Low thyroid function is not associated with an accelerated deterioration in renal function

Abstract Background Chronic kidney disease (CKD) is frequently accompanied by thyroid hormone dysfunction. It is currently unclear whether these alterations are the cause or consequence of CKD. This study aimed at studying the effect of thyroid hormone alterations on renal function in cross-sectional and longitudinal analyses in individuals from all adult age groups. Methods Individual participant data (IPD) from 16 independent cohorts having measured thyroid stimulating hormone, free thyroxine levels and creatinine levels were included. Thyroid hormone status was defined using clinical cut-off values. Estimated glomerular filtration rates (eGFR) were calculated by means of the four-variable Modification of Diet in Renal Disease (MDRD) formula. For this IPD meta-analysis, eGFR at baseline and eGFR change during follow-up were computed by fitting linear regression models and linear mixed models in each cohort separately. Effect estimates were pooled using random effects models. Results A total of 72 856 individuals from 16 different cohorts were included. At baseline, individuals with overt hypothyroidism (n = 704) and subclinical hypothyroidism (n = 3356) had a average (95% confidence interval) −4.07 (−6.37 to −1.78) and −2.40 (−3.78 to −1.02) mL/min/1.73 m2 lower eGFR as compared with euthyroid subjects (n = 66 542). In (subclinical) hyperthyroid subjects (n = 2254), average eGFR was 3.01 (1.50–4.52) mL/min/1.73 m2 higher. During 329 713 patient years of follow-up, eGFR did not decline more rapidly in individuals with low thyroid function compared with individuals with normal thyroid function. Conclusions Low thyroid function is not associated with a deterioration of renal function. The cross-sectional association may be explained by renal dysfunction causing thyroid hormone alterations.

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Association between ultrasonography echogenicity and heterogeneity and thyroid function in autoimmune diffuse thyroid diseases in children and adolescents

10.21203/rs.3.rs-557677/v1 ◽

2021 ◽

Author(s):

Ji Eun Park ◽

Sook Min Hwang ◽

Ji-Young Hwang ◽

Jin Hee Moon ◽

Ik Yang ◽

...

Keyword(s):

Thyroid Function ◽

Thyroid Dysfunction ◽

Thyroid Stimulating Hormone ◽

Thyroid Diseases ◽

Overt Hypothyroidism ◽

Thyroid Ultrasound ◽

Thyroid Status ◽

Children And Adolescent ◽

Overt Hyperthyroidism

Abstract Purpose: To evaluate the association between thyroid echogenicity and heterogeneity seen on ultrasonography (US) and thyroid function in pediatric and adolescent populations with autoimmune diffuse thyroid diseases (AITD).Methods: From 2000 to 2020, we reviewed thyroid ultrasound (US) images and thyroid function statuses in 133 children and adolescent AITD patients. Our review of the images focused on decreased echogenicity and heterogeneity, which were classified into four grades.Results: Among patients with overt hypothyroidism or overt hyperthyroidism, 94.2% (65/69) showed a US grade of 3 or 4. In patients with subclinical hyper/hypothyroidism or euthyroidism, 45.3% (29/64) showed grades 1 or 2. There were no overt hyper/hypothyroidism patients with US grade 1. When we compared US grades according to thyroid status, more severe thyroid dysfunction was significantly associated with higher US grade (p=0.047). Thyroid stimulating hormone (TSH) level differed significantly according to US grades when we evaluated hyperthyroid (p=0.035) and hypothyroid (p=0.027) states independently. 11 patients showed both US grade and thyroid function status changes on follow-up US.Conclusions: In children and adolescent AITD patients, there was an association between decreased echogenicity and heterogeneity on US and thyroid dysfunction.

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Thyroid dysfunction in preeclampsia and related fetomaternal outcomes

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20191944 ◽

2019 ◽

Vol 8 (5) ◽

pp. 1928

Author(s):

Puja Banik ◽

R. K. Praneshwari Devi ◽

Aheibam Bidya ◽

Akoijam Tamphasana ◽

M. Agalya ◽

...

Keyword(s):

Thyroid Function ◽

Thyroid Dysfunction ◽

Birth Asphyxia ◽

Normal Pregnancy ◽

Thyroid Stimulating Hormone ◽

Severe Preeclampsia ◽

Intrauterine Fetal Death ◽

Overt Hypothyroidism ◽

Thyroid Function Tests ◽

Cross Sectional

Background: Changes in thyroid function in normal pregnancy are well-documented but in complicated pregnancy like preeclampsia, very little is known. Studies have shown evidences of hypothyroidism in preeclampsia necessitating thyroid function tests to be done in preeclampsia. The study was done to analyze the fetomaternal outcome of preeclampsia with coexisting thyroid dysfunction.Methods: A cross-sectional analytical study was done over 18 months on 95 preeclamptic patients admitted at the antenatal ward and fetomaternal outcomes were analyzed according to thyroid status.Results: Out of 95 patients with preeclampsia, 42 (44.2%) had thyroid dysfunction. Among these 42 patients, 37 (38.9%) patients had subclinical hypothyroidism, 4 (4.2%) had overt hypothyroidism and 1 (1%) had hyperthyroidism. Severe preeclampsia was seen in 64.3% of the patients with thyroid dysfunction compared with 39.6% in euthyroid patients. The mean thyroid stimulating hormone (TSH) level was significantly higher and means free thyroxine (fT4) level was significantly lower in severe preeclampsia compared with non-severe preeclampsia. Complications like abruption, intrauterine fetal death (IUD), intrauterine growth restriction (IUGR), oligohydramnios, preterm deliveries, postpartum hemorrhage (PPH), low birth weight babies, birth asphyxia in babies and subsequent neonatal intensive care unit (NICU) admissions were significantly higher (p <0.05) in the preeclampsia patients with thyroid dysfunction in comparison with euthyroid ones.Conclusions: Hypothyroidism may be a modifiable risk factor for preeclampsia. Thyroid screening early in pregnancy may be helpful in predicting the occurrence of preeclampsia and timely thyroid hormone administration can reduce the maternal and perinatal morbidity and mortality associated with preeclampsia.

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Evaluation of renal function in subclinical hypothyroidism

Journal of Laboratory Physicians ◽

10.4103/jlp.jlp_67_17 ◽

2018 ◽

Vol 10 (01) ◽

pp. 050-055 ◽

Cited By ~ 6

Author(s):

Vijayetha P. Patil ◽

Alagilwada S. Shilpasree ◽

Vidya S. Patil ◽

Kangokar R. Pravinchandra ◽

Deepti G. Ingleshwar ◽

...

Keyword(s):

Renal Function ◽

Serum Creatinine ◽

Subclinical Hypothyroidism ◽

Linear Regression Analysis ◽

Laboratory Diagnosis ◽

Thyroid Stimulating Hormone ◽

Function Parameter ◽

Overt Hypothyroidism ◽

Free Triiodothyronine ◽

Cross Sectional

Abstract INTRODUCTION: Patients with subclinical hypothyroidism (SCH) have a few or no symptoms or signs of thyroid dysfunction and thus by its very nature, SCH is a laboratory diagnosis. Serum creatinine is elevated and glomerular filtration rate (GFR) values are reversibly reduced in overt hypothyroid patients. We hypothesize that SCH also may be associated with low GFR. AIMS AND OBJECTIVES: The objective of this study was (1) to know the effect of SCH on kidney function, (2) to find the correlation between the renal function parameter creatinine, estimated GFR (eGFR), and thyroid-stimulating hormone (TSH), and (3) to know if creatinine values can be predicted by TSH values in SCH cases. MATERIALS AND METHODS: This is a hospital-based cross-sectional study for 1 year. A total of 608 subjects of either sex were included in the study and were divided into 3 groups: (1) SCH, (2) overt hypothyroidism (OHT), and (3) euthyroidism (ET). TSH, free triiodothyronine, free thyroxine, and serum creatinine were estimated and eGFR was calculated using modification of diet in renal disease study equation and the chronic kidney disease epidemiology collaboration equations. RESULTS: Serum creatinine levels were higher and eGFR was lower significantly in the subclinical hypothyroid group when compared to the control ET group (P < 0.001). The overtly hypothyroid group had significantly higher levels of serum creatinine and lower eGFR when compared to both the groups (P < 0.001). Significant correlation between TSH, creatinine, and eGFR was found in OHT group only. Linear regression analysis showed the regression in creatinine upon TSH is attributable to 44.5% among OHT group, 48.2% in SCH group. CONCLUSION: It can be concluded that the SCH group behaves biochemically similar to OHT group and changes in serum creatinine reflect tissue hypothyroidism in SCH cases.

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The relationship between ultrasound findings and thyroid function in children and adolescent autoimmune diffuse thyroid diseases

Scientific Reports ◽

10.1038/s41598-021-99016-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ji Eun Park ◽

Sook Min Hwang ◽

Ji-Young Hwang ◽

Jin Hee Moon ◽

Ik Yang ◽

...

Keyword(s):

Thyroid Function ◽

Thyroid Dysfunction ◽

Thyroid Stimulating Hormone ◽

Thyroid Diseases ◽

Overt Hypothyroidism ◽

Children And Adolescent ◽

Ultrasound Findings ◽

The Relationship ◽

Overt Hyperthyroidism

AbstractTo evaluate the association between thyroid echogenicity and heterogeneity seen on ultrasonography (US) and thyroid function in pediatric and adolescent populations with autoimmune diffuse thyroid diseases (AITD). From 2000 to 2020, we reviewed thyroid ultrasound (US) images and thyroid function statuses in 133 children and adolescent AITD patients. Our review of the images focused on decreased echogenicity and heterogeneity, which were classified into four grades. Among patients with overt hypothyroidism or overt hyperthyroidism, 94.2% (65/69) showed a US grade of 3 or 4. In patients with subclinical hyper/hypothyroidism or euthyroidism, 45.3% (29/64) showed grades 1 or 2. There were no overt hyper/hypothyroidism patients with US grade 1. When we compared US grades according to thyroid status, more severe thyroid dysfunction was significantly associated with higher US grade (p = 0.047). Thyroid stimulating hormone (TSH) level differed significantly according to US grades when we evaluated hyperthyroid (p = 0.035) and hypothyroid (p = 0.027) states independently. 11 patients showed both US grade and thyroid function status changes on follow-up US. In children and adolescent AITD patients, there was an association between decreased echogenicity and heterogeneity on US and thyroid dysfunction.

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Thyroid Dysfunction States and Incident Cardiovascular Events: The Tehran Thyroid Study

Hormone and Metabolic Research ◽

10.1055/s-0043-121031 ◽

2017 ◽

Vol 50 (01) ◽

pp. 37-43 ◽

Cited By ~ 6

Author(s):

Maryam Tohidi ◽

Arash Derakhshan ◽

Samaneh Akbarpour ◽

Atieh Amouzegar ◽

Ladan Mehran ◽

...

Keyword(s):

Thyroid Function ◽

Subclinical Hypothyroidism ◽

Thyroid Dysfunction ◽

Middle Eastern ◽

Thyroid Stimulating Hormone ◽

Overt Hypothyroidism ◽

Subclinical Hyperthyroidism ◽

Significant Difference ◽

Middle Eastern Population

AbstractThe objective of the study was to investigate the relation of different thyroid function states with the incidence of cardiovascular disease (CVD)/coronary heart disease (CHD) among a Middle-Eastern population with a high incidence of CVD/CHD. A total of 3975 participants entered the study (43.6% men). According to their thyroid stimulating hormone (TSH) and free thyroxin (FT4) levels, the participants were categorized into 5 groups: euthyroid, subclinical hypothyroidism, overt hypothyroidism, subclinical hyperthyroidism, and overt hyperthyroidism. Multivariable Cox proportional hazard models were used to assess the relation of different thyroid function states with incident CVD/CHD, with euthyroid state as reference. The mean age (SD) of the participants was 46.5 (12.0) years. At baseline, no significant difference was observed in the frequency of prevalent CVD cases (n=201) between all groups. No significant interaction was found between prevalent CVD and different thyroid function states with outcomes, hence, we did not exclude participants with prevalent CVD from data analysis. A total of 400 CVD events (358 CHD cases) during a median follow-up of 11.2 years (inter-quartile range: 1.96) occurred. During the follow-up, even in the age and sex adjusted model, no association was observed between different states of thyroid dysfunction and incidence of CVD/CHD. The multivariable hazard ratios (95% CI) of subclinical hypothyroidism, hypothyroidism, subclinical hyperthyroidism, and hyperthyroidism for CVD events were 1.21 (0.77–1.88), 0.76 (0.33–1.69), 0.81 (0.46–1.41) and 1.48 (0.70–3.16), respectively. Both at baseline and during follow-up, no relation was observed between different states of thyroid function with prevalence and incidence of CVD/CHD.

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Association of Age with Thyroid Hormone Status and Ischaemic Heart Disease (IHD)

Journal of Enam Medical College ◽

10.3329/jemc.v2i2.12842 ◽

2012 ◽

Vol 2 (2) ◽

pp. 80-84

Author(s):

Nasreen Sultana Lovely ◽

Rokeya Begum ◽

Qazi Shamima Akhter ◽

Salma Akhter ◽

Nilufar Yasmin Mili ◽

...

Keyword(s):

Thyroid Hormone ◽

Thyroid Function ◽

Healthy Subjects ◽

Meta Analysis ◽

Age Groups ◽

Cross Sectional Study ◽

College Hospital ◽

Cross Sectional ◽

Medical College ◽

Cardiology Department

Background: Aging is associated with increased prevalence of thyroid function abnormalities including hypothyroidism. A meta-analysis showed an increased prevalence and incidence of cardiovascular mortality only in a relatively younger population. Objective: To compare the thyroid function status in IHD patients of different age groups. Methods: This cross sectional study was carried out on 31 IHD subjects aged 35-59 years (Group B1) and 19 IHD subjects aged 60-85 years (Group B2) in the Department of Physiology, Dhaka Medical College, Dhaka from July 2009 to June 2010. For comparison 24 healthy subjects aged 35-59 years (Group A1) and 26 with age 60-85 years (Group A2) were studied. The IHD subjects were selected from coronary care unit of cardiology department and OPD of Dhaka Medical College Hospital, Dhaka. Serum FT3, FT4 and TSH of all subjects were measured by radioimmunoassay. Statistical analysis was done by unpaired Students t test. Results: The mean ± SD of FT3 and FT4 were significantly lower and TSH was significantly higher in Group B1 IHD patients than that of Group A1 healthy subjects, but no difference was found between Group A2 and Group B2 and between Group B1 and Group B2.Conclusion: Thyroid hormone levels are significantly lower in younger IHD population (age 35-59 years) than the age-matched normal controls. DOI: http://dx.doi.org/10.3329/jemc.v2i2.12842 J Enam Med Col 2012; 2(2): 80-84

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Fatigue in Patients with Autoimmune Thyroid Diseases

Serbian Journal of Experimental and Clinical Research ◽

10.1515/sjecr-2016-0028 ◽

2017 ◽

Vol 18 (1) ◽

pp. 39-44

Author(s):

Zorica Jovanovic ◽

Svetlana Miletic-Drakulic ◽

Gordana Toncev ◽

Olgica Mihaljevic ◽

Svetlana Djukic ◽

...

Keyword(s):

Thyroid Function ◽

Thyroid Stimulating Hormone ◽

Control Group ◽

Overt Hypothyroidism ◽

Thyroid Antibodies ◽

Autoimmune Thyroid Diseases ◽

Cross Sectional ◽

Limit Values ◽

Autoimmune Thyroid ◽

Normal Thyroid Function

Abstract Fatigue is a common feature in a wide variety of chronic inflammatory and autoimmune diseases, but fatigue in autoimmune thyroid disease (AITD) has not been investigated so far. The aim of this study was to examine fatigue in patients with AITD and to analyse the correlation between fatigue and the serum concentrations of thyroid antibodies, thyroid function and depression. This cross-sectional clinical study included 62 patients with increased concentrations of thyroperoxidase antibodies (TPOAbs) as confirmation of AITD and 52 healthy individuals who were negative for thyroid antibodies; all controls were euthyroid. Thyroid antibodies, free thyroxine and thyroid-stimulating hormone were measured in the sera of all subjects. The Fatigue Severity Scale was used to measure the severity of fatigue; the level of depression was measured by the Beck Depression Inventory. Eight (12.9%) patients had evident fatigue, 7 (11.3%) patients had fatigue limit values, and 47 (75.8%) patients had no fatigue. The frequency of fatigue was highly significant and almost three times higher in the AITD patients compared to the control group, in which only 2 (3.8%) patients had evident fatigue. The majority of patients with fatigue had normal thyroid function, and only one (1.6%) patient had overt hypothyroidism. Seven (11.3%) patients had both fatigue and depression, whereas one (1.6%) patient had fatigue without depression. We did not find significant correlations between fatigue and the concentrations of thyroid antibodies, but we found statistically significant correlations between fatigue and depression in AITD patients.

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Hormonal Outcomes Following Hemithyroidectomy

Otolaryngology ◽

10.1177/0194599820962486 ◽

2020 ◽

pp. 019459982096248

Author(s):

Lauren Anne Buehler ◽

Nabil Zuhayr Madhun ◽

James Bena ◽

Christian Nasr ◽

Joseph Scharpf ◽

...

Keyword(s):

Thyroid Hormone ◽

Cleveland Clinic ◽

Retrospective Chart Review ◽

Thyroid Stimulating Hormone ◽

Overt Hypothyroidism ◽

Care Hospital ◽

Characteristic Analysis ◽

Hospital System ◽

Sh Group

Objective To assess hormonal outcomes and thyroid hormone (TH) replacement after hemithyroidectomy (HT). Study Design Retrospective chart review. Setting Quaternary care hospital system. Methods A retrospective analysis was performed on patients who had an HT at Cleveland Clinic between 2000 and 2010 with outcomes assessed up to 5 years post-HT. Patients with overt hypothyroidism (OH; thyroid-stimulating hormone [TSH] >10 mIU/L, TSH >4.2 mIU/L on thyroid hormone [TH]), subclinical hypothyroidism (SH; TSH >4.2-10 mIU/L, no TH), or euthyroidism (EU; TSH 0.4-4.2 mIU/L, no TH) were compared. Patients with SH who returned to EU were compared to those who continued to have SH. For immediate start on TH, a receiver operating characteristic analysis was performed to determine dosage of TH above which suppression of TSH <0.4 mIU/L was predicted. Results We identified 335 patients (average age 51 years, 78% female, median follow-up of 50 months). Of the 210 not immediately started on TH, 32.4% were OH, 13.3% were SH, and 54.3% were EU. EU patients were younger (48 years), had more remaining gland, were less likely to have lymphocytic infiltrate, and had a lower preoperative TSH (1.2 mIU/L). In the SH group, 58.3% of patients normalized their TSH. With immediate TH start, 45% developed suppressed TSH. Those on LT4 >1.05 mcg/kg/d were more likely to suppress (sensitivity 89%). Conclusion Most patients post-HT will remain EU, and immediate start of TH may lead to TSH suppression. Those with SH may ultimately normalize TSH. These findings together suggest that observation may be a better option than TH replacement after HT.

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Stability of thyroid function in older adults: the Birmingham Elderly Thyroid Study

British Journal of General Practice ◽

10.3399/bjgp18x698861 ◽

2018 ◽

Vol 68 (675) ◽

pp. e718-e726 ◽

Cited By ~ 6

Author(s):

Lesley Roberts ◽

Deborah McCahon ◽

Oliver Johnson ◽

M Sayeed Haque ◽

James Parle ◽

...

Keyword(s):

Thyroid Function ◽

Thyroid Dysfunction ◽

Cost Savings ◽

Thyroid Stimulating Hormone ◽

Overt Hypothyroidism ◽

Thyroid Function Tests ◽

Older Individuals ◽

Original Result ◽

Over Time

BackgroundThyroid function tests (TFTs) are among the most requested tests internationally. However, testing practice is inconsistent, and potentially suboptimal and overly costly. The natural history of thyroid function remains poorly understood.AimTo establish the stability of thyroid function over time, and identify predictors of development of overt thyroid dysfunction.Design and settingLongitudinal follow-up in 19 general practices in the UK.MethodA total of 2936 participants from the Birmingham Elderly Thyroid Study (BETS 1) with a baseline TFT result indicating euthyroid or subclinical state were re-tested after approximately 5 years. Change in thyroid-stimulating hormone (TSH), free thyroxine (FT4), and thyroid status between baseline and follow-up was determined. Predictors of progression to overt dysfunction were modelled.ResultsParticipants contributed 12 919 person-years; 17 cases of overt thyroid dysfunction were identified, 13 having been classified at baseline as euthyroid and four as having subclinical thyroid dysfunction. Individuals with subclinical results at baseline were 10- and 16-fold more likely to develop overt hypothyroidism and hyperthyroidism, respectively, compared with euthyroid individuals. TSH and FT4 demonstrated significant stability over time, with 61% of participants having a repeat TSH concentration within 0.5 mIU/L of their original result. Predictors of overt hypothyroidism included new treatment with amiodarone (odds ratio [OR] 92.1), a new diagnosis of atrial fibrillation (OR 7.4), or renal disease (OR 4.8).ConclusionHigh stability of thyroid function demonstrated over the 5-year interval period should discourage repeat testing, especially when a euthyroid result is in the recent clinical record. Reduced repeat TFTs in older individuals is possible without conferring risk, and could result in significant cost savings.

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Reference intervals for thyroid-stimulating hormone (TSH) and free thyroxine (FT4) in infants’ day 14–30 of life and a comparison with other studies

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2020-0148 ◽

2020 ◽

Vol 33 (9) ◽

pp. 1125-1132

Author(s):

Jeanne Sze Lyn Wong ◽

Nalini M. Selveindran ◽

Rashdan Zaki Mohamed ◽

Fuziah M. Zain ◽

Siti S. Anas ◽

...

Keyword(s):

Thyroid Function ◽

Small Sample Size ◽

Age Groups ◽

Reference Intervals ◽

Thyroid Stimulating Hormone ◽

Small Sample ◽

Free Thyroxine ◽

Significant Difference ◽

Stimulating Hormone

AbstractObjectivesEstablished reference intervals of thyroid function in neonates are important; however, studies often consist of a small sample size or lack of clinical information. We aim to define reference intervals for thyroid-stimulating hormone (TSH) and free thyroxine (FT4) for infants aged 14–30 days. We also reviewed follow-up TSH for infants with initial values 10–20 mIU/L.MethodsVenous TSH and FT4 of term babies aged 14–30 days with breast milk jaundice that had thyroid function test performed as part of a prolonged jaundice workout from September 2016 to March 2017 were analyzed. Electronic medical records were reviewed to ensure only well babies with no pathological causes of jaundice or conditions that may affect thyroid function were included. TSH and FT4 were analyzed using immunoassay analyzer Dxl 800, Beckman Coulter.ResultsThere were no correlations between FT4 and TSH with gender, birth weight and ethnicity. Correlation coefficient between FT4 and total bilirubin was weak at 0.138 (p=0.001). No association was found between TSH and bilirubin levels. Mean FT4 was higher in the younger age group day 14–21 (p<0.01). There was no significant difference in TSH values between the age groups. Infants with mildly elevated TSH 10–20 mIU/L had normalized values on follow-up (mean, 11.41 vs. 4.42 mIU/L; p<0.01; 95%CI, 5.88–8.09). The following reference intervals (2.5–97.5th percentile) were derived: FT4 day 14–21 (n=513): 11.59–21.00 pmoL/L; FT4 day 22–30 (n=66): 10.14–19.60 pmoL/L; TSH day 14–30 (n=579): 1.90–10.34 mIU/L. Comparison between studies showed variations of reference intervals with different manufacturer assays, age and methodology.ConclusionsOur reference intervals would be useful in the clinical setting. Infants with mildly elevated TSH could be monitored first instead of immediate treatment.

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