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.

Association of insulin resistance and lipid profile with serum T3, T4, and TSH in patients with hypothyroidism

Background: Hypothyroidism is a common endocrine derangement met with in clinical practice. Deficiency of thyroid hormones can have a significant effect on lipid and carbohydrate metabolism. Aims and Objectives: The aim of the study was to study the association of insulin resistance and lipid profile with serum triiodothyronine (T3), tetraiodothyronine (T4), and thyroid-stimulating hormone (TSH) in hypothyroidism. Materials and Methods: A comparative cross-sectional study was conducted in a tertiary care hospital after obtaining clearance from the Institutional Ethics Committee. Thirty primary hypothyroid subjects were selected as cases based on their TSH values (>4 uIU/mL) and thirty normal subjects as controls after proper exclusion and after getting the informed consent. Their fasting plasma glucose levels, lipid profile, and serum T3, T4, TSH were measured. Homeostasis model Assessment using OXFORD HOMA 2 CALCULATOR was used to determine the insulin resistance (HOMA-IR). Results: The mean values of HOMA-IR, total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides were significantly higher in hypothyroid group than in normal controls. HOMA-IR showed a significant negative correlation with T3 and T4. The correlations of HOMA-IR, total cholesterol, LDL cholesterol, and triglycerides with TSH were positive. Conclusion: The present study shows that hypothyroidism leads to an elevated insulin resistance and dyslipidemia.

Atypical pituitary hormone-target tissue axis / 医学前沿

A long-held belief is that pituitary hormones bind to their cognate receptors in classical target glands to actuate their manifold functions. However, a number of studies have shown that multiple types of pituitary hormone receptors are widely expressed in non-classical target organs. Each pituitary gland-derived hormone exhibits a wide range of nonconventional biological effects in these non-classical target organs. Herein, the extra biological functions of pituitary hormones, thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, adrenocorticotrophic hormone, and prolactin when they act on non-classical organs were summarized, defined by the novel concept of an "atypical pituitary hormone-target tissue axis." This novel proposal explains the pathomechanisms of abnormal glucose and lipid metabolism, obesity, hypertension, fatty liver, and atherosclerosis while offering a more comprehensive and systematic insights into the coordinated regulation of environmental factors, genetic factors, and neuroendocrine hormones on human biological functions. The continued exploration of the physiology of the "atypical pituitary hormone-target tissue axis" could enable the identification of novel therapeutic targets for metabolic diseases.

A multi-center analysis of thyroid-stimulating hormone level in apparently healthy elderly population in China / 南方医科大学学报

OBJECTIVE@#To investigate serum thyroid stimulating hormone (TSH) level and its changes with age in apparently healthy Chinese elderly population and analyze the differences between TSH levels detected using Roche and Snibe electrochemiluminescence immunoassay analyzers.@*METHODS@#General clinical data and frozen fasting serum samples were collected from 5451 apparently healthy Chinese elderly individuals (> 60 years) from 10 centers in different geographic regions in China. Thyroid function indexes including TSH level were detected using Roche and Snibe electrochemiluminescence immunoassay analyzer, and the median (2.5% and 97.5% quantiles) TSH level was calculated. The variations of TSH level among the participants with geographic regions, gender, and age (with an interval of 5 years) were analyzed to determine the influence of these factors on TSH level.@*RESULTS@#The reference ranges of serum TSH level established using Roche and Snibe electrochemiluminescence immunoassay analyzers were 0.42-9.47 mU/L and 0.36-7.98 mU/L, respectively, showing significant differences between the two methods (P < 0.001). The TSH levels measured at two centers in Western China were significantly higher than those at the other centers (P < 0.05). In elderly male population, serum TSH level tended to increase with age, which was not observed in elderly female population. At the age of 60-75 years, women generally had higher serum TSH level than men, but this difference was not observed in the population beyond 75 years.@*CONCLUSION@#In elderly population, serum TSH level can vary with geographic region, gender, and age, but there was no need for establishing specific reference ranges for these factors. The differences between different detection methods should be evaluated when interpreting the detection results of TSH level.

The combination of high-frequency ultrasound and thyroid-stimulating hormone/thyroglobulin ratio in the diagnostic value of benign and malignant lesions of thyroid nodules / 中国医师进修杂志

Objective:To analyze the diagnostic value of high-frequency ultrasound combined with serum thyroid-stimulating hormone (TSH) / thyroglobulin (Tg) ratio for the benign and malignant lesions of thyroid nodules (TN).Methods:A retrospective analysis was made on the clinical data of 772 patients with TN admitted to Changxing County People′s Hospital from June 2020 to June 2021. All patients received high-frequency ultrasound examination and serum TSH detection, 320 patients (41.45%) received Tg detection to calculate the TSH/Tg ratio. According to the benign and malignant thyroid nodules, they were divided into benign group and malignant group based on the pathological results as the "gold standard". The ultrasonographic characteristics, serum TSH and Tg levels and TSH/Tg ratio of the two groups were compared, and the accuracy of high-frequency ultrasound, TSH/Tg ratio and the combination in the diagnosis of benign and malignant thyroid nodules were evaluated.Results:A total of 83 patients with thyroid nodules were diagnosed as malignant by pathological results. In the malignant group, the nodules were mostly irregular in shape, extremely low in internal echo, accompanied by calcification, aspect ratio ≥1 and enlarged cervical lymph nodes. The levels of TSH and Tg as well as the ratio of TSH/Tg in the malignant group were higher than those in the benign group (16.52 ± 4.49) mU/L vs. (6.75 ± 1.18) mU/L, (11.37 ± 3.16) kU/L vs. (8.14 ± 1.40) kU/L, 1.45 ± 0.76 vs. 0.83 ± 0.06, there were statistical differences( P<0.05). The sensitivity and accuracy of high-frequency ultrasound combined with TSH/Tg ratio in the diagnosis of benign and malignant thyroid nodules were 92.77%, 95.47%, and higher than those in the single diagnosis. Conclusions:The morphological high-frequency ultrasonography features of malignant thyroid nodules are mostly irregular, with extremely low internal echo, accompanied by calcification, aspect ratio ≥1 and cervical lymph node enlargement. TSH/Tg ratio is higher than that of benign thyroid nodules. The combination of high-frequency ultrasonography and TSH/Tg ratio can improve the diagnosis rate of thyroid cancer.

Secretory expression of human thyroid stimulating hormone receptor A subunit in sf9 insect cell system / 西安交通大学学报(医学版)

【Objective】 To construct the secretory expression system of insect cells to express the secretory TSHR A subunit protein in the ovarian cells of Spotoma oryzae (sf9). 【Methods】 A recombinant plasmid containing the target protein was constructed, and then the positive bacmid was screened out by the blue and white spots experiment. The verified bacmid was transfected into SF9 insect cells to obtain recombinant baculovirus. The virus was amplified, and the titer level was detected by virus plaque assay. Finally, Western blotting was used to identify the expression of the recombinant protein and optimize the expression conditions. 【Results】 During the construction of the protein expression system, PCR identification and sequencing results confirmed the correctness of the sequences of the recombinant plasmid and the recombinant bacmid. After the transfection of the bacmid, the signs of virus budding were observed in sf9 cells. The virus was collected and amplified. The titer of P1 generation virus was 2×107 pfu/m according to the plaque assay. The recombinant protein was identified by Western blotting and confirmed to be exogenous into the culture medium. The optimal condition for virus infection and protein expression was 72 h after the infection when the multiplicity of infection (MOI) was 1. 【Conclusion】 We constructed an insect cell expression system secreting TSHR 22-289 (55 ku), and the protein could be successfully glycolyzed. This system provides a preliminary basis for the construction and production of its industrial platform and also provides a useful tool for studies on TSHR protein and prevention of GO in the future.

Expressions of serum thyroid stimulating hormone, thyroid peroxidase antibody and thyroglobulin antibody in papillary thyroid carcinoma and their clinical significances / 肿瘤研究与临床

Objective:To explore the relationship between serum levels of thyroid stimulating hormone (TSH), thyroid peroxidase antibody (TPO-Ab) and thyroglobulin antibody (Tg-Ab) and the development of papillary thyroid carcinoma.Methods:The clinical data of 574 patients with thyroid nodules who received surgical treatment in Tengzhou Central People's Hospital from January to December 2021 were retrospectively analyzed. Using histopathological diagnosis as the gold standard, the patients were divided into papillary thyroid carcinoma group (malignant group, 267 cases) and benign thyroid nodules group (benign group, 307 cases). The clinical data and the preoperative serum TSH, TPO-Ab and Tg-Ab levels were compared between the two groups. The correlation between preoperative serum TSH, TPO-Ab and Tg-Ab levels and papillary thyroid cancer was analyzed by logistic regression.Results:There were no statistical differences in the age and gender of patients between the malignant group and the benign group (all P > 0.05). TSH [2.37 mIU/L (1.43 mIU/L, 5.09 mIU/L)], TPO-Ab [17.84 IU/ml (11.94 IU/ml, 40.68 IU/ml)] and Tg-Ab [15.69 IU/ml (10.57 IU/ml, 132.00 IU/ml)] in the malignant group were higher than those in the benign group [TSH 1.60 mIU/L (0.88 mIU/L, 2.57mIU/L), TPO-Ab 14.29 IU/ml (10.00 IU/ml, 21.17 IU/ml), Tg-Ab 12.23 IU/ml (10.00 IU/ml, 16.51 IU/ml)], and the differences were statistically significant ( Z values were -6.43, -4.60 and -6.15, all P < 0.05). Multivariate logistic regression analysis showed that positive TPO-Ab ( OR = 0.996, 95% CI 0.993-0.999, P = 0.013) and positive Tg-Ab ( OR = 0.996, 95% CI 0.994-0.998, P < 0.05) were independent risk factors for papillary thyroid cancer. Conclusions:Preoperative serum TSH, TPO-Ab and Tg-Ab levels are closely related to papillary thyroid cancer, among which positive serum TPO-Ab and positive Tg-Ab are independent risk factors for papillary thyroid cancer and have important values in the differential diagnosis of benign and malignant thyroid nodules.

Analysis of risk factors for recurrence of differentiated thyroid carcinoma after surgical resection combined with iodine-131 and TSH suppression therapy / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the risk factors of recurrence after surgical resection of differentiated thyroid carcinoma combined with iodine-131 and TSH（Thyroid stimulating hormone） inhibition therapy. Methods:From January 2015 to April 2020, the clinical data of patients with structural recurrence and without recurrence were retrospectively collected after surgical treatment combined with iodine-131 and TSH inhibition therapy in the First Medical Center of PLA General Hospital. The general conditions of the two groups of patients were analyzed and the measurement data in line with the normal distribution was used for comparison between groups. For measurement data with non-normal distribution, the rank sum test was used for inter-group comparison. The Chi-square test was used for comparison between the counting data groups. Univariate and multivariate regression analyses were used to determine the risk factors associated with relapse. Results:The median follow-up period was 43 months（range 18-81 months） and 100 patients（10.5%） relapsed among the 955 patients. Univariate analysis showed that tumor size, tumor multiple, the number of lymph node metastases>5 in the central region of the neck, and the number of lymph node metastases>5 in the lateral region were significantly correlated with post-treatment recurrence（P<0.001, P=0.018, P<0.001, P<0.001）. Multivariate analysis showed that tumor size（adjusted odds ratio OR: 1.496, 95%CI: 1.226-1.826, P<0.001）, tumor frequency（adjusted odds ratio OR: 1.927, 95%CI: 1.003-3.701, P=0.049）, the number of lymph node metastases in the central neck region>5（adjusted odds ratio OR: 2.630, 95%CI: 1.509-4.584, P=0.001） and the number of lymph node metastases in the lateral neck region>5（adjusted odds ratio OR: 3.074, 95%CI: 1.649-5.730, P=0.001） was associated with tumor recurrence. Conclusion:The study showed that tumor size, tumor multiple, the number of lymph node metastases in the central region of the neck>5 and the number of lymph node metastases in the side of the neck >5 are independent risk factors for recurrence of differentiated thyroid cancer after surgical resection combined with iodine-131 and TSH inhibition therapy.

Association between psoriasis and thyroid function: results from the Brazilian Longitudinal Study of Adults Health (ELSA-Brasil)

ABSTRACT Objective: To determine the relationship between psoriasis, thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triodothyronine (FT3), thyroid peroxidase antibodies (TPOAb), and subclinical thyroid dysfunctions in middle-aged and older adults. Materials and methods: Cross-sectional analyses included a self-reported medical diagnosis of psoriasis and thyroid function from the 3rd visit (2017-2019) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). TSH, FT4, and FT3 levels were analyzed as continuous variables and quintiles, and TPOAb positivity and subclinical hypothyroidism as a yes/no variable. Logistic regression models were built as crude and adjusted by main confounders (age, sex, education level, race/ethnicity, and smoking). Results: From 9,649 participants (52.3% women; 59.2 ± 8.7 years old), the prevalence of psoriasis was 2.8% (n = 270). TSH, FT4, TPOAb positivity, and subclinical hypothyroidism were not associated with psoriasis in the main analyses. In the stratified analysis, our findings showed positive associations of the lowest (OR = 2.01; 95% CI 1.05-3.84; p = 0.036) and the highest (OR = 2.13; 95% CI 1.12-4.05; p = 0.022) quintiles of FT4 and a protective association of TPOAb positivity (OR = 0.43; 95% CI 0.19-0.98; p = 0.046) with prevalent psoriasis in women. In the logistic regression for FT3, participants in the 1st quintile showed a statistically significant association with psoriasis for the whole sample (OR = 1.66; 95% CI 1.11-2.46; p = 0.013) and for men (OR = 2.25; 95% CI 1.25-4.04; p = 0.007) in the sex-stratified analysis. Conclusions: The present study showed that the association of FT4 levels with psoriasis are different according to sex, with a possible U-shaped curve in women but not in men. Although there were some associations of FT3 with psoriasis, they may be a consequence of non-thyroidal illness syndrome. Further prospective data may clarify the association of thyroid function and psoriasis.

Reference intervals for serum TSH concentrations of healthy children from the Central Region of Brazil

ABSTRACT Objective: The objective of this study was to determine the serum thyroid-stimulating hormone (TSH) concentration reference intervals (RIs) of healthy children aged 1 to 10 years of both sexes, living in the Central Region of Brazil. Subjects and methods: 1,735 children [869 (50.1%) female; 866 (49.9%) male] enrolled in the morning shift of 47 pre- and 83 public elementary schools in the municipality of Cuiabá, Mato Grosso, were studied by gathering anthropometric and social data and their medical history. A blood sample was collected from each child to determine the TSH concentration using the electrochemiluminescence method on a Cobas® 6000 modular analyzer (Analyzer series, Roche Diagnostics). Results: The RIs were determined using the 2.5 and 97.5 percentile and the mean ± 2 standard deviations methods. After identifying the homoscedastic groups by age and sex, outliers higher or lower than three standard deviations were excluded. The distribution of serum TSH concentrations showed no significant age or sex differences. Based on the percentile method, TSH RI ranged from 0.93 to 5.86 μIU/mL. Based on the mean ± 2 standard deviations, TSH RI ranged from 0.30 to 5.29 μIU/mL. Conclusion: The normal serum TSH concentration of the Brazilian children evaluated in this study differ from those of populations from other countries. Other regional population studies may validate the RIs found in this study and enable its safer use in pediatric clinical practice.

A study to compare thyroid profile between premenopausal and postmenopausal women

Background: The most abundant disorders worldwide are the thyroid disorders next to diabetes. Normal levels of thyroid hormones are essential for normal reproductive behavior. The onset of thyroid disorder increases with age. Thyroid disorders are more common in women than men. It is common that women develop menstrual cycle-related symptoms and are usually prone to thyroid dysfunction. Aim and Objectives: The objectives of this study were as follows: (i) To assess the thyroid profile in premenopausal women; (ii) to assess the thyroid profile in postmenopausal women; and (iii) to compare the thyroid profile between premenopausal and postmenopausal women. Materials and Methods: Subjects were selected according to premenopausal and postmenopausal status. Seventy premenopausal women more than 40 years of age and 70 postmenopausal women with menopause duration not more than 5 years. Thyroid profile was done in the central laboratory of Amala institute of Medical sciences, Thrissur. The tests were done basal-fasting state. Results: The mean thyroid-stimulating hormone levels in the postmenopausal group (3.33 ± 3.88) were higher than premenopausal group (2.65 ± 2.36 MIU/L). The mean FT3 level in postmenopausal group (5.39 ± 0.64 pmol/L) was higher than in premenopausal group (5.19 ± 0.66 pmol/L) and the mean FT4 level was also higher in postmenopausal group (12.01 ± 2.99 pmol/L) than in premenopausal group (11.22 ± 2.13 pmol/L). There was no statistically significant difference in the thyroid hormone profile in premenopausal and postmenopausal status. Conclusion: This study, the difference of thyroid parameters between premenopausal and postmenopausal women, does not show statistical significance. Further study with larger sample size in Indian population is required to evaluate association between thyroid status with pre- and postmenopausal status.

A study of biochemical inflammatory marker of TNF-alpha in hypothyroidism patients

Background: Deranged thyroid function may be caused by autoimmune disorders like auto-immune thyroiditis. The medical staging of the disease shows an extensive display of symptoms like overt hypothyroidism. Various scientific studies had shown that auto-immune thyroiditis may be due to the interaction of cytokines (tumor necrosis factor-alpha � TNF-?). Current studies had shown that TNF-? plays a crucial role in the regulation of thyroid transcription factors. Aims and Objectives: The study aimed to assess the comparative changes of inflammatory markers in diagnosed thyroid patients and control subjects. Materials and Methods: The present study comprises 200 subjects of both sexes whom 00 are healthy controls and 100 are clinically confirmed cases of hypothyroidism, with an age group ranging from 25 to 70 years. Serum TNF-? and serum thyroid stimulating hormone were estimated by ELISA Method. Results: The inflammatory marker (Serum TNF-?) was significantly (P > 0.05) raised in clinically diagnosed hypothyroid patients (4.09 � 0.94) as compared to age and gender match healthy control subjects (3.06 � 0.55). Conclusion: Many studies have shown that inflammatory markers are the primary cause of thyroid function problems. The current cogitation proved that raised serum TNF-? is concerned with the pathogenesis of autoimmune thyroid destruction. It seems that TNF-? is highly significant in the case of Hypothyroidism.

A comparative study of auditory reaction time between normal and hypothyroid patients before and after treatment

Background: One of the most common endocrine disease is hypothyroidism which is usually associated with mental retardation, lack of concentration, motor dysfunction, memory deficits, visual, and hearing impairment. These symptoms suggest the involvement of nervous system, where the processing efficiency and sensory motor association is affected, which can be assessed by reaction time. Aims and Objective: The aim of the study was to compare the auditory reaction time in controls, newly diagnosed hypothyroid patients and in hypothyroid patients after attaining euthyroid status. Materials and Methods: Auditory reaction time was recorded from 35 subjects from general population, who formed the control group and 35 newly diagnosed hypothyroid patients who were selected from OBG and Medicine department, RRMCH, Bangalore. These patients were followed up and reaction time recording was repeated after they attained euthyroid status. Results: Statistically significant increase in ART values was observed in newly diagnosed hypothyroid patients compared to controls. The values were significantly reduced in hypothyroid patients after the treatment on attaining euthyroid status. There was no significant difference in both ART values between controls and hypothyroid patients after the treatment on attaining euthyroid status. Conclusion: The present study showed a significantly prolonged auditory reaction time in hypothyroid patients which improved with treatment. We also demonstrated a positive correlation between ART and thyroid stimulating hormone levels. Hence, we conclude that auditory reaction time tests could be added to the routine thyroid dysfunction tests to know the early recognition of the neuronal involvement, prompt treatment, and assess prognosis of hypothyroid patients.Department of Obstetrics and Gynaecology, GMERS Medical College, Gandhinagar, Gujarat, India

Department of Obstetrics and Gynaecology, GMERS Medical College, Junagadh, Gujarat, India

Asociación de los niveles de ácidos biliares y hormonas tiroideas en la colestasis intrahepática del embarazo

La colestasis intrahepática del embarazo (CIE) conduce a resultados perinatales adversos y estos resultados se ven afectados por los niveles elevados de ácido biliar total (ABT). Los estudios han demostrado que las hormonas tiroideas regulan el metabolismo de los ácidos biliares. Sin embargo, pocos estudios han evaluado el papel de las hormonas tiroideas en la CIE. Objetivo: Evaluar la función tiroidea junto con los niveles de ABT en la CIE. Métodos. En este estudio retrospectivo, se evaluaron 252 mujeres embarazadas, incluyendo 126 CIE y 126 controles. Se determinaron los niveles de ABT, hormona estimulante de la tiroides (TSH) y tiroxina libre (fT4) del tercer trimestre de todas las embarazadas. Se examinó la correlación entre los niveles de ABT, fT4 y TSH. Además, se estudiaron los resultados perinatales de ambos grupos. Resultados. Los niveles de fT4 fueron significativamente mayores en la CIE. También hubo una correlación positiva entre los niveles de fT4 y ABT. Los niveles de TSH fueron similares en ambos grupos y no hubo una correlación significativa con los niveles de ABT. No hubo diferencias significativas entre los dos grupos en cuanto a enfermedades tiroideas en el tercer trimestre. Conclusiones. Un mayor nivel de fT4 se asoció a un mayor nivel de ABT y el nivel de fT4 se asoció a un mayor riesgo de CIE y a la gravedad de la CIE, pero el nivel de TSH no se asoció a un mayor riesgo de ABT y de CIE.

Intrahepatic cholestasis of pregnancy (ICP) leads to adverse perinatal outcomes and these outcomes are affected by high total bile acid (TBA) levels. Studies have shown that thyroid hormones regulate bile acid metabolism. However, few studies have evaluated the role of thyroid hormones in ICP. Objective: To evaluate thyroid function along with TBA levels in ICP. Methods: In this retrospective study, 252 pregnant women, including 126 ICP and 126 controls, were evaluated. Third trimester TBA, thyroid-stimulating hormone (TSH), and free thyroxine (fT4) levels of all pregnant women were assessed. Correlation between TBA and fT4, TSH levels were examined. In addition, the perinatal outcomes of both groups were determined. Results: fT4 levels were significantly higher in ICP. There was also a positive correlation between fT4 and TBA levels. TSH levels were similar in both groups and there was no significant correlation with TBA levels. There was no significant difference between the two groups in thyroid diseases in the third trimester. Conclusions: Higher fT4 level was associated with higher TBA level and fT4 level was associated with higher ICP risk and ICP severity, but TSH level was not associated with higher TBA and higher ICP risk.

Approach to Subclinical Hypothyroidism in Adults / Abordaje del Hipotiroidismo subclínico en el Adulto

Thyroid pathology is the morphofunctional evolution of the thyroid glands that leads to different types of clinical pictures. Within it is subclinical hypothyroidism, which is a biochemical alteration due to the elevation of thyroid-stimulating hormone (TSH) between 4.5 to 10 mUI that can occur with or without symptoms of multifactorial origin. The worldwide prevalence is 4-10% and Latin America 15-25%. 90% of patients with this pathology do not require treatment, but in turn there is an overmedicalization and underdiagnosis of it. This bibliographic review analyzes from its morphofunctional changes towards clinical criteria for a comprehensive approach to subclinical hypothyroidism, where we have an individualization by its comorbidities, age group, diagnostic algorithm, follow-up and differentiated treatment according to recent studies within this pathology. Therefore, an adequate diagnosis, follow-up and treatment provides a better lifestyle for patients.

La patología tiroidea es la alteración morfofuncional de la glándula tiroides que lleva a diferentes tipos de cuadros clínicos. Dentro de ella se encuentra el Hipotiroidismo subclínico que es una alteración bioquímica por la elevación de la Hormona Estimulante de la tiroides (TSH) entre 4,5 a 10 mUI que puede presentarse con o sin sintomatología y tiene etiología multifactorial. La prevalencia mundial es del 4-10 % y latinoamericana del 15-25%. El 90% de pacientes con esta patología no requieren tratamiento, pero a su vez existe una sobremedicalización y una subdiagnóstico del mismo. La presente revisión bibliografía analiza a partir de su alteración morfofuncional hacia criterios clínicos para un abordaje integral del Hipotiroidismo subclínico, donde tenemos una individualización por sus comorbilidades, grupo etario, algoritmo diagnóstico, seguimiento y tratamiento diferenciado según últimos estudios dentro de esta patología. Por lo que un adecuado diagnóstico, seguimiento y tratamiento brinda un mejor estilo de vida a los pacientes.

Associations of arsenic and estrogen levels with the risk ofpapillary thyroid carcinoma / 预防医学

Objective@#To examine the associations of arsenic and estrogen levels with the risk of papillary thyroid carcinoma, so as to provide insights into prevention of papillary thyroid carcinoma.@*Methods@#Totally 57 patients with papillary thyroid carcinoma admitted to two tertiary hospitals in Urumqi, Xinjiang Uygur Autonomous Region in 2018 were selected as the case group, while 57 subjects with normal thyroid functions during the same period were selected as the control group. Subjects' gender, age, ethnicity, occupation and medical history of thyroid disease were collected using questionnaire surveys. Serum dimethyl arsenic acid (DMA) and monomethyl arsenic acid (MMA) were determined using high-performance liquid chromatography (HPLC) coupled to hydride generation-atomic fluorescence spectrometry (HG-AFS), serum thyroid hormone (TSH) by radioimmunoassay, estradiol (E2) by enzyme-linked immunosorbent assay and estrogen receptor ERα and ERβ by western blotting. The associations of arsenic and estrogen levels with the risk of papillary thyroid carcinoma were evaluated using a multivariable logistic regression model.@*Results@#There were 16 males (28.07%) and 41 females (71.93%) in the case group, with a mean age of (42.63±11.01) years, and there were 21 males (36.84%) and 36 females (63.16%) in the control group, with a mean age of (40.89±11.30) years. There were no significant differences between the case and control groups in terms of age (χ2=0.373, P=0.542), gender (χ2=1.000, P=0.317) or ethnic composition (χ2=0.291, P=0.590). The serum levels of TSH [2.85 (1.61) vs. 2.45 (1.79) μmol/L], E2 [74.93 (120.44) vs. 61.60 (37.35) pmol/L], ERα [1.49 (1.13) vs. 0.70 (0.31)], ERβ [1.59 (0.55) vs. 0.72 (0.36)], DMA [116.02 (100.48) vs. 32.33 (56.06) μg/L] and MMA [56.92 (47.90) vs. 27.90 (24.99) μg/L] were all significantly higher in the case group than in the control group (Z=-2.414, -2.292, -4.923, -5.167, -5.448 and -4.019, all P<0.05). Multivariable logistic regression analysis showed DMA (OR=1.013, 95%CI: 1.003-1.024) and E2 levels (OR=1.020, 95%CI: 1.004-1.036) were associated with the risk of papillary thyroid carcinoma.@*Conclusion@#Increased arsenic load and elevated estradiol levels may be associated with the risk of papillary thyroid carcinoma.

Investigate the thyroid function of radiation workers and analysis of influence factors / 中华劳动卫生职业病杂志

Objective: To analyze the thyroid condition and influencing factors of radiation workers, and to provide scientific basis for radiation protection management. Methods: In April 2020, 4308 radiation workers from October 1, 2017 to September 30, 2019 were collected for occupational health examination in Hangzhou Occupational Disease Prevention and Treatment Hospital, the data included basic information, Thyroid hormone level and thyroid color doppler ultrasound results. The thyroid status of radiation workers in different subgroups was compared. The influencing factors of Thyroid nodule were analyzed by multiple logistic regression. Results: 616 radiation workers had abnormal thyroid gland (14.3%, 616/4308) . The main manifestations of thyroid gland abnormality were abnormal Thyroid nodule (5.1%, 220/4308) and abnormal TSH level (7.1%, 308/4308) . Compared with the male radiation workers, the abnormal rate of Thyroid nodule, T3 and Tsh in female radiation workers was higher (P<0.05) , and the abnormal rate of Thyroid nodule, T3 and T4 increased with the increase of working age (P<0.05) . Radiation Workers in non-rated medical institutions and private medical institutions had the highest detection rate of Thyroid nodule (P<0.05) , and there was no significant difference in thyroid abnormalities among Workers (P<0.05) . By multiple logistic regression analysis, Sex (female) , age and institution type (private) were all independent risk factors for Thyroid nodule (95% CI: 1.548~2.763、1.002~1.030, P<0.05) . Conclusion: Ionizing radiation can cause thyroid damage in radiation workers, so we should pay more attention to the radiation protection management of female, high age, private and district medical organizations, so as to protect the health of radiation workers.

Difficulties and prospects in the treatment of Graves′ disease / 中华内分泌代谢杂志

Although traditional treatment for Graves′ disease(GD) displays some effects, it is imperative to explore new treatment methods. Based on the pathogenesis of GD, biologic agents developed by consumption of B lymphocytes and acting on thyroid stimulating hormone receptor(TSHR), such as monoclonal antibodies, TSHR antagonists and epitopes, can provide more options for patients with GD, and some new drugs are expected to be put into clinical practice. By restoring the damaged immune system and maintaining normal thyroid function continuously, it can avoid the disadvantages of conventional therapies such as long-term treatment, induction or aggravation of Graves ophthalmopathy, permanent hypothyroidism, and other complications. Preliminary experience suggests that thermotherapy is effective and safe for patients with refractory GD. In addition, the traditional Chinese medicine improves the symptoms and thyroid function of GD patients.The emergence of new therapeutic modalities and techniques will provide new approaches for the future treatment of GD and help clinicians to make the best decision.

Association between levels of thyroid-stimulating hormone and prognosis of patients admitted to intensive care units: an analysis using the MIMIC-Ⅲ / 中华危重病急救医学

Objective:To explore the association between levels of thyroid-stimulating hormone (TSH) on admission and prognosis of patients admitted to intensive care unit (ICU).Methods:The data were collected from patients who were admitted to the ICU of the Beth Israel Deaconess Medical Center in the United States from 2001 to 2012 with available TSH test records within 24 hours after the ICU admission via the Medical Information Mart for Intensive Care-Ⅲv1.4 (MIMIC-Ⅲv1.4). Information including gender, age, ethnicity, type of admission, mechanical ventilation (MV) or renal replacement therapy (RRT) received on admission, comorbidities, and TSH test records within 24 hours after the ICU admission were collected. The sequential organ failure assessment (SOFA) score, simplified acute physiology score Ⅱ (SAPS Ⅱ) and the comorbidities index Elixhauser (SID30) score were calculated according to the parameters. The primary outcome was hospital mortality. Differences in baseline characteristics and prognosis were examined between patients with normal TSH levels and abnormal TSH levels which was determined according to a dichotomous variable provided by the data. Multivariable Logistic regression was used to analyze the association between TSH levels and prognosis after adjusting for confounding factors. A sensitivity analysis was conducted which categorized the study population as three groups (i.e., decreased, normal, and elevated TSH levels) using the range of 0.30-3.00 mU/L as the normal range of TSH.Results:A total of 3 425 ICU patients were enrolled in the study, of which 2 692 (78.60%) were with normal TSH and 733 (21.40%) were with abnormal TSH. There was no statistically significant difference in gender, age, ethnicity, type of admission and the ratio of MV between the normal TSH and abnormal TSH groups. Compared with normal TSH group, the patients in abnormal TSH had a higher SOFA, SAPS Ⅱ and SID30 scores as well as the ratio of RRT [SOFA score: 4 (2, 7) vs. 4 (2, 6), SAPS Ⅱ score: 38.02±13.76 vs. 36.53±13.75, SID30 score: 11 (4, 22) vs. 11 (0, 20), RRT ratio: 5.32% (39/733) vs. 3.49% (94/2 692), all P < 0.05]. The hospital mortality of patients in normal TSH was significantly higher than that of those in abnormal TSH [9.82% (72/733) vs. 5.94% (160/2 692), P < 0.01]. After adjusting for confounding factors, abnormal TSH was significantly associated with hospital mortality [odds ratio ( OR) = 1.71, 95% confidence interval (95% CI) was 1.24-2.35, P = 0.001]. In the sensitivity analysis in which the range of 0.30-3.00 mU/L was used as the normal range of TSH, compared with normal TSH, decreased TSH ( OR = 2.36, 95% CI was 1.40-3.97, P = 0.001) and elevated TSH ( OR = 1.44, 95% CI was 1.05-1.98, P = 0.023) were both significantly associated with increased hospital mortality. Conclusion:An abnormal level of TSH within 24 hours after admitted to ICU is an independent risk factor for hospital mortality among ICU patients.

Clinical study on thyroid function in children with congenital hypothyroidism / 中国基层医药

Objective:To investigate thyroid function, physical growth, and psychological and behavioral development in children with congenital hypothyroidism.Methods:Thirty-two children with congenital hypothyroidism who were born in Yuyao People's Hospital from January 2014 to December 2018 were included in the observation group. Thirty healthy neonates who were born in the same period were included in the control group. Thyroid function index changes at the age of 1 year relative to at birth, physical, intellectual, and neuropsychological development and bone age at the age of 1 year were compared between the observation and control groups.Results:Thyroid-stimulating hormone level at birth was significantly higher in the observation group than in the control group [(18.23 ± 2.71) mU/L vs. (2.85 ± 0.34) mU/L, t = 30.84, P < 0.001]. Free thyroxine level at birth was significantly lower in the observation group than in the control group [(6.76 ± 1.54) pmol/L vs. (17.91 ± 2.04) pmol/L, t = 24.39, P < 0.001]. In the observation group, thyroid-stimulating hormone and free thyroxine levels at the age of 1 year were (2.68 ± 0.78) mU/L and (17.26 ± 2.11) pmol/L, respectively, which were not significantly different from those in the control group [(2.77 ± 0.63) mU/L and (17.54 ± 2.20) pmol/L, t = 0.50, 0.51, both P > 0.05]. Body weight, body length, head circumference, and bone age at the age of 1 year were (9.21 ± 1.20) kg, (79.84 ± 3.05) cm, (43.73 ± 1.42) cm, (1.01 ± 0.15) years old, respectively in the observation group, which were significantly lower than those in the control group [(10.12 ± 1.32) kg, (84.54 ± 3.41) cm, (45.85 ± 2.04) cm, (1.14 ± 0.28) years old, t = 2.84, 5.73, 4.77, 2.30, P < 0.05]. The proportion of children patients with bone age lag was significantly higher in the observation group than in the control group [21.88% (7/32) vs. 3.33% (1/30), χ2 = 4.74, P < 0.05]. There was a significant difference in intellectual development at the age of 1 year between the two groups ( χ2 = 7.05, P < 0.05). Gross movement, fine movement, adaptability, language ability, and social ability in the observation group were scored (90.43 ± 6.96) points, (92.03 ± 6.03) points, (88.45 ± 4.85) points, (84.04 ± 5.71) points, and (85.05 ± 6.17) points, respectively, which were significantly lower than those in the control group [(99.47 ± 5.40) points, (104.12 ± 5.71) points, (98.47 ± 5.22) points, (94.16 ± 4.98) points, and (104.34 ± 5.70) points ( t = 5.69, 8.09, 7.84, 7.42, 12.76, all P < 0.001]. Conclusion:Neonate patients with congenital hypothyroidism have obvious physical growth and psychological and behavioral development disorders. Early screening and treatment of neonatal congenital hypothyroidism should be strengthened to improve the prognosis.