Short-term outcomes among patients with subclinical hypothyroidism undergoing primary percutaneous coronary intervention

Objectives: This study aimed to examine possible associations between previously undiagnosed subclinical hypothyroidism and short-term outcomes and mortality in a sample of Iraqi patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Design: This is a prospective observational cohort study. Setting: The study was conducted in a single tertiary referral centre in Baghdad, Iraq. Participants: Thyroid-stimulating hormone and free T4 levels were measured in 257 patients hospitalised with STelevation myocardial infarction who underwent primary percutaneous coronary intervention between January 2020 and March 2022. Main outcome measures: Adverse cardiovascular and renal events during hospitalisation and 30-day mortality were observed. Results: Previously undiagnosed subclinical hypothyroidism was detected in 36/257 (14%) ST-elevation myocardial infarction patients and observed more commonly in females than males. Patients with subclinical hypothyroidism had significantly worse short-term outcomes, including higher rates of suboptimal TIMI Flow (< III) (p =0.014), left ventricular ejection fraction ≤ 40% (p=0.035), Killip class >I (p=0.042), cardiogenic shock (p =0.016), cardiac arrest in the hospital (p= 0.01), and acute kidney injury (p= 0.044). Additionally, 30-day mortality was significantly higher in patients with subclinical hypothyroidism (p= 0.029). Conclusion: Subclinical hypothyroidism previously undiagnosed and untreated had a significant association with adverse short-term outcomes and higher short-term mortality within 30 days compared to euthyroid patients undergoing primary percutaneous coronary intervention. Routine thyroid function testing during these patients' hospitalisation may be warranted.

Biochemical pattern of thyroid function test and clinical impression of thyroid disorder in a rural tertiary health institution in Nigeria

Thyroid disorders are one of the most common endocrine disorders seen globally. Diagnostic challenge may arise both clinically and biochemically because of the multiple function of thyroid hormones (THs). Request for thyroid function test (TFT s) may be based on clinical impression that may suggest thyroid dysfunction or obvious symptoms and signs that are diagnostic of hyperthyroidism or hypothyroidism. Materials and Methods: This retrospective study looks at the biochemical patterns of TFTs and the clinical impression of thyroid disorders in a rural tertiary institution. Information extracted from the laboratory register includes indication for the test, the hospital number, the gender, the age, and the THs assayed. The corresponding biochemical pattern of the TFT result was established. Results: A total of 297 requests were submitted for TH assay; 34 were excluded from the present study because there were no clinical information. There were 239 females and 24 males giving a female-to-male ratio of 9.9:1. Majority of the requests (36.5%) were for goiters, followed by gynecological disorders (20.9%) and clinical thyroid disorders (17.9%). About 46% (45.8%) of the goiter cases were biochemically euthyroid, whereas 13.5% were biochemically primary hyperthyroid. Among the 47 cases of thyroid disorders by the physician's clinical impression, 27.7% were euthyroid, 17% were biochemically hyperthyroid, and 10.6% were hypothyroid. Of the 55 gynecological disorders assessed, only 7.3% show biochemical evidence of TH alteration with 56.4% being euthyroid. About 47% (46.6%) of those that did routine medical examination had altered TH level that includes hyperthyroidism and hypothyroidism. Conclusion: Goiter is the most prevalent thyroid disorder in this environment. Biochemical pattern of thyroid function test in our environment was mostly euthyroid despites clinical features suggestive of thyroid disorders

The relationship between thyroid function and bone health in euthyroid healthy adult Nigerians

There is a dearth of reports on variation in thyroid function within the reference range on bone health in euthyroid healthy adults in Nigeria This study evaluated the variation in thyroid function within reference range on biochemical bone markers and bone mineral density in healthy adults. This prospective study was carried out among 40 healthy participants above 21 years of age but less than 50 years by systematic random sampling. Exclusion criteria included subjects with acute or chronic disease states, previous fractures, any drug use, history of alcohol or smoking. Interviewer ­questionnaire was administered. Anthropometric indices determined. Blood samples for thyroid function tests included triiodothyronine (FT3), thyroxine(FT4), Thyroid Stimulating Hormone(TSH-thyrotropin), osteocalcin (OC), and Alkaline phosphatase (ALP), serum calcium adjusted for albumin, inorganic phosphorus, and urine sample for calcium and creatinine were collected after 10 - 12 hours fast. 24 hour calcium excretion was calculated (CaE). Bone mineral Density determined by Dual X - ray Absorptiometry scan. Statistical analysis done,< 0.05 set as level of significant. The mean age 34.10 years (7.8), with BMI 26.32kg/m2 (4.02),waist circumference 76.60cm (17.07). The mean levels of bone markers were osteocalcin 17.68ng/ml (10.67), alkaline phosphatase70.60 IU/L (16.56) and 24hour calcium excretion 396.10mg/dl (101.89). OC and ALP inversely correlated with age but CaE did not. TSH positively correlates OC( r =0.35,p=0.029), but not CaE, p > 0.05. FT4 correlates bone formation markers OC,ALPand CaE p <0.05. Neither FT3,FT4 or TSH neither correlates with zscore BMD. Normal variation in the levels of ft4 and TSH has an early impact on biochemical bone markers compared to bone mineral density. Biochemical bone markers are thus suggested as screening tools for early detection of metabolic bone diseases in euthyroid healthy adults