Perinatal effects of maternal FT3/FT4 ratio on gestational transient thyrotoxicosis

ABSTRACT Objective: The effects of maternal thyroid hormone levels on the course of pregnancy and birth weight have attracted interest. The aim of the present study was to consider FT3 and FT3/FT4 ratio in the evaluation of the effects of maternal thyroid functions in gestational transient thyrotoxicosis (GTT). Materials and methods: This case-control study included 45 patients with GTT and 45 healthy pregnant women. Maternal history before pregnancy, thyroid function tests, thyroid autoantibodies, and thyroid ultrasonography results in 6th to 10th weeks of pregnancy were used in the differential diagnosis of GTT. In both groups, the effects of FT3, FT4 and FT3/FT4 ratios on gestational age and birth weight were evaluated. Results: There was no significant difference in the gestational age between the GTT and control groups (39,3±1,0 weeks and 39,2±1,2 weeks, respectively). Birth weights were similar in both groups (3205,2±4899 g and 3196,6±309,3 g, respectively). When maternal weight was adjusted, a positive correlation was observed between maternal FT3/FT4 ratio and birth weight (r=0,317, p=0,017). Additionally there was a positive correlation between the gestational age and the birth weight in the control group (ρ=0,726, p=0,001). Conclusion: GTT had no significant effect on the gestational age and the birth weight. On the other hand an increase in the maternal FT3/FT4 ratio had a positive effect on the birth weight in the patient with GTT. Maternal characteristics (age, weight, BMI) and FT3/FT4 ratio should be taken into consideration in future impact assessment studies on this issue.

Efficacy of methimazole combined with 1α-hydroxyvitamin D3 in patients with Graves disease of high-titer thyrotropin receptor antibodies / 中国医师杂志

Objective:To observe the efficacy of methimazole (MMI) combined with 1α-hydroxyvitamin D3 (alfacalcidol, ALF) in patients with Graves disease of high-titer thyrotropin receptor antibodies (TRAb) and to explore new clinical strategies to reduce serum TRAb in Graves disease.Methods:120 patients with Graves disease initially diagnosed in Quanzhou First Hospital Affiliated to Fujian Medical University and the People′s Hospital Affiliated to Quanzhou Medical College from June 2017 to June 2019 were prospectively selected as the research objects. All patients received conventional dose of MMI for anti hyperthyroidism treatment. The patients were randomly divided into three groups: group A [ n=40, treated with MMI combined with high-dose ALF (0.5 μg/d)], group B [ n=37, treated with MMI combined with low-dose ALF (0.25 μg/d)] and group C ( n=43, treated with MMI only). The treatment lasted for 24 weeks. The serum free triiodothyronine (FT 3), free thyroxine (FT 4), thyroid stimulating hormone (TSH) and TRAb in patients before and after above treatments were detected. The blood routine, liver function, alkaline phosphatase (ALP), 25(OH)D, serum calcium (CA) and serum phosphorus were detected regularly. Results:After drug treatment: ⑴ the thyroid function of the three groups returned to normal. The average daily dosage of MMI in group A was significantly lower than that in group B and C ( P<0.05), and that in group B was also lower than that in group C ( P<0.05), with significant difference. After 24 weeks of treatment, the daily dosage of MMI in group A and B was significantly lower than that in group C ( P<0.05). ⑵ There was no significant difference in thyroid function among the three groups. The concentration of serum TRAb in group A was significantly lower than that in group B and C ( P<0.05), and that in group B was also lower than that in group C ( P<0.05). ⑶ During the 24 week follow-up, there was no significant difference in serum 25(OH)D, ALP, Ca and P among the three groups ( P>0.05); no leukopenia in peripheral blood and no abnormal liver function were found in the three groups. Conclusions:MMI combined with ALF can effectively treat Graves′ disease, reduce the dosage of MMI drugs, decline the level of TRAb in the serum of Graves′ patients, and improve the prognosis of Graves′ disease.

Clinical efficacy of methimazole in the treatment of hyperthyroidism / 中国基层医药

Objective:To investigate the clinical efficacy of methimazole in the treatment of hyperthyroidism.Methods:A total of 110 patients with hyperthyroidism who received treatment in Zhuji Central Hospital between January 2016 and June 2019 were included in this study. They were randomly assigned to receive treatment either with propylthiouracil (control group, n = 55) or methimazole (observation group, n = 55) for 6 successive months. Thyroid function indicators, bone metabolism indicators, clinical efficacy, and adverse events were compared between the control and observation groups. Results:After treatment, free triiodothyronine (FT 3), free thyroxine (FT 4) and thyroid stimulating hormone (TSH) levels in the observation group were (4.46 ± 1.02) pmol/L, (14.45 ± 2.16) pmol/L and (1.89 ± 0.64) mU/L respectively, which were significantly lower than those in the control group [(6.37 ± 1.38) pmol/L, (18.54 ± 4.46) pmol/L and (3.47 ± 0.99) mU/L, t = 8.254, 6.121, 9.940, all P < 0.05). Calcitonin level in the observation group was significantly higher than that in the control group [(68.62 ± 6.75) ng/L vs. (61.45 ± 6.47) ng/L, t = 5.687, P < 0.05]. Bone Gla-protein level in the observation group was significantly lower than that in the control group [(6.38 ± 1.64) ng/L vs. (8.21 ± 2.19) ng/L, t = 4.960, P < 0.05]. Total effective rate in the observation group was significantly higher than that in the control group [92.73% (51/55) vs. 78.18% (43/55), χ2= 4.681, P < 0.05]. Adverse reaction rate in the observation group was significantly lower than that in the control group [9.09% (5/55) vs. 25.45% (14/55), χ2= 5.153, P < 0.05]. Conclusion:Methimazole is safe and effective in the treatment of hyperthyroidism, which can effectively improve thyroid function and bone metabolism. This study is of certain clinical significance and innovation.

Reproductive outcomes in cases of subclinical hypothyroidism and thyroid autoimmunity: a narrative review / Resultados reprodutivos nos casos de hipotireoidismo subclínico e autoimunidade tireoidiana: Uma revisão narrativa

Abstract Thyroid diseases are relatively common in women in the reproductive period. It is currently understood that clinically-evident thyroid disorders may impair ovulation and, consequently, fertility. However, to date it has not been proven that high serum levels of thyroid-stimulating hormone and/or positivity for antithyroid antibodies are associated to a reduction in fertility, mainly in the absence of altered thyroxine levels. The present comprehensive review aims to present current data on the association between subclinical hypothyroidism and/or thyroid autoimmunity and reproductive outcomes.

Resumo As doenças da tireoide são relativamente comuns em mulheres no período reprodutivo. Atualmente, entende-se que distúrbios da tireoide clinicamente evidentes podem prejudicar a ovulação e, consequentemente, a fertilidade. No entanto, não se provou até o presente que níveis séricos altos do hormônio estimulador da tireoide e/ou positividade para anticorpos antitireoidianos estão associados a uma redução na fertilidade, sobretudo na ausência de níveis alterados de tiroxina. Esta revisão narrativa tem como objetivo apresentar dados atuais sobre a associação entre hipotireoidismo subclínico e/ou autoimunidade tireoidiana e resultados reprodutivos.

Association between Serum Free Thyroxine and Anemia in Euthyroid Adults: A Nationwide Study

BACKGROUND: Studies on the relationship between thyroid function and anemia in the euthyroid range are scarce. We aimed to evaluate the association between anemia and serum free thyroxine (fT4) and thyrotropin (TSH) in euthyroid adults.METHODS: Data on 5,352 participants aged ≥19 years were obtained from the Korea National Health and Nutrition Examination Survey VI (2013 to 2015). Anemia was defined as hemoglobin (Hb) <13 and <12 g/dL for men and women, respectively.RESULTS: Overall, 6.1% of participants had anemia, and more women (9.9%) had anemia than men (2.8%, P<0.001). In multivariate analysis, serum fT4 levels, but not TSH, were positively associated with serum Hb levels in both sexes (P<0.001, each). Serum Hb levels linearly reduced across decreasing serum fT4 quartile groups in both sexes (P<0.001, each). After adjusting for potential confounding factors, participants with low-normal fT4 had 4.4 (P=0.003) and 2.8 times (P<0.001) higher risk for anemia than those with high-normal fT4 among men and women, respectively. When participants were divided into two groups at 50 years of age, in younger participants, men and women with the first quartile were at higher risk of anemia than men with the second quartile (odds ratio [OR], 3.3; P=0.029) and women with the forth quartile (OR, 3.2; P<0.001), respectively. This association was not observed in older participants.CONCLUSION: These results suggest that a low-normal level of serum fT4 was associated with a lower serum Hb level and a higher risk of anemia in euthyroid adults, especially in younger participants.

TRH stimulation test in patients with repeatedly elevated TSH and normal FT4 / Teste de estímulo com TRH em pacientes com TSH repetidamente elevado e T4L normal

ABSTRACT Subclinical hypothyroidism (SCH) is defined by elevated thyroid-stimulating hormone (TSH) with normal free thyroxine (FT4). We aimed to evaluate the thyrotropin-releasing hormone (TRH) stimulation test in patients with repeatedly elevated TSH (up to 10 mIU/l) and normal FT4, but without apparent thyroid disease. Women with TSH > 4.5 and ≤ 10 mIU/l (in two measurements) and normal FT4 were selected. Women with a known non-thyroid cause of TSH elevation, those treated with anti-thyroid drugs, amiodarone, lithium, and those with a history of thyroidectomy, neck radiotherapy and 131I treatment were excluded. Seventy women had negative antithyroperoxidase antibodies. Ultrasonography revealed a eutopic thyroid, usual echogenicity, and a volume ≤ 15 ml, and they underwent the TRH stimulation test during initial evaluation. After stimulation with TRH, TSH > 30 mIU/l was observed in 38 women (expected response), while 32 women had TSH < 20 mIU/l (inadequate response). Age, basal TSH or thyroid volume did not differ between both groups, but FT4 concentrations were significantly lower in the first group. Follow-up was available for 66/70 women. Seven women developed a need for levothyroxine, all of them in the group with an adequate response to TRH [7/36 (19.4%) versus 0/30]. The results suggest that some cases of TSH elevation (even persistent) do not represent the early stage of thyroid insufficiency.

RESUMEN El hipotiroidismo subclínico (HSC) es definido por la elevación de los niveles de hormona tiroestimulante (TSH) con los niveles de tiroxina libre (T4L) dentro de rangos de normalidad. El objetivo de este reporte fue evaluar la prueba de estímulo con hormona liberadora de tirotropina (TRH) en pacientes con TSH persistentemente elevado (hasta 10 mUI/l) y T4L normal, pero sin enfermedad tiroidea aparente. Se eligieron mujeres con TSH > 4,5 y ≤ 10 mUI/l (en dos medidas) y T4L normal. Se excluyeron aquellas con causa no tiroidea conocida de alza de TSH además de las tratadas con medicamentos antitiroideos, amiodarona, litio y con historia de tiroidectomía, radioterapia cervical y tratamiento con 131I. Setenta mujeres presentaron anticuerpos antitiroperoxidasa negativos. La ecografía mostró tiroides eutópica, ecogenicidad usual y volumen ≤ 15 ml; todas se sometieron a la prueba de estímulo con TRH en la evaluación inicial. Tras estímulo con TRH, TSH > 30 mUI/l se observó en 38 mujeres (respuesta esperada), mientras 32 mujeres presentaron TSH < 20 mUI/l (respuesta inadecuada). El seguimiento estuvo disponible para 66/70 mujeres. Siete pacientes evolucionaron con necesidad de levotiroxina, todas ellas en el grupo con respuesta adecuada al TRH [7/36 (19,4%) versus 0/30]. Los resultados sugieren que algunos casos de alza de TSH (aunque persistente) no representan la fase inicial de una insuficiencia tiroidea.

RESUMO O hipotireoidismo subclínico (HSC) é definido pela elevação dos níveis de hormônio tireoestimulante (TSH) com os níveis de tiroxina livre dentro da normalidade (T4L). O objetivo deste relato foi avaliar o teste de estímulo com hormônio liberador de tirotrofina (TRH) em pacientes com TSH repetidamente elevado (até 10 mUI/l) e T4L normal, mas sem doença tireoidiana aparente. Mulheres com TSH > 4,5 e ≤ 10 mUI/l (em duas medidas) e T4L normal foram selecionadas. Foram excluídas aquelas com causa não tireoidiana conhecida de elevação do TSH, além das tratadas com medicamentos antitireoidianos, amiodarona, lítio e com histórico de tireoidectomia, radioterapia cervical e tratamento com 131I. Setenta mulheres apresentaram anticorpos antitireoperoxidase negativos. A ultrassonografia revelou tireoide eutópica, ecogenicidade usual e volume ≤ 15 ml; todas foram submetidas ao teste de estímulo com TRH na avaliação inicial. Após estímulo com TRH, TSH > 30 mUI/l foi observado em 38 mulheres (resposta esperada), enquanto 32 mulheres apresentaram TSH < 20 mUI/l (resposta inadequada). Idade, TSH basal ou volume da tireoide não diferiram entre os dois grupos, mas as concentrações de T4L foram significativamente menores no primeiro grupo. O acompanhamento foi disponível para 66/70 mulheres. Sete pacientes evoluíram com necessidade de levotiroxina, todas elas no grupo com resposta adequada ao TRH [7/36 (19,4%) versus 0/30]. Os resultados sugerem que alguns casos de elevação do TSH (mesmo persistente) não representam a fase inicial de uma insuficiência tireoidiana.

Evaluation of renal function in subclinical and overt hypothyroidism

Background: Thyroid hormones can cause significant changes in renal function such as decrease in sodium re-absorption in the proximal tubules, impairment in the concentrating and diluting capacities of the distal tubules, a decrease in the urinary urate excretion and a decrease in the renal blood flow and glomerular filtration rate (GFR). This study was therefore planned to analyse the changes in biochemical markers of renal function in patients with subclinical and overt hypothyroidism and to correlate these values with the thyroid profile of the patients with an aim to determine whether thyroid dysfunction has deleterious effects on renal function.Methods: Study was conducted on 200 patients, in the age group of 20-70 years, in the Department of Medicine, in collaboration with Department of Biochemistry, GMC Jammu over a period of 6 months. After centrifugation, the serum was divided into 2 aliquots: one for renal function tests and the other for thyroid function tests.Results: Age wise, mean was found to be 33.2±9.3 years for euthyroid group and 42.8±8.7 years for hypothyroid group. Patients with both subclinical hypothyroidism and overt hypothyroidism showed statistically significant rise in TSH levels as compared to controls.Conclusions: It was seen that primary hypothyroidism is associated with a reversible elevation of serum creatinine in adults as well as children. It is believed that renal impairment with hypothyroidism is due to reduced cardiac output and increased systemic and renal vasoconstriction leading to reduced renal blood and plasma flow and decreased GFR.

Cytomorphological alterations of thyroid gland consequent upon fluorosis

Background: Study aimed at assessing the impact of elevated fluoride from drinking water on thyroid gland structure and function in fluorosis prone areas. Iodine is incorporated in the thyroid synthesis by thyroid gland but in the presence of low Iodine levels fluoride is likely to interfere with the concentrating capacity of thyroid of iodine in thyroid production, consequently reflecting changes in thyroid parameters and also cytomorphological features manifesting hypothyroidism in association with different pathological entities.Methods: Prakasam district in Andhra Pradesh is fluorosis prone zone and subjects are picked up from highly vulnerable zone in this district and their specimens are collected to study cytomorphological changes of the thyroid gland and biochemical parameters of blood samples for thyroid function test were considered. Cytological study by way of Fine Needle Aspiration Cytology (FNAC) of thyroid gland, biochemical parameters pertaining to function of thyroid gland namely Free triiodothyronine (FT3), Free Thyroxine (FT4) and Thyroid stimulating hormone (TSH) were assessed in the subjects from fluorosis prone zone.Results: The results were statistically significant with concurrent association of different cytological alterations of thyroid gland in these subjects like Hashimoto’s thyroiditis of hypothyroidism, adenomatous goitre, colloid goitre and few of follicular adenoma/neoplasm. FNAC makes cytological changes evident showing different morphological features that comprise different pathological entities largely with an evidence of hypothyroidism in most of the cases in the given study.Conclusions: The results of the study strongly suggest assessing the magnitude of the problem of fluorosis and also magnitude of its influence on thyroid structure and function that warrants assessment of the thyroid function by biochemical and cytological studies.

Clinical analysis of primary hyperthyroidism complicated with thyroid carcinoma / 中国基层医药

Objective To analyze the clinicopathological features of primary hyperthyroidism complicated with thyroid carcinoma. Methods From January 2010 to July 2018,418 patients complicated with thyroid cancer underwent thyroidectomy in the First Affiliated Hospital of Xiamen University were retrospectively analyzed.According to thyroid function,418 patients were divided into two group:A group ( n =39 ) had hyperthyroidism with thyroid carcinoma,and B group(n=379) had normal thyroid function.The clinicopathological features of the two groups were analyzed and compared.Results There were no statistically significant differences in age,sex,tumor stage and tumor diameter between the two groups(all P>0.05).The lymph node metastasis rate in A group was 17.9%(7/39), which was higher than that in B group[6.1%(23/379)] (χ2 =5.814,P=0.016).The incidence rate of temporary hypoparathyroidism in A group was 28.2%(11/39),which was higher than that in B group[13.2%(50/379)] (χ2 =6.394,P＜0.05).The local recurrence rate in A group was 5.1%(2/39),which was higher than that in B group[2.4%(9/379)],but there was no statistically significant difference(χ2 =0.248,P=0.619).The 5 -year disease-free survival rate in A group was 84. 6%( 33/39 ), which was lower than that in B group [ 95. 8%(363/379)]( χ2 =6.740,P＜0.05).Conclusion Hyperthyroidism complicated with thyroid carcinoma has high aggressive behavior and should be treated actively.

The Relationship between Thyroid Nodules Detected through Ultrasonography and Thyroid Function Test Results in Healthy Individuals

BACKGROUND: The detection of thyroid nodules through ultrasonography (US) has improved with the development of imaging technologies and thyroid cancer screening in Korea. We evaluated the relationship between the presence of thyroid nodules on US and thyroid function test (TFT) results in healthy individuals.METHODS: We performed a retrospective review of data from 449 adults (313 men and 136 women) who underwent tests to evaluate serum thyrotropin (TSH) and free thyroxine levels, thyroid US, and if needed, fine needle aspiration cytology (FNAC).RESULTS: Of the 449 subjects, 144 subjects (32.1%) had thyroid nodules. Among the 144 with thyroid nodules, 24 (16.7%) were advised to undergo FNAC, and all of them showed normal serum TSH levels. Logistic regression analysis showed that the presence of thyroid nodules was not related to abnormalities noted on TFTs after adjusting for age, sex, smoking status, and presence of risky drinking behavior and hypertension (P=0.647).CONCLUSION: The presence of thyroid nodules on US in healthy adults was not associated with abnormal TFT results. Serum TSH check-ups during the evaluation of thyroid nodules discovered through US in asymptomatic individuals living in areas with a low prevalence of autonomous functioning thyroid nodules might not be necessary from the perspective of cost-effectiveness and subject convenience.

Clinical analysis of primary hyperthyroidism complicated with thyroid carcinoma / 中国基层医药

Objective@#To analyze the clinicopathological features of primary hyperthyroidism complicated with thyroid carcinoma.@*Methods@#From January 2010 to July 2018, 418 patients complicated with thyroid cancer underwent thyroidectomy in the First Affiliated Hospital of Xiamen University were retrospectively analyzed.According to thyroid function, 418 patients were divided into two group: A group(n=39) had hyperthyroidism with thyroid carcinoma, and B group(n=379) had normal thyroid function.The clinicopathological features of the two groups were analyzed and compared.@*Results@#There were no statistically significant differences in age, sex, tumor stage and tumor diameter between the two groups(all P>0.05). The lymph node metastasis rate in A group was 17.9%(7/39), which was higher than that in B group[6.1%(23/379)](χ2=5.814, P=0.016). The incidence rate of temporary hypoparathyroidism in A group was 28.2%(11/39), which was higher than that in B group[13.2%(50/379)](χ2=6.394, P<0.05). The local recurrence rate in A group was 5.1%(2/39), which was higher than that in B group[2.4%(9/379)], but there was no statistically significant difference(χ2=0.248, P=0.619). The 5-year disease-free survival rate in A group was 84.6%(33/39), which was lower than that in B group [95.8%(363/379)](χ2=6.740, P<0.05).@*Conclusion@#Hyperthyroidism complicated with thyroid carcinoma has high aggressive behavior and should be treated actively.

Interpretation of puzzling thyroid function tests

With the generalized use of highly sensitive thyroid stimulating hormone (TSH) and free thyroid hormone assays, most thyroid function tests (TFTs) are straightforward to interpret and confirm the clinical impressions of thyroid diseases. However, in some patients, TFT results can be perplexing because the clinical picture is not compatible with the tests or because TSH and free T4 are discordant with each other. Optimizing the interpretation of TFTs requires a complete knowledge of thyroid hormone homeostasis, an understanding of the range of tests available to the clinician, and the ability to interpret biochemical abnormalities in the context of the patient's clinical thyroid status. The common etiologic factors causing puzzling TFT results include intercurrent illness (sick euthyroid syndrome), drugs, alteration in normal physiology (pregnancy), hypothalamic-pituitary diseases, rare genetic disorders, and assay interference. Sick euthyroid syndrome is the most common cause of TFT abnormalities encountered in the hospital. In hypothalamic-pituitary diseases, TSH levels are unreliable. Therefore, it is not uncommon to see marginally high TSH levels in central hypothyroidism. Drugs may be the culprit of TFT abnormalities through various mechanisms. Patients with inappropriate TSH levels need a differential diagnosis between TSH-secreting pituitary adenoma and resistance to thyroid hormone. Sellar magnetic resonance imaging, serum α-subunit levels, serum sex hormone-binding globulin levels, a thyrotropin-releasing hormone stimulation test, trial of somatostatin analogues, and TR-β sequencing are helpful for the diagnosis, but it may be challenging. TFTs should be interpreted based on the clinical context of the patient, not just the numbers and reference ranges of the tests, to avoid various pitfalls of TFTs and unnecessary costly evaluations and therapies.

A Case with Thyroid Hormone Resistance Syndrome

Thyroid hormone resistance is a rare syndrome of reduced tissue responsiveness to thyroid hormone. We report the case of a 13-month girl with short height and low weight. She was born at 37+6 weeks gestation and weighed 2,470 g. In the neonatal screening test, patients' thyroid stimulation hormone (TSH) level was increased to 13.1 µIU/mL. In follow-up test after getting levothyroxine medication, patients' free T4 level continued to increase and TSH level was normalized. After stop medication, the patient visited Soonchunhyang University Seoul Hospital every 2 to 3 months and done laboratory test, and the result was not changed. Despite good feeding, she consistently shows 5–10 percentile weight and 5–10 percentile height. Her bone age was delayed by 5 months compared to the expected age. In suspicious thyroid hormone resistance, THRβ gene study and brain magnetic resonance imaging (MRI), and T3 suppression test was done. Brain MRI and T3 suppression test shows the exception of pituitary thyroid adenoma. Gene study result was THRβ gene mutation, c.1012C>T (p.Arg338Trp), and heterozygous. This gene mutation was reported at thyroid hormone resistance family. After diagnosis of thyroid hormone resistance, because of the patient is asymptomatic, she does not have medication. We are checking developmental delay, growth delay, and other clinical hypothyroid symptoms.

Prognostic value of cortisol and thyroid function tests in poisoned patients admitted to toxicology ICU / 世界急诊医学杂志（英文）

BACKGROUND:Prognostic value of cortisol and thyroid function tests (TFTs) has previously been evaluated in medical ICUs. We aimed to evaluate prognostic efficacy of cortisol and TFTs in critical y il poisoned patients admitted to toxicology intensive care unit (ICU). METHODS:In a prospective study of consecutively enrolled subjects admitted to the toxicology ICU, lab analyses included TFTs (total T3 and T4 as well as TSH) and cortisol levels drawn between 8 am–10 am during period of the first 24 hours post-ingestion/exposure. Simplified Acute Physiology Score II (SAPS II) and Acute Physiology and Chronic Health Evaluation II (APACHE II) were recorded. All scores were compared to detect the best prognostic factor. Type of poisoning was also included. RESULTS:In 200 patients evaluated, 129 were male and mean age was 31 years. In general, SAPS II, T4, and cortisol could prognosticate death. After regression analysis, only cortisol had such efficacy (P=0.04; OR=1.06; 95％CI=1.05–1.08; cut-off=42 μg/dL; sensitivity=70％; specificity=82％). Between aluminium phosphide (ALP)- and non ALP-poisoned patients, level of consciousness, mean arterial pressure, and cortisol level could prognosticate death in ALP poisoning (all Ps<0.001 in both uni and multivariate analyses). Median (interquartile range; IQR) GCS was 7 (6, 10) and 15 (8, 15) in non-ALP and ALP-poisoned patients (P<0.003). SAPS II and APACHE II could not prognosticate death at all. CONCLUSION:Cortisol best prognosticated outcomes for subjects admitted to the toxicology ICU. Its level is higher in ALP-poisoned patients probably due to the higher stress while they remain conscious till the final stages of toxicity and are aware of deterioration of their clinical condition or may be due to their significantly lower blood pressures.

Thyroid Dysfunction and Diabetes: A Relationship Thats Not Sweet

Background: The aim of the present study was to evaluate the clinical association of thyroid disorders in type 2 diabetes mellitus patients and to correlate the thyroid function tests with diabetic control, duration and its complications. Materials and methods: A hospital based case control study was conducted at Department of Medicine of a tertiary care hospital. The study population included diagnosed cases of type 2 DM and their non-diabetic family members of similar age and gender as control. A detailed history was taken and examination was done as per the pre-tested, structured interview schedule. All patients in addition to hematological and routine urine work up underwent target organ evaluation for diabetes. All patients were evaluated for thyroid status and assessment of T3, T4 and TSH levels was carried out at our institution. Diabetic state of the patients was estimated by analyzing HbA1c and blood sugar indices (FBS/ PPBS). Data was analyzed using SPSS software ver. 21. Results: Mean age of diabetics (T2DM) and non-diabetics was 55.09±10.99 years and 51.11±8.78 years respectively while in each group 57 (50%) males and 57 (50%) females were included. Among cases, 33 (29%) patients were detected with thyroid disorders of which 25 (22%) were hypothyroid and 8 (7%) were hyperthyroid. Among controls, 15 (13%) patients were detected with thyroid disorders of which 11 (9.6%) were hypothyroid and 4 (3.5%) were hyperthyroid. A significant association was observed between prevalence of thyroid disorder and diabetes (p<0.05). No association was observed between prevalence of thyroid disorder and control and duration of diabetes or presence of microvascular complications (p>0.05). Conclusion: A high prevalence of Thyroid dysfunction was observed in type 2 Diabetes Mellitus patients as compared to non-diabetic population with Hypothyroidism and Clinical thyroid disorders being more common than hyperthyroidism and subclinical thyroid disease. Thus, one must have strong suspicion of thyroid dysfunction in patients with diabetes mellitus.

Correlation of thyroid function and iodine nutritional status among pregnant women of Han nationality in Urumqi / 中华临床营养杂志

Objective To establish reference interval of thyroid hormones in pregnant women in Urumqi,standardize the diagnostic criteria of thyroid diseases in pregnancy,assess the iodine nutrition and thyroid function at different stages of pregnancy,and provide evidence to guide iodine supplementation.Methods A cross-sectional survey was performed in 3 731 pregnant women in Urumqi from May 2015 to June 2016.1 206 of them were in the first trimester,1 125 in the second and 1 400 in the third.500 non-pregnant women were recruited as controls.Levels of serum thyrotrophin (TSH),free triiodothyrunine (FT3),free thyroxine (FT4),anti-thyroid peroxidase (anti-TPO) and antithyroglobulin (anti-TG) were measured,and urinary iodine levels were detected by arsenic-cerium catalytic spectrophotometry.Results There were statistically significant differences between the pregnant groups and the control group in FT3,FT4,and TSH levels (P＜0.05).The serum thyroid concentrations in each group were FT3 values:(4.64±1.15),(4.36±0.89),(3.89±0.92),(5.24±0.65) pmol/L;FT4:(16.49±2.78),(15.06±3.76),(12.38± 1.65),(17.56± 1.12) pmol/L;TSH:(1.98±0.65),(2.43 ±0.83),(3.15± 1.25),(2.13 ± 0.75) mU/L.The reference intervals of thyroid hormones in early,middle and late pregnancy (P2.5 to P97.5) were:FT3:3.24-7.58,3.16-5.47,3.05-4.28 pmol/L;FT4:13.36-22.58,12.04-19.77,12.78-20.03 pmoL/L;TSH:0.24-3.78,0.51-3.91,0.55-4.55 mU/L.The medians of anti-TG and anti-TPO at different stages of pregnancy were significantly different,with the first trimester being the lowest and the third trimester being the highest (P=0.07,0.04).The medians of urinary iodine in all four groups were 235.78 μg/L (controls),198.25 μg/L (first trimester),175.36 pg,/L (second trimester) and 141.24 μg/L (third trimester),showing a significant gestational age-dependent decrease (P =0.036).Changes in serum levels of TSH,FT3,FT4,anti-TG and anti-TPO seemed to be in accordance with changes of urinary iodine levels;yet the correlations were not statistically significant (P＞0.05).Conclusions Iodine nutritional status was closely related to gestational age.Abnormal TSH levels were mainly observed in the second and third trimesters,abnormal serum levels of FT3,FT4,anti-TG and anti-TPO in the first trimester,and iodine deficiency in the third trimester.Thyroid function and urinary iodine should be monitored at each trimester during pregnancy.

Influence of 131 I therapy on thyroid function and bone metabolism in patients with Graves disease / 中国基层医药

Objective To analyze the influence of 131 I therapy on thyroid function and bone metabolism in patients with Graves 's disease. Methods From February 2014 to January 2017,60 Graves patients in Shaoxing Central Hospital were studied. According to the random number table method,they were divided into observation group and control group,with 30cases in each group. The patients in the control group were treated with methimidazole,and the patients in the observation group were treated with 131 I combined with methimidazole. After treatment for 1 month, the clinical efficacy,three triiodothyronine (FT3 ),free thyroxine (FT4 ),thyroid stimulating hormone (TSH) concen-tration,parathyroid hormone (PTH),procollagen amino terminal propeptide (PINP) and osteocalcin (OCN),1,25 hydroxyvitamin D3(1,25(OH)2D3),bone mineral density (BMD),the incidence of goiter,exophthalmos,incidence of hypothyroidism of the two groups were observed. Results After treatment,the total effective rate of the observation group was 93. 33％ ,which of the control group was 73. 33％ . There was statistically significant difference between the two groups (χ2 = 4. 320,P = 0. 037). Before treatment,the levels of FT3 ,FT4 ,TSH between the two groups had no statisticallysignificant differences (all P > 0. 05). After treatment,the FT3 ,FT4 levels of the observation group were (12. 41 ± 1. 24) pmol/ L,(18. 33 ± 4. 25) pmol/ L,respectively,which were significantly lower than those of the control group[ (15. 98 ± 1. 30)pmol/ L,(22. 75 ± 4. 31)pmol/ L](t = 10. 884,P < 0. 0001;t = 4. 000,P < 0. 000). The concentration of TSH in the observation group was (2. 16 ± 0. 39)mIU/ L,which was significantly higher than that of the control group[(1. 72 ± 0. 34)mIU/ L](t = 4. 658,P < 0. 0001). Before treatment,the PTH,PINP,OCN,1,25 (OH)2D3 and BMD between the two groups had no statistically significant differences (all P > 0. 05). After treat-ment,the PINP and OCN of the observation group were (43. 21 ± 3. 69) μg/ L,(27. 42 ± 6. 48) μg/ Lrespectively, which were significantly lower than those of the control group [(55. 87 ± 3. 71) μg/ L,(31. 84 ± 6. 55) μg/ L] (t =13. 252,P < 0. 0001;t = 2. 628,P = 0. 011). The PTH,1,25 ( OH)2D3 and BMD of the observation group were (55. 87 ± 3. 18)ng/ L,(25. 16 ± 2. 84) nmol/ L,(0. 98 ± 0. 17) g/ cm2 ,respectively,which were significantly higher than those in the control group [(49. 89 ± 3. 21)ng/ L,(23. 2 ± 2. 76)nmol/ L,(0. 85 ± 0. 15)g/ cm2 ] (t = 7. 249, P < 0. 001;t = 2. 697,P = 0. 009;t = 3. 141,P = 0. 003). After treatment,the incidence rate of exophthalmos in the observation group was 6. 67％ ,which in the control group was 30. 00％ ,there was statistically significant difference between the two groups (χ2 = 5. 455,P = 0. 020). The incidence rate of goiter of observation group was 3. 33％ ,which was significantly lower than 23. 33％ of the control group (χ2 = 5. 192,P = 0. 023). The incidence rate of hypothy-roidism of the observation group was 13. 33％ ,which in the control group was 10. 00％ ,the difference between the two groups was not statistically significant (χ2 = 0. 162,P = 0. 688). Conclusion 131 I therapy has good clinical effect on Graves disease. It can effectively improve the thyroid function and bone metabolism and has high safety. It is worthy of widely application and popularizing in clinic.

The effect of Korean traditional alternative medicine products on thyroid function level in post-total thyroidectomy patients: A pilot study

PURPOSE: Although many Koreans consume traditional alternative remedial products to alleviate symptoms of fatigue, there have been no studies on their effect on thyroid function levels in thyroidectomized patients on levothyroxine replacement. The aim of this study was to assess the effect of Korean traditional alternative remedies on thyroid function levels in post total thyroidectomy patients.METHODS: A retrospective review of medical records from a single tertiary referral center was performed on patients who received total thyroidectomy from 2010 to 2015 and became euthyroid postoperatively. Gender, age, body mass index, preoperative thyroid function test results, interval to first hypothyroidism occurrence, recurrence of hypothyroidism, number and types of alternative remedy were evaluated.RESULTS: Postoperative hypothyroidism occurred among 174 out of 917 patients (18.9%) and 100 (57.5%) of them had a history of alternative medication usage. The first episode of hypothyroidism occurred at median of 38.5 months after operation in the 100 patients. Six of the 100 patients received an increased dosage of levothyroxine due to severe hypothyroidism but the rest received the same dose and were requested not to consume alternative products. All patients recovered to euthyroid status afterwards. Thirty-three patients subsequently experienced recurrence even after being restricted from consuming alternative remedial products. Apart from thyroiditis on pathology reports (P=0.001), there were no variables significantly related to the recurrent hypothyroidism.CONCLUSION: This pilot study demonstrated the possible role of consumption patterns of traditional alternative remedial products in thyroidectomized patients under hormone supplement in restoring euthyroid status without levothyroxine increase.

Clinical course of infants with congenital heart disease who developed thyroid dysfunction within 100 days

PURPOSE: We investigated the clinical course of infants with congenital heart disease (CHD) who experienced thyroid dysfunction within 100 days of birth. METHODS: We performed retrospective medical reviews of 54 CHD patients (24 male patients) who underwent a thyroid function test (TFT) between January 2007 and July 2016. Data were collected on birth history, diagnosis of CHD, underlying chromosomal or genetic abnormalities, medication history, surgery, ventilator care, and exposure to iodine contrast media (ICM). Results of neonatal screening tests (NSTs) and TFTs were reviewed. RESULTS: A total of 36 patients (29 transient, 7 permanent) showed thyroid dysfunction. Among the seven patients with permanent hypothyroidism, three had an underlying syndrome, three showed abnormal NST results, and one was admitted to the intensive care unit for macroglossia and feeding cyanosis. We found that infants with transient thyroid dysfunction had a lower birth weight and were more commonly exposed to thyroid disrupting medication and/or ICM. However, these risk factors were not significant. A total of 8 patients with a history of ICM exposure showed thyroid dysfunction. Excluding 3 patients with elevated thyroid stimulating hormone before ICM exposure, 5 patients recovered from transient thyroid dysfunction. CONCLUSIONS: We observed thyroid dysfunction in two-thirds of CHD infants (53.7% transient, 13.0% permanent) who had risk factors and received TFT screening within 100 days, despite normal NSTs. Further studies with larger sample sizes are required to revise the criteria for TFT screening in CHD infants.

Hipotiroidismo y apnea del sueño / Hypothyroidism and sleep apnea

Resumen La salud es un derecho fundamental de todo ser humano, ya reconocido por la Ley Estatutaria de Salud (Ley 1751 de 2015). Esta ley devuelve la autonomía profesional al médico y para hacer buen uso de ella, debemos ejercer nuestra profesión dentro de un marco de autorregulación, ética, racionalidad y evidencia científica. Somos los médicos los llamados a liderar la identificación de los gastos innecesarios en salud, sin descuidar la calidad de la atención. Iniciamos aquí una serie de artículos en los que esperamos exponer, bajo evidencia científica, cuáles prácticas en medicina debemos continuar, mejorar o abolir con el fin de autorregularnos bajo conceptos éticos, de calidad y de racionalidad científica. El cuadro clínico del hipotiroidismo y de la apnea del sueño son bastantes similares, sin embargo cada una tiene unas características clínicas particulares que son las que debemos evaluar. ¿Se recomienda solicitar rutinariamente pruebas de función tiroidea a todos los pacientes con sospecha diagnóstica o diagnóstico confirmado de apnea del sueño?; ¿Se recomienda realizar un estudio del sueño a todos los pacientes con diagnóstico de hipotiroidismo clínico o subclínico?. No se recomienda realizar pruebas de función tiroidea a todos los pacientes con diagnóstico de apnea del sueño, así como tampoco hacer estudio del sueño a todos los pacientes con hipotiroidis-mo. Solo se recomienda hacer cuando la sospecha clínica lo amerite. Sugerimos la realización de investigaciones de costo/efectividad. (Acta Med Colomb 2016; 41: 138-140).

Abstract Health is a fundamental right of every human being, as recognized by the Statutory Health Law (Law 1751 of 2015). This law puts professional autonomy to the doctor, and to make good use of it we must exercise our profession within a framework of self-regulation, ethics, rationality and scientific evidence. We the physicians are the ones who are called to lead the identification of unnecessary health expenses without sacrificing quality of care. We begin here a series of articles in which we expect expose, on scientific evidence, which medical practices must we continue, improve or abolish in order to self-regulate us under ethical, quality and scientific rationality concepts. The clinical picture of hypothyroidism and sleep apnea are quite similar, yet each has unique clinical features that are what we have to assess. Is it recommended routinely request thyroid tests to all patients with suspected or confirmed diagnosis of sleep apnea?. Is it recommended to perform a sleep study to all patients diagnosed with clinical or subclinical hypothyroidism?. It is not recommended practice thyroid function tests to all patients diagnosed with sleep apnea, nor do sleep study to all patients with hypothyroidism. It is recommended only when the clinical suspicion warrants it. We suggest carry out cost / effectiveness research. (Acta Med Colomb 2016; 41: 138-140).