free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), and TyG index, the patients were respectively separated into four groups: low TyG/FT3 (low or high), high TyG/FT3 (low or high), low TyG/FT4 (low or high), high TyG/FT4 (low or high), low TyG/TSH (low or high), high TyG/TSH (low or high). The baseline analysis showed that FT4 level differs among the three groups according to the tertile of the TyG index. Multiple linear regression analysis revealed decreased serum FT3 level and serum FT4 level as an independent risk factor for elevated TyG index. After adjusting for confounding variables, multiple logistic regression analysis showed that patients with lower TyG index and higher FT3 level had an important protective effect on CAD when considering patients with lower TyG index and FT3 level as reference(OR = 0.536, 95% CI: 0.369-0.778, P = 0.001). Patients with higher TyG index and FT4 level (lower or higher) had a significantly increased risk of CAD (OR 1.656, 95% CI: 1.117-2.455; OR = 1.920, 95% CI: 1.279-2.848, respectively). The area under the curve for the combined diagnosis of CAD by TyG index and FT3 level is 0.615. These findings suggest that TyG is independently negatively correlated with FT3 or FT4 in euthyroid. In addition, there was a significant interaction between TyG index and THs on the risk of CAD.

Subclinical Hypothyroidism and Functional Hemodynamics of the Heart

Subclinical hyperthyroidism (SHyper), a laboratory decrease in thyroid-stimulating hormone levels with peripheral thyroid hormone levels within the reference interval, is considered a medical condition, especially its impact on cardiac hemodynamics among young women. To determine the effects of subclinical thyroid dysfunction on hemodynamics in young women. clinical observation included two groups of women: (1) the main group consisted of 30 patients with subclinical hyperthyroidism, which was examined at the Family Medicine Clinic of the West Kazakhstan Marat Ospanov Medical University (Aktobe, Kazakhstan) and (2) the control group consisted of 30 practically healthy women. The groups were comparable in age (30–42), mean age 36.2±7.0 years. Blood pressure (BP) was measured, heart rate (HR) was counted, and thyroid hormones were determined. in the examined patients, clinical symptoms of pathology were not observed; laboratory tests determined a decrease in thyroid-stimulating hormone (TSH) in the main group of patients to 2.48±0.23 mIU/L in comparison with the control group 3.65±1.3 mIU/L, which was significant (p0.05) increase in blood pressure SBP/DBP from 122.34±2.7/78.3±2.7 to 127.8±3.1/83.2±2.1 mmHg and HR from 77.7±1.9 to 82.2±2.6 in 1 minute. A significant (r2 =0.482) interaction was determined between TSH -0.236 mIU/L and HP +20.3 in 1 minute, this could be a predictor of an increase in heart rate greater than the reference value (60–80 per minute), and an increased heart rate is considered a predictor of an increase in blood pressure. Subclinical hyperthyroidism may produce a significant laboratory decrease in TSH, without significant clinical symptoms of increased blood pressure. In conclusion, current observational experience suggests that small decreases in laboratory values of thyroid-stimulating hormone may affect blood pressure and heart rate.

Permanent vs Transient Congenital Hypothyroidism in Chinese Children: Physical Growth and Predictive Nomogram

Abstract Context Few reliable markers are available to distinguish transient congenital hypothyroidism (TCH) and permanent congenital hypothyroidism (PCH). Additionally, the differences in growth between TCH and PCH remain unclear. Objective To investigate the growth of children with TCH and PCH and develop a nomogram for early differentiation of these forms. Methods This retrospective study included children with TCH or PCH. The predictive efficacy of the prognostic predictors was analyzed using receiver operating characteristic analysis. Multivariate prediction models were developed. Measurements of growth were compared between groups. Results Patients with TCH had lower initial thyroid-stimulating hormone (TSH) than those with PCH at newborn screening (NBS). The supplementary dose of levothyroxine (L-T4) gradually decreased with age in TCH but not in PCH. The area under the curve (AUC) values of the initial TSH, L-T4 dose at 1 year of age, and L-T4 dose at 2 years of age for distinguishing TCH from PCH were 0.698, 0.71, and 0.879, respectively. The predictive efficacy of the multivariate models at 1 and 2 years of age improved, with AUC values of 0.752 and 0.922, respectively. A nomogram was built based on the multivariate model at 1 year of age. The growth did not differ between children with TCH and those with PCH. However, at 1 year of age, girls with CH exhibited higher z-scores in terms of height and weight than boys with CH. Conclusion TSH at NBS and L-T4 doses during treatment can be used to distinguish between PCH and TCH early in life, and the predictive efficacy can be improved using multivariable models with a visualized nomogram. At 3 years of age, patients with TCH and PCH showed similar growth.

Comparison of Thyroglobulin and Thyroid Function in Pregnant Women between Counties with a Median Urinary Iodine Concentration of 100–149 μg/L and 150–249 μg/L

ObjectiveThis study explored whether thyroglobulin and thyroid disease prevalence rates were higher in pregnant Chinese women with a median urinary iodine concentration of 100–149 μg/L, compared with those with a median urinary iodine concentration of 150–249 μg/L maintained through sustainable universal salt iodization. MethodsThis was a cross-sectional study in which 812 healthy pregnant women were enrolled to collect samples of their household edible salt, urine, and blood during their routine antenatal care in the 18 counties in Fujian Province, China. The levels of salt iodine concentration, urinary iodine concentration (UIC), free triiodothyronine (FT3), free thyroid hormone (FT4), thyroid-stimulating hormone (TSH), thyroglobulin (Tg), thyroid peroxidase antibody and thyroglobulin antibody were assessed during the routine antenatal care visits. ResultsThe median UIC (mUIC) in pregnant women was 130.8 μg/L (interquartile range = 91.5–198.1 μg/L) in the counties with an mUIC of 100–149 μg/L (Group I), and 172.0 μg/L (interquartile range = 123.5–244.4 μg/L) in the counties with an mUIC of 150–249 μg/L (Group II). Goiter prevalence and thyroid nodule detection rates showed no difference between Group I and Group II (P > 0.05). Except for FT4 values, the TSH, FT4, FT3, Tg and Tg values > 40 (μg/L) and the thyroid diseases prevalence rate (TDR) showed no significant differences between Group I and Group II (P > 0.05), whether or not iodine supplementation measures were taken. ConclusionCompared with an mUIC of 150–249 μg/L, not only there was no difference in thyroid morphology, but also the Tg value, rate of Tg values > 40 μg/L, and TDR were not higher in pregnant women in the counties with an mUIC of 100–149 μg/L achieved through sustainable universal salt iodization in Fujian Province, China.

Pituitary dysfunction following mild traumatic brain injury in female athletes.

Pituitary dysfunction following mild traumatic brain injury can have serious physical and psychological consequences, making correct diagnosis and treatment essential. To the best of our knowledge, this study is the first to study the prevalence of pituitary dysfunction following mild traumatic brain injury in an all-female population following detailed endocrinological work-up after screening for pituitary dysfunction in female athletes. This is a retrospective cohort study. Hormone screening blood tests, including serum blood values for thyroid-stimulating hormone, free thyroxin, insulin-like growth factor 1, prolactin, cortisol, follicle-stimulating hormone, luteinizing hormone, estrogen and progesterone, were taken in 133 female athletes. Results were repeatedly outside the reference value in 88 women necessitating further endocrinological evaluation. Two of those were lost to follow-up, and further endocrinological evaluation was performed in 86 participants. Six women (4.6%, n = 131) were diagnosed with hypopituitarism, four (3.1%) with central hypothyroidism and two with growth hormone deficiency (1.5%). Ten women (7.6%) had hyperprolactinemia, and four (3.1%) of them had prolactinoma. Medical treatment was initiated in 13 (9.9%) women. Significant prognostic factors were not found. As 12.2% of female athletes with a history of mild traumatic brain injury had pituitary dysfunction (hypopituitarism 4.6%, hyperprolactinemia 7.6%), we conclude that pituitary dysfunction is an important consideration in post-concussion care. Hyperprolactinemia in the absence of prolactinoma may represent pituitary or hypothalamic injury following mild traumatic brain injury. Mild traumatic brain injury (mTBI) has become a growing public health concern as 50 million people worldwide sustain a traumatic brain injury annually, with mTBI being the most common (70-90%). As studies on mTBI have focused on mostly male populations this study aims to explore pituitary dysfunction (PD) in female athletes following mTBI. To the best of our knowledge, it is the first all-female study on PD following mTBI. The study found that 12.2% of the participating women had PD after mTBI. Six (4.6%) had hypopituitarism and ten (7.6%) had hyperprolactinemia. These findings suggest that PD following mTBI is an important consideration that endocrinologists and other medical staff working with athletes need to be aware of.

Relationship between Iron Deficiency and Thyroid Function: A Systematic Review and Meta-Analysis.

Objective: Iron deficiency (ID) is the most prevalent nutritional deficiency worldwide. Low levels of serum ferritin (SF) could affect the thyroid gland and its functioning. The purpose of this systematic review and meta-analysis is to summarize the main currently available evidence and analyze data on the relationship between ID and thyroid function. Methods: This study included all articles evaluating the relationship between ID and thyroid function. Quality assessment was performed using Cambridge Quality Checklists. The search strategy included the following combination of Medical Subjects Headings terms and keywords: "iron deficiency", "thyroid function", "thyroid disease", "thyroid dysfunction", and "hypothyroidism". A meta-analysis was performed to evaluate whether thyroid stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) levels differed between patients with ID and healthy controls without ID. For statistical comparison between cases and controls, the mean difference (MD) was calculated, and a subgroup analysis of pregnant and non-pregnant women was performed. Cochran's Q testing and heterogeneity indices (I2) were used to assess statistical heterogeneity. Sensitivity analysis and publication bias analyses were also performed, both qualitatively and quantitatively. Finally, a meta-regression analysis was performed to evaluate the correlation between serum TSH or FT4 levels and SF in the study population. Results: Ten cross-sectional studies were identified and reviewed. Patients with ID showed TSH (MD: -0.24 mIU/L; 95% CI -0.41, -0.07; I2 = 100%, p = 0.005), FT4 (MD: -1.18 pmol/L; 95% CI -1.43, -0.94; I2 = 99%, p < 0.000001), and FT3 (MD: -0.22 pmol/L; 95% CI -0.32, -0.12; I2 = 99%, p < 0.00001) levels that were significantly lower. Subgroup analysis confirmed significantly lower TSH, FT4, and FT3 levels in pregnant women. Non-pregnant women showed significantly lower serum FT4 and FT3 levels but no difference in TSH values. Meta-regression analysis showed that serum TSH and FT4 levels were positively correlated with SF levels. Our systematic review of the literature found that ID significantly increases the prevalence of thyroid autoantibody (anti-thyroglobulin antibodies and anti-thyroid peroxidase antibodies) positivity both individually and collectively. Conclusion: Studies currently published in the literature indicate a possible relationship between ID, thyroid function, and autoimmunity, especially in some patient groups. Data analysis shows that thyroid hormone levels are lower in patients with ID and, in particular, in pregnant women. Further studies are needed to understand the role played by iron in thyroid metabolism.