scholarly journals Isfahan Thyroid Cohort Study (ITCS)

2021 ◽  
Vol 24 (11) ◽  
pp. 788-795
Author(s):  
Samaneh Shahrokh Esfahani ◽  
Aliye Tabatabaee ◽  
Ashraf Aminorroaya ◽  
Masoud Amini ◽  
Awat Feizi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Subclinical Hypothyroidism ◽  
Epidemiological Studies ◽  
Overt Hypothyroidism ◽  
Cluster Sampling ◽  
Thyroid Peroxidase ◽  
Second Phase ◽  
Thyroid Disorders ◽  
Subclinical Hyperthyroidism ◽  
Overt Hyperthyroidism

Background: The Isfahan Thyroid Cohort Study (ITCS) is one of the few population-based epidemiological studies in Iran that investigates the prevalence and incidence of thyroid disorders including hypothyroidism, hyperthyroidism, goiter, nodule, and iodine status. Methods: This cohort is located in Isfahan, Iran. The first phase was initiated in 2006 with 2523 participants (1275 males, 1248 females). The participants were selected using multi-stage cluster sampling from the general residents of Isfahan, Iran. The study had two phases (2006 and 2011) and its third stage is planned for 2020–2021. Results: The prevalence of thyroid function states was euthyroid (89.3%, 95% CI: 88%–90%), overt hypothyroidism (2.8%, 95% CI: 2%‒3%), subclinical hypothyroidism (5.8%, 95% CI: 4%–6%), overt hyperthyroidism (0.8%, 95% CI: 0.4%‒1%), and subclinical hyperthyroidism (0.99%, 95% CI: 0.6%–1%). Hypothyroidism and hyperthyroidism were significantly associated with goiter. The incidence of thyroid dysfunction was reported as follows: overt hypothyroidism (2.7, 95% CI: 1.6–3.7), subclinical hypothyroidism (20.6, 95% CI: 18–23), overt hyperthyroidism (1.9, 95% CI: 1–2.7) and subclinical hyperthyroidism (2.7, 95% CI: 1.6–3.7) per 1000 (person-year). Conclusion: We assessed the prevalence and incidence of thyroid disorders in Isfahan in the first and second phase, respectively. We are conducting the third phase of the ITCS in order to study the associations between thyroid peroxidase antibody (TPOAb) level and environmental factors such as infection.

scholarly journals Prevalence of thyroid disorders in pregnancy

2018 ◽  
Vol 7 (9) ◽  
pp. 3493
Author(s):  
Sangeeta Pahwa ◽  
Sabia Mangat
Keyword(s):  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
First Trimester ◽  
Antenatal Clinic ◽  
Fetal Outcome ◽  
Overt Hypothyroidism ◽  
Thyroid Disorders ◽  
Subclinical Hyperthyroidism ◽  
Thyroid Screening ◽  
In Pregnancy

Background: Thyroid disorders are among the common endocrine problems in pregnant women. Often overlooked in pregnancy due to nonspecific symptoms and hyper-metabolic state of pregnancy. Western literature shows prevalence of hypothyroidism in pregnancy as 2.5% and hypothyroidism as 0.1-0.4%. There is paucity of data on prevalence of thyroid disorders in India pregnant population. This study was carried out to know prevalence of thyroid disorders in pregnant women in Indian population.Methods: One hundred pregnant women attending antenatal clinic in first trimester were registered. Detailed history and examination was done. Apart from routine basic and obstetrical investigations, TSH, FT3 and FT4 level estimation was done.Results: Prevalence of thyroid dysfunction was high in this study in first trimester pregnant women, with subclinical hypothyroidism in 6%, overt hypothyroidism in 2%, subclinical hyperthyroidism 2 % and overt hyperthyroidism 0%.Conclusions: Prevalence of thyroid disorders, especially subclinical hypothyroidism (6%), overt hypothyroidism (2%) and subclinical hyperthyroidism (2%) was high. To prevent adverse effects on maternal and fetal outcome, we are emphasizing the importance of routine antenatal thyroid screening.

scholarly journals The Relation Between Thyroid Function and Anemia: A Pooled Analysis of Individual Participant Data

2018 ◽  
Vol 103 (10) ◽  
pp. 3658-3667 ◽  
Author(s):  
Daisy M Wopereis ◽  
Robert S Du Puy ◽  
Diana van Heemst ◽  
John P Walsh ◽  
Alexandra Bremner ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Sensitivity Analyses ◽  
Overt Hypothyroidism ◽  
Individual Participant Data ◽  
Subclinical Hyperthyroidism ◽  
Thyroid Status ◽  
Increased Risk ◽  
Individual Participant ◽  
Overt Hyperthyroidism

Abstract Context Anemia and thyroid dysfunction often co-occur, and both increase with age. Human data on relationships between thyroid disease and anemia are scarce. Objective To investigate the cross-sectional and longitudinal associations between clinical thyroid status and anemia. Design Individual participant data meta-analysis. Setting Sixteen cohorts participating in the Thyroid Studies Collaboration (n = 42,162). Main Outcome Measures Primary outcome measure was anemia (hemoglobin <130 g/L in men and <120 g/L in women). Results Cross-sectionally, participants with abnormal thyroid status had an increased risk of having anemia compared with euthyroid participants [overt hypothyroidism, pooled OR 1.84 (95% CI 1.35 to 2.50), subclinical hypothyroidism 1.21 (1.02 to 1.43), subclinical hyperthyroidism 1.27 (1.03 to 1.57), and overt hyperthyroidism 1.69 (1.00 to 2.87)]. Hemoglobin levels were lower in all groups compared with participants with euthyroidism. In the longitudinal analyses (n = 25,466 from 14 cohorts), the pooled hazard ratio for the risk of development of anemia was 1.38 (95% CI 0.86 to 2.20) for overt hypothyroidism, 1.18 (1.00 to 1.38) for subclinical hypothyroidism, 1.15 (0.94 to 1.42) for subclinical hyperthyroidism, and 1.47 (0.91 to 2.38) for overt hyperthyroidism. Sensitivity analyses excluding thyroid medication or high levels of C-reactive protein yielded similar results. No differences in mean annual change in hemoglobin levels were observed between the thyroid hormone status groups. Conclusion Higher odds of having anemia were observed in participants with both hypothyroid function and hyperthyroid function. In addition, reduced thyroid function at baseline showed a trend of increased risk of developing anemia during follow-up. It remains to be assessed in a randomized controlled trial whether treatment is effective in reducing anemia.

scholarly journals Assessment of Thyroid Disorder in FarWestern Part of Nepal: A Hospital Based Study

2012 ◽  
Vol 11 (4) ◽  
pp. 303-306
Author(s):  
Naval Kishor Yadav ◽  
C Hanpari ◽  
Mukesh Kumar Shrewastwa ◽  
Rabindra Kumar Mittal ◽  
Bidhan Chandra Koner
Keyword(s):  
Serum Level ◽  
Subclinical Hypothyroidism ◽  
Medical Science ◽  
Age Groups ◽  
Western Region ◽  
Thyroid Disorders ◽  
Thyroid Disorder ◽  
Subclinical Hyperthyroidism ◽  
The People ◽  
Overt Hyperthyroidism

Objectives: This study was conducted to know the status of thyroid disorder in people of far western region  of Nepal.Methods: A total of 808 cases, out of which 133 male and 675 female were included and study  was carried out using data retrieved from the register maintained in the Department of Biochemistry of the  Nepalgunj Teaching Hospital, Kohalpur, Banke, Nepal, between 1st January, 2011 and 28th February, 2012.  The variables collected were age, sex, and thyroid function profile including free T3, free T4 and TSH. The  data was analyzed using Excel 2003, R 2.8.0 Statistical Package for the Social Sciences (SPSS) for Windows  Version 16.0 (SPSS Inc; Chicago, IL, USA) and the EPI Info 3.5.1 Windows Version. Results: The percentage  of thyroid disorders was 33.66% in people of far western region of Nepal. The people were highly affected  by overt hyperthyroidism (14.9%) followed by subclinical hyperthyroidism (9.9%). The subclinical  hypothyroidism was 7.9% while 1% overt hypothyroidism only. Serum fT3, fT4 and TSH level were significantly  different in male and females. Similarly, fT3, fT4 and TSH levels show statistically significant differences  in different thyroid disorders. The fT3 and fT4 level in overt hyperthyroidism and subclinical  hypothyroidism showed statistically significant differences when compared with euthyroidism group.  Likewise, TSH level also shows statistically significant in all the thyroid disorders when compared with  euthyroidism group. The fT3 and fT4 levels were statistically insignificant in all the age groups whereas  TSH level showed statistically significant different in all the age groups. The fT3 and fT4 level in 21-40  years showed statistically significant when compared with serum level of fT3 and fT4 of 0-20 years.  Similarly, serum level of TSH in 21-40 and 41-60 years also showed statistically significant when compared  with serum level of TSH of 0-20 years. Conclusion: The people residing in far western region have risk for  thyroid disorders. They were suffering with thyroid disorder, especially overt hyperthyroidism (14.9%) and  subclinical hyperthyroidism (9.9%). Further studies are required to characterize the reasons for this high  prevalence of overt hyperthyroidism and subclinical hyperthyroidism. DOI: http://dx.doi.org/10.3329/bjms.v11i4.12601 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct’12

scholarly journals Thyroid Dysfunction in Patients with Metabolic Syndrome: A Cross-Sectional, Epidemiological, Pan-India Study

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Vaishali Deshmukh ◽  
Faraz Farishta ◽  
Milind Bhole
Keyword(s):  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Overt Hypothyroidism ◽  
Subclinical Hyperthyroidism ◽  
Cross Sectional ◽  
Fasting Plasma ◽  
Indian Patients ◽  
Overt Hyperthyroidism

Background. This study was conducted to assess the prevalence and clinical and epidemiological factors of thyroid dysfunction (TD) in Indian patients diagnosed with metabolic syndrome (MetS). Methods. In this cross-sectional study, 432 adults with an established diagnosis of MetS were enrolled across ten centers in India. Anthropometric measurements and vital signs were noted. Blood samples were tested for hemogram, coagulogram, lipid profile, and thyroid function. Fasting plasma glucose (FPG) and fasting plasma insulin were used for the calculation of homeostasis model assessment-estimated insulin resistance (HOMA-IR). Overt hypothyroidism was defined as thyroid-stimulating hormone TSH>4.50 μIU/mL with free thyroxine FT4<0.8 ng/dL and free triiodothyronine FT3<1.4 pg/mL; subclinical hypothyroidism as TSH>4.50 μIU/mL with FT4=0.8-1.8 ng/dL and FT3=1.4-4.4 pg/mL; overt hyperthyroidism as TSH<0.45 μIU/mL with FT4>1.8 ng/dL and FT3>4.4 pg/mL; and subclinical hyperthyroidism as TSH<0.45 μIU/mL with FT4=0.8-1.8 ng/dL and FT3=1.4-4.4 pg/mL. Results. About 121 out of 432 patients (28%) were diagnosed with TD (mean age±SD: 47.9±10.96 years), with women predominance (75% versus 25%). Most patients were in the >45 years of age group (men: 63%; women: 59%). TD was associated with high waist circumference (99.17%), reduced high-density lipoprotein-C (87.60%), raised HOMA-IR (86.78%), systolic blood pressure (77.69%), diastolic blood pressure (59.50%), fasting glucose (58.68%), and triglycerides (33.06%). Overt hypothyroidism was reported in 17.59% (N=76) of patients. Subclinical hypothyroidism, overt hypothyroidism, and subclinical hyperthyroidism were reported in 8.10%, 1.60%, and 0.70% patients with newly occurred TD, respectively. No case of overt hyperthyroidism was present in these patients. Conclusion. Hypothyroidism was the most common TD in Indian patients with MetS. A large proportion of TD cases diagnosed during the study highlight the need for vigilant thyroid screening in patients with MetS in a real-life setting.

scholarly journals Prevalence of thyroid disorders among patients attending the antenatal clinic at tertiary care centre, Parel, Mumbai, India

2017 ◽  
Vol 6 (4) ◽  
pp. 1235
Author(s):  
Jaya Kundan Gedam ◽  
Disha A. Rajput
Keyword(s):  
Tertiary Care ◽  
Antenatal Clinic ◽  
Overt Hypothyroidism ◽  
Thyroid Disorders ◽  
Thyroid Disorder ◽  
Tertiary Care Centre ◽  
Indian Women ◽  
Thyroid Screening ◽  
A Prospective Study ◽  
Overt Hyperthyroidism

Background: Pregnancy is associated with major changes in the physiology of the thyroid gland. Undiagnosed thyroid disorders can adversely affect fetal and maternal outcome. This study was done to study the prevalence of thyroid disorder among antenatal women.Methods: This was a prospective study done in the antenatal clinic in the Department of Obstetrics and Gynaecology, ESI PGIMSRMGM Hospital, Parel, Mumbai, India.Results: In present study, fifty out of three hundred and fifty pregnant women screened had thyroid disorder. The prevalence of thyroid disorder in this study was 14.2%. The prevalence of subclinical hypothyroidism was 7.7% (n= 27), overt hypothyroidism was 4% (n=14), subclinical hyperthyroidism was 1.7% (n=6) and overt hyperthyroidism was 0.8% (n=3).Conclusions: Thyroid disorders in pregnancy are associated with adverse fetomaternal outcome. Its prevalence is high in Indian women. Thus thyroid screening should be included in the routine antenatal investigations.

scholarly journals Prevalence of thyroid disorders among pregnant women at a tertiary care hospital in Rajasthan

2021 ◽  
Vol 10 (3) ◽  
pp. 1111
Author(s):  
Shalini Singh ◽  
Pragya Shree ◽  
Vaibhav Kanti ◽  
Kalpana Kumari ◽  
Rajeev Suchdeva
Keyword(s):  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Tertiary Care ◽  
First Trimester ◽  
Overt Hypothyroidism ◽  
Thyroid Disorders ◽  
Care Hospital ◽  
Second Trimester ◽  
Maternal Weight

Background: Hormonal changes and metabolic demands during pregnancy result in profound alterations in the biochemical parameters of thyroid function. Screening for thyroid disorders and initiation of its management at the earliest stage during first trimester is essential as maternal thyroid failure during the first half of pregnancy has been associated with several pregnancy complications and intellectual impairment in offspring. Aim was to evaluate the prevalence of thyroid dysfunction during the first and second trimester of pregnancy among women of Rajasthan state in India.Methods: The study comprised a cohort of 313 consecutive pregnant women in the first and second trimester that attended the OPD and were admitted as pregnant women in Obstetrics and Gynecology Department of the NIMS Medical College and Hospital, Jaipur, Rajasthan. Thyroid stimulating hormone (TSH) levels and free T4 (fT4) were estimated. The subjects were grouped into six groups based on the value of serum TSH and fT4.Results: Out of 313 antenatal women enrolled in the study, 213 (68%) attended antenatal clinic in first trimester of pregnancy and 100 (32%) women in their second trimester. The prevalence of thyroid dysfunction was 15.97% (overt hypothyroidism 1.28%, subclinical hypothyroidism 4.79%, isolated hypothyroxinemia 4.47%, overt hyperthyroidism 1.92%, and subclinical hyperthyroidism 3.51%). The women with overt hypo- or hyperthyroidism and subclinical hypothyroidism were older than euthyroid women. Maternal weight was high in pregnant women with overt hypothyroidism (58.22±6.18 kg) and subclinical hypothyroidism (52.04±2.94 kg). Gravid status was high in pregnant women with overt hypothyroidism, subclinical hypothyroidism and isolated hypothyroxinemia, but low in hyperthyroid group. History of miscarriage was high in pregnant women with subclinical hypothyroidism.Conclusions: With this study, it was concluded that there is high prevalence of thyroid dysfunction in pregnancy predominantly in rural population of Rajasthan. Majority among these being subclinical hypothyroidism and hypothyroxinemia.

scholarly journals Study on thyroid function test in pregnancy in a tertiary care hospital

2021 ◽  
pp. 20-25
Author(s):  
Ajit Kumar Nayak ◽  
Manorama Swain ◽  
Sujata Misra ◽  
Manju Kumari Jain
Keyword(s):  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Tertiary Care ◽  
Overt Hypothyroidism ◽  
Thyroid Disorders ◽  
Care Hospital ◽  
Thyroid Disorder ◽  
Singleton Pregnancy ◽  
Free T4

Thyroid disorder is a very common endocrine problem encountered by pregnant women. Maternal thyroid dysfunction is associated with adverse outcome both in mother and fetus. The aim of the study: to find out the prevalence of various thyroid disorders in pregnant women attending antenatal clinic. Materials and methods. This prospective cross-sectional study was carried out in the Department of Obstetrics and Gynecology, F.M. Medical College & Hospital, Balasore, Odisha from June 2020 to May 2021. 220 women with uncomplicated singleton pregnancy were included. Serum Thyroid-stimulating hormone (TSH), free T4 (FT4) and free T3 (FT3) were estimated by using electro-chemiluminescence immunoassay technique. Results. Out of 220 pregnant women screened for thyroid dysfunction, 68 were found to have thyroid disorders. 27.3 % of pregnant women had subclinical hypothyroidism, 1.4 % had overt hypothyroidism, 1.8 % had subclinical hyperthyroidism and 0.5 % had overt hyperthyroidism. Prevalence of subclinical hypothyroidism was 6.36 % when the upper reference limit of TSH level taken as 4 mIU/L. Prevalence of thyroid disorder among pregnant women in the age groups 18–25 years, 26–30 years and 31–40 years were 28.9 %, 32.1 % and 38.9 % respectively. There were 35.5 %, 28 % and 26 % pregnant women with thyroid disorders in the first, second and third trimester respectively. Prevalence of both subclinical and overt hypothyroidism were more in multigravida compared to primigravida. Conclusion. Our study revealed high prevalence of thyroid disorders in pregnant women and maternal subclinical hypothyroidism was the most common pattern.

Quantitative thyroid scintigraphy for the differentiation of Graves’ disease and hyperthyroid autoimmune thyroiditis

2004 ◽  
Vol 43 (04) ◽  
pp. 124-128 ◽  
Author(s):  
C. O. Sahlmann ◽  
U. Siefker ◽  
K. Lehmann ◽  
E. Harms ◽  
M. Conrad ◽  
...  
Keyword(s):  
Autoimmune Thyroiditis ◽  
Subclinical Hypothyroidism ◽  
Spontaneous Remission ◽  
Tsh Receptor ◽  
Thyroid Peroxidase ◽  
Graves Disease ◽  
Thyroid Scintigraphy ◽  
Thyroid Uptake ◽  
Reliable Differentiation ◽  
Overt Hyperthyroidism

Summary Aim: The TCTUs (global 99mTc-pertechnetate thyroid uptake under suppression) can be used as an estimate of the iodine clearance of non-TSH regulated tissue. High TCTUs levels are characteristic for Graves’ disease (GD). Decreased uptake has been described in autoimmune thyroiditis (AIT). However, systematically investigated data in a larger series of AIT-patients with subclinical or overt hyperthyroidism are not published so far. The purpose of this study is the evaluation of the TCTUs in the differentiation between AIT and GD in patients with hyperthyroidism. Methods: We determined the TCTUs in 59 patients with untreated hyperthyroid GD and in 51 patients with AIT who had subclinical or manifest hyperthyroidism without medication. Patients with GD were characterized by the presence of hyperthyroidism, decreased echogenicity of the thyroid, elevation of TSH-receptor autoantibodies (TRAb). AIT was defined by a decreased echogenicity of the thyroid, absence of elevated TSH-receptor autoantibodies (TRAb), autoantibodies against the thyroid peroxidase (anti-TPO) and spontaneous remission or development of subclinical hypothyroidism within 3 months. Results: Thyroid volumes of patients with AIT were significantly lower than those of patients with GD (p <0.05). TRAb levels were significantly higher in GD-patients (median: 19.5 U/ml; range: 15.3-35 U/ml) than in AIT-patients (median: 1.3 U/ml; range: 0-4.1 U/ml). 73% (38/59) of patients with GD had elevated anti-TPO levels. In these patients anti-TPO levels (median: 768 U/l; range: 83-6397 U/l) were not significantly different from anti-TPO levels of patients with AIT (median: 834 U/l; range: 107-8675 U/l; p = 0.17). TCTUs values of patients with AIT were significantly lower (p <0.05; median: 0.9%; range: 0.1-3.2%) than those of patients with GD (median: 5.7%; range: 1.9-28.3%). Conclusion: In our patients quantitative thyroid scintigraphy with 99mTcO4 - offered rapid and reliable differentiation between hyperthyroid GD and AIT.

Thyroid evaluation of children and adolescents with Williams syndrome in Zhejiang Province

2017 ◽  
Vol 30 (12) ◽  
Author(s):  
Wei-Jun Chen ◽  
Chai Ji ◽  
Dan Yao ◽  
Zheng-Yan Zhao
Keyword(s):  
Children And Adolescents ◽  
Thyroid Function ◽  
Williams Syndrome ◽  
Subclinical Hypothyroidism ◽  
Thyroid Stimulating Hormone ◽  
Zhejiang Province ◽  
Overt Hypothyroidism ◽  
Thyroid Peroxidase ◽  
Thyroid Antibodies ◽  
Free Triiodothyronine

AbstractBackground:The objective of the study was to describe the prevalence of abnormal thyroid function and volume in children and adolescents with Williams syndrome (WS) in Zhejiang Province, China.Methods:Thyroid function, including thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), and thyroid antibodies (thyroid peroxidase and thyroglobulin) were measured in 83 patients with WS, aged 0.2–16.5 years. Twenty-three patients were followed for an average of 1.7 years (0.4–4.1), and multiple TSH determinations were considered. Thyroid ultrasonography was performed on 49 patients.Results:One patient was diagnosed with overt hypothyroidism, and 23 patients (27%) had subclinical hypothyroidism (SH). Thyroid antibodies were absent in all patients. In five age groups (0–1 years, 1–3 years, 3–6 years, 6–9 years, 9–18 years), the prevalence of patients with subclinical hypothyroidism was 25%, 28.5%, 44.4%, 16.7% and 4.7%, respectively. Through ultrasound examination, 21 patients (42%) were observed to have thyroid hypoplasia (TH), and there were no cases of thyroid haemiagenesis. The incidence rate of TH increased with age, rising from 20% in the youngest group to 66% in the oldest.Conclusions:SH and TH is common in children and adolescents with WS. Yearly evaluation of thyroid must be performed in all patients in this population, regardless of the result of the neonatal screening. Age under 6 years and existing thyroid abnormalities are risk factors for developing SH, and a shorter follow-up interval is needed for screening in these individuals, SH is often self-limiting, and clinicians should be alert to overt hypothyroidism.

Subclinical hypothyroidism

2019 ◽  
Vol 12 (3) ◽  
pp. 131-135
Author(s):  
Adam Grice
Keyword(s):  
Cardiovascular Disease ◽  
Subclinical Hypothyroidism ◽  
Thyroid Stimulating Hormone ◽  
Normal Serum ◽  
Overt Hypothyroidism ◽  
Thyroid Peroxidase ◽  
Autoimmune Thyroid ◽  
Thyroid Peroxidase Antibodies ◽  
Increased Risk ◽  
Stimulating Hormone

Subclinical hypothyroidism is a common condition associated with a raised thyroid-stimulating hormone and a normal serum free thyroxine that affects about 10% of females over 55 years in age. The most common cause is autoimmune thyroid disease, with 2.5% of patients with subclinical hypothyroidism progressing to clinically overt hypothyroidism each year. The rate of progression is higher in patients with anti-thyroid peroxidase antibodies and higher levels of thyroid-stimulating hormone. Only a small proportion of patients with subclinical hypothyroidism have symptoms, and although there is some debate in the literature about which patients should be treated, the National Institute for Health and Care Excellence clinical knowledge summaries give clear recommendations. There is an increased risk of cardiovascular disease in patients with subclinical hypothyroidism; it is uncertain whether treatment with levothyroxine reduces this risk. When deciding whether to treat subclinical hypothyroidism consider the patient’s age, symptoms, presence of anti-thyroid peroxidase antibodies, thyroid-stimulating hormone levels and risk factors such as cardiovascular disease.

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