A cross-sectional study to assess hypothyroid status of pregnant women at 12–16 weeks of gestation

Background: Physiological changes occur during pregnancy. These changes include metabolic, hematologic, cardiovascular, renal, and respiratory changes. In some cases, these changes may alter and lead to complications which result in adverse pregnancy outcomes. In India, hypothyroidism in pregnancy has a prevalence of 4.8–11%. Aims and Objectives: The aim of this study was to estimate the prevalence of hypothyroidism in pregnant women at 12–16 weeks of gestation. Materials and Methods: A cross-sectional study was planned on pregnant women attending the ANC clinic of Outpatient Department of Obstetrics and Gynecology at K.L. E’S Dr Prabhakar Kore Hospital and Medical Research Center Belagavi. Serum thyroid stimulating hormone (TSH) was estimated in the study participants. Serum TSH levels >4.5 ?IU/ml were labeled as hypothyroid pregnant women. Results: In our study, the prevalence of hypothyroidism was observed to be 8.68%. Conclusion: Hence, we conclude that all pregnant women should be screened for hypothyroidism at earlier weeks of gestation.

Prevalencia de hipotiroidismo subclínico y biomarcadores de riesgo cardiovascular en pacientes del Hospital General de Riobamba / Prevalence of subclinical hypothyroidism and biomarkers of cardiovascular risk in patients of the General Hospital of Riobamba

El Hipotiroidismo subclínico (HSC) es definido bioquímicamente por una elevación en la concentración sérica de la hormona TSH con niveles normales de T4 libre. El objetivo de este estudio fue determinar la prevalencia de HSC en los pacientes que asistieron a la consulta de medicina interna del Hospital General IESS de Riobamba. Así como, analizar la correlación entre los parámetros hormonales y ciertos marcadores bioquímicos asociados con el incremento de riesgo cardiovascular. Se realizó una investigación de tipo descriptiva, observacional, con un diseño no experimental de corte transversal, que abarcó el periodo comprendido desde enero de 2019 hasta septiembre de 2021. 245 pacientes fueron diagnosticados con HSC, lo cual representó el 10.58 % del universo poblacional estudiado, 61.2% eran del sexo femenino, mientras que el 38.8% del sexo masculino. El mayor número de casos (59.61 %) se observó en el grupo etario mayor de 65 años, distribuidos de la siguiente manera: (22.86% hombres y 36.75% mujeres), también se encontró que el HSC está asociado con un perfil lipídico aterogénico, caracterizado por un incremento en la concentración de colesterol total y LDL los cuales se correlacionaron positivamente con las concentraciones de TSH.

Subclinical hypothyroidism (SH) is biochemically defined by an elevation in the serum concentration of TSH hormone with normal levels of free T4. The aim of this study was to determine the prevalence of SH in patients attending the internal medicine clinic of the General Hospital IESS of Riobamba. Also, to analyze the correlation between hormonal parameters and certain biochemical markers associated with increased cardiovascular risk. A descriptive, observational, non-experimental cross-sectional design was performed, covering the period from January 2019 to September 2021. 245 patients were diagnosed with SH, which represented 10.58 % of the population universe studied, 61.2% were female, while 38.8% were male. The highest number of cases (59.61 %) was observed in the age group over 65 years, distributed as follows: (22.86% men and 36.75% women), it was also found that SH is associated with an atherogenic lipid profile, characterized by an increase in the concentration of total cholesterol and LDL which correlated positively with TSH concentrations.

A study of gonadal dysfunction in women with thyroid disease

Background:Thyroid diseases are among the commonest endocrine disorders. It effects growth, embryonic development, tissue differentiation, maturation, metabolism, increases chronotropic and inotropic action of heart. The aim was to study gonadal dysfunction in womenwith thyroid disease; to study levels of FSH, LH, prolactin, estrogen and testosterone in hypothyroid and hyperthyroid.Methods:All participants fulfilling the inclusion criteria were interviewed as per proforma and medical details were recorded in proforma sheet and patients were subjected to necessary blood investigations.Results:Among 80 study subjects, majority were in the age group 26-35 years (60.1%) and majority had overt hypothyroid disease (72.5%). Symptoms of hypothyroid subjects mainly were fatigue, weight gain, hair loss, oligomenorrhea. Hyperthyroid subjects had fatigue, palpitations, oligomenorrhea, polymenorrhea. Prolactin had positive correlation with TSH in hypothyroid subjects, their LH, FSH levels were normal and sex steroid levels were low. In contrary, majority of the hyperthyroid subjects had normal prolactin and FSH, high LH and high sex steroid levels.Conclusions:The study demonstrated that thyroid disease in women causes menstrual abnormalities due to altered gonadotropinpatterns which in turn alter ovarian hormone pattern. Hypothyroidism is associated with hyperprolactinemia leading to anovulation and abnormal menstrual cycle. Hyperthyroidism is associated with increased levels of LH, estrogen and testosterone with normal levels of PRL and FSH. Screening, identifying and correcting thyroid disease should be undertaken to prevent infertility as early as possible.

EVALUATION OF THYROID PROFILE IN THE INDIAN POPULATION WITH ALOPECIA AREATA

Alopecia areata is an autoimmune disease that causes hair loss. It is characterized by patchy hair loss that affects the scalp and other areas of the head, as well as the eyelashes, beard, and complete body hair. Alopecia areata manifests as a circular patch of hair loss that may progress to baldness of the entire scalp (Alopecia areata totalis) or loss of full body hair (Alopecia areata universals). The disease's etiopathogenesis is unknown, however autoimmunity appears to play a signi?cant role. Thyroid problems are frequently linked to AA, the most common of which is autoimmune Thyroid disorders. Aim: The goal of our research is to see if Alopecia Areata (AA) is linked to thyroid hormones (T3, T4, and TSH) and to evaluate the T3, T4, and TSH levels. Material and Methods: The present study included 150 A.A patients(cases) and 150 controls attended to Department of Dermatology in collaboration with Department of Biochemistry, LNMC & J.K Hospital, Bhopal. The levels of T3, T4 and TSH was estimated by ELISA. Result: The present study shows statistically signi?cant differences between patients and controls regarding Thyroid Hormones levels of TSH, T3 and T4. Conclusions: The ?ndings imply an association between Alopecia Areata and Thyroid function issues. Thyroid function abnormalities should be checked in all patients with alopecia areata, regardless of their clinical condition

Pregnancy with hypothyroidism and its adverse pregnancy outcomes

Background: Thyroid disorders are among the common endocrine disorders in pregnant woman after diabetes mellitus. Pregnancy is a stress test of maternal thyroid function. Several changes are observed in maternal thyroid function during pregnancy and failure to adapt to these physiological changes results in thyroid dysfunction. Subclinical hypothyroidism occurs in 10% of all pregnancies. Hypothyroidism has adverse effects on mother and fetus like anemia, pre eclampsia, preterm delivery, low birth weight and mental retardation of neonate. Decreased availability of thyroid hormones also impair neurological and intellectual development of the fetus. The relevance of this study is to document the association of hypothyroidism and its adverse effects on mother and fetus. Materials and methods: This prospective observational study was carried out during the period January 2020 to December 2020 (12 months) at Government General Hospital (GGH), Rangaraya Medical College, Kakinada, Andhra Pradesh, India. Subjects of this study were 170 antenatal women in third trimester with singleton pregnancy admitted in the obstetric ward, and informed consent was obtained. Women were chosen irrespective of age, parity, residence and socioeconomic status. Women with multiple pregnancy, a known case of thyroid disorder, or any pre-existing medical disorder were excluded. Routine hematological parameters and estimation of T3, T4 and TSH was conducted. Results: In this study out of 170 cases, anemia was seen in-15.29%, pre eclampsia in-11.77%, GDM in-4.11%, Oligohydramnios with IUGR in-5.88%, preterm labor in-3.53%, LSCS in-35.29% and IUFD in-0.59% of case and low birth weight (8.24%), Hyperbilirubinemia (3.53%) and NICU admissions (11.76%). Conclusion: This Study concluded that hypothyroidism in pregnancy leads to preeclampsia, preterm labour, increases caesarean delivery, low birth weight and hyperbilirubinemia in neonates. Henceeffective treatment of hypothyroidism ensures safe pregnancy with minimal maternal and foetal complications.

Profile of Levothyroxine Replacement Therapy in Graves’ Disease patients with Hypothyroidism Post-Radioactive Iodine Ablation: Focus on different weight-based regimens / Journal of the ASEAN Federation of Endocrine Societies

Objective@#To evaluate the status of euthyroidism achieved among Thai patients with post-ablative hypothyroidism and to examine the difference between various weight-based daily levothyroxine (LT4) replacement regimens in these patients.@*Methodology@#We conducted a retrospective review of Thai patients with Graves’ disease (GD) who developed hypothyroidism following radioactive iodine treatment from 2016 to 2020 at Theptarin hospital. Daily LT4 dose was calculated based on actual body weight (ABW), ideal body weight (IBW), and estimated lean body mass (LBM).@*Results@#We reviewed a total of 271 patient records. Of these, 81.2% were females with a mean age of 40.8±11.7 years, LT4 intake duration of 27.1±14.6 months, and LT4 dose/kg ABW of 1.4±0.5 μg/kg/day. At the final follow-up, 62.4% of patients achieved thyroid-stimulating hormone (TSH) levels within the reference interval, 15.5% had TSH levels over, and 22.1% had TSH levels under the reference range. Obese patients required a lower daily LT4 dose relative to ABW and higher daily LT4 dose relative to IBW to attain euthyroidism (ABW 1.1±0.4 μg/kg/day and IBW 2.0±0.8 μg/kg/day). Estimated daily LT4 dose based on LBM showed a constant dosage of 2.0 μg/kg/day in all BMI categories.@*Conclusions@#Suboptimum LT4 replacement therapy was found in almost half of hypothyroid patients with GD treated with radioactive iodine. Estimated LBM was a better indicator for dosing calculation in these patients compared with ABW and IBW.

Prognostic study and influencing factors analysis for the dynamic changes of serum FT3, FT4 and TSH levels in patients with hemorrhagic stroke under 45 years of age / 公共卫生与预防医学

Objective To discuss the epidemiological characteristics of the dynamic changes of serum FT3, FT4, and TSH levels in patients with hemorrhagic stroke under the age of 45, and to discuss the prognostic evaluation effects and influencing factors of these indicators. Methods From January 2017 to January 2020, 227 patients with multicenter hemorrhagic stroke in our hospital were selected for analysis. Collect and analyze prognosis (death, rebleeding, no adverse prognosis) at baseline and 12 months of follow-up; monitor serum FT3, FT4, and TSH levels during treatment at the same time during follow-up, 7 days after treatment, and 14 days after treatment. Observe the trend characteristics of dynamic changes. The assay method is enzyme-linked immunosorbent assay. At the end of the follow-up, the subjects were divided into three groups: death, rebleeding, and no adverse prognosis according to the prognostic outcome of the 12-month short-term follow-up. The epidemiological characteristics of patients with different prognosis and the dynamic change trend of FT3, FT4 and TSH in the same serum were compared. The interconnectedness. Results There were no statistically significant differences in gender and age between the three groups (P>0.05), but the differences in hypertension, hyperglycemia, and hyperlipidemia were statistically significant (P0.05). The FT4 level of the case group was significantly higher than that of the control group at all times (P0.05). The TSH level of the case group was significantly higher than that of the control group at all times (P0.05). With the decrease of the patient's age, the serum FT3 level has a gradually increasing trend, and the serum FT4, TSH level, mortality and rebleeding rate have a gradually decreasing trend (P<0.05). Conclusion The continuous decrease of FT3 level and the continuous increase of FT4 and TSH levels are potentially associated with the poor prognosis of patients with hemorrhagic stroke, which is worthy of clinical attention.

TSH receptor inhibitory antibody(TBAb) promotes extracellular accumulation of hyaluronic acid in pretibial myxedema primary fibroblasts via PI3K-AKT pathway / 中华内分泌代谢杂志

Objective:Pretibial myxedema (PTM) is a localized myxedema characterized by excessive dermal hya-luronan (HA) deposition and elevated serum TSH receptor antibody (TRAb). In this study, we investigated the effects of TRAb and its subtypes, stimulating antibody [TSAb (M22)] and inhibitory antibody[TBAb (K1-70)], on the synthesis of hyaluronic acid produced by PTM primary dermal fibroblasts.Methods:Normal and PTM dermal fibroblasts were isolated and stimulated with M22, K1-70, and IgG from patients respectively. HA concentration in the supernatant before and after stimulation was tested by ELISA. The protein level and phosphorylation variation of CEMIP, HAS2 and PI3K-AKT pathway were detected by Western blot.Results:IgG from patients (TRAb 8.4 IU/L) significantly stimulated the extracellular accumulation of HA in PTM primary fibroblasts. Similarly, both M22 and K1-70 also upregulated HA level in the supernatant, though K1-70 seemed much more effecitve. After treatment with IgG, M22, and K1-70, the expression of HAS2 increased and the expression of CEMIP decreased; meanwhile, p-PI3K and p-AkT increased. Among them, further study on K1-70, promoting HA production by regulating PI3K-AkT signal pathway could be inhibited by PI3K inhibitor (LY294002).Conclusion:TSAb (M22) and TBAb (K1-70), especially TBAb, increase HAS2 and inhibit CEMIP expression by activating PI3-AKT signaling pathway in PTM fibroblasts, leading to increased extracellular HA level.

Transient hypothyroxinemia of prematurity and its risk factors in an extramural neonatal intensive care unit

ABSTRACT Objective: Thyroid functions in preterm newborns may be altered in the first week of life. Hypothyroxinemia has been commonly reported in these babies, which could be due to the immaturity of the hypothalamic pituitary thyroid axis or acute illness. It could have a long-term impact on the developing brain of these babies. We conducted this study to estimate the incidence of transient hypothyroxinemia of prematurity (THOP) and to determine its risk factors. Materials and methods: We analyzed thyroid stimulating hormone (TSH) and free T4 levels of 64 preterm neonates admitted in the neonatal intensive care unit. TSH and free T4 levels were measured in the first week and then at 14-21 days of life to estimate the incidence of THOP and determine its risk factors. We also estimated the incidence of congenital hypothyroidism (CH) and delayed TSH elevation in CH. Risk analysis was conducted using simple and multiple logistic regression, and numerical data was compared using the Mann Whitney U test and t test. Results: THOP was seen in 25% of the preterm babies. Caesarean delivery, presence of one or more morbidities, mechanical ventilation, birth weight ≥ 1,500 g, and gestational age ≥ 32 weeks were identified as risk factors for THOP based on simple logistic regression. In multiple regression, mechanical ventilation and gestational age ≥ 32 weeks were significantly associated with THOP. CH was seen in 2 (3.1%) babies, and 1 of these cases had delayed TSH elevation. Conclusion: Thyroid abnormalities are common in preterm admitted neonates. Mechanical ventilation is an independent risk factor for development of THOP.

Hipotiroidismo en pacientes del Centro de Especialidades Médicas; IESS-La Libertad

Resumen El hipotiroidismo es el cuadro clínico resultante de la disminución en la producción de hormonas tiroideas. Objetivo. Fue caracterizar el hipotiroidismo en pacientes que acudieron al laboratorio clínico del Centro de Especialidades IESS de la Libertad, durante el período enero 2018 - enero 2020 mediante la medición de niveles de FT3, FT4, TSH. Materiales y Métodos. Se realizó un estudio de tipo descriptivo, de diseño documental. El universo constituye 2451 pacientes con sospecha de enfermedad tiroidea que acudieron al servicio de laboratorio del Centro de Especialidades IESS, La Libertad durante el período enero 2018 a enero 2020. Se procedió a revisar archivos de historial de resultados de los pacientes atendidos en el laboratorio. Resultados. 617 pacientes cumplen criterios de hipotiroidismo primario lo cual representa una prevalencia del 25,2%. El hipotiroidismo subclínico, constituye el 70,8%, el hipotiroidismo clínico representa el 29,2%, estos fueron más frecuentes en mujeres. En cuanto al grupo etario el hipotiroidismo subclínico se presenta con mayor frecuencia en el grupo de adultos 44,9 % y en adultos jóvenes 24,8 %. En referencia a las comorbilidades asociadas; tanto en el hipotiroidismo clínico y subclínico las más representativas en orden de frecuencia son: hipertensión arterial (35%), dislipidemia (25,8%) y diabetes mellitus (14,1%). Conclusiones . Existe una alta prevalencia de hipotiroidismo primario, los hombres se clasifican mayoritariamente con hipotiroidismo clínico, las mujeres tienen mayor frecuencia de hipotiroidismo subclínico. La presencia de comorbilidades como hipertensión arterial, dislipidemias y diabetes mellitus tipo II están presentes en los pacientes hipotiroideos estudiados.

Abstract Hypothyroidism is the clinical picture resulting from decreased thyroid hormone production. Objective. Was to characterize hypothyroidism in patients attending the clinical laboratory of the Centro de Especialidades IESS de la Libertad, during the period January 2018 - January 2020 by measuring levels of FT3, FT4, TSH. Materials and Methods . A descriptive study of documentary design was performed. The universe constituted 2451 patients with suspected thyroid disease who attended the laboratory service of the Centro de Especialidades IESS, La Libertad during the period January 2018 to January 2020. We proceeded to review the results history files of the patients attended in the laboratory. Results. 617 patients met criteria for primary hypothyroidism which represents a prevalence of 25.2%. Subclinical hypothyroidism constitutes 70.8%, clinical hypothyroidism represents 29.2%, these were more frequent in women. Regarding the age group, subclinical hypothyroidism was more frequent in adults 44.9% and in young adults 24.8%. In reference to the associated comorbidities; both in clinical and subclinical hypothyroidism the most representative in order of frequency are: arterial hypertension (35%), dyslipidemia (25.8%) and diabetes mellitus (14.1%). Conclusions. There is a high prevalence of primary hypothyroidism, men are mostly classified with clinical hypothyroidism, women have a higher frequency of subclinical hypothyroidism. The presence of comorbidities such as arterial hypertension, dyslipidemias and type II diabetes mellitus are present in the hypothyroid patients studied.

Resumo O hipotireoidismo é o quadro clínico resultante da diminuição da produção de hormônios da tireóide. Objetivo. Caracterizar o hipotireoidismo em pacientes que freqüentam o laboratório clínico do Centro de Especialidades IESS de la Libertad, durante o período de janeiro de 2018 a janeiro de 2020, medindo os níveis de FT3, FT4, TSH. Materiais e métodos. Foi realizado um estudo descritivo do projeto documental. O universo consistia de 2451 pacientes com suspeita de doença da tireóide que compareceram ao serviço laboratorial do Centro de Especialidades IESS, La Libertad, durante o período de janeiro de 2018 a janeiro de 2020. Procedemos à revisão dos arquivos de histórico dos resultados dos pacientes atendidos no laboratório. Resultados. 617 pacientes preencheram os critérios para o hipotireoidismo primário, o que representa uma prevalência de 25,2%. O hipotireoidismo subclínico constituía 70,8%, o hipotireoidismo clínico 29,2%, e estes eram mais frequentes nas mulheres. Em termos de faixa etária, o hipotireoidismo subclínico foi mais freqüente em adultos (44,9%) e em adultos jovens (24,8%). Em referência às co-morbidades associadas; tanto no hipotireoidismo clínico como no subclínico, as mais representativas em ordem de frequência são: hipertensão arterial (35%), dislipidemia (25,8%) e diabetes mellitus (14,1%). Conclusões . Há uma alta prevalência de hipotireoidismo primário, os homens são na maioria classificados com hipotireoidismo clínico, as mulheres têm uma maior frequência de hipotireoidismo subclínico. A presença de co-morbidades como hipertensão, dislipidemia e diabetes mellitus tipo II estão presentes nos pacientes hipotireóides estudados.

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.

Association between TSH status and prevalence of miscarriages and stillbirth

Thyroid hormones play a significant role in normal human body growth. Abnormalities in thyroid stimulating hormone (TSH) levels can result in pregnancy loss due to miscarriages and intrauterine death (IUD). The objective of the study was to assess the levels of association of thyroid stimulating hormone with miscarriages and IUD. The descriptive study involving 110 samples between 18-40 years of age fulfilling inclusion criteria were sampled for TSH testing (2ml blood) after attaining their written informed consent. The mean age of participants was 29.49±4.26 year. The prevalence of hypothyroidism and hyperthyroidism was 3.64% and 2.73%, respectively. Complications like gestational hypertension, depression and oligomenorrhea were found prevalent in these females. Majority of females were taking high/low iodine than recommended iodine level (150mcg). This work shows that there is a significant association between pregnancy loss and disturbed TSH levels among pregnant females.

Incremento de la proteína C reactiva ultrasensible en pacientes con hipotiroidismo subclínico y su posible relación con el desarrollo de daño cardiovascular / Increase in high sensitivity C-reactive protein in patients with subclinical hypothyroidism and its possible relationship to the development of cardiovascular damages

INTRODUCCIÓN: El hipotiroidismo subclínico (HSC) se define bioquímicamente por una elevación en la concentración sérica de la hormona estimulante de la tiroides (TSH), con niveles normales de tiroxina libre (T4L). La asociación entre el HSC y el daño cardiovascular ha sido un tema controversial. OBJETIVO: determinar la asociación entre el HSC y el desarrollo de la enfermedad cardiovascular mediante la cuantificación de la proteína C reactiva ultrasensible PCR-us y la determinación de lípidos circulantes asociados a la enfermedad cardiovascular y la ateroesclerosis. MÉTODOS: Estudio descriptivo, correlacional de corte transversal realizado en el Hospital IESS de Riobamba, Ecuador en el periodo comprendido desde enero a diciembre de 2019. Se estudiaron 70 individuos (40 pacientes con HSC y 30 controles) con edades entre 18 y 75 años. Se realizaron las historias clínicas y el examen físico a cada paciente y la toma de las muestras sanguíneas para determinar la concentración sérica de los siguientes parámetros bioquímicos y hormonales: colesterol total, triglicéridos, HDL colesterol y LDL colesterol, TSH, T4L y PCR-us. RESULTADOS: Se encontró un incremento significativo en la concentración de colesterol total (p<0.0001), LDL colesterol (p<0.01) y PCR-us (p<0.0001) en los pacientes con HSC vs los controles. Se observó una correlación positiva (p<0.0001; r=0.9148) entre la TSH y la PCR-us en los pacientes con HSC. CONCLUSIÓN: los pacientes con HSC experimentan una elevación en los niveles séricos de PCR-us la cual está correlacionada con un incremento en la concentración sérica de TSH. Estos parámetros asociados a un aumento del colesterol total y de la LDL colesterol sugieren un estado inflamatorio de bajo grado que podría estar asociado con el desarrollo de aterosclerosis y daño cardiovascular.

INTRODUCTION: Subclinical hypothyroidism (SH) is defined biochemically by an elevation in serum thyroid stimulating hormone (TSH) concentration, with normal levels of free thyroxine (T4L). The association between SH and cardiovascular damage has been a controversial issue. OBJECTIVE: to determine the association between SH and the development of cardiovascular disease through the quantification of the high sensitivity C-reactive protein (hs-PCR) and the determination of circulating lipids associated to cardiovascular disease and atherosclerosis. METHODS: Observational, correlational cross-sectional study with patients captured in the internal medicine office as well as those attending screening activities at the IESS Hospital in Riobamba- Ecuador, in the period from January to December 2019. Seventy individuals (40 patients with SH and 30 controls) between the ages of 18 and 75 years were studied. Each patient's medical history and physical examination were performed, and blood samples were taken to determine the serum concentration of the following biochemical and hormonal parameters: total cholesterol, triglycerides, HDL cholesterol and LDL cholesterol, TSH, T4L and hs-PCR. RESULTS: A significant increase in the concentration of total cholesterol (p<0.0001), LDL cholesterol (p<0.01) and hs-PCR (p<0.0001) was found in patients with SH vs. controls. A positive correlation (p<0.0001; r=0.9148) was observed between TSH and hs-PCR in patients with SH. CONCLUSION: patients with SH experience an elevation in serum hs-PCR levels which is correlated with an increase in serum TSH concentration. These parameters associated with an increase in total cholesterol and LDL cholesterol suggest a low-grade inflammatory state that may be associated with the development of atherosclerosis and cardiovascular damage.

Impact of the reduction in TSH cutoff level to 6 mIU/L in neonatal screening for congenital hypothyroidism in Santa Catarina: final results

ABSTRACT Oubjective: To assess the implications of changing the cutoff level of TSH from 10 to 6 mIU/L. Subjects and methods: The study population was constituted by 74.123 children screened for congenital hypothyroidism by the National Screening Program in Santa Catarina, from March 2011 to February 2012. The cutoff of TSH was 6 mIU/L. If TSH between 6-10 mIU/L, the newborn was recalled for a second TSH measurement on filter paper. If TSH > 6 mIU/L in the second sample, the child was sent for medical evaluation. In children with normal topic thyroid, levothyroxine was suspended for 1 month at the age of 3 years for identification of the etiology and evaluation of the need to continue treatment. Results: Among the children screened, 435 were recalled for presenting TSH between 6 and 10 mIU/L in the first sample, 28 remained TSH > 6 mIU/L in the second sample. Among these, 11 had a final diagnosis of dyshormonogenesis, two of ectopic thyroid, two of thyroid hypoplasia and one of transient hypothyroidism. Ten children presented normal TSH levels on the first medical evaluation and two lost follow-up. Conclusion: A decrease in the TSH cutoff level from 10 to 6 mIU/L in a neonatal screening program for congenital hypothyroidism reduced the number of false-negative results, increasing the sensitivity of the test, but increased the number of false-positive results and recalls. Since a TSH cutoff level of 6 mIU/L detects thyroid function abnormalities requiring treatment, the adoption of this cutoff level is justified.

Avaliação de dinapenia e associação com função tireoidiana em idosos da Universidade Aberta à Terceira Idade ­ UATI / Evaluation of dynapenia and association with thyroid function in elderly at the Open University of the Elderly ­ UATI

Introdução: o presente artigo analisou e avaliou a prevalência de dinapenia em associação da idade dos Hormônio Estimulador da tireoide (TSH) e T3 em idosos da Universidade Aberta à Terceira Idade ­ UATI. A tireoide produz e secreta os hormônios triiodotironina (T3) e tiroxina (T4), responsáveis por controlar o metabolismo celular. O termo dinapenia tem sido utilizado para descrever a diminuição da força muscular relacionada à idade separando desta forma, a dinapenia da redução da massa muscular. Metodologia: trata-se de um estudo de corte transversal que investigou 63 mulheres com idade entre 60 e 95 anos, resultando numa idade média das participantes foi de 69,6 anos, não institucionalizadas, matriculados no projeto "Universidade Aberta à Terceira Idade (UATI)", da Universidade Estadual da Bahia (UNEB). A força de preensão palmar (FPP) foi avaliada em quilograma (kg), por meio do dinamômetro digital manual da marca INSTRUTHERM. Resultados: foram diagnosticados com dinapenia as pacientes que possuíram a FPP inferior a 20 kg. Descobriu-se que 23 idosas (36,51%) foram diagnosticadas com dinapenia. A correlação entre as variáveis TSH e dinapenia foi positiva e fraca Spearman=0.17 (p-valor= 0.22). Assim, a relação entre o FPP e a idade não parece ser linear possuindo uma correlação negativa e fraca: Spearman= -0.11 (p-valor= 0.39). Conclusão: o nível sérico de TSH e idade não tiveram associação significativa com a presença de dinapenia. Houve associação entre T3 sérico e dinapenia, porém não é possível identificar em qual quartil está essa associação.

Introduction: this article analyzed and evaluated the prevalence of dynapenia in association with the age of thyroid stimulating hormones (TSH) and T3 in the elderly at Universidade Aberta do Idoso ­ UATI. The thyroid produces and secretes the hormones triiodothyronine (T3) and thyroxine (T4) responsible for the control of cellular metabolism. The term dynapenia has been used to describe the decrease in muscle strength related to age, separating dynapenia from the reduction of muscle mass. Methodology: this is a cross-sectional study that investigated 63 women between 60 and 95 years old, resulting in an average age of participants of 69.6 years old, non-institutionalized, registered in the project the Open University Of The Elderly (UATI)", of Bahia State University (UNEB). The Hand Grip Strength (HGS) was measured in kilograms (kg), using the INSTRUTHERM manual digital dynamometer. Results: patients with FPP less than 20 kg were diagnosed with dynapenia. It was found that 23 elderly women (36.51%) were diagnosed with dynapenia. The correlation between TSH and dynapenia variables was positive and weak Spearman = 0.17 (p-value = 0.22). Thus, the relationship between (FPP) and age does not appear to be linear with a weak and negative correlation: Spearman = -0.11 (p-value = 0.39). Conclusion: the serum TSH level and age had no significant association with the presence of dynapenia. There was an association between(T3) and serum dinapenia, but it is not possible to identify in which quartile this association is found.

Relationship of gender and age on thyroid hormone parameters in a large Chinese population

ABSTRACT Objective This study aimed to present the impact of age and gender on thyroid hormone levels in a large Chinese population with sufficient iodine intake. Subjects and methods A total of 83643 individuals were included and were stratified by age and gender. The median, 2.5th and 97.5th of thyrotropin (TSH), free triiodothyronine (FT3), free thyroxine (FT4) and FT3/FT4 ratio were calculated for both genders for every decade from 18 to over 80 years. TSH, FT3, FT4, FT3/FT4 distribution in each age group was evaluated for females and males using smoothing splines in the generalized additive models (GAM). TSH concentrations were compared in the different age groups in gender. Results In the over 80s age group, the TSH level (median: 2.57 mIU/L, 2.5th-97.5th: 0.86-7.56 mIU/L) was significantly higher than other age groups, irrespective to gender (P<0.001). Females had a higher TSH value than males in all age groups (P<0.001). Results of the smoothing curves showed that TSH increased with age, FT3 concentration was higher in males than in females and the tendency of the FT3/FT4 ratio was basically similar to that of FT3. TSH concentration in the 50s age group (median 2.48 mIU/L for females versus 2.00 mIU/L for males) was significantly higher than that in the 30s age group (median 2.18 mIU/L for females versus median 1.85 mIU/L for males). Conclusions In accord with increasing TSH values during aging, females and older adults have lower FT3 values and lower FT3/FT4 ratios, while the FT4 values remain stable.

Vitamin D Status Association with Thyroid Antibodies in Hypothyroidism Patients

Background: Deficiency in Vitamin D is a global health issue, in the recent decade, there has been substantial proof that low levels of Vitamin D can lead to thyroid disorders. The present study aims to analyze the relationship between hypothyroidism and the level of Vitamin D, as well as to analyze the relationship between Vitamin D level with thyroid antibodies (TPO-Abs and TG-Abs). Methods: Forty patients diagnosed as hypothyroidism which compared with twenty healthy control groups with matching in sex and age between studied groups. The blood sample was collected from both groups to estimate the level of vitamin D, T3, T4, TSH hormones and the existence of thyroid autoantibodies. Results: Patients with hypothyroidism showed a significantly lower mean of Vitamin D level compared with the healthy control group (p=0.0001). Half (20/40) of the hypothyroid group tested positive for TPO-Ab, (15/40) were positive for TG-Ab, and (14/40) of hypothyroidism patients have positive results for Anti-Thyroid Peroxidase and AntiThyroglobulin antibodies with highly statistical significant between hypothyroid group according to the presences of autoantibodies. As for the interaction of vitamin D levels with autoantibodies in patients with hypothyroidism, we observed that levels of Vitamin D were correlated with neither TPO antibodies (p=0.292) nor TG antibodies (p=0.108). Conclusion: The levels of vitamin D were significantly lower in patients with hypothyroidism relative to healthy control. Vitamin D does not have a strong association with the titers of thyroid antibodies.

Congenital Hypothyroidism in children – A cross-sectional study in a tertiary centre in Malaysia / Journal of the ASEAN Federation of Endocrine Societies

Introduction@#The causes of congenital hypothyroidism (CHT) are thyroid dysgenesis (TD), dyshormonogenesis (TDH) or transient hypothyroidism (TH).@*Methodology@#This is a cross-sectional study looking at data over a period of 16 years (2000-2016). Confirmed cases had thyroid scan at the age of 3-years-old and repeated TFT (after 6 weeks off medications). Relevant data was collected retrospectively.@*Results@#Forty (60% female) children with CHT were included in the study. Thirty (75%) children presented with high cord TSH. Nine (23%) presented after 2 weeks of life. Majority were diagnosed with TDH (42.5%) with TD and TH of 40% and 17.5% respectively. Median cord TSH of children with TD was significantly higher compared to TDH and TH (p=0.028 and p=0.001 respectively). L-thyroxine doses were not significantly different between TD, TDH and TH at diagnosis or at 3 years.@*Conclusions@#TDH is highly prevalent in our population. TD may present after 2 weeks of life. One in five children treated for CHT had TH. Differentiating TD, TDH and TH before initiating treatment remains a challenge in Malaysia. This study provides clinicians practical information needed to understand the possible aetiologies from a patient’s clinical presentation, biochemical markers and treatment regime. Reassessing TH cases may be warranted to prevent unnecessary treatment.

Historia de las pruebas de función tiroidea / History of thyroid function tests

El desarrollo de las pruebas de función tiroidea no ha sido fácil, con múltiples retos para mejorar algunas características que son insatisfactorias, incluso en la actualidad. En 1960 se logró la medición de tiroxina total (T4 total), y aunque fue un gran avance, los investigadores sabían que era insuficiente para una evaluación precisa de la función tiroidea. Uno de los problemas importantes radica en que existen diferencias marcadas interindividuales en la composición y en las cantidades de las proteínas de transporte de la T4 y la triyodotironina (T3). Por lo tanto, los depósitos de T4 y T3 son muy diferentes a los valores de T4 libre (T4L) y T3 libre (T3L). Por ejemplo, la mujer embarazada tiene el doble de globulina fijadora de tiroxina (TBG) y tres cuartas partes de la cantidad de albúmina que tenía cuando no estaba embarazada. También se pierde transtiretina y albúmina en enfermedades graves o con traumas, como quemaduras o sepsis. Entre 1963 y 1965 se desarrolló una prueba para tratar de obtener una estimación de la T4L, con el método de absorción de la hormona tiroidea a partir de la T4 total. Sin embargo, este análisis no funcionó correctamente, especialmente teniendo en cuenta la variabilidad en la TBG

Macro TSH como causa de hipotiroidismo refractario: a propósito de dos casos clínicos / Macro TSH as a cause of refractory hypothyroidism: based on two clinical cases

Se presenta el caso de dos mujeres con hipotiroidismo, con TSH persistentemente elevada, lo que hacía aumentar la dosis de levotiroxina y llegar a un hipertiroidismo clínico con TSH anormalmente alto. Se realizó un seguimiento de los niveles de TSH y T4 libre, durante un período de 20 y 10 meses respectivamente. En ambas situaciones no hubo una respuesta esperable a las dosis de levotiroxina ascendentes. Después de descartar causas posibles que explicaran esta situación, se sospechó y confirmó la presencia de Macro TSH, que es un complejo biológicamente inactivo de TSH e Inmunoglobulina G. Se obtiene como resultado la estabilidad de ambas pacientes siendo su seguimiento prioritariamente clínico y con mediciones de T4L, comprendiendo por qué la TSH persiste elevada. Nos pareció interesante la comunicación de estos casos, que permite recordar causas atípicas de refractariedad al tratamiento con levotiroxina, como es la macro TSH, indispensable pesquisar para el manejo adecuado de estos pacientes.

An inadequate response to levothyroxine treatment in a patient with hypothyroidism suggests lack of intake, lack of absorption, nephrotic syndrome, thyroid hormone resistance among other reasons. We present the case of two women with hypothyroidism and a persistently elevated level of TSH, which required increasing the dose of levothyroxine, resulting in a clinical hyperthyroidism with an abnormally high TSH. A TSH and free T4 follow up was performed during a period of 20 and 10 months respectively, in both situations there was not an adequate response to rising levothyroxine treatment. After ruling out other possible causes that could explain this situation, it was suspected and then confirmed the presence of Macro TSH, which is a biologically inactive complex of TSH and Immunoglobulin G. Therefore, both patients achieved disease stability once controlled by clinical state and free T4 measurements, understanding why THS persited high. We present these interesting cases, because this allows us to remember atypical causes of refractory treatment with levothyroxine, such as the Macro TSH, indispensable to search for the proper management of these patients.