Correlation analysis of body composition and thyroid function in different genders of T2DM based on propensity score matching / 西安交通大学学报(医学版)

【Objective】 To investigate the correlation between body composition and thyroid function indicators in type 2 diabetic patients with euthyroidism of different genders. 【Methods】 Type 2 diabetic patients with euthyroidism who were hospitalized in the Endocrinology Department of The Second Affiliated Hospital of Xi’an Jiaotong University from February 2016 to September 2018 were enrolled in this study. Bioelectric impedance analysis was used to measure body composition, and the thyroid function indicators (FT3, FT4, and TSH) were tested. The male and female subjects were matched according to the ratio of 2:1 using the propensity score matching method, and the correlation between body composition and thyroid function indicators was studied in different genders by correlation analysis. 【Results】 The basal metabolic rate, trunk fat mass, fat-free mass, fat-free mass index, bone mass, water mass, total body muscle mass, skeletal muscle mass, and skeletal muscle index were positively correlated with FT3 in male patients (P<0.05). The percentage of body fat mass and fat mass index were positively correlated with FT3 and TSH (P<0.05), and the percentages of lean mass, water mass, and total body muscle mass were negatively correlated with FT3 and TSH (P<0.05), and the basal metabolic rate was negatively correlated with FT4 (P<0.05) in female. 【Conclusion】 In euthyroid type 2 diabetic patients, the correlation between body composition and thyroid function indicators are different between males and females. In males, only FT3 is positively correlated with basal metabolic rate, trunk fat mass, and fat free-related composition; while in females, both FT3 and TSH are positively correlated with fat-related composition, but negatively correlated with fat-free-related composition.

A rare case of acute thyroid eye disease in a young male

Thyroid Eye Disease also known as Thyroid Associated Orbitopathy, Grave’s Disease is typically a self-limiting autoimmune process associated with dysthyroid states usually manifesting in middle age. The clinical presentation may vary from very mild disease to severe irreversible sight threatening complications. Primary risk factors for TED are environmental influences especially smoking, previous pathogen exposures, stress, previous use of radio iodine and complex genetic components. Here we report a case of 25-year-old male who presented to our OPD with complaints of swelling of eyes, photophobia, lacrimation since 3days. Bilateral mild proptosis, severe congestion and conjunctival injection with 20/20 vision in both eyes were noted on examination. Blood investigations showed Eu-clinical Thyroid state whereas MRI Brain and Orbits showed all four Recti muscle belly enlargement. This case emphasizes one of the rare presentations of TED in accordance to Age, Sex and Clinical status of the thyroid.

Parameters affecting the period for being euthyroid in newly-diagnosed Graves’ disease treated with antithyroid agent

Background: There are limited data about the factors affecting the response time to medical treatment in Graves’ disease (GD) although many studies examined the predictors of the relapse after drug withdrawal. The aim of the current study was to evaluate the time for becoming euthyroid under antithyroid drug (ATD) therapy and the parameters influencing this period in patients diagnosed as GD.Methods: Patients with newly-diagnosed GD and decided to treat with ATD initially between March 2017 and September 2018 were retrieved retrospectively. Sociodemographic features as well as laboratory parameters like thyroid function tests and thyroid-stimulating hormone-receptor antibody (TRab) at the time of diagnosis were recorded.Results: Out of 41 patients, 63.4% (n=26) were female. The mean age was 36.1±11.7 years and 43.9% (n=18) of them were smoking. The time between the initiation of treatment and the duration of becoming euthyroid was 2.4±1.8 months. No significant difference was noted between age, gender, and smoking status and the time to become euthyroid under ATD treatment. This period was significantly positively correlated with levels of free triiodothyronine, free thyroxine, and negatively correlated with thyroid-stimulating hormone. Response to ATD therapy was higher in patients with pre-treatment TRab levels <10 IU/l than TRab ≥10 IU/l (p=0.011).Conclusions: Pretreatment thyroid function tests and TRab levels may be taken into consideration before deciding treatment in patients with newly diagnosed GD. It would be useful to design more comprehensive studies so that this proposal can find a response in clinical practice.

Trikatu Churna In The Management Of Hypothyroidism

Thyroid disease especially Hypothyroidism is one of the commonest endocrine disorders worldwide and its prevalence of is increasing day by day. In allopathic system hypothyroidism is managed by replacement therapy with L-thyroxin which appears effective in restoring biochemical euthyroidism. However, studies continue to show problems in the management of this condition. Many patients report not feeling well with persistent symptoms despite adequate T4 replacement therapy. It has become necessary to find alternative medicine for managing hypothyroid symptoms. The main underlying pathology in Hypothyroidism is Hypometabolism in the tissues. This hypometabolism can be correlated to Mandagni in Ayurveda. Keeping this in mind we can plan the treatment of hypothyroidism in the line of treatment of Mandagni. In the treatment of Mandagni, on effective Ayurvedic formulation is Trikatu Churna. In this clinical study we have used Trikatu churna, as a dietary supplement in 30 patients from the OPD of Govt. Ayurvedic College and Hospital, Guwahati, to study its potential in the management of hypothyroidism. The statistical analysis of the data in trial group with Trikatu churna showed the value at 1.86 with level of significance at 1% (p<0.10). The Result of the clinical trial signifies that Trikatu churna is effective in the management of hypothyroidism.

RE: Novel Application of Quantitative Single-Photon Emission Computed Tomography/Computed Tomography to Predict Early Response to Methimazole in Graves' Disease

No abstract available.

Novel Application of Quantitative Single-Photon Emission Computed Tomography/Computed Tomography to Predict Early Response to Methimazole in Graves' Disease

OBJECTIVE: Since Graves' disease (GD) is resistant to antithyroid drugs (ATDs), an accurate quantitative thyroid function measurement is required for the prediction of early responses to ATD. Quantitative parameters derived from the novel technology, single-photon emission computed tomography/computed tomography (SPECT/CT), were investigated for the prediction of achievement of euthyroidism after methimazole (MMI) treatment in GD. MATERIALS AND METHODS: A total of 36 GD patients (10 males, 26 females; mean age, 45.3 ± 13.8 years) were enrolled for this study, from April 2015 to January 2016. They underwent quantitative thyroid SPECT/CT 20 minutes post-injection of (99m)Tc-pertechnetate (5 mCi). Association between the time to biochemical euthyroidism after MMI treatment and %uptake, standardized uptake value (SUV), functional thyroid mass (SUVmean × thyroid volume) from the SPECT/CT, and clinical/biochemical variables, were investigated. RESULTS: GD patients had a significantly greater %uptake (6.9 ± 6.4%) than historical control euthyroid patients (n = 20, 0.8 ± 0.5%, p < 0.001) from the same quantitative SPECT/CT protocol. Euthyroidism was achieved in 14 patients at 156 ± 62 days post-MMI treatment, but 22 patients had still not achieved euthyroidism by the last follow-up time-point (208 ± 80 days). In the univariate Cox regression analysis, the initial MMI dose (p = 0.014), %uptake (p = 0.015), and functional thyroid mass (p = 0.016) were significant predictors of euthyroidism in response to MMI treatment. However, only %uptake remained significant in a multivariate Cox regression analysis (p = 0.034). A %uptake cutoff of 5.0% dichotomized the faster responding versus the slower responding GD patients (p = 0.006). CONCLUSION: A novel parameter of thyroid %uptake from quantitative SPECT/CT is a predictive indicator of an early response to MMI in GD patients.

Relación Clínico-ecográfica de la Orbitopatía asociada a tiroides / Clinical and sonographic relationship associated with thyroid orbitopathy

Se busca cualificar y cuantificar los cambios clínicos no detectables en los estadíos iniciales de la enfermedad tiroidea, a través de la ecografía orbitaria y la ecografía Doppler-dúplex color; adicionalmente medir los valores hemodinámicos de la arteria y vena oftálmicas, con el fin de detectar modificaciones precoces observables en el nervio óptico. Estudio descriptivo, transversal, y correlacionalde 80 pacientes; 40 pacientes con diagnóstico de enfermedad tiroidea y 40 pacientes grupo control, a los que se les realizó ecografía orbitaria y Doppler color desde Julio a Diciembre. Del grupo con enfermedad tiroidea, 90% eran femeninos y 10% masculinos; 75% tenían entre 25-59 años, 45% hipertiroideos, 35% hipotiroideos y 10% eutiroideos; 35% presentaron hábitos tabáquicos positivos y 47,5% hábitos cafeínicos. El 87,3% tenían exoftalmometrías<23mm. Hubo reflectividad moderada en 136 músculos (43%) predominando en el complejo recto superior-elevador del párpado superior. El índice de pulsatibilidad, índice de resistencia y la velocidad pico sistólico de la arteria oftálmica se encontró elevados en los hipertiroideos. Los índices de la vena oftálmica como V1 y V2 estuvieron elevados en los tres grupos (hiper, hipo y eutiroideos). Concluyendo que el eco orbitario evalúa alteraciones cuantitativas y cualitativas tales como grosor muscular, alteraciones en la reflectividad interna de los mismos, edema asociados a las glándulas lagrimales, edema en la cabeza de los nervios ópticos, cambios en la grasa orbitaria, etc., los cuales son significativos en el diagnóstico y seguimiento de estos pacientes. El eco Doppler reveló alteraciones hemodinámicas importantes en parámetros índices de pulsatibilidad y velocidad pico sistólico en los pacientes hipertiroideos.

This paper seeks to qualify and quantify non detectable clinical changes in the initial stages of thyroid disease, through orbit ultrasound and Doppler color duplex ultrasonography; as well as to measure the hemodynamic values of the ophthalmic artery and vein for early detection of observable changes in the optic nerve. Descriptive, cross-sectional and correlational field study of 80 patients, 40 patients diagnosed with thyroid disease and 40 control group patients, who underwent orbital color Doppler ultrasound from July 2006 to December 2007. From the thyroid disease group, 90% were female and 10% male; 75% were between 25-59 years, 45% with hyperthyroidism, 35% with hypothyroidism and 10% euthyroid; 35% had positive smoking habits and 47.5% caffeine habits. 87.3% with <23mm of Exophtalmometry. Moderate reflectivity was present in 136 muscles (43%) with predominance in the upper-right lifting complex of the upper eyelid. Pulsatility index, resistance index and systolic peak velocity of the ophthalmic artery were elevated in hyperthyroidism subjects. Indices of the ophthalmic vein as V1 and V2 were elevated in all groups (hyper, hypo and euthyroid). It is concluded that the orbital eco evaluates quantitative and qualitative alterations such as edema and fibrosis, which are significant in the diagnosis and monitoring of these patients. The Doppler echo revealed significant hemodynamic changes in pulsatility index parameters and systolic peak velocity in hyperthyroidism patients.

FT3/FT4 ratio predicts non-alcoholic fatty liver disease independent of metabolic parameters in patients with euthyroidism and hypothyroidism

OBJECTIVE: This study was performed to evaluate the effects of metabolic parameters and thyroid dysfunction on the development of non-alcoholic fatty liver disease (NAFLD). METHODS: The current study evaluated a total of 115 patients, 75 female and 40 male. Physical examination and anthropometric measurements were applied to all participants. Hypothyroidism was considered at a thyroid stimulating hormone level ≥ 4.1 mIU/L. Patients with euthyroidism and patients with hypothyroidism were compared. Abdominal ultrasonography was used to diagnose non-alcoholic fatty liver disease. The participants were further compared with regard to the presence of non-alcoholic fatty liver disease. Logistic regression modeling was performed to identify the relationship between non-alcoholic fatty liver disease and independent variables, such as metabolic parameters and insulin resistance. RESULTS: Non-alcoholic fatty liver disease was identified in 69 patients. The mean waist circumference, body mass index, fasting plasma insulin, HOMA-IR (p<0.001) and FT3/FT4 ratio (p=0.01) values were significantly higher in the patients with NAFLD compared to those without it. Multivariate regression analysis revealed that FT3/FT4 ratio, waist circumference and insulin resistance were independent risk factors for non-alcoholic fatty liver disease. CONCLUSION: Insulin resistance, enlarged waist circumference, elevated body mass index, higher FT3/FT4 ratio and hypertriglyceridemia are independent risk factors for NADLF, whereas hypothyroidism is not directly related to the condition.

The prevalence of the metabolic syndrome increases through the quartiles of thyroid stimulating hormone in a population-based sample of euthyroid subjects / Prevalência de síndrome metabólica aumenta em quartis de hormônio tireoestimulante em uma amostra de sujeitos eutiroides baseada na população

Objective The aim of the study was to assess the prevalence and characteristics of metabolic syndrome (MetS) and its elements in relation to TSH in euthyroid subjects. Materials and methods In the cross-sectional study, 2,153 euthyroid adults, 47.2 ± 14.5 years (20-94) with no current antithyroid or thyroid replacement therapy were enrolled. All participants filled a questionnaire on past and current morbidities, medication and smoking. Body weight, height, waist circumference, serum TSH, glucose and lipids were measured. The subjects were stratified by quartiles of TSH (QTSH) and the prevalence of the MetS elements was calculated. MetS was determined by the IDF 2005 criteria. Results Overweight prevalence was 37.2% (35.2-39.2), obesity in 25.1% (23.3-26.9), abdominal obesity – 61.4% (59.3-63.5), hypertension – 42.1% (38.9-43.1), diabetes/increased fasting glucose – 13.6% (12.1-15), low HDL-cholesterol – 27.6% (25.7-29.5), hypertriglyceridemia – 24.1% (22.3-25.9), MetS – 32.2% (30.2-34.2). MetS was more prevalent in the highest QTSH (34.9%, 30.9-38.9) than the lowest (27%, 23.3-30.9), p < 0.001, as were low HDL-C (32%, 28-35.9 vs. 25%, 21.3-28.7, p < 0.001) and hypertriglyceridemia (26.8%, 23-30.5 vs. 20.4%, 17-23.8, p = 0.015). Each QTSH increased the risk of MetS by 14%, p < 0.001, of hypertriglyceridemia by 20%, p = 0.001 and of low LDL-C by 9%, p = 0.042. Other significant factors for MetS were age, male gender and obesity. Conclusion The prevalence of MetS increased with higher QTSH within the euthyroid range, mostly by an increase in the dyslipidemia. Arq ...

Objetivo O objetivo deste estudo foi avaliar a prevalência e características da síndrome metabólica (MetS) e seus elementos em relação ao TSH em sujeitos eutireoides. Materiais e métodos Foram analisados, em um estudo transversal, 2.153 adultos eutiroides, de 47,2 ± 14,5 anos (20-94) sem terapia antitiroidiana ou de reposição. Todos os participantes preencheram um questionário sobre doenças atuais e passadas, medicações e tabagismo. O peso corporal, altura, circunferência da cintura, TSH, glicose e lipídios séricos foram medidos. Os sujeitos foram estratificados em quartis de TSH (QTSH) e a prevalência dos elementos da MetS foram calculados. Os critérios da MetS foram determinados pela IDF 2005. Resultados A prevalência de sobrepeso foi de 37,2% (35,2-39,2), de obesidade – 25,1% (23,3-26,9), obesidade abdominal – 61,4% (59,3-63,5), hipertensão – 42,1% (38,9-43,1), diabetes/aumento da glicose de jejum – 13,6% (12,1-15), baixo colesterol HDL – 27,6% (25,7-29,5), hipertrigliceridemia – 24,1% (22,3-25,9), MetS – 32,2% (30,2-34,2). A MetS foi mais prevalente no QTSH mais alto (34,9%; 30,9-38,9) do que no mais baixo (27%; 23,3-30,9), p < 0,001, assim como o baixo HDL-C (32%, 28-35,9 contra 25%, 21,3-28,7; p < 0,001) e hipertrigliceridemia (26,8%; 23-30,5 contra 20,4%, 17-23,8; p = 0,015). Cada QTSH aumentou o risco MetS em 14%, p < 0,001, de hipertrigliceridemia em 20%, p = 0,001 e de baixo LDL-C em 9%, p = 0,042. Outros fatores significativos para a MetS foram idade, sexo masculino e obesidade. ...