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.

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.

Relationship between thyroid hormone level and obesity related indices in patients with type 2 diabetes mellitus / 中国基层医药

Objective:To investigate the relationship between serum thyroid hormone levels in the normal range and body weight, blood glucose, blood lipids, and other obesity-related indexes in patients with type 2 diabetes mellitus.Methods:Seventy obese patients with type 2 diabetes mellitus and ninety-two patients with type 2 diabetes mellitus with normal weight who were treated in the Nangang Branch of Heilongjiang Provincial Hospital from May 2020 to May 2021 were included in this study. Thyroid-stimulating hormone level was in the normal range (0.35-4.94 mU/L) in all participants. Serum levels of free triiodothyronine, free thyroxine, thyroid-stimulating hormone, thyroid peroxidase antibody, thyroglobulin antibody, triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting blood glucose, glycosylated hemoglobin, fasting C peptide, fasting insulin, systolic blood pressure, diastolic blood pressure, and serum uric acid were measured in all participants.Results:Free triiodothyronine level was positively correlated with fasting blood glucose and glycosylated hemoglobin levels ( r = 0.19, P = 0.021; r = 0.21, P = 0.017). Free thyroxine level was positively correlated with serum glycosylated hemoglobin level ( r = 0.25, P = 0.009) and negatively correlated with total cholesterol ( r = -0.17, P = 0.029). Thyroid-stimulating hormone level was positively correlated with body mass index as well as total cholesterol and low-density lipoprotein cholesterol levels ( r = 0.33, P < 0.001; r = 0.33, P < 0.001; r = 0.32, P < 0.001). Conclusion:Thyroid hormones in the normal range play an important role in the regulation of body weight, blood glucose, and blood lipids in patients with type 2 diabetes mellitus. Blood glucose level increases markedly in patients with relatively high free triiodothyronine and free thyroxine levels. The risks of obesity and dyslipidemia increase in patients with relatively high serum thyroid-stimulating hormone levels

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.

Síndrome do T3 baixo como fator prognóstico em pacientes na unidade de terapia intensiva: estudo de coorte observacional / Low T3 syndrome as a prognostic factor in patients in the intensive care unit: an observational cohort study

RESUMO Objetivo: Avaliar a síndrome do doente eutireóideo como fator prognóstico em pacientes na unidade de terapia intensiva, detectar fatores que possam influenciar a mortalidade e desenvolver uma equação para calcular a probabilidade de morte. Métodos: Este foi um estudo de coorte longitudinal, observacional e não concorrente realizado na unidade de terapia intensiva da Fundação Santa Casa de Misericórdia do Pará. Realizou-se coleta de 20mL de sangue em 100 adultos sem endocrinopatia previamente documentada para a dosagem do hormônio estimulante da tireoide, da tetraiodotironina livre, da tri-iodotironina livre e da tri-iodotironina reversa. Resultados: A maioria dos pacientes era do sexo feminino, com idades entre 20 e 29 anos. A maioria dos pacientes que morreram era mais velha (idade mediana de 48 anos), e 97,5% deles possuíam a síndrome do doente eutireóideo. A síndrome do doente eutireóideo esteve relacionada à morte, às comorbidades, à idade e ao tempo de internação (mediana de 7,5 dias) na unidade de terapia intensiva. A baixa dosagem de hormônio estimulante da tireoide estava associada à morte. Os pacientes com dosagem da tri-iodotironina livre menor que 2,9pg/mL tinham maior probabilidade de morrer e, naqueles que morreram, a dosagem de tri-iodotironina reversa era maior que 0,2ng/mL. A tri-iodotironina livre apresentou maior sensibilidade e acurácia, e a tri-iodotironina reversa teve maior especificidade para prever a mortalidade. Com base nos resultados e pontos de corte, desenvolveu-se uma fórmula de regressão logística múltipla para calcular a probabilidade de morte. Conclusão: Sugere-se verificar oportunamente a dosagem da triiodotironina livre e reversa em pacientes graves e aplicar a equação proposta.

ABSTRACT Objective: To assess euthyroid sick syndrome as a prognostic factor in patients in the intensive care unit; to detect factors that may affect mortality; and to develop an equation to calculate death probability. Methods: This was a longitudinal, observational, nonconcurrent cohort study developed in the intensive care unit of Fundação Santa Casa de Misericórdia do Pará. One hundred adults with no prior documented endocrinopathy were submitted to a 20mL blood sample collection for the measurement of thyroid stimulating hormone, free tetraiodothyronine, free triiodothyronine and reverse triiodothyronine. Results: Most patients were female, aged 20 to 29 years. Most patients who died were older (median age of 48 years), and euthyroid sick syndrome was present in 97.5% of them. Euthyroid sick syndrome was related to death, comorbidities, age and length of stay in the intensive care unit (median of 7.5 days). There was an association between lower thyroid stimulating hormone and death. Patients with free triiodothyronine levels below 2.9pg/mL were more likely to die; reverse triiodothyronine rates were above 0.2ng/mL in those who died. Free triiodothyronine had greater sensitivity and accuracy, and reverse triiodothyronine had greater specificity to predict mortality. Based on the results and cutoff points, a multiple logistic regression formula was developed to calculate the probability of death. Conclusion: The main limitation of this study is the fact that it was conducted in a reference hospital for maternal and child care; therefore, there was a greater number of female patients and, consequently, a sampling bias existed. However, opportune measurement of free and reverse triiodothyronine levels in critical patients and application of the proposed equation are suggested.

Research progress in thyroid hormone replacement therapy for low T3 syndrome / 中国综合临床

Low triiodothyronine syndrome (LT3S) is an abnormal alteration of thyroid hormone levels in patients with acute and severe illnesses in certain disease states, without clinical symptoms corresponding to altered thyroid function. There is a clear correlation between LT3S and the severity of the patient's condition and prognosis. The lower the triiodothyronine (T3) level is, the more severe the patient's condition is, and combined with acute physiology and chronic health score and other indicators, it can predict the prognosis of the patient's condition. The mechanism of occurrence and development of LT3S is relatively complex. In the early stage, it may be the adaptive change of the body to the stress condition. With the aggravation and extension of the disease course, it may participate in the disease progression.Current guidelines mostly do not recommend hormone replacement therapy (HRT) for patients with LT3S. New and more unified observational indicators should be available to fully verify the effectiveness of TH therapy.

Value of serum free triiodothyronine level in predicting the prognosis of patients with HBV-related acute-on-chronic liver failure / 临床肝胆病杂志

Objective To investigate the value of serum free triiodothyronine (FT3) level in predicting the 90-day prognosis of patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF). Methods Related clinical data were collected from 122 patients with HBV-ACLF who were hospitalized in Beijing YouAn Hospital, Capital Medical University, from September 2018 to January 2020, and according to their prognosis on day 90 after confirmed diagnosis, they were divided into survival group with 77 patients and death group with 45 patients. ELISA was used to measure the serum level of FT3, which was then compared between the two groups; a logistic regression analysis was used to investigate the risk factors for prognosis and establish an FT3-related predictive model; the area under the receiver operating characteristic (ROC) curve (AUC) of the predicted probability value was used to evaluate the discriminatory ability of the predictive model, and a linear regression analysis was used to evaluate calibration degree. AUC was used to compare the predictive value of this model and Model for End-Stage Liver Disease (MELD) score. The t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups; univariate and multivariate logistic regression analyses were used to investigate the influencing factors for prognosis. Results The death group had a significantly lower serum level of FT3 than the survival group (2.27±0.38 pmol/L vs 2.69±0.55 pmol/L, t =4.526, P < 0.001). FT3 (odds ratio [ OR ]=0.534, 95% confidence interval [ CI ]: 0.300-0.950, P =0.013) was an independent protective factor against poor prognosis, while age ( OR =1.047, 95% CI : 1.013-1.082, P =0.007), total bilirubin (TBil) ( OR =1.096, 95% CI : 1.059-1.134, P < 0.001), international normalized ratio (INR) ( OR =1.101, 95% CI : 1.029-1.178, P < 0.005), and creatinine (Cr) ( OR =4.583, 95% CI : 2.102-7.992, P < 0.001) were independent risk factors. In terms of discriminatory ability, the FT3-related predictive model had an AUC of 0.869 (95% CI : 0.831-0.907, P < 0.001), and for calibration ability, R 2 =0.340, P =0.268. The FT3-related formula was better than MELD score in predicting prognosis ( P < 0.05). Conclusion FT3 is an independent influencing factor for 90-day prognosis in patients with HBV-ACLF, and the FT3-related predictive model based on FT3 in combination with age, TBil, INR, and Cr has a good value in predicting 90-day prognosis.

Prognostic value of serum free triiodothyronine in patients with hepatitis E-related acute liver failure / 中华临床感染病杂志

Objective:To investigate the prognostic value of serum free triiodothyronine (FT3) in patients with hepatitis E-related acute liver failure (HEV-ALF).Methods:Clinical data of 88 patients with HEV-ALF and 86 patients with acute hepatitis E (AHE) were collected from the member hospitals of Chinese Consortium for the Study of Hepatitis E between January 2016 and December 2021; the data of 100 health subjects who underwent health check-up in Suzhou Municipal Hospital were also collected as healthy control (HC) group. Serum FT3 levels were analyzed in all subjects. HEV-ALF patients were divided into survival group ( n=73) and death group ( n=15) according to their 30 day survival. Correlation between serum FT3 level and prognosis of HEV-ALF patients were analyzed by Cox regression and orthogonal partial least squares discriminant analysis (OPLS-DA). The receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were used to assess the predictive value of serum FT3 levels for predicting the prognosis of patients, and its prediction efficacy was compared with conventional Model for End-Stage Liver Disease (MELD), King’s College Hospital criteria (KCH) and Child-Pugh models. Results:The levels of serum FT3 in HEV-ALF patients were significantly lower than those in AHE patients and HC group ( P=0.006 or <0.001). Cox regression analysis showed that international standardized ratio ( HR=17.984, 95% CI 2.804-115.362), hepatic encephalopathy ( HR=12.895, 95% CI 2.386-69.695) and total cholesterol ( HR=2.448, 95% CI 1.108-5.409) were independent risk factors for death in HEV-ALF patients, and serum FT3 level ( HR=0.323, 95% CI 0.119-0.876) was a protective factor. OPLS-DA results showed serum FT3 levels had high predictive value. ROC curve analysis results showed that the area under the curve was 0.828 (95% CI 0.733-0.900, P<0.001), the sensitivity was 80.00%, and the specificity was 78.08%. DCA showed that FT3 has good prediction ability and decision-making level serum FT3 levels in patients with improvement and fluctuation were significantly higher than those in the patients with deterioration ( P<0.05 or <0.01). Conclusion:Serum FT3 levels are closely related to the prognosis of HEV-ALF patients and it may be used as a biomarker for the prognosis of patients with HEV-ALF.

The effect of triiodothyronine on the heart: A brief review / 中华内分泌代谢杂志

Thyroid hormone receptors are expressed in myocardium and vascular endothelial tissue and are very sensitive to changes in circulating thyroid hormone (TH) levels, especially triiodothyronine (T 3), therefore small changes can adversely affect the cardiovascular system. Evidence from several studies in recent years supports the association between abnormal thyroid function at the time of cardiovascular event and subsequent adverse cardiovascular outcomes. Several clinical trials have found that treatment of subclinical thyroid disease improves cardiovascular risk factors, suggesting the potential benefit of TH therapy in reducing cardiovascular outcome events. This article reviews the relationship between T 3 and cardiovascular disease and its physiological effects on the heart, as well as the therapeutic potential of T 3 in heart failure and acute myocardial infarction.

Association between non-thyroidal illness syndrome and pre-sarcopenia in elderly patients / 中华老年医学杂志

Objective:To explore the association between non-thyroid illness syndrome(NTIS)and pre-sarcopenia in the elderly.Methods:In the retrospective study, a total of 219 patients aged 60-85 years in Department of Geriatrics, Sir Run Run Hospital, Nanjing Medical University from April 2018 to March 2021, included 60 patients with NTIS and 159 patients without NTIS.Clinical data, laboratory results and body composition data were collected.Pre-sarcopenia was diagnosed based on human composition determination data and diagnostic criteria of pre-sarcopenia.Logistic regression analysis, Pearson's correlation analysis and the area under receiver operator characteristic curve(ROC)were used to explore the correlation between serum thyroid hormone levels and diagnostic data level of pre-sarcopenia.Results:Of 54 pre-sarcopenia patients, 30.3%(36/119)were male, 18.0%(18/100)were female with statistically significantly differences( P<0.01). Mean age was higher in both male and female patients in the NTIS group than in the non-NTIS group( P<0.01). The body mass index, levels of triiodothyronine(T3), free triiodothyronine(FT3), hemoglobin, and albumin were lower in NTIS group than in non-NTIS group( P<0.05). The prevalence of presarcopenia in female patients was higher in the NTIS group than in the non-NTIS group[42.9%(10/17) vs.10.6%(8/83), χ2=9.564, P<0.01]. Multivariate logistic regression analysis showed that the risk of pre-morbidity of sarcopenia was significantly higher in NTIS patients than in non-NTIS patients.FT3 was positively correlated with skeletal muscle mass index, fat-free body weight, and phase angle, and negatively correlated with visceral fat area( r=-0.17, P<0.05). While, free thyroxine(FT4)was negatively correlated with skeletal muscle mass index( r=-0.21), fat-free body weight( r=-0.16)and phase Angle( r=-0.2, P<0.01 or P<0.05), and was positively correlated with body fat percentage and visceral fat area( r=0.20 and 0.22, respectively, P<0.01). The use of area under ROC curve(AUC)of FT3 predicting sarcopenia stage showed that the AUC was 0.768(95% CI: 0.691~0.844). Conclusions:In elderly patients, NTIS is correlated with the pre-sarcopenia in the elderly, and FT3 and FT4 are related to muscle mass.The low level of FT3 can predict the pre-validation of pre-sarcopenia.

Establishment of biological reference interval for reverse triiodothyronine by indirect method / 中华核医学与分子影像杂志

Objective:To establish reverse triiodothyronine (rT 3) biological reference interval suitable for laboratory by indirect method. Methods:From April to September 2019, 797 cases (332 males, 465 females, age: 12-95 years) underwent thyroid function, thyroid related antibody and rT 3 tests from hospitalized population in Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine were retrospectively analyzed. The reference individuals with normal thyroid hormone, antibody and without thyroid nodule or goiter were screened as inclusion criteria, and the factors such as acute and chronic diseases or drugs that might affect the values of rT 3 were excluded. Independent sample t test, one-way analysis of variance and least significant difference t test were used to analyze data. The rT 3 reference interval was established by non-parametric sequencing method, and 2.5% and 97.5% percentile values of data distribution were selected as the upper and the lower reference limits. In order to verify the rT 3 reference interval, 20 healthy individuals and 20 inpatients who met the inclusion and exclusion criteria were selected to test rT 3 with a simple random sampling method. Results:A total of 159 reference individuals (66 males, 93 females, age: 23-87 years) were enrolled. The rT 3 values of 23-29( n=4), 30-39( n=18), 40-49( n=29), 50-59( n=43), 60-69( n=40), 70-79( n=19) and over 80( n=6) years old groups were (0.62±0.16), (0.63±0.12), (0.64±0.11), (0.61±0.11), (0.65±0.14), (0.65±0.11) and (0.79±0.10) μg/L, respectively. There was a statistically significant difference in the rT 3 test results among different age groups ( F=2.17, P=0.049). There were statistically significant differences of rT 3 between the individuals over 80 years old and other age groups (all P<0.05), while there were no statistically significant differences among the other groups (all P>0.05). The rT 3 of males and females under 80 years old were (0.62±0.11) and (0.64±0.12) μg/L, respectively, with no significant difference between them ( t=-0.81, P=0.420). The newly established rT 3 reference interval suitable for people above 20 years old and below 80 years old was 0.47-0.92 μg/L, and the lower limit was significantly higher than that of the reference interval in the reagent specification (0.20-0.95 μg/L). The rT 3 range of 20 healthy individuals was 0.57-0.82 μg/L and that of 20 inpatients was 0.48-0.77 μg/L, which were all within the new reference interval. Conclusion:The rT 3 biological reference interval established here has clinical application value, but its applicable range of age still needs to be further improved.

Serum concentration of thyroxine and triiodothyronine in newborn calves from cows supplemented with barium selenate / Concentración sérica de tiroxina y triiodotironina en terneros recién nacidos de madres suplementadas con selenato de bario / Concentração de tiroxina e triiodotironina sérica em bezerros recém-nascidos de mães suplementadas com selenato de bário

Abstract Background: Barium selenate is an inorganic source of selenium (Se) used in prolonged-release preparations to treat selenium deficiency in bovines. Objective: To evaluate serum concentrations of triiodothyronine (T3) and thyroxine (T4) hormones in newborn calves from mothers supplemented with barium selenate during prepartum. Methods: Six black Frisian pregnant cows were supplemented with barium selenate subcutaneously during the last two months of gestation, until calving. Six cows were used as controls. All cows were subjected to a low Se diet, consisting of hay from natural pasture and commercial concentrate lacking Se. The Se balance was measured through the activity of erythrocyte glutathione peroxidase (GPx). Serum concentration of T3 and T4 in calves was determined by electrochemiluminescence. Results: Se supplementation during prepartum increased GPx activity in cows from day 45 post-supplementation (p<0.05). Calves from supplemented mothers showed higher average serum Se concentration than calves from non-supplemented mothers. The average concentration of T3 in the calves from supplemented mothers was lower in the first hour of life (p<0.05) compared with calves from mothers of the non-supplemented group. A decrease (p<0.05) in T4 serum concentrations was observed in both groups at seven days of age. Conclusions: Administration of barium selenate to cows during prepartum generates a reduction in serum concentration of T3 in the first hour of life of calves.

Resumen Antecedentes: El selenato de bario es una fuente inorgánica de selenio (Se) utilizada en preparaciones de liberación prolongada para corregir el estado de carencia de Se en bovinos. Objetivo: Evaluar las concentraciones séricas de triyodotironina (T3) y tiroxina (T4) en terneros recién nacidos de madres suplementadas durante el preparto con selenato de bario. Métodos: Seis vacas frisón negro con 7 meses de gestación fueron suplementadas vía subcutánea con selenato de bario dos meses previos a la fecha de parto. Otras seis vacas permanecieron como controles. Todas las vacas se mantuvieron con una dieta cuyo aporte de Se fue inferior a los requerimientos y consistió en heno de pradera natural y concentrado comercial sin Se. El balance de Se se midió usando la actividad eritrocitaria de glutatión peroxidasa (GPx) y las concentraciones de T3 y T4 en terneros mediante electroquimioluminiscencia. Resultados: La suplementación con Se aumentó la actividad de GPx en vacas desde el día 45 post suplementación (p<0,05). Los terneros de madres suplementadas mostraron una concentración sérica promedio de Se mayor que los terneros de madres no suplementadas. La concentración promedio de T3 de terneros de madres suplementadas fue menor en la primera hora de vida (p<0,05) que en terneros de madres no suplementadas. A los 7 días de edad hubo una disminución (p<0,05) en las concentraciones séricas de T4 en ambos grupos. Conclusión: La administración de selenato de bario en vacas preparto genera una disminución en la concentración sérica de T3 en la primera hora de vida del ternero.

Resumo Antecedentes: O selenato de bário é uma fonte inorgânica de selênio (Se) usada em preparações de liberação prolongada para corrigir o status de deficiência de Se em bovinos. Objetivo: Avaliar as concentrações séricas de triiodotironina (T3) e tiroxina (T4) em bezerros recém-nascidos de mães suplementadas durante o pré-parto com selenato de bário. Métodos: Seis vacas friesianas negras aos 7 meses de gestação foram suplementadas com selenato de bário por via subcutânea dois meses antes do parto. Seis outras vacas permaneceram como controle. Todas as vacas foram mantidas em uma dieta cuja contribuição de Se foi inferior aos requeridos e consistiram em feno natural da pradaria e concentrado comercial sem Se. O balanço de Se foi medido usando a atividade eritrocitária das concentrações de glutationa peroxidase (GPx) e T3 e T4 em bezerros por eletroquimiluminescência. Resultados: A suplementação com atividade de GPx aumentou em vacas a partir do dia 45 após a suplementação (p<0,05). Os bezerros de mães suplementadas apresentaram uma concentração sérica média de Se maior que os bezerros de mães não suplementadas. A concentração média de T3 dos bezerros das mães suplementadas foi menor na primeira hora de vida (p<0,05) do que nos bezerros das mães não suplementadas. Aos 7 dias de idade houve uma diminuição (p<0,05) nas concentrações séricas de T4 nos dois grupos. Conclusão: A administração de selenato de bário em vacas de parto gera uma diminuição na concentração sérica de T3 na primeira hora de vida do bezerro.

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.

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

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

Disfunción tiroidea y trastornos del ánimo: revisión del estado del arte / Thyroid dysfunction and mood disorders: review of the state of the art

La relación entre función tiroidea y trastornos del ánimo se ha observado desde hace más de 50 años. Las hormonas tiroideas, actúan en el cerebro modulando génicamente proteínas asociadas a la fisiopatología de los trastornos del ánimo y potenciando los sistemas de neurotransmisión serotoninérgica y noradrenérgica. En el tratamiento de un episodio depresivo, la normalización de hormonas tiroideas es fundamental, y debe realizarse en todo paciente con sintomatología anímica, especialmente en aquellos con respuestas insuficientes a tratamiento, que requieren niveles de hormonas más estrictos que lo recomendado para población general. En pacientes eutiroideos, la potenciación con triyodotironina ha sido probada, pero también se ha utilizado T4 en altas dosis en casos resistentes, en que se postula que pudiese existir un estado de resistencia a hormonas tiroideas, no reflejado en los niveles hormonales periféricos evaluados rutinariamente. Las enzimas deiodasas, el receptor de hormona tiroidea, y el transportador de hormona tiroidea en la barrera hematoencefálica son blancos a investigar. Los objetivos de la presente revisión son ofrecer orientaciones respecto del uso de hormonas tiroideas en pacientes con trastornos del ánimo, una puesta al día sobre la relación entre hormonas tiroídeas y sistema nervioso central, y las interacciones entre psicofármacos y función tiroidea.

The relationship between thyroid function and mood disorders has been observed for more than 50 years. Thyroid hormones act in the brain genetically modulating proteins associated with the pathophysiology of mood disorders and potentiating the serotonergic and noradrenergic neurotransmission systems. In the treatment of a depressive episode, the normalization of thyroid hormones is essential, and should be performed in all patients with mood symptoms, especially in those with insufficient responses to treatment, which require more stringent hormone levels than recommended for the general population. In euthyroid patients, potentiation with triiodothyronine has been proven, but T4 has also been used in high doses in resistant cases, in which it is postulated that there might be a state of resistance to thyroid hormones, not reflected in the peripheral hormonal levels evaluated routinely. The enzymes deiodasas, the thyroid hormone receptor, and the thyroid hormone transporter in the blood brain barrier are white to investigate. The objectives of this review are to provide guidance regarding the use of thyroid hormones in patients with mood disorders, an update on the relationship between thyroid hormones and central nervous system, and the interactions between psychoactive drugs and thyroid function.

Influence of obesity on serum levels of thyroid hormones among Indian adult population

Background: Obesity and thyroid dysfunction are two most common clinical conditions that have been linked together closely in adult. The link has become more relevant in the context of an unprecedented rise in the prevalence of obesity worldwide. Obesity is normally observed by patients as being secondary dysfunction on serum levels of thyroid hormones. Objective: The Purpose of this study to assess serum thyroid hormones levels (fT3, fT4, TSH) variation in patients with obesity and normal thyroid function among Indian adults and to correlate serum levels of thyroid hormones with their classes of Body Mass Index (BMI).Methods: Authors performed a retrospective study of adult patients who were examined and analyzed serum levels of thyroid hormones at authors centre between February 2018 to November 2019.Results: A total of 231 adult patients were included. 122(52.8%) were males, mean age was 35.4±10.4 and mean BMI 34.2±5.8 respectively. Obesity was found higher in female 58(53.2%) than male 37(30.3%) participants (p<0.001), respectively. The mean TSH serum levels were significantly increased with increased BMI (2.04±1.19,2.51±1.22 and 3.39±1.19; p=<0.001).  No association was found of serum fT4 (p=0.227) and serum fT3 (p=0.063) with BMI.Conclusions: Mean TSH serum levels showed a significantly increased with increased BMI. BMI was negatively associated with serum fT4 but had no association with serum fT3.

Interpretación de las pruebas de función tiroidea / Interpretation of thyroid function tests

Los desórdenes de la glándula tiroides son comunes y pueden afectar hasta el 10% de la población en general. En muchas ocasiones los síntomas pueden ser inespecíficos, por lo que el médico en busca de un trastorno tiroideo debe llegar a un diagnóstico funcional y anatómico. Las mediciones séricas de las hormonas tiroideas confirman si hay un exceso, un déficit o si las concentraciones son normales. Para ello, se requiere un rango de referencia de la población local, y específicamente por grupos de edad, para una correcta interpretación de las pruebas de función tiroidea. Las hormonas tiroideas juegan un papel fundamental en el sistema endocrino, controlan el metabolismo general del cuerpo, el desarrollo neural, el crecimiento normal y la maduración de los huesos, así como funciones cardiovasculares y renales, entre otras. En esta revisión se pretende dar una aproximación a las pruebas tiroideas más relevantes, partiendo de la biosíntesis y secreción de las hormonas tiroideas, hasta llegar al abordaje para un diagnóstico inicial del paciente con trastorno tiroideo, mencionando los aspectos más importantes de los diferentes patrones tiroideos. El tratamiento detallado de cada uno de ellos, supera las expectativas de esta revisión

Thyroid gland disorders are common and can affect up to 10% of the general population. In many cases the symptoms can be nonspecific, so the physician in search for a thyroid disorder should reach a functional and anatomical diagnosis. Serum measurements of thyroid hormones confirm if there is an excess, a deficit, or if concentrations are normal. For this, reference ranges of the local population, and specifically by age groups, are required for a correct interpretation of thyroid function tests. Thyroid hormones play a fundamental role in the endocrine system, control of the general metabolism of the body, neural development, normal growth and maturation of bones, as well as in cardiovascular and renal functions, among others. In this review, the most relevant thyroid tests will be described, starting with the biosynthesis and secretion of thyroid hormones, and continuing with an approach to reach an initial diagnosis. Finally, the most important aspects of the different thyroid patterns will be mentioned. It is beyond the scope of this review, to describe the treatment for thyroid disorders.

Alteraciones cardiovasculares causadas por hipotiroidismo clínico y subclínico / Cardiovascular disorders caused by clinical and subclinical hypothyroidism

El hipotiroidismo es un trastorno endocrino en el cual la glándula tiroides tiene su función disminuida; teniendo como consecuencia paralela la perdida de homeostasia del cuerpo alterando así su adecuado funcionamiento. Para diagnosticar la enfermedad, sumado a la clínica, se recurre a medir los niveles sanguíneos de hormonas tiroideas. Como el sistema cardiovascular y la glándula tiroides están relacionados fisiológicamente, los trastornos de la glándula tiroides afectan de gran manera al sistema cardiovascular. Se detallan los mecanismos intracelulares y extracelulares de las hormonas tiroideas; y, utilizando esta información, se explican todos los cambios morfológicos y fisiológicos que esta patología causa en el corazón y en las células de músculo liso. Además, se dan a conocer las implicaciones que la enfermedad tiene a nivel del miocardio, sobre la hemodinámica, su relación con la insuficiencia cardíaca congestiva, la hipertensión y los efectos en general sobre los vasos sanguíneos, con el objetivo de describir la relación entre hipofunción tiroidea clínica y subclínica como factor de riesgo determinante para el desarrollo de alteraciones cardiovasculares.

Hypothyroidism is an endocrine disorder in which the thyroid gland has a diminished function; having as a consequence the loss of homeostasis of the body, therefore, altering its proper functioning. To diagnose this disease, physical examination, blood tests and thyroid stimulating hormone tests are utilized. Since the cardiovascular system and the thyroid gland are physiological related, the general disorders of the thyroid gland greatly affect the cardiovascular system. The intracellular and extracellular mechanisms of thyroid hormones are detailed; and, using this information, all the morphological and physiological changes that this pathology causes in the heart and on smooth muscle cells are explained. In addition, the implications of the disease on the myocardium, on hemodynamics, its relation to congestive heart failure, hypertension and general effects on blood vessels are revealed, with the objective of describing the relationship between clinical and subclinical thyroid hypofunction as a determining risk factor for the development of cardiovascular disorders.

Clinical significance of serum CER, HA and FT3 in diagnosis of liver fibrosis in chronic hepatitis B patients / 解放军医学杂志

Objective To investigate the clinical significance of serum ceruloplasmin (CER), hyaluronic acid (HA) and free thyroxine 3 (FT3) in detecting liver fibrosis in patients with chronic hepatitis B (CHB). Methods One hundred and thirty-six cases of CHB patients, 44 cases of post-CHB cirrhosis patients, 20 cases with HBsAg-positive hepatocellular carcinoma (HCC), and 50 healthy controls were randomly selected from July 2014 to January 2018. Serum CER was detected by immune scattering turbidimetry, and direct chemiluminescence method was used for the detection of HA and FT3, one-way ANOVA analysis or rank sum test was used to compare the levels of serum CER, HA, FT3 and other related indexes between each group and the control group. Analysis of the correlation between CER, HA, FT3 and diagnosis model of liver fibrosis was performed and its results were analyzed using the receiver operating characteristic (ROC) curves. Results (1) The level of serum CER in severe CHB and decompensated liver cirrhosis group was significantly lower than that in control group (P<0.05). The concentration of HA in severe CHB and liver sclerosis groups was significantly higher than that in control group, and the difference was statistically significant (P<0.05). And the concentration of FT3 in cirrhotic group and HCC group was significantly different from that in control group (P<0.05). (2) CER was negatively correlated with APRI (r=-0.202, P=0.004) and FIB-4 (r=-0.200, P=0.006), HA was positively correlated with APRI (r=0.491, P<0.000) and FIB-4 (r=0.514, P<0.000), and FT3 was positively correlated with APRI (r=-0.246, P<0.001) and FIB-4 (r= 0.361, P<0.000). (3) The AUC (area under the curve) of FT3, HA and CER for the diagnosis of cirrhosis were 0.831, 0.826 and 0.668, respectively. In order from high to low, the diagnostic efficacy of the groups was CER+HA+FT3, HA+FT3, CER+HA and CER+FT3. Conclusion The levels of serum CER, HA and FT3 in patients with CHB are correlated with the degree of liver fibrosis, and has an important reference value for diagnosis of post-CHB cirrhosis.

Clinical study of Jianpi-Huatan-Huoxue Decoction combine with levothyroxine sodium tablets in the treatment of subclinical hypothyroidism / 国际中医中药杂志

Objective@#To evaluate the clinical effect of Jianpi-Huatan-Huoxue Decoction combine with levothyroxine sodium tablets in the treatment of subclinical hypothyroidism (SCH).@*Methods@#According to the random digital table method, 105 patients with SCH from January 2017 to December 2018 in the First Affiliated Hospital of Guangzhou University of Chinese Medicine were divided into control group (52 cases) and research group (53 cases). The control group was treated by takinglevothyroxine sodium tablets orally, while the research group was treated with Jianpi-Huatan-Huoxue Decoction based oncontrol group. The two groups both were treated for 3 months. The clinical efficacy of the two groups were evaluated and compared. The content of TSH, FT3, FT4, IL-10, IL-2 and IL-2R were detected by double antibody sandwich ELISA. The content of TC, TG, LDL-C and HDL-C were detected by automatic biochemical analyzer.@*Results@#The total effective rate was 94.3% (50/53) in the research group and 75.0% (39/52) in the control group, and the difference between the two groups was statistically significant (χ2=7.601, P=0.006). After the treatment, the content of TSH (4.39 ± 1.05 mU/L vs. 8.20 ± 2.11 mU/L, t=11.747) in the research group was significantly lower than the control group (P<0.05), the content of FT3 (5.53 ± 1.33 μmol/L vs. 4.15 ± 1.26 μmol/L, t=5.456) and FT4 (18.54 ± 5.56 μmol/L vs. 16.18 ± 5.12 μmol/L, t=2.261) were significantly higher than the control group (P<0.05), the serum level of IL-10 was significantly higher than the control group (t=3.218, P=0.002), and the levels of IL-2 and IL-2R were significantly lower than the control group (t=11.203, 2.849, P<0.05), the levels of TC, TG and LDL-C were significantly lower than the control group (t=2.764, 9.473, 9.628, P<0.05), and the levels of HDL-C was significantly higher than the control group (t=4.506, P<0.05).@*Conclusions@#Jianpi-Huatan-Huoxue Decoction can improve the thyroid function and blood lipid level of patients with SCH, regulate the level of inflammatory factors, and improve the curative effect.