Subclinical Hypothyroidism In Childhood, Treatment Or Only Follow-Up?

Abstract Background: Subclinical hypothyroidism is defined as serum levels of thyroid-stimulating hormone (TSH) above the upper limit with normal concentrations of free T4 (fT4). Its management remains challenging. The aim of the study was to evaluate clinical and laboratory findings as well as clinical course of children with SH followed in a third level hospital. 65 patients aged between 2 and 18 years were retrospectively studied. Methods: The patients were followed for a median period of 9 months (range 6 months to 24 months). Those who normalized TSH levels were discharged (Group 1). If TSH persisted mild elevated (5-10µUI/mL) with normal fT4 and negative TPOAb/TgAb were classified as Group 2 and followed semiannually without treatment. In those patients who’s TSH raised ≥10µUI/mL or maintained TSH 5-10µUI/mL and positive TPOAb/TgAb were considered suitable for thyroxin therapy (Group 3, G3). Results: By ROC curves analysis we tested which initial TSH concentration best discriminated between patients who reverted to normality (Group 1) from those who finally required treatment (Group 3), the best cut-off being a TSH concentration >8.1µUI/mL (93.18% E, 57.14% S, AUC 0.765±0.107, p= 0.01). In 89% of our patients, TSH concentrations spontaneously reverted to normality or remained stable without treatment, whereas less than 11% progressed to clinical hypothyroidism. Conclusion: patients with initial TSH concentrations above 8.1µUI/mL have an increased risk of progression to hypothyroidism.

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Effect of the Cut-Off Level for Thyroid-Stimulating Hormone on the Prevalence of Subclinical Hypothyroidism among Infertile Mexican Women

Diagnostics ◽

10.3390/diagnostics11030417 ◽

2021 ◽

Vol 11 (3) ◽

pp. 417

Author(s):

Lidia Arce-Sánchez ◽

Salvatore Giovanni Vitale ◽

Claudia Montserrat Flores-Robles ◽

Myrna Souraye Godines-Enriquez ◽

Marco Noventa ◽

...

Keyword(s):

Insulin Resistance ◽

Subclinical Hypothyroidism ◽

Thyroid Autoimmunity ◽

Cross Sectional Study ◽

Thyroid Stimulating Hormone ◽

Mexican Women ◽

Cross Sectional ◽

Group 3 ◽

Group 2 ◽

Group 1

The primary aim of this study was to compare the prevalence of subclinical hypothyroidism (SCH) using two different cut-off levels for TSH values (≥2.5 mIU/L versus ≥4.1 mIU/L). The secondary objective was to analyze the clinical-biochemical characteristics in women with and without SCH. This was a retrospective cross-sectional study. In total, 1496 Mexican women with infertility were included: Group 1, women with TSH levels ranging between 0.3 and 2.49 mIU/L, n = 886; Group 2, women with TSH between 2.5 and 4.09 mIU/L, n = 390; and Group 3, women with TSH ≥4.1 mIU/L n = 220. SCH prevalence was 40.7% (CI 95%: 38.3–43.3%) with TSH cut-off ≥ 2.5 mIU/L, and 14.7% (CI 95%: 12.7–16.5%) with TSH cut-off ≥ 4.1 mIU/L, (p = 0.0001). The prevalence of overweight was higher in Group 2 than in Groups 1 and 3. Thyroid autoimmunity, obesity and insulin resistance were higher in Group 3 than in Group 1 (p < 0.05). No other differences were observed between groups. Conclusions: The prevalence of SCH in our selected patients increased almost three times using a TSH cut-off ≥ 2.5 mIU/L compared with a TSH cut-off ≥ 4.1 mIU/L. Women with TSH ≥4.1 mIU/L compared with TSH cut-off ≤ 2.5 mIU/L more often presented with obesity, thyroid autoimmunity and insulin resistance.

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Subclinical Hypothyroidism – Whether and When To Start Treatment?

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2017.195 ◽

2017 ◽

Vol 5 (7) ◽

pp. 1042-1046 ◽

Cited By ~ 7

Author(s):

Milena Cojić ◽

Ljiljana Cvejanov-Kezunović

Keyword(s):

Subclinical Hypothyroidism ◽

Normal Values ◽

Neuromuscular Disorders ◽

Thyroid Stimulating Hormone ◽

Thyroid Antibodies ◽

Substitution Therapy ◽

Ovarian Dysfunction ◽

Laboratory Findings ◽

Increased Risk ◽

Initiation Of Therapy

Subclinical hypothyroidism represents a state with increased values of thyroid stimulating hormone (TSH) and normal values of thyroxine (T4) and triiodothyronine (T3). The disorder is asymptomatic, and the diagnosis is made based on the results of laboratory findings when the level of TSH reaches values above 4.0 mU/l. It is still subject to debate whether patients with subclinical hypothyroidism are at increased risk of cardiovascular disease, neuropsychiatric and neuromuscular disorders. Studies have shown that the appearance of general symptoms and complications are more common in patients whose values of TSH are above 10 mU/l. Therefore, the initiation of therapy with levothyroxine, which is the foundation of substitution therapy, is advised in patients whose TSH is >10 mU/l. As for patients whose values of TSH are from 4.0 to 10.0 mU/l and who make up 90% of the patients with subclinical hypothyroidism, further research is needed to determine the effects of the disorder and levothyroxine therapy on the health. Until then, the introduction of the substitution therapy in patients with TSH which is <10 mU/l should be considered in the case of the presence of general symptoms, anti-thyroid antibodies, increased lipids and other risk factors, goitre, pregnancy, ovarian dysfunction and infertility.

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Subclinical Hypothyroidism in Children: A Review

Dhaka Shishu (Children) Hospital Journal ◽

10.3329/dshj.v36i2.54396 ◽

2021 ◽

Vol 36 (2) ◽

pp. 146-151

Author(s):

Rabi Biswas

Keyword(s):

Subclinical Hypothyroidism ◽

Reference Range ◽

Serum Levels ◽

Free T4 ◽

Factors Associated ◽

Scientific Investigations ◽

Adverse Health Outcomes ◽

Increased Risk ◽

Levothyroxine Treatment ◽

Mild Hypothyroidism

Subclinical hypothyroidism is defined as serum levels of TSH above the upper limit of the reference range in the presence of normal concentrations of total T4 or free T4. This biochemical profile might be an indication of mild hypothyroidism, with a potential increased risk of metabolic abnormalities and cardiovascular disease among adults. Whether subclinical hypothyroidism results in adverse health outcomes among children is a matter of debate and so management of this condition remains challenging. Mild forms of untreated subclinical hypothyroidism do not seem to be associated with impairments in growth, bone health or neurocognitive outcome. However, ongoing scientific investigations have highlighted the presence of subtle proatherogenic abnormalities among children with modest elevations in their TSH levels. Although current findings are insufficient to recommend levothyroxine treatment for all children with mild asymptomatic forms of subclinical hypothyroidism, they highlight the potential need for assessment of cardiovascular risk among children with this condition. Increased understanding of the early metabolic risk factors associated with subclinical hypothyroidism in childhood will help to improve the management of affected individuals. DS (Child) H J 2020; 36(2): 146-151

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Relationship between NT-proBNP and Cardio-Renal Dysfunction in Patients with Advanced Liver Cirrhosis

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld-1279 ◽

2014 ◽

Vol 23 (1) ◽

pp. 51-56 ◽

Cited By ~ 2

Author(s):

Adriana Cavasi ◽

Eduard Cavasi ◽

Mircea Grigorescu ◽

Adela Sitar-Taut

Keyword(s):

Liver Cirrhosis ◽

Liver Disease ◽

Renal Dysfunction ◽

Cardiac Dysfunction ◽

Serum Levels ◽

Qtc Interval ◽

Advanced Liver Cirrhosis ◽

Group 3 ◽

Group 2 ◽

Group 1

Background & Aims: ProBNP is a sensitive marker of cardiac dysfunction. We assessed the concentration of circulating NT-proBNP in patients with liver cirrhosis in various stages of the disease and its correlation with markers of cardiac and renal dysfunction and with markers of liver disease severity.Patients and methods: A number of 88 patients with liver cirrhosis were included in the study, divided into 3 groups: group 1 - 18 control patients without ascites; group 2 - 35 non-azotemic patients with ascites; group 3 - 35 patients with hepatorenal syndrome. The cardiac dysfunction was assessed by measuring the NT-proBNP serum levels and the QTc interval. The markers of renal dysfunction were the estimated glomerular filtration rates - formulas involving creatinine and serum cystatin C. The Child-Pugh score was used to assess the liver disease severity.Results: The median NT-proBNP serum levels significantly increased in patients with advanced liver cirrhosis (group 3: 960 fmol/ml and group 2: 660 fmol/ml) as compared to group 1 (435 fmol/ml) (p<0.05). A significant direct correlation was found between the NT-proBNP concentration and the QTc interval (r=0.540, p<0.001). The NT-proBNP levels also correlated with the Child-Pugh score (r=0.501, p<0.01), proving the link between the cardiac dysfunction and the liver disease severity. The cardio-renal interrelation is supported by the relationship between the NT-proBNP concentration and the estimated clearances.Conclusion: The high NT-proBNP levels in patients with advanced cirrhosis indicate the presence of cardiac dysfunction, which has a role in the pathogenesis of the hepatorenal syndrome.Abbreviations: DP: diastolic pressure; GFR: glomerular filtration rate; HRS: hepatorenal syndrome; MAP:mean arterial pressure; NT-proBNP: N-terminal fragment of the prohormone B-type natriuretic peptide; proBNP: prohormone brain natriuretic peptide; SBP: spontaneous bacterial peritonitis; SP: systolic pressure; TIPS: tranjugular intrahepatic portosystemic shunt.

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A comparative study on outcomes of preprandial versus postprandial thyroid function test

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20194945 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1662

Author(s):

Vasim Ismail Patel ◽

Akshay B. K.

Keyword(s):

Thyroid Function ◽

Subclinical Hypothyroidism ◽

Clinical Symptoms ◽

Thyroid Function Test ◽

Thyroid Stimulating Hormone ◽

Endocrine Gland ◽

Thyroid Function Tests ◽

Sample Collection ◽

Free T4 ◽

Group 2

Background: The thyroid is an endocrine gland. It secretes two hormones thyroxine (T4), triiodothyronine (T3). Hypothyroidism is a common condition encountered by a clinician. Subclinical hypothyroidism (SCH) defined as normal free thyroxine (T4) and elevated thyroid stimulating hormone (TSH), is primarily a biochemical diagnosis with or without clinical symptoms. Studies have observed that TSH levels vary at different times in a day. In practice not much importance is given to the timing of the sample collection (pre-prandial or post-prandial sate). SCH is diagnosed depending on TSH value. So the condition may be under or over diagnosed based on a single value. So we conducted this study to determine whether timing of sample collection had any significant relationship in the determination of levels of thyroid hormones.Methods: The study was carried on 114 patients who visited ENT department, NMCH between July 2018 and June 2019. Group-1 consisted of 38 normal patients. Group-2 consisted of 36 hypothyroidism patients GROUP-3 consisted of 40 subclinical hypothyroidism patients. Thyroid function tests (TSH and free T4) were done in fasting state and 2 hours postprandially. Results: TSH values were found to be significantly lowered after food in all the three groups. Free T4 values did not show any statistically significant alteration after food.Conclusions: There was a significant decline in TSH values postprandially. This might lead to inappropriate diagnosis and management of patients as cases of hypothyroidism, especially in cases of sub clinical hypothyroidism.

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Thyroid Hormone Therapy and Incident Stroke

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab444 ◽

2021 ◽

Author(s):

Maria Papaleontiou ◽

Deborah A Levine ◽

David Reyes-Gastelum ◽

Sarah T Hawley ◽

Mousumi Banerjee ◽

...

Keyword(s):

Atrial Fibrillation ◽

Thyroid Hormone ◽

Hormone Treatment ◽

Population Based ◽

Thyroid Stimulating Hormone ◽

Prior History ◽

Veterans Health ◽

Health Administration ◽

Free T4 ◽

Increased Risk

Abstract Context Stroke is a leading cause of death and disability and there is a need to identify modifiable risk factors. Objective Determine the relationship between thyroid hormone treatment intensity and incidence of atrial fibrillation and stroke. Design Retrospective cohort study using data from the Veterans Health Administration between 2004 and 2017, with a median follow-up of 59 months. Setting Population-based. Participants 733,208 thyroid hormone users aged ≥18 years with at least two thyroid stimulating hormone (TSH) measurements between thyroid hormone initiation and incident event or study conclusion (406,030 thyroid hormone users with at least two free T4 measurements). Main Outcome Measures Incident atrial fibrillation and stroke. Results Overall, 71,333/643,687 (11.08%) participants developed incident atrial fibrillation and 41,931/663,809 (6.32%) stroke. In multivariable analyses controlling for pertinent factors such as age, sex and prior history of atrial fibrillation, low TSH or high free T4 levels (i.e., exogenous hyperthyroidism; e.g., TSH<0.1 mIU/L, OR 1.33, 95% CI 1.24-1.43) and high TSH or low free T4 levels (i.e., exogenous hypothyroidism; e.g., TSH>5.5 mIU/L, OR 1.29, 95% CI 1.26-1.33; free T4<0.7 ng/dL, OR 1.29, 95% CI 1.22-1.35) were associated with higher incidence of stroke compared to euthyroidism (TSH >0.5-5.5 mIU/L and free T4 0.7-1.9 ng/dL). Risk of developing atrial fibrillation and stroke was cumulative over time for both patients with exogenous hyperthyroidism and hypothyroidism. Conclusions Both exogenous hyper- and hypothyroidism were associated with increased risk of stroke, highlighting the importance of patient medication safety.

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Prevalence of Subclinical Hypothyroidism among Patients with Acute Myocardial Infarction

ISRN Endocrinology ◽

10.5402/2011/810251 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 7

Author(s):

Okuyan Ertugrul ◽

Uslu Ahmet ◽

Enhos Asim ◽

Hepgul E. Gulcin ◽

Ayca Burak ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Subclinical Hypothyroidism ◽

Large Scale ◽

Thyroid Stimulating Hormone ◽

Free T4 ◽

Upper Limit ◽

St Elevation ◽

Elevation Acute Myocardial Infarction ◽

Tsh Levels

Introduction. Subclinical hypothyroidism (SCH) is defined as a serum thyroid-stimulating hormone (TSH) level above the upper limit of normal despite normal levels of serum free thyroxine. There is growing evidence that SCH is associated with increased cardiovascular risk. We tried to investigate prevalence of SCH in acute myocardial infarction patients. Methods and Results. We evaluate free T3, free T4, and TSH levels of 604 patients (age 58.4) retrospectively, who have been admitted to the coronary intensive care unit between years 2004–2009 with the diagnosis of ST elevation (STEMI) or non-ST elevation acute myocardial infarction (NSTEMI). Mild subclinical hypothyroidism (TSH 4.5 to 9.9 mU/l) was present in 54 (8.94%) participants and severe subclinical hypothyroidism (TSH 10.0 to 19.9 mU/l) in 11 (1.82%). So 65 patients (10.76%) had TSH levels between 4.5 and 20. Conclusions. In conclusion, 65 patients (10.76%) had TSH levels between 4.5 and 20 in our study, and it is a considerable amount. Large-scale studies are needed to clarify the effects of SCH on myocardial infarction both on etiologic and prognostic grounds.

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Study of the Differential Consequences of Neglect and Poverty on Adaptive and Maladaptive Behavior in Children

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17030739 ◽

2020 ◽

Vol 17 (3) ◽

pp. 739

Author(s):

Carlos Herruzo ◽

Antonio Raya Trenas ◽

María J. Pino ◽

Javier Herruzo

Keyword(s):

Assessment System ◽

Maladaptive Behavior ◽

Adaptive Skills ◽

School Problems ◽

Increased Risk ◽

Externalizing And Internalizing Problems ◽

Group 3 ◽

Physical Neglect ◽

Group 2 ◽

Group 1

The consequences of physical neglect on retardation in the development of adaptive behaviors and the increased risk of poor physical and mental health are well documented. As physical neglect is a phenomenon found almost exclusively among socially deprived people, it is important to distinguish the health effects caused by neglect from those caused by poverty. The objective of this study was to compare the effects of poverty and physical neglect on the development of problematic externalizing and internalizing behaviors, adaptive skills, and school problems among school children between the ages of 3 and 12. A group of 157 children were chosen from 28 Andalusian schools and classified in three homogeneous groups. Children in group 1 (n = 53) had two target conditions: living in slums (poverty) and suffering from neglect. Children in group 2 (n = 52) had one target condition: living in the same slums as the children in group 1, but not suffering from neglect. Group 3 (n = 52) consisted of children from other (non-slum) neighborhoods who did not suffer from neglect. Adaptive and maladaptive behaviors were evaluated with the Behavior Assessment System for Children (BASC). Significant differences were found between group 1 and group 2, but there were no important differences between group 2 and group 3. The conclusion was that externalizing and internalizing problems, school problems, and low adaptive skills found in neglected children were associated with neglect rather than with poverty or socially deprived environments.

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Paraneoplastic hematological, biochemical, and hemostatic abnormalities in female dogs with mammary neoplasms

Pesquisa Veterinária Brasileira ◽

10.1590/s0100-736x2017000500009 ◽

2017 ◽

Vol 37 (5) ◽

pp. 479-484 ◽

Cited By ~ 1

Author(s):

Naila C.B. Duda ◽

Stella de F. Valle ◽

Juliana P. Matheus ◽

Natália C. Angeli ◽

Luciane C. Vieira ◽

...

Keyword(s):

Mammary Cancer ◽

Tumor Staging ◽

Tumor Type ◽

Thrombin Time ◽

Coagulation Test ◽

Laboratory Findings ◽

Blood Samples ◽

Group 3 ◽

Group 2 ◽

Group 1

ABSTRACT: Paraneoplastic laboratory abnormalities are identified in several types of cancers in dogs and cats. In veterinary medicine, particularly in mammary cancer, there are few studies that correlate abnormal laboratory findings with tumor type and staging. The aim of this study was to evaluate hematological, biochemical, and hemostatic abnormalities and correlate them with mammary tumor staging in female dogs with mammary cancer. Blood samples from 24 female dogs were evaluated, and the hematological, biochemical, and hemostatic parameters were correlated with tumor staging obtained by physical examination, imaging exams, and histopathological surgical biopsies. The groups were organized according to tumor staging: group 1 (stages I and II), group 2 (stage III), and group 3 (stages IV and V). Anemia, neutrophilic leukocytosis, monocytosis, eosinophilia, thrombocytosis, hypoalbuminemia, hypocalcemia, hypoglycemia, and low blood urea were observed. The variables MCHC, TPP, and RDW were correlated with tumor staging with no clinical relevance. Thrombin time and fibrinogen were significant between the groups in the coagulation test, being associated with tumor staging. The findings suggest influence of the proinflammatory cytokines released during tumor growth.

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Postpartum Morbidity Associated With Advanced HIV Disease

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/idog/2006/79512 ◽

2006 ◽

Vol 2006 ◽

pp. 1-5 ◽

Cited By ~ 5

Author(s):

Judette Louis ◽

Mudathiru A. Buhari ◽

Dianne Allen ◽

Bernard Gonik ◽

Theodore B. Jones

Keyword(s):

Cesarean Delivery ◽

Care Center ◽

Tertiary Care ◽

Wound Complication ◽

Hiv Disease ◽

Increased Risk ◽

Group 3 ◽

Group 2 ◽

Advanced Hiv Disease ◽

Group 1

Objective. To investigate the postpartum morbidity and postpartum management of febrile morbidity associated with advanced HIV infection. Methods. A case control study of HIV infected women at a tertiary care center during January 2000–June 2005 was performed. Postpartum morbidity was defined as endometritis, blood transfusion, wound complication, readmission, infectious morbidity, or unexpected surgery. Results. Women in Group 1 had AIDS (N=33), Group 2 were relatively immunocompetent HIV infected women (N=115), and Group 3 were uninfected women (N=152). Group 1 was more likely to have a postpartum morbidity (32.3 versus 19.3 and 13.2%,P=.03) and to have postpartum imaging 18.8 versus 7.9 and 2.6%,P=.002. After controlling for potential confounders, cesarean delivery (OR 6.2, 95%CI 2.1–505.5) but not advanced HIV disease was associated with an increased risk of postpartum morbidity. Conclusion. Cesarean delivery and not advanced HIV disease increases the risk of postpartum morbidity in women with AIDS.

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