Are Changes in Thyroid Hormones Associated with Mortality in Non-Thyroidal Illness Syndrome?

Introduction: Non-thyroidal illness syndrome (NTIS) can be defined as afunctional impairment of the hypothalamic-pituitary-thyroid axis accompanied by signs of non-thyroidal disease with changes in thyroid stimulating hormone (TSH), free T3 (fT3) and free T4 (fT4) levels. NTIS and thyroid hormone levels in this syndrome are thought to be related with mortality. This study was performed to evaluate the relationship between hormone levels and mortality in this syndrome. Methods: The 5-year mortality data of patients who were hospitalized in the first 6 months of 2014 and whose thyroid hormone levels could be checked twice within 5 years were evaluated. In our study conducted with 405 patients whose thyroid function tests was repeated, the follow-up period was 5 years. Biochemical parameters including thyroid function tests were sent from all patients. NTIS was defined as a condition in patients with low fT3 levels (<2.5 pg/mL) and TSH levels within the normal range (0.38-5.33 mIU / L). Results: 128 patients died, and the number of surviving patients was 277 during the follow-up period. Positive acute phase reactants such as CRP, sedimentation, ferritin was high and albumin (negative acute phase reactant) and fT3 levels were low in patients who died. In addition, these changes in biochemical values were statistically significant. The mortality rate was increased in patients with low fT3 and high fT4 levels. In the follow-up period, changes in TSH levels were not significantly associated with mortality. Conclusion: Both the decrease in fT3 levels and the increase in fT4 levels can be used as predictors and independent risk factors for long-term mortality risk in chronically ill and hospitalized patients with NTIS.

Convolutional Neural Network-Based Computer-Assisted Diagnosis of Hashimoto’s Thyroiditis on Ultrasound

Purpose This study investigates the efficiency of deep learning models in the automated diagnosis of Hashimoto’s thyroiditis (HT) using real-world ultrasound data from ultrasound examinations by computer-assisted diagnosis (CAD) with artificial intelligence. Methods We retrospectively collected ultrasound images from patients with and without HT from two hospitals in China between September 2008 and February 2018. Images were divided into a training set (80%) and a validation set (20%). We ensembled nine convolutional neural networks (CNNs) as the final model (CAD-HT) for HT classification. The model’s diagnostic performance was validated and compared from two hospital validation sets. We also compared the accuracy of CAD-HT against seniors/junior radiologists. Subgroup analysis of CAD-HT performance in different thyroid hormone levels, such as hyperthyroidism, hypothyroidism, and euthyroidism, was also evaluated. Results 39280 ultrasound images from 21118 patients were included in this study. The accuracy, sensitivity, specificity of the ensemble HT-CAD model were 0.892, 0.890 and 0.895, respectively. HT-CAD performance between two hospitals was not significantly different. The HT-CAD model achieved a higher performance (P &lt; 0.001) when compared to senior radiologists, with a nearly 9% accuracy improvement. HT-CAD had almost similar accuracy (from 0.871 to 0.894) among the three differences of thyroid hormone level subgroups. Conclusion The HT-CAD strategy based on CNN significantly improved the radiologists’ diagnostic accuracy on HT. Our model demonstrates good performance and robustness in different hospitals and for different thyroid hormone levels.

µ-Crystallin Is Associated with Disease Outcome in Head and Neck Squamous Cell Carcinoma

Thyroid hormone levels may be associated with disease outcome in head and neck squamous cell carcinoma (HNSCC). µ-Crystallin (CRYM), a thyroid hormone binding protein, blocks intracellular binding of the thyroid hormone T3 to its receptors. In this study, we aimed to analyze the association of CRYM levels with disease outcome in HNSCC patients. We retrospectively assessed immunohistochemical CRYM expression in 121 head and neck cancer patients. Preoperative thyrotropin levels could be extracted for 50 patients. Patients with low thyrotropin levels had a worse prognosis compared to euthyroid patients (5-year overall survival TSH low 20% vs. TSH norm 58%). We observed an association of CRYM+ patients with improved overall survival (5-year overall survival for CRYM+ 78.6% vs. CRYM− 56%). Interaction analysis between CRYM and HPV revealed that this effect was limited to HPV− patients (CRYM+|HPV− HR 0.12, 95% CI 0.01–0.87, p = 0.036). These results were replicated in an independent dataset. CRYM expression identified patients with favorable disease progression for HPV− HNSCC patients and could serve as a useful biomarker in this patient population. This study further confirms a correlation of thyroid hormone levels with adverse disease outcome in HNSCC patients, which could be potentially exploited as a therapeutic target.

Thyroid hormone levels in Tortoises (Testudo spp.) depending on Season and Sex

Thyroid hormones and the factors influencing them are rarely studied in tortoises. This study therefore aimed to calculate reference intervals (RI) for specific species, sexes, and seasons for thyroid hormones and iodine levels in blood of four adult Mediterranean tortoise species and to evaluate possible correlations between thyroid hormones, serum iodine, plasma protein and increased liver and kidney values. Thyroid hormones (total tetraiodothyronine [tT4], free tetraiodothyronine [fT4], total triiodothyronine [tT3], and free triiodothyronine [fT3]) were measured in plasma from adult, healthy Hermann´s (Testudo hermanni, n = 255), spur-thighed (Testudo graeca, n = 89), marginated (Testudo marginata, n = 72), and Russian tortoises (Testudo horsfieldii, n = 30). Species, sex and season specific variations were determined by Bayesian information criterion (BIC) and correlations between plasma thyroid hormones, protein, iodine and increased liver/kidney values were evaluated by Spearman’s rank correlation test. Total T4 did not reveal any species, sex, or seasonal differences (RI 0.102 to 0.455 µg/dL), while seasonal differences were found for fT4 (RI spring 0.624 to 9.012; summer 0.379 to 5.476; fall 0.376 to 5.426 pmol/L). The tT3 levels differed significantly depending on species, season, and the interaction of species x season. Seasonal differences were also found for fT3 and iodine. Several significant (p &lt; 0.05) correlations were detected between the tested analytes, especially positive correlations between tT4 and fT4. These results provide a tool for the evaluation of thyroid hormone levels in Mediterranean tortoises and indicate the influence of season on the thyroid in these animals.

THYROID FUNCTION AND MENTAL HEALTH IN CHILDBEARING AGE WOMEN

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.