Historia familiar de enfermedad tiroidea y riesgo de hipotiroidismo congénito en neonatos con síndrome de Down / Family history of thyroid disease and risk of congenital hypothyroidism in neonates with Down syndrome

Resumen Introducción: La historia familiar de enfermedad tiroidea (HFET) como factor de riesgo para hipotiroidismo congénito (HC), en síndrome de Down (SD) aún no ha sido explorada. Objetivo: Determinar si la HFET está asociada a mayor riesgo de HC en neonatos con SD. Método: Estudio de casos y controles en 220 neonatos con SD. Se compararon las pruebas de función tiroidea (PFT) de 37 con SD e HFET (casos), frente a las PFT de 183 recién nacidos con SD sin HFET (grupo de referencia). Se realizó análisis de regresión logística multivariante y se calculó la razón de momios (RM) y sus respectivos intervalos de confianza del 95 % (IC 95 %). Resultados: Nueve casos HC (4.1 %). El HC mostró asociación con la HFET (RMa = 8.3, IC 95 %: 2.0-34.3), particularmente en los varones (RMa = 9.0, IC 95 %: 1.6-49.6). La ausencia de HFET tuvo una RM de protección para HC (RMa = 0.4, IC 95 %: 0.1-0.8). Conclusiones: La HFET puede es una estrategia fácil y accesible para identificar pacientes con SD con mayor riesgo de HC.

Abstract Introduction: Family history of thyroid disease (FHTD) as risk factor for congenital hypothyroidism (CH) in patients with Down syndrome (DS) has not yet been explored. Objective: To determine whether FHTD is associated with an increased risk for CH in DS. Method: Case-control study in 220 neonates with DS. Thyroid function tests of 37 infants with DS and FHTD (cases) were compared with those of 183 DS newborns without FHTD (reference group). Data were analyzed using multivariate logistic regression analysis and adjusted odds ratios (aORs) with their respective 95 % confidence intervals (CI) were calculated. Results: Nine newborns with DS in our sample had CH (4.1 %). FHTD showed an association with CH in neonates with DS (aOR = 8.3, 95 % CI: 2.0-34.3), particularly in males (aOR = 9.0, 95 % CI: 1.6-49.6). In contrast, newborns with DS without FHTD were less likely to suffer from CH (aOR = 0.4, 95 % CI: 0.1-0.8). Conclusions: FHTD detailed evaluation can be an easy and accessible strategy to identify those newborns with DS at higher risk for CH.

Fluorosis and its impact on thyroid hormones: a cross-sectional study in Bankura District, West Bengal, India

Background: Fluorosis is an important public health problem in India. Fluoride ions can interact with iodide which can leads to abnormal thyroid function.Methods: The present descriptive, community based study was conducted over a period of 1 year and 6 months in the endemic and non-endemic areas of Bankura district with the sample size of 200. High serum fluoride level (≥0.02 mg/L) was also noted in fluorosis endemic areas (39%) with respect to non-endemic areas (3%). Thyroid profiles were investigated among the participants.Results: Hypothyroidism was found to be higher in proportion in endemic regions (34%) with respect to non-endemic regions (20%). The levels of serum TSH, fT4 and fluoride in endemic areas were correlated significantly with non-endemic areas. Fluoride level was found to be in significant positive correlation with TSH level and in negative significant correlation with fT4 and fT3.Conclusions: High fluoride level could produce hypofunctioning of thyroid gland and so hypothyroidism was found to be higher in proportion in fluorosis endemic areas in respect to non-endemic areas.

Significance Of Anti-Thyroperoxidase Antibody Estimation In Patients With Hypothyroidism

Introduction: Hypothyroidism is a common endocrine disorder characterized by decreased levels of thyroid hormones. Anti-thyroperoxidase antibody is produced in autoimmune thyroiditis which inhibits the synthesis of thyroid hormones. Aims & Objectives: The study was planned to explore the significance of anti-TPO antibody in hypothyroid patients. Materials and Methods: 150 newly diagnosed patients, age 20-60 years were enrolled for the study. Patients were divided on the basis of antiTPO levels as anti-TPO positive(n=87) anti-TPO negative (n=63).Thyroid hormones viz. serum triiodothyronine (T3), thyroxine (T4), free T3 (FT3), free T4 (FT4) and thyroid stimulating hormone (TSH) levels were compared between the two groups. Results: Mean serum TSH level was significantly higher in anti-TPO positive group. Mean serum T3 & T4 levels were comparable (P= NS) among the two groups whereas FT3 (P= 0.014) and FT4 (P= 0.003) were significantly lower in the anti-TPO positive group. Conclusion: Serum FT3 & FT4 represent the biologically active proportion of thyroid hormones. The present study suggests that lower FT3 & FT4 levels can better correlate with anti-TPO activity in patients of hypothyroidism

Sensitivity of supplementation of thyroid hormone on treatment of idiopathic short-stature children during therapy with recombinant human growth hormone / 医学前沿

This study aimed to evaluate the effects of thyroid hormone supplementation on growth rate of children with idiopathic short stature (ISS) and low-normal serum free thyroxine FT4 who were receiving growth hormone therapy. We selected 64 prepubertal children with FT4 levels in the lowest third of the normal range as the lower FT4 group, and these children were divided randomly into two subgroups: L-thyroxine (L-T4)-treated subgroup was treated with L-T4 (0.5-3.0 g/(kg·d)) from the beginning of the study, and the non-L-T4-treated subgroup received placebo. We also selected 39 ISS children with FT4 in the upper two-thirds of the normal range as the higher FT4 group. During the first year, the lower FT4 group featured lower FT3, FT4, thyroid stimulating hormone (TSH), and insulin-like growth factor-I standard deviation score (IGF-I SDS) and significantly lower height velocity (HV) compared with the higher FT4 group. However, in the lower FT4 group, the L-T4-treated subgroup presented higher FT4, FT3, TSH, and IGF-I SDS concentrations and significantly higher HV compared with children in the non-L-T4-treated subgroup. In children with ISS, the negative effect of thyroid hormone deficiency on growth rate should be considered when FT4 level lies in the low-normal range prior to recombinant human growth hormone treatment.

Prevalence and pattern of Hypothyroidism in patients attending the Outpatient department of a tertiary care teaching hospital.

Introduction: Among the endocrine disorders, Hypothyroidism is now believed to be the worldwide problem next to Diabetes. Aims: This study was carried out to ascertain the prevalence and pattern of Hypothyroidism. Methods: This prospective, epidemiological study was conducted in patients aged ≥20 years suspicion of thyroid disorders at a tertiary care teaching hospital from Jan 2012 to Dec 2013 in Bhuj, Gujrat. Thyroid abnormalities were diagnosed on the basis of laboratory results (serum FT3, FT4 and Thyroid Stimulating Hormone [TSH]). Results: Out of 425 patients enrolled in our study, only 345 patients completed left. Out of the 345 analysable subjects, Female [n=217 (62.89%)] predominance is seen. Around n=72 cases were confirmed having thyroid abnormalities, Out of n=72 cases, only n=32 (9.27%) participants were found to have Hypothyroidism, Subclinical hypothyroidism was detected in n=28(8.11%) cases. Only n=12 (3.47%) cases had signs and symptoms of Clinical hyperthyroidism. Conclusion: The prevalence of hypothyroidism was high, affecting approximately 9.27% study population. Hypothyroidism is found to have close association with Female gender and older age. Iodine intake ceases to be the sole etiological contender for thyroid disorders in urban areas.

Assessment of Thyroid Disorder in FarWestern Part of Nepal: A Hospital Based Study.

Objectives: This study was conducted to know the status of thyroid disorder in people of far western region of Nepal. Methods: A total of 808 cases, out of which 133 male and 675 female were included and study was carried out using data retrieved from the register maintained in the Department of Biochemistry of the Nepalgunj Teaching Hospital, Kohalpur, Banke, Nepal, between 1st January, 2011 and 28th February, 2012. The variables collected were age, sex, and thyroid function profile including free T3, free T4 and TSH. The data was analyzed using Excel 2003, R 2.8.0 Statistical Package for the Social Sciences (SPSS) for Windows Version 16.0 (SPSS Inc; Chicago, IL, USA) and the EPI Info 3.5.1 Windows Version. Results: The percentage of thyroid disorders was 33.66% in people of far western region of Nepal. The people were highly affected by overt hyperthyroidism (14.9%) followed by subclinical hyperthyroidism (9.9%). The subclinical hypothyroidism was 7.9% while 1% overt hypothyroidism only. Serum fT3, fT4 and TSH level were significantly different in male and females. Similarly, fT3, fT4 and TSH levels show statistically significant differences in different thyroid disorders. The fT3 and fT4 level in overt hyperthyroidism and subclinical hypothyroidism showed statistically significant differences when compared with euthyroidism group. Likewise, TSH level also shows statistically significant in all the thyroid disorders when compared with euthyroidism group. The fT3 and fT4 levels were statistically insignificant in all the age groups whereas TSH level showed statistically significant different in all the age groups. The fT3 and fT4 level in 21-40 years showed statistically significant when compared with serum level of fT3 and fT4 of 0-20 years. Similarly, serum level of TSH in 21-40 and 41-60 years also showed statistically significant when compared with serum level of TSH of 0-20 years. Conclusion: The people residing in far western region have risk for thyroid disorders. They were suffering with thyroid disorder, especially overt hyperthyroidism (14.9%) and subclinical hyperthyroidism (9.9%). Further studies are required to characterize the reasons for this high prevalence of overt hyperthyroidism and subclinical hyperthyroidism.

Influência da função tireoidiana nos níveis séricos de CPK / Influence of thyroid function in CPK serum levels

OBJETIVO: Determinar a variação da CPK sérica em função do TSH e T4 livre (FT4) e avaliar a CPK sérica nos estados patológicos da tireoide (hipertireoidismo e hipotireoidismo), em relação ao eutireoidismo. MATERIAIS E MÉTODOS: Analisaram-se, retrospectivamente, 6.230 exames laboratoriais de 2007 a 2011, com as dosagens de TSH e CPK. Destas, 3.369 com dosagens de FT4. Avaliou-se a correlação entre CPK com TSH e com os estados patológicos da tireoide. RESULTADOS: A correlação entre TSH e CPK foi positiva (r = 0,065), enquanto entre CPK e FT4 foi inversamente proporcional (r = -0,091, p < 0,05). Do total, 586 (9,4%) medidas foram de hipertireoidismo com mediana (intervalo) do CPK de 98 U/L (27 a 1.113) e 556 (8,9%), hipotireóideos com CPK de 114 U/L (25-4.182). CONCLUSÃO: Houve correlação positiva entre CPK sérica e TSH e negativa com FT4, sendo a CPK menor no grupo com hipertireoidismo e maior no grupo de hipotireoidismo.

OBJECTIVE: To determine serum CPK variation based on TSH e free T4 (FT4), and to assess serum CPK in pathological states of the thyroid (hyperthyroidism and hypothyroidism), in relation to the euthyroidism. MATERIAL AND METHODS: We evaluated retrospectively 6,230 laboratory results of TSH and CPK from 2007 to 2011. From these, 3,369 had free T4 results. We evaluated the correlation between CPK and TSH and the pathological states of the thyroid. RESULTS: The correlation between TSH and CPK was positive (r = 0.065), while that between CPK and FT4 was negative (r = -0.091, p < 0.05). From the total of results analyzed, 586 (9.4%) were measures of hyperthyroidism, with a median (range) of CPK of 98 U/L (27 to 1,113), and 556 (8.9%) were of hypothyroidism, with CPK of 114 U/L (25-4,182). CONCLUSION: A positive correlation was found between serum CPK and TSH, and a negative correlation between CPK and FT4. CPK was lower in the group with hyperthyroidism, and greater in that with hypothyroidism.

Differential Diagnostic Value of Total T3/Free T4 Ratio in Graves' Disease and Painless Thyroiditis Presenting Thyrotoxicosis

BACKGROUND: It is important to differentiate Graves' disease from that of painless thyroiditis in patients with thyrotoxicosis. In this study, we evaluated the usefulness of total T3 to free T4 ratio in making a differential diagnosis between Graves' disease and painless thyroiditis. METHODS: We reviewed medical records of thyrotoxic patients, who had been diagnosed with Graves' disease or painless thyroiditis, from October 2009 to July 2011. We assessed clinical characteristics, serum levels of total T3, free T4, thyroid stimulating hormone, thyrotropin-binding inhibitory immunoglobulin, and findings of 99mTechnetium thyroid scan. We analyzed the total T3/free T4 ratios between Graves' disease and painless thyroiditis patients. RESULTS: A total of 76 untreated thyrotoxic patients "49 Graves' disease and 27 painless thyroiditis" were examined. The total T3, free T4 levels and the total T3/free T4 ratios were significantly higher in patients with Graves' disease than in those with painless thyroiditis (P 73, the possibility of Graves' disease was significantly higher than in painless thyroiditis (sensitivity, 75.5%; specificity, 70.3%). The sensitivity and specificity of the total T3/free T4 ratio in patients with free T4 < 3.6 ng/dL have been increased (sensitivity, 100%; specificity, 71.4%). CONCLUSION: The total T3/free T4 ratios was useful for making a differential diagnosis between Graves' disease and painless thyroiditis.

Comparación de oos niveles de hormonas tiroideas entre dos líneas de pollo de engorde / Comparisonof thyyroid hormone levels between two lines of broilrrs

Objetivo: establecer valores de referencia en los niveles de TSH y T4 libre, para las líneas de pollo de engorde Ross y Cobb, así mismo, comparar los niveles de hormonas tiroideas en suero sanguíneo entre estas dos líneas. Materiales y métodos: se obtuvo suero en ayunas de 100 pollos de engorde (50 Ross y 50 Cobb) de 35 días de edad y se determinaron los niveles de TSH y T4L mediante inmunoensayo enzimático. Resultados: los valores de TSH para la línea Ross (µUI/mL) fueron: promedio 0.00; mínimo 0.06; máximo 0.34 y desviación estándar de 0.07. Para la línea Cobb (µUI/mL) fueron: promedio 0.01; mínimo 0.08; máximo 0.42 y desviación estándar 0.09. El valor P del test F es superior o igual a 0.05, por tanto, no hay diferencia estadísticamente significativa, con una confidencia del 95 % para la TSH entre líneas. Los valores de T4L para la línea Ross (ng/dL) fueron: promedio 0.71, mínimo 0.60, máximo 1.15 y desviación estándar de 0.27, mientras que los valores encontrados para la línea Cobb (ng/dL) fueron: promedio 0.76; mínimo 0.20; máximo 1.26 y desviación estándar 0.28. El valor P del test F es superior o igual a 0.05, por ende, no hay diferencia estadísticamente significativa, con una confidencia del 95 % para T4L entre líneas. Conclusión: los niveles de TSH y de T4L entre las dos líneas evaluadas, son similares, lo cual es atribuible a que poseen una respuesta hormonal similar a causa de la selección genética a la que han sido sometidas. Se aportan valores de referencia para las dos líneas comerciales de pollo de engorde evaluados.

Objective: to establish reference values for TSH and free T4 in two lines of broilers (Ross and Cobb), and also to compare the thyroid hormone levels in serum of those two lines. Materials and methods: after fasting, serum of one-hundred, 35 days of age broilers (50 Ross and 50 Cobb) was obtained, and TSH and free T4 levels were measured using enzymatic immunoassay. Results: the TSH values for the Ross line (µUI/mL) were: average 0.00; minimum 0.06; maximum 0.34; and 0.07 standard deviation. For the Cobb line (µUI/mL) the values were: average 0.01; minimum 0.08; maximum 0.42; and 0.09, standard deviation. The P value for the F test is superior or the same as 0.05. As a consequence, there is no statistically significant difference with a confidence level of 95 %. for TSH between the two analyzed lines The free T4 values for the Ross (ng/dL) line were: average 0.71; minimum 0.60; maximum 1.15; and 0.27 standard deviation, and the values found for the Cobb line were: average 0.76; minimum 0.20; maximum 1.26; and 0.28 standard deviation. The P value for the F test is superior or the same as 0.05. As a consequence there is no statistically significant difference with a confidence level of 95 %. for free T4 between the two analyzed lines. Conclusion: levels of TSH and free T4 are similar for the two lines tested, which can be attributed to a similar hormonal response they have due to the genetic selection they have undergone. Reference values for TSH and free T4 are presented.

Comparación de oos niveles de hormonas tiroideas entre dos líneas de aves ponedoras / Comparison o thyyroid hormone levels between two lines of laying hens

Objetivo. Establecer valores de referencia en los niveles de TSH y T4 libre, para las líneas de ponedoras Hy-Line W-36 y Lohmann Brown-Classic, asimismo, comparar los niveles de hormonas tiroideas en suero sanguíneo entre estas dos líneas. Materiales y métodos. Se obtuvo suero en ayunas de 100 gallinas ponedoras (50 Hy-Line W-36 y 50 Lohmann Brown-Classic) de 25 semanas de edad, y se determinaron los niveles de TSH y T4 libre mediante inmunoensayo enzimático. Resultados. Los valores de TSH para la línea Hy-Line W-36 (uUI/ml) fueron: promedio, mínimo, máximo y desviación estándar de 0,09, 0,00, 0,82, 0,15, respectivamente. Para la línea Lohmann Brown-Classic (uUI/ml) fueron: 0,29; 0,00; 4,98; 0,78, respectivamente. El valor P del test F es mayor o igual a 0,05, por lo cual no hay diferencia estadísticamente significativa, con una confidencia del 95% para la TSH entre líneas. Los valores de T4 libre para la línea Hy-Line W-36 en ng/dl fueron: promedio, mínimo, máximo y desviación estándar de 0,95, 0,11, 2,00, 0,53, respectivamente, mientras que los valores encontrados para la línea Lohmann Brown-Classic en ng/dl fueron: 1,54, 0,21, 2,58, 0,49, respectivamente. El valor P del test F es inferior a 0,05, evidenciando diferencia estadísticamente significativa, con una confidencia del 95% para T4 libre entre líneas. Conclusión. Se observó diferencia estadística para los niveles de T4 libre entre las líneas estudiadas; esto podría explicarse ya que la línea semi-pesada (Lohman Brown-Classic) deposita una mayor cantidad de grasa en el organismo, influyendo en el aumento de los niveles de T4 para esta y no para la línea liviana Hy-Line W-36. Se aportan valores de referencia para las dos líneas comerciales de ponedoras evaluadas.

Objective. To establish reference values for TSH and free T4, in two lines of laying hens (Hy-Line W-36 and Lohmann Brown-Classic),as well as to compare the thyroid hormone levels in serum between those two lines. Materials and methods. One hundred, 25 weeks of age laying fasting hens serum (50 Hy-Line W-36 and 50 Lohmann Brown-Classic) was obtained and TSH and free T4 levels were measured using enzymatic inmunoessay. Results. The values obtained for TSH for High-Line W-36 (uUI/ml) were: mean, minimal, maximal, and standard deviation, 0.09, 0.00, 0.82, 0.15 respectively. For the Lohmann Brown-Classic (uUI/ml) the values were, 0.29, 0.00, 4.98, 0.78, respectively. The P value of test F was greater or equal to 0.05 reason why there is not statistical significant difference, with a 95% confidence for TSH between the lines studied. The free T4 values obtained for Hy-Line W-36 in ng/dl were mean, minimal, maximal, and standard deviation of 0.95, 0.11, 2.00, 0.53 respectively while the values found for the Lohmann Brown-Classic line in ng/dl were 1.54, 0.21, 2.58, 0.49 respectively. The P value for the F test was inferior to 0.05, showing statistically significant difference with a 95% confidence for free T4 between the lines studied. Conclusion. Statistical difference was observed for free T4 between the two studied lines. This could be explained because the semi-heavy line (Lohman Brown-Classic) deposits a higher quantity of fattening in the organism influencing the increase of T4 levels for this line and not for the light Hy-Line W-36. Reference values for the two laying hens studied lines are presented.

Free T4 is negatively correlated with body mass index in euthyroid women

BACKGROUND/AIMS: Overt thyroid dysfunction is well known to affect weight. However, the influence of normal-range changes in thyroid status on body mass index (BMI) is unclear. We sought to evaluate thyroid function (free T4, TSH) and its possible relationship with BMI and lipid profiles in euthyroid subjects. METHODS: A total of 1572 euthyroid women (mean age 46.2 years) who visited Daegu Catholic University Medical Centre for primary health screening participated in this cross-sectional study. Women who were not euthyroid and women who took thyroid medication were excluded. TSH, free T4, and lipid profile [total-cholesterol, triglyceride (TG), HDL-C, LDL-C] were evaluated. RESULTS: Obese euthyroid women had lower free T4 levels than did lean euthyroid women. After adjustment for age and smoking, free T4, but not TSH, was significantly negatively correlated with BMI. After adjustment for age, smoking, and BMI, free T4 was negatively correlated with TG to a significant degree. CONCLUSIONS: We demonstrated a negative correlation between free T4 within the normal range and BMI in euthyroid subjects. These findings suggest that low free T4 is associated with obesity in euthyroid subjects.

Change of TSH, T4, and Free T4 Concentrations During the 48 Hours of Postnatal Period / 대한소아내분비학회지

PURPOSE: Congenital hypothyroidism is the most common endocrine disease in infant period and if it is not treated in good time it would cause irreversible failure to thrive and mental retardation. For this reason neonatal screening test for diagnosis is critical in early infant. TSH concentrations which were performed to know thyroid functions normally or not increased rapidly at 30 minutes of life and then fell at 48 hours of life so it was considered inappropriate for neonatal screening test because of false positive result. Otherwise free T4 is not variable within 48 hours, and that's why authors proposed free T4 as an applicable way to early discharge neonates for neonatal screening test. METHODS: We have performed this study to obtain normal TSH, T4, and free T4 concentrations in Korean neonates. Total 17 neonates were studied in Soonchunhyang University Hospital from March 2004 to June 2004. 17 samples were performed at 15, 30 minutes, 1, 2, 3, 4, 24, 48 hours of life from 17 neonates who have had no perinatal problem, medication history and mother's illness studied and the results were compared by applying enzyme linked immunosorbent assay. RESULTS: In the early postnatal period, serum TSH concentrations increased rapidly to peak level (mean of 32.06 microIU/mL) at 30 minutes of life and then fell very gradually to mean concentration (mean of 4.18 microIU/mL) at 48 hours of life and serum T4 concentrations shows variable pattern but the mean values of T4 showed normal range of T4 (6.0-19.9 microgram/dL). On the other hand, serum free T4 concentrations increased to peak level (mean of 3.00 microgram/dL) at 24 hours of life and gradually decreased and it was observed that the mean values of free T4 maintained higher than the diagnostic criteria of congenital hypothyroidism (0.85 microgram/dL). CONCLUSION: According to this result, we consider that free T4 is much more applicable way to early discharge neonates for neonatal screening test because of its slim variability.