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Purpose: To investigate the relationship between bone turnover markers (BTMs) and thyroid indicators in Graves' disease (GD) and to further assess predictive value of changes in early stage retrospectively. Methods: We studied 435 patients with GD and 113 healthy physical examiners retrospectively and followed up these two groups of patients after 6 months. We investigated the correlations between BTMs and other 15 observed factors, and analyzed the predictive value of FT3 and FT4 before and after treatment (FT3-P/FT3-A, FT4-P/FT4-A) on whether BTMs recovered. Results: The levels of thyroid hormones and BTMs in GD group were significantly higher than those in control group (P < 0.05) and decreased after 6 months of treatment. FT3, W, Ca and ALP were independent factors in predicting the elevation of OST. Duration of disease, FT3, TSH and ALP were independent factors in predicting the elevation of P1NP. Age, duration of disease, TRAb and ALP were independent factors in predicting the elevation of CTX-1. The AUC of FT3-P/FT3-A and FT4-P/FT4-A for predicting OST recovery were 0.748 and 0.705 (P < 0.05), respectively, and the cut-off values were 0.51 and 0.595. There was no predictive value for P1NP and CTX-1 recovery (P > 0.05). Conclusion: BTMs were abnormally elevated in GD and were significantly correlated with serum levels of FT3, FT4, TRAb, Ca, and ALP. FT3 decreased more than 51% and FT4 dropped more than 59.5% after 6 months of treatment were independent predictors for the recovery of BTMs in GD. [ABSTRACT FROM AUTHOR]

Introduction: Functional connectivity (FC) is the correlation between brain regions' activities, studied through neuroimaging techniques like fMRI. It helps researchers understand brain function, organization, and dysfunction. Hyperthyroidism, characterized by high serum levels of free thyroxin and suppressed thyroid stimulating hormone, can lead to mood disturbance, cognitive impairment, and psychiatric symptoms. Excessive thyroid hormone exposure can enhance neuronal death and decrease brain volume, affecting memory, attention, emotion, vision, and motor planning. Methods: We conducted thorough searches across Google Scholar, PubMed, Hinari, and Science Direct to locate pertinent articles containing original data investigating FC measures in individuals diagnosed with hyperthyroidism. Results: The systematic review identified 762 articles, excluding duplicates and non-matching titles and abstracts. Four full-text articles were included in this review. In conclusion, a strong bilateral hippocampal connection in hyperthyroid individuals suggests a possible neurobiological influence on brain networks that may affect cognitive and emotional processing. [ABSTRACT FROM AUTHOR]

Cardiac dysfunction in thyrotoxicosis is believed to arise from changes in preload, afterload, heart rate, and contractility. Cardiomyopathy is a less frequent cardiac complication linked to thyrotoxicosis. Here, we present a rare case of thyrotoxicosis induced cardiomyopathy in a 30-year-old male, where dilated cardiomyopathy manifested as the initial sign of thyrotoxicosis. The patient was treated with antithyroid drugs, diuretics and beta blockers. General surgery opinion obtained and planned to do thyroidectomy after euthyroid status. Patient was followed up and after 6 weeks was symptomatically better and was found to be euthyroid and repeat 2D ECHO showed an improvement in systolic function with EF of 55% and the patient was planned for thyroidectomy. In the management of thyrotoxicosis induced cardiomyopathy, pharmacological interventions involve the use of specific thyroid therapies such as thionamides (methimazole, carbimazole, propylthiouracil) and beta-blockers, coupled with heart failure management.

The objective of this study was to determine the association between birthweight and risk of thyroid and autoimmune conditions in a large sample of postmenopausal women. Baseline data from the Women's Health Initiative (n = 80,806) were used to examine the associations between birthweight category (

Background: Brain natriuretic peptide (BNP) is released from the ventricular myocardium as a reaction to volume expansion and pressure overload. Since the thyroid hormones stimulate the release of BNP, it can be used as an indicator of thyroid failure and guiding in thyroid control. This study was THUS designed to assess the value of measuring serum BNP as a marker for diagnosis and follow up of patients with subclinical and overt hyperthyroidism. Patients and Methods: This is a prospective cohort study for patients with hyperthyroidism. Patients have been enrolled from Endocrinology Outpatient Clinic at Zagazig University Hospitals in the period from December 2018 to October 2020. Results: Patients were divided into two major groups; overt hyperthyroidism (group 1) and subclinical hyperthyroidism (group 2). In all cases BNP level over 100 ng/l. Median for BNP in group (1) 671.89 and the median BNP in group (2 ) 318.19. We noticed a significant elevation of BNP levels in group (1) than group (2) (p = <0.001), Hyperthyroid patients with major clinical symptoms had showed higher BNP levels (656.9) than those with minor clinical complaint (314 .6) (p =<0.001). Positive correlations between BNP, F.T4 (p= <0.001) and F.T3 (p= <0.001) were documented. But there was no correlation between BNP and TSH or BMI (p= 0.595, p 0.104 respectively). Conclusions: BNP levels were significantly elevated in all patients of the study, especially in overt hyperthyroid than subclinical hyperthyroid patients. [ABSTRACT FROM AUTHOR]

This document presents the results of a study on the relationship between thyroid hormone status and blood pressure. The study divided participants into three groups: hypothyroid patients, hyperthyroid patients, and healthy controls. The study found that resting systolic blood pressure was significantly higher in hyperthyroid patients compared to the other groups. The study suggests that elevated levels of thyroid hormone can increase cardiac output, leading to higher blood pressure. The study concludes that maintaining normal thyroid hormone levels is important for preventing the negative effects of elevated blood pressure. [Extracted from the article]

Hypokalemic Periodic Paralysis (HPP) is a neurological manifestation of hypokalemia, with a prevalence of 1 in 100,000. HPP is recognized by the sudden onset of muscle paralysis and low serum potassium. Due to its various causes, it may be misdiagnosed and neglected. We present a case of 42-year-old Asian female with weakness of both legs and cramps. The weakness was felt upon awakening from sleep. She also complained of palpitation, tiredness, sweating, heat intolerance, and hand tremors. In the recent weeks, her appetite increased. Periodic paralysis (PP) is characterized by bursts of painless muscle weakening. A possible cause of periodic paralysis is hypokalemia which was found in our case. Hyperthyroid is classified into potassium depletion by extra renal route which was found in this case. Management When managing a patient with sudden onset weakness or paralysis, it is crucial to consider the possibility of periodic paralysis. HPP is a rare but serious medical emergency. This should be suspected in any patient presenting with sudden muscle weakness. Prompt correction of any abnormalities in potassium levels can lead to rapid and complete symptom resolution. To avoid persistent or recurrent paralysis, any underlying causes should be effectively managed wherever possible. [ABSTRACT FROM AUTHOR]

Cardiac dysfunction in thyrotoxicosis is believed to arise from changes in preload, afterload, heart rate, and contractility. Cardiomyopathy is a less frequent cardiac complication linked to thyrotoxicosis. Here, we present a rare case of thyrotoxicosis induced cardiomyopathy in a 30-year-old male, where dilated cardiomyopathy manifested as the initial sign of thyrotoxicosis. The patient was treated with antithyroid drugs, diuretics and beta blockers. General surgery opinion obtained and planned to do thyroidectomy after euthyroid status. Patient was followed up and after 6 weeks was symptomatically better and was found to be euthyroid and repeat 2D ECHO showed an improvement in systolic function with EF of 55% and the patient was planned for thyroidectomy. In the management of thyrotoxicosis induced cardiomyopathy, pharmacological interventions involve the use of specific thyroid therapies such as thionamides (methimazole, carbimazole, propylthiouracil) and beta-blockers, coupled with heart failure management. [ABSTRACT FROM AUTHOR]

IntroductionFunctional connectivity (FC) is the correlation between brain regions’ activities, studied through neuroimaging techniques like fMRI. It helps researchers understand brain function, organization, and dysfunction. Hyperthyroidism, characterized by high serum levels of free thyroxin and suppressed thyroid stimulating hormone, can lead to mood disturbance, cognitive impairment, and psychiatric symptoms. Excessive thyroid hormone exposure can enhance neuronal death and decrease brain volume, affecting memory, attention, emotion, vision, and motor planning.MethodsWe conducted thorough searches across Google Scholar, PubMed, Hinari, and Science Direct to locate pertinent articles containing original data investigating FC measures in individuals diagnosed with hyperthyroidism.ResultsThe systematic review identified 762 articles, excluding duplicates and non-matching titles and abstracts. Four full-text articles were included in this review. In conclusion, a strong bilateral hippocampal connection in hyperthyroid individuals suggests a possible neurobiological influence on brain networks that may affect cognitive and emotional processing.Systematic Review RegistrationPROSPERO, CRD42024516216.

Background Recent studies have connected microribonucleic acid (miRNA) to several illnesses as a stimulant or inhibitor. Oxidative stress and thyroid diseases are connected to miRNA-22. The underlying pro- cesses remain unknown. In this study, hyperthyroid women’s miRNA-22 expression is linked to oxidative stress. Materials and Methods 40 women suffering from hyperthyroidism and 40 in this study, healthy volunteers who served as controls were in- cluded. The levels of serum thyroid-stimulating hormone (TSH) were mea- sured by sandwich assay, While the competitive binding immunoenzymatic assay was used to determine the levels of free triiodothyronine (FT3) and thyroxine (T4). To assess lipid profiles, an automated analyzer was em- ployed. By enzyme-linked immunosorbent assay (ELISA), Interleukin 6 (IL-6) levels were measured. Activity of superoxide dismutase (SOD), catalase activity (CAT), (MDA) malondialdehyde, and levels of advanced oxidation protein products (AOPPs) assessed using a colorimetric tech- nique. The quantitative polymerase chain reaction was used to evaluate the expression of serum miRNA-22. Results Non-significantly increase SOD and significantly increase CAT activity were identified in patient groups than in the control group (P

Diabetes mellitus (DM) and thyroid dysfunction, which have a significant incidence worldwide, are the most common endocrine system disorders that occur together in patients. Our aim is to explain these 2 diseases with high incidence and the relationship between these 2 diseases. Thyroid hormones (TH) are essential hormones that govern body metabolism. Thyroid hormone changes are thought to be effective on the pathogenesis of DM. Diabetes mellitus treatments can be beneficial, as TH changes may contribute to the pathogenesis of DM. However, more research needs to be done. This lack of information limits potential biomarkers and targets for diagnosis, prognosis, and the development of new DM treatments. The limitations of the use of natural THs have led to the development of synthetic hormones called thyromimetics. However, most of the thyromimetics tested so far have been ineffective or toxic. [ABSTRACT FROM AUTHOR]

Objective: To compare the demographic and clinical phenotypes of thyroid-associated ophthalmopathy (TAO) with euthyroidism (Eu-TAO), hyperthyroidism (Hr-TAO), and hypothyroidism (Ho-TAO). Methods: We enrolled 2158 TAO patients in this retrospective study and assessed their demographics, clinical manifestations, activity, and severity. Results: Among the enrolled patients, 526 (24.37%) had Eu-TAO, 1544 (71.55%) had Hr-TAO, and 88 (4.08%) had Ho-TAO. Compared to Hr-TAO (2.02) and Ho-TAO (2.52) patients, Eu-TAO (1.57) patients had the lowest female-to-male ratio (p = 0.026). The mean ages of Eu-TAO, Hr-TAO, and Ho-TAO patients were 43.11 ± 12.05, 42.23 ± 13.63, and 47.39 ± 13.28 years, respectively (p = 0.001). Patients with Eu-TAO had more unilateral involvement (50% vs. 14.38% vs. 21.59%, p < 0.001) than Hr-TAO or Ho-TAO patients. Clinically active TAO patients presented 8.56% in euthyroid vs. 13.86% in hyperthyroid vs. 11.36% in hypothyroid (p = 0.006). Regarding the severity of the European Group on Graves' Orbitopathy (EUGOGO) classification among euthyroid, hyperthyroid, and hypothyroid patients, mild TAO was present in 67.68, 54.27, and 72.72% of participants, moderate-to-severe TAO in 31.18, 42.49, and 26.14%, and sight-threatening TAO in 1.14, 3.24, and 1.14%, respectively. Eu-TAO was positively correlated with unilateral involvement (OR = 5.671, p < 0.001) and age (OR = 1.013, p = 0.003) and negatively correlated with the female-to-male ratio (OR = 0.656, p < 0.001) and TAO severity (OR = 0.742, p < 0.01). Conclusions: Eu-TAO patients are older and less likely to be female, and show more unilateral and milder clinical phenotypes than hyper/hypothyroid TAO patients. [ABSTRACT FROM AUTHOR]

Introduction: Hypothyroid or Hyperthyroid state affects all the physiological systems including cardiovascular system, central nervous system, digestive system, blood, etc. Despite increasing knowledge of thyroid physiology and better means for investigation of thyroid functions, we still are at preliminary stage of understanding the pathophysiology of these disorders Objectives: The present study was carried out to compare body T3, T4 and TSH levels in newly diagnosed patients of hypothyroidism, hyperthyroidism and age and gender matched euthyroid subjects Materials and methods: The present study was carried out in 90 female subjects in the age group of 30 to 45. Diagnosis of hypothyroidism and hyperthyroidism was based on both clinical and biochemical criteria. Subjects were divided in euthyroid, hypothyroid and hyperthyroid groups with each group containing 30 subjects. T3, T4 & TSH levels were measured in all the groups. Results: Hyperthyroid group had significantly higher T3 and T4 levels as compared to euthyroid and hypothyroid groups. Hypothyroid group had significantly higher TSH as compared to euthyroid and hyperthyroid groups. Conclusion: T3 and T4 levels are significantly higher in hyperthyroidism and they are significantly lower in Hypothyroidism as compared to euthyroid premenopausal women. TSH levels are significantly higher in hypothyroid subjects, while TSH levels are significantly lower in hyperthyroid subjects. Regular monitoring of T3, T4 and TSH especially in women is recommended. [ABSTRACT FROM AUTHOR]

Thyroid is on the rise all across the world in modern times. The prevalence of thyroid disease in India is notably high, reaching 1 in 10. Due to the general public's lack of knowledge, the situation with that illness is fast deteriorating. Early diagnosis is crucial so that medical professionals can administer effective treatment before the condition worsens. This is especially true when using deep learning (DL) to predict sickness. One of DL's strengths is its ability to predict how a disease will progress in the future. Once more, several feature selection procedures have benefited in the process of disease prediction and assumption. The most common types of hypothyroidism in this study, we make an effort to predict the initial stage of thyroid development. To achieve this goal, the research has relied heavily on the feature selection strategy in addition to several different categorization methods. Each iteration of the projected adaptive tunicate swarm optimisation (ATSA) consists of two primary phases: searching all over the search space using an arbitrarily picked tunicate and refining the search using the position of the finest tunicate. By making this adjustment, the procedure is better able to explore its environment while simultaneously being protected from the dangers of a sudden convergence. Additionally, a deep convolutional neural network (DeepCNN) is used for disease identification, and the Grey Wolf Optimizer (GWO) is used for its training. Both could be associated more accurately. We were able to improve the suggested model's accuracy to 95% after tweaking the dataset, with 92% specificity. [ABSTRACT FROM AUTHOR]

Thyroid storm, though extremely rare in toddlers, requires prompt diagnosis and treatment because it can be fatal if left untreated. However, thyroid storm is not often considered in the differential diagnosis of a febrile convulsion due to its rarity in children. Herein, we report the case of a 3-year-old girl with thyroid storm who presented with febrile status epilepticus. Although the seizure was stopped by diazepam administration, her tachycardia and widened pulse pressure persisted, and severe hypoglycemia was observed. Based on the findings of thyromegaly, a history of excessive sweating and hyperactivity, and a family history of Graves' disease, she was eventually diagnosed with a thyroid storm. The patient was successfully treated with thiamazole, landiolol, hydrocortisone, and potassium iodide. Propranolol, a non-selective β-blocker, has been used to manage tachycardia during thyroid storm. However, a cardio-selective β1-blockers, landiolol hydrochloride, was used in our case to avoid worsening hypoglycemia. Febrile status epilepticus is one of the most common medical emergencies in childhood; it is necessary to rule out treatable underlying critical diseases such as septic meningitis and encephalitis. Thyroid storm should be considered in children presenting with prolonged febrile convulsion accompanied by findings that are not usually observed with febrile convulsions.

Introduction: Thyroid disorders are common in the reproductive age group of women and these can cause significant perinatal outcomes.Though the effect of abnormal thyroid hormones on the foetus and its development is established, their effect on the placenta and its contribution towards the effect is not elaborately studied. Aim: To compare the microscopic features of euthyroid placentae with those of mothers with thyroid dysfunction. Materials and Methods: This is prospective observational study wherein placentae received from October 1 ,2017 to March 31, 2019 in the Department of pathology, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India, were collected, processed and analysed. A total of 539 cases were received for histopathological examination during this period, of these 64 cases had abnormal antenatal thyroid profile. These were compared grossly and microscopically with the control group of 64 euthyroid cases. Results: The total sample of the study comprised of case group(n=64) and control group(n=64), mean age: mean age of the women 26.91±4.1 years. The case group samples included 3 hyperthyroid cases and 61 hypothyroid cases.In the control group, 3 (2.3%) foetuses were dead as compared to 6 (4.7%) foetuses in hypothyroid group and 3 (2.3% of total, 100% of hyperthyroid group) foetuses in hyperthyroid group (p< 0.001). Abnormal shape of the placenta was seen in 1 (0.8%) case in normal group as compared to 3 (2.3%) in hypothyroid group and 1 (0.8%) case in hyperthyroid group (p=0.018). However, there weren’t any significant microscopic changes. Conclusions: Maternal thyroid disorders result in abnormal shape of placenta and hence resulting in foeto-maternal insufficiency and subsequent foetal growth restriction and adverse foetal outcome.

The main task of thyroid hormones is controlling the metabolism rate of humans, the development of neurons, and the significant growth of reproductive activities. In medical science, thyroid disorder will lead to creating thyroiditis and thyroid cancer. The two main thyroid disorders are hyperthyroidism and hypothyroidism. Many research works focus on the prediction of thyroid disorder. To improve the accuracy in the classification of thyroid disorder this paper proposes optimization-based feature selection by using differential evolution with the Butterfly optimization algorithm (DE-BOA). For the classifier fuzzy C-means algorithm (FCM) is used. The proposed DEBOA-FCM is evaluated with parametric metric measures of sensitivity, specificity, and accuracy. In this work, the thyroid disease dataset collected from the machine learning University of California Irvine (UCI) database was used. The accuracy rate for the Differential Evolutionary algorithm got 0.884, the Butterfly optimization algorithm got 0.906, Fuzzy C-Means algorithm got 0.899 and DEBOA + Focused Concept Miner (FCM) proposed work 0.943. [ABSTRACT FROM AUTHOR]

Thyroid hormone exerts effects across all organ systems. Hence, patients with thyroid dysfunction are at a risk of numerous complications. The stresses encountered during the perioperative period may exacerbate underlying thyroid disorders, potentially precipitating decompensation, and even death. Thus, it is of the utmost importance for the clinician to comprehend the mechanisms by which thyroid disease may complicate surgery and postoperative recovery and to optimize the status of thyrotoxic and hypothyroid patients. This article describes the adverse effects of thyroid dysfunction in patients undergoing nonthyroid surgery and recommends treatment approaches aimed at appropriate build-up to decrease perioperative risk.

Acute suppurative thyroiditis (AST) is a rare clinical entity that must be treated immediately because of its morbidity, especially swelling in the thyroid area accompanied by fever. AST is often preceded by infection at another site; therefore, it is important to identify the source. A 40-year-old woman came to the Dr. Soetomo General Hospital complaining of pain and swelling in the neck, difficulty swallowing, and fever. The patient suffered from chronic kidney disease. One week before, she had an infected arteriovenous hemodialysis shunt. Laboratory results showed an increased fT4 (3.5 ug/dL) and a decreased TSH (0.015 uIU/mL), leukocytosis, and a raised C reactive protein (CRP). Thyroid ultrasound showed an abscess involving the entire left thyroid. Thyroid fine needle biopsy showed AST. Culture of the pus grew Staphylococcus aureus. The thyroid tests supported the diagnosis of AST with hyperthyroidism; immediate treatment was indicated. Three weeks after treatment, the patient was euthyroid and still had drainage of the wound. The AST was considered to be secondary to the hemodialysis AV shunt infection. Leukocytosis and increased CRP levels supported the presence of inflammation and culture grew Staphylococcus aureus. The patient improved with Clindamycin therapy. To our knowledge, this is the first AST case preceded by hemodialysis AV shunt infection.

Background: Patients with hyperthyroidism present a morbid life. The quality of life is low. Under this setting, understanding the clinical profile of these patients helps to improve their quality of life by the physician. Objectives: To study various cardiac manifestations in overt hyperthyroidism and subclinical hyperthyroidism. Methods: A total of 46 consecutive unselected patients with overt and subclinical hyperthyroidism were recruited. Institutional Ethics Committee permission was obtained and informed consent was taken from each and every patient. All had a structured cardiovascular history and examination, including measurements of blood pressure (BP) and pulse rate. All had resting 12-lead electrocardiogram and 2D-ECHO. Data was entered and analyzed. Results: In Hyperthyroidism out of 46. In patients population female preponderance was seen with male to female ratio being 4.5:5. Palpitation was the most common cardiovascular symptom, present in thirty two (70%) cases followed by Dyspnea and Chest pain. Atrial fibrillation was the predominant ECG finding in the present study, 19 patients out of 46 patients of hyperthyroidism followed by Sinus Tachycardia (35%), RAD (15%), RVHi (17%) and ST Changes (13%) 2D-Echocardiographic analysis showed Pulmonary Hypertension in 10 (22%) cases and Chamber Enlargement in 12 (26%) cases followed by Systolic Dysfunction (21.7%), Diastolic Dysfunction and Regurgitant Lesion chiefly MR & TR in a isolate case. Conclusion: In conclusion, thyroid disorder is a frequent disease, affecting more women than men. Thyroid hormones have essential effects on the cardiovascular system. Imbalance of their levels leads to disturbance in the homeostasis of the cardiovascular system. Serious cardiac complications such as congestive heart failure, atrial fibrillation, and angina pectoris may arise in thyroid disorder patients importantly, most of these deleterious hormone-mediated cardiovascular effects can be reversed or managed with the proper regulation or blockade of these hormones. Therefore, it is important for both endocrinologists and cardiologists to apply a global approach in the assessment of such patients and to improve the prognosis of severe cardiac complications in overt / subclinical hyper-thyroid dysfunction. [ABSTRACT FROM AUTHOR]

Objective: To find out the frequency of anemia, agranulocytosis and thrombocytopenia in hyperthyroid patients after the use of propylthiouracil. Study Design: Cross sectional study. Place and Duration of Study: Out Door Patients Department and Pathology Laboratory in Liaquat University Medical & Health Sciences, Hospital Hyderabad/Jamshoro, from May 2016 to Apr 2017. Methodology: Two hundred cases, comprising of adult patients were categorized into five groups, age group 15-30 years 79 (39.5%) patients presenting the highest out of total, age group 31-45 years 68 (34%) patients, age group 46-60 years 36 (18%), age group 61-75 years 14 (7%) patients, age group >75 years 3 (1.5) patients. Complete blood count was analyzed on Sysmex Kx21 and thyroid profiles were analyzed on Elecysis 2010 from the Pathology Department. SPSS version 22 was used for data analysis. Result: Out of total patients, 32 (16%) were males and 168 (84%) were females with mean age of 37.44 ± 14.82 years. Majority of patients 68 (34%) were anemic, while 4 (2%) had agranulocytosis and 11 (5.5%) had thrombocytopenia. Headache was reported in 111 (55.5%), exophthalmos in 106 (53%), sore throat in 172 (86%), fever in 136 (68%) and weight loss in 95 (47.5%) patients. Conclusion: Propylthiouracil causes defective hematopoiesis in hyperthyroid patients because propylthiouracil has adverse suppressive effects on bone marrow.

Thyroid hormone exerts effects across all organ systems. Hence, patients with thyroid dysfunction are at a risk of numerous complications. The stresses encountered during the perioperative period may exacerbate underlying thyroid disorders, potentially precipitating decompensation, and even death. Thus, it is of the utmost importance for the clinician to comprehend the mechanisms by which thyroid disease may complicate surgery and postoperative recovery and to optimize the status of thyrotoxic and hypothyroid patients. This article describes the adverse effects of thyroid dysfunction in patients undergoing nonthyroid surgery and recommends treatment approaches aimed at appropriate build‑up to decrease perioperative risk. [ABSTRACT FROM AUTHOR]

Objective: To see the impact of abnormal secretion of thyroid hormones on red cell indices in patients of thyroid disorders. Study Design: Descriptive Cross Sectional study. Setting: Department of Pathology, Sahiwal Teaching Hospital, Sahiwal. Period: September 2020 to March 2021. Material & Methods: Two hundred and thirty four (234) patients of thyroid disorders were enrolled in total, out of which 44 were hyperthyroid, 102 were euthyroid and 88 were hypothyroid. Patients of both genders with age limit of 20-60 years were included. Blood samples for CBC and serum TSH were analysed. SPSS 20 was used to analyse data. To analyze significance among various groups of thyroid dysfunction, we applied an independent t-test. Results: The comparison of hyperthyroid and euthyroid groups, showed a statistically significant difference in the RBC count (p=0.043) and hematocrit (p=0.032). Between hyperthyroid and hypothyroid groups a statistically significant difference was also noted in the mean hemoglobin (p=0.036) and hematocrit (p=0.022). Comparison of hypothyroid and euthyroid groups remained statistically non-significant for any of the hematological parameters. Conclusion: A fluctuation in hematological indices is seen due to interrelation between erythropoiesis and thyroid dysfunction, therefore in patients with thyroid disorders, monitoring of hematological parameters should be done. [ABSTRACT FROM AUTHOR]

Synopsis: Hyperthyroid‐induced pulmonary hypertension in pregnancy is reversible with aggressive treatment together with close monitoring of cardiac function. [ABSTRACT FROM AUTHOR]

Abstract Background Liver‐type fatty acid‐binding protein (L‐FABP) and neutrophil gelatinase‐associated lipocalin (NGAL) are candidate biomarkers for the detection of early chronic kidney disease (CKD) in cats. Objective To evaluate urinary and serum L‐FABP and NGAL concentrations in CKD cats and in hyperthyroid cats before and after radioiodine (131I) treatment. Animals Nine CKD cats, 45 healthy cats and hyperthyroid cats at 3 time points including before (T0, n = 49), 1 month (T1, n = 49), and 11 to 29 months after (T2, n = 26) 131I treatment. Methods Cross‐sectional and longitudinal study. Serum L‐FABP (sL‐FABP), serum NGAL (sNGAL), urinary L‐FABP (uL‐FABP), and urinary NGAL (uNGAL) were compared between the 3 groups and between hyperthyroid cats before and after treatment. Data are reported as median (min‐max). Results CKD cats had significantly higher sL‐FABP (13.50 [3.40‐75.60] ng/ml) and uL‐FABP/Cr (4.90 [0.97‐2139.44] µg/g) than healthy cats (4.25 [1.34‐23.25] ng/ml; P = .01 and 0.46 [0.18‐9.13] µg/g; P < .001, respectively). Hyperthyroid cats at T0 had significantly higher uL‐FABP/Cr (0.94 [0.15‐896.00] µg/g) than healthy cats (P < .001), thereafter uL‐FABP/Cr significantly decreased at T2 (0.54 [0.10‐76.41] µg/g, P = .002). For the detection of CKD, uL‐FABP/Cr had 100% (95% confidence interval [CI], 66.4‐100.0) sensitivity and 93.2% (95% CI, 81.3‐98.6) specificity. There were no significant differences in sNGAL and uNGAL/Cr between the 3 groups. Conclusions and Clinical Importance L‐FABP, but not NGAL, is a potential biomarker for the detection of early CKD in cats. Utility of uL‐FABP to predict azotemia after treatment in hyperthyroid cats remains unknown.

Objectives: The aim of this study was to evaluate the efficacy of gabapentin as an anxiolytic in hyperthyroid cats. Methods: Cats (n = 47) with confirmed hyperthyroidism were successfully enrolled. The cat owner allocated a temperament score and a transport stress score at their first visit. For the second visit the cat owner (blinded to treatment) administered either liquid gabapentin 20 mg/kg (n = 22) or an indistinguishable placebo solution (n = 25) 1 h prior to leaving home. A second transport score was allocated by the cat owner at this visit. Upon admission a compliance score was independently assigned by two veterinary nurses blinded to treatment. Excess blood from routine blood draw was analysed for gabapentin plasma concentration from cats in the gabapentin group. Results: There were no significant differences in baseline transport score between groups (P = 0.13), but significant differences were noted in the second visit transport score between cats medicated with gabapentin compared with placebo (P = 0.018). Mean compliance scores were significantly different between cats in the treatment group compared with placebo (P = 0.019). Further sedation was required to complete the procedures in 24% of cats in the placebo group compared to 9% in the gabapentin group (P = 0.25). Mean plasma gabapentin concentrations were 10.1 mg/l (range 1.7–22.7) in the gabapentin group within a 1–3 h time frame post-administration. Conclusions and relevance: Hyperthyroid cats medicated with 20 mg/kg gabapentin 1 h prior to leaving home were more relaxed during transport and more compliant with veterinary procedures than cats administered a placebo solution. [ABSTRACT FROM AUTHOR]

Acute suppurative thyroiditis (AST) is a rare clinical case that must be treated immediately because of its fatality, especially cases of swelling on thyroid area accompanied by fever. AST is often preceded by infection, therefore it is necessary to find the source. A 40 years old woman came to the hospital with complain of pain on the swollen neck,difficulty on swallow and fever. The patient suffered from chronic kidney disease (CKD). One week before she had an AV hemodialysis shunt infection. Laboratory results showed an increase of fT4 3.5 ug/dL and a decrease in TSH (0.015 uIU/mL), leukocytosis and an increase of CRP. Thyroid ultrasound showed an abscess in entire left thyroid while thyroid lobe FNAB showed AST. Pus culture showed the growth of Staphylococcus aureus bacteria. Thyroid test supported an AST with hyperthyroidism and should be treated immediately. Three weeks after treatment the patient was euthyroid and had drainage of the pus. AST occurred due to hemodialysis AV shunt infection. Laboratory results show the presence of leukocytosis and increased of CRP levels, supporting signs of inflammation. Pus culture revealed significant growth of Staphylococcus aureus and improved with Clyndamycin therapy. To our knowledge, this is the first AST case preceded by hemodialysis AV shunt infection. Cases of swelling on thyroid, painful swallowing, fever, preceded by a shunt AV hemodialysis infection were considered to examine thyroid markers, ultrasound and FNAB for early diagnosis of AST because it can be life-threatening. [ABSTRACT FROM AUTHOR]

Introduction: previous studies in African populations have not extensively described the spectrum of thyroid dysfunction using the profile of thyroid hormones. Although iodine deficiency is a common thyroid disorder in Africa, it does not represent the entire spectrum of thyroid dysfunction seen in patients. This retrospective study aimed to describe the spectrum of thyroid dysfunction among patients seen at the Korle-Bu Teaching Hospital (KBTH), a tertiary care hospital in Accra, Ghana., Methods: a retrospective analysis of medical records of all consultations on thyroid disorders seen at the Internal Medicine Department of KBTH between January 2019 and December 2021 was conducted. Information on patient demographics, and thyroid hormone profiles (triiodothyronine - FT3, thyroxine - FT4, and thyroid stimulating hormone - TSH) were extracted and subjected to descriptive statistics. The thyroid hormone profiles of the subjects were analyzed and classified into thyroid dysfunction categories using guidelines from the American Thyroid Association (ATA)., Results: out of the 215 patients with thyroid disorders enrolled, 85.1% (n=183) were females and 14.9% (n=32), were males. The mean age of patients was 45±14 years, with most of the patients within the age range of 31-50 years (49.3%; n=106). The most reported thyroid function dysfunction was primary hyperthyroidism (57.7%), followed by primary hypothyroidism (22.3%), subclinical hyperthyroidism (9.3%), euthyroid sick syndrome (6.5%), and subclinical hypothyroidism (4.6%) respectively., Conclusion: primary hyperthyroidism was the most commonly diagnosed thyroid dysfunction. Hyperthyroidism has been associated with cardiac morbidity and mortality. Timely interventions are required to reduce the morbidity risks and burden associated with the hyperthyroid state., Competing Interests: The authors declare no competing interests., (Copyright: Emmanuel Donkoh Aidoo et al.)

Genetic variations among people mainly determine the blood levels of lipoprotein (a) (Lp(a)), and it is relatively stable throughout one's lifetime. Nevertheless, there could still be other factors that control the Lp(a) level. Thyroid hormones are known to influence the serum lipid level by regulating the expression of key enzymes that are involved in lipid metabolism. Both hypo and hyperthyroidism are associated with changes in lipid levels. Even though thyroid hormone abnormalities have been shown to alter traditional lipid parameters like low-density lipoprotein (LDL-C), its influence on Lp(a) has not been established. This review aims to identify the relationship between Lp(a) and thyroid hormones by reviewing data from correlative studies and observing treatment-related Lp(a) level changes in thyroid disorders from interventional studies. We searched MEDLINE, Cochrane, and Google Scholar databases with predefined search criteria and search strategies for paper identification. Individual reviewers reviewed identified papers for selection. Finalized papers were reviewed for Lp(a) levels and their responses to treatment in patients with thyroid disorders to establish the relationship between Lp(a) and thyroid hormone. We concluded that the data were limited and sometimes contradicted one another to establish a clear relationship between Lp(a) and thyroid hormones. Even though correlative studies data showed strong indications that overt-hypothyroidism was associated with high Lp(a) levels, thyroid hormone replacement studies did not show any significant changes in Lp(a) levels compared to pre-treatment in patients with both overt-hypothyroidism and subclinical hypothyroidism. More clinical trials focusing on Lp(a) with longer periods of treatment and follow-up in thyroid patients are needed to establish the relationship between the two. The possibility of dose-related Lp(a) responses to thyroid hormone treatment should also be explored., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Lwin et al.)

Objective: To find out the frequency of anemia, agranulocytosis and thrombocytopenia in hyperthyroid patients after the use of propylthiouracil. Study Design: Cross sectional study. Place and Duration of Study: Out Door Patients Department and Pathology Laboratory in Liaquat University Medical & Health Sciences, Hospital Hyderabad/Jamshoro, from May 2016 to Apr 2017. Methodology: Two hundred cases, comprising of adult patients were categorized into five groups, age group 15-30 years 79 (39.5%) patients presenting the highest out of total, age group 31-45 years 68 (34%) patients, age group 46-60 years 36 (18%), age group 61-75 years 14 (7%) patients, age group >75 years 3 (1.5) patients. Complete blood count was analyzed on Sysmex Kx21 and thyroid profiles were analyzed on Elecysis 2010 from the Pathology Department. SPSS version 22 was used for data analysis. Result: Out of total patients, 32 (16%) were males and 168 (84%) were females with mean age of 37.44 ± 14.82 years. Majority of patients 68 (34%) were anemic, while 4 (2%) had agranulocytosis and 11 (5.5%) had thrombocytopenia. Headache was reported in 111 (55.5%), exophthalmos in 106 (53%), sore throat in 172 (86%), fever in 136 (68%) and weight loss in 95 (47.5%) patients. Conclusion: Propylthiouracil causes defective hematopoiesis in hyperthyroid patients because propylthiouracil has adverse suppressive effects on bone marrow. [ABSTRACT FROM AUTHOR]

Thyroid crisis is a rare complication of hyperthyroidism, with a greater risk about 10 times during pregnancy, also clinical manifestations and significant increasing of level of thyroxine (T4) and tri-iodothyronine (T3). Thyroid crisis could cause mortality in >10%. A 58-year-old female was referred from Bangkalan Hospital, presented with palpitation, shortness of breath, diarrhea 2-3×/day, vaginal bleeding, fever for 1 day before admittance. Hyperthyroid for 3 years ago and routinely consumed thyrozol (1×2tab) in 2 years but did not take the medicine for 1 year ago. Physical examination: BP 147/100 mmHg, pulse rate 124×/minute, temperature 38.4 °C, RR 30/minute, conjunctiva anemia, thyroid palpable, exopthalmus. ECG results: presence of sinus tachycardia, Chest X-Ray: cardiomegaly. Burch Wartofsky Score obtained a total score of 45, (temperature 38.5 C=15, diarrhea=10, tachycardia=15, CHF=5). Laboratory results: TSH <0.004 IU/mL, FT4 5.31 ng/dl. Thyroid crisis is a rare case of hyperthyroidism, a greater risk during pregnancy which could lead to death. Many symptoms arise in hyperthyroidism which could lead to thyroid crisis. The criteria which used to assess thyroid analysis is the Burch Wartofsky Score, FT4 levels increased 5.31 ng/dl. This patient was diagnosed as thyroid storm in post-partum, based on Burch Wartofsky Score, low TSH level and an elevated FT4 level and not taking medicine for 1 year ago. [ABSTRACT FROM AUTHOR]

Introduction: Atrial fibrillation (AF) is the most common cardiac dysrhythmia. Current guidelines recommend obtaining thyroid-stimulating hormone (TSH) levels in all patients presenting with AF.Our aim was to investigate the utility of TSH levels for emergency department (ED) patients with a final diagnosis of AF while externally validating and potentially refining a clinical decision rule that recommends obtaining TSH levels only in patients with previous stroke, hypertension, or thyroid disease.  Methods: We conducted a retrospective, cross-sectional study of consecutive patients who presented to an ED from January 2011 to March 2014 with a final ED diagnosis of AF. Charts were reviewed for historical features and TSH level. We assessed the sensitivity and specificity of the previously derived clinical decision rule.Results: Of the 1,964 patients who were eligible, 1,458 (74%) had a TSH level available for analysis. The overall prevalence of a low TSH (5µIU/mL) were identified in 11% (n=159). The clinical decision rule had a sensitivity of 88.9% (95% CI [73.0-96.4]) and a specificity of 27.5% (95% CI [25.2-29.9]) for identifying a low TSH. When analyzed for its ability to identify any abnormal TSH values (high or low TSH), the sensitivity and specificity were 74.4% (95% CI [67.5-80.2]) and 27.3% (95% CI [24.9-29.9]), respectively.  Conclusion: Low TSH in patients presenting to the ED with a final diagnosis of AF is rare (2%). The sensitivity of a clinical decision rule including a history of thyroid disease, hypertension, or stroke for identifying low TSH levels in patients presenting to the ED with a final diagnosis of atrial fibrillation was lower than originally reported (88.9% vs. 93%). When elevated TSH levels were included as an outcome, the sensitivity was reduced to 74.4%. We recommend that emergency medicine providers not routinely order TSH levels for all patients with a primary diagnosis of AF. Instead, these investigations can be limited to patients with new onset AF or those with a history of thyroid disease with no known TSH level within three months . [West J Emerg Med. 2015;16(1):–0.]

National Baseline Health Research 2013 showed that there were 706,757 (0.4%) hyperthyroid patients in Indonesia. Hyperthyroidism is characterized by abnormal thyroid stimulating immunoglobulin (TSI) which causes low TSH and high FT4 levels. Hyperthyroid patients have a decrease of serum iron levels due to acute phase reactions of hyperthyroidism. This study aimed to analyze the correlation between dietary iron intake and serum iron with TSH and FT4 levels in adult hyperthyroid patients. This study was conducted in February–July 2020 at the Clinic of Magelang Health Research and Development Center. Sampling of this cross sectional study was based on inclusion criteria in order to obtain 50 adult hyperthyroid patients. Dietary iron intake was collected with 2 × 24 h dietary recall, serum iron was measured with colorimetric analysis, the levels of TSH and FT4 were measured by ELISA. The collected data were analyzed using Spearman correlation and multivariate linear regression with 95% confidence level. Deficiencies of dietary iron intake was found in 20 hyperthyroid patients (40%). Low serum iron levels were found in 10 hyperthyroid patients (20%). Spearman correlation analysis showed that dietary iron intake had a negative correlation with TSH (r=−0.294; p<0.05) but did not correlate with FT4 (r=−0.142; p>0.05), while serum iron didn't associated with both TSH (r=0.110; p>0.05) and FT4 (r=0.142; p>0.05). Furthermore, regression analysis showed that dietary iron intake, serum iron, phytate, and thyrozol intake correlate with TSH levels (R square=0.193; p<0.05) and FT4 levels (R square=0.341; p<0.05), but there were no independent association between dietary iron intake and serum iron with TSH and FT4 levels (p>0.05). Intake and serum of iron didn't correlate with TSH and FT4 levels in adult hyperthyroid patients. [ABSTRACT FROM AUTHOR]

Background: The type 1 diabetic population has an increased incidence of thyroid dysfunction, accounting for approximately 17-30%. Thyroid dysfunction may interfere with insulin sensitivity and insulin requirements in individuals who have type 1 diabetes. This study aimed to find an association between thyroid function and poor glycemic control among adults with type 1 diabetes mellitus using TSH and HbgA1C, respectively. Methods: A cross-sectional study was conducted in King Abdulaziz Medical City, Riyadh - Kingdom of Saudi Arabia (a tertiary hospital). Our subjects were adults with type 1 diabetes mellitus who had their TSH levels tested, between 2015 to 2019. Patients were categorized based on their TSH level as either hypothyroid, hyperthyroid, or normothyroid. The following variables were measured: patient's demographics, Thyroid-stimulating hormone level, the presence of anemia, WBCs, LDL level, and history of diabetic ketoacidosis. Results: There were a total of 1425 adult patients with T1DM between 2015 and 2019, only 282 patients fulfilled our inclusion criteria. 36.2% were males (N=102) and 63.8% were females (N=180). The patients' mean age was 27.03 years with an average BMI of 25.62 kg/m2. 18.4% were hypothyroid and 9.9% were hyperthyroid. Our subjects had a mean HbA1c of 8.76%. hyperthyroid patients had higher HbA1c levels with a mean of 8.907 while hypothyroid patients had a mean of 8.11%. Also, we have found that patients with hyponatremia tend to have poor glycemic control in comparison to hypernatremia and normal serum sodium. We found that age, TSH, having a history of diabetic ketoacidosis and serum sodium to be significantly associated with HbA1c with P-values of 0.016, 0.012, 0.005 and <0.001 respectively. Conclusion: Thyroid dysfunction was observed in a high proportion of our patients. We have found a clear association between thyroid function and glycemic control among adults with type 1 diabetes mellitus. Glycemic control was better among hypothyroid patients compared to hyperthyroid and normothyroid patients. Also, glycemic control is poor in hyponatremia in comparison to hypernatremia and normal serum sodium patients. HbA1C was significantly associated with age, TSH, serum sodium, and having a history of diabetic ketoacidosis but not with gender, body mass index and LDL level. [ABSTRACT FROM AUTHOR]

Abstract Acute myocarditis and hyperthyroidism are common diseases that often present in young, otherwise healthy patients. Autoimmunity is central to the pathogenesis of both. Patients presenting with acute myocarditis should be screened for symptoms of hyperthyroidism, and physicians should consider screening for myocarditis in patients with hyperthyroidism and persistent cardiac symptoms.