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2022 ◽  
Vol 11 (1) ◽  
Author(s):  
Georgiana Sitoris ◽  
Flora Veltri ◽  
Pierre Kleynen ◽  
Malika Ichiche ◽  
Serge Rozenberg ◽  
...  

Objective It is unknown if foetal gender influences maternal thyroid function during pregnancy. We therefore investigated the prevalence of thyroid disorders and determined first-trimester TSH reference ranges according to gender. Methods A cross-sectional study involving 1663 women with an ongoing pregnancy was conducted. Twin and assisted pregnancies and l-thyroxine or antithyroid treatment before pregnancy were exclusion criteria. Serum TSH, free T4 (FT4) and thyroid peroxidase antibodies (TPOAb) were measured at median (interquartile range; IQR) 13 (11–17) weeks of gestation. Subclinical hypothyroidism (SCH) was present when serum TSH levels were >3.74 mIU/L with normal FT4 levels (10.29–18.02 pmol/L), and thyroid autoimmunity (TAI) was present when TPOAb were ≥60 kIU/L. Results Eight hundred and forty-seven women were pregnant with a female foetus (FF) and 816 with a male foetus (MF). In women without TAI and during the gestational age period between 9 and 13 weeks (with presumed high-serum hCG levels), median (IQR range) serum TSH in the FF group was lower than that in the MF group: 1.13 (0.72–1.74) vs 1.24 (0.71–1.98) mIU/L; P = 0.021. First-trimester gender-specific TSH reference range was 0.03–3.53 mIU/L in the FF group and 0.03–3.89 mIU/L in the MF group. The prevalence of SCH and TAI was comparable between the FF and MF group: 4.4% vs 5.4%; P = 0.345 and 4.9% vs 7.5%; P = 0.079, respectively. Conclusions Women pregnant with an MF have slightly but significantly higher TSH levels and a higher upper limit of the first-trimester TSH reference range, compared with pregnancies with a FF. We hypothesise that this difference may be related to higher hCG levels in women pregnant with a FF, although we were unable to measure hCG in this study. Further studies are required to investigate if this difference has any clinical relevance.


2021 ◽  
Vol 25 (6) ◽  
pp. 359-363
Author(s):  
Mustafa Ş. Akgül ◽  
Bilgehan Baydil

Background and Study Aim. Thyroid hormone responses to acute maximal aerobic exercise is still unclear, so the aim of the study is to investigate the effect of acute maximal aerobic exercise resulting in fatigue on blood thyroid levels in men and women. Material and Methods. The study included 8 male and 7 female subjects who did not actively exercise. Both group participants were students in the Kastamonu University in the period of study. The heights, weights, resting hearth rates and 5 cc. venous blood samples of subjects were taken before the exercise. The subjects warmed up for ten minutes before they had 20 m shuttle run. The purpose of this test was to tire the subjects to the exhaustion. The heart rate were measured at the end of the test in order to determine the exhaustion levels of the participants. The 5 cc. venous blood samples were taken again just after the exhaustion exercise. Statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) 23 program (SPSS Inc. Chicago. II. USA). P value was set at p<0.05. Results. When results were compared between both sexes, no significant difference was found among variables (p>0.05). There was significant change in TSH values in all group. They increased following the exercise compared to pre-exercise values. Moreover, total T3 decreased in all group. No other significant difference was found in free T3 and free T4 variables. Conclusions. In conclusion, thyroid responses to exercise emerge in a very complex way, which makes it difficult to reach a clear conclusion about its effects. The reason why the results are so contradictory is that the duration and intensity of the exercise, age, not being able to control the diet, and the timing of collection of blood samples after exercise.


2021 ◽  
Vol 12 ◽  
Author(s):  
Wismandari Wisnu ◽  
Idrus Alwi ◽  
Nafrialdi Nafrialdi ◽  
Kuntjoro Harimurti ◽  
Tjokorda Gede D. Pemayun ◽  
...  

BackgroundHyperthyroidism is related to vascular atherosclerosis. Propylthiouracil (PTU) and methimazole, other than their antithyroid effects, may have different mechanisms in preventing atherogenesis in Graves’ disease.ObjectiveThis study aimed to investigate the effect of antithyroid drugs on markers of vascular atherosclerosis in Graves’ hyperthyroidism.MethodsThis study was a single-blind, randomized clinical trial conducted on 36 patients with Graves’ disease in Cipto Mangunkusumo General Hospital, Jakarta, Indonesia, from June 2019 until July 2020. Graves’ disease was diagnosed from clinical manifestation of hyperthyroidism with diffuse goiter and then confirmed by thyroid stimulation hormone (TSH), free T4 (fT4), and TSH-receptor antibody (TRAb) measurements. Participants were randomly assigned to either a PTU or a methimazole treatment group and followed up for 3 months. Markers of vascular atherosclerosis were represented by adhesion molecules [intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and E-selectin], carotid artery stiffness [pulse wave velocity (PWV)], and thickness [carotid intima media thickness (cIMT)].ResultsBy the end of the study, 24 participants reached euthyroid condition (13 from the PTU group and 11 from the methimazole group). After 3 months of follow-up, in the PTU group, we noticed an improvement of ICAM-1 [pretreatment: 204.1 (61.3) vs. posttreatment: 141.6 (58.4) ng/ml; p = 0.001], VCAM-1 [837 (707–977) vs. 510 (402–630) ng/ml; p &lt; 0.001] and E-selectin [32.1 (24.1–42.7) vs. 28.2 (21.6–36.8) ng/ml; p = 0.045] in the PTU group. In the methimazole group, only VCAM-1 improvement [725 (565–904) vs. 472 (367–590); p = 0.001] was observed. Meanwhile, we found no significant changes in PWV or cIMT in either group.ConclusionAntithyroid treatment in Graves’ disease leads to improvement in adhesion molecules, with a lesser effect on methimazole, whereas there were no significant changes in PWV or cIMT. PTU may have a better mechanism compared with methimazole in terms of improving adhesion molecules.


2021 ◽  
Vol 13 (1) ◽  
pp. 75-84
Author(s):  
Suryati Kumorowulan ◽  
Yusi Dwi Nurcahyani ◽  
Leny Latifah ◽  
Diah Yunitawati

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.


2021 ◽  
pp. 58-64
Author(s):  
I.Е. Shtina ◽  
◽  
S.L. Valina ◽  
К.P. Luzhetskiy ◽  
М.Т. Zenina ◽  
...  

Chemical environmental factors trophic for the endocrine system and its organs produce negative influence on it that becomes apparent through growing incidence and pathomorphism of endocrine diseases. Our test group was made up of 102 children with diagnosed autoimmune thyroiditis (AIT) who were chronically exposed to metals (lead, manganese, nickel, chromium, and zinc) being components in emissions from metallurgic enterprises in Perm region. Our reference group included 46 children with AIT who lived beyond zones influenced by the aforementioned enterprises in areas with the sanitary-hygienic situation being relatively favorable. We comparatively analyzed the results of clinical and ultrasound examinations that focused on evaluating children’s thyroidal and immune state. A growth in incidence with thyroiditis amounted to 63.6 % on the test territory over 10 years and it was 1.6 times higher than on average in the region (40.8 %); there was no growth in the indicator detected on the reference territory. Concentrations of chromium, nickel, lead, zinc, and manganese higher than regional background level were 1.7–5.5 times more frequently detected in blood of children from the test group against the reference one. A number of AIT cases was higher among exposed boys (by 2.0 times, p = 0.070); exposed children also had higher Ig A, M, and G contents in blood serum (by up to 2.9 times, p = 0.015–0.056), higher TSH levels (by 2.0 times, p = 0.096), and lower free T4 contents (by 5.4 times, p = 0.057). Diffuse damage to the thyroid gland was by 1.3 times more frequent under exposure to adverse factors created by metallurgic production; AIT combined with other diseases was also more frequent (p = 0.041). Rates and growth in incidence of thyroid gland diseases and thyroiditis are by 1.3–2.3 times higher among children and teenagers living on territories where metallurgic enterprises are located against the same indicators on territories where sanitary-hygienic situation is relatively favorable. We detected less apparent gender-related differences in AIT frequency, a greater number of improper thyroidal state, elevated risks of diffuse changes in the thyroid gland and activation of humoral immune response that was by 2.2–3.4 times more frequent together with concomitant damage to other systems under elevated contents of metals in blood.


2021 ◽  
Vol 10 (23) ◽  
pp. 5503
Author(s):  
Camil Ciprian Mireștean ◽  
Roxana Irina Iancu ◽  
Dragoș Petru Teodor Iancu

Radiation therapy is part of the therapeutic arsenal for breast cancer, whether it is adjuvant treatment after lumpectomy or radical mastectomy, or it is used as a palliative option in the case of metastatic or recurrent disease. Significant advances in diagnostic and therapeutic stratification of breast cancers have significantly prolonged survival, even in the metastatic stage. Exposure of patients during the course of the disease in a multidisciplinary therapeutic approach including chemotherapy, hormone therapy, targeted anti-HER therapies or CDK4/6 inhibitors had led to improved survival but with the price of additional toxicity. Among them, hypothyroidism is a well-known consequence of external radiation therapy, especially in the case of cervical region irradiation, including supraclavicular and infra-clavicular nodal levels. In this situation, the thyroid gland is considered as an organ at risk (OAR) and receives a significant dose of radiation. Subclinical hypothyroidism is a common endocrine disorder characterized by elevated TSH levels with normal levels of FT4 (free T4) and FT3 (free T3), and as a late effect, primary hypothyroidism is one of the late effects that significantly affects the quality of life for patients with breast cancer receiving multimodal treatment. Hypothyroidism has a significant impact on quality of life, most often occurring as late clinical toxicity, secondary to thyroid irradiation at doses between 30 and 70 Gy. Dose-volume parameters of irradiation, gland function at the beginning of the treatment and associated systemic therapies may be factors that alter thyroid radio-sensitivity and affect thyroid gland tolerance. In the case of head and neck tumor pathology, in which doses of >50 Gy are routinely used, the thyroid gland is generally considered as an OAR, the rate of radio-induced hypothyroidism being estimated at rates of between 20% and 52%. For breast cancer, the thyroid is often neglected in terms of dosimetry protection, the rate of late dysfunction being 6–21%.


Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Ashish Patel ◽  
Sae Jang ◽  
Samir Saba

Case Presentation: A 29-year-old man with a history of hyperthyroidism presented to an outside hospital with altered mentation and palpitations in the setting of non-adherence to thyroid medications. He was found to be in atrial fibrillation with rapid ventricular response. Initial vital signs included a heart rate of 165 beats/min, respiratory rate of 43 breaths/min, blood pressure of 134/115 mmHg, and O2 saturation of 94% on 2L of oxygen. Point of care ultrasound showed an EF of 10% and a dilated IVC. Labs showed a creatinine of 0.7 mg/dL, total bilirubin of 3.9 mg/dL, ALT of 39 IU/L, AST of 62 IU/L, ALP of 181 IU/L, lactate of 7.6 mMol/L, TSH of < 0.01 uIU/mL, free T4 of > 5.00 ng/dL, and a T3 of > 30.00 pg/mL. He was treated with methimazole and then switched to propylthiouracil (PTU). Esmolol and diltiazem resulted in worsening cardiogenic shock and PEA arrest twice requiring VA ECMO cannulation. Upon transfer to our facility, he was started on potassium iodide (SSKI). He had electrical cardioversion twice with reversion back to atrial fibrillation. He was then started on amiodarone and digoxin. He remained in atrial fibrillation but achieved rate control with heart rates in the 100s. Discussion: Amiodarone is typically avoided in atrial fibrillation in the setting of thyrotoxicosis due to its high iodine content which can precipitate further thyroid hormone synthesis. However, in the setting of cardiogenic shock, treatment options are limited. We learned from our endocrinology colleagues that amiodarone can be beneficial when patients are treated with PTU and SSKI as amiodarone blocks the conversion of T4 to T3. Amiodarone should be started after PTU as PTU prevents thyroid hormone synthesis and blunts the effect of the iodine load of amiodarone. In conclusion, amiodarone can be considered earlier for the treatment of atrial fibrillation in the setting of thyrotoxicosis especially if treatment options are limited by cardiac dysfunction granted the patient has been started on PTU.


Author(s):  
Rasha T Hamza ◽  
Amira I Hamed ◽  
Basma B B Hassan ◽  
Wafaa O Ahmed

Purpose: The study examined the effect of antenatal steroids on thyroid functions in late preterm infants on the third to the seventh day of life. Patients and Methods: A comparative Cross-Sectional study was conducted on 75 neonates admitted to NICU in the first week of life. They were divided according to exposure to antenatal steroids into three groups. First group: exposed to complete course of ANS. Second group: exposed to partial course of ANS. The third group: not exposed to ANS. Serum samples were obtained from selected cases free T3, Free T4, and TSH levels in the third day of life, compared to the cut of levels currently available (the TSH reference range is (1.7 to 9.1 mU per L), T4 should be greater than( 10 mcg per dL). Using Eleusis and Cubase analyzers kits (Roche Diagnostics, Indianapolis, IN, USA) by ELISA (enzyme-linked immune sorbent assay) technique. Results: The study showed that there were significantly higher serum T4 levels in group 1 that was exposed to a complete course compared to group 2 (partial course) and 3 (Third group). There were no significant differences in serum TSH, T3 levels between groups. The current study found a decreased incidence of the ROP, NEC and BPD among group 1 as compared to the other two groups although was non statistically significant. In addition, the complete course of ANS had delayed the date of delivery (P=0.04) as compared to the partial course in the current study. Conclusion: Antenatal corticosteroids can influence thyroid function in late preterm infants as serum T4 was significantly higher in infants exposed to complete course compared to those who were exposed to partial course or did not receive antenatal corticosteroids.


Author(s):  
V. Abhinaya ◽  
S. Magesh Kumar

Background: Kidneys have a significant role in the metabolism, degradation and excretion of thyroid hormones. Both thyroid hormones and kidney functions have a multifaceted mutual interdependence. Objectives: To find out the possible association between the severity of chronic kidney disease and thyroid dysfunction; To estimate the correlation between thyroid dysfunction and various stages of chronic kidney disease. Materials and Methods: A prospective Cross-sectional study was done on 50 patients with Chronic kidney disease who were not on dialysis and fulfilled all the inclusion criteria at Saveetha medical college over a period of 6 months. Free T3, Free T4 and TSH levels were estimated for those patients. Results: Results of this study showed that majority of subjects included in our study were in the age group of 50-60 years with Male predominance. Out of 50 patients included in our study, 8 patients(16%) were found to hypothyroidism; 5 patients (10%) were having subclinical hypothyroidism; 20 patients (40%) were having low T3 syndrome and 17 patients (34%) were having normal functioning thyroid gland. Staging of CKD was done in relation to the glomerular filtration rate .Most of the patients(n=20) were in Stage 5 of Chronic kidney disease out of which 18 patients were having thyroid disorders. Conclusion: There is a positive correlation between the severity of CKD and thyroid dysfunction. Hence a routine thyroid function status should be evaluated in each and every patient of CKD to reduce the morbidity and mortality rate of CKD patients as well as reduce the social burden and health expenditure.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yun Mi Choi ◽  
Min Kyung Kim ◽  
Mi Kyung Kwak ◽  
Dooman Kim ◽  
Eun-Gyoung Hong

AbstractThyroid dysfunction has been implicated as a potential pathophysiological factor in glucose homeostasis and insulin resistance (IR). This study aimed to identify the correlation between thyroid dysfunction and IR. We used data from the sixth Korean National Health and Nutrition Examination Survey to evaluate a total of 5727 participants. The triglyceride glucose (TyG) index and homeostasis model assessment of insulin resistance (HOMA-IR) were calculated to represent IR. Correlation analysis was performed between thyroid dysfunction and IR. The log-transformed TSH (LnTSH) and free T4 were significantly correlated with the TyG index (TSH, beta coefficient 0.025, 95% confidence interval [CI] 0.014–0.036, p < 0.001; free T4, − 0.110 (− 0.166 to − 0.054), p < 0.001) but not HOMA-IR. Overt hypothyroidism is correlated with increased TyG index in pre-menopausal females (0.215 (0.122–0.309) p < 0.001). On the other hand, overt hyperthyroidism is correlated with increased HOMA-IR in males (0.304 (0.193–0.416), p < 0.001) and post-menopausal females (1.812 (1.717–1.907), p < 0.001). In euthyroid subjects, LnTSH and TyG index were significantly correlated in females. In conclusion, both hyperthyroidism and hypothyroidism might be associated with IR but by different mechanisms. It might be helpful to assess IR with appropriate indexes in patients with thyroid dysfunction.


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