Autoimmune thyroid disease in diabetic children and adolescents: a single center study from south Punjab

Objective: To evaluate the prevalence of autoimmune thyroid disease (AITD) in diabetic children in south Punjab. Methods: This was an observational cross sectional study from Jan 2019 to Dec 2019 in the outpatient diabetic clinic of the department of pediatric endocrinology at Children Hospital and The Institute of Child Health Multan. A total of 161 consecutive patients of both genders with TIDM were enrolled in this study after taking informed consent. Blood samples for Thyroid functions testes including thyroid stimulating hormone (TSH), free thyroxin (fT4), Thyroid peroxidase antibody (TPO-Ab), thyroglobulin antibody (TG-Ab) and glycosylated hemoglobin (HbA1C) level were sent. Results: Among diabetic children males were 83 (51.6%). Age range was 2-15 years. Mean age and standard deviation was 9.7± 4.3. TPO-Ab was positive in 34 patients (21.1%) and TG-Ab in 27 patients (16.7%), whereas both antibodies were positive in 17 patients (10.5%). Six patients (3.7%) had evidence of subclinical hypothyroidism, 8 patients (4.9%) had overt hypothyroidism and 1 patient (0.62%) had hyperthyroidism Conclusion: The prevalence of AITD among children and adolescents with type 1 diabetes mellitus was 21.1% in our study. Hypothyroidism was more prevalent in these children compared to hyperthyroidism. All diabetic children should be screened for AITD. Thyroid functions should be checked where TPO antibody is positive. Keywords: Autoimmune thyroid disease, anti thyroid peroxidase antibody, anti thyroglobulin Continuous...

Surgical Outcome and Malignant Risk Factors in Patients With Thyroid Nodule Classified as Bethesda Category III

BackgroundThyroid nodules are a very common finding in the general population. Fine-needle aspiration (FNA) has been recommended as the initial test for the evaluation of thyroid nodules. The trend on reporting as atypia of undetermined significance (AUS) has been significantly increased, but the malignant risk is still controversial among different studies. The aim of this study is to investigate the malignancy risk of thyroid nodules reported as Bethesda category III (AUS/FLUS) on initial FNA.MethodWe reviewed 272 papillary thyroid cancer (PTC) patients with suspicious thyroid nodules who underwent fine-needle aspiration and received surgical treatment during 2019 to 2020.ResultsOne hundred ten (40.4%) patients were diagnosed with PTC. Multivariate analysis showed that microcalcification (p = 0.037, OR = 2.260, 95% CI: 1.051–4.860), shape (p = 0.003, OR = 4.367, 95% CI: 1.629–11.705), diameters (p = 0.002, OR = 0.278, 95% CI: 0.123–0.631), anti-thyroglobulin antibodies (TGAb) (p = 0.002, OR = 0.150, 95% CI: 0.046–0.494), anti-thyroid peroxidase antibody (A-TPO) (p = 0.009, OR = 4.784, 95% CI: 1.486–15.401), and nodule goiter (p < 0.001, OR = 0.100, 95% CI: 0.046–0.217) were independent malignant risk factors in patients with thyroid nodule classified as Bethesda category III.ConclusionIn this study, malignant risk factors in patients with thyroid nodule classified as Bethesda category III were significantly associated with preoperative serum TGAb, A-TPO, microcalcification, irregular shape, and nodule diameters. Nodules with malignant factors should be carefully elevated; surgery may be the better option for those patients.

Peri conceptional association of the triad of hyperhomocsteinemia, hypothyroidism and impaired carbohydrate metabolism with recurrent pregnancy loss

Background: Recurrent pregnancy loss is a cause of great concern to the affected couple as well as the treating physician. We evaluated the periconceptional association of the triad of hyperhomocystienemia, hypothyroidism, and impaired carbohydrate metabolism with RPL and to identify the potential risk factors for RPL which are probably nutritional.Methods: Seven hundred ninety-six consecutive pregnancies with two or more abortions referring to our Infertility clinic were selected to be studied in a descriptive, prospective observational study in 2012-2014. All the pregnant women were subjected to routine blood tests/ examination/ imaging as per hospital protocols. All underwent TSH, FT4, GTT 75 gm (fasting and 2 h postprandial) as per routine antenatal workup. Additionally, fasting plasma homocysteine, antinuclear antibody, anti phospholipid antibody, anti- thyroid peroxidase antibody tests were performed for patients with RPL. All the patients were studied for the triad of hypothyroidism, hyperhomocysteinemia and impaired carbohydrate metabolism.Results: The incidence of RPL was found to be 5.65 %. Majority of women (51.1%) were in the age group 30-34 years. Majority of the women (55.6%) had 2 previous abortions. Majority of women (57.7%) had conceived normally. Majority of women (46.7%) had BMI<25. PCOS was reported in 28.9% women. HHcy, hypothyroidism and impaired carbohydrate metabolism was found in 78%, 73% and 73% women, respectively. The presence of two factors was reported in 60 to 65% women. 56% women reported the presence of the triad. About 7% of the patients underwent repeat abortion in second trimester of which 66.6% had the association of triad.Conclusions: Investigating these three factors in patients with RPL would help in early recognition, monitoring, and aggressive surveillance, which will help prevent obstetric complications. Simple nutritional correction may allow for better maternal and fetal programming and appropriate risk modulation.

Comparison of the Frequency of Raised Level of Anti-Thyroid Peroxidase Antibody in the Patients of Hypothyroidism and the Euthyroids

The goal of this study was to compare the frequency of raised level of anti-thyroid peroxidase antibody in patients of hypothyroidism and the euthyroids. This case-control study was carried out at the department of Pathology, Quaid e Azam Medical College/Bahawal Victoria Hospital, Bahawalpur, from October 1, 2018 to Setember 30, 2019 and the subjects were selected by the non-probabilty consecutive sampling technique. The frequency of raised level of anti-thyroid peroxidase antibody in patients of hypothyroidism and the euthyroids was compared. In the present study, the mean age of the patients with cases of hypothyroidism was 32 ± 10 years, and the mean age of controls was 32 ± 10 years. Raised anti-thyroid peroxidase antibodies were found in 20 (28.99%) cases and 5 (7.25%) controls. After applying a Chi-squared test, a statistically significant (P = .00) difference in the level of anti-thyroid peroxidase antibodies between the cases and controls was detected. The presence of raised anti-thyroid peroxidase antibodies was also significantly associated with age and female gender. In conclusion the early screening of the anti-thyroid peroxidase antibodies specially in women above 30-years would notably affect the outcome of the disease with congruent disease management.he euthyroids was compared. In the present study, the mean age of the patients with cases of hypothyroidism was 32 ± 10 years, and the mean age of controls was 32 ± 10 years. Raised anti-thyroid peroxidase antibodies were found in 20 (28.99%) cases and 5 (7.25%) controls. After applying a Chi-squared test, a statistically significant (P = .00) difference in the level of anti-thyroid peroxidase antibodies between the cases and controls was detected. The presence of raised anti-thyroid peroxidase antibodies was also significantly associated with age and female gender. In conclusion the early screening of the anti-thyroid peroxidase antibodies specially in women above 30-years would notably affect the outcome of the disease with congruent disease management.

Hyperthyroidism Prevalence in China After Universal Salt Iodization

BackgroundUniversal salt iodization (USI) was implemented in mainland China in 1996. The prevalence of hyperthyroidism and its risk factors now require examination.MethodsData were acquired from a nationwide Thyroid, Iodine, and Diabetes Epidemiological survey (TIDE 2015–2017) of 78,470 subjects from 31 provinces. Iodine status, and thyroid hormones and antibodies were measured. ResultsAfter two decades of USI, the prevalence of overt hyperthyroidism (OH), Graves’ disease (GD), severe subclinical hyperthyroidism (severe SCH), and mild subclinical hyperthyroidism (mild SCH) in mainland China was 0.78%, 0.53%, 0.22%, and 0.22%, respectively. OH and GD prevalence were higher in women than in men (OH: 1.16% vs. 0.64%, P&lt;0.001; GD: 0.65% vs. 0.37%, P&lt;0.001).Prevalence was significantly decreased after 60 years-of-age compared with 30–39 years-of-age (OH:0.61% vs. 0.81%, P&lt;0.001; GD: 0.38% vs. 0.57%, P&lt;0.001).Excessive iodine(EI) and deficient iodine(DI) were both related to increased prevalence of OH (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.68–2.59; OR1.35, 95%CI 1.07–1.72, respectively); however, only deficient iodine was associated with increased prevalence of GD (OR1.67, 95%CI 1.30–2.15). Increased thyroid peroxidase antibody and thyroglobulin antibody levels were significantly associated with prevalence of OH and GD, but not severe SCH and mild SCH. Although hyperthyroidism was more prevalent in women, the association disappeared after adjusting for other factors such as antibody levels.ConclusionOH and GD prevalences in mainland China are stable after two decades of USI. Iodine deficiency, elevated thyroid antibody levels, and middle age are the main risk factors for OH and GD. The severe SCH population, rather than the mild SCH population, shows similar characteristics to the OH population.

Role of the Specialized Pro-resolving Mediator Resolvin D1 in Hashimotoʼs Thyroiditis

Objective Resolvins are produced by the catabolism of polyunsaturated fatty acids (PUFAs) and play vital roles in inflammation resolution. Resolvins have been associated with autoimmune disorders. This study aimed to measure the level of Resolvin D1 (RVD1) in the serum of Hashimoto's thyroiditis (HT) patients and healthy controls (HCs) and to further analyse its correlation with thyroid autoantibodies and inflammatory factors. Methods Sixty-three participants were recruited, namely, 30 untreated HT patients and 33 sex- and age-matched HCs. Serum RVD1 and inflammatory chemokine (MCP-1 and IP-10) levels were measured by ELISA according to the manufacturer’s protocol. Serum total T3 (TT3), TT4, free T3 (FT3), FT4, thyroglobulin antibody (TgAb), thyroid peroxidase antibody (TPOAb) and thyroid-stimulating hormone (TSH) levels were measured using an electrochemiluminescence immunoassay. Thyroid homeostasis parameters, including the thyroid secretory capacity (SPINA-GT), the total deiodinase activity (SPINA-GD), Jostel’s TSH index (TSHI) and the thyrotroph thyroid hormone sensitivity index (TTSI), were calculated. Results Serum RVD1 levels in HT patients (134.76, 85.35–201.36 pg/mL) were significantly lower than those in HCs (187.64, 131.01–326.85 pg/mL) (P=0.004). As the TPOAb level increased, the RVD1 level showed a decreasing trend (P for trend=0.002). Both multinomial and ordinal logistics analyses revealed that serum RVD1 levels were negatively correlated with TPOAb levels in the adjusted models. Moreover, RVD1 showed a negative correlation with the inflammatory chemokine IP-1 0 (r=–0.276, P=0.034), TSHI (r=–0.269, P=0.036) and TTSI (r=–0.277, P=0.031). Conclusions Thyroid autoimmunity may be associated with low levels of RVD1. Decreased RVD1 levels indicate impaired resolution of inflammation in HT patients.