scholarly journals Relationship between Subclinical Thyroid Dysfunction and the Risk of Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

2017 ◽  
Vol 2017 ◽  
pp. 1-15 ◽  
Author(s):  
Jing Sun ◽  
Liang Yao ◽  
Yuan Fang ◽  
Ruifei Yang ◽  
Yaolong Chen ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Meta Analysis ◽  
Total Mortality ◽  
Cardiovascular Outcomes ◽  
Cochrane Library ◽  
Subclinical Hyperthyroidism ◽  
Estimation Risk ◽  
Increased Risk

Background. Evidence on the association between subclinical thyroid dysfunction and the risk of cardiovascular outcomes are conflicting. Methods and Results. PubMed, EMbase, Web of Science, Cochrane Library, and China Biology Medicine (CBM) databases were searched from inception to July 10, 2016. A total of 16 studies were included for meta-analysis. We found that subclinical hypothyroidism was not correlated with coronary heart disease (CHD) (RR = 1.17; 95% CI, 0.91–1.52), total mortality (RR = 1.02; 95% CI, 0.93–1.13), cardiovascular mortality (RR = 1.06; 95% CI, 0.77–1.45), heart failure (RR = 1.17; 95% CI, 0.87–1.57), and atrial fibrillation (RR = 1.05; 95% CI, 0.91–1.21), except CHD mortality (RR = 1.37; 95% CI, 1.03–1.84). Subgroup analysis indicated a higher estimation risk in CHD (RR = 1.54; 95% CI, 1.00–2.39), cardiovascular mortality (RR = 2.14; 95% CI, 1.43–3.22), and CHD mortality (RR = 1.54; 95% CI, 1.11–2.15) among participants < 65 years. Furthermore, subclinical hyperthyroidism was found to be associated with CHD (RR = 1.20; 95% CI, 1.02–1.42), total mortality (RR = 1.27; 95% CI, 1.07–1.51), and CHD mortality (RR = 1.45; 95% CI, 1.12–1.86). Conclusions. Subclinical hypothyroidism is likely associated with an increased risk of CHD mortality, and subclinical hyperthyroidism is likely associated with increased risk of CHD, CHD mortality, and total mortality.

Association between systemic lupus erythematosus and thyroid dysfunction: a meta-analysis

Lupus ◽  
2018 ◽  
Vol 27 (13) ◽  
pp. 2120-2128 ◽  
Author(s):  
W Luo ◽  
P Mao ◽  
L Zhang ◽  
Z Yang
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Meta Analysis ◽  
Healthy Controls ◽  
Subclinical Hyperthyroidism ◽  
Systemic Lupus ◽  
Increased Risk ◽  
Chronic Autoimmune Disease

Introduction Systemic lupus erythematosus (SLE) is a chronic autoimmune disease, the pathogenesis of which remains elusive. The deficiency or excess of thyroid hormone is defined as thyroid dysfunction, including (subclinical) hypothyroidism and (subclinical) hyperthyroidism. Autoimmune factors are likely to be relevant to the development of SLE and thyroid dysfunction. Recently, many studies have indicated that the prevalence of thyroid dysfunction is higher in SLE patients than in the general population. The objective of our study was to perform a systematic review and meta-analysis to find out the relationship between SLE and thyroid dysfunction. Methods Literature databases were searched, including PubMed, Embase, Web of science, Cochrane, CNKI, CHINESE WANFANG, China Science and Technology Database (VIP). Studies comparing presence of thyroid dysfunction in SLE patients to healthy controls were extracted. All the statistical analyses were performed with STATA 12.0 software. Results Ten studies with 10,500 SLE patients and 44,170 healthy controls were included in this study. The meta-analysis results showed that the prevalence of (subclinical) hypothyroidism in SLE patients was higher than in the healthy controls (hypothyroidism: OR = 2.93, 95% CI = 1.81–4.75; subclinical hypothyroidism: OR = 5.67, 95% CI = 3.50–9.18). No statistical difference of (subclinical) hyperthyroidism was found between SLE patients and controls. Conclusion Our meta-analysis suggests that SLE is significantly associated with increased risk of (subclinical) hypothyroidism, but it has little influence on (subclinical) hyperthyroidism.

scholarly journals Subclinical Thyroid Function and Cardiovascular Events in patients with Atrial Fibrillation

2021 ◽  
Author(s):  
Elisavet Moutzouri ◽  
Christina Lyko ◽  
Martin Feller ◽  
Manuel Raphael Blum ◽  
Luise Adam ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Total Mortality ◽  
Composite Endpoint ◽  
Community Dwelling ◽  
Sensitivity Analyses ◽  
Subclinical Hyperthyroidism ◽  
Increased Risk ◽  
Multivariable Adjustment

Objective: To evaluate if subclinical thyroid dysfunction is associated with cardiovascular (CV) risk in patients with atrial fibrillation (AF). Methods: Swiss-AF is a prospective cohort of community-dwelling participants aged ≥ 65 years with AF. Primary outcome was a composite endpoint of CV events (myocardial infarctions, stroke/transitory ischemic events, systemic embolism, heart failure (HF) hospitalizations, CV deaths). Secondary outcomes were component endpoints, total mortality and AF-progression. Exposures were thyroid dysfunction categories, TSH and fT4. Sensitivity analyses were performed for amiodarone use, thyroid hormones use and competing events. Results: 2415 patients were included (mean age 73.2 years; 27% women). 196 (8.4%) had subclinical hypothyroidism and 53 (2.3%) subclinical hyperthyroidism. Subclinical thyroid dysfunction was not associated with CV events, during a median follow-up of 2.1 years (max 5 years): age- and sex- adjusted hazard ratio (adjHR) of 0.99 (95% confidence interval (CI) 0.69-1.41) for subclinical hypothyroidism; and 0.55 (95%CI 0.23-1.32) for subclinical hyperthyroidism. Results remained robust following multivariable adjustment and sensitivity analyses. In euthyroid patients, fT4 levels were associated with an increased risk for the composite endpoint and HF (adjHR 1.46 95%CI 1.04- 2.05; adjHR 1.70 95%CI 1.08-2.66, respectively, for the highest quintile versus the middle quintile). Results remained similar following multivariable adjustment. Results remained significant for HF in sensitivity analyses. No association between subclinical thyroid dysfunction and total mortality or AF-progression was found. Conclusions: Subclinical hypothyroidism was not associated with increased CV risk in AF patients. Higher levels of fT4 with normal TSH were associated with higher risk for HF.

P1818Descending aortic thoracic diameter: a risk marker for major adverse cardiovascular outcomes in women

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
O L Rueda Ochoa ◽  
L R Bons ◽  
S Rohde ◽  
K E L Ghoud ◽  
R Budde ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Risk ◽  
Cardiovascular Mortality ◽  
Total Mortality ◽  
Population Based ◽  
Cardiovascular Outcomes ◽  
Increased Risk ◽  
Almost All

Abstract Background Thoracic aortic diameters have been associated with cardiovascular risk factors and atherosclerosis. However, limited evidence regarding the role of thoracic aortic diameters as risk markers for major cardiovascular outcomes among women and men exist. Purpose To evaluate the independent associations between crude and indexed ascending and descending aortic (AA and DA) diameters with major cardiovascular outcomes among women and men and to provide optimal cutoff values associated with increased cardiovascular risk. Methods and results 2178 women and men ≥55 years from the prospective population-based Rotterdam Study underwent multi-detector CT scan of thorax. Crude diameters of the AA and DA were measured and indexed by height, weight, body surface area (BSA) and body mass index (BMI). Incidence of stroke, coronary heart disease (CHD), heart failure (HF), cardiovascular and all-cause mortality were evaluated during 13 years of follow-up. Weight-, BSA-, or BMI-indexed AA diameters showed significant associations with total or cardiovascular mortality in both sexes and height-indexed values showed association with HF in women. Crude AA diameters were associated with stroke in men and HF in women. For DA, crude and almost all indexed diameters showed significant associations with either stroke, HF, cardiovascular or total mortality in women. Only weight-, BSA- and BMI-indexed values were associated with total mortality in men. For crude DA diameter, the risk for stroke increased significantly at the 75th percentile among men while the risks for HF and cardiovascular mortality increased at the 75th and 85th percentiles respectively in women. Conclusions Our study suggests a role for descending thoracic aortic diameter as a marker for increased cardiovascular risk, in particular for stroke, heart failure and cardiovascular mortality among women. The cut points for increased risk for several of cardiovascular outcomes were below the 95th percentile of the distribution of aortic diameters.

scholarly journals The Association with Subclinical Thyroid Dysfunction and Uric Acid

2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Yuling Xing ◽  
Linlin Yang ◽  
Jing Liu ◽  
Huijuan Ma
Keyword(s):  
Uric Acid ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Meta Analysis ◽  
Serum Levels ◽  
Subclinical Hyperthyroidism ◽  
Funnel Plot ◽  
Different Types ◽  
Standardized Mean Difference ◽  
The Relationship

The relationship between subclinical thyroid dysfunction and uric acid was not well established. This study aimed to determine if subclinical thyroid dysfunction is associated with hyperuricemia risk and to evaluate the levels of uric acid in patients with different forms of subclinical thyroid dysfunction. A systematic search was conducted in 4 databases to obtain relevant studies on subclinical thyroid dysfunction (subclinical hyperthyroidism and subclinical hypothyroidism) and uric acid. The standardized mean difference (SMD) or odds ratio (OR) and 95% confidence interval (95% CI) were used for evaluation, and the sensitivity analysis was conducted. Publication bias was estimated by funnel plot, Egger’s test, and Begg’s test. A total of 73 studies were included in this meta-analysis. The results demonstrated that serum levels of uric acid in patients with subclinical hypothyroidism were significantly higher than those of controls and patients with subclinical hyperthyroidism. Patients with subclinical thyroid dysfunction had a higher prevalence of hyperuricemia compared with normal clinical thyroid function. Subclinical thyroid dysfunction was associated with the prevalence of hyperuricemia. Different types of subclinical thyroid dysfunction had varied effects on serum levels of uric acid.

scholarly journals Spectrum of thyroid dysfunction and dementia: a dose–response meta-analysis of 344,248 individuals from cohort studies

2021 ◽  
Vol 10 (4) ◽  
pp. 410-421
Author(s):  
Xingyao Tang ◽  
Zhi-Hui Song ◽  
Dawei Wang ◽  
Jinkui Yang ◽  
Marly Augusto Cardoso ◽  
...  
Keyword(s):  
Dose Response ◽  
Thyroid Dysfunction ◽  
Disease Risk ◽  
Meta Analysis ◽  
Functional Relation ◽  
Thyroid Stimulating Hormone ◽  
Subclinical Hyperthyroidism ◽  
Hormone Concentration ◽  
Increased Risk ◽  
Stimulating Hormone

Thyroid hormone, as a modifiable risk factor for dementia, promotes neurocognitive function and regulates metabolic processes. Various studies have defined different thyroid-stimulating hormone cutoffs, but the safest thyroid-stimulating hormone concentration was absent. A dose–response meta-analysis describing the overall functional relation and identifying exposure intervals associated with a higher or lower disease risk is thus desirable. Therefore, our current analysis was conducted to understand the influence of thyroid dysfunction on dementia risk. We searched PubMed, Embase, and Web of Science before May 1, 2020 for human studies published in English. Studies were considered for inclusion if they used a cohort study design to measure the risk of dementia in different thyroid function status groups, diagnosed thyroid functional status and all-cause dementia, included participants aged >18 years, and provided quantitative measures of data. The analysis contained 17 articles with 344,248 individuals with a 7.8-year mean follow-up. Ten studies with 329,287 participants indicated that only subclinical hyperthyroidism was associated with an increased risk of dementia. In contrast, subclinical hypothyroidism, clinical hyperthyroidism, and clinical hypothyroidism did not affect dementia. In the dose–response meta-analysis with 46,417 samples from 11 studies, the association of thyroid-stimulating hormone with the risk of dementia exhibited a U-shaped curve. Our study indicated that subclinical hyperthyroidism was associated with the risk of dementia and the thyroid-stimulating hormone concentration at around 1.55–1.60 mU/L as the optimum range for the risk of dementia.

Abstract 3215: Effects of Selective and Non-Selective Beta-Blockers on Cardiovascular Risk in Patients with Heart Failure or Acute Coronary Syndrome: a Meta-Analysis.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Olav R de Peuter ◽  
Federico Lussana ◽  
Pieter W Kamphuisen
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Cardiovascular Mortality ◽  
Beta Blockers ◽  
Meta Analysis ◽  
Total Mortality ◽  
Cochrane Library ◽  
Mortality And Morbidity ◽  
Coronary Syndrome ◽  
Patients With Heart Failure

Background: Guidelines generally recommend the use of beta-blockers in patients with heart failure (HF) and acute coronary syndrome (ACS). It has recently been suggested that non-selective beta-blockers were more effective than selective beta-blockers in HF. However, a better efficacy of different beta-blockers, specifically analyzing total and cardiovascular (CV) mortality and morbidity, in patients with HF or ACS is unclear. Methods: We performed a meta-analysis of randomized controlled trials (RCTs) through Medline, EMBASE, and Cochrane Library databases to identify RCTs comparing selective or non-selective beta-blockers with placebo (29 studies, 31,856 patients), or directly comparing the two different beta-blockers (5 studies, 3,733 patients). Studies were selected using a priori defined criteria and data on study characteristics, study quality and outcomes were abstracted. All included studies had (cardiovascular) mortality as primary or secondary endpoint. Results: In patients with HF non-selective beta-blockers were associated with a reduction in total mortality (RR 0.75, 95%CI 0.61–0.92), and with a non significant decrease in CV mortality. Selective beta-blockers decreased total and CV mortality (RR 0.76, 0.68–0.84 and RR 0.78, 0.66–0.92, respectively). In patients with ACS non-selective beta-blockers were associated with a significant decrease in total mortality (RR 0.73, 0.64–0.82), CV mortality (RR 0.69, 0.60–0.80) and CV morbidity. Selective beta-blockers however had no effect on total mortality (RR 0.88, 0.68–1.15) or CV mortality (RR 0.89, 0.69–1.15). In HF, direct comparison showed a significantly decreased mortality (RR 0.86, 0.78–0.94) for non-selective beta-blockers compared to selective beta-blockers. For ACS, only one study directly compared different beta-blockers. Conclusions: In patients with HF, selective and non-selective beta-blockers seem equally effective in reducing mortality. In patients with ACS, selective beta-blockers had no influence on total and cardiovascular mortality, in contrast to non-selective beta-blockers. This meta-analysis suggests that patients with ACS should specifically be treated with non-selective beta-blockers to reduce total and cardiovascular mortality.

Iodine contrast prior to or during pregnancy and neonatal thyroid function: a systematic review

2021 ◽  
Vol 184 (1) ◽  
pp. 189-198 ◽  
Author(s):  
Nienke van Welie ◽  
Maite Portela ◽  
Kim Dreyer ◽  
Linda J Schoonmade ◽  
Madelon van Wely ◽  
...  
Keyword(s):  
Systematic Review ◽  
Contrast Media ◽  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Iodinated Contrast Media ◽  
Iodinated Contrast ◽  
Increased Risk ◽  
Neonatal Thyroid Function

Objective Thyroid dysfunction is a known side effect of iodinated contrast media. There is some evidence to suggest that iodinated contrast media administered to pregnant women may cause thyroid dysfunction not only in themselves but also in their offspring. Here, we systematically evaluated literature on the use of iodinated contrast media prior to or during pregnancy on the offspring’s thyroid function. Design Systematic review of published literature. Materials and methods Relevant studies were identified by PubMed, EMBASE and The Cochrane Library up to June 5, 2020. All study designs, reporting on the foetal or neonatal thyroid function after exposure to iodinated contrast media prior to or during pregnancy, were included. We undertook random effects meta-analysis and pooled the estimates as proportions with 95% CIs. Results We identified 402 articles, of which 26 were included. Six studies reported (n = 369) on exposure to iodinated contrast media prior to pregnancy by hysterosalpingography and 20 studies (n = 670) on exposure to these media during pregnancy by amniofetography, urography or CT. There was low to high risk of bias. The proportion of (transient) neonatal thyroid dysfunction was 0.0% (95% CI: 0.0–2.9% based on 3 studies) for hysterosalpingography, 2.25% (95% CI: 0.03–6.55% based on 2 studies) for amniofetography and 0.0% (95% CI: 0.0–0.02% based on 5 studies) for CT. There was a tendency towards an increased risk of thyroid dysfunction with higher amounts of contrast used. Conclusions Exposure to iodinated contrast media prior to or during pregnancy may increase the risk of thyroid dysfunction in offspring. We recommend keeping the amount of contrast used as low as possible.

scholarly journals Elevated Osteoprotegerin Concentration Predicts Increased Risk of Cardiovascular Mortality in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 45 (4) ◽  
pp. 565-575
Author(s):  
Qing-xiu Huang ◽  
Jian-bo Li ◽  
Naya Huang ◽  
Xiao-wen Huang ◽  
Yan-lin Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cardiovascular Mortality ◽  
Meta Analysis ◽  
Cardiovascular Death ◽  
Cochrane Library ◽  
Random Effects Models ◽  
Hazard Ratios ◽  
Increased Risk

Introduction: Studies have shown inconsistent results regarding the association between osteoprotegerin (OPG) concentration and cardiovascular mortality in patients with chronic kidney disease (CKD). This systematic review and meta-analysis aims to investigate the association between OPG concentration and cardiovascular mortality in patients with CKD. Methods: Between January 1970 and February 2020, the PubMed, EMBASE, and Cochrane Library databases were searched for eligible studies investigating the association between OPG concentration and cardiovascular mortality in patients with CKD. Pooled hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were calculated using random effects models. Results: In total, 10 studies comprising 2,120 patients (including 1,723 receiving dialysis) with CKD were included. The included studies were considered to be of fair to high quality. Patients in the highest OPG concentration group had a significantly higher risk of cardiovascular mortality (4 studies; adjusted HR, 2.05; 95% CI, 1.39–3.00) than patients in the low OPG concentration group. An increase of 1 pmol/L in OPG concentration was associated with a 4% increased risk of cardiovascular mortality (6 studies; adjusted HR, 1.04; 95% CI, 1.02–1.07). Conclusion: Elevated OPG concentrations are associated with an increased risk of cardiovascular death in patients with CKD.

scholarly journals Subclinical thyroid dysfunction and incident atrial fibrillation - a systematic review and meta-analysis

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
H Singh ◽  
MZ Shahid ◽  
SL Harrison ◽  
DA Lane ◽  
GYH Lip ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Subgroup Analysis ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Subclinical Hyperthyroidism ◽  
Quality Of Evidence

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This project was supported by the MRes programme in the Institute of Life Course and Medical Sciences at The University of Liverpool. Thyroid hormones can act directly and indirectly on the cardiovascular system and studies have demonstrated associations between overt and subclinical thyroid dysfunction and adverse cardiovascular outcomes including heart failure, myocardial infarction, and coronary heart disease. The aim of this study was to assess the association between subclinical thyroid dysfunction and atrial fibrillation (AF).  The protocol was registered on PROSPERO (CRD42020221565). MEDLINE and Scopus were searched from inception to 13th November 2020 for studies investigating subclinical thyroid dysfunction and incident AF. Risk of bias was assessed using the Risk of Bias Assessment Tool (RoBANS). The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) tool. Subgroup analysis was performed for post-operative and non-post-operative AF. 5413 records were identified. Nine cohort studies were suitable for inclusion in the systematic review, of which seven studies were included in the meta-analysis. The meta-analysis comprised 595,058 patients. Subclinical hyperthyroidism was associated with a 99% increase in the risk of incident AF (Risk ratio (RR): 1.99; 95% confidence intervals (CI); 1.43 to 2.77; p &lt; 0.0001; I² = 67%). Subclinical hypothyroidism was also associated with a greater risk of AF (RR: 1.24; 95% CI; 1.05 to 1.47; p = 0.01; I² = 65%). Subgroup analysis demonstrated a 76% increase in the risk of post-operative AF in patients with subclinical hypothyroidism compared to euthyroid post-operative patients (RR: 1.76; 95% CI; 1.36 to 2.28; p &lt; 0.0001; I² = 0%). Six studies were rated as low risk of bias and three as medium risk of bias according to the RoBANS tool. The quality of evidence for AF in subclinical hyper- and hypothyroid patients was low. Subclinical hyperthyroidism and subclinical hypothyroidism were associated with a higher risk of incident AF and post-operative AF, respectively. The quality of the current evidence is low and ideally a randomised controlled trial should be conducted to confirm these associations and assess impacts of treatments. Abstract Figure.

scholarly journals Systematic Review, Meta-analysis, and Network Meta-analysis of the Cardiovascular Safety of Macrolides

2018 ◽  
Vol 62 (6) ◽  
Author(s):  
Einat Gorelik ◽  
Reem Masarwa ◽  
Amichai Perlman ◽  
Victoria Rotshild ◽  
Mordechai Muszkat ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiovascular Mortality ◽  
Meta Analysis ◽  
Significant Risk ◽  
Cardiovascular Death ◽  
Cochrane Library ◽  
Macrolide Antibiotics ◽  
Cardiovascular Safety ◽  
Primary Analysis ◽  
Increased Risk

ABSTRACT Studies reporting an increased risk for cardiac toxicities with macrolide antibiotics have raised concern regarding their cardiovascular safety. We sought to assess the cardiac safety of macrolide antibiotics as a class and of the individual agents by conducting a systematic review and network meta-analysis. Medline, Embase, and the Cochrane Library were searched up to February 2018 for studies reporting on cardiovascular outcomes with macrolides. We followed the PRISMA 2009 guidelines for data selection and extraction. Outcomes were pooled using random-effects models and odds ratios (OR), and 95% confidence intervals (CI) were calculated for arrhythmia, cardiovascular death, and myocardial infarction (MI). A total of 33 studies and data on 22,601,032 subjects were retrieved and included in the current meta-analyses. Macrolide use was not associated with the risk of arrhythmia or cardiovascular mortality. In the primary analysis, macrolide use was associated with a small but statistically significant 15% increase in risk for MI (OR = 1.15 [95% CI, 1.01 to 1.30]). In indirect network meta-analysis, erythromycin and clarithromycin were ranked considerably more likely to be associated with a higher risk for MI and significantly associated with increased risk of MI compared to azithromycin (OR = 1.58 [95% CI, 1.18 to 2.11] and OR = 1.41 [95% CI, 1.11 to 1.81], respectively). Our findings indicate that macrolide antibiotics as a group are associated with a significant risk for MI but not for arrhythmia and cardiovascular mortality. Among the macrolides, erythromycin and clarithromycin were associated with a greater risk of MI. However, it is possible that the association between macrolide use and risk of MI is the result of residual confounding.

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