Assessment of decrease in renal function associated with hypothyroidism

Objective: Study was aimed to see the effects of hypothyroidism on GFR as a renal function. Material and methods: Total of Fifty-eight patients were included in the study. Out of those forty-eight patients were female and the rest were male. Out of fifty eight patients, fifty three patients were of thyroid cancer in which hypothyroidism was due to discontinuation of thyroxine before the administration of radioactive iodine for Differentiated thyroid cancer.Moreover, remaining five patients were post radioactive iodine treatment (for hyperthyroidism) hypothyroid. All of the patients were above eighteen years of age with TSH value > 30µIU/ml. Pregnant and lactating females were excluded.Renal function tests (urea/creatinine, creatinine clearance) and serum electrolytes followed by Tc-99m-DTPA renal scan for GFR assessment (GATES’ method) were carried out in all subjects twice during the study, One study during hypothyroid state (TSH > 30 µIU/ml) and other during euthyroid state (TSH between 0.4 to 4µ IU/ml). The results of Student’s t-test showed significant difference in renal functions (Urea, creatinine, creatinine clearance, GFR values) in euthyroid state and hypothyroid state (p-value <0.05). RESULTS: In case of creatinine the paired t test reveal the mean 1.014±0.428, with standard error of 0.669 within 95% confidence interval, for creatinine clearance 80.11±14.12 with standard error of 1.94 within 95% confidence intervals, for urea the mean 28±12.13 with standard error of 1.607 within 95% confidence intervals and for GFR for individual kidney is 38.056±8.56 with standard error of 1.3717 within 95% confidence interval. There was no difference in the outcome of the 2 groups. Conclusion: Hypothyroidism impairs renal function to a significant level and hence needs to be prevented and corrected as early as possible.

Resting Energy Expenditure and Cold Induced Thermogenesis in Patients with Overt Hyperthyroidism

Context Thyroid hormone is crucial for the adaptation to cold. Objective To evaluate the effect of hyperthyroidism on resting energy expenditure (REE), cold-induced thermogenesis (CIT) and changes in body composition and weight. Design Prospective cohort study. Setting Endocrine outpatient clinic at tertiary referral center. Patients Eighteen patients with overt hyperthyroidism. Main Outcome Measures We measured REE during hyperthyroidism, after restoring euthyroid TH levels and after 3 months of normal thyroid function. In fourteen patients energy expenditure (EE) was measured before and after a mild cold exposure of two hours and CIT was the difference between EEcold and EEwarm. Skin temperatures at eight positions were recorded during the study visits. Body composition was assessed by dual X-ray absorption. Results Free T4 (fT4) and free T3 (fT3) decreased significantly over time (fT4, p=0.0003; fT3, p=0.0001). REE corrected for lean body mass (LBM) decreased from 42 ± 6.7 kcal/24h/kg LBM in the hyperthyroid to 33±4.4 kcal/24h/kg LBM (-21%, p&lt;0.0001 vs hyperthyroid) in the euthyroid state and three months later to 33 ± 5.2 kcal/24h/kg LBM (-21%, p=0.0022 vs. hyperthyroid, overall p&lt;0.0001). Free T4 (p=0.0001) and free T3 (p&lt;0.0001) were predictors of REE. CIT did not change from the hyperthyroid to the euthyroid state (p=0.96). Hyperthyroidism led to increased skin temperature at warm ambient conditions but did not alter core body temperature, nor skin temperature after cold exposure. Weight regain and body composition were not influenced by REE and CIT during the hyperthyroid state. Conclusions CIT is not increased in patients with overt hyperthyroidism.

Synaptic Loss in a Mouse Model of Euthyroid Hashimoto’s Thyroiditis: Possible Involvement of the Microglia

Background: Hashimoto’s thyroiditis (HT) is an autoimmune illness that renders individuals vulnerable to neuropsychopathology even in the euthyroid state, the mechanisms involved remain unclear. We hypothesized that activated microglia might disrupt synapses, resulting in cognitive disturbance in the context of euthyroid HT, and designed the present study to test this hypothesis. Methods: Experimental HT model was induced by immunizing NOD mice with thyroglobulin and adjuvant twice. Morris Water Maze was measured to determine mice spatial learning and memory. The synaptic parameters such as the synaptic density, synaptic ultrastructure and synaptic-markers (SYN and PSD95) as well as the interactions of microglia with synapses were also determined. Results: HT mice had poorer performance in Morris Water Maze than controls. Concurrently, HT resulted in a significant reduction in synapse density and ultrastructure damage, along with decreased synaptic puncta visualized by immunostaining with synaptophysin and PSD-95. In parallel, frontal activated microglia in euthyroid HT mice showed increased engulfment of PSD95 and EM revealed that the synaptic structures were visible within the microglia. These functional alterations in microglia corresponded to structural increases in their attachment to neuronal perikarya and a reduction in presynaptic terminals covering the neurons.Conclusion: Our results provide initial evidence that HT can induce synaptic loss in the euthyroid state with deficits might be attributable to activated microglia, which may underlie the deleterious effects of HT on spatial learning and memory.

THYROID CYTOLOGY AND IT'S INTERPRETATION WITH THYROID FUNCTION TEST

INTRODUCTION: The Thyroid gland is unique among the endocrine glands. It is the largest of all the endocrine glands and it is supercial in location. It is the only gland which is easily approachable to direct physical, cytological and histopathological examination. The thyroid gland is affected by a variety of pathological lesions that are manifested by various morphologies including developmental, inammatory, hyperplastic and neoplastic pathology which are quiet common in the clinical practice. AIM OFTHE STUDY:In this study, we aimed to assess the cytological ndings of palpable thyroid nodules in conjunction with thyroid hormonal prole of the patient. To study the incidence in relevance to age, sex in various categories of thyroid lesions. MATERIALS & METHODS: Study Design: Institutional based Cross-sectional Study. Duration of study: January 2019 to August 2020. Source of data: Patients presenting to the OPD and admitted in the In-patient ward at Darbhanga Medical College, Bihar. Place of study: Department of Pathology, Darbhanga Medical College and Hospital, Laheriasarai, Bihar. Sample Size: 60 patients of enlarged thyroid gland. RESULTS & OBSERVATIONS: We found that the 53.3% Patients are in euthyroid state. Nodular goitre is the most common nding. In the present study among 60 patients, Nodular goiter accounts for 83.3 % of all cases; 41.7% of them were in euthyroid state, 21.7 % in hypothyroid state , 8.3 % in subclinical hypothyroid and remaining 11.7 % in hyperthyroid state . SUMMARY AND CONCLUSION: FNAC together with thyroid function test (TFT) analysis leads to early and accurate diagnosis of various thyroid diseases and reduces surgical intervention. The study showed that FNAcytologic diagnosis cannot be used to predict thyroid function using total serum T4, T3 and TSH concentrations. Measurement of TSH, free T4, and free T3 would be preferable

Pre-operative use of Lugol’s iodine in a case with toxic adenomatous goiter

Euthyroid state is considered a requisite before planning a thyroid surgery. Before such a surgery, pharmacotherapy can be used for managing a hyperthyroid state. It warrants a long-term treatment with pharmacotherapy agents like imidazole class (carbimazole, methimazole) or propylthiouracil. In cases with large goiters, with pressure symptoms like dyspnoea, dysphagia, dysphonia; a surgeon would prefer a pharmacotherapy with a quicker action than the established agents. Lugol’s iodine was used pre-operatively before the advent of newer agents. In rural areas, where patients present with large goiters, hyperthyroid states due to lack of awareness and availability of the modern pharmacotherapy, Lugol’s iodine can be a rescue pre-operative therapy to make such a patient euthyroid and to decrease the vascularity of the goiter, which facilitates a safer thyroid surgery.

Pituitary thyrotoxicosis presenting as abnormal thyroid function testing during pregnancy: a case report

Background Central hyperthyroidism is a rare form of hyperthyroidism caused by thyrotrope pituitary adenomas. It is characterized by elevated thyroid-stimulating hormone alongside high thyroxine and triiodothyronine. Goiter is the most common symptom of central hyperthyroidism. Surgical resection as well as somatostatin analog therapy typically achieve resolution of hyperthyroid symptoms and restoration of a euthyroid state. Case presentation We report the case of a 30-year-old primigravida Caucasian/White female who presented with abnormal thyroid function testing results and multinodular goiter during pregnancy. Postpartum, she was found to have multinodular goiter on physical examination as well as persistent elevated thyroid-stimulating hormone with elevated free thyroxine and free triiodothyronine. Magnetic resonance imaging disclosed a large pituitary macroadenoma, and she subsequently underwent resection of the mass. She achieved a sustained euthyroid state postoperatively. Conclusions This case shows how central hyperthyroidism can present without the more apparent symptoms of thyrotoxicosis and that successful resolution of central hyperthyroidism may be achieved postoperatively.

Assessment and management: Primary hypothyroidism in women

Hypothyroidism is a common endocrine disorder affecting nearly 2 in 100 women. Primary hypothyroidism can be diagnosed and effectively managed by primary care providers. Pharmacologic treatment is essential and lifelong, with most patients achieving euthyroid state and enjoying good quality of life.

Association of Systemic Lupus Erythematosus with Autoimmune Hypothyroidism

Introduction: Autoimmune disease has got tendency to co-exist with another autoimmune disease. SLE and hypothyroidism are common autoimmune diseases. They may be associated with each other. Objectives: To find the association of SLE and Autoimmune Hypothyroidism. Materials and Methods: This prospective case control study was conducted in the department of Rheumatology, CMH Dhaka from January 2017 to June 2019. Total 100 cases of SLE (Group A) were included in the study to see the presence of co-existing autoimmune hypothyroidism. Another 100 age and sex matched healthy controls without SLE (Group B) were screened for hypothyroidism. Verbal consent was taken and ethical issue was addressed. Data were collected in a pre-planned and pre-designed form after face to face interview, clinical history, physical examination and relevant laboratory investigations and plotted in tables and charts. Data were analyzed in computer SPSS Version 16. Chi-square test was done to see the level of significance. Results: Total 100 SLE patients were enrolled in this study (Group A). Age range was from 14-65. Amongst them 96 were females and only 4 were males. Majority of them belonged to 20-30 and 31-40 years age group and frequency were 40 (40%) and 35 (35%) respectively. Out of 100 SLE cases 8 patients had coexisting autoimmune hypothyroidism, 6 patients had subclinical hypothyroidism and another 4 had thyroid autoantibody with biochemically euthyroid state. Amongst the control group only 1 had hypothyroidism, 2 had subclinical hypothyroidism and 1 had thyroid autoantibody with biochemically euthyroid state. The differences in two groups were statistically significant. Conclusion: There is a strong positive association between SLE and autoimmune hypothyroidism. There are also overlapping clinical manifestations in these conditions. Therefore, thyroid screening test may be done in every case of SLE for early detection of autoimmune hypothyroidism to effectively manage both diseases. Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 10-12