STUDY ON THYROID ABNORMALITY AMONG CHRONIC KIDNEY DISEASE PATIENTS

Chronic Kidney Disease is a worldwide health problem with an increasing incidence and prevalence. Abnormalities in the structure and function of the thyroid gland and in the metabolism and plasma concentration of thyroid hormones are common in patients with Chronic Kidney Disease. Patients with CKD having many signs and symptoms suggestive of thyroid dysfunction like sallow complexion, edema, dry skin, cold intolerance, decreased BMR, asthenia and hyporeexia. So in cases of CKD, it is difcult to exclude thyroid dysfunction on mere clinical background. Total number of 100 patients with Chronic Kidney Disease were selected in this prospective study. 100 patients with Chronic Kidney Disease (CKD) fullling the criteria for CKD who were on conservative management were studied, among these 100 patients 70 were male and 30 were female Among the 100 patients in our study 55 of them had low serum T3 levels (55%), 17 patients among the low serum T3 level also had high TSH value of >20 ILIU/m1 with low T4 levels and also symptoms suggestive of hypothyroidism.

A CLINICAL STUDY OF THYROID DYSFUNCTION IN OVERWEIGHT AND OBESE PATIENT-A HOSPITAL BASED STUDY

To find out thyroid hormone profile (Serum T3, T4, TSH level) in overweight and obese subjects of either sex and age. (18-60 yrs.) This study was undertaken to find out relationship between thyroid function tests with overweight and obesity. Methods: A cross sectional study was conducted in the Medicine Department of Jhalawar Medical College. Approximately overweight and obese patient of BMI >25 come in to OPD or emergency department & admitted in Jhalawar hospital. Total 100 subjects taken for study which fulfil the inclusion and exclusion criteria of study. Results: In our study, Maximum 3 (50%) hypothyroid patient had extremely risk of obesity having BMI >40 and 4 (28.6%) patient having very high risk obesity BMI 35-40 and 6 (18.75%) patient having high risk BMI 30-35 and only 6 (12.5%) patient having BMI 25-30 overweight (low risk) patient. Conclusion: This study concludes that obesity increases the risk of hypothyroidism, which is more common among, younger female than males. in this study some overweight and obese subject were found both clinically and biochemically hypothyroid and some subject are found only biochemically hypothyroid.

Monocarboxylate Transporter 8 Deficiency: From Pathophysiological Understanding to Therapy Development

Genetic defects in the thyroid hormone transporter monocarboxylate transporter 8 (MCT8) result in MCT8 deficiency. This disorder is characterized by a combination of severe intellectual and motor disability, caused by decreased cerebral thyroid hormone signalling, and a chronic thyrotoxic state in peripheral tissues, caused by exposure to elevated serum T3 concentrations. In particular, MCT8 plays a crucial role in the transport of thyroid hormone across the blood-brain-barrier. The life expectancy of patients with MCT8 deficiency is strongly impaired. Absence of head control and being underweight at a young age, which are considered proxies of the severity of the neurocognitive and peripheral phenotype, respectively, are associated with higher mortality rate. The thyroid hormone analogue triiodothyroacetic acid is able to effectively and safely ameliorate the peripheral thyrotoxicosis; its effect on the neurocognitive phenotype is currently under investigation. Other possible therapies are at a pre-clinical stage. This review provides an overview of the current understanding of the physiological role of MCT8 and the pathophysiology, key clinical characteristics and developing treatment options for MCT8 deficiency.

Efficacy and safety of Barg-e-Sahajna (Moringa olifera Lam.) in primary hypothyroidism

Objectives Hypothyroidism is the most common disorder arising from hormone deficiency. It frequently affects women than men. The prevalence of overall hypothyroidism has been reported to be 4.8–11%. Levothyroxine is the treatment of choice for all types of hypothyroidism. The purpose of this pilot study was to evaluate the efficacy and safety of Barg-e-Sahajna (Leaves of Moringa olifera Lam.) among diagnosed patients of primary hypothyroidism. Methods This study was an open observational study. A total of 22 patients were screened, out of which 10 were excluded (did not meet inclusion criteria) and 2 refused to consent to be part of the study, rest 10 participants were enrolled after obtaining written informed consent finally 8 subjects completed the study and 2 are dropout in last follow up. The drug was given in the form of decoction at the dose of 5 g fresh leaves twice a day after meal for 45 days. Results The study effects on objective parameter thyroid stimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4) were found extremely significant when compared before (16.62 ± 11.49, 132 ± 19.32, 9.28 ± 1.46) and after (4.75 ± 3.12, 150.37 ± 20.68, 11.84 ± 3.81) treatment with a significant decrease in serum TSH level (p<0.0246) and an increase in serum T3 (p<0.0005) and T4 (p<0.0438) levels. The results were analyzed using paired “t” test. Conclusions The improvements in thyroid profiles (TSH, T3 and T4) after consuming ‘Barg-e-Sahajna’ show that the test drug is effective in primary hypothyroidism and the relief was considerable. No significant effect on safety parameters (serum-glutamic-oxaloacetic-transaminase [SGOT], serum glutamic-pyruvic transaminase [SGPT], blood urea, and serum creatinine) was observed. Therefore, it may be concluded that the Barg-e-Sahajna is preliminarily safe and effective in the management of primary hypothyroidism.

Efficacy and safety of Barg-e-Sahajna (Moringa oleifera Lam.) in primary hypothyroidism

Objectives Hypothyroidism is the most common disorder arising from hormone deficiency. It frequently affects women than men. The prevalence of overall hypothyroidism has been reported to be 4.8–11%. Levothyroxine is the treatment of choice for all types of hypothyroidism. The purpose of this pilot study was to evaluate the efficacy and safety of Barg-e-Sahajna (Leaves of Moringa oleifera Lam.) among diagnosed patients of primary hypothyroidism. Methods This study was an open observational study. A total of 22 patients were screened, out of which 10 were excluded (did not meet inclusion criteria) and 2 refused to consent to be part of the study, rest 10 participants were enrolled after obtaining written informed consent finally 8 subjects completed the study and 2 are dropout in last follow up. The drug was given in the form of decoction at the dose of 5 g fresh leaves twice a day after meal for 45 days. Results The study effects on objective parameter thyroid stimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4) were found extremely significant when compared before (16.62 ± 11.49, 132 ± 19.32, 9.28 ± 1.46) and after (4.75 ± 3.12, 150.37 ± 20.68, 11.84 ± 3.81) treatment with a significant decrease in serum TSH level (p<0.0246) and an increase in serum T3 (p<0.0005) and T4 (p<0.0438) levels. The results were analyzed using paired “t” test. Conclusions The improvements in thyroid profiles (TSH, T3 and T4) after consuming ‘Barg-e-Sahajna’ show that the test drug is effective in primary hypothyroidism and the relief was considerable. No significant effect on safety parameters (serum-glutamic-oxaloacetic-transaminase [SGOT], serum glutamic-pyruvic transaminase [SGPT], blood urea, and serum creatinine) was observed. Therefore, it may be concluded that the Barg-e-Sahajna is preliminarily safe and effective in the management of primary hypothyroidism.

EXTENDED ABSORPTION OF LIOTHYRONINE FROM POLY-ZINC LIOTHYRONINE (PZL) IN HUMANS

Background: Liothyronine (LT3) has been increasingly used in combination with levothyroxine (LT4) in the treatment of hypothyroidism. A metal coordinated form of LT3, known as poly-zinc-liothyronine (PZL), avoided in rats the typical T3 peak seen after oral administration of LT3. Objectives: To evaluate in healthy volunteers (i) the pharmacokinetics of PZL-derived T3 after a single dose, (ii) the pharmacodynamics of PZL-derived T3, (iii) monitoring for the adverse events; (iv) exploratory analysis of the sleep patterns after LT3, PZL or placebo administration. Methods: 12 healthy volunteers 18 to 50 years of age were recruited for a Phase 1, double-blind, randomized, single-dose placebo-controlled, cross-over study to compare PZL against LT3 or placebo. Subjects were admitted three separate times to receive a randomly assigned capsule containing placebo, 50-mcg LT3, or 50-mcg-PZL, and were observed for 48h. A 2-week wash-out period separated each admission. Results: LT3-derived serum T3 levels exhibited the expected profile, with a Tmax at 2h and return to basal levels by 24-36h. PZL-derived serum T3 levels exhibited a ~30% lower Cmax that was 1 h delayed and extended into a plateau that lasted up to 6h. This was followed by a lower but much longer plateau; by 24 hours serum T3 levels still exceeded 1/2 of Cmax. TSH levels were similarly reduced indistinguishably in both groups. Conclusion: PZL possesses the necessary properties to achieve a much improved T3 pharma-cokinetic. Drug product development of PZL should improve the delivery of T3 even further. PZL is on track to provide hypothyroid patients with stable levels of serum T3.

T3 as predictor of mortality in any cause non-critically ill patient

Background: Low T3 syndrome refers to a set of thyroid hormone metabolism alterations present in disease state. A correlation between low T3 and poor clinical outcomes in the intensive care unit is more established. Nonetheless, studies on non-critically ill patients are few and controversial. Objective: To evaluate the prevalence and predictive value of low T3 levels on 30 days- and six month-term mortality in non-critically ill patients. Secondary outcomes evaluated length of hospital stay, overall mortality, and hospital readmission. Design: Prospective cohort study. Methods: 345 consecutive patients from Internal medicine ward of a tertiary hospital in southern Brazil included from October 2018 to April 2019 and followed for 6 months. Levels of total serum T3 were measured weekly, from admission to discharge, and correlated with 30-day hospital mortality. Results: Prevalence of low T3 was 36.6%. Low T3 levels were associated with higher 30-days hospital mortality (15.1% versus 4.1%, p<0.001) and higher 6-months overall mortality (31.7% versus 13.2%, p<0.001). Total serum T3 at admission was an independent predictor of 30-days hospital mortality. Conclusion: Low T3 levels are a prevalent condition among non-critically ill patients and this condition is associated with poor clinical outcomes in this population. Total serum T3 levels, alone or in association with other predictive scores, were demonstrated to be an easy and valuable tool for risk stratification, and should be further employed in this setting.

Assessment of prognostic value of FT3, FT4 and TSH among critically ill patients

Background: Thyroid dysfunction is found to be associated with increased morbidity and mortality rates in intensive care unit (ICU) admitted patients. Critically ill patients who were admitted to ICU showed free triiodothyronine (FT3) levels to be an independent and important predictor of mortality. Decreased levels of free thyroxine (T4) and thyroid stimulating hormone (TSH) showed an indication of worsening of disease and poor prognosis. The most common thyroid hormonal change reported in critically ill patients is reduced serum T3 level. The aim of this study was assessment and prognostic value of thyroid function values among critically ill patients.Methods: The prospective observational study was conducted at department of medicine, at tertiary care hospital of Kanpur, India on 100 critically ill patients admitted who were more than 18 years of age. Patients with history s/o previous thyroid illness and documented thyroid disease, and clinically evident thyroid enlargement were excluded from the study.Results: 50 (50.0%) of 100 patients were males and 50 (50.0%) were females. A total 44.0% mortality was reported with 57±11.96 years of mean age of non-survivors. Only FT3 of thyroid functions have shown statistically highly significant differences (p<0.01). Conclusions: In our study patient admitted in ICU, FT3 was the strongest predictor of ICU mortality in comparison to all other important parameters included in our study.