Thyroid function in COVID-19 and the association to cytokine levels and mortality

The hypothalamic-pituitary-thyroid hormone axis might be affected in COVID-19, but existing studies have shown varying results. It has been hypothesized that hyperinflammation, as reflected by secretion of cytokines, might induce thyroid dysfunction among patients with COVID-19. We explored thyroid hormone involvement in the acute phase of symptomatic COVID-19, and its possible associations with cytokine levels and mortality risk. This was a single-center study of 116 consecutive patients hospitalized for moderate‐to‐severe COVID-19 disease. Serum concentrations of thyroid‐stimulating hormone (TSH), free thyroxine (T4) and 45 cytokines/chemokines were measured in all patients within 3 days of admission. Data were extracted retrospectively through manual review of health records. At admission, 95 (81.9%) were euthyroid, while 21 (18.1%) had a biochemical thyroid dysfunction. This included subclinical thyrotoxicosis (n=11), overt thyrotoxicosis (n=2), hypothyroidism (n=1), non-thyroidal illness (n=2), and normal TSH but high free T4 (n=5). TSH levels were inversely correlated with IL-8 (r = -0.248), IL-10 (r = -0.253), IL-15 (r = -0.213), IP-10 (r = -0.334) and GM-CSF (r = -0.254). Moreover, IL-8 levels, IP-10, and GM-CSF were significantly higher in patients with serum TSH <0.4 mIU/L. Lastly, a twofold increment of IL-8 and IL-10 was associated with significantly higher odds of having TSH <0.4 mIU/L (odds ratio 1.86 [1.11–3.10] and 1.78 [1.03–3.06]). Serum TSH was not associated with 30- or 90-day mortality. In conclusion, this study suggests that fluctuations of TSH levels in patients with COVID-19 may be influenced by circulating IL-8, IL-10, IL-15, IP-10, and GM-CSF, as previously described in autoimmune thyroid diseases.

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Familial dysalbuminemic hyperthyroxinemia confounding management of coexistent autoimmune thyroid disease

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-19-0161 ◽

2020 ◽

Vol 2020 ◽

Author(s):

Serena Khoo ◽

Greta Lyons ◽

Andrew Solomon ◽

Susan Oddy ◽

David Halsall ◽

...

Keyword(s):

Thyroid Hormone ◽

Thyroid Disease ◽

Autoimmune Thyroid Disease ◽

Graves Disease ◽

Thyroid Function Tests ◽

Thyroid Status ◽

Free T4 ◽

Autoimmune Thyroid ◽

Analytical Interference ◽

Tsh Levels

Summary Familial dysalbuminemic hyperthyroxinemia (FDH) is a cause of discordant thyroid function tests (TFTs), due to interference in free T4 assays, caused by the mutant albumin. The coexistence of thyroid disease and FDH can further complicate diagnosis and potentially result in inappropriate management. We describe a case of both Hashimoto’s thyroiditis and Graves’ disease occurring on a background of FDH. A 42-year-old lady with longstanding autoimmune hypothyroidism was treated with thyroxine but in varying dosage, because TFTs, showing high Free T4 (FT4) and normal TSH levels, were discordant. Discontinuation of thyroxine led to marked TSH rise but with normal FT4 levels. She then developed Graves’ disease and thyroid ophthalmopathy, with markedly elevated FT4 (62.7 pmol/L), suppressed TSH (<0.03 mU/L) and positive anti-TSH receptor antibody levels. However, propylthiouracil treatment even in low dosage (100 mg daily) resulted in profound hypothyroidism (TSH: 138 mU/L; FT4: 4.8 pmol/L), prompting its discontinuation and recommencement of thyroxine. The presence of discordant thyroid hormone measurements from two different methods suggested analytical interference. Elevated circulating total T4 (TT4), (227 nmol/L; NR: 69–141) but normal thyroxine binding globulin (TBG) (19.2 µg/mL; NR: 14.0–31.0) levels, together with increased binding of patient’s serum to radiolabelled T4, suggested FDH, and ALB sequencing confirmed a causal albumin variant (R218H). This case highlights difficulty ascertaining true thyroid status in patients with autoimmune thyroid disease and coexisting FDH. Early recognition of FDH as a cause for discordant TFTs may improve patient management. Learning points: The typical biochemical features of familial dysalbuminemic hyperthyroxinemia (FDH) are (genuinely) raised total and (spuriously) raised free T4 concentrations due to enhanced binding of the mutant albumin to thyroid hormones, with normal TBG and TSH concentrations. Given the high prevalence of autoimmune thyroid disease, it is not surprising that assay interference from coexisting FDH may lead to discordant thyroid function tests confounding diagnosis and resulting in inappropriate therapy. Discrepant thyroid hormone measurements using two different immunoassay methods should alert to the possibility of laboratory analytical interference. The diagnosis of FDH is suspected if there is a similar abnormal familial pattern of TFTs and increased binding of radiolabelled 125I-T4 to the patient’s serum, and can be confirmed by ALB gene sequencing. When autoimmune thyroid disease coexists with FDH, TSH levels are the most reliable biochemical marker of thyroid status. Measurement of FT4 using equilibrium dialysis or ultrafiltration are more reliable but less readily available.

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Age and Menopausal Status Affect Osteoprotegerin and Osteocalcin Levels in Women Differently, Irrespective of Thyroid Function

Clinical Medicine Insights Endocrinology and Diabetes ◽

10.4137/cmed.s15466 ◽

2014 ◽

Vol 7 ◽

pp. CMED.S15466 ◽

Cited By ~ 7

Author(s):

Alexander D. Shinkov ◽

Anna-Maria I. Borissova ◽

Roussanka D. Kovatcheva ◽

lliana B. Atanassova ◽

Jordan D. Vlahov ◽

...

Keyword(s):

Body Mass Index ◽

Thyroid Function ◽

Vascular Function ◽

Thyroid Dysfunction ◽

Bone Cells ◽

Menopausal Status ◽

Thyroid Stimulating Hormone ◽

Multiple Factors ◽

Serum Tsh ◽

Tsh Levels

Osteoprotegerin (OPG) and osteocalcin (OC) are essential bone proteins. Recent studies have demonstrated that they are not secreted solely by bone cells; they play roles in the vascular function and energy metabolism, and they are influenced by multiple factors. The aim of the current study was to investigate the influence of menopause and age on OPG and OC in women with different thyroid-stimulating hormone (TSH) levels. Material and Methods We studied 49 women with elevated TSH, 26 with suppressed TSH, and 67 age-matched euthyroid controls. Of them 64 were menstruating and 78 postmenopausal. Body weight, height, waist circumference (WC), body mass index (BMI), serum TSH, free thyroxin (FT4), OPG, and OC were measured. Results Generally, both OPG and OC were higher in the postmenopausal women than in the menstruating subjects (OPG 3.85 ± 1.49 pmol/L vs. 5.84 ± 2.42 pmol/L, P < 0.001; OC 8.84 ± 3.70 ng/dL vs. 12.87 ± 6.45 ng/dL, P < 0.001), and within the two thyroid dysfunction subgroups and the controls (all P < 0.05). OPG correlated with age (postmenopausal rho = 0.57, P < 0.001; premenopausal rho = 0.31, P = 0.015). Among the premenopausal subjects, OPG was higher in those with low TSH than in the controls ( P = 0.048). OC correlated negatively with BMI and WC in the postmenopausal group (Spearman rho = –-0.25, P = 0.03 and rho = –-0.42, P < 0.001 respectively). OC was higher in the postmenopausal subjects with low TSH than in those with elevated TSH ( P = 0.024), and correlated positively with FT4 (rho = 0.40, P = 0.002) and negatively with TSH (rho = -0.29, P = 0.013). CONCLUSIONS In women, OPG and OC depended differently on age and menopause and, to a lesser extent, on the thyroid function and body composition.

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Evaluation of thyroid function and autoimmunity in HIV-infected women

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/s0004-27302013000600007 ◽

2013 ◽

Vol 57 (6) ◽

pp. 450-456 ◽

Cited By ~ 13

Author(s):

Leiliane Gonçalves de Carvalho ◽

Patrícia de Fátima dos Santos Teixeira ◽

Ana Luiza Brandão Galotti Panico ◽

Marcela Vaisberg Cohen ◽

Maria Fernanda Miguens Castelar Pinheiro ◽

...

Keyword(s):

Thyroid Dysfunction ◽

University Hospital ◽

Autoimmune Thyroid Diseases ◽

Autoimmune Thyroid ◽

Viral Loads ◽

Highly Active ◽

Cell Counts ◽

Immunodeficiency Virus ◽

Thyroperoxidase Antibodies ◽

Serum Tsh

Autoimmune thyroid diseases (AITD) are the main causes of thyroid dysfunction and the most common autoimmune diseases in the world. An association between AITD and infections with the human immunodeficiency virus (HIV), in combination with the effects of highly active anti-retroviral therapy (HAART), has been suggested by several research groups. The aim of the present study was to evaluate the frequency of thyroid dysfunction and AITD in women > 35 years of age infected with HIV, and to identify factors associated with the emergence of these thyroid abnormalities. HIV-infected women (n = 153) selected from the infectious disease outpatient clinic at a University Hospital in Rio de Janeiro were characterized based on their circulating CD4+ lymphocytes levels, viral loads, serum TSH levels, and the presence of FT4 and anti-thyroperoxidase antibodies (TPO-Ab). A total of 129 participants were on HAART and 24 were not. The frequency of thyroid disorders was 7.8% (12/153 patients) and all were on HAART at the time of diagnosis, yielding a prevalence of 9.3% in patients receiving HAART compared with 0% in patients not on HAART. AITD, hyper, and hypothyroidism were detected in 4.6%, 3.1%, and 4.1% of HAART patients. It was not detected any thyroid dysfunction or autoimmunity in HIV-infected women not on HAART. This study demonstrated an association between HAART and the development of AITD. In addition AITD only developed in HAART patients also presenting with undetectable viral loads and slightly elevated CD4+ T cell counts.

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Coexistence of Autoimmune Hyper- and Hypothyroidism in a Kindred with Reduced Sensitivity to Thyroid Hormone

European Thyroid Journal ◽

10.1159/000506424 ◽

2020 ◽

Vol 9 (5) ◽

pp. 263-268

Author(s):

Yasmine Abdellaoui ◽

Dimitra Magkou ◽

Sofia Bakopoulou ◽

Ramona Zaharia ◽

Marie-Laure Raffin-Sanson ◽

...

Keyword(s):

Thyroid Hormone ◽

Thyroid Hormone Receptor ◽

Thyroid Stimulating Hormone ◽

Graves Disease ◽

Free Triiodothyronine ◽

Autoimmune Thyroid Diseases ◽

Autoimmune Thyroid ◽

Autoimmune Hypothyroidism ◽

First Time ◽

Receptor Antibodies

Introduction: Resistance to thyroid hormone beta (RTHβ) is a rare disease with an autosomal dominant transmission. Diagnosis may be challenging especially in patients with hyper- or hypothyroidism. Case Presentation: A 31-year-old male patient with suppressed thyroid-stimulating hormone (TSH), elevated free thyroxine and free triiodothyronine, along with high thyroid receptor antibodies was diagnosed with Graves’ disease. Benzylthiouracil was started. One month later, reduced sensitivity to thyroid hormones was suspected because of persistently high thyroid hormone levels contrasting with high TSH level. Molecular analysis highlighted a 10c.1357C>T p.P453S mutation in the thyroid hormone receptor beta gene (THRB). RTHβ was diagnosed. Several relatives also had RTHβ (the mother, the young son, and 2 out of 3 siblings). Autoimmune hypothyroidism was present in the mother, whereas 2 out of 3 siblings had asymptomatic autoimmunity. Discussion/Conclusion: Both Graves’ disease and autoimmune hypothyroidism were described in patients with RTHβ. We show here for the first time that autoimmune hypo- and hyperthyroidism may coexist in kindred with RTHβ. Seven previously published cases of Graves’ disease and RTHβ were retrieved and analyzed. Treatments and thyroid hormone level targets are discussed as well as the possible link between RTHβ and autoimmune thyroid diseases.

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Thyroid Hormone Profile and Its Prognostic Impact on the Coronavirus Disease 2019 in Korean Patients

Endocrinology and Metabolism ◽

10.3803/enm.2021.1109 ◽

2021 ◽

Vol 36 (4) ◽

pp. 769-777

Author(s):

Jiyeon Ahn ◽

Min Kyung Lee ◽

Jae Hyuk Lee ◽

Seo Young Sohn

Keyword(s):

Thyroid Hormone ◽

Disease Severity ◽

Thyroid Dysfunction ◽

Severe Disease ◽

Prognostic Significance ◽

Thyroid Stimulating Hormone ◽

Prognostic Impact ◽

Hormone Profile ◽

Serum Tsh ◽

Subclinical Thyrotoxicosis

Background: Data on the association between coronavirus disease 2019 (COVID-19) and thyroid have been reported, including overt thyrotoxicosis and suppression of thyroid function. We aimed to evaluate the thyroid hormone profile and its association with the prognosis of COVID-19 in Korean patients.Methods: The clinical data of 119 patients with COVID-19, admitted in the Myongji Hospital, Goyang, South Korea, were retrospectively evaluated. The thyroid hormone profiles were analyzed and compared based on disease severity (non-severe disease vs. severe to critical disease). Clinical outcomes were analyzed according to the tertiles of thyroid hormones.Results: Of the 119 patients, 76 (63.9%) were euthyroid, and none presented with overt thyroid dysfunction. Non-thyroidal illness syndrome was the most common manifestation (18.5%), followed by subclinical thyrotoxicosis (14.3%) among patients with thyroid dysfunction. Thyroid stimulating hormone (TSH) and triiodothyronine (T3) levels were significantly lower in patients with severe to critical disease than in those with non-severe disease (P<0.05). Patients in the lowest T3 tertile (<0.77 ng/mL) had higher rates of mechanical ventilation, intensive care unit admission, and death than those in the middle and highest (>1.00 ng/mL) T3 tertiles (P<0.05). COVID-19 patients in the lowest T3 tertile were independently associated with mortality (hazard ratio, 5.27; 95% confidence interval, 1.09 to 25.32; P=0.038) compared with those in the highest T3 tertile.Conclusion: Thyroid dysfunction is common in COVID-19 patients. Changes in serum TSH and T3 levels may be important markers of disease severity in COVID-19. Decreased T3 levels may have a prognostic significance in COVID-19 related outcome.

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MANAGEMENT OF ENDOCRINE DISEASE Subclinical hypothyroidism in children

Acta Endocrinologica ◽

10.1530/eje-20-0051 ◽

2020 ◽

Vol 183 (2) ◽

pp. R13-R28

Author(s):

Mariacarolina Salerno ◽

Nicola Improda ◽

Donatella Capalbo

Keyword(s):

Subclinical Hypothyroidism ◽

Thyroid Dysfunction ◽

Current Data ◽

Free T4 ◽

Endocrine Disease ◽

Cognitive Domains ◽

Risk Of Progression ◽

Intellectual Outcome ◽

Serum Tsh ◽

Tsh Levels

Subclinical hypothyroidism (SH) is biochemically defined as serum TSH levels above the upper limit of the reference range in the presence of normal free T4 (FT4) concentrations. While there is a general agreement to treat subjects with serum TSH levels above 10 mU/L, the management of mild form (TSH concentrations between 4.5 and 10 mU/L) is still a matter of debate. In children, mild SH is often a benign and remitting condition and the risk of progression to overt thyroid dysfunction depends on the underlying condition, being higher in the autoimmune forms. The major concern is to establish whether SH in children should always be considered an expression of mild thyroid dysfunction and may deserve treatment. Current data indicate that children with mild SH have normal linear growth, bone health and intellectual outcome. However, slight metabolic abnormalities and subtle deficits in specific cognitive domains have been reported in children with modest elevation of TSH concentration. Although these findings are not sufficient to recommend levothyroxine treatment for all children with mild SH, they indicate the need for regular monitoring to ensure early identification of children who may benefit from treatment. In the meanwhile, the decision to initiate therapy in children with mild SH should be based on individual factors.

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Comparison of Autoimmune Thyroid Disease in Patients With Progressive and Stable Vitiligo

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475415604551 ◽

2015 ◽

Vol 20 (2) ◽

pp. 135-138 ◽

Cited By ~ 3

Author(s):

Mohammad Javad Yazdanpanah ◽

Seyed Ali Seyedi Noghabi ◽

Morteza Taghavi ◽

Monavar Afzal Aghaee ◽

Naghmeh Zabolinejad

Keyword(s):

Physical Examination ◽

Selection Criteria ◽

Autoimmune Thyroid Disease ◽

Thyroid Dysfunction ◽

Thyroid Stimulating Hormone ◽

Thyroid Peroxidase ◽

Autoimmune Thyroid ◽

Patient Selection Criteria ◽

Antibody Levels ◽

Tsh Levels

Background and Objective: Activity of vitiligo has not been considered as a patient selection criteria in previous studies; we decided to compare the presence of elevated thyroid auto-antibodies in patients with progressive and stable vitiligo. Methods: Seventy-two patients with vitiligo were examined for thyroid problems and were divided into 2 groups of stable and progressive vitiligo according to their history and physical examination. Anti-thyroid peroxidase antibodies (anti-TPO antibodies), thyroxine (T4), and thyroid stimulating hormone (TSH) levels were assessed for all patients. Results: Elevated levels of anti-TPO antibodies were observed in 43.7% of the patients with stable vitiligo and in 37.5% of patients with progressive vitiligo, which was not statistically significant ( P = .315). Conclusion: This study not only confirmed thyroid dysfunction in patients with vitiligo but also showed that there was no difference in thyroid dysfunction and anti-TPO antibody levels in the subgroups of patients with stable or progressive vitiligo.

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Study of thyroid dysfunction in patients with type 1 diabetes mellitus

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20173677 ◽

2017 ◽

Vol 4 (5) ◽

pp. 1241

Author(s):

Rajesh V. Gosavi ◽

Bhushan R. Mishal

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Thyroid Dysfunction ◽

Thyroid Peroxidase ◽

Free T4 ◽

Autoimmune Thyroid ◽

Free T3 ◽

Serum Tsh

Background: The association of autoimmune thyroid disease with type 1 diabetes mellitus has been well documented across populations, with it being most prevalent immunological disease in patients with type 1 diabetes. The aim of this study was to ascertain the association between type 1 diabetes and thyroid dysfunction clinically, biochemically and immunologically.Methods: Serum TSH, free T3 and free T4 values were compared between cases of type 1 diabetes mellitus and non-diabetic age and sex matched controls. Cases of type 1 diabetes mellitus were further divided in two groups, depending upon the presence or absence of antibodies against thyroid peroxidase (Anti-TPO antibodies). Mean serum TSH, free T3, free T4 levels were compared between these two groups to find or refute any association.Results: Abnormal thyroid function was reported in total 6 (14.63%) cases. Comparison of TSH, T3 and T4 levels showed statistically insignificant differences (p<0.05) in TSH levels (µIU/ml) (Cases- 3.44±2.41, controls- 3.34±0.78); T3 levels (pg/ml) (cases- 3.31±1.06, controls- 3.36±0.52) and T4 levels (ng/dl) (cases- 0.92±0.31, controls- 0.95±0.23). Total of 6 cases (14.63%) cases of type 1 diabetes mellitus were positive for anti-TPO antibodies (4- females, 2- males).Conclusions: Thyroid dysfunction is more common amongst type 1 diabetics, especially females. Estimation of anti-TPO antibodies is valuable in detecting thyroid dysfunction in type 1 diabetics.

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THYROID FUNCTION AND MENTAL HEALTH IN CHILDBEARING AGE WOMEN

Media Gizi Mikro Indonesia ◽

10.22435/mgmi.v13i1.5670 ◽

2021 ◽

Vol 13 (1) ◽

pp. 75-84

Author(s):

Suryati Kumorowulan ◽

Yusi Dwi Nurcahyani ◽

Leny Latifah ◽

Diah Yunitawati

Keyword(s):

Mental Health ◽

Thyroid Hormone ◽

Thyroid Function ◽

Thyroid Dysfunction ◽

Thyroid Stimulating Hormone ◽

Childbearing Age ◽

Free T4 ◽

Hormone Levels ◽

Childbearing Age Women ◽

Thyroid Hormone Levels

Background. Thyroid dysfunction is frequently associated with psychiatric problems, such as anxiety or depression. On the other hand, thyroid dysfunction patients have little reason to be concerned about their mental health. Childbearing age women are included in the priority category because they require excellent health conditions to prepare for pregnancy and parenthood. Objective. This study aimed to investigate relationship between thyroid function (as evaluated by thyroid hormone levels and thyroid stimulating hormone (TSH) levels) with mental health in childbearing age women. Method. This study is a cross sectional study, with childbearing age women (aged 15 years and up) who are already menstruating but have not yet reached menopause. The research was conducted in Yogyakarta City and Bukittinggi City with a total sample of 487 people. This study’s independent variables were TSH and free T4 levels. The dependent variables were anxiety and depression. Other things to consider are height, body weight, and age. Blood samples had used to measure TSH and free T4 levels. All respondents were interviewed to assess whether they were depressed or anxious using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Results. There is a significant difference in score of BAI (21.1±11,67 vs 19.7±11.18, p<0.000) and BDI (10.1±8.06 vs 9.50±7.36, p<0.000) between groups. Other results found that disfunction thyroid hormone levels (TSH <0.3 mIU/mL) was related to depression (OR 2.324 95% CI 1.072–5.041, p<0.05; AOR 2.718 95% CI 1.028–7.186, p<0.05), but not associated with anxiety. Conclusion. Thyroid dysfunction, particularly low thyroid stimulating hormone levels, has been linked to higher risk of depression in childbearing age women.

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Homeopathic Treatment of Subclinical Hypothyroidism—A Series of 19 Cases

Homeopathy ◽

10.1055/s-0041-1734028 ◽

2021 ◽

Author(s):

Luiz Carlos Esteves Grelle ◽

Luiz Antonio Bastos Camacho

Keyword(s):

Subclinical Hypothyroidism ◽

Clinical Importance ◽

Clinical Problem ◽

Thyroid Stimulating Hormone ◽

Exclusion Criteria ◽

The Mean ◽

Common Clinical Problem ◽

Prompt Diagnosis ◽

Serum Tsh ◽

Tsh Levels

Abstract Background Subclinical hypothyroidism (SCH) is a common clinical problem. Controversy surrounds the definition, clinical importance, and need for prompt diagnosis and treatment of the mild form of SCH. Aim The aim of the study was to analyze the evolution of serum thyroid stimulating hormone (TSH) levels after a therapeutic homeopathic intervention in women older than 40 years with SCH. Methods This study is a retrospective series of 19 cases of SCH, with serum TSH levels between 5 and 10 mIU/L, treated exclusively with homeopathic medicines prescribed on an individualized basis. Results Nineteen patients were included according to the inclusion and exclusion criteria. Their mean age was 56 years, they were followed for a mean duration of 69 months, the mean number of serum TSH level measurements was 18, and the intervention was successful for 13 patients. Conclusion The homeopathic therapeutic intervention was successful in 68% of the patients, with serum TSH levels back within the normal range (0.5–5.0 mIU/L).

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