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Spontaneous coronary artery dissection (SCAD) is a rare condition that is frequently under-recognized. It has been connected to several triggers and predisposing factors. Interestingly, hypothyroidism has been linked to a higher likelihood of arterial dissections.We present the case of a 49-year-old woman who was admitted for acute coronary syndrome. Coronary angiography revealed signs of SCAD affecting the distal left anterior descending artery and the right ventricular branch. Additionally, microaneurysms were detected in the distal circumflex artery, the main septal artery, and a branch of the distal right coronary artery. During her hospitalization, a goiter was identified, and further evaluation confirmed autoimmune thyroiditis. The patient was managed with conservative treatment. A follow-up angiogram 6 months later showed that the previously dissected coronary segments and microaneurysms had regressed.This case highlights the possible role of hypothyroidism in increasing risk of SCAD and possibly microaneurysms which has been suggested in only isolated cases in the literature. It also demonstrates the effectiveness of a conservative treatment approach for this condition.

Abstract Objective Ulcerative colitis (UC) and Hashimoto’s thyroiditis frequently cooccur in patients with multiple autoimmune conditions, but the specific association between UC and hypothyroidism is unknown. We used Mendelian randomization (MR) methods to determine the causal relationship between UC and hypothyroidism. Methods We obtained single nucleotide polymorphisms (SNPs) related to ulcerative colitis (UC) and hypothyroidism from genome-wide association studies (GWAS) available in the public database of the Integrated Epidemiology Unit (IEU). To assess the causal relationship between UC and hypothyroidism, we employed MR-Egger, weighted median, inverse variance weighted (IVW), simple mode, and weighted mode methods. Sensitivity analyses were performed using Cochran’s Q test, the horizontal pleiotropy test, and the leave-one-out (LOO) method to assess the reliability of the MR data. The genes corresponding to instrumental variables (IVs) were subjected to Gene Ontology (GO) functional annotation, Kyoto Encyclopedia of the Genome (KEGG) pathway enrichment analysis, and protein-protein interaction (PPI) analysis to explore the mechanisms behind the causal relationships at the gene level. Results Forward MR analysis indicated that hypothyroidism was associated with an increased risk of UC (IVW: P = 0.02, OR = 9.71, 95% confidence interval (CI) = 1.36–69.46). In contrast, reverse MR did not demonstrate a causal relationship between UC and hypothyroidism (IVW: P = 0.53). Sensitivity analysis proved the reliability of the results. The PPI network revealed CD247, CD80, and STAT4 as central genes. GO and KEGG analyses revealed significant enrichment of the T cell, gamma interferon (IFN-γ), and programmed cell death-1 (PD-1)/programmed cell death ligand-1 (PD-L1) pathways. Conclusion Hypothyroidism was a risk factor for UC. The balance of T-cell differentiation played an important role in the process of hypothyroidism-induced UC, and IL-21 might be the key to finding a cure. Enrichment of PD-1/PD-L1 might attenuate inflammation by suppressing the immune action of T cells.

Abstract Background Long-term management of patients with hypothyroidism on thyroxine replacement requires thyroid function test (TFT) monitoring once every six–12 months as recommended by clinical practice guidelines. This study determined their thyroid function status during two-year follow-up visits in primary care, and the factors influencing their thyroid status, and assessed the optimal interval for TFTs. Methods A retrospective cohort study was conducted on adults with a clinical diagnosis code for hypothyroidism in their electronic health records taken from a group of polyclinics in Singapore between July 2017 and June 2020. The follow-up thyroid status was categorized as under-replacement (TSH ≥ 3.70mIU/L), over-replacement (TSH ≤ 0.65mIU/L) or euthyroid (TSH 0.65–3.70mIU/L). The patients’ demographic, clinical and TFT data were analyzed using appropriate statistical tests during the two-year follow-up. Stepwise logistic regression analysis identified the factors associated with suboptimal thyroid control. Kaplan–Meier analysis was used to compare their thyroid function status in association with the interval between TFT monitoring. Results Data from 5,749 eligible subjects (mean age 62.1 ± 13.29 years; 79% female; 79.7% Chinese) were analyzed. After a two-year follow-up, 61.9% (n = 3558) of all subjects were euthyroid, with 29.5% (n = 1694) being under-replaced and 8.6% (n = 497) over-replaced. However, thyroid status did not differ significantly with the various dose regimen (daily, segmented, or alternate days) (p = 0.193). Stepwise logistic regression showed that thyroxine under-replacement was significantly associated with the male gender (AOR = 1.25,95%CI = 1.03–1.51,p = 0.02) and obesity (AOR = 1.34,95%CI = 1.08–1.66,p = 0.008). Every unit (μg/kg body weight) increase in the mean daily thyroxine dose was associated with 2.72 times greater odds of over-replacement. When comparing thyroid function monitoring at intervals of 13-24 months, monitoring at shorter intervals (≤ 12 months) was less likely to detect thyroxine under-replacement (AOR = 0.57,95%CI = 0.44–0.74,p

Background: Any abnormal change in thyroid hormone levels leads to thyroid disorders, including hyperthyroidism, hypothyroidism, goiter, and so on. Recent studies have reported an increasing prevalence and incidence of thyroid disorders worldwide. This study aims to determine the hypothyroid prevalence, incidence, and risk factors related to this disorder. Methods: Data from a comprehensive prospective cohort study, collected from a population of 10,000 Yazd (Iran) individuals over a period of 6 years (2015-2021) was analyzed. Physicians diagnosed hypothyroidism and reported it. Data processing and preparation were performed using SQL18 and Excel, while STATA17 and SPSS22 software were employed for data analysis. Descriptive statistics, logistic regression, and Chi-square tests were conducted at a significance level of 0.05.Results: The prevalence of hypothyroidism was found to be 93/1000, and the incidence was 15/1000 of the population, respectively. Women had five folds more chance of hypothyroidism (adjusted OR=5.31, 95% CI=3.06-9.19 vs. unadjusted OR=6.28, 95% CI=3.90-10.12), and they usually developed it between the ages of 30 and 39. Eating less (iodized) salt also increased the risk of hypothyroidism (unadjusted OR=1.47, 95% CI=1.02-2.11). Iron supplementation (unadjusted OR=2.09, 95% CI=1.26-3.48) was identified as one of the significant risk factors. Based on our findings in the unadjusted model, tooth brushing once or twice a day increases the chance of hypothyroidism (OR=1.89, P=0.008, and OR=2.12, P=0.016, respectively). Tobacco smoking (unadjusted OR=0.29, 95% CI=0.107-0.786) was also among the factors that need further investigation. Conclusion: The increasing trend of hypothyroidism is concerning in our population. The high prevalence, particularly among women of childbearing age, is notable.

Objective: There are few reports of subacute thyroiditis (SAT) during pregnancy. This study aimed to clarify the clinical characteristics of SAT in pregnant patients. Methods and results: Seven patients diagnosed with SAT during pregnancy at our institution from January 2004 to December 2021 were identified, and their clinical findings were retrospectively examined. At SAT diagnosis, the median age was 34 (range: 31–42) years, the median duration of pregnancy was 5 (4–24) weeks, and all patients had neck pain but no fever. On laboratory examination, median (range) free thyroxine, free triiodothyronine, and C-reactive protein levels were 2.66 (1.14–7.77) ng/dL, 7.1 (3.3–16.1) pg/mL, and 2.22 (0.42–5.79) mg/dL, respectively, and all patients had a hypoechoic lesion of the thyroid gland. Three patients (43%) were treated with steroids, and three patients (43%) received replacement therapy with levothyroxine for hypothyroidism following destructive thyroiditis. There were no pregnancy complications in any of the cases. These seven patients (pregnancy group) were compared with 217 non-pregnant female patients (non-pregnancy group) aged 31 to 42 years who were diagnosed with SAT at our institution from 2016 to 2019. The frequency of body temperatures above 37°C was lower in the pregnancy group than in the non-pregnancy group (0% vs 65%). Conclusion: Patients who develop SAT during pregnancy may have less fever than non-pregnant patients with SAT. There were no pregnancy complications in the pregnancy group in this study. This suggests that adverse pregnancy outcomes may be avoided by the appropriate management of SAT, including hypothyroidism after destructive thyroiditis.

The androgen receptor signaling inhibitor apalutamide is used successfully for the treatment of prostate cancer. An increased risk of hypothyroidism, mostly subclinical, has been reported in the SPARTAN and TITAN trials. We present three cases of subacute deterioration of previously known but well-controlled hypothyroidism treated with levothyroxine, occurring shortly after the initiation of treatment with apalutamide, resulting in severe hypothyroidism. These cases highlight the importance of awareness of thyroid dysfunction during treatment with apalutamide, particularly in patients with pre-existing thyroid disease, common in the general population. We provide practice recommendations for thyroid management prior to and during apalutamide treatment as well as after the interruption of this therapy.

Introduction: There is a notable association between hypothyroidism and reduced muscle function as well as compromised neuromuscular coordination. In this study, we aimed to investigate the potential link between Vitamin D and handgrip strength (HGS) in patients with hypothyroidism. Methods: The study involved 40 patients diagnosed with hypothyroidism and subclinical hypothyroidism while excluding individuals with hypothyroid medications, cardiovascular, pulmonary, renal, neurological, reproductive disorders, hand anomalies, Parkinson’s disease, and Vitamin D supplementation. They were evaluated for T3, T4, and thyroid-stimulating hormone (TSH) levels, HGS, and serum Vitamin D levels; triceps fold was measured using a Lange caliper, and a correlation between these variables was assessed. Results: The mean age of the study group was 39.95 ± 6.41 years, with the majority falling in the age group of 41–50 years. A female preponderance (70%) was observed among the study group. The mean value for Vitamin D and HGS was 14.69 ± 6.12 ng/ml and 19.65 ± 5.38 kg, respectively. The mean values for T3, T4, and TSH were 47.23 ± 14.56 ng/dl, 5.86 ± 2.12 μg/dl, and 18.28 ± 7.64 mIU/ml, respectively. A robust, significant positive correlation was found between HGS and Vitamin D (r = 0.42, P < 0.01). The correlation between body mass index (BMI) and Vitamin D was moderately positive but was not statistically significant (r = 0.26, P > 0.01). No significant correlation was observed between Vitamin D and T4, TSH, and triceps fold. A moderate negative correlation was observed for TSH and BMI but was insignificant (r = −0.27, P > 0.05). Conclusion: A strong, significant positive correlation was found between HGS and Vitamin D, while BMI showed moderate positive correlations. No significant correlation was found between Vitamin D, T4, TSH, or triceps fold.

Purpose: To estimate the proportion and pattern distribution of glaucoma disease in a teaching hospital of North-East India. MATERIALS AND METHODS: Retrospective hospital-based study of glaucoma cases from January 2014 to December 2022. Results: Out of a total of 89725 new patients, 449 patients had glaucoma with a prevalence of 0.50% (95% CI: 0.46%-0.55%) of which 361 (80.4%) were ≥40 years and 88 (19.6%) were

Introduction: Hypothyroidism is among the most prevalent endocrine disorders worldwide. Its risk increases with menopause. The prevalence of hypothyroidism among menopausal women in India is unknown, as conclusive data are scarce. The present study was conducted to find out the prevalence of hypothyroidism among menopausal women in Delhi, India, and study the socio-demographic factors associated with it. Methods: This was a cross-sectional community-based study done among 282 menopausal women in an urbanised village in Delhi, India. Women with a previously known history of diagnosed thyroid disorders were also included in the study. Informed written consent was obtained from all participants. A socio-demographic profile was gathered by questionnaire and blood samples were collected and analysed for thyroid hormone levels. Results: The mean age of study participants was 51.1 years. The prevalence of hypothyroidism among postmenopausal women was 27.3% (77) with 19.9% (56) previously diagnosed and 7.3% (21) diagnosed by the present study. Out of 56 previously diagnosed hypothyroid study participants, only 26 (46.4%) participants had thyroid hormones in a normal range. Age, socio-economic status and literacy status were found to be significantly associated with hypothyroidism. Conclusion: About three postmenopausal women out of 10 were found to be hypothyroid. Nation-wide data were required to estimate the true burden of thyroid disorders in this population. The prevalence increased with age underscoring the need for further research to have conclusive evidence regarding this association. Hypothyroid women who are on treatment should undergo regular evaluation of thyroid hormones so that appropriate dose adjustments can be made for pharmacological therapies.

Background: The thyroid gland is one of the largest endocrine glands in the body, secreting thyroxine (T4) and triiodothyronine (T3). Mild hypothyroidism can have negative consequences for a variety of tissues, even though clinically the patients are euthyroid. Many research studies were conducted to evaluate the serum creatinine levels of people with hypothyroidism; however, relatively little research was conducted to evaluate serum urea and serum creatinine levels in subclinical hypothyroidism. As a result, the current study was carried out to investigate urea, uric acid, and creatinine levels in hypothyroidism. OBJECTIVES: Our study aimed to determine and correlate the levels of urea, uric acid and creatinine in newly diagnosed primary hypothyroidism cases. MATERIALS AND METHODS: In this cross-sectional study, 96 newly diagnosed cases of primary hypothyroidism were included. The findings were correlated with 20–60-year-old and sex-matched cases. Serum urea was determined by the kinetic method (Glutamate Dehydrogenase Method), serum uric acid by the uricase method and serum creatinine by Jaffe’s method in Erba’s Mannheim fully automated analyser. Result: This study showed a positive correlation between uric acid and thyroid stimulating hormone (TSH) and a negative correlation between urea and creatinine. There was no statistical significance in the mean values of urea, uric acid and creatinine but an increased level of urea, uric acid and creatinine was seen in the age group 20–30 years when compared with the other age groups. Conclusion: The study concludes that serum urea showed a positive correlation with TSH, whereas uric acid and creatinine showed a negative correlation with TSH, and there was no statistical significance in the mean values of urea, uric acid and creatinine in hypothyroid patients.

The study examines the complex relationship between growth hormone (GH) and thyroid hormones in hypo and hyperthyroid conditions in premature male rats, concentrating on the physiological impacts of hormonal alterations and genetic effects. It was done in an animal housing facility at the University of Mosul Faculty of Veterinary Medicine. A study of 50 male rats, 30 days old and weighing 160 ± 5g, was conducted over 21 days. The first control group (G1) received normal saline subcutaneously. The second group (G2) induced by growth hormone deficiency via sodium diethyldithiocarbamate (SDDT) subcutaneously, the third group (G3) were given a growth hormone drug (Norditropin) subcutaneously, while fourth group (G4) induced hypothyroidism by Propylthiouracil (PTU) orally, and the fifth group (G5) induced hyperthyroidism by (Levothyroxine) orally. This experiment showed that thyroid stimulating hormone (TSH) has a high significance value at p>0.05 in G4 and G2 compared to G1. However, Triiodothyronine (T3) and Thyroxin (T4) are significant in G3 and G5. Regarding Reverse Triiodothyronine (rT3) in G3 and G4 display highest level in contrast to the other groups. Thyroid-binding globulin (TBG) and Thyroid peroxidase antibodies (TPO) were greatest in G4, whereas growth hormone (GH) and IGF-1 were highest in G2 and G5. The gene expression results showed that GH and IGF-1are up-regulated in comparison to the rest of the groups by using a modified conventional PCR with the formula. In conclusion, one hormonal agent system may significantly affect other hormonal activities, stressing the need for a complete endocrine approach.

Background: Hypothyroidism is an endocrine disorder in which the thyroid gland does not produce an adequate amount of thyroid hormones. This study aimed to determine the efficacy of yoga asanas as an add-on therapy for the management of hypothyroidism. Materials and Methods: For this interventional clinical study, a total of 450 study participants were screened for eligibility. Out of this, 170 study participants were found fit for preliminary eligibility following stringent inclusion and exclusion criteria. Further, 58 participants were excluded before randomization. A total of 112 hypothyroidism patients (57 in the control group and 55 in the yoga group) participated in this study. The study participants were further followed up for 8 weeks in both the yoga practice (yoga+ standard care of treatment) and control group (standard care of treatment only). The markers of oxidative stress, inflammation, and thyroid hormones were assessed at baseline and after 8 weeks of follow-up/intervention. Results: After 8 weeks, the study participants in yoga group showed a significant reduction in serum thyroid-stimulating hormone and malondialdehyde levels as compared to baseline (P < 0.05). There was also a positive trend of improvement in other oxidative markers (catalase, superoxide dismutase, and glutathione), and a significant reduction in interleukin-6 levels (P < 0.05) was found in the yoga group as compared to the baseline. However, there was no significant change found in the control group of subjects. Conclusion: Frequent yoga practice can be an effective lifestyle intervention for hypothyroidism, reducing oxidative stress, inflammation, and potentially improving overall well-being.

Abstract Background The thyroid function test (free triiodothyronine [FT3], free thyroxine [FT4], and thyroid-stimulating hormone [TSH]) is one of the key determinant of glucose homeostasis by regulating the balance of insulin. Thyroid dysfunction alters glucose metabolism, leading to insulin resistance (IR). This study aimed to assess the association between thyroid function and IR in pregnant Sudanese women. Method A cross-sectional study was conducted in Saad Abuelela Hospital, Khartoum-Sudan, from January to April 2021. Obstetric/sociodemographic characteristics were gathered through questionnaires. Serum TSH, FT3, FT4, fasting plasma glucose (FPG), and fasting insulin levels were measured and evaluated, and IR was estimated using the homeostatic model assessment for insulin resistance (HOMA-IR) equation. Results In total, the study included 127 pregnant women with a median age of 27.0 years (interquartile range [IQR] 23.0‒31.2) and a median gestational (IQR) age of 25.0 (IQR 25.0‒27.0) weeks. The medians (IQRs) of the TSH, FT3, and FT4 were 1.600 (1.162‒2.092) IU/ml, 2.020(1.772‒2.240) nmol/l, and 10.70 (9.60‒11.90) pmol/l, respectively. The median (IQR) of the FPG and fasting blood insulin level was [69.0 (62.00‒78.00) mg/dl] and [5.68(2.99‒11.66) IU/ml], respectively. The median (IQR) of the HOMA-IR level was 0.9407 (0.4356‒2.1410). There was a positive correlation between HOMA -IR and FT3 levels (r = 0.375; P

Abstract Background In this study, we explored the impact of hypothyroidism and thyroid hormone replacement therapy on the risk of developing cardiovascular diseases, including myocardial infarction, heart failure, and cardiac death, via Mendelian randomization analysis. Methods Genetic instrumental variables related to hypothyroidism, levothyroxine treatment (refer to Participants were taking the medication levothyroxine sodium) and adverse cardiovascular events were obtained from a large publicly available genome-wide association study. Two-sample Mendelian randomization analysis was performed via inverse-variance weighting as the primary method. To ensure the reliability of our findings, we performed MR‒Egger regression, Cochran’s Q statistic, and leave-one-out analysis. Additionally, multivariable Mendelian randomization was employed to regulate confounding factors, including systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), diabetes, cholesterol, low-density lipoprotein (LDL), triglycerides and metformin. A mediation analysis was conducted to assess the mediating effects on the association between exposure and outcome by treating atrial fibrillation and stroke as mediator variables of levothyroxine treatment and bradycardia as mediator variables of hypothyroidism. Results Genetically predicted hypothyroidism and levothyroxine treatment were significantly associated with the risk of experiencing myocardial infarction [levothyroxine: odds ratio (OR) 3.75, 95% confidence interval (CI): 1.80–7.80; hypothyroidism: OR: 15.11, 95% CI: 2.93–77.88]. Levothyroxine treatment was also significantly related to the risk of experiencing heart failure (OR: 2.16, 95% CI: 1.21–3.88). However, no associations were detected between hypothyroidism and the risk of experiencing heart failure or between hypothyroidism or levothyroxine treatment and the risk of experiencing cardiac death. After adjusting for confounding factors, the results remained stable. Additionally, mediation analysis indicated that atrial fibrillation and stroke may serve as potential mediators in the relationships between levothyroxine treatment and the risk of experiencing heart failure or myocardial infarction. Conclusion The results of our study suggest a positive association between hypothyroidism and myocardial infarction and highlight the potential effects of levothyroxine treatment, the main thyroid hormone replacement therapy approach, on increasing the risk of experiencing myocardial infarction and heart failure.

INTRODUCTION: Point-of-Care Ultrasound (POCUS) refers to the use of portable ultrasound machines to perform quick and focused ultrasound examinations at a patient’s bedside or point-of-care. POCUS can be performed by all health workers with specific training to use POCUS. The aim of this study was to investigate the radiological performance and feasibility of POCUS using a handheld ultrasound device (HHUSD) in children for examining the thyroid gland. METHODS: A pediatric endocrinologist performed thyroid imaging in children referred to our hospital with suspected thyroid disease using an HHUSD. The same children underwent ultrasonography (US) imaging using the same device by the first radiologist, and a second radiologist performed thyroid US using an advanced high-range ultrasound device (AHUSD) (defined as the gold-standard method) within two hours. The data obtained by the three researchers were compared with each other. RESULTS: This study included 105 patients [68.6% girls (n=72)] with a mean age 12.8±3.6 years. When the thyroid volume was evaluated, a strong correlation was found between the measurements of the three researchers (AA vs. MG: r=0.963, AA vs. GT: r=0.969, MG vs. GT: r=0.963, p

Abstract Background Many studies have investigated the association between hypothyroidism and frozen shoulder, but their findings have been inconsistent. Furthermore, earlier research has been primarily observational, which may introduce bias and does not establish a cause-and-effect relationship. To ascertain the causal association, we performed a two-sample bidirectional Mendelian randomization (MR) analysis. Methods We obtained data on “Hypothyroidism” and “Frozen Shoulder” from Summary-level Genome-Wide Association Studies (GWAS) datasets that have been published. The information came from European population samples. The primary analysis utilized the inverse-variance weighted (IVW) method. Additionally, a sensitivity analysis was conducted to assess the robustness of the results. Results We ultimately chose 39 SNPs as IVs for the final analysis. The results of the two MR methods we utilized in the investigation indicated that a possible causal relationship between hypothyroidism and frozen shoulder. The most significant analytical outcome demonstrated an odds ratio (OR) of 1.0577 (95% Confidence Interval (CI):1.0057–1.1123), P = 0.029, using the IVW approach. Furthermore, using the MR Egger method as a supplementary analytical outcome showed an OR of 1.1608 (95% CI:1.0318–1.3060), P = 0.017. Furthermore, the results of our sensitivity analysis indicate that there is no heterogeneity or pleiotropy in our MR analysis. In the reverse Mendelian analysis, no causal relationship was found between frozen shoulders and hypothyroidism. Conclusion Our MR analysis suggests that there may be a causal relationship between hypothyroidism and frozen shoulder.

Background Thyroid dysfunction is common in patients with coronary artery disease (CAD) following percutaneous coronary intervention (PCI). However, its impact on cardiac structure and function within the context of chronic comorbidities remains unclear. Objective To investigate the effects of thyroid dysfunction on cardiac structure and function in CAD patients post-PCI. Methods Data were sourced from the "Xinjiang People's Hospital Cardiovascular Specialty Big Data Analysis Platform-Yidu Cloud" including clinical data of CAD patients post-PCI from 2013 to 2022. Thyroid function, echocardiography, and biochemical indices were measured. Patients were classified based on diagnostic criteria into clinical hyperthyroidism group (n=263), clinical hypothyroidism group (n=357), and a control group of euthyroid patients (n=300). Spearman rank correlation was used to explore the relationship between thyroid function and cardiac structure/function. Multivariate Logistic regression and unconditional multivariate Logistic regression analyses were conducted to investigate factors affecting cardiac systolic and diastolic dysfunction. Receiver operating characteristic (ROC) curves were plotted to determine the diagnostic value of thyroid function indices for cardiac dysfunction and to calculate the area under the ROC curve (AUC) . Results Significant differences were observed among the three groups in age, gender, diastolic blood pressure (DBP), systolic blood pressure (SBP), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), cystatin C (CysC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), B-type natriuretic peptide (BNP), fasting glucose (GLU), lipoprotein (a) (LPa), thyroxine (T4), free thyroxine (FT4), triiodothyronine (T3), free triiodothyronine (FT3), thyroid-stimulating hormone (TSH), thyroglobulin antibody (TgAb), and thyroid peroxidase antibody (TPOAb) (P0.05), whereas TSH showed differences (Ptrend

Thyme (Thymus vulgaris) is often used thanks to its anti-infectious properties to treat seasonal influenza. Some patients use it in conjunction with their conventional treatment, which can expose them to adverse effects or interactions. A case of probable pharmacokinetic interaction of levothyroxine and thyme is described. This is a case of 52-year-old woman admitted to the toxicology department in January 2024 after a phytovigilance questionnaire. The patient had a treatment for hypothyroidism consisting in levothyroxine sodium with a daily dose of 150 µg, but she showed palpitations following the taking of a T. vulgaris tea to treat her seasonal flu. She reported that the symptoms disappeared by reducing the doses of T. vulgaris. The score of the probability scale of the interaction was 6, so a probable interaction may occur in patients with thyroid disorders and taking levothyroxine sodium concomitantly with T. vulgaris.

Purpose The present study aimed to determine the serum level of asprosin, a novel glucogenic and orexigenic hormone, in NAFLD and hypothyroidism patients.Methods This is a case–control study that included three groups of age and sex-matched subjects: hypothyroid patients with NAFLD (n = 26), hypothyroid patients without NAFLD (n = 25) and normal control subjects (n = 27). A detailed clinical history was obtained, and an examination was performed. Laboratory tests included fasting plasma glucose and insulin, lipid profile, TSH, free T4, AST, ALT, albumin, and asprosin. The homeostatic model assessment of insulin resistance (HOMA-IR) score was calculated. Abdominal ultrasonography was performed to calculate the hepatorenal index and define participants with NAFLD. The data were statistically analyzed.Results There was a statistically significant difference between the three groups regarding serum asprosin concentration (p

Background: Hypothyroidism was highly prevalent in India, with 10.95% affected patients as compared with only 2% in the United Kingdom and 4·6% in the USA. The prevalence of Hyperthyroidism was found to be 1.6%. Copper has an essential role in thyroid metabolism, thyroid hormone production, and absorption. Copper is an essential part of thyroxine (T4) hormone and thyroid-stimulating hormone (TSH) synthesis. Objectives: This study evaluated the status of serum copper and ceruloplasmin levels in hypothyroidism and Grave’s hyperthyroidism in comparison with euthyroid participants. Materials and Methods: This was a hospital-based case–control study that involved 100 cases of hypothyroidism and 60 cases of Grave’s hyperthyroidism compared with 100 euthyroid participants aged 15–60 years. After detailed case history and examination, the blood sample was collected and analyzed the same day for FreeT3, FreeT4, TSH, serum copper, and ceruloplasmin levels. Results: Compared to euthyroid participants, patients with clinical hypothyroidism had statistically significant (P < 0.05) lower levels of serum copper and ceruloplasmin. The scenario was the opposite in the case of Grave’s hyperthyroidism patients. Our study found statistically significant (P < 0.05) higher serum copper and ceruloplasmin levels in Grave’s hyperthyroidism patients. Conclusion: Our study found serum copper levels directly affected the thyroid profile and vice versa. The deficiency of one parameter affected the other. Patients with hypothyroidism and hyperthyroidism should be routinely screened for serum copper and ceruloplasmin levels for more effective thyroid treatment.

Chronic kidney disease (CKD), can alter thyroid hormone production, distribution, and excretion. Thyroid dysfunctions like hypothyroidism, hyperthyroidism, and euthyroidism are identified in renal failure patients. This study aimed to determine thyroid dysfunction prevalence among CKD patients who attended Diagnostic Laboratory Services in Bulawayo from January to December 2023. The study was analytical cross-sectional and archival data collection methods were to gather information from 118 CKD patients who underwent both thyroid function tests and urea and electrolytes tests. A descriptive and analytical statistic test was used to determine the prevalence of thyroid dysfunction among CKD patients Chi square test was used to test association between thyroid’s dysfunction in CKD setting with various risk factors, P< 0.05 was considered as statistically significant. Thyroid dysfunction (TD) prevalence was 53%, increasing with CKD severity, with stage 3B having a high prevalence of 37%. Major types include subclinical hypothyroidism (11%), overt hypothyroidism (16%), and subclinical hyperthyroidism (4.2%), with 36% of females presenting with thyroid dysfunction as compared to 31% of males. Prevalence of thyroid dysfunction increased with an increase in age Majors risk factor for CKD in TD setting were hypertension, diabetes, and heart failure. In conclusion, there was a high prevalence of thyroid dysfunction (53%) among chronic kidney disease patients.

Introduction: Significant reduction of subjective health status is frequently reported by many patients with Hashimoto thyroiditis despite adequate thyroxine replacement therapy. Studies have shown that thyroidectomy improves quality of life (QoL) in patients with HT and persistence symptoms, however there are conflicting evidence and we do not have our own data. QoL is an important aspect in management of chronic diseases like hypothyroidism which is less well touched in our population. Our findings highlight the potential of thyroidectomy in enhancing QoL for HT patients, contributing to the ongoing research on optimal management strategies for this condition. Objectives: To assess the QoL in patients with Hashimoto's thyroiditis (HT) who are biochemically euthyroid on thyroxine replacement therapy and to compare the QoL between patients managed medically and those who have undergone thyroidectomy with histologically confirmed HT. Methodology: We conducted a case-control study to compare the QoL using the SF-36 questionnaire among two groups of euthyroid Hashimoto’s thyroiditis patients: those receiving medical management and those who are post-thyroidectomy, as well as a healthy matched control group. Confounders that could affect QoL were rigorously excluded, and parametric tests were utilized for data analysis. Results: A significantly lower overall QoL was noted in the medically managed group (n=23) compared to the thyroidectomy group (n=24), with mean scores of 63.72 versus 84.25, respectively (P-value < 0.0001). This trend was consistent across all domains of the SF-36 QoL questionnaire. The QoL scores of patients who underwent surgery were similar to those of the healthy control group. Additionally, no significant correlation was found between thyroperoxidase (TPO) antibody titers and QoL in the regression analysis. Conclusion: Overall, patients with Hashimoto's thyroiditis on medical management exhibit significantly poorer QoL, despite adequate thyroxine replacement. This may be attributable to a complex interplay of immunological factors associated with an intact thyroid gland. Thyroidectomy could serve as a viable treatment alternative for these individuals. It is essential to develop algorithms to identify patients who would benefit most from thyroidectomy, ensuring they are thoroughly informed about the risks and benefits. Ongoing studies and the establishment of therapeutic guidelines are crucial for improving the management of patients with Hashimoto's thyroiditis.

Abstract Many cellular processes are governed by protein–protein interactions that require tight spatial and temporal regulation. Accordingly, it is necessary to understand the dynamics of these interactions to fully comprehend and elucidate cellular processes and pathological disease states. To map de novo protein–protein interactions with time resolution at an organelle-wide scale, we developed a quantitative mass spectrometry method, time-resolved interactome profiling (TRIP). We apply TRIP to elucidate aberrant protein interaction dynamics that lead to the protein misfolding disease congenital hypothyroidism. We deconvolute altered temporal interactions of the thyroid hormone precursor thyroglobulin with pathways implicated in hypothyroidism pathophysiology, such as Hsp70-/90-assisted folding, disulfide/redox processing, and N-glycosylation. Functional siRNA screening identified VCP and TEX264 as key protein degradation components whose inhibition selectively rescues mutant prohormone secretion. Ultimately, our results provide novel insight into the temporal coordination of protein homeostasis, and our TRIP method should find broad applications in investigating protein-folding diseases and cellular processes.

Background: Thyroid dysfunction evaluation during pregnancy is important for the mother’s health, obstetric outcomes, and the child’s cognitive development. This study is conducted to know various thyroid disorders that can occur during antenatal and their impact on mother and fetus outcomes. Materials and Methods: This observational research was conducted over two years at a tertiary center in Western Rajasthan, India. Seven hundred and seventy-two low-risk singleton pregnant patients who met the inclusive criteria were recruited. The estimation of T3, T4, and TSH was done along with a routine investigation in antenatal women. Antenatal having abnormal thyroid profiles were then analyzed for mother and fetus problems. Results: The prevalence of thyroid dysfunction in antenatal women is 16.5%. Subclinical hypothyroidism (SCH) was seen in 12.5% of cases, overt hypothyroidism in 3.36%, and subclinical hyperthyroidism in only 0.51% of cases. Anti-TPO was positive in 46 (41.44%) women with hypothyroidism and 1 (25%) with hyperthyroidism. Compared to euthyroid women, women with overt hypothyroid (19.23% vs 3.1%, P = 0.002) and subclinical hypothyroid (9.27% vs 3.1%, P = 0.003) were found to be associated with a higher risk of hypertensive disease. Concerning fetal outcomes. There was a high risk for preterm (12.37% v/s 4.9%, P = 0.004) and fetal growth retardation (FGR) in patients with SCH (7.21% v/s 3.1%, P = 0.04). Conclusion: Considering the significant influence of thyroid disorders on mother and fetus outcomes, the screening for thyroid during pregnancy should be considered universally, particularly in developing countries with high prevalent rates, such as India.

Abstract Objective The relationship between thyrotropin (TSH), free triiodothyronine (FT3), free thyroxine (FT4) and diabetic kidney disease (DKD) is still controversial, and this study analyzed the correlation between TSH, FT3, FT4 and DKD in patients with type 2 diabetes mellitus (T2DM). Methods T2DM patients (1216) were divided into five groups based on serum TSH, FT3, and FT4 levels, differences in urinary albumin excretion rate (UACR), estimated glomerular filtration rate (eGFR) were compared. Binary logistic regression verified independent correlations among TSH, FT3, FT4 and UACR, eGFR. TSH and FT3 predictive values for DKD were analyzed using receiver operating characteristic (ROC) curves. Results The prevalence of albuminuria with decreased eGFR was higher in T2DM patients with subclinical hypothyroidism and overt hypothyroidism than that in patients with normal thyroid function. TSH positively correlated with UACR (r = 0.133, p

Abstract Background Hypothyroidism, a common worldwide syndrome caused by insufficient thyroid hormone secretion, affects number of people at different ages. Artemisinin (ART), a well-known effective agent in the treatment of malaria, also has anti-oxidative stress functions in various diseases. The L1 cell adhesion molecule exerts multiple protective roles in diseased systems. The aim of the present study was to evaluate the role of ART in adult male hypothyroid rats and the underlying mechanisms. Methods The propylthiouracil (PTU) rat model was treated with or without 5 mg/kg ART and with or without L1 short-interfering RNA (siRNA), followed by the experiments to determine the effect of ART on thyroid function, depression and anxiety, cognition impairments, liver, kidney and heart functions, and oxidative stress. Results In the current study, it was shown that ART can ameliorate thyroid function, mitigate depression and anxiety symptoms, attenuate cognition impairments, improve liver, kidney and heart functions, and inhibit oxidative stress; however, the effects exerted by ART could not be observed when L1 was silenced by L1 siRNA. Conclusion These results indicated that ART can upregulate the L1 cell adhesion molecule to ameliorate thyroid function and the complications in adult male hypothyroid rats, laying the foundation for ART to be a novel strategy for the treatment of hypothyroidism.

Gongjie Zhang,1 Xinlyu Huang,1 Hanlin Li,1 Huizi Gong,1 Yabin Zhou,2 Fang Liu1 1Department of Dermatology, Venereology and Cosmetology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China; 2Department of Dermatology, Beijing Children’s Hospital, Capital Medical University, National Centre for Children’s Health, Beijing, 100045, People’s Republic of ChinaCorrespondence: Yabin Zhou, Department of Dermatology, Beijing Children’s Hospital, Capital Medical University, National Centre for Children’s Health, No. 56 Nan Lishi Road, Xicheng District, Beijing, 100045, People’s Republic of China, Tel +86 10 59616884, Email chouyabin@163.com Fang Liu, Department of Dermatology, Venereology and Cosmetology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti Nan Road, Chaoyang District, Beijing, 100020, People’s Republic of China, Tel +86 18611369216, Email roseliufang@qq.comBackground: Hair loss is common in hypothyroidism patients. However, the link with alopecia areata (AA) and androgenetic alopecia (AGA) is unclear. Previous observational studies have presented completely opposite results. This study aims to causally link hypothyroidism with AA and AGA.Methods: A two-sample Mendelian Randomization (MR) study, utilizing data from FinnGen Consortium, investigated the causal link between hypothyroidism and AA and AGA. We employed Inverse Variance Weighted (IVW), MR-Egger, Weighted Median, Simple Mode, and Weighted Mode to assess the risk association.Results: The discovery samples included 13,429 hypothyroidism cases (94,436 controls), 767 alopecia areata cases (394,105 controls), and 220 androgenetic alopecia cases (219,249 controls). MR analysis showed a causal link between hypothyroidism and AA, with significant results from IVW (OR, 1.34; CI, 1.16– 1.56; P = 0.0001), MR-Egger (OR, 1.56; CI, 1.09– 2.23; P = 0.0240), and weighted median (OR, 1.34; CI, 1.06– 1.69; P = 0.0140). However, no clear causal relationship was found between genetically predicted hypothyroidism and AGA risk (p > 0.05).Conclusion: The results show hypothyroidism causally associated with AA onset, but not AGA. These findings address contentious issues in observational studies. Comprehensive thyroid function assessments are crucial for AA patients, emphasizing thorough clinical examinations’ importance.Keywords: hypothyroidism, alopecia areata, androgenetic alopecia, Mendelian randomization study, causality

Fatemah Mohammed AlAhmari,1 Hind Saleh Albahouth,2 Hadeel Ali Almalky,2 Ebtihal Saad Almutairi,2 Muzun Hamoud Alatyan,2 Lama Ali Alotaibi2 1Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia; 2College of Dentistry, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Fatemah Mohammed AlAhmari, King Saud University, Riyadh, Saudi Arabia, Email falahmari@ksu.edu.saObjective: Periodontal diseases are chronic inflammatory disorders influenced by systemic health of the individual. This study aimed to investigate the association between hypothyroidism and periodontal disease in a cohort of adult Saudi population.Methods: This case–control study included 201 adults with hypothyroidism on hormone replacement therapy and 188 healthy controls. The medical files of patients were reviewed to check thyroid stimulation hormone (TSH) and free thyroxine (FT4) levels. Participants completed a questionnaire on demographic and health information, followed by a comprehensive periodontal examination. Pearson chi-square and binary logistic regression analyses determined associations, with a significance set at p ≤ 0.05.Results: Gingivitis was found in 20.9% of cases and 58% of controls. Periodontitis stages I, II, III and IV were in general higher in cases compared to controls (23.4%, 27.9%, 21.9%, 6% in cases versus 13.8%, 17%, 9.6%, 1.6% in controls, respectively). Mean PPD and CAL values were higher in cases (5.54 ± 2.5 and 3.88 ± 3.1) than in controls (4.03 ± 1.6 and 1.72 ± 2.4). Significant associations between periodontal status and hypothyroidism were found (p < 0.0001). The periodontal status in hypothyroid cases correlated significantly with hormone replacement therapy dose and duration (p < 0.0001).Conclusion: The findings of the current study showed that, in a cohort of adult Saudi subjects, patients with hypothyroidism have higher prevalence and more severe periodontal disease symptoms compared to controls, suggesting significant association.Keywords: hypothyroidism, periodontal diseases, hormone replacement therapy, association, case–control study

Abstract Background The prevalence of celiac disease (CD) and hypothyroidism exhibit significant variation in different studies among patients with congenital heart disease (CHD). This study evaluated the frequency of laboratory test abnormalities in children and adolescents with CHD in Shiraz, Iran. Methods This prospective case-control study was conducted on 223 children and adolescents with CHD and healthy individuals referred to the heart clinic affiliated with Shiraz University of Medical Sciences between February 2019 and December 2021. They were classified into case and control groups. Blood tests were performed for total IgA antibody, anti-tissue transglutaminase IgA antibody (anti-TTG Ab), T4, and thyroid stimulating hormone (TSH) and anti-thyroid peroxidase antibodies in serum, along with transthoracic echocardiography. Likewise, demographic characteristics of patients, including age, sex, weight, height, and body mass index (BMI), were recorded. Also, anti-TTG Ab levels were compared among CHD patients according to cyanosis status, gender, age (above and below five years), and BMI (under and over 18.5). Results Ninety-eight CHD patients and 100 healthy individuals with an average age of 5.32 ± 4.05 years (1–18 years) were examined. In children with CHD, atrial septal defect (27%), ventricular septal defect (20%), and tetralogy of Fallot (13%) were the most prevalent disorders. Only one CHD patient had an anti-TTG Ab level of 16.6 unit/mL, considered borderline for seropositive CD diagnosis. There was no difference in anti-TTG Ab levels between age (above and below five years), BMI (under and over 18.5), cyanosis status, and gender groups. Seven CHD patients had high TSH levels, three had cyanotic CHD, and one had Down syndrome. The TSH levels and non-autoimmune hypothyroidism were significantly higher in CHD patients than in normal subjects (p

Abstract Introduction As the fetus relies on maternal thyroid hormones in early pregnancy, maternal hypothyroidism plays an important role in fetal development. However, the association between maternal hypothyroidism and metabolic disease in offspring is unclear. Objective To examine the association between maternal hypothyroidism in pregnancy and metabolic outcomes (obesity, hypertension, type 2 diabetes mellitus, and dyslipidemia) in children 1 million children. The follow-up time ranged from 6 to 20 years. Included studies support an increased risk of hypertension and glucose dysregulation in offspring exposed to maternal hypothyroidism (hypertension: OR 1.08, 95% CI 0.75, 1.57 and HR 1.81, 95% CI 1.21, 2.69; diabetes: RR 2.7, 95% CI 0.7, 10). In the pooled analysis, maternal hypothyroidism was not associated with obesity in offspring (OR 1.04, 95% CI 0.64, 1.70). Conclusion This study found inconsistent evidence on the association between maternal hypothyroidism in pregnancy and metabolic outcomes in offspring, though associations with hypertension and glucose dysregulation are possible.

Background: Hypothyroidism is a significant contributor to complications in various metabolic and cardiovascular diseases. Thyroid hormones, including lipids, play a crucial role in macromolecule metabolism. C-reactive protein (CRP) is a key marker for cardiovascular diseases and hypothyroidism independently. This study aimed to evaluate serum high-sensitivity CRP (Hs-CRP) levels, lipid profiles, and their relationship with thyroid hormones in patients with hypothyroidism compared to a control group. Methods: This case-control study included 90 participants (45 hypothyroid patients and 45 healthy controls). Blood samples were collected, centrifuged to separate serum, and analyzed using commercial kits. ELISA measured T3, T4, TSH, and Hs-CRP, while TG, HDL, LDL, VLDL, and total cholesterol were measured by spectroscopy. Results: The findings revealed higher Hs-CRP levels in hypothyroid patients compared to controls, although not statistically significant (P-value = 0.09). Hs-CRP positively correlated with TSH, T3, and TG but negatively correlated with T4, total cholesterol, VLDL, and HDL in hypothyroid subjects. These correlations were only significant between Hs-CRP and TG and Hs-CRP and LDL (P-value < 0.05). Conclusion: The positive correlation between Hs-CRP and TSH in hypothyroidism highlights a potential link between hypothyroidism and cardiovascular diseas.

Introduction: Hypothyroidism is being increasingly recognized as a risk factor for developing non-alcoholic fatty liver disease (NAFLD). This study was planned to study the prevalence and evaluate any possible association between hypothyroidism and severity of NAFLD. Material and Methods: This case control study was conducted in the department of Medicine, IMS and SUM Hospital, Bhubaneswar among 50 hypothyroid patients and 50 age and sex matched control group. USG abdomen, and various biochemical parameters including TSH levels were done and NAFLD fibrosis score was calculated. Results: Out of the 50 hypothyroid cases, 42 (84%) showed fatty liver changes, whereas only 6 (12%) of controls demonstrated fatty liver changes on ultrasonography. A positive correlation was found among the various grades of NAFLD and TSH, triglyceride, and cholesterol levels (p0.05, r=0.064). Conclusion: The prevalence of NAFLD in hypothyroid patients excluding all other confounding risk factors in our study was 84%. A positive correlation was found between hypothyroidism and the NAFLD fibrosis score but not with ALT levels. A larger group of NAFLD subjects secondary to hypothyroidism is required to validate such association.

Cardiovascular and oncological diseases are the main causes of disability and mortality in Russia, sharing common risk factors and exacerbating each other. The specific toxicological effects of fluoropyrimidines, platinum drugs, and taxanes commonly used in the treatment of gastric and colorectal malignancies have been noted to potentially contribute to the onset of cardiovascular pathologies in some cases. However, the manifestation and prevalence of cardiovascular toxicity due to cancer treatment regimens are influenced by various factors beyond just the chemotherapy protocols employed. Gender, age, overall health status (including cardiac and thyroid functions), and other risk factors play significant roles in the development and progression of heart and vascular diseases in these patients. Thyroid dysfunction, even in the absence of severe clinical symptoms, can significantly impact the course of cardiovascular pathologies, complicating the management of toxic effects associated with polychemotherapy on both the cardiac muscle and vascular system. This paper analyzes modern ideas about pathogenetic relationship between cardiovascular diseases and gastric and colon cancer. The profile and mechanism of cardiovascular toxicity of chemotherapy in patients with gastric and colon cancer, pathogenetic relationship of thyroid status and cardiovascular diseases are presented. Organizational management issues of chemotherapy toxicity are briefly highlighted.

Background/Aims Statins are common lipid-lowering agents used in dyslipidemia. However, they increase serum creatinine phosphokinase (CPK) levels. Currently, there are no studies on the effect of thyroid-stimulating hormone (TSH) levels on CPK levels after statin administration. Therefore, this study aimed to investigate CPK level alterations after statin administration according to TSH quartiles in participants with euthyroidism. Methods This retrospective analysis included 25,047 patients with euthyroidism. CPK levels were measured before and 6 months after statin administration. Normal TSH levels were divided into four quartiles, and the CPK levels and proportions of patients with normal CPK levels after statin administration for each TSH quartile were evaluated. Results The baseline CPK level was significantly higher in the lowest TSH quartile (Q1) compared to the other quartiles but decreased after statin administration. Thus, the difference between the CPK levels and the other quartile groups was not significant. The proportion of patients with normal CPK levels was also significantly lowest in Q1 before statin administration; however, no significant difference was noted in the ratio among each group after statin administration. These findings were consistent with the findings of the analysis according to statin intensity. Conclusions In patients in the lowest TSH quartile of the normal TSH range, the CPK level decreased, and the proportion of normal CPK levels increased significantly after statin administration. However, similar changes were not observed in other TSH quartiles. Therefore, further studies are required to mechanistically confirm these conclusions.

Abstract Background The incidence of hypothyroidism following hemithyroidectomy and risk factors associated with its occurrence are not completely understood. This systematic review investigated the incidence and risk factors for hypothyroidism, thyroxine supplementation following hemithyroidectomy as well as the course of post-operative hypothyroidism, including the time to hypothyroidism and incidence of transient hypothyroidism. Methods Searches were conducted in MEDLINE, EMBASE, Scopus, and Cochrane library for studies reporting the incidence of hypothyroidism or thyroxine supplementation following hemithyroidectomy. Results Sixty-six studies were eligible for inclusion: 36 reported risk factors, and 27 reported post-operative course of hypothyroidism. Median follow-up was 25.2 months. The pooled incidence of hypothyroidism was 29% (95% CI, 25-34%; P

Background: Thyroid hormones play a crucial role in major metabolic pathways in the body and dyslipidemia is a major metabolic abnormality seen in thyroid disorders. Cardiovascular diseases (CVDs) are now emerging as the leading cause of morbidity and mortality worldwide and the most important risk factor for CVDs is dyslipidemia. The lipid ratios that have a positive association with CVD risk are atherogenic index of plasma (AIP), Castelli’s risk index (CRI)-I and II, and atherogenic coefficient (AC). Clinically, both an excess and deficiency of thyroid hormones can exacerbate or induce CVDs and lipid ratio can be used as an inexpensive marker for predicting CVD risk. Aims and Objectives: This study aims to evaluate the lipid ratios (AIP, CRI-I, CRI-II, AC) in patients with thyroid dysfunction and compare the results with lipid ratios in euthyroid individuals. This study also aims to find any correlation, if exists, between lipid ratios and serum thyroid-stimulating hormone (TSH) levels in thyroid dysfunction. Materials and Methods: The serum TSH and lipid profile were evaluated in fifty euthyroid, fifty hypothyroid, fifty subclinical hypothyroid, and fifty hyperthyroid patients. The lipid ratios (AIP, CRI-I, CRI-II, AC) were calculated from the lipid profile. Results: The mean lipid ratios were higher in hypothyroid, followed by subclinical hypothyroid cases when compared to euthyroid controls and hyperthyroid patients. A positive correlation was observed between the TSH and lipid ratios in euthyroid, hypothyroid, and subclinical hypothyroid subjects. There was no significant correlation between TSH and lipid ratios in hyperthyroid patients. Conclusion: This study demonstrates that the evaluation of lipid ratios along with TSH can provide an effective screening tool to assess the cardiovascular risk in patients with subclinical and overt hypothyroidism, especially in the absence of imaging techniques in resource-limited centers.

Background Thyroid autoantibody is a marker for the diagnosis of Hashimoto's thyroiditis (HT), and B cells are essential in the pathogenesis of HT. Enhancer of Zeste homolog 2 (EZH2), which is an important epigenetic regulator, plays an important role in the regulation of lymphocytes development and function. Objective To investigate EZH2 expression in plasmoblasts and plasma cells in HT, and further explore the therapeutic effect of EZH2 inhibitors in experimental autoimmune thyroiditis (EAT) model. Methods The thyroid tissues from 6 patients who underwent thyroidectomy (3 HT patients with PTC, 3 patients with PTC alone) in Peking University First Hospital between 2010 and 2020 were obtained from the contralateral lobe with thyroid cancer, and screened for the expression of B-lymphocyte-related genes by RNA-seq; thyroid tissues from 16 HT patients and 8 normal thyroid tissues were collected and verified for the the expression of EZH2 in B cells in HT thyroid tissues by immunohistochemistry or immunofluorescence, respectively. Fine-needle aspiration (FNA) samples from patients with HT (n=25), and peripheral blood from patients with HT (n=19) or healthy donors (n=12) were analyzed by flow cytometry to define altered EZH2 expression in plasmablasts and plasma cells. Fifteen seven-week-old NOD.H-2h4 mice were randomly divided into the control (n=5), EAT without injection group (n=5), and EZH2 inhibitor+ GSK126 injection group (10 mg/kg, intraperitoneal injection 3 times /week, n=5). The degree of thyroid inflammation and changes in TgAb levels were observed after 8 weeks. Results RNA sequencing analysis showed that EZH2 and genes associated with the B-cell phenotype such as CD19, CD27, CD38, CD52 were higher expressed in HT hyroid tissues compared with normal thyroid tissues. Immunohistochemical results showed that immunohistochemical staining for EZH2 in 16 HT thyroid tissue specimens was strongly positive with positive cells observed in the GC region, and no positive cells were observed in the staining of 8 normal thyroid tissues. EZH2 staining in HT thyroid tissue was highly expressed in the GC region, and EZH2 was specifically expressed in CD19+ B cells. The results of flow cytometry assay showed that the proportion of CD19+ B cells, plasmablasts and plasma cells in HT FNA samples was higher than that of HD peripheral blood and HT peripheral blood samples (P

Central hypothyroidism and dyslipidemia are well-known adverse events (AEs) of bexarotene therapy. Although hypothyroidism is known to cause dyslipidemia, no study has examined the association between hypothyroidism and dyslipidemia in patients undergoing bexarotene therapy. The aim of this study is to examine this association. A retrospective observational study was performed among 294 patients who initiated bexarotene therapy in Japan (nation-wide postmarketing complete surveillance). Jonckheere-Terpstra (one sided) test was performed to evaluate the effect of the bexarotene dose on lipid metabolisms, and regression analyses were performed to evaluate associations of bexarotene dose, free thyroxine (FT4), body mass index (BMI), and lipid metabolisms. Most patients developed hypothyroidism. Two-third of patients showed FT4 values below the lower limit at 1 week. Triglycerides (TG) increased in a bexarotene dose–dependent manner, and grade ≥3 AEs on hypertriglyceridemia was observed in 39% of the patients. Additionally, one-third of grade ≥3 AEs on hypertriglyceridemia occurred within 1 week. The delta_FT4 (difference in FT4 from baseline) negatively correlated with TG increase at 1 week (p = 0.012) but not with low density lipoprotein cholesterol (LDL-C) increase at any week. Bexarotene-induced hypothyroidism is almost inevitable and occurred quickly. Bexarotene-induced hypertriglyceridemia showed positive bexarotene dose dependency and negative delta_FT4 dependency. Prophylactic and appropriate thyroid hormone compensation therapy and starting bexarotene at low doses with subsequent titration while managing dyslipidemia may have a beneficial effect for the successful continuation of bexarotene therapy without severe endocrine and metabolic AEs.

Background: Several studies have reported a strong association between depression and hypothyroidism, including from several regions of Saudi Arabia. However, studies on the frequency of depression among patients with hypothyroidism from the Western region of Saudi Arabia is limited. Objectives: To determine the frequency and risk factors of depression among patients with hypothyroidism in the Western Region of Saudi Arabia. Materials and Methods: This cross-sectional study was conducted at a tertiary care hospital in Jeddah, Saudi Arabia, and included adult patients diagnosed with hypothyroidism. After contacting the patients through phone calls and obtaining their consent, a questionnaire weblink was sent. The first part of the questionnaire elicited details regarding demographics and history of hypothyroidism, while the second part comprised the Arabic version of the Patient Health Questionnaire-9 to evaluate depression. Results: A total of 100 patients completed the survey, of which 80% were found to have depression (mild: 35%, moderate: 26%, moderate to severe: 12, severe: 7%). There was no significant association between depression and gender, age group, employment status, and marital status. In the bivariate analysis, a significant association was found between depression and reporting fatigue (P < 0.001), constipation (P < 0.001), hair loss (P = 0.002), cold intolerance (P = 0.014), dry skin (P = 0.028), memory problems (P = 0.029), and menorrhagia (P = 0.037). However, in the multivariate analysis, only reporting fatigue was found to be significantly associated with depression (P = 0.040; OR = 15.215). Conclusion: This study found that the prevalence of depression was very high among patients with hypothyroidism in the Western region of Saudi Arabia, and that fatigue is an independent risk factor of depression.

Hypothyroidism is the most common endocrinopathy in the dogs resulting from triiodothyronine (T3) and thyroxine (T4) deficiency. Deficiency of thyroid hormones is associated with metabolic and dermatological effects. Hypothyroidism can therefore significantly impact on the life quality of dogs. Several risk factors have been reported for hypothyroidism in dogs. The work focuses on the prevalence of hypothyroidism in predisposed breeds of dogs, and risk factors for the development of the disease. In a retrospective study, 24 patient records of 15 breeds of dogs diagnosed with hypothyroidism from Anicura Elverum Dyrehospital in Elverum, Norway, during 2021 were selected and categorized according to the breed. Dog´s breeds with the highest prevalence of hypothyroidism were concluded to be: English Setter, English Cocker Spaniel, and the Gordon Setter. Out of 24 dogs, five patient records from the most prevalent breeds were selected, and compared according to age, gender, and whether they were neutered, and body condition scoring. Our results showed, that increased age, and overweight (body condition score of 6‒9), are risk factors for dogs living with hypothyroidism.

Introduction: Effects of levothyroxine therapy on the lipid profile of hypothyroid patients lead to decrease in the risk of cardiovascular diseases and mortality. Objective: Overt or subclinical hypothyroid dysfunction has negative effects on lipid metabolism and leads to hypercholesterolemia that in turn increases the risk of cardiovascular diseases and mortality. In this matter, several interventional studies investigated the effects of levothyroxine therapy on the lipid profile of hypothyroid patients, and conflicting results have been obtained. The current research aims to investigate the effect of levothyroxine replacement on cholesterol levels in hypothyroid patients. Methods: The present prospective study examined 112 patients (mean age of 43.80 ± 14.36 years) with overt hypothyroidism. To do so, 72.3% of patients were females. Levothyroxine replacement therapy was prescribed for patients, and they were examined monthly to evaluate the effects of therapy on their lipid profiles. After reaching normal thyroid stimulating hormone (TSH), the patients’ laboratory parameters, including TSH, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides, were surveyed. Results: After Levothyroxine therapy, there was a significant reduction in mean TSH (62.03 vs. 2.33 ± 1.95; P < 0.0001), triglycerides (145.57 ± 88.65 vs. 121.91 ± 59.52, P = 0.002), cholesterol (203.90 ± 53.73 vs. 166.65 ± 40.07, P < 0.0001), and serum LDL (123.61 ± 45.03 vs. 95.99 ± 24.20, P < 0.0001), but the mean value of serum HDL did not show any significant change (54.18 ± 16.60 vs. 51.59 ± 18.38, P = 0.274). Conclusions: Levothyroxine therapy has beneficial effects on lipid profile in patients with overt hypothyroidism because it decreases serum triglyceride, total cholesterol, and LDL. However, levothyroxine therapy does not significantly change HDL levels.

Abstract Background Hypothyroidism is a common endocrine disruption observed in utero that adversely affects fetal growth and maturation leading to long-term impacts on health; however, the exact molecular mechanisms by which these deleterious effects occur are unknown. We hypothesize that fetal hypothyroidism during late gestation will disrupt cell cycle regulation in a tissue-specific manner. To evaluate this, eight pregnant gilts were dosed with either methimazole or an equivalent negative control during days 85–106 out of 114 days of gestation (n = 4/group). Following treatment, the gilts were humanely euthanized, and tissue samples of fetal heart, ileum, kidney, lung, liver, muscle, spleen, and thymus taken from two male and two female fetuses (n = 32) from each gilt. Results The relative expression of three cell cycle promoters (CDK1, CDK2, and CDK4), and one cell cycle inhibitor (CDKN1A) was compared in each tissue to determine the effect of hypothyroidism on the developing fetus. All of the eight tissues examined experienced at least one significant up- or downregulation in the expression of the aforementioned genes as a result of treatment with methimazole. Substantial changes were observed in the liver and muscle, with the latter experiencing significant downregulations of CDK1, CDK2, and CDK4 as a result of treatment. In addition, all tissues were examined for changes in protein content, which further elucidated the impact of hypothyroidism on the fetal liver by the observation of a marked increase in protein content in the methimazole-treated group. Finally, the heart and liver were histologically examined for evidence of cellular hyperplasia and hypertrophy by measuring average nuclei density and size in each tissue, with the results showing a significant decrease in average nuclei size in the liver of hypothyroid fetuses. Conclusions Collectively, these findings indicate the occurrence of organ-specific disruptions in cell cycle progression as a result of in utero hypothyroidism, which may explain the long term and widespread effects of hypothyroidism on fetal development.

Abstract Background Hypothyroidism is a common endocrine ailment, whose current standard of care is hormonal replacement therapy with levothyroxine (LT4). There is a medical need for alternative and safer therapies as LT4 is associated with special treatment considerations and adverse effects. Thyrogrit (THY) is a polyherbal formulation indicated for the treatment of hypothyroidism. The present study, describes the characterization of the phytocompounds present in THY and its in-vivo efficacy in rat model of hypothyroidism, in combination with a sub-optimal dose of LT4. Methods Ultra High Performance Liquid chromatography was employed for the identification of the phytocompounds present in THY. For the evaluation of its in-vivo efficacy, female Wistar rats were administered THY orally, 15-days prior to disease induction, and continued throughout the experiment. Subsequently, hypothyroidism was induced by oral administration of propylthiouracil (PTU). From day 45 onwards, animals were administered orally with a sub-optimal dose of LT4 (2 μg/kg) till the end of the study. On day 79, animals were euthanized, blood was collected for measurement of thyroid hormones and other clinical chemistry parameters. Weights of liver, kidney and thyroid were recorded. Finally, the thyroid was subjected to histopathological evaluation through hematoxylin and eosin (H&E staining), immunohistochemistry as well as immunofluorescence. Results The principal phyto-components detected in THY by Ultra High Performance Liquid Chromatography included gallic acid, protocatechuic acid, corilagin, ellagic acid, piperine, guggulsterone E and Z, which are documented to exerted beneficial effects on thyroid function. In the in-vivo study, THY when supplemented with a low dose of levothyroxine restored the PTU-induced reduction in the serum levels of T3 and T4 and improved PTU-induced renal impairment. THY treatment ameliorated the hallmark histopathological changes associated with hypothyroidism and C-cell hyperplasia. Further, co-administration of THY and LT4 did not show any major non-clinical safety concerns even after the administration for more than twelve weeks. Conclusion This study has demonstrated that co-administration of THY and LT4 improves the PTU-evoked alterations in the thyroid ultrastructure and function, abrogates hypothyroidism-associated renal impairment and exhibits an acceptable basic safety profile. Graphical abstract

Background: Current guidelines recommend different postpartum approaches for patients started on levothyroxine (LT4) during pregnancy. Objective: We studied the postpartum management of these patients and determined factors associated with long-term hypothyroidism. Methods: A retrospective study was conducted at a tertiary center between 2014 and 2020, with LT4 initiation according to 2014 ETA recommendations. We performed multivariate logistic regression (MVR) and a receiver operating characteristic curve analysis to determine variables associated with long-term hypothyroidism and their optimal cutoffs. Results: LT4 was initiated in 177 pregnant women, and 106/177 (60%) were followed at long-term (at least 6 months post partum) (28.5 (9.0–81.9) months). LT4 could have been stopped in 45% of patients who continued it immediately after delivery. Thirty-six out of 106 (34%) patients were long-term hypothyroid. In them, LT4 was initiated earlier during pregnancy than in euthyroid women (11.7 ± 4.7 vs 13.7 ± 6.5 weeks, P = 0.077), at a higher thyroid-stimulating hormone (TSH) level (4.1 (2.2–10.1) vs 3.5 (0.9–6.9) mU/L, P = 0.005), and reached a higher dose during pregnancy (62.8 ± 22.2 vs 50.7 ± 13.9 μg/day, P = 0.005). In the MVR, only the maximal LT4 dose during pregnancy was associated with long-term hypothyroidism (odds ratio (OR) = 1.03, 95% CI: 1.00–1.05, P = 0.003). The optimal cutoffs for predicting long-term hypothyroidism were an LT4 dose of 68.75 μg/day (87% specificity, 42% sensitivity; P = 0.013) and a TSH level ≥ 3.8 mU/L (68.5% specificity, 77% sensitivity; P = 0.019). Conclusion: One-third of the patients who started on LT4 during pregnancy had long-term hypothyroidism. The TSH level at treatment initiation and the LT4 dose during pregnancy could guide the decision for continuing long-term LT4.

Background. In recent decades, the frequency of surgical interventions on reproductive system organs has been steadily increasing. In gynecological practice, preference is given to minimally invasive surgery and precision treatments, especially involving ovaries. Despite the modern approach, it is not always possible to preserve this endocrine organ, which leads to post-surgical menopause (PSM). The relatively high incidence of total hysterectomy-associated PSM and primary hypothyroidism in late reproductive age often leads to their combination. Clinical manifestations aggravating each other form an unfavorable vicious circle. Aim. To study the features of the PSM course with concomitant primary hypothyroidism. Materials and methods. A prospective clinical study included 130 women aged 45 to 55 years with a history of PSM. The main group consisted of 70 patients with PSM with subclinical primary hypothyroidism. A control group included 60 PSM patients without thyroid disorders. We assessed the effect of hypothyroidism on the PSM course by comparing several indicators in the main and control groups. Results. It was found that in the main group patients, severe 26.5% and moderate 38.8% menopausal syndrome prevailed, while in the control group patients, such forms were twice as common. In the women of the main group, the levels of triglycerides were higher than those in the control group by 1.3 times (2.6±0.86 mmol/L and 1.43±0.33 mmol/L, respectively). The total serum alkaline phosphatase activity in patients in the study groups was 29.8% higher than in healthy women. Conclusion. It can be concluded that the severity of menopausal disorders depends on the thyroid status, with more severe in patients of the main group with hypothyroidism. In addition, in patients of the main group with hypothyroidism, dyslipidemia is more pronounced, which predisposes them to severe diseases in the future, in particular cardiovascular disorders, the unfavorable course of metabolic syndrome, and the development of postmenopausal osteoporosis.

Abstract Background Persistent symptoms in hypothyroid patients despite normalized TSH levels suggest the need for alternative treatments. This study aims to evaluate the effectiveness of combined T4 and T3 therapy or desiccated thyroid (DTE) compared to T4 monotherapy, with a focus on thyroid profile, lipid profile, and quality of life metrics. Methods We conducted a systematic review in Embase, Medline/PubMed, and Web of Science up to 11/23/2023. We used the following keywords: “Armour Thyroid,” OR “Thyroid extract,” OR “Natural desiccated thyroid,” OR “Nature-Throid,” “desiccated thyroid,” OR “np thyroid,” OR “Synthroid,” OR “levothyroxine,” OR “Liothyronine,” “Cytomel,” OR “Thyroid USP,” OR “Unithroid.” AND “hypothyroidism. “ We only included RCTs and excluded non-RCT, case–control studies, and non-English articles. Results From 6,394 identified records, 16 studies qualified after screening and eligibility checks. We included two studies on desiccated thyroid and 15 studies on combined therapy. In this meta-analysis, combination therapy with T4 + T3 revealed significantly lower Free T4 levels (mean difference (MD): -0.34; 95% CI: -0.47, -0.20), Total T4 levels (mean difference: -2.20; 95% CI: -3.03, -1.37), and GHQ-28 scores (MD: -2.89; 95% CI: -3.16, -2.63), compared to T4 monotherapy. Total T3 levels were significantly higher in combined therapy (MD: 29.82; 95% CI: 22.40, 37.25). The analyses demonstrated moderate to high heterogeneity. There was no significant difference in Heart Rate, SHBG, TSH, Lipid profile, TSQ-36, and BDI Score. Subjects on DTE had significantly higher serum Total T3 levels (MD: 50.90; 95% CI: 42.39, 59.42) and significantly lower serum Total T4 (MD: -3.11; 95% CI: -3.64, -2.58) and Free T4 levels (MD: -0.50; 95% CI: -0.57, -0.43) compared to T4 monotherapy. Moreover, DTE treatment showed modestly higher TSH levels (MD: 0.49; 95% CI: 0.17, 0.80). The analyses indicated low heterogeneity. There was no significant difference in Heart Rate, SHBG, Lipid profile, TSQ-36, GHQ-28, and BDI Score. Conclusions Our study revealed that combined therapy and DTE lead to higher T3 and lower T4 levels, compared to T4 monotherapy in hypothyroidism. However, no significant effects on heart rate, lipid profile, or quality of life were noted. Given the heterogeneity of results, personalized treatment approaches are recommended.

Abstract Thyroid hormones(THs) are essential for the proper functioning of the ovaries, and multiple studies have shown that thyroid abnormalities, especially during adolescence and reproductive age, can lead to lifelong ovarian dysfunction. Autoimmune thyroid disease (AITD), one of the most common organ specific autoimmune diseases, is mainly mediated by cellular autoimmune reactions, and has strong inflammatory infiltration and immune active cells, including chemokines and cytokines, which are important components of ovarian aging. This suggests that autoimmune and inflammatory molecular processes may play a role in the emergence of ovarian dysfunction. The purpose of this review is to summarize recent in vivo and in vitro evidence of a complex relationship between AITD and ovarian dysfunction. AITD is closely related to the decline of ovarian function from the perspective of antibody, cytokine, oxidative stress, and genetic factors. Finally, some of the currently known treatments for AITD and hypo ovarian disease are summarized.

Abstract Background Based on several case reports and observational studies, there is a growing concern regarding the potential association between roxadustat, a hypoxia-inducible factor prolyl-hydroxylase inhibitor, and suppression of thyroid function. In this systematic review and meta-analysis (PROSPERO: CRD42023471516), we aimed to evaluate the relationship between roxadustat use and suppression of thyroid function. Methods We conducted a comprehensive search of MEDLINE via PubMed, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials databases using the search term “roxadustat” to identify all relevant studies. The study population comprised adults with renal anemia who participated in a randomized controlled trial or observational study, with roxadustat as the intervention and a placebo or erythropoiesis-stimulating agent (ESA) as the comparator. The primary outcome was suppression of thyroid function and the secondary outcome was hypothyroidism. A meta-analysis was conducted using the DerSimonian–Laird random effects model based on the size of the intention-to-treat population, and the odds ratio (OR) and 95% confidence interval (CI) were calculated. Two reviewers independently screened the articles, extracted data, and assessed studies using the ROBINS-I tool. Results Of the six studies eligible for inclusion, a meta-analysis was performed using data from two observational studies comparing roxadustat and ESA. The meta-analysis showed that the incidence of suppression of thyroid function was significantly higher with roxadustat use than with ESA use (OR: 6.45; 95% CI: 3.39–12.27; I 2 = 12%). Compared with ESA, roxadustat seemed to potentially increase the risk for suppression of thyroid function in patients with renal anemia. Conclusions Our findings highlighted the importance of monitoring thyroid function in patients treated with roxadustat. The results of this review may enhance the safety of using roxadustat to treat renal anemia through advance recognition of the risk for suppression of thyroid function.

Background: Thyroid disease is one of the most common illnesses in the UAE, which could be linked to vast numbers of people suffering from vitamin D deficiency. This study aimed to explore the association between serum 25(OH)D levels and thyroid function parameters in men and women with diagnosed hypothyroidism. Methods and Results: This cross-sectional observational study included 86 patients (78[90.7%] women and 8[9.3%] men) with diagnosed hypothyroidism. The patients were divided into two groups, male and female. These two groups were compared in terms of age, TSH, free-T4 (FT4), vitamin D, free-T3 (FT3), and body mass index (BMI). In addition, the correlation between levels of vitamin D and TSH was also examined in these two groups. The mean age of the patients was 27.5 years, and BMI was 28.00 kg/m2, indicating overweight. Vitamin D deficiency was found in 61(70.9%) patients and severe vitamin D deficiency in 10(11.6%) patients with hypothyroidism. 25(OH)D levels were significantly low in patients with high TSH levels, showing a weak negative correlation (r=-0.132, P=0.043). A negligible positive correlation was identified between 25(OH)D levels and FT4 r=0.089, P>0.05) and FT3 (r=0.071, P>0.05), and a negligible negative correlation with BMI (r=-0.059, P>0.05). Conclusion: There is a clear indication that vitamin D deficiency is prevalent in hypothyroid patients and that these subjects have lower levels of serum 25(OH)D. Suggesting that lower serum 25(OH)D is related to hypothyroidism and the deficiency in vitamin D plays a role in the development of the disease.

Aim. To compare the frequency of cardiovascular events (CVE), to assess the risk of cardiovascular death using the mSCORE and the development of type 2 diabetes mellitus (DM) using the FINDRISC in patients with rheumatoid arthritis (RA) with and without hypothyroidism. Materials and methods. The study included 149 patients (125 women, 24 men) with RA (median age – 57 [52; 61] years). In all patients, traditional factors of cardiovascular risk and glucose metabolism disorders (age, smoking status, total blood cholesterol, blood pressure, overweight, abdominal obesity – AO, heredity burdened by diabetes, insufficient physical activity, the lack of the necessary amount of berries, fruits and vegetables in the daily diet, history of hyperglycemia episodes), the 10-year risk of death from cardiovascular causes according to the mSCORE and the risk of developing type 2 DM according to the FINDRISС were assessed, a history of CVE (myocardial infarctions, and its revascularization, stroke) was recorded. Results. Hypothyroidism was diagnosed in 17.4% of RA patients. Patients with hypothyroidism (group 1) were more likely to have AO and less likely to consume unsufficient dietary fiber than patients with euthyroidism (group 2). Moderate, high and very high risk of development according to the mSCORE and FINDRISC was detected in 61.5% of hypothyroid patients and 48.8% euthyroid patients, according to mSCORE alone – in 30.8 and 44.7%, according to FINDRISC – in 0 and 2.4%, respectively (p0.05 in all cases); 11.5% of patients in group 1 and 6.5% in group 2 suffered from CVE (OR 1.875, 95% CI 0.462–7.607; p=0.63). Conclusion. It is necessary to evaluate the thyroid gland function, especially in patients with AO due to the high frequency of hypothyroidism in RA. Hypothyroidism did not have an independent effect on the severe CVЕ rates, as well as risk assessment according to the score and FINDRISC in RA patients. Theses, with and without hypothyroidism, were predominantly in the moderate, high, very high risk groups according to both scales.