Upper Range Of Normal Research Articles

Thyroid disorders in pregnancy

Thyroid disorders are common in pregnancy and the most common disorder is subclinical hypothyroidism. Due to the complex hormonal changes during pregnancy, it is important to remember that thyroxine requirements are higher in pregnancy. According to recent American Thyroid Association (ATA) guidelines, the recommended reference ranges for TSH are 0.1 to 2.5 mIU/L in the first trimester, 0.2 to 3.0 mIU/L in the second trimester, and 0.3 to 3.0 mIU/L in the third trimester. Maternal hypothyroidism is an easily treatable condition that has been associated with increased risk of low birth weight, fetal distress, and impaired neuropsychological development. Hyperthyroidism in pregnancy is less common as conception is a problem. Majority of them are due to Graves’ disease, though gestational hyperthyroidism is to be excluded. Preferred drug is propylthiouracil (PTU) with the target to maintain free T4 in upper normal range. Doses can be reduced in third trimester due to the immune-suppressant effects of pregnancy. Early and effective treatment of thyroid disorder ensures a safe pregnancy with minimal maternal and neonatal complications.

Papillary Thyroid Carcinoma Hidden behind the Hot Nodule

52-year-old woman was presented with palpitation and weight loss. Thyroid function test revealed low thyroid-stimulating hormone level with upper normal range of Free T4 and thyroid scan showed 2 cm hot nodule in left upper pole. Thyroid ultrasonography was also done and it showed two nodules in left upper pole. The one was considered as functioning benign nodule, but the other nodule was compatible with malignancy. She underwent total thyroidectomy and final pathology revealed papillary thyroid carcinoma.

Lack of mutations in the gene coding for the hGR (NR3C1) in a pediatric patient with ACTH-secreting pituitary adenoma, absence of stigmata of Cushing's syndrome and unusual histologic features

Rare cases of human glucocorticoid receptor (hGRalpha) (NR3C1) gene mutations have been described in the gemline or somatic state in Cushing's disease (CD). We describe a pediatric patient with CD with clinical evidence of partial glucocorticoid resistance (GR) due to the relative absence of stigmata of Cushing's syndrome (CS). A 14-year-old boy with slow growth and hypertension, but no other signs of CS was admitted for CD evaluation. Urinary free cortisol levels (UFC) were consistently 2-3-fold the upper normal range. Pituitary magnetic resonance imaging (MRI) revealed a 3x4 mm hypoenhancing lesion in the right side of the pituitary gland anteriorly (microadenoma). A graded dexamethasone suppression test indicated that the patient had partial GR. Histology confirmed an adrenocorticotrophin (ACTH)-producing pituitary adenoma. We hypothesized that a NR3C1 mutation was present. Sequencing of the entire coding region of the gene produced normal results in both peripheral and tumor DNA. We present the case of a pediatric patient with an ACTH-producing tumor but little evidence of CS. No mutations in the coding sequence of NR3C1 were detected. We conclude that low level somatic mosaicism for NR3C1 mutations or a mutation in another molecule participating in hGRalpha-signaling may account for this case.

Impairments in Gas Exchange and Mechanical Properties of the Lung in Miners in Comas Induced by Acute Ischemic Stroke

Objective: to study the specific features of lung gas exchange and mechanical properties in comas induced by acute stroke (AS) in miners having an underground length of 10 years or more for the further optimization of intensive care. Subject and methods. Gas exchange (oxygenation index (PaO2/FiO2), the degree of intrapulmonary blood shunting (Qs/Qt)), the mechanical properties of the lung (mean airway pressure (Pmean), airway resistance (Raw), static thoracopulmonary compliance (Cltst)), and intracranial pressure (ICP) were studied and brain spiral computed tomography was conducted on days 1, 3, 5, and 7 of the acute phase of AS in 49 patients. The patients were divided into 2 groups: 1) 12 miners (pensioners) (a study group) and 2) 37 patients without underground work length (a control group). Results. Pmean values increased in both groups on days 3 to 7, rose on day 5 in miners. Cltst was decreased and Raw increased. PaO2/FiO2 decreased on days 3—5, more in the miners and Qs/Qt increased ICP persisted in the upper normal range in both groups. The miners were found to have a higher incidence of pneumonias than the patients having no underground length and the former had longer mechanical ventilation and a higher overall mortality. Conclusion. As compared to the patients without underground length, the miners with existing baseline changes in the respiratory organs showed earlier and pronounced development of impairments in gas exchange and the mechanical properties of the lung in the presence of comas induced by acute stroke. This leads to severer acute respiratory distress syndrome, increases the frequency of other complications, irnd results in higher mortality in this group of patients. Keywords: ischemic stroke; coma; gas exchange; mechanical properties of the lung; underground work length; miner.

Factors influencing insulin sensitivity in patients with mild primary hyperparathyroidism before and after parathyroidectomy

Objectives: Primary hyperparathyroidism (PHPT) is associated with cardiovascular disease. The aims of this study were to investigate lipid and glucose metabolism in mild PHPT, and to identify whether insulin sensitivity correlates with circulating levels of adiponectin, SHBG, and osteocalcin before and after parathyroidectomy (PTX). Materials and methods: Forty-five patients with PHPT were examined before and 1 year after PTX. Circulating levels of triglycerides, total cholesterol, HDL-cholesterol, insulin, glucose, adiponectin, SHBG, osteocalcin, and erythropoietin were measured. Results: At baseline, the mean serum levels of total cholesterol, LDL-cholesterol and triglycerides were above the upper reference limit or in the upper normal range, and insulin sensitivity was reduced as assessed using the HOMA index. One year after parathyroidectomy, serum lipids as well as HOMA index and erythropoietin were unchanged while adiponectin had increased (p < 0.05), and SHBG and osteocalcin had decreased (p < 0.05 and p < 0.0001, respectively). HOMA index correlated negatively with circulating levels of adiponectin, SHBG and osteocalcin. In multiple regression analysis SHBG was the most important predictor of insulin sensitivity, both pre- and postoperatively. Conclusion: Untreated mild PHPT is associated with a moderate derangement of lipid and glucose metabolism. As previously shown in population-based cohorts, insulin sensitivity is positively associated with circulating concentrations of adiponectin, SHBG and osteocalcin. One year after PTX, the mean level of adiponectin was increased, but the levels of SHBG and osteocalcin had decreased and the levels of serum lipids and the insulin sensitivity remained unchanged as compared with baseline.

Study of the diagnostic value of the serum level of the marker SCCA in esophageal squamous cell carcinoma

The level of a serological marker for squamous cell carcinomas (SCC) was studied in patients with primary, remitting, and relapsing esophageal SCC (ESCC). The levels of SCC antigen (SCCA) increased from Stage I to Stage IV (from 0.8±0.3 to 1.7±0.3 ng/ml, so as the percentage of patients with elevated SCCA (from 20 to 60%, respectively). In remission, the values of SCCA were within the upper normal range in all the patients. The diagnostic sensitivity of SCCA in relapse was similar to that in primary SCC (38/9 and 39.8%, respectively). The proportion of SCCA-positive cases was higher in patients with low- and moderate-grade tumors than in those with high-grade tumors (54.1 and 21.4% of cases, respectively). The mean level of SCCA slightly rose after invasive diagnostic procedures. Hence, this group of patients should undergo serum SCCA tests before and 3-4 days after invasive diagnostic procedures. For the monitoring of the efficiency of treatment and preclinical detection of relapses, it is expedient to use SCCA as a serological marker in 30-40% of all patients with primary ESCC and in approximately 50% of patients with low- and moderate-grade SCC.

Antihypertensive Therapy Is Associated with Reduced Rate of Conversion to Alzheimer's Disease in Midregional Proatrial Natriuretic Peptide Stratified Subjects with Mild Cognitive Impairment

Hypertension is a major risk factor of Alzheimer's disease (AD); however, controlled studies on the effect of antihypertensive treatment on the risk of dementia are inconclusive. Therefore, a biological marker that predicts individual response to antihypertensive treatment would be of high clinical relevance. Midregional proatrial natriuretic peptide (MR-proANP), an inactive surrogate molecule of the mature atrial natriuretic peptide, is related to circulatory function and hypertension. A sample population of 134 subjects with mild cognitive impairment (MCI) was followed for up to 6 years. Multivariable Cox regression analysis was conducted to predict conversion to AD based on all relevant variables. Baseline MR-proANP was significantly increased in the AD converter group (p < .0001). The conversion rate of patients treated with antihypertensive drugs was significantly reduced only in patients with elevated MR-proANP at baseline (p = .046). Using an optimized MR-proANP cutoff of 74 pmol/L, representing a value in the upper normal range, treatment with antihypertensive drugs reduced the conversion rate to AD by 36% (p = .035) for patients with levels >74 pmol/L. Further subgrouping by age (>/≤ 72 years at baseline) increased the positive correlation of antihypertensive treatment and MCI outcome for patients below the age of 72 years (conversion rate reduced by 74%, p = .016). These data seem to support the notion of a potential impact of circulatory function for the prognosis of AD at a prodromal stage. The MR-proANP levels may be useful to predict the effect of antihypertensive treatment on conversion rates to AD in subjects with MCI.

Serum albumin and survival in glioblastoma multiforme

Serum albumin is an established predictor of survival in numerous cancers but its prognostic value in central nervous system tumours has not been established. Here we have examined prognostic factors in 685 patients with histologically proven glioblastoma multiforme (GBM), the majority of which (n = 549) had pre-operative serum albumin assayed. Mean serum albumin was 34.7 g/l (SD 5.2). Post-operative survival was significantly less for patients with hypoalbuminaemia (<30 g/l, n = 82) than for patients with normal albumin level (median 2.3 vs. 5.6 months, P < 0.001 Log-rank test). Furthermore, patients with lower normal albumin (30-40 g/l, n = 371) had significantly shorter survival compared against patients with albumin in the upper normal range (40-50 g/l, n = 96; median 5.1 vs. 8.8 months, P < 0.001). Multivariate Cox regression showed the independent predictors of survival were age, debulking surgery, chemoradiotherapy, and serum albumin (Hazard Ratio 0.97 per g/l, P < 0.005). This study suggests pre-operative serum albumin level is a significant predictor of survival in patients with GBM. Further studies are needed to examine the relationship between albumin and other known prognostic factors, and to determine if pre-operative serum albumin is a clinically useful predictor of survival.

Protection against β adrenoceptor agonist reduction of plasma potassium in severe but not in moderate hypokalemia

K-depleted and control rats were anesthetized and infused with terbutalin. In controls, plasma K concentration (pK) decreased by 0.7 mm (P = 0.01). In moderate hypokalemia terbutalin-induced decrease in pK was reduced by 0.3 mm for each 1 mm decrease in pK (n = 8, R(2) = 0.82, P = 0.002) and by 0.2 mm for each 10 mmol/g wet wt. decrease in muscle K content (n = 8, R(2) = 0.66, P = 0.01). Hence, for baseline pK of 4, 3 and 2 mm, decrease in pK was 0.7, 0.4 and 0.1 mm, respectively. In severe hypokalemia (1.7 mm), terbutain induced no further reduction in pK. The combined infusion of insulin and terbutalin showed no additive effect. Normalization of pK by KCl infusion in severe hypokalemia immediately abolished protection against terbutalin induced further pK reduction. Hence, terbutalin clamped pK at around 4 mm, whereas it continued to increase to around 5 mm without terbutalin infusion. Major new findings are: Protection against terbutalin induced further reduction in pK in severe pre-existing hypokalemia (<2 mm) and blunted but nevertheless severe further reduction in pK in more moderate pre-existing hypokalemia; immediate abolishment of protection by normalization of pK; protection against additive reduction in pK by terbutalin and insulin in severe hypokalemia. It may be advisable to avoid hypokalemia when using β adrenoceptor agonists and to maintain pK in the upper normal range if at the risk of arrhythmia.

Transaminase levels in the upper normal range are associated with oral hypoglycemic drug therapy failure in patients with type 2 diabetes

Incident diabetes and the worsening of diabetes have recently been linked to hepatic steatosis. Aim of our study was to determine whether oral hypoglycemic agent failure is associated with higher transaminase levels (valid measure of liver steatosis). We selected 200 patients, attenders (3 consecutive annual evaluations) in our clinic, with type 2 diabetes among which 100 with oral hypoglycemic agents failure and 100 who were still responsive to oral therapy. Failure to therapy was defined as glycated hemoglobin >7.5% despite maximal-dose oral therapy. We analyzed patient histories and laboratory data. Compared with oral-therapy-responsive patients, those with failure had a significantly higher level mostly of alanine aminotransferase at the time of therapy failure and 2 years before. They were more likely to have had symptoms of hyperglycemia at the time of diabetes diagnosis. Regression analysis indicated that each 5-unit increase in transaminase levels independently increased the risk for oral hypoglycemic agents failure by 1.70. Higher liver transaminase levels, especially in patients who had symptomatic hyperglycemia at diabetes diagnosis, associate with oral hypoglycemic agent failure. The possible pathogenetic link between transaminase and declining islet function might consist of insulin resistance and increased circulating fatty acid levels, in turn causing liver steatosis and beta-cell dysfunction.

Serum phosphorus predicts incident chronic kidney disease and end-stage renal disease

Elevations in serum phosphorus are associated with renal decline in animal models and progression of established chronic kidney disease (CKD) in human observational studies. We examined whether serum phosphorus levels increase the risk of incident CKD or end-stage renal disease (ESRD) in two population-based prospective cohort studies. Overall, 2269 participants free of CKD [estimated glomerular filtration rate (eGFR) <60 mL/min/1.73(2)] from the Framingham Heart Study (FHS; mean age 42 years; 53% women) and 13,372 participants from the Third National Health and Nutrition Examination Survey (NHANES III; mean age 44.3 years, 52% women) contributed to the present study. In the FHS, we evaluated the relationship between baseline phosphorus category (<2.5 mg/dL, 2.5-3.49 mg/dL, 3.5-3.99 mg/dL and ≥4 mg/dL) and incident CKD (n = 267). In NHANES, we examined the relationship between phosphorus below and above 4 mg/dL in relation to incident ESRD (n = 65). FHS participants in the highest phosphorus category had an increased risk of CKD [odds ratio 2.14; 95% confidence interval (CI), 1.07-4.28; P = 0.03] in multivariable-adjusted models when compared to the referent group (2.5-3.49 mg/dL). Similarly, NHANES III participants with phosphorus levels ≥4 mg/dL demonstrated an increased risk of incident ESRD compared to those <4 mg/dL (relative risk 1.90; 95% CI 1.03-3.53; P = 0.04). In prospective studies of the general population, serum phosphorus levels in the upper-normal range were associated with a doubling in the risk of developing incident CKD and ESRD.

HNF1A mutation presenting with fetal macrosomia and hypoglycemia in childhood prior to onset of overt diabetes

HNF1A-MODY (MODY3) is a common subtype of autosomal dominant diabetes. Unlike HNF4-MODY where fetal macrosomia and early postnatal hyperinsulinemic hypoglycemia have been reported, a history of transient insulin overproduction has not been recognized in individuals with HNF1A-MODY yet. Here, we report a 40-year-old male patient with HNFJA mutation p.Arg272His (c.815G>A) with a history of fetal macrosomia (4750 g, 59 cm) and, at least, one attack of symptomatic hypoglycemia in childhood. Diabetes was subsequently diagnosed at 19 years. The proband's daughter who developed diabetes at 16 years carries the same mutation, but her birth weight and length were in the upper normal range, and she never experienced hypoglycemic symptoms. The observation of fetal macrosomia and hypoglycemia in childhood is suggestive of a biphasic impact of the HNF1A mutation on beta-cell function over the lifespan, leading from inappropriate insulin oversecretion to final clinical diabetes.

HNF1A mutation presenting with fetal macrosomia and hypoglycemia in childhood prior to onset of overt diabetes

HNF1A-MODY (MODY3) is a common subtype of autosomal dominant diabetes. Unlike HNF4-MODY where fetal macrosomia and early postnatal hyperinsulinemic hypoglycemia have been reported, history of transient insulin overproduction has not yet been recognized in individuals with HNF1A-MODY. Here, we report on a 40-year-old male patient with HNF1A mutation p.Arg272His (c.815G>A) having a history of fetal macrosomia (4750 g, 59 cm), and, at least, one attack of symptomatic hypoglycemia in childhood. Diabetes was subsequently diagnosed at 19 years of age. The proband's daughter who developed diabetes at 16 years carries the same mutation, but her birth weight and length were in the upper normal range, and she never experienced hypoglycemic symptoms. The observation of fetal macrosomia and hypoglycemia in childhood is indicative of a biphasic impact of the HNF1A mutation on p-cell function over the lifespan, leading from inappropriate insulin oversecretion to final clinical diabetes.

Thyroid Function within the Upper Normal Range Is Associated with Reduced Bone Mineral Density and an Increased Risk of Nonvertebral Fractures in Healthy Euthyroid Postmenopausal Women

Thyroid Function within the Upper Normal Range Is Associated with Reduced Bone Mineral Density and an Increased Risk of Nonvertebral Fractures in Healthy Euthyroid Postmenopausal Women

Thyroid Function within the Upper Normal Range Is Associated with Reduced Bone Mineral Density and an Increased Risk of Nonvertebral Fractures in Healthy Euthyroid Postmenopausal Women

Thyroid Function within the Upper Normal Range Is Associated with Reduced Bone Mineral Density and an Increased Risk of Nonvertebral Fractures in Healthy Euthyroid Postmenopausal Women

Aromatase Deficiency Influences the Acute Response to Myocardial Ischaemic Insult in Female Mice—A Matter of Local Sex Steroid Balance?

Sex differences exist in ischaemic heart disease, and the conventional view is that estrogen confers cardioprotection. Oestrogen synthesis depends on androgen availability, with aromatase regulating conversion of testosterone toestradiol. Extra-gonadal aromataseexpression has been shown to mediate estrogen production in some tissues, but a role for local steroid conversion has not yet been demonstrated in the heart. The aim of this study was to determine whether aromatase deficiency influences myocardial function and ischaemic resilience. RT-PCR analysis of C57Bl/6 mouse hearts confirmed cardiac-specific aromatase expression in adult females. Functional performance of isolated hearts from female aromatase knockout (ArKO) and wild-type (ArWT) mice were compared. In aerobic perfusion, left ventricular developed pressures (LVDP) were similar, but dP/dt max was modestly reduced in ArKO hearts (4272± 154mmHg/s vs 3725± 144mmHg/s, of cardiac ischaemia. In this study, we documented the release of BNP-SP and high sensitivity troponin T (Trop T hs) during dobutamine stress echocardiography (DSE) in those with coronary artery disease (CAD) and healthy volunteers. Methods: Sixteen patients withCADand 10 healthy volunteers were recruited. Plasma samples were collected just prior to the DSE and then half hourly for a total of four hours after DSE. At each time point, BNP-SP levelswere determinedby our published radioimmunoassay, whereas Trop T hs levels were determined on a Roche Elecsys analyser. Results:Themajority of patientswithCAD remained on anti-anginals including B blockers at the time of the DSE (11/16). A clear significant rise was seen in both groups in both markers above the 99th percentile upper normal range (25 pmol/l for BNP-SP and 14pg/ml for Trop T hs). The two markers had very different temporal profiles of release with BNPSP peaking at 0.5 h, whereas Trop T hs peaked at 3.5–4.0 hours. There was no significant difference in the pattern of release between groups for either marker as determined by two way repeat ANOVA analysis (BNP-SP, P= 0.34; Trop T hs, P= 0.34).

Increased markers of inflammation and endothelial dysfunction in patients with mild primary hyperparathyroidism

Objectives: The association between primary hyperparathyroidism (PHPT) and cardiovascular disease is incompletely understood. The aims of this study were to evaluate how cardiac function and markers of inflammation and endothelial dysfunction correlate in patients with mild PHPT, and how these markers are influenced by surgical cure of the parathyroid disease (PTX). Material and methods: Forty-five patients with PHPT were examined before and 1 year after PTX. Serum/plasma concentrations of calcium, PTH, highly sensitive C-reactive protein (CRP), interleukin-6 (IL-6), vascular adhesion molecule-1 (VCAM1), E-selectin, and NT-proBNP were measured as well as erythrocyte sedimentation rate (ESR) and creatinine clearance. Cardiac function was evaluated by equilibrium radionuclide angiography. Results: The baseline serum level of IL-6 correlated negatively with baseline parameters of cardiac function (exercise capacity, p < 0.001, left ventricular ejection fraction at exercise, p < 0.01). The mean serum concentrations of IL-6 and CRP and the ESR had increased 1 year after PTX (p < 0.001, p < 0.01, and p < 0.001, respectively) in parallel with a decrease in cardiac function and an increase in circulating NT-proBNP. The mean serum level of VCAM1 was above the upper normal range at baseline and had not changed significantly 1 year after PTX. Conclusion: Patients with mild PHPT and normal renal function displayed signs of subclinical inflammation and endothelial dysfunction. One year after PTX, the inflammatory markers were increased in parallel with a subclinical decrease in cardiac function. Further studies are warranted to clarify the natural course and clinical implications of these changes.

The TSH dynamics in upperand low-normal range in patients with primary hypothyroidism: clinical presentation, well-being and quality of life

In our study we try to determine whether small changes in thyroxine treatment is effective in patients with symptoms of hypothyroidism but with thyroid function tests within the reference range, and to investigate the effect of thyroxine treatment on psychological and physical wellbeing in healthy participants. Sixty ambulatory patients with primary hypothyroidism receiving levothyroxine (L-T4) participated in the study. Patients were divided into 2 groups according to their TSH level. The first group was in TSH low-normal range (0.4–2.0 mU/l), the second in upper-normal (2.1–4.0 mU/l) range. We analyzed the results of several tests: “12 classical hypothyroidism symp- toms”, SF36, HARS, HDRS, Zung scale at baseline and in 3 months. With a small-dose changes we cross the groups to compare the results. Results: At baseline analyze there was a small differ-ence between two groups. Women with in the upper-normal TSH range had more expressed symptoms of hypothyroidism. After small changes in thyroxine treatment we could not say that the clinical picture of a hypothyroidism has changed cardinally, however, it is necessary to notice that there was dynamics of separate symptoms. The same picture was noticed with the depression and anxiety levels. The meanings were rather close and small dose changes in L-T4 treatment were more expressed in group with upper-normal range. The positive dynamics of well-being after dose changing were registered in both groups. Conclusion: Small changes in T4 dosage do not produce measurable changes in hypothyroid symptoms, well-being, or quality of life.

Elastic properties of the vascular wall in patients with rheumatoid arthritis and changes in blood pressure levels

Objective. To evaluate the elastic properties of the vascular wall in patients with rheumatoid arthritis (RA) as applied to the course of the underlying disease and the changes in blood pressure (BP) from one-year follow-up results. Subjects and methods. Therapeutic effectiveness was evaluated in 52 patients with RA according to the EULAR and ACR criteria; pulse wave propagation velocity (PWPV) along the vessels of elastic and muscular types was measured on an apparatus (OOO Neurosoft) at baseline and after one-year follow-up. Results. PWPV values were found to correlate with age, functional class of RA, risk level by the Framingham model, ventricular septal thickness, left ventricular relative wall thickness, erythrocyte sedimentation rate, and the presence of C-reactive protein. After one-year follow-up, the diminished elasticity of vessels correlated with the baseline duration of morning stiffness, the number of swollen joints, and ineffective therapy for RA. The RA patients in whom BP increased to the upper normal range or who developed essential hypertension (EH) had significantly higher values of vascular wall rigidity at the beginning of the follow-up. BP elevation was also associated with age, baseline clinical activity, the systemic manifestations of RA, the cardiovascular risk by the Framingham model. There was an association of vascular elastic properties in RA patients with the magnitude and uncontrolled activity of inflammation and with elevated BP. Conclusion. The findings show it important to reduce the elastic properties of vessels in the emergence of EH in RA.

Lipid profile and early predictors of endothelian dysfunction in hypothyroidism against the TSH level within reference range

Hypothyroidism is associated with premature atherosclerosis and cardiovascular disease. High levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides and recently, homocysteine (Hcy) and C-reactive protein (CRP) emerged as additional cardiovascular risk factors. Sixty ambulatory patients with primary hypothyroidism receiving levothyroxine (L-T4) participated in the study. Patients were divided into 2 groups according to their TSH level. The first group was in TSH low-normal range (0.4–2.0 mU/l), the second in upper-normal (2.1–4.0 mU/l) range. We analyzed the results of lipid profile data, CRP and HCY levels at baseline and in 3 months. With a small-dose changes we cross the groups to compare the results. Patients in upper-normal range group had significantly higher levels of total cholesterol (p = 0.002), LDL-C (p = 0.02), triglycerides (p = 0.03) at baseline. After decreasing the dose of L-T4 in group with low-normal TSH range there were no significant difference in levels of total cholesterol and triglycerides. After dose-changing the level of LDL-C was significantly higher in group with upper-normal TSH range (p = 0.02). After increasing the L-T4 dose in group with upper-normal TSH range we didn't find any significant differences in lipid profile level, but the early predictors of endothelium dysfunction were sig-nificantly lower in group with low-normal TSH range: CRP (p = 0.004), HCY (p =0.05). Conclusion: Small-changes in L-T4 dose which help to achieve the low-normal TSH range leads to significantdecrease in levels of early predictors of en-dothelium dysfunction – C-reactive protein and homocysteine.