Prevalence of subclinical hypothyroidism in patients of chronic liver disease

Background: Chronic liver disease (CLD) is a continuous process of inflammation, destruction, and regeneration of liver parenchyma, which leads to fibrosis and cirrhosis. Liver plays an essential physiological role in thyroid hormone activation and inactivation, transport, and metabolism, as well as the synthesis of thyroid binding globulin. A complex relationship exists between thyroid and liver in health and disease. Methods: 103 patients of CLD were included in this study from December 2020 to September 2022. They were classified as per child Pugh scoring after clinical assessment and investigations. Thyroid function profile was measured for all the patients. Results: Among 103 patients, 8 (7.76%) patients were having overt hypothyroidism and 28 (27.18%) patients had subclinical hypothyroidism, while 67 (65.04%) patients had normal thyroid profile levels. There was significant correlation between CTP class and hypothyroidism status of patient (p value <0.001) with 25 (56.81%) patients of CTP class C having subclinical hypothyroidism, while 3 (7.5%) patients of CTP class B had subclinical hypothyroidism and none patient of CTP class A had subclinical hypothyroidism. Conclusions: Our study found that there was increased prevalence of subclinical hypothyroidism in CLD patients which increased with severity of CLD as assessed with CTP class.

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

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

Expression of TPO-Ab and FT3 in patients with acute cerebral infarction and their disease progression and mechanism of action / 中风与神经疾病杂志

@#Objective　To explore the correlation between the expression of TPO-Ab and FT3 and prognosis in patients with acute cerebral infarction and its mechanism.Methods　Research object selection in our hospital between January 2018 and January 2021,120 cases of acute cerebral infarction patients,all patients were divided into good prognosis group (60 cases) and poor prognosis group (60 cases),TPO-Ab,FT3 expression were observed and compared between the two groups of patients with platelet function,inflammation,related parameters of hemodynamics,blood vessel function.Results　The levels of TPO-Ab,CD62p,CD63,platelet aggregation rate,plasma viscosity,whole blood viscosity,hematocrit,serum inflammatory factors and ET-1 in the good prognosis group were lower than those in the poor prognosis group,and the levels of FT3 and NO were higher than those in the poor prognosis group (P<0.05).Abnormal levels of TPO-Ab and FT3 were independent risk factors for intracranial artery stenosis,and their levels were correlated with platelet function,inflammatory response,hemodynamics and vascular function (P<0.05).Conclusion　The prognosis of patients with acute cerebral infarction is correlated with the expression of TPO-Ab and FT3.The expression of TPO-Ab and FT3 can affect the prognosis of patients by affecting platelet function,inflammatory response and vascular function.

Serum FT4 / FT3 Ratio, a Predictive Biochemical Marker for Subclinical Hypothyroidism in Patients with Chronic Kidney Disease.

Subclinical hypothyroidism (ScHt) is an early stage of hypothyroidism which can progress to overt hypothyroidism and lead to adverse metabolic abnormalities. Surge in frequency of hypothyroidism is seen in chronic kidney disease (CKD) cases, including those receiving dialysis. Many studies reported the relation amid thyroid function with metabolic syndrome, though the link among the Free T3: Free T4 and ScHt is not clearly determined. We wanted to investigate the Free T3:Free T4 ratio in predicting ScHt in CKD. MethodsIn this study, 53 known CKD subjects who have not undergone haemodialysis and 60 normal healthy subjects were included. In both study groups, creatinine and estimated glomerulus filtration rate (eGFR) are determined to evaluate the kidney function. Thyroid function parameters namely serum FT3, FT4 and TSH were measured to determine the FT3 / FT4 ratio. ResultsTSH levels were significantly increased in patients with CKD not undergoing dialysis as compared to patients in the control group (P<0.034). Low Free T3 level (P<0.001) and FT3 / FT4 ratio is highly significant (P< 0.001) in study subjects as compared to controls. Area Under the Curve (AUC) of ROC for the continuous variables of serum FT4 / FT3 ratio was 0.914 with CI: 0.832 to 0.997. ConclusionsIndividually FT3, FT4 have very little sensitivity in the diagnosis of sub clinical hypothyroidism in chronic kidney disease. FT4/FT3 ratio determination is a very useful step in diagnosing ScHt with chronic kidney disease.

Prevalence of thyroid dysfunction in neonatal population

Background: The objectives of this study was to study the prevalence of thyroid disorders in high risk neonatal populations and to study association of maternal thyroid dysfunction with neonatal thyroid problems and outcome.Methods: This was an observational study, conducted in NICU at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar. The study included neonates born to mothers with thyroid disorder or with clinical features suggestive of thyroid dysfunction. Neonates with history of maternal thyroid dysfunction were screened at 72 to 96 hrs of postnatal age. Those with TSH >10 mIU/L or free T4 <1.1 ng /ml were followed up after two weeks. The neonates with clinical features suggestive of thyroid dysfunction were screened at presentation and those with abnormal thyroid profile were followed up after two weeks. Results obtained were statistically analyzed using SPSS 17.0 software.Results: Out of 260 neonates screened, 208 neonates were born to mothers with hypothyroidism, 6 neonates had increased levels of TSH during first week which normalised on follow up during third week. One neonate born to hyperthyroid mother, showed increased TSH levels during first week and 2nd week which declined to normal level on follow up at 3rd week. Out of 51 neonates with clinical features suggestive of thyroid dysfunction, born to euthyroid mothers, 3 neonates had increased levels of TSH on presentation which normalised on further follow up. Thus, majority of high risk neonates at birth show transient hypothyroidism.Conclusions: None of the neonate was labelled as hypothyroid, all the 10 neonates showed transient hyperthyrotropinemia.

Association of Thyroid Hormones with Prolactin, Follicle Stimulating Hormone and Luteinizing Hormone in Female Infertility

Human infertility is a major health problem worldwide having its impact on the social, psychological, economical and sexual life of a couple. Methods: Total of 80 subjects (Out of which 50 infertile female and 30 normal fertile female) were selected on gynecology infertility outpatient department between age group of 20 to 44 years. Out of 50 infertile women, 34 were of primary infertility and 16 of secondary infertility. Results: Statistically significant higher serum TSH levels were noted in the infertile subject with euthyroid (p=0.03) and hypothyroidism (p<0.001) when their distributions were compared to their respective fertile subjects. The rise in serum FT3 and FT4 in the infertile subjects with hyperthyroidism was found to be not significant as compared to the fertile subjects with hyperthyroidism. The mean serum prolactin concentration in the infertile female with euthyroid was significantly higher (p<0.01) than the fertile subjects with euthyroid. The infertile women with hypothyroidism had statistically significant higher prolactin levels than the other three categories (the fertile female and the infertile subjects with euthyroid and hyperthyroidism) (p<0.01). Conclusion: High prevalence of hypothyroidism was seen in infertile female. These disorders may lead to menstrual irregularities resulting in infertility.

Study of Liver Function Tests in Patients of Hypothyroidism

The liver is fundamental in metabolizing thyroid hormones,and hepatocytes are often affected in thyroid disease. Thyroiddisorders often accompany abnormal serum enzyme levelsand disturbances in liver functions. These thyroid-liverassociations may cause diagnostic confusions. Neglect of thesefacts may result in over or under diagnosis of associated liveror thyroid diseases and thereby cause errors in patient care.Aim of the present study was to determine the biochemicalmarkers of liver function test Aspartate transaminase (AST),Alanine transaminase (ALT) and Alkaline phosphatase (ALP)in patients with hypothyroidism and to find their possiblecorrelation with thyroid profile.Material and Methods: The study included 50 patients withsubclinical hypothyroidism (TSH 6.0-9.9miu/l), 50 patientswith overt hypothyroidism (TSH ≥10.0 miu/l) and 50 agematched normal euthyroid controls. In all study groups FT3,FT4, TSH, AST ALT and ALP were estimated. Thyroid profileand LFT were estimated using fully autoanalyser. p value<0.05 considered as significant.Results: Subjects with both subclinical hypothyroidism andovert hypothyroidism had significantly raised serum AST,ALT and ALP (p<0.0001) compared to controls. Further, TSHshowed significant positive correlation with AST, ALT andALP (P<0.001) in both subclinical and overt hypothyroidism,Conclusion: Hypothyroid patients should be regularlychecked for biochemical parameters of LFT. As early detectionand treatment can prevent the further complications relatedto the disorder and will be helpful during the management ofhypothyroid patients.

La fonction thyroïdienne au cours du premier trimestre de la grossesse / Thyroid function in the first trimester of pregnancy

Introduction : Les dysthyroïdies représentent les secondes pathologies les plus fré-quentes après le diabète chez la femme enceinte. La thyroïde subit de nombreux changements physiologiques pendant la grossesse et son activité fonctionnelle augmente de 50%. Les hormones thyroïdiennes jouent un rôle im-portant dans les premiers stades du développement du cerveau. Au cours du premier trimestre, le fœtus est dépendant de la production d'hormones thyroïdiennes mater-nelles. Il est donc important de détecter, typer et éventuellement traiter toute anomalie thyroïdienne au début de la grossesse; l'idéal étant bien évidemment une prise en charge de ces pathologies avant la conception.Patients et méthodes - Dans ce travail, nous avons étudié les variations des concen-trations plasmatiques des paramètres du bilan thyroïdien à savoir l'hormone thyréos-timulante (TSH), la thyroxine libre (fT4) et tri-iodothyronine libre (fT3) chez cinquante gestantes au 1ertrimestre de la grossesse.Résultats - Parmi les cinquante femmes enceintes au 1er trimestre concernées par notre étude, 11 étaient au 1er mois, 19 au 2ème et 20 au 3ème mois de grossesse. L'âge moyen de nos gestantes était de 30±6,76 ans avec des extrêmes allant de 17 à 45 ans. Le dosage de la TSH a révélé une valeur moyenne chez nos gestantes de 2,37± 4,01mUI/L avec des extrêmes allant de 0,031 à 26,37mUI/L. La prévalence de l'hypothyroïdie dans notre série était de 8 %. Les deux autres paramètres du bilan thyroïdien (fT3, fT4) ont présenté une élévation de leurs concentrations au premier mois puis une stabilisation au 2ème et 3ème mois de grossesse.Conclusion - Les dysthyroïdies sont fréquentes dans notre population d'étude, elles doivent être systématiquement recherchées chez toute femme enceinte et correcte-ment prises en charge afin de prévenir les complications à la fois maternelles et fœtales.

Introduction - Dysthyroidism represents the second most frequent pathologies after diabetes in pregnant women. The thyroid undergoes many physiological changes during pregnancy and its functional activity increases by 50%. Thyroid hormones play an important role in the early stages of brain development. During the first trimester, the fetus is dependent on the production of maternal thyroid hormones. It is therefore important to detect, type and possibly treat any thyroid abnormality at the start of pregnancy; ideally, of course, taking care of these pathologies before conception. Patients and methods - we studied the variations in the plasma concentrations of the parameters of the thyroid balance, namely the thyroid stimulating hormone (TSH), the free thyroxine (fT4) and the free tri-iodothyronine (fT3) in fifty pregnant women in the 1st trimester of pregnancy. Results - Among the fifty pregnant women in the 1st trimester concerned by our study, 11 were in the 1st month, 19 in the 2nd and 20 in the 3rd month of pregnancy. The average age of our pregnant women was 30 ± 6.76 years with extremes ranging from 17 to 45 years old. The TSH assay revealed an average value in our pregnant women of 2.37 ± 4.01 mUI/L with extremes ranging from 0.031 to 26.37 mUI/L. The prevalence of hypothyroidism in our series was 8%. The other two parameters of the thyroid balance (fT3, fT4) showed an increase in their concentrations in the first month and then stabilization in the 2nd and 3rd month of pregnancy. Conclusion - Dysthyroidism is frequent in our study population, it must be systematically sought in any pregnant woman and properly managed in order to prevent complications both maternal and fetal.

Curative efficacy of euthyrox in treatment of hypothyroidism during pregnancy and its effect on levels of TSH,FT3 and FT4 / 中国生化药物杂志

Objective To study curative efficacy of euthyrox in treatment of hypothyroidism during pregnancy and its effect on levels of TSH , FT3 and FT4.Methods 100 patients of hypothyroidism during pregnancy who received therapy from June 2014 to June 2015 in our hospital were selected as research objects, and divited into control group and observation group,50 cases in each group.The control group was treated with Fugui Dihuang wan, while the observation group was treated with euthyrox on the basis of control group.Then the levels of TSH,FT3 and FT4, pregnancy outcome, neonatal adverse outcome, treatment outcome of two groups after treatment were compared.Results After treatment, the level of TSH in observation group was lower than the control group, the levels of FT3 and FT4 was higher than the control group ( P<0.05 ); Incidence of pregnancy complications in observation group was less than the control group [12.00%(6/50)vs 40.00%(20/40)](P<0.05);Total neonatal adverse outcomes [8.00%(4/50) vs 26.00%(13/50)](P<0.05); The total effective rate of observation group was statistically higher than that in the control group [96.00%(48/50) vs 80.00%(40/50)](P<0.05).Conclusion Euthyrox is well for hypothyroidism during pregnancy, which can improve TSH, FT3 and FT4 levels, relieve clinical symptoms.

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

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

Assessment of thyroid function in euthyroid obese medical students.

Background: It is well known that Thyroid Hormones play a key role in regulating energy homeostasis. The association between thyroid hormones and energy expenditure is well established. There is inverse relationship between obesity and energy expenditure. There is a limited data on thyroid function in euthyroid obese young individuals. Objectives: The present study was designed to evaluate the relationship between thyroid function and obesity in euthyroid young individuals. Materials & Methods: Obesity was defined as per Body Mass Index. (BMI)Undergraduate medical students were grouped as normal, overweight and obese as per their Body Mass Index Thyroid function was assessed by measuring fT3, fT4 and TSH levels by using automated chemiluminescence immunoassay system. Results: We found that the levels of TSH showed significant increase in overweight and obese subjects (p< 0.001) however there was no statistical difference in the levels of fT3and fT4 in overweight and obese students as compared to normal(p> 0.05). Interpretation & Conclusion: Our results suggest that thyroid function though within the normal range could be one of several factors acting in concert to determine body weight in a population. Even slightly elevated serum TSH levels are associated with an increase in BMI.

Age Related Change in Thyroid Function.

Background: Thyroid hormones play a vital role in metabolism, sensitivity of tissues to other hormones and also in oxygen consumption of almost all cells of the body. However, mild to moderate decrease in function of thyroid gland may occur with advancing age even in apparently healthy elderly subjects. Objectives: To observe age related change in thyroid function status in apparently healthy elderly subjects in Bangladesh. Methods: This cross sectional study was carried out in the Department of Physiology, Sir Salimullah Medical College, Dhaka between 1st January 2011 and 31st December 2011. Sixty apparently healthy elderly subjects of both sexes aged 50 to 75 years were taken as study group. They were collected from Probin Nibash Hitoishi Shangha, Agargaon, Dhaka. In addition, 30 apparently healthy young adult subjects aged 20-40 years were included as control. For assessment of thyroid function, serum free thyroxine (FT4), free triiodothyronine (FT3) and thyroid stimulating hormone (TSH) levels were estimated by ELISA method. Statistical analysis was done by one way ANOVA, Bonferroni test and Pearson’s Correlation Coefficient test as applicable. Results: In this study, mean serum free thyroxine (FT4) and free triiodothyronine (FT3) levels were significantly (p<0.001) lower and serum thyroid stimulating hormone (TSH) level was significantly (p<0.001) higher in apparently healthy elderly subjects in comparison to those of the healthy young subjects. Again, serum FT4 and FT3 levels were negatively correlated whereas serum TSH level was positively correlated with age of the subjects. Conclusion: The present study revealed a progressive decrease in thyroid function with advancement of age.

Thyroid Status in Patients with Low Serum Ferritin Level.

Iron deficiency is the most important but preventable nutritional problem in Bangladesh. Thyroid peroxidase, an iron containing enzyme, is essential for initial two steps of thyroid hormone synthesis which is a component of tissue iron. Tissue iron diminishes early in the course of iron deficiency. So thyroid hormone level may be altered in iron deficient patients. This case-control study was carried out in the Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University (BSMMU) from July 2006 to June 2007. This study was done to find out the changes of thyroid hormonal activity in iron deficiency. In this study 72 subjects were selected from the out-patient department of the hospital. Patients with low serum ferritin level <12 mgm/L were selected as cases (n=36) and healthy persons with normal serum ferritin level were taken as controls. Serum ferritin, thyroid stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3) were measured in all study subjects. Values were expressed as mean ± SD. Unpaired 't' test and Pearson's correlation test were performed to see the level of significance and p value <0.05 was taken as significant. Serum ferritin level in cases and controls were 6.78±4.05 mgm/L and 79.04±28.08 mgm/L respectively which showed significant difference (P<0.0001). Serum TSH concentration in cases and controls were 3.32±1.54 mIU/L and 1.89±0.86 mIU/L respectively. Serum FT4 concentration in cases and controls were 11.66±1.77 pmol/L and 13/10±1.36 pmol/L respectively and that of FT3 were 3.00±0.68 and 3.31±0.61 pmol/L respectively. All showed significant difference between groups. Serum ferritin and Serum TSH showed significant negative correlation in controls whereas in cases they showed negative correlation which was not statistically significant. Both serum FT4 and FT3 revealed positive correlation with serum ferritin but that too was not significant statistically. Though the study failed to show any significant positive correlation between serum ferritin and thyroid hormones, lower level of thyroid status in iron deficient patients suggest that it could be a reflection of disturbed activities of iron dependent enzymes such as thyroid peroxidase that impairs thyroid hormone synthesis. However, a large scale study is recommeded to establish the fact. This study showed that there was significant difference in thyroid hormonal status between iron deficient patients and normal healthy persons. Therefore it can be concluded that iron deficiency may impair normal thyroid hormone status.

Effects of heroin dependence on rat's calcitonin positive cells in thyroid gland and serum FT_3, FT_4, TSH / 解剖学报

Objective To investigate the effect of the heroin addicts on rat's thyroid C cells, the secretion of calcitonin(CT) and serum FT_3, FT_4, TSH. Methods Adulthood 55 male SD rats were randomly divided into normal control group(NCG), saline control group(SCG) and heroin dependence group(HDG). Heroin-dependent rat models were set up by the way of subcutaneous injection of heroin and the thyroid glands were excised on the 10th, 17th, 24th, 31st, and 38th days after models were set up. Tissues were assessed by immunohistochemical SABC method, cell counting, image analysis method and chemiluminescence techniques. ResultCompared with the normal control group(NCG)and saliane control group( SCG), the immune staining intensity was weakened;the number of CT positive cells was reduced(P<0.05);the average gray value was significantly higher(P<0.05) and showed a gradual increase in the CT positive cells of heroin dependence group(HGD). The concentration of TSH in HDG was not statistically significant as compared with the NCG. The concentration of FT_3 in HDG decreased gradually on the 10th day and the 17th day as compared with the NCG.(P<0.05). The concentration of FT_4 in HDG increased gradually on the 24th day and the 38th day as compared with the NCG.(P<0.05). Conclusion During heroin dependence period, the number and functional of CT positive cells has decreased. The changes of concentration of FT_3 and FT_4 suggest that the function of thyroid gland has changed.

Evaluation of Clinical Effect of Serum FT_3,FT_4 in Patients With Liver Cirrhosis / 中国医师杂志

Objective To study the relationship between changes of contents of serum free-triiodothyronine(FT 3),Free-thyroxine(FT 4) and liver cirrhosis,and analyse it's clinical significanec.Methods The concentration of serum FT 3 and FT 4 were determined by radioimmunoassay in 69 patients with liver cirrhosis,compared with liver function classification(Child-Pugh).Results Contents of serum FT 3,FT 4 in cirrhosis patients were markedly lower than that of controls(P

A Study of the Levels of Serum Total and Free Thyroid Hormones in Newborns and Their Mothers / 昆明医科大学学报

Serum total and free thyroid hormone concentrations were in 45 newborns, their preg- nant mothers and in 30 nonpregnant women. The levels of serum TT4, TT3, FT4, FT3 in newborns (umbilical cord serum) were significantly lower than those in pregnant mothers at term (P