A Hidden Link between Subclinical Hypothyroidism and Depression: A literature Review

The association between Subclinical hypothyroidism and Depression is recognised. It is found that patients with Thyroid disorders are more prone to develop depressive symptoms and depression may be accompanied by various subtle thyroid abnormalities. The most commonly documented abnormalities are elevated T4 levels, Low T3, elevated rT3, a blunted TSH response to TSH, Positive anti thyroid autoantibodies and elevated CSF TRH concentrations. It is also found that thyroid hormone supplements appear to accelerate and enhance the clinical response to antidepressants. It is found out that Depression is associated with changes in Hypothalamic-pituitary axis as thyroid hormones act on the central nervous system. Mild thyroid dysfunction causes depression in younger patients (<60 years old) diagnosed by depressive scale. It was found that differences in age group may cause depressive episodes. Depressive episodes such as anxiety and the risk of committing suicide are considerable factors that differ according to the age of the individuals.SCH was found to be associated with depression in the younger adults (<60 years old). The only difference between SCH and normal thyroid function is TSH.In depressive disorder and subclinical hypothyroidism sex differences have also been recognised. Association between subclinical hypothyroidism and Depression is assessed by various depressive scores such as Beck Depression Inventory and Hamilton depression rating scale. As Subclinical hypothyroidism is associated with low mood, Serum levels of TSH, FT3, FT4 and Hamilton depression, treatment with Levothyroxine showed significant decrease is TSH levels and Hamilton scores were decreased. Since the prevalence of depressive symptoms in hypothyroidism is high TSH cut-off levels is used,TSH cut off value for hypothyroidism is based on associated symptoms,TSH cut-off value is 2.5 MIU/L is optimal

A Hidden Link between Subclinical Hypothyroidism and Depression: A literature Review

The association between Subclinical hypothyroidism and Depression is recognised. It is found that patients with Thyroid disorders are more prone to develop depressive symptoms and depression may be accompanied by various subtle thyroid abnormalities. The most commonly documented abnormalities are elevated T4 levels, Low T3, elevated rT3, a blunted TSH response to TSH, Positive anti thyroid autoantibodies and elevated CSF TRH concentrations. It is also found that thyroid hormone supplements appear to accelerate and enhance the clinical response to antidepressants. It is found out that Depression is associated with changes in Hypothalamic-pituitary axis as thyroid hormones act on the central nervous system. Mild thyroid dysfunction causes depression in younger patients (<60 years old) diagnosed by depressive scale. It was found that differences in age group may cause depressive episodes. Depressive episodes such as anxiety and the risk of committing suicide are considerable factors that differ according to the age of the individuals.SCH was found to be associated with depression in the younger adults (<60 years old). The only difference between SCH and normal thyroid function is TSH.In depressive disorder and subclinical hypothyroidism sex differences have also been recognised. Association between subclinical hypothyroidism and Depression is assessed by various depressive scores such as Beck Depression Inventory and Hamilton depression rating scale. As Subclinical hypothyroidism is associated with low mood, Serum levels of TSH, FT3, FT4 and Hamilton depression, treatment with Levothyroxine showed significant decrease is TSH levels and Hamilton scores were decreased. Since the prevalence of depressive symptoms in hypothyroidism is high TSH cut-off levels is used,TSH cut off value for hypothyroidism is based on associated symptoms,TSH cut-off value is 2.5 MIU/L is optima

Association of Reduced Free T3 to Free T4 Ratio with Lower Serum Creatinine in Japanese Hemodialysis Patients

Purpose: Low T3 syndrome is defined by a fall in free triiodothyronine (FT3) in spite of normal serum thyroid-stimulating hormone (TSH) and often normal free thyroxin (FT4). A low FT3/FT4 ratio, a relevant marker for low T3 syndrome, is known as a risk of mortality in hemodialysis (HD) patients, as well as low muscle mass in the general population. Because of the local activation of T4 to FT3 in muscle tissue, we examined the association of FT3/FT4 ratio with serum creatinine, a marker of muscle mass and strength in HD patients to investigate the significance of muscle tissue in the development of low T3 syndrome in HD patients. Methods: This was a cross-sectional study derived from our prospective cohort study, named DREAM, of Japanese HD patients. After the exclusion of patients with treated and untreated thyroid dysfunction, 332 patients were analyzed in the study. Results: The serum FT4 and TSH of HD patients (n = 332) were 0.9 ± 0.1 ng/dL. and 2.0 ± 0.9IU/mL, which were within the respective normal range, while serum FT3 was 2.2 ± 0.3 pg/mL. As many as 101 out of 332 (30.4%) HD patients exhibited a serum FT3 less than the normal lower limit of 2.2 pg/mL. The serum FT3/FT4 ratio correlated significantly positively with serum creatinine, and inversely with serum log CRP and total cholesterol, while it exhibited a tendency towards positive correlation with serum albumin. Multiple regression analysis, which included serum creatinine, albumin, and log CRP, simultaneously, in addition to sex, age, diabetic kidney disease or not, log HD duration, body mass index, systolic blood pressure, and Kt/V, as independent variables, revealed an independent and significant positive association of serum creatinine, but not serum albumin or CRP, with the serum FT3/FT4 ratio. Conclusions: The present study demonstrated an independent and positive correlation of serum creatinine with the serum FT3/FT4 ratio in HD patients. The lack of association of the serum FT3/FT4 ratio with serum albumin and CRP suggested the presence of a creatinine-specific mechanism to associate with serum FT3/FT4 ratio. Because of the local activation of T4 to T3 at muscle tissue, a lower muscle mass may be causatively associated with low T3 syndrome.

Safety of PRRSV-2 MLV vaccines administrated via the intramuscular or intradermal route and evaluation of PRRSV transmission upon needle-free and needle delivery

Two distinct experiments (Exp) were conducted to evaluate the shedding and efficacy of 2 modified live porcine reproductive and respiratory syndrome virus (PRRSV) type 2 vaccines (MLV) when administered intramuscularly (IM) or intradermally (ID) (Exp A), and the potential of PRRSV transmission using a needle-free device (Exp B). One-hundred fifty-four, 3-week-old castrated-male, pigs were procured from a PRRSV-free herd. In Exp A, 112 pigs were randomly allocated into 4 groups of 21 pigs including IM/Ingelvac MLV (G1), IM/Prime Pac (G2), ID/Prime Pac (G3), and non-vaccination (G4). Twenty-eight remaining pigs were served as non-vaccination, age-matched sentinel pigs. G1 was IM vaccinated once with Ingelvac PRRS MLV (Ing) (Boehringer Ingelheim, Germany). G2 and G3 were IM and ID vaccinated once with a different MLV, Prime Pac PRRS (PP) (MSD Animal Health, The Netherlands), respectively. Following vaccination, an antibody response, IFN-γ-SC, and IL-10 secretion in supernatants of stimulated PBMC were monitored. Sera, tonsils, nasal swabs, bronchoalveolar lavage, urines, and feces were collected from 3 vaccinated pigs each week to 42 days post-vaccination (DPV) and assayed for the presence of PRRSV using virus isolation and qPCR. Age-matched sentinel pigs were used to evaluate the transmission of vaccine viruses and were introduced into vaccinated groups from 0 to 42 DPV. Seroconversion was monitored. In Exp B, 42 pigs were randomly allocated into 5 groups of 3 pigs each including IM/High (T1), ID/High (T2), IM/Low (T3), ID/Low (T4), and NoChal. Twenty-seven remaining pigs were left as non-challenge, age-matched sentinel pigs. The T1 and T2, and T3 and T4 groups were intranasally challenged at approximately 26 days of age with HP-PRRSV-2 at high (106) and low (103 TCID50/ml) doses, respectively. At 7 days post-challenge, at the time of the highest viremia levels of HP-PRRSV-2, T1 and T2, and T3 and T4 groups were IM and ID injected with Diluvac Forte using needles and a need-less device (IDAL 3G, MSD Animal Health, The Netherlands), respectively. Same needles or needle-less devices were used to inject the same volume of Diluvac Forte into sentinel pigs. Seroconversion of sentinels was evaluated. The results demonstrated that PP vaccinated groups (G2 and G3), regardless of the route of vaccination, had ELISA response significantly lower than G1 at 7 and 14 DPV. PP-vaccinated groups (G2 and G3) had significantly higher IFN-γ-SC and lower IL-10 secretion compared to the Ing-vaccinated group (G1). The two different MLV when administered intramuscularly demonstrated the difference in virus distribution and shedding patterns. PP-vaccinated pigs had significantly shortened viremia than the Ing-vaccinated pigs. However, ID-vaccinated pigs had lower virus distribution in organs and body fluids without virus shedding to sentinel pigs. In Exp B, regardless of the challenge dose, sentinel pigs intradermally injected with the same needle-less device used to inject challenged pigs displayed no seroconversion. In contrast, sentinel pigs intramuscularly injected with the same needle used to inject challenged pigs displayed seroconversion. The results demonstrated the transmission of PRRSV by using a needle, but not by using a needle-less device. In conclusion, our results demonstrated that ID vaccination might represent an alternative to improve vaccine efficacy and safety, and may be able to reduce the shedding of vaccine viruses and reduce the iatrogenic transfer of pathogens between animals with shared needles.

Hypovitaminosis D and Low T3 Syndrome: A Link for Therapeutic Challenges in Patients with Acute Myocardial Infarction

Background and Aims: Vitamin D counteracts the reduction in the peripheral conversion of tiroxine (T4) into triiodothyronine (T3), which is the mechanism of low T3 syndrome (LT3) in acute myocardial infarction (AMI). The aim of this study was to assess the relationship between LT3 and hypovitaminosis D in AMI patients. Methods and Results: One hundred and twenty-four AMI patients were enrolled. Blood samples were taken at admission, and at 3, 12, 24, 48, and 72 h after admission. LT3 was defined as a value of fT3 ≤ 2.2 pg/mL, occurring within 3 days of hospital admission. Levels were defined as follows: sufficiency as a value of ±30 ng/mL, vitamin D insufficiency as 25-hydroxyvitamin D (25(OH)D) between 21 and 29 ng/mL, deficiency in 25(OH)D as below 20 ng/mL, and severe deficiency as values under 10 ng/mL. The percentage of subjects with severe 25(OH)D deficiency was significantly higher in the LT3 group (33% vs. 13%, p < 0.01). When LT3S was evaluated as a dependent variable, severe 25(OH)D deficiency (OR 2.6: 95%CI 1–6.7, p < 0.05) remained as an independent determinant after logistic multivariate adjustment together with age (>69 yrs, 50th percentile; OR 3.4, 95% CI 1.3–8.3, p < 0.01), but not female gender (OR 1.7, 95% CI 0.7–4.2, p = ns). Conclusions: This pilot study shows a relationship between hypovitaminosis D and LT3 in AMI patients. This association opens potential therapeutic challenges concerning the restoration of euthyroidism through vitamin D administration, together with the normalization of hypovitaminosis.

Effect of serum bisphenol A and low T3 on short-term prognosis of young patients with intracerebral hemorrhage

BackgroundBisphenol A (BPA) is widely present in daily necessities, and its exposure is almost everywhere. We aimed to evaluate the relationship between serum BPA levels, biomarkers and recent mortality in young patients with intracerebral hemorrhage (YICH) and low T3 .MethodsUsing a multi-center longitudinal prospective study, the research team recruited 600 YICH patients and divided into two subgroups according to their thyroid function, of which 320 (53.3%) were in the LT3, Sub-clinical hypothyroidism (SCH) was 280 (46.6%) and control group (n = 600).All patients received serum BPA, and biomarker blood draws.ResultsCalculating the cumulative quantification of plastic bag products, BPA increased by 0.204 standard deviation unit per log unit (P<0.003). Serum BPA, thrombin and matrix metalloproteinase (MMP-9) {BPA (0.91±0.14) vs (0.765±0.13) vs. (0.535±0.11) pg/ml, thrombin (1.35±0.18) vs (0.66±) 0.15) vs (0.66 ±0.15) ng/ml, MMP-9 (104±10 vs (53±8.1) vs (53±) 8.1) pg/ml, both P<0.01}. Linear correlation analysis showed that serum BPA was positively correlated with miR-388-3p and 24hDBPCV, and negatively correlated with LT3 and miR-451. Multiple linear regression showed that BPA affected the increase of nDBP Percentage of independent risk factors (β = 0.286), P <0.01. Mortality rate showed 2 ,15 and 30 days of patients in the LT3 and the SCH of 4.7%vs 2.5%,6.25% vs 3.75%,4.68%vs 2.5%, P<0.01.ConclusionHigh BPA exposure strongly predicts the risk of ICH in young patients. The activation of NF-κB signaling pathway, secondary thyroid function, ambulatory blood pressure scores, and changes in messenger ribonucleic acid construct an inflammatory response system. There are also significant differences in recent mortality between the LT3 group and the SCH group.Trial registrationThe trial is registered at clinical .gov (www.medresman.Chi CTR1900023626)

Low triiodothyronine levels correlate with high B-type natriuretic peptide levels in patients with heart failure

Thyroid hormone metabolism can be closely associated with cardiovascular disorders. We examined the relationship between low triiodothyronine (T3) levels and heart failure status, including B-type natriuretic peptide (BNP) levels, in 625 patients with cardiovascular disorders who underwent cardiac catheterization. A multiple regression analysis revealed that the left ventricular ejection fraction (LVEF), hemoglobin (Hb) levels, sex (male), free T3 (FT3) levels, and estimated glomerular filtration rate (eGFR) were significantly negatively associated with the log BNP value, while age was significantly positively associated with the log BNP value (P < 0.001 each). Furthermore, the log BNP and age were significantly negatively associated with the FT3 levels, while the Hb and body mass index (BMI) were significantly positively associated with the FT3 levels (P < 0.001 each). Theoretically constructed structure equation modeling (SEM) revealed an inverse association between FT3 and BNP (β = −0.125, P = 0.002), and the same relationship remained in the patient group with normal-range BNP values (β = −0.198, P = 0.008). We demonstrated a significant relationship between high BNP and low serum FT3 levels, and this relationship remained significant in patients with normal BNP levels. These results indicate that low T3 is associated with high plasma BNP levels rather than worsening of hemodynamics.

Thyroid Function Test in Patients with Chronic Kidney Disease

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.

Clinical characteristics of cardiovascular patients with extremely low levels of high-density lipoprotein cholesterol

Background Extremely low levels of high-density lipoprotein cholesterol (HDL-C) are related to high cardiovascular mortality. The underlying mechanism is not well known. This research aims to study the clinical characteristics of cardiovascular patients with extremely low levels of HDL-C. Methods All cardiovascular patients in a single Chinese cardiology center that were admitted from January to December 2019 were reviewed. The clinical characteristics of those with HDL-C<20 mg/dL were investigated. Results A total of 20,655 individuals were enrolled. Of these, 52.17 % were males, and the average age was 58.20 ± 12.98 years old. The prevalence of HDL-C<20 mg/dL was 0.47 % for all patients (N=98) and 1.05 % for inpatients. Of those with HDL-C<20 mg/dL, 88.8 % were inpatients, and 77.6 % were males. Their average age was 60.7 ± 15.1 years. Compared with matched patients with normal HDL-C, systemic inflammation (OR= 5.556, 95% CI 2.798–11.030), hypoalbuminemia (OR=5.714, 95% CI 2.702–12.085), hyperuricemia (OR=5.156, 95% CI 2.560–10.386), low T3 syndrome (OR=4.278, 95% CI 1.627–11.245), anemia (OR=3.577, 95% CI 1.680–7.617), diabetes (OR=3.534, 95% CI 1.693–7.376) and hypertriglyceridemia (OR=2.493, 95% CI 1.264–4.918) were identified as adverse concomitant factors of extremely low HDL-C. HDL-C levels were inversely correlated with the total risk scores in patients with HDL-C<20 mg/dL (r=-0.381, P<0.001) and more significantly correlated in patients with HDL-C<15 mg/dL (r=-0.511, P=0.004). Conclusions Extremely low levels of HDL-C tend to occur more frequently in males, older individuals and inpatients. For cardiovascular patients, extremely low levels of HDL-C are usually due to the presence of multiple adverse factors with relatively severe conditions. This could explain the high cardiovascular mortality of individuals with extremely low levels of HDL-C.