The incidence of thyroid dysfunction in diabetic patients – A study done at a tertiary care center in South India

It has been noted that in the Indian population the incidence of thyroid disorder is common and its incidence rises with advancing age. Screening for thyroid disorder is indicated for the certain high risk patients such as elderly and those already having other endocrinal disorders There are various studies that have shown a finding that a higher than normal prevalence of thyroid disorders in type 2 diabetic patients, of which hypothyroidism is the commonest disorder Owing to this we at the medical college at south India decided to evaluate the occurrence of thyroid dysfunction in patients who have been diagnosed with diabetes mellitus and also to compare the level of thyroid dysfunction in the younger and the older population.Department of surgery, medicine and Pharmacology at Al Azhar Medical College Thodupuzha, Kerala, India for a duration of 3 years on 300 patients. The present study was an observational study during the period of study, the test subjects patients having diabetes mellitus and healthy individuals (Controls)coming for regular health check-up with no co morbidities detected were included in this study as controls.In the non -geriatric age group the mean age was 49.6 years SD + 8.15 years and in the geriatric age group the mean age was 68.78 years SD + 4.83 years. The commonest age group in the study was between the age of 61-70 years with of the study population. The age group in the present study ranged between the age of 30 years and 79 years. The incidence of diabetes mellitus increased with age, but the control of sugars is better with age thyroid dysfunction was as follows 20% had hyperthyroidism (36%) hypothyroidism. There is a linear increase with the prevalence of thyroid disorders with age with a r= 0.77 and p < 0.05.The incidence of thyroid dysfunction also increased with age As compared to the non -geriatric group which was the incidence higher in older age group p < 0.05.This study reveals about at least one in three who have DM are suffering from thyroid dysfunction, that increases with increasing age and uncontrolled sugars in this part of the world, which might warrant routine screening.

The Independent Association of TSH and Free Triiodothyronine Levels With Lymphocyte Counts Among COVID-19 Patients

BackgroundBoth lymphopenia and thyroid dysfunction are commonly observed among COVID-19 patients. Whether thyroid function independently correlates with lymphocyte counts (LYM) remains to be elucidated.MethodsWe included consecutive adults without known thyroid disorder admitted to Queen Mary Hospital for COVID-19 from July 2020 to April 2021 who had thyroid-stimulating hormone (TSH), free thyroxine (fT4), free triiodothyronine (fT3) and LYM measured on admission.ResultsA total of 541 patients were included. Median LYM was 1.22 x 109/L, with 36.0% of the cohort lymphopenic. 83 patients (15.4%) had abnormal thyroid function tests (TFTs), mostly non-thyroidal illness syndrome (NTIS). Patients with lymphopenia had lower TSH, fT4 and fT3 levels than those without. Multivariable stepwise linear regression analysis revealed that both TSH (standardized beta 0.160, p<0.001) and fT3 (standardized beta 0.094, p=0.023), but not fT4, remained independently correlated with LYM, in addition to age, SARS-CoV-2 viral load, C-reactive protein levels, coagulation profile, sodium levels and more severe clinical presentations. Among the 40 patients who had reassessment of TFTs and LYM after discharge, at a median of 9 days from admission, there were significant increases in TSH (p=0.031), fT3 (p<0.001) and LYM (p<0.001). Furthermore, patients who had both lymphopenia and NTIS were more likely to deteriorate compared to those who only had either one alone, and those without lymphopenia or NTIS (p for trend <0.001).ConclusionTSH and fT3 levels showed independent positive correlations with LYM among COVID-19 patients, supporting the interaction between the hypothalamic-pituitary-thyroid axis and immune system in COVID-19.

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.

Spectrum and Prevalence of Thyroid Diseases at a Tertiary Referral Hospital in Mogadishu, Somalia: A Retrospective Study of 976 Cases

Background. Thyroid disorder is one of the most common noncommunicable diseases worldwide and neglected public health issues in Somalia. The aim of the study thus was to investigate the thyroid disorders in patients attending to the largest tertiary referral hospital in Somalia. Methods. This retrospective study was conducted on patients admitted to the internal department of Somalia Mogadishu-Turkey Education and Research Hospital, Somali, between January 2017 and December 2019. Patients who were tested for thyroid function tests and had complete data were included. Patients with incomplete data and currently treated for any thyroid disorder were excluded from the study. Abstracted data including patients’ sociodemographic characteristics, thyroid function tests, and histopathological findings were retrieved from the hospital database system. Results. A total of 976 patients with thyroid disorders were enrolled, of whom 66.6% (n = 650) were female and 33.4% (n = 326) were male. The mean age of the patients was 47 ± 18.5 years. The majority of the patients were reported in the 31–50 (35.9%) age range. The most reported thyroid function disorders were 58.8% euthyroid sick syndrome followed by 15.4% hypothyroidism, 12.5% subclinical hypothyroidism, 7.6% hyperthyroidism, and 5.7% subclinical hyperthyroidism. The distribution of comorbidity indicated that 13.4% had diabetes mellitus, 10.4% had HIV, 4.9% had malaria, and 4.5% had HIV and malaria coinfection. Thyroid malignancies were detached in 22 (2.2%) patients including eleven papillary thyroid cancer, nine patients had follicular thyroid cancer, and two patients had differentiated thyroid cancer. Conclusions. Euthyroid sick syndrome was the most common type of thyroid disease in our setup. Hypothyroidism is the second most common, followed by subclinical hypothyroidism. Papillary thyroid cancer was the predominant histology among thyroid malignancies, followed by follicular thyroid cancer. This study revealed that thyroid diseases emerge as an important endocrine disorder encountered in Somali, necessitating a major public health response.

Association of Thyroid Dysfunction and Pregnancy Outcomes

Background: Hypothyroidism in pregnancy results in serious consequences for both mother and fetus. Pregnant women are prone to thyroid dysfunction due to physiological changes taking place in body. This study is undertaken to see the effect of thyroid dysfunction on pregnancy outcomes. Methodology: A prospective observational study was done. Study was conducted in a private gynecological and obstetric unit. A sample size of 200 women in selected institute with singleton pregnancy was recruited. Pregnant women with chronic disabilities and previously known thyroid disorders were excluded. Data was analyzed using SPSS version 23.0 and binary logistic regression analysis was done. Ethical rules were followed throughout the study and consent taken from all participants. Results: Out of 200, 23 participants were positive for thyroid disorder. Thyroid dysfunctions are responsible for causing multiple complications in pregnancy for mother and fetus. Findings suggest a signification association of thyroid dysfunction and feto-maternal consequences (p-value <0.005). Conclusion: Subclinical hypothyroidism is a common finding during pregnancy. It is compulsory to detect and treat thyroid dysfunction early in pregnancy so that adverse outcomes could be avoided. There is a need for timely screening of thyroid profile in suspected pregnancies. keywords: TSH, FT3, FT4, Pregnancy, Outcomes.

Effective Voting Ensemble of Homogenous Ensembling with Multiple Attribute-Selection Approaches for Improved Identification of Thyroid Disorder

Thyroid disease is characterized by abnormal development of glandular tissue on the periphery of the thyroid gland. Thyroid disease occurs when this gland produces an abnormally high or low level of hormones, with hyperthyroidism (active thyroid gland) and hypothyroidism (inactive thyroid gland) being the two most common types. The purpose of this work was to create an efficient homogeneous ensemble of ensembles in conjunction with numerous feature-selection methodologies for the improved detection of thyroid disorder. The dataset employed is based on real-time thyroid information obtained from the District Head Quarter (DHQ) teaching hospital, Dera Ghazi (DG) Khan, Pakistan. Following the necessary preprocessing steps, three types of attribute-selection strategies; Select From Model (SFM), Select K-Best (SKB), and Recursive Feature Elimination (RFE) were used. Decision Tree (DT), Gradient Boosting (GB), Logistic Regression (LR), and Random Forest (RF) classifiers were used as promising feature estimators. The homogeneous ensembling activated the bagging- and boosting-based classifiers, which were then classified by the Voting ensemble using both soft and hard voting. Accuracy, sensitivity, mean square error, hamming loss, and other performance assessment metrics have been adopted. The experimental results indicate the optimum applicability of the proposed strategy for improved thyroid ailment identification. All of the employed approaches achieved 100% accuracy with a small feature set. In terms of accuracy and computational cost, the presented findings outperformed similar benchmark models in its domain.

Combined effect of Levothyroxine, Antihyperlipidemic and oral hypoglycemic agents on lipid profile and cognition level in hypothyroidism patients

Aim: To evaluate the effect of combination therapy on lipid profile and cognition level in hypothyroidism patients. Methods: A prospective observational study was conducted in a private hospital at Tiruchengode. Patients who were under the management of thyroid disorder and hyperlipidemia more than 10 years was screened and selected for the study. There were 155 patients were included in the study and the patients who were on Levothyroxine 50mcg as control (Group 1), Group 2 Patients prescribed with levothyroxine 50mcg and Atorvastatin 20mg were checked with lipid profile parameter like Total cholesterol (TC), Triglycerides (TG), High density Lipoprotein (HDL-C), Low density Lipoprotein (LDL-C) and compared with control group values. Group 3 patients prescribed with levothyroxine 50mcg and Atorvastatin 20mg, Glimepride 2mg, Metformin 500mg were checked with lipid profile, compared with control group. The patients were interviewed using a Mini mental state examination questionnaire and their cognitive skills were assessed and compared with control group. Independent samples T test was used to compare the complication of the management. Conclusion: Hyperlipidemia management with levothyroxine 50mcg and Atorvastatin 20mg, Glimepride 2mg, Metformin 500mg (Group 3) has an association on the managing lipid profile efficiently than the control (Group 1) Significant (p<0.01). Cognition impairment was high in the combination therapy. (p <0.01)

Effect of the transition from more than adequate iodine to adequate iodine on national changes in the prevalence of thyroid disorders: Repeat national cross-sectional surveys in China

Objective: Longitudinal studies have investigated the effects of changing iodine status on thyroid disorders, but the effect of a transition from more than adequate iodine to adequate iodine on national changes in prevalence adjusted for changing risk factors remains unclear. Design: Two repeat nationwide surveys were conducted from 2009-2010 to 2015-2017 to assess changes in thyroid disorder prevalence and iodine status in China. Methods: A multistage stratified random sampling method was used to obtain a nationally representative sample of urban adults aged 18 and older in mainland China in 2009 (n=14925) and 2015 (n=12553). Changes in thyroid disorder prevalence, urinary iodine concentration (UIC), and thyroid-stimulating hormone (TSH) levels were assessed. Logistic regression models were used to examine changes in prevalence over time. Results: The median UIC decreased significantly from 219.7 to 175.9 μg/L (P<0.0001). The weighted prevalence of overt hyperthyroidism, subclinical hyperthyroidism, Graves’ disease, and goitre decreased between 2009 and 2015 in the overall population (P<0.05 for all). Despite no significant changes in subclinical hyperthyroidism or hypothyroidism or anti-thyroid peroxidase or anti-thyroglobulin antibody positivity prevalence, a significant increase in thyroid nodule prevalence (P<0.0001) was found in the overall population. The 2.5th TSH percentile increased by 0.15 mIU/L (95%CI, 0.01 to 0.30 mIU/L, P=0.04) from 2009 to 2015. Conclusions: With the iodine status transition from more than adequate to adequate, thyroid disorder (except for thyroid nodules) prevalence remained stable or even decreased after adjusting for confounding factors among adults in mainland China between 2009 and 2015. Additional studies are needed to explore the reasons for the increased thyroid nodule prevalence.

MATERNALAND PERINATAL OUTCOME IN HYPOTHYROIDISM IN PREGNANCY.

BACKGROUND: Pregnancy is a period that places great physiological stress on both the mother and the foetus .This study was conducted to analyse the fetomaternal outcome of pregnant women with hypothyroidism. The commonest thyroid disorder found in pregnancy is hypothyroidism and it adversely affects the maternal and foetal health in the form of infertility, early pregnancy loss, pre eclampsia , anaemia ,FGR, PROM, preterm labour, neonatal and maternal morbidity and mortality. Routine screening, early detection and conrmation of diagnosis and prompt treatment is required to ensure favourable maternal and foetal outcomes. METHODS: The present study was conducted in the department of obstetrics and gynaecology of Adhichunchanagiri Institute of Medical Sciences ,B.G Nagara , Mandya from November 2019 to October 2020.All pregnant females who are diagnosed as hypothyroidism , admitted to labour room were included in the study . RESULTS: In the present study the most common maternal complication is preeclampsia , postpartum haemorrhage and fetal complication is preterm labour. CONCLUSION: Maternal hypothyroidism is a disorder with great potential to adversely affect maternal and foetal outcomes .If the condition is diagnosed early and prompt initiation of treatment ,adequate follow up is done then the condition can be easy treated with very little detrimental effects to the mother and the foetus. This study concludes that sufcient education of the doctors and the patients about the universal screening, thyroid associated complications along with ease and advantages of prompt management is very much necessary.

COVID-19 in Children with Down Syndrome: Data from the Trisomy 21 Research Society Survey

Adults with Down Syndrome (DS) are at higher risk for severe outcomes of coronavirus disease 2019 (COVID-19) than the general population, but evidence is required to understand the risks for children with DS, which is necessary to inform COVID-19 shielding advice and vaccination priorities. We aimed to determine the epidemiological and clinical characteristics of COVID-19 in children with DS. Using data from an international survey obtained from a range of countries and control data from the United States, we compared the prevalence of symptoms and medical complications and risk factors for severe outcomes between DS and non-DS paediatric populations with COVID-19. Hospitalised COVID-19 patients <18 years with DS had a higher incidence of respiratory symptoms, fever, and several medical complications from COVID-19 than control patients without DS <18 years. Older age, obesity, and epilepsy were significant risk factors for hospitalisation among paediatric COVID-19 patients with DS, and age and thyroid disorder were significant risk factors for acute respiratory distress syndrome. Mortality rates were low in all paediatric COVID-19 patients (with and without DS), contrasting with previous findings in adults with DS (who exhibit higher mortality than those without DS). Children with DS are at increased risk for more severe presentations of COVID-19. Efforts should be made to ensure the comprehensive and early detection of COVID-19 in this population and to identify children with DS who present comorbidities that pose a risk for a severe course of COVID-19. Our results emphasize the importance of vaccinating children with DS as soon as they become eligible.