TSH Levels Research Articles

Therapeutic Potential of the Algerian Ground Nut (Bunium bulbocastanum) Dietary Supplement in the Treatment of Thyroid-induced Dysfunction and Associated Growth Performance and Meat Quality in Rabbits (Oryctolagus cuniculus)

Background: Both traditional usage and initial scientific findings suggest that Bunium bulbocastanum, commonly known as Talghouda tuber nut, may offer health benefits, particularly for thyroid dysfunction. This study aims to investigate the therapeutic potential of dietary supplementation in managing pharmacologically thyroid-induced dysfunction and its effects on growth performance and meat quality in rabbits. Methods: Thirty 45-day-old male Lionhead rabbits were divided into three groups, each with two subgroups. The Control groups received either a standard diet (C) or a diet supplemented with 35% dried Talghouda (Csup). The Hypothyroid group included rabbits induced with hypothyroidism using carbimazole at a dose of 5 mg/kg BW/day (HytCar) and those subsequently treated with dried Talghouda (HytTal). Similarly, hyperthyroid group comprised rabbits induced with hyperthyroidism using levothyroxine (HyrLevo) and those treated with dried Talghouda (HyrTal). Thyroid function was assessed by measuring serum levels of T3, T4 and TSH. Additionally, growth performance and meat quality parameters were evaluated. Result: Talghouda supplementation significantly influenced thyroid hormone levels in rabbits, elevating T3 and T4 in the hyperthyroid groups (HyrLevo and HyrTal) compared to controls, while suppressing TSH in hyperthyroid groups and elevating it in hypothyroid groups. Talghouda treatment improved growth performance, evidenced by increased weight gain and higher eviscerated carcass weights in the hyperthyroid-treated groups. Meat quality also improved, with favourable pH, dry matter percentage and mineral content observed in the Talghouda-treated hypothyroid group. These findings suggest that Bunium bulbocastanum is a viable natural intervention for managing thyroid dysfunction while maintaining or enhancing growth and meat quality in rabbits, offering promising pharmacological and economic benefits.

Electrodiagnostic Findings of Median Nerve Motor and Sensory Conduction in Neurological Asymptomatic Newly Diagnosed Patients with Hypothyroidism

BACKGROUND: The influence/impact of thyroid hormones on peripheral nervous system has still not been thoroughly/substantially studied/examined. Neurographic studies, which measure motor and sensory nerve conduction along with F-wave, have an important role in diagnosing diseases of the peripheral nerves since electrophysiological sings of neuropathy can be detected even in subclinical state/cases. AIM: The aims of this study were to assess the neurophysiological parameters of the median nerve by electrodiagnostic measurements using electromyoneurogaphy (EMNG) in the region of radiocarpal joint in patients with newly diagnosed and medically untreated primary hypothyroidism who had no symptoms and signs of peripheral nerve damage/injury/lesion. Furthermore, it was our aim to make an insight of the possible early detection of the latent damage of peripheral nervous system in untreated hypothyroidism. MATERIAL AND METHODS: This was a prospective clinical study that comprised 78 subjects/patients according to inclusion criteria, divided into two groups: one with primary hypothyroidism and the other group involving euthyroid subjects. Thyroid status was examined in each subject; anthropometric parameters were analyzed, and electromyoneurographic imaging (EMNG) of hand median nerve was realized. RESULTS: Of the total number of 78 subjects included in the study, 58 (74.36%) had hypothyroidism and 20 were euthyroid subjects (25.64%). The calculated mean levels of thyroid status parameters in hypothyroid patients, TSH, aTPO and FT4, were 6.19±1.85 mIU/L, 872.22±296.66 U/mL and 0.78±0.11 ng/dL, respectively. In euthyroid patients, the mean levels of TSH, aTPO and FT4 were 0.27±0.08 mIU/L, 31.2071±5.65 U/mL and 1.31±0.25 ng/dL, respectively. Statistically significant differences were obtained between hypothyroid and euthyroid subjects regarding: age (p=0.0147, r=0.3239), body weight (p=0.0441, r= -0.531), body mass index (p=0.0050, r= -0.301), WHO classification for BMI (p=0.0032, r= -0.250), TSH (p<0.0001, r=-0.309), aTPO (p<0.0001, r=0.5554) and FT4 (p<0.0001, r= -0.317). In the group of 58 hypothyroid subjects, 38 (65.52%) were women and 20 (34.48%) were men. A strong correlation and significant statistical difference were registered in EMNG pathological findings in patients with pathologic BMI and with mild predilection for the sensory part of the median nerve. Of the 58 hypothyroid patients, EMNG pathologic findings were present in 18 that, in terms of their features, indicated a distal lesion of the median nerve. These 18 subjects had an increased body mass index (30.83±5.65 kg/m2). CONCLUSIONS: Discovery, definition and explanation of etiopathogenic nodes in peripheral nervous system diseases will require extensive and multidisciplinary strategies in the next decades. These complex conditions, in our opinion, will claim a steady/a step-by-step/ approach to the problems, as well as consistency and symmetry in the design and methodology of the research procedures.

Evaluation of Thyroid Dysfunction among Libyan Patients with Type-2 Diabetes Mellitus

Thyroid disorders are more common in people with diabetes compared to the general population. This study aimed to evaluate the prevalence of thyroid disorders in Libyan patients with type 2 diabetes mellitus (T2DM) and the association between thyroid dysfunction and T2DM parameters. The current study included a total of 50 participants: 40 with T2DM, and 10 healthy volunteers. They were divided into three groups: G1 (10 healthy controls), G2 (30 patients with T2DM [DM]), and group 3 [10 patients with T2DM and thyroid dysfunction (DM+TD)]. The average age of control and patients was 33.1±10.9 years and 55.3±12.8 years, respectively. The diabetes profile (FBS, RBS, and HbA1c), and thyroid profile (TSH, FT3, and FT4) of each participant were assessed. The levels of FBG, RBS, and HbA1c showed a highly significant (P=0.000) increase in the DM and DM+TD groups compared to the healthy control group. Additionally, the findings indicated that the majority of the participants with diabetes (75%) had normal thyroid function, while 25% had thyroid disorders., Among the patients with thyroid disorders, 10% had subclinical hypothyroidism, 7.5% nonthyroidal illness syndrome (NITS), and 7.5% exhibited high levels of TSH, FT4, and FT3.,. The prevalence of thyroid disorders was higher in women (22.5%) than in men (2.5%). None of the diabetic patients showed hyperthyroidism in this study. The study concluded that 25% of patients with type 2 diabetes mellitus had a thyroid disorder, and subclinical hypothyroidism was more prevalent. Also, the current study showed that female gender and family history of thyroid disorders are important risk factors.

68 Ga-DOTATATE PET/CT Versus 18 F-FDG PET/CT in TENIS Syndrome: A Head-to-Head Comparison With Elevated and Suppressed TSH Levels in Papillary Thyroid Carcinoma-A Pilot Study.

TENIS syndrome is characterized by reduced expression of sodium-iodine symporter, rising serum thyroglobulin (Tg) levels, and negative whole-body 131 I scans. In such patients, somatostatin receptor imaging with 68 Ga-DOTATATE PET/CT (somatostatin receptor [SSR] PET/CT) and 18 F-FDG PET/CT (FDG PET/CT) can identify metastases and were compared under 2 conditions: elevated (eTSH) and suppressed (sTSH) TSH serum levels. Potential candidates for peptide receptor radionuclide therapy (PRRNT) were identified in 15 patients prospectively enrolled. All patients underwent 4 examinations. Images were blindly evaluated for differences in SUV max values and lesion detectability. Reference standard consisted of neck ultrasound, CT, MRI, PET/CT, biopsy, and follow-up. Three patients were received PRRNT. sTSH SSR PET/CT detected a greater number of cervical ( P = 0.0253 and P = 0.0176) and distant LNs ( P = 0.0253 and P = 0.0391) when compared with sTSH FDG PET/CT, respectively, in a per-patient and on a per-lesion based analysis. Likewise, eTSH SSR PET/CT detected a greater number of patients with local recurrences ( P = 0.0455) and distant LN metastases ( P = 0.0143). Per-lesion analysis revealed greater number of cervical and distant LNs ( P = 0.0337 and P = 0.0039, respectively) when compared with eTSH FDG PET/CT. There was no difference in detection of distant metastases by both tracers for lung and bone metastases (κ = 1). Both skeletal and pulmonary lesions were also detected by conventional CT part of FDG or DOTATATE PET/CT scans. TSH stimulation had no additional value in a per-patient analysis for both FDG and DOTATATE PET scans (κ varying from 0.6087 to 1). However, TSH stimulation led to more lesion identifications in DOTATATE PET/CT; most of those metastases were not confirmed by the reference standard leading to a decrease in specificity (84% vs 74%). One of 3 patients submitted to 3 cycles of PRRNT presented with a visual partial response, a 20% reduction in quantitative analyses, and stable disease regarding Tg and TgAb levels. Patients with TENIS syndrome can be imaged with SSR PET/CT as well as FDG PET/CT with high overall accuracy regardless of TSH levels (86% to 92% and 92% to 85%, respectively, with eTSH and sTSH). SSR PET/CT detected a greater number of locoregional and distant LN metastases than FDG PET/CT with both sTSH and eTSH. One of 3 patients submitted to PRRNT presented a partial response to treatment. Our findings may impact in patient restaging, management, and theranostics strategies with radiolabeled somatostatin analogs.

Evaluation of MELD Scores and Thyroid Hormones as Prognostic Factors of Liver Cirrhosis.

Background and Objectives: Hepatic cirrhosis is a disease with an increasing frequency globally, but its mechanisms of disease development are not yet completely known. The aim of this study was to evaluate the relationship between thyroid hormone levels (T3, fT4, and TSH) and survival in patients with chronic liver disease. Materials and Methods: A total of 419 patients diagnosed with liver cirrhosis were included in the study. The MELD score was computed, and TSH, T3, and fT4 were collected from each patient using the ELISA procedure. Signs and symptoms of liver failure and portal hypertension confirmed the clinical diagnosis of liver cirrhosis, and biological tests and imaging methods confirmed the diagnosis. Results: The MELD score was positively associated with TSH on admission and TSH on discharge and negatively associated with T3 at discharge. TSH levels were higher in non-survivors than in survivors. The values of T3 and fT4 present no significant changes to be considered as prognostic factors. Conclusions: Although the differences between the median TSH values of the patients who died and those who survived are not very large, the statistical significance of the data obtained demonstrates that there are changes in metabolism of the thyroid hormones during the progression of liver cirrhosis. It is possible that TSH is the one which maintains the normal balance of thyroid activity for patients with liver cirrhosis, so it can be considered as an important marker of evolution of these patients.

The effect of diabetes on the alevel of thyroid gland hormones in patients with uncontrolled type 2 diabetes in Thi-Qar Province,Iraq.

Background: Diabetes mellitus and thyroid dysfunction represent two prominent endocrine disorders frequently encountered in clinical practice. The objective of this research was to examine the prevalence of hypothyroidism among hospitalized individuals diagnosed with type 2 diabetes mellitus, along with its associated factors. Methods: A total of 120 in patients suffering from type 2 diabetes mellitus were admitted to the metabolic diseases unit. The findings of this investigation indicated a notable elevation of T3 and T4 levels in patients with uncontrolled diabetes (GI) when compared to those with controlled diabetes (GII) and the control group. Conversely, the levels of TSH exhibited a significant reduction in patients with uncontrolled diabetes (GI) relative to both the controlled diabetic patients (GII) and the control group. Utilizing a significance threshold of (P ≤ 0.05), this study revealed a substantial decrease in the concentrations of thyroid hormones, alongside a reduction in thyroid stimulating hormone levels in patients with uncontrolled diabetes when contrasted with the controlled diabetic patients and the control group.. Aims of Study: Evaluation the risk degree of developing of metabolic disorders complications in patients with DM and their prevalence in Thi-Qar province. Conclusion: It was concluded from this study that there is a clear relationship between high blood glucose levels and low T3 and T4 levels.

Unraveling the impact of hyperleptinemia on female reproduction: insights from transgenic pig model

BackgroundInfertility is a growing global health concern affecting millions of couples worldwide. Among several factors, an extreme body weight adversely affects reproductive functions. Leptin is a well-known adipokine that serves as an endocrine signal between adiposity and fertility. However, the exact mechanisms underlying the effects of high leptin level on female reproduction remain unclear.MethodsTransgenic pigs overexpressing leptin (♀) were produced by backcrossing and screened for leptin overexpression. The growth curve, fat deposition, reproductive performance, apoptosis, serum hormones and cholesterol production, RNA sequencing, and single-nucleus RNA sequencing (snRNA-seq) of the leptin-overexpressing pigs and wild-type group were evaluated.ResultsTransgenic pigs overexpressing leptin (♀) were obtained, which exhibited significantly reduced body weight, body size, and back fat thickness. These pigs manifested a late onset of puberty (330 ± 54.3 vs. 155 ± 14.7 days), irregular estrous behavior characterized by increased inter-estrous interval (29.2 ± 0 vs. 21.3 ± 0.7 days), and more number of matings until pregnancy (at least 3 times). This reproductive impairment in leptin pigs was related to hormonal imbalances characterized by increased levels of FSH, LH, prolactin, E2, P4, and TSH, altered steroidogenesis such as increased levels of serum cholesterol esters along with steroidogenic markers (StAR, CYP19A), and ovarian dysfunctions manifested by neutrophilic infiltration and low expression of caspase-3 positive cells in the ovaries. Moreover, bulk RNA sequencing of the ovaries also revealed neutrophilic infiltration followed by upregulation of inflammation-related genes. Furthermore, snRNA-seq reflected that leptin overexpression triggered immune response, suppressed follicle development and luteinization, resulting in metabolic dysfunction and hormone imbalance in the ovary.ConclusionsLow body weight in leptin overexpressing pigs adversely affects the reproductive performance, causing delayed puberty, irregular estrous cycles, and reduced breeding efficiency. This is linked to metabolic imbalances, an increased immune response, and altered ovarian functions. This study provides a theoretical basis for the complex mechanisms underlying leptin, and infertility by employing leptin-overexpressing female pigs.

Relationship of TSH and FT3 Levels to The Incidence of Hashimoto's Thyroiditis in Autoimmune Patients

Hashimoto's thyroiditis is portrayed by the presence of thyroid autoantibodies. Pathogenetic systems, a few cytokine networks have been recognized to be engaged with thyroid cells in a progression of proinflammatory impacts, like the statement of provocative parts, and a progression of imperfections in administrative Lymphocytes that control the deficiency of resistance to thyroid autoantigens, subsequently assuming an immediate part in the autoimmune cycle causing a few diligent side effects. The point of this review was to assess the connection between 36 autoimmune patients matured 14 to 52 years with responsive ANA test results. Then, Thyroid-Animate Hormone (TSH) and free Triiodothyronine (fT3) levels were analyzed utilizing the Enzyme-linked immunosorbent assay (ELISA) technique. The consequences of the review showed that the quantity of ladies was more prominent than men, 32 individuals (88.9%) and 10 individuals matured between 20-25 years. The typical TSH level was 9.65uIU/mL and the free T3 level was 1.64pg/ml. The consequences of the Spearman connection test among TSH and free T3 levels got a worth of p = 0.029 (p<0.05), implying that the connection between TSH levels and the free T3 test had an adequate relationship of - 0.364 (0.260-0.500), however was negative and not in a similar heading, so that when the levels TSH expands, fT3 levels will diminish. All in all, in autoimmune sufferers essential hypothyroidism happens, when the thyroid organ creates low Free T3, causing the deficiency of negative criticism restraint on the front pituitary, bringing about expanded creation of the TSH hormone which causes Hashimoto's thyroiditis.

Investigating the Relationship Between Serum Thyroid Hormone and Vitamin D Levels in Women with Melasma

Patches and macules of hyperpigmentation characterize melasma, a prevalent condition of skin pigmentation. Known risk factors for melasma include a genetic predisposition, sun exposure, and pregnancy. Melasma may have a connection to thyroid issues, according to previous research. Considering that vitamin D influences and promotes melanocytes' melanin formation, this study sought to examine the correlation between thyroid problems, blood vitamin D levels, and melasma in female patients seen at Al-Mahmoudiya Hospital. Both Wood's light investigation and clinical evaluation by seasoned dermatologists verified the melasma diagnosis. There were 80 participants in total, with 40 assigned to the melasma group and 40 to the control group. Their ages and sexes were matched. In all groups, blood samples were taken to assess levels of TSH, Anti-TPO, T3, T4, and vitamin D. Melasma patients' clinical pigmentation severity was assessed using the standard mMASI score. I used SPSS (IBM Statistical Package for the Social Sciences) version 21 to conduct the statistical analysis. Melasma patients were more likely to have thyroid problems (50%) and lower vitamin D serum levels (47.5%), compared to the control group (27.5%) and healthy individuals (40%). The levels of thyroid hormone (T3) and vitamin D were found to be considerably higher in the case group as compared to the control group (P<0.05). A relationship was found between Anti-TPO and mMASI Score (P< 0.05) when the relationship between age, thyroid hormones, vitamin D, and mMASI Score was investigated. Melasma and pigmentation intensity are linked to thyroid autoimmune diseases. The most prevalent clinical form of melasma is the centro facial variant as well.

Gender Differences In Thyroid Cancer In A Tertiary Care Hospital Bangladesh

Background: The gender disparity in incidence, aggressiveness and prognosis is well established for thyroid cancer but the cause of the disparity is poorly understood. Objective: The main objective of the study was to evaluate the gender difference in thyroid disease. Materials and Methods: This cross sectional study was conducted in the Department of Otolaryngology-Head & Neck Surgery of Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2013 to December 2015. The thyroid gland was assessed by palpation in all patients. Estimation of serum TSH concentrations were performed by automated immune chemiluminescent assay. Results: In this study out of 400 thyroid cancer patients, 327 were females and 73 were males. The mean age was almost similar between male and female patients (p=0.245). HOMA-IR was significant higher in female patients than male patients (1.9±0.5 vs 1.7±0.6). FT3, FT4 and TPO antibody were significantly higher in male patients than female patients, whereas TSH level was significantly higher in female patients than male patients (5.7±2.9 vs 4.5±2.8 µIU/mL). In multivariate logistic regression analysis abnormal TSH patient had 3.61 (95% CI 1.66 to 7.81) times more likely to have female. Abnormal FT3 patient had 2.56 (95% CI 1.08 to 6.05) times more likely to have female. Abnormal TSH and FT3 were significantly associated with female patients. Conclusion: Serum TSH and FT3 levels were significantly associated with thyroid cancer especially for females. Our results suggest the necessity of monitoring TSH and FT3 in the population for thyroid cancer risk assessment, especially female.

Energy metabolism, immune function, and intestinal flora in rats with kidney-yin deficiency treated with raw or saltwater-processed Phellodendron chinense Schneid

ObjectiveTo clarify the specific mechanisms of action of raw Phellodendron chinense Schneid. (RPC) and saltwater-processed PC (SPC) in the treatment of rats with a kidney-yin deficiency pattern (KYDP). MethodsHealthy rats were administered hydrocortisone to establish a KYDP model. The rats were divided into seven groups: blank control, model, positive control (Liuwei Dihuang pills), high-dose RPC, low-dose RPC, high-dose SPC, and low-dose SPC. Enzyme-linked immunosorbent assay was used to measure the levels of cAMP, cGMP, TRH, TSH, T3, T4, IFN-γ, TNF-α, and testosterone in the serum and the levels of Na+-K+-ATPase and Ca2+-Mg2+-ATPase in the liver. TRH mRNA expression in the rat hypothalamus was measured using RT-PCR. THRα1+2 protein expression in the hypothalamus of rats was measured using Western blot. Immunohistochemistry was performed to determine the expression levels of FAS, FasL, and TSHR. Flow cytometry was used to determine CD4+ and CD8+ T lymphocyte levels. Illumina MiSeq sequencing technology was used to evaluate the diversity of intestinal flora in KYDP rats. ResultsThe cAMP/cGMP ratio was significantly higher in the model group than in the blank control group (P = .048). Compared with the model group, after administration, the levels of the above-mentioned serum and liver indexes decreased, except that of testosterone. The CD4+/CD8+ ratio also decreased. Compared with the RPC group, the levels of T3, IFN-γ, FAS, FasL, and TSHR in the SPC group decreased whereas that of testosterone increased. Additionally, immune function and intestinal flora diversity improved in the SPC group. SPC proved to be more effective in improving liver energy metabolism in KYDP rats than RPC. ConclusionSPC had a better therapeutic effect on KYDP than RPC. The underlying mechanism of action may be related to improvements in liver energy metabolism, immune function, and intestinal flora diversity.

Therapeutic efficacy and patient compliance of levothyroxine liquid and softgel formulations taken with meals: a systematic review.

Levothyroxine (L-T4) is the drug of choice for treating primary hypothyroidism. L-T4 tablets should be taken at least 30 min before breakfast. Several studies have suggested that serum thyroid profile is not affected by concomitant intake of liquid/softgel L-T4 with meals. Our aim is to review the evidence on therapeutic efficacy and patient compliance with the liquid and softgel formulation of L-T4 taken with meals, also compared with the standard tablet therapy regimen, in hypothyroid patients. We performed a systematic review of literature by searching PubMed, Embase, and Cochrane Library databases. PRISMA guidelines were applied, and the risk of bias of the included studies was assessed using the RoB 2 and ROBINS tools. The methodological quality was assessed following the GRADE criteria. We included 13 studies, accounting for a total of 1697 patients. The timing of liquid L-T4 intake from breakfast did not affect the therapeutic efficacy of the treatment. No significant differences in the absorption of liquid L-T4 were found when administered together with different foods, beverages, drugs, or other supplements. TSH levels are not influenced by taking softgel L-T4 at breakfast; the efficacy of softgel and liquid formulation is similar when they are taken with a meal, but superior to that of tablet formulation. Shifting from L-T4 tablets taken 30 min before breakfast to liquid/softgel formulation taken with the meal improved medication adherence and perceived quality of life of patients. Liquid and softgel formulation of L-T4 can be taken at breakfast or close to meals, without losing therapeutic efficacy. These formulations could also improve patient compliance and quality of life compared to L-T4 tablet therapy taken 30 min before breakfast.

Correlation of serum thyrotropin and thyroid hormone levels with diabetic kidney disease: a cross-sectional study

ObjectiveThe relationship between thyrotropin (TSH), free triiodothyronine (FT3), free thyroxine (FT4) and diabetic kidney disease (DKD) is still controversial, and this study analyzed the correlation between TSH, FT3, FT4 and DKD in patients with type 2 diabetes mellitus (T2DM).MethodsT2DM patients (1216) were divided into five groups based on serum TSH, FT3, and FT4 levels, differences in urinary albumin excretion rate (UACR), estimated glomerular filtration rate (eGFR) were compared. Binary logistic regression verified independent correlations among TSH, FT3, FT4 and UACR, eGFR. TSH and FT3 predictive values for DKD were analyzed using receiver operating characteristic (ROC) curves.ResultsThe prevalence of albuminuria with decreased eGFR was higher in T2DM patients with subclinical hypothyroidism and overt hypothyroidism than that in patients with normal thyroid function. TSH positively correlated with UACR (r = 0.133, p < 0.001) and positively correlated with eGFR (r = -0.218, p < 0.001), FT3 negatively correlated with UACR (r = -0.260, p < 0.001) and positively correlated with eGFR (r = 0.324, p < 0.001). With the change from the lower normal level to the increased level of TSH and the change from the higher normal level to the reduced level of FT3, the prevalence of albuminuria gradually increased, the prevalence of decreased eGFR gradually increased in TSH groups and FT3 groups. After adjusting for age, BMI, duration of diabetes, TPOAb, TGAb, smoking, drinking, hypertension, the use of anti-diabetic medications (metformin, sodium–glucose cotransporter 2 inhibitors), HbA1c, CRP, TC, TG, LDL-C, and HDL-C, both TSH and FT3 correlated with increased UACR (TSH: OR 1.253, p = 0.001; FT3: OR 0.166, p < 0.001) and decreased eGFR (TSH: OR 1.245, p < 0.001, FT3: OR 0.579, p < 0.001), but this correlation of TSH with eGFR < 60 mL/min/1.73 m2 was not found in male. The area under the ROC curve (AUC) for FT3 was greater than that for TSH (FT3: 0.64; TSH: 0.61).ConclusionsIncreased TSH and reduced FT3 levels were associated with DKD in T2DM patients, but in a sex-dependent manner. FT3 had a higher predictive value for DKD.

Assessment of micronutrients in pediatric vertigo

Aim: This study aimed to evaluate the clinical characteristics of patients admitted to the pediatric neurology outpatient clinic with the complaint of vertigo and to investigate the role of micronutrients in the etiology of vertigo Materials and Methods: This study retrospectively evaluated the patients aged four to 18 years who were admitted to the pediatric neurology outpatient clinic with the complaint of vertigo to evaluate the clinical characteristics and the role of micronutrients in the etiology of vertigo. Patients, for whom the Z00.1 code, the routine child health examination code, was entered in the pediatric outpatient clinic in the same period when the patients presented with the complaint of vertigo were included as the healthy control group. Hemogram and hormone profiles [25(OH)D, FT4, TSH, vitamin B12, folic acid and ferritin] of the groups were compared. Results: There was no statistically significant difference between the study group and healthy controls in terms of age and gender. Hematocrit (p&amp;lt;0.001), platelet (p&amp;lt;0.001), vitamin B12 (p=0.015), vitamin D (p=0.043) and TSH (p=0.013) levels were found to be significantly lower in the vertigo group compared to the control group. Conclusion: The importance of micronutritional deficiencies cannot be denied in patients presenting with vertigo symptoms. Main point that makes our study valuable is that there are limited number of studies in the literature comparing laboratory parameters of pediatric patients with vertigo symptoms and healthy controls. There is a need for prospective studies, involving more cases and awareness on this issue.

Endocrine immune-related adverse events by immune checkpoint inhibitors and potential predictive markers: a prospective study from a single tertiary center.

Immune checkpoint inhibitors (ICIs) can trigger immune-related adverse events (irAEs). The appearance pattern of irAEs, who is prone to them, and their mechanisms are still uncertain. In this study, we aimed to monitor patients initiated on ICIs for endocrinological aspects and to investigate the potential predictive markers in the development of endocrine-irAEs. The study prospectively included 43 patients with metastatic disease scheduled for anti-PD-1/L1 therapy. Endocrinological follow-up was conducted at specified intervals as well as in response to any additional reported complaints. Serum concentrations of CXCL10, IL-1beta, and IL-17A were measured prior to ICI and during the endocrine-irAEs. A total of 39.5% of the patients experienced endocrine-irAEs, with a median onset time of 3 months. Among patients, 34.9% developed thyroid-related adverse events, and 4.6% experienced hypophysitis. Thyroid autoantibodies were associated with a higher incidence of thyroid-related irAEs (P = 0.004). In the irAE group, median pre-ICI CXCL10 and baseline thyroid stimulating hormone (TSH) levels were significantly higher, baseline total testosterone level in men was lower than in the non-irAE group (P < 0.05), whereas IL-1beta and IL-17A levels did not differ (P > 0.05). Serum CXCL10, IL-1beta, and IL-17A concentrations did not differ significantly pre-ICI and during adverse events (P > 0.05). Pre-ICI CXCL10 concentration was correlated positively with anti-TPO levels in patients with at least one thyroid autoantibody positivity (r = 0.706, P = 0.01) and negatively with baseline total testosterone level of men (r = 0.509, P = 0.002). Our results suggest that higher pre-ICI serum CXCL10 and TSH levels might have a predictive role in the development of endocrinopathies. Besides, baseline thyroid antibody measurements could be beneficial in predicting thyroid dysfunction.

Metabolic Risk in Patients with a Diminished Ovarian Reserve and Premature Ovarian Insufficiency.

Objective: Diminished ovarian reserve (DOR) and premature ovarian insufficiency (POI) represent conditions of different severity, characterized by an earlier-than-expected decrease in ovarian activity. The present study aims to compare metabolic disturbances between women with DOR and patients with POI from a different origin. Materials and methods: A total of 226 women (28 healthy women; 77 individuals with DOR, and 121 patients with POI/36 with Turner syndrome [TS] and 85 with non-TS POI/) have been studied retrospectively. Data concerning anthropometric indices, and metabolic parameters were collected. Results: Patients with DOR, non-TS POI, and TS had increased blood pressure and liver enzymes, pronounced insulin resistance, and worse lipid profiles than controls (p < 0.008 for all). TS patients had significantly higher ASAT, GGT, and TSH levels compared to non-TS POI and DOR individuals. The prevalence of type 2 diabetes tended to be higher in TS women compared to other groups. The prevalence of previously diagnosed polycystic ovarian syndrome was lower in the non-TS POI patients than in the DOR patients (p = 0.005). Conclusions: patients with decreased ovarian function suffer from insulin resistance, abnormal lipid profile, and subtle hepatic disturbances, irrespective of the severity of the condition and the presence of chromosomal aberrations.

The association between serum soluble α-Klotho and thyroid profile among adults from NHANES 2007–2012

BackgroundThyroid hormone is the key endocrine regulator of growth, development, metabolism, and other bodily functions. α-Klotho has been involved in the aging process and acts as an endocrine factor involved in the regulation of various metabolic processes in humans. However, the relationship between α-Klotho and thyroid profile has not been uniformly recognize.ObjectiveTo determine the relationship between α-Klotho and thyroid profile in adult individuals.MethodsPopulation data of 4614 adult individuals were obtained from the NHANES database during the period of 2007–2012. Weighted multivariable regression analysis was performed using a general linear model with serum α-Klotho as the independent variable and thyroid profile as the dependent variables, respectively. The generalized additive model was used for smoothing curve fitting and threshold effect analysis.Resultsα-Klotho was associated with a slightly higher FT3, TT3 and TT4 level in unadjusted and adjusted regression models. However, a higher α-Klotho level was associated with a lower TSH level. After α-Klotho was grouped as quantiles with reference (Q1), α-Klotho still showed a statistically significant positive correlation with FT3 and TT3 levels in Q2, Q3 and Q4. In addition, α-Klotho was positively corrected with TT4, but negatively associated with TSH in Q4.ConclusionsSerum soluble α-Klotho was positively associated with FT3, TT3 and TT4, but negatively correlated with TSH. The significant effect of α-Klotho on thyroid profile suggests its potential as a predictive marker of thyroid functions, indicating its possible involvement in the regulation of thyroid hormone secretion.

Generalized edema on a hypothyroid patient with incorrect use of levothyroxine

Hypothyroidism is manifested when thyroid hormone isn’t enough for body's requirement and is usually diagnosed by high levels of TSH and low levels of fT4. Generalized edema is commonly associated with cardiovascular, hepatic, or renal diseases and is quite uncommon to see in hypothyroidism; the edema is usually generalized when the disease is severe. Generalized edema in hypothyroidism is traditionally accompanied with more serious hypothyroid symptoms, which is not the case here. It is discussed why the other common causes of generalized edema such as heart failure, advanced kidney disease, nephrotic syndrome, and cirrhosis do not fit here. And we emphasize the importance of thyroid hormone and drug use evaluation. In our case, a 60-year-old man comes with chief complaint of generalized swelling of his body and weakness that slowly worsening. He presents with extremely high blood pressure and generalized edema but with otherwise normal findings. From the labs there is high TSH and low ft4. He was then admitted and given supportive treatment. His levothyroxine was adjusted and he was reeducated for his wrong levothyroxine use, which he took after meal. He was then slowly improving and was discharged.

Effect of bariatric surgery on tsh levels and levothyroxine dosage in patients with thyroid disease: sleeve gastrectomy vs roux-en-y gastric bypass

Effect of bariatric surgery on tsh levels and levothyroxine dosage in patients with thyroid disease: sleeve gastrectomy vs roux-en-y gastric bypass

Testing for a causal role of thyroid hormone measurements within the normal range on human metabolism and diseases: a systematic Mendelian randomization

Variation in thyroid function parameters within the normal range has been observationally associated with adverse health outcomes. Whether those associations reflect causal effects is largely unknown. We systematically tested associations between genetic differences in thyrotropin (TSH) and free thyroxine (FT4) within the normal range and more than 1100 diseases and more than 6000 molecular traits (metabolites and proteins) in three large population-based cohorts. This was performed by combining individual and summary level genetic data and using polygenic scores and Mendelian randomization (MR) methods. We performed a phenome-wide MR study in the OpenGWAS database covering thousands of complex phenotypes and diseases. Genetically predicted TSH or FT4 levels within the normal range were predominately associated with thyroid-related outcomes, like goitre. The few extra-thyroidal outcomes that were found to be associated with genetic liability towards high but normal TSH levels included atrial fibrillation (odds ratio=0.92, p-value=2.13×10-3), thyroid cancer (odds ratio=0.57, p-value=2.97×10-4), and specific biomarkers, such as sex hormone binding globulin (β=-0.046, p-value=1.33×10-6) and total cholesterol (β=0.027, p-value=5.80×10-3). In contrast to previous studies that have described the association with thyroid hormone levels and disease outcomes, our genetic approach finds little evidence of an association between genetic differences in thyroid function within the normal range and non-thyroidal phenotypes. The association described in previous studies may be explained by reverse causation and confounding. This research was funded by the Swiss National Science Foundation (P1BEP3_200041). The Fenland study (DOI 10.22025/2017.10.101.00001) is funded by the Medical Research Council (MC_UU_12015/1, MC_PC_13046 and MC_UU_00006/1). The EPIC-Norfolk study (DOI 10.22025/2019.10.105.00004) has received funding from the Medical Research Council (MR/N003284/1, MC-UU_12015/1, MC_PC_13048 and MC_UU_00006/1).