TSH DAN fT4 DENGAN INDEKS MASSA TUBUH (IMT) PADA PASIEN DEWASA: STUDI CROSS-SECTIONAL DI KLINIK LITBANGKES MAGELANG

Latar Belakang. Disfungsi tiroid terjadi jika fungsi kelenjar tiroid terganggu, ditandai dengan kadar Thyroid Stimulating Hormone (TSH) dan free Thyroxine (fT4) yang lebih tinggi atau lebih rendah dari normal. Perubahan kadar hormon tiroid menyebabkan perubahan basal metabolic rate (BMR) yang menyebabkan perubahan keseimbangan energi dan berat badan. Tujuan. Penelitian bertujuan untuk menganalisis hubungan TSH dan fT4 dengan indeks massa tubuh (IMT) pada pasien dewasa baru di Klinik Litbangkes Magelang. Metode. Penelitian ini dilakukan dengan menggunakan metode cross-sectional dan menggunakan data sekunder dari rekam medis pasien. Sampel penelitian adalah pria dan wanita dewasa (>17 tahun) yang pertama kali mengunjungi Klinik Litbangkes Magelang pada tahun 2019 sebanyak 173 orang. Variabel penelitian adalah TSH, fT4, dan IMT. Pengujian hipotesis dengan uji statistik Korelasi Rank Spearman. Hasil. Rata-rata kadar TSH responden adalah normal yaitu 0,91±2,17 µIU/mL, sedangkan rata-rata kadar fT4 responden di atas normal yaitu 3,20±5,83 ng/dL. Sebagian besar subjek memiliki IMT normal (55,5%) dengan rata-rata 23,74±4,57. Uji Korelasi Rank Spearman menunjukkan bahwa terdapat hubungan yang signifikan antara TSH dan IMT (p=0,003) dengan korelasi positif (r=0,228) dan ada hubungan yang signifikan antara fT4 dan IMT (p=0,000) dengan korelasi negatif (r=-0.323). Kesimpulan. Terdapat hubungan antara kadar TSH dan fT4 dengan nilai IMT pasien. Semakin tinggi kadar TSH maka semakin tinggi pula nilai IMT pasien, begitu juga sebaliknya, serta semakin tinggi kadar fT4 maka nilai IMT pasien semakin rendah, dan sebaliknya.

Indications for hemithyroidectomy for nodular goiteragainst the background of autoimmune thyroiditis and prognosis of long-term results

Aim — to study the possibility of determining the indications for choice of the extent of surgery in patients with unilateral nodular goiteragainst the background of autoimmune thyroiditis(AIT) with compression syndrome and prognosis for the long-term results of surgical treatment.Materials and methods. The analysis has been performed for the long-term results of hemithyroidectomy in 101 women aged from 23 to 72, patients with unilateral nodular goiteragainst the AITbackground with compression syndrome. It has been established what exactly indications to the surgery,includingvolume of the gland, echostructure variant, blood levels of thyroid stimulating hormone(TSH), free thyroxine and triiodothyronine, thyroid peroxidase(TPO) antibodies, apoptosis and proliferation indicators, provided satisfactory and unsatisfactory treatment results.Results. Based on the results of investigation in 3 years after hemithyroidectomy, no violations of the functional state of the thyroid glandwere revealed in 75 patients; in them ultrasoundinvestigation of parenchyma of the remaining lobe of the gland showed that pre-operativeAITsigns did not progress or progressed without hypothyroidism and changes of the variant of ultrasound picture (satisfactory result). In 26 patients an increase in the volume of the remaining part of the thyroid gland and progression of the autoimmune process with the development of hypothyroidism were established (unsatisfactory result).One can expect the satisfactory result of hemithyroidectomy in the treatment of patients with unilateral nodular goiteragainst the AIT backgroundwith compression syndrome in cases where at the time of surgery the volume of the lobe does not exceed 10 cm3, its echostructure corresponds to hypoechoic and heterogeneous and pseudomicronodular variants, TSH is not higher than 2.85 IU/L, levels of free thyroxine and triiodothyronine are not lower than 16.7 and 5.3 pmol/l, respectively, TPO antibodies level is not higher than 150 IU/ml.Conclusions. One of the possible options for surgical treatment of patients with unilateral nodular goiteragainst the AIT background with compression syndrome may be hemithyroidectomy with preserved hormonal function of the gland and structural changes in the parenchyma in the lobe, which remains at the level of hypoechoic and heterogeneous or pseudomicrous variants. Hemithyroidectomy is contraindicated in cases of pseudolarge nodular and severe variants of parenchyma echostructure of the thyroid gland.

Prescription of Sageretia hamosa Brongn Relieved Goiter through Promoted Apoptosis of Thyroid Cells via miR-511-3p and PTEN/PI3K/Akt Pathway

Goiter is thyroid enlargement, in China, Sageretia hamosa Brongn (SHB) can be used to treat goiter, but it has not been reported. Therefore, data analytics of SHB prescription on thyroid were explored in this study to provide a theoretical support for SHB in the treatment of goiter. In this study, rat in goiter model was constructed by using propylthiouracil (PTU) and treated with SHB prescription. Thyroid function about the triiodothyronine (T3), free thyroxine (T4), free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) were measured by ELISA; thyroid coefficient was calculated after weighed thyroid; and HE staining was applied to assess the morphology of thyroid tissue. miRNA microarrays were employed to detect miRNA expression in thyroid tissue of rats. Expression of miR-511-3p was measured by RT-qPCR; expression of proteins (PTEN and apoptosis-related proteins) was tested by western blotting; relationship between miR-511-3p and PTEN was investigated by dual luciferase reporter gene assay; cell viability rate was determined by CCK-8; and cell cycle distribution and apoptosis rate were detected by flow cytometry. The results showed that SHB prescription ameliorated goiter and downregulated miR-511-3p. miR-511-3p targeted PTEN in thyroid cells and PTEN negatively regulated the activation of PI3K/Akt pathway. Furthermore, the inhibition of apoptosis in thyroid cells caused by the overexpression of miR-511-3p or the activation of PI3K/Akt pathway was reversed by treatment of SHB prescription, inhibition of miR-511-3p, or overexpression of PTEN. In conclusion, SHB prescription promoted apoptosis of thyroid through decreased miR-511-3p and regulated PTEN/PI3K/Akt pathway, it might suggest possible medical applications.

Myopathy Associated with Treatment of Graves’ Disease

Here, we report a case of an increase in serum creatine kinase (CK) concentration in an 11-year-old girl being treated for Graves’ disease with antithyroid drugs (ATDs). The patient complained of myalgia two weeks after methimazole treatment. Triiodothyronine (T3) and free thyroxine (FT4) levels were normal, but the serum CK level was significantly elevated. After switching to propylthiouracil, the serum CK level decreased to normal, and the myalgia was resolved. The development of myopathy during the treatment of hyperthyroidism may be considered as an adverse reaction of MMI. In this report, we present a rare pediatric case, along with a discussion on the possible causes of myopathy that occurred during the treatment of Graves’ disease. A careful follow-up (serum CK levels and thyroid function) and treatment reassessment should always be considered after antithyroid treatment.

PREVALENCE OF SUBCLINICAL AND UNDIAGNOSED OVERT HYPOTHYROIDISMIN HABITUAL ABORTION

Background:Hypothyroidism is the second most common endocrine disorder in women of childbearing age with an increased risk of pregnancy loss.Pregnancy loss associated with subclinical hypothyroidism (SCH), defined as elevatedthyroid-stimulating-hormone level, with normal free thyroxine. In overt hypothyroidism (OH), the free thyroxine is low. Materials and methods:Cases recruited from those attending high risk pregnancy unit of obstetrics and gynecology department of Benha university hospital Egypt from 2019 till 2020. We examined theprevalence of subclinical and undiagnosed overt hypothyroidism in women with recurrent miscarriage, late miscarriageand stillbirth.Cases with sporadic miscarriages, autoimmune disorders, thrombophilias and known hypothyroidism were excluded. Sample size: Two-hundredwomen were included. Median maternal age was 35 years (range 18-47). Subclinical andundiagnosed overt hypothyroidism was found in 24 cases (12%) of women. Sixteen women (8%) had subclinical hypothyroidism,eight (4%) had undiagnosed overt hypothyroidism. Results were compared to women with ongoing pregnancies. Results: The prevalence of subclinical and undiagnosed overt hypothyroidism in the pregnancy loss population was 12% (24 /200), where 8 %( 16/200) were subclinical, and 4% (8/200) were undiagnosed overt. In the control population, prevalence of hypothyroidism was 1.5% (3/200).

Frequency of endemic goiter and indicators of pituitary-thyroid profile in Arctic children

Objective. Analysis of the frequency of endemic goiter and indicators of the pituitary-thyroid profile in children aged 10-18 years living in the Arctic regions of Yakutia. Materials and methods. The study was conducted among children and adolescents of the Arctic regions of Yakutia (Bulunsky, Anabarsky, Allaikhovsky, Nizhnekolymsky, Verkhnekolymsky district) during field medical expeditions in 20182020. A total of 392 children aged 1018 years were examined. Results. In 30 % of the examined children, an increase in the thyroid gland was observed, which was accompanied by elevated levels of free thyroxine. In 3 % of children, an increase in the level of thyroid-stimulating hormone was detected against the background of reduced or normal levels of free thyroxine. Conclusions. As for the prevalence of cases of endemic goiter, the Arctic regions of Yakutia are the areas of severe goiter endemia. The results obtained justify the need for additional scientific studies to assess the degree of iodine availability (by the concentration of iodine in the urine) in different population groups and real implementation of the strategy of mass preventive measures.

Patients with Central Hypothyroidism are Less Sufficiently Treated with Levothyroxine than Patients with Primary Hypothyroidism

Background Contrary to patients with hypothyroidism after radioiodine (HRI) or after thyroidectomy (HTh), patients with central hypothyroidism (CH) cannot rely on thyrotropin (TSH) level to guide their treatment with L-thyroxine (L-T4). Consequently, they are at constant risk of under- or overtreatment. We aimed to establish the adequacy of L-T4 treatment in patients with CH in our cohort. Methods Consecutive patients with CH on L-T4 treatment were compared with patients adequately treated for HRI or HTh. Levels of free thyroxine (fT4) and free triiodothyronine (fT3) were evaluated and the fT4/fT3 ratio was calculated. Results Forty patients with CH, 136 patients with HRI and 43 patients with HTh were included in this study. Patients with HRI were significantly younger than patients with HTh and CH (p<0.001 for both). Levels of fT4 were significantly lower in CH than in adequately treated patients with HRI and HTh (median (range), 15.6 (12.7–21.3), 18.4 (12.2–28.8), and 18.7 (13.8–25.5) pmol/L, respectively, p<0.001 for both comparisons). Levels of fT3 did not differ significantly (p=0.521) between CH, HRI and HTh (median (range), 4.5 (2.7–5.9), 4.3 (3.2–6.2), and 4.4 (2.9–5.5) pmol/L, respectively). Accordingly, the fT4/fT3 ratio was significantly lower in the CH group than in HRI and HTh groups (median (range), 3.7 (2.5–5.2), 4.2 (1.2–7.7), and 4.4 (2.5–6.1), respectively, p<0.001 for both comparisons). Conclusions Patients with CH have lower fT4 levels and lower fT4/fT3 ratios than patients adequately treated for HRI or HTh. The cause for this difference may be the unreliable TSH levels in patients with CH.