Correlation of Abnormal Uterine Bleeding (AUB) with Thyroid Profile and Endometrial Biopsy

Abnormal uterine bleeding (AUB) is defined as any change in the frequency of menstruation, duration of flow or amount of loss. Menstrual disturbances and different endometrial pattern may accompany and precede thyroid dysfunction. The objective of the study was to correlate thyroid profile with endometrial biopsy in cases of AUB. This study was conducted on 74 patients who presented with AUB, had undergone TFT and endometrial biopsy/hysterectomy. Among 74 patients, thyroid disorders were identified in 26 patients. Maximum number of patients with AUB belonged to the category of hypothyroidism (27%) and 8.1% of cases had hyperthyroidism. In the present study 29 (39.1%) had proliferative endometrium, followed by secretory pattern in 21 (28.4%) patients. Hormone induced changes was seen in 3 (4.1%) patients. Disordered proliferative endometrium and endometrial hyperplasia was observed in 6 patients (8.1%) each. Malignant lesion was not common and it comprised of only 1.4% cases. AUB is frequently seen in patients with thyroid dysfunction. Thyroid function test is a cost effective, easily available test and can detect a possibly curable cause of AUB and avoid unnecessary intervention like hormonal treatment and hysterectomy. AUB due to endometrial cause is an age related pathology. Histopathological examination of endometrial biopsy is a major diagnostic tool in evaluation of AUB. It helps the physician to plan therapy for successful management of AUB.

Lingual thyroid with absent thyroid gland in neck

<p class="abstract">Lingual thyroid is defined as an ectopic thyroid gland tissue located in the midline of the tongue base. Patients with lingual thyroid tissue usually present with symptoms such as dysphagia, choking, haemorrhage, dyspnea and occasionally life threatening airway obstruction. Lingual thyroid is a rare anomaly with an incidence of 1 in 3000 of the thyroid cases seen, with overall prevalence of 1 in 100,000. Here we presented a case with complaint of difficulty in swallowing and foreign body sensation throat. The intraoral examination showed spherical mass with 2 cm of diameter, covered with intact mucosa, located midline at base of tongue. She was diagnosed clinically as lingual thyroid and evaluated further. By proper transdisciplinary approach correct diagnosis can be made and patient can be managed. In present case, thyroid profile, USG neck and thyroid scintigraphy helped in diagnosis. Patient was managed medically with tablet levothyroxine which relieved her symptoms. Surgical management was not considered as patient improved with levothyroxine and surgical excision would have made patient further hypothyroid as there was no thyroid gland in neck.</p>

Review of thyroid profile in patients with heavy menstrual bleeding in a tertiary care hospital

Background: Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss which interferes with a woman's physical, social, emotional and/or material quality of life. It can occur alone or in combination with other symptoms. Thyroid hormone affects menstrual pattern. The objective of this study was to evaluate thyroid function in women with menorrhagia (HMB).Methods: It is a type of journal article. Study design- retrospective study. The present study was conducted in the Department of obstetrics and Gynecology, cama and albess hospital, Mumbai, Maharashtra, India, from a period of January 2021 to July 2021, 51 women of reproductive age group between menarche-menopause with HMB. Quantitative determination of T3, T4 and TSH by CLIA estimated in autoanalyser.Results: About 51 women participated in the study in which most of the subjects belong to 45-49 years of age group. Maximum patients are multipara. Commonest cause of menorrhagia is fibroid. Most females with menorrhagia are euthyroid. Most of patients with HMB are O +ve. In most of the patients, anaemia due to HMB is treated by blood transfusion.Conclusions: Biochemical evaluation of thyroid function tests should be compulsory in all patients with menorrhagia to detect thyroid dysfunction. Most females with menorrhagia are euthyroid.

Circulating Leptin, Insulin and Thyroid Profile Levels in Different Age Groups of Women Population of Manipur, India

Background: Age is linked to a number of hormonal disorders. This study was designed to look for changes in leptin, insulin, and thyroid profile concentrations in women of various ages. Materials and Methods: This study was carried out in the Department of Physiology, Regional Insititute of Medical Sciences, Imphal. Female subjects (350 participants) between the ages of 20 and 65 were recruited. Subjects were grouped as pre-menopause (< 40 age), menopause (≥ 40 to < 50 age) and post-menopause (≥ 50 age). Blood samples were separated serum and estimated levels of leptin, insulin and thyroid profile levels. Statistical calculation was done using SPSS software version 26, at P < 0.05 as significant. Results: Body mass index (BMI) had significant changes in different age groups (P < 0.05), but the levels were not in the higher range of BMI. Serum levels of leptin, insulin, T4 (thyroxine) and TSH (thyroid stimulating hormone) were found no significant differences among the different age groups. Conclusion: Study demonstrates that age has no effect on the levels of leptin, insulin, T4, and TSH in this Manipuri women's group.

Thyroid Disfunction in Critically Ill COVID-19 Patients. Relationship with In-Hospital Mortality

The incidence of thyroid disfunction has not been analyzed in critically ill COVID-19 patients. Our objective was to analyze the relationship of the thyroid profile and in-hospital mortality in critically ill COVID-19 patients. This was a prospective single-center study involving critically ill COVID-19 patients admitted to the ICU of a tertiary University Hospital. Thyroid hormones were measured through drawing blood samples from a central venous catheter at ICU admission and on the fifth day. A multiple logistic regression analysis was performed to analyze the variables associated with mortality. The ability of the different thyroid hormones to predict in-hospital mortality was evaluated by calculating the receiver operating characteristics (ROCs) and the area under the curve (AUC). A total of 78 patients were included in the study at ICU admission; 72 had their thyroid profile measured at day 5. In-hospital mortality reached 29.5%. Multiple logistic regression analysis showed that variables associated with mortality were age and prior beta-blocker therapy at ICU admission and age fT4 at day 5. The AUC for in-hospital mortality predictions of fT4 at day 5 was 0.69. Thyroid responses are commonly observed in critically ill COVID-19 patients. fT4 at day 5 after ICU admission was associated with mortality.

Sheehan’s syndrome with hypothyroidism: a rare case report

Sheehan's syndrome is a form of hypopituitarism caused by pituitary gland necrosis caused by hemorrhagic shock during pregnancy. It's a rare issue with a wide range of symptoms and a long time to diagnose. A 40-year-old female presented with a giddiness which was rotatory type followed by headache, vomiting associated with nausea, decreased appetite for one week. She has experienced excessive vaginal bleeding and secondary amenorrhea exists for 20 years. Patients diagnosed to have acute liver injury, hyponatremia, and acute gastritis. The thyroid profile showed hypothyroidism and the patient started on appropriate medication. Hypopituitarism due to Sheehan's disease was discovered after a thorough clinical examination, endocrine investigations, and a pituitary magnetic resonance scan. Following the start of hormone replacement therapy, she showed significant improvement. The current case demonstrates that undiagnosed Sheehan's syndrome is linked to long-term morbidity, and we want to emphasize the importance of a high index of suspicion for early diagnosis of the syndrome during routine clinical visits to avoid complications that can arise from delayed diagnosis.

The Relation between Vitamin D Levels and Cardiovascular Comorbidities in Obese Children

Background Childhood obesity is accompanied by increased cardiovascular co morbidities and vitamin D deficiency. However, the relation between vitamin D deficiency and cardiovascular comorbidities remains uncertain. Objectives We aim to determine if there is an association between vitamin D deficiency and cardiovascular risks in obese children. Patients and Methods A case control study was conducted on 63 prepubertal patients with simple obesity recruited from the pediatric obesity clinic, Ain Shams University. They were divided into 2 groups: 33 cases with deficient 25(OH) D (&lt; 20ng/ml) and 30 with sufficient 25(OH) D (≥ 20ng/ml). Both groups were subjected to full history taking, general examination including blood pressure, anthropometric measurements and laboratory evaluation including lipid profile, thyroid profile and glucose homeostasis parameters. Results There was a positive correlation between 25(OH) D and HDL cholesterol (r = 0.407, p = 0.026). Obese children with deficient 25(OH) D had significantly higher diastolic blood pressure percentiles (86.20 ±9.20 in deficient vs 78.44±15.50 in sufficient, p = 0.018). Conclusion A possible relationship exists between obesity related comorbidities and vitamin D status. Further studies should focus on the effect of vitamin D deficiency on obesity related comorbidities.

EVALUATION OF THYROID PROFILE OF TERM AND PRETERM NEONATES AT 1ST AND 4TH WEEK AFTER BIRTH: A HOSPITAL BASED OBSERVATIONAL STUDY.

Objective: st th To evaluate the thyroid prole(T4,FT4 and TSH) in term and preterm neonates at 1 week after birth and during follow up at 4 week. Material and Method: This prospective observational hospital based study was conducted with 30 term(>37 completed week) and 30 preterm neonates(from 28 to 36 week 6days) with exclusion criteria of maternal thyroid disease or neonates with co-morbidity or signicant congenital st th anomalies. Serum T4,FT4 and TSH level were measured at 1 week and 4 week of postnatal age and results are analysed statistically. Results: st th We found TSH was elevated more in preterm than in term neonates in the 1 week, which decreased in both the groups at the 4 week . T4 st th and FT4 were signicantly higher in the term neonates than in preterm in the 1 week. During follow up in the 4 week, T4 and FT4 decreases in st term and increases in preterm so that the FT4 level almost matches in both the group at the end of 1 month. Conclusion: Our study shows that T4, FT4 and TSH has a signicant relationship with gestational age. Premature infants are born with higher th levels of TSH and lower levels of FT4 and T4 than term, which almost normalizes at 4 week.

Frequency of Hypocalcaemia following total Thyroidectomy

Background: The most common post-thyroidectomy complication is hypocalcaemia. It could be permanent or transitory. Permanent hypocalcaemia has a prevalence of 0-13% and transient hypocalcaemia has a prevalence of 1-6%. Aim: The study objective was to ascertain the prevalence of postoperative hypocalcaemia in patients following total thyroidectomy. Materials and Methods: This cross-sectional study was carried out on 84 thyroid patients who underwent total thyroidectomy in the surgical department of HBS General Hospital, Islamabad for period of nine months during from September 2020 to May 2021. Patients within the age range of 15-69 years and had indicated thyroidectomy caused by carcinoma thyroid, multinodular goiter, and recurrent goiter were enrolled. Inform consent was obtained from each participant. Ethical approval was taken from the institutional ethical committee. Thyroid profile and serum calcium were done for a routine investigation. Serum calcium levels were measured 24 hours, 48 hours, and 7 days after total thyroidectomy. Signs and symptoms in hypocalcaemia patients were recorded on a proforma. Patients with hypocalcaemia were followed for six months. SPSS version 20 was used for data analysis. Results: The mean age of the patients was 46.7 ± 4.6 years with an age range of 16 to 69 years. Of the total 84 patients, 38 (45.2%) underwent total thyroidectomy and 46 (54.8%) underwent a complete thyroidectomy. The prevalence of male and female patients was 22 (26.2%) and 62 (73.8%) respectively. Malignant and benign were present in 71 (84.5%) and 13 (15.5%) respectively. Of the total 84 patients, 68 (81%) developed hypocalcaemia. Out of 68 hypocalcaemia patients, 29 (42.6%) and 39 (57.4%) were from the benign and malignant groups respectively. Conclusion: Postoperatively hypocalcaemia was prevalent following thyroidectomy. Malignant patients (84.5%) were more prevalent compared to benign patients (15.5%) after total thyroidectomy. Careful surgical procedures, parathyroid gland vascularity preservation, and identification are critical in preventing hypocalcaemia following total thyroidectomy. Keywords: Hypocalcaemia; Total thyroidectomy; Complete Thyroidectomy