Associationj of TSHR Gene Single Neucleotide Intronic Polymorphism with the Risk of Hypothyroid and Hyperthyroid Disorders in Yazd Province.

The present study was carried, for the first time, out to evaluate the association of rs2268458 polymorphism, biochemical and environmental factors on hypothyroid and hyperthyroid disorders in thyroid patients and healthy individuals in Yazd province, Iran. In this study, blood samples were collected from a total of 100 cases, including 60 hypothyroid, 20 hyperthyroidism individual cases and 20 normal individuals. DNA was extracted from blood samples and the rs2268458 single neucleotide intronic polymorphism was evaluated using RFLP-PCR. The results have shown that 59 cases were homozygote (TT), 40 cases heterozygote (TC) with one homozygote (CC) case, as follows; A total of 25 (TT) homozygote cases were observed to be hypothyroid females, 20 (TC) heterozygote cases of hypothyroid females, 7 (TT) homozygote male hypothyroid cases and 7 (TC) heterozygote male hypothyroid cases and 1 (CC) homozygote male hypothyroid patient. While, 7 (TT) homozygote hyperthyroid female cases, 8 (TC) heterozygote hyperthyroid female cases,were also observed. According to our study, heterozygote cases (TC) showed less severe symptoms, while homozygote cases (TT) showed no serious symptoms and the (CC) homozygote case (CC) showed severe thyroid abnormality symptoms. So, it can be concluded that the TSHR-related rs2268458 polymorphism is associated with hypothyroidism and hyperthyroidism in the male and female polulations of Yazd Province, Iran and C allele can be a risk factor for some physio-biochemical and hormonal imbalance in the thyroid disorder patients.

A CLINICAL STUDY OF THYROID DYSFUNCTION IN OVERWEIGHT AND OBESE PATIENT-A HOSPITAL BASED STUDY

To find out thyroid hormone profile (Serum T3, T4, TSH level) in overweight and obese subjects of either sex and age. (18-60 yrs.) This study was undertaken to find out relationship between thyroid function tests with overweight and obesity. Methods: A cross sectional study was conducted in the Medicine Department of Jhalawar Medical College. Approximately overweight and obese patient of BMI >25 come in to OPD or emergency department & admitted in Jhalawar hospital. Total 100 subjects taken for study which fulfil the inclusion and exclusion criteria of study. Results: In our study, Maximum 3 (50%) hypothyroid patient had extremely risk of obesity having BMI >40 and 4 (28.6%) patient having very high risk obesity BMI 35-40 and 6 (18.75%) patient having high risk BMI 30-35 and only 6 (12.5%) patient having BMI 25-30 overweight (low risk) patient. Conclusion: This study concludes that obesity increases the risk of hypothyroidism, which is more common among, younger female than males. in this study some overweight and obese subject were found both clinically and biochemically hypothyroid and some subject are found only biochemically hypothyroid.

The Role of Ultrasound in Hypothyroidism, Technique, Differential Diagnosis and Follow-Up

In hypothyroidism, which is as old as humanity, ultrasound has been the first and most important imaging examination in recent decades. This disease is involved in almost all steps in the spectrum from inflammatory diseases to cancer of the thyroid gland. Thyroid ultrasound is a critical tool in the differential diagnosis of hypothyroidism. if thyroid antibodies are negative. It is helpful to determine whether the thyroid is present and to visualize the parenchyma. In a hypothyroid patient, the US may lead to cost savings. if a typical autoimmune pattern is present on US, as a cost-reducing move, further investigations may not be required for the diagnosis of Hashimoto’s thyroiditis. Moreover, the ultrasound image may contribute to the decision process whether to treat patients with positive antithyroid antibodies who are euthyroid or have only a mild subclinical hypothyroidism.

Over-the-counter protein supplement resulting in impaired thyroxine absorption in a hypothyroid patient

Summary Whey protein is a popular dietary supplement that is claimed to provide multiple health benefits. It has been shown to delay gastric emptying and impair ileal nutrient absorption. Additionally, some of the other additives like papain enzyme, soy lecithin in these protein supplements could interfere with L-thyroxine absorption. There is no evidence in the literature for the effects of protein supplements on L-thyroxine absorption. Herein, we describe a case of a 34-year-old lady who was on endocrinology follow up for primary hypothyroidism with stable thyroid-stimulating hormone (TSH) levels within the normal range while on L-thyroxine with a dose of 125 µg daily for the last 3 years, presenting with mild hypothyroid symptoms and elevated TSH level following a recent introduction of a protein supplement by her physical care adviser. Her treatment adherence and ingestion technique were good throughout, she was not on other medications or herbal remedies, there were no other changes in her food pattern or features suggestive of malabsorption, she was not pregnant, was taking the same L-thyroxine brand and TSH test was done from the routine lab. Since the only factor which could have contributed to the deranged TSH levels was the recent introduction of the whey protein supplement, we advised her to stop the protein supplement while continuing the same dose of L-thyroxine. Her TSH level was repeated in 6 weeks and was found to be normal (1.7 mIU/L). Our case report demonstrates that over-the-counter protein supplements could interfere with L-thyroxine absorption. Therefore, patients on L-thyroxine should be cautious when taking them. Learning points Over-the-counter protein supplements could interfere with oral L-thyroxine absorption. The underlying mechanism could be the effect of whey protein by delaying gastric emptying and reduced responsiveness of organic anion transporters in the ileum, and there may be a contribution from other additives like papain and soy lecithin present in these supplements. When there is an elevation of previously stable thyroid-stimulating hormone (TSH) value in a hypothyroid patient on oral L-thyroxine, the patient's assessment should include inquiring for a recent introduction of protein supplement, in the absence of other well-known risk factors. Discontinuation of protein supplement results in normalization of thyroid function tests. Patients on oral L-thyroxine should be cautious when taking over-the-counter protein supplementation.

Decreased Expression of Ileal Thyroid Hormone Transporters in a Hypothyroid Patient: A Case Report

BackgroundMalabsorption of levothyroxine (LT4) is a common problem faced in clinical practice. It is usually solved, if there are no complexities including gastrointestinal absorption disorder, by taking medicines on an empty stomach and avoiding foods interfering with LT4. Herein we present a rare case of a patient exhibiting malabsorption of LT4 with decreased membranous expression of ileal transporters.CaseThe 22-Year-old female presented with sustained hypothyroid status despite medication of 7.8 μg/kg LT4. Medical history and LT4 absorption test (the absorption rate 8.4%) excluded pseudomalabsorption. No organic gastrointestinal disorder was found in the patient by blood chemistry, endoscopies, and abdominal computed tomography scan. The immunohistochemical analysis showed decreased membranous expression of LAT1 and LAT2 in distal ileum and ascending colon in the patient compared to 20 controls who have no thyroid disease. The expression of MCT8 in colon appeared at both nucleus and brush border in the patient, while it was limited to brush border in controls. The expression of other transporters was similar between the patient and controls.ConclusionThe changes of the expression of LAT1 and LAT2 in this patient showing LT4 malabsorption might help to understand the role of intestinal transporters in the absorption of LT4 in humans. The functional relevance of the decrement of LAT1 and LAT2 in this patient remains to be elucidated.

Factitious Total Triiodothyronine(T3) Elevation in a Euthyroid Patient With Paraproteinemia

Background: We report a rare case of a patient treated with levothyroxine for hypothyroidism who also had paraproteinemia and was found to have a clinically inconsistent elevation of T3 by RIA. Clinical Case: A 72 Year old African American female with a history of hypothyroidism and IgG kappa Multiple Myeloma (MM) was admitted to the hospital for altered mental status. Her hypothyroidism had been well controlled for years on a stable dose of levothyroxine 0.075mg daily. Review of systems were negative pertinent to thyroid dysfunction. Family history: negative for thyroid disease. On physical exam, an elderly female clinically euthyroid without palpable thyromegaly but was confused and disoriented. Initial Vital signs: BP 117/67, HR 62, RR 14, T 98, SpO2 99% on room air. BMI 19. EKG: normal sinus rhythm, CXR: normal, TSH: 6.27 (0.55-4.78 uIU/mL), total T3: >600 (60-181ng/dL), total T4: 4.5 (3.2-12.6 ug/dL), FT4: 1.22 (0.89-1.76 ng/dL), hemoglobin: 6.6 (12-16 g/dL), hematocrit: 20.9 (38-47 %), Na: 132 (136-145 mmol/L), K: 4.0 (3.5-5.1 mmol/L), Cl: 104 (98-10/ mmol/L), BUN: 45 (20-31 mmol/L), creatinine: 2.8 (0.6-1.0 mg/dL), total protein: 10.1 (5.7-8.2 g/dL), albumin: 1.8 (3.4- 5.0 g/dL), A:G ratio: 0.22 (0.60-1.50 mmol/L). Serum protein electrophoresis revealed Gamma Globulin 5.8 (0.8-1.7 g/dL), Kappa 9270 mg/L (3.3 -19.4 mg/L) Lambda 9.3 (5.7-26.3mg/L), K/L 996.7 (0.26 -1.65), B2 - macroglobulin: 17.9 (ref: <or= 2.51mg/L) which is consistent with an M- spike migrating in the gamma globulin region. Serum TPO, TG, TSI antibodies were negative. Further testing again reported Total T3 >600 with normal reverse T3 21(8-25 ng/dL). Conclusion: Rare cases of factitious elevations of thyroid hormone have been reported in patients with elevated abnormal IgG or IgA proteins having high binding affinity for thyroid hormone.[1] This hypothyroid patient was clinically and biochemically euthyroid except for a dramatic but clinically inconsistent elevated total T3. She also had multiple myeloma with paraproteinemia (IgG Kappa M spike). The few cases reported to date have shown factitious elevation of either or both total T4 and total T3. In our case the factitious elevation was limited to total T3. We alert clinicians to be aware of factitious elevation of thyroid hormones due to high affinity binding to immunoglobulins. In our case this caused spurious elevation of total T3, but not total T4, in a patient with multiple myeloma and an IgG kappa M spike paraprotein. Reference: 1: Marianna Antonopoulou, Arnold Silverberg, “Spurious T3 Thyrotoxicosis Unmasking Multiple Myeloma”, Case Reports in Endocrinology, vol. 2013, Article ID 739302, 3 pages, 2013. https://doi.org/10.1155/2013/739302

A study of cardiovascular manifestations of thyroid disorders

Background: Dysfunction and anatomic abnormalities of the thyroid gland are among the most common diseases of the endocrine glands. The study has been undertaken with the aim to assess the different cardiovascular manifestations in patients of hypothyroidism and hyperthyroidism in Manipur and find out any correlation of it with age, sex, type of thyroid disorder and BMI. Materials and Method: The study was a cross sectional study of patients who were diagnosed as hypothyroid or hyperthyroid in the Department of Medicine, Regional Institute of Medical Sciences(RIMS), Imphal, Manipur. Clinical parameters including history and clinical examination were recorded including thyroid function testing, ECG, chest X-ray, trans-thoracic echocardiography. Results: Among 59 patients of thyroid disorder studied, 38 patients were found to be hypothyroid and 21 patients hyperthyroid. The average BMI in hypothyroid patient was 27.25. The average BMI in hyperthyroid patients was 25.41 which were lower than hypothyroid. Diastolic hypertension was found in 44.7% of hypothyroid patients. Sinus bradycardia and sinus tachycardia were the most common ECG findings in hypothyroid and hyperthyroid patients respectively. 15.8% had cardiomegaly on chest x-ray in hypothyroid patients while 9.5% had cardiomegaly in hyperthyroid patients. On echocardiographic evaluation, 13.1% and 9.5% had pericardial effusion in hypothyroid and hyperthyroid groups respectively.

Hypothyroidism Induced Lipid Peroxidation and Coronary Hazard in Lucknow

BACKGROUND Dyslipidaemia is a common trait in subclinical (S.H.T.) and overt (O.H.T.) hypothyroidism and had been comprehensively studied; the association of dyslipidaemia, peroxidation of lipids, and coronary lipid risk factors have not been well-thought-out in sub-clinical and clinical hypothyroidism in contrast to controls. The intend of our study was to estimate lipid profile, coronary lipid risk factors, lipid peroxidation index, and malondialdehyde (M.D.A.). Our intension is also to determine their associations with TSH, thyroid hormone (fT3, fT4), and B.M.I. in hypothyroid patients. METHODS This is a case control study conducted among 176 OHT patients, 176 SHT patients, and 176 healthy controls from OPD of the medical college. RESULTS It was observed that all lipid parameters were higher in O.H.T. patients when measured against controls (p < 0.05). Similarly, the parameters were also high in the S.H.T patients group compared to euthyroid controls (p < 0.05). HDL-C was low in both hypothyroid groups when evaluated against controls (p < 0.05). Coronary lipid risk factors and levels of serum M.D.A. were also seen to be high in both hypothyroid patient groups (p < 0 .05). FT3 and FT4 were correlated with TC (p = < 0.05) and (p < 0.05) respectively and with non-HDL-C (p < 0.05) and correspondingly (r = - 0.34, p < 0.05) in OHT subjects. TC (p < 0.05), LDL-C (p < 0.05), Non-HDL-C (p < 0.05), LDL-C / HDL-C (p < 0.05) and MDA (p < 0.01) were correlated with TSH. After nullification with B.M.I., M.D.A.'s relation to LDLC / HDL-C along with TC / HDL-C ratios constantly continued although similarity between M.D.A. and LDL-C had been lost. If the function of M.D.A. was cancelled, B.M.I. correlations with T.G., T.C., and VLDL-C remained constant along with the correlation with atherogenic lipid factors and atherogenic index (A.I.) whereas the B.M.I. and LDL-C link had been lost. No associations were observed in patients with S.H.T however. CONCLUSIONS Dyslipidaemia, coronary lipid risk factors, and peroxidation of lipids were more distinct in overt hypothyroids than in the sub-clinical group. KEYWORDS Atherogenic Risk, Dyslipidaemia, Lipid Peroxidation, Thyroid Hormone

Myxedema Coma: a Review

Myxedema coma, represents the extreme degree of severity of hypothyroidism, whose mortality can reach very high percentages, therefore, it is a true medical emergency. In general, its development is associated with the presence of a triggering factor in a controlled hypothyroid patient and manifests with multisystem alteration. Currently, tools have been developed for clinical diagnosis that use the profile and clinical models, and have good sensitivity-specificity. They allow an early diagnosis which favored the early start of treatment and therefore improves the prognosis. The patient with myxedema coma needs an integral approach, with intensive treatment and close monitoring of hemodynamic parameters. However, the basis of treatment remains hormone replacement, which should be initiated with a combination of levothyroxine and triiodothyronine.