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Abstract Background Acute illness can result in changes in serum total thyroxine (tT4), total triiodothyronine (tT3), and thyrotropin (TSH) concentrations in euthyroid dogs defined as nonthyroidal illness syndrome, but longitudinal evaluation of these hormones during the recovery phase is lacking. Objectives To longitudinally evaluate serum tT4, tT3, and TSH concentrations during the acute phase and recovery from acute illness in dogs. Animals Nineteen euthyroid client‐owned dogs hospitalized for acute illness at a veterinary teaching hospital. Methods Prospective longitudinal study. Serum tT4, tT3, and TSH concentrations were measured at the admission (T0), at last day of hospitalization (T1), and during the recovery phase at 3, 7, 14, and 21 days after the discharge (T2, T3, T4, and T5), respectively. Results tT4 and tT3 were below the reference interval (RI) at T0 in 3 (16%) and 18 (95%) dogs, respectively; tT4 normalized in all dogs early in the recovery phase, while low tT3 persisted at the end of the study in 16 (83%) dogs. Median TSH concentrations were increased at T5 compared with T1 (0.19 ng/mL [range 0.03‐0.65] vs 0.11 ng/mL [range (0.05‐0.26)], mean difference = 0.09 ng/mL; P = .03). Five (26%) dogs had TSH above the RI at least at 1 time point during the recovery phase. None of the dogs had concurrent low tT4 and high TSH during the study. Conclusions and Clinical Relevance In euthyroid dogs acute illness can interfere with evaluation of thyroid function up to 21 days during the recovery phase. Thyroid testing should be avoided or postponed in these dogs.

ABSTRACT Objectives To determine the incidence, presentation, frequency and management of immune checkpoint inhibitors (ICI)‐related endocrinopathies in a comprehensive cancer centre in Oman, particularly with programme death 1/programme death‐ligand 1 (PD‐1/PD‐L1) inhibitors. Background A high number of patients treated with PD‐1/PD‐L1 inhibitors for the management of solid tumours developed endocrinopathies. Methods This is a retrospective study of patients admitted to Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC) from August 2021 to December 2022. All adults diagnosed with solid cancers and have received at least one dose of ICIs were included. Patients with incomplete data were excluded from the analysis. Data regarding the ICI‐induced endocrinopathy were collected. Results A total of 139 patients were included in the study of which 58% were females. The median age of the cohort was 56 years. The incidence of endocrine‐related adverse events was 28%. The mean time for the development of endocrine adverse events after treatment initiation was 4.1 ± 2.8 months. Of the patients who developed toxicity, 90% had hypothyroidism. Ten patients developed hyperthyroidism, two patients were diagnosed with secondary adrenal insufficiency/hypophysitis and one patient developed Type 1 diabetes mellitus (DM). Using univariable logistic regression weight and body mass index (BMI) significantly impacted the development of endocrine immune‐related adverse events (irAEs). Conclusions This is the first study from the Sultanate of Oman to assess PD‐1/PDL‐1 ICI‐induced endocrinopathies. The most common endocrine adverse event is thyroid dysfunction, mainly hypothyroidism followed by hyperthyroidism. Hypophysitis, primary adrenal insufficiency and CIADM occur less frequently, but have a more significant effect on the patient's health. The treating physician should be aware of ICI‐induced endocrinopathies, screening and treatment. Furthermore, our study showed that patients with a higher BMI have a greater risk of developing irAES. Further studies are needed to establish the predictors of endocrine irAEs.

Abstract Background Nonthyroidal illness syndrome (NTIS) can result in thyroid function test alterations that mimic hypothyroidism. The duration of NTIS‐induced changes in dogs is not well‐described. Objectives Document alterations in thyroid function tests during NTIS and recovery, and the time necessary for their resolution. Animals From 103 dogs sampled, 25 euthyroid dogs with acute, resolvable illness having a low serum total thyroxine (TT4) concentration on admission were analyzed. Methods Prospective observational study. Serum TT4 concentration was measured in 103 dogs within 4 hours of admission. If below the reference interval (RI), subsequent serum samples were obtained every 24 hours from admission until discharge (acute phase) and at 2 weeks and 4 weeks after discharge (recovery phase). Serum samples were submitted for batch measurement of serum TT4, free thyroxine (fT4), total 3,5,3′‐triiodothyronine (TT3), and thyroid‐stimulating hormone (TSH) concentrations. Results In the cohort of dogs analyzed, serum TT4, TT3, and fT4 concentrations were below the RI in 100%, 80%, and 16% at admission; 20%, 80%, and 0% at discharge; 4%, 8%, and 0% at 2 weeks; and 0%, 0%, and 0% at 4 weeks, respectively. Serum TSH concentration was within the RI in 100% at admission and discharge, and above the RI in 4% and 12% at 2 weeks and 4 weeks, respectively. Conclusions and Clinical Importance Naturally occurring NTIS in dogs induces alterations in thyroid function tests during acute illness and recovery. Measurement of serum TT4 concentration 2 to 4 weeks after discharge or serum fT4 concentration by ED during illness is recommended for accurate assessment of thyroid function in acutely ill dogs.

Key Clinical Message Takotsubo syndrome and transient global amnesia can occur simultaneously, not only in the context of acute but also long‐standing emotional stress. Probably, hypothyroidism and migraine make the patient more susceptible to both of these disorders.

Key Clinical Message Hypophyseal dysfunction may be overlooked by the currently generally accepted laboratory routine for the differential diagnosis in patients suffering from symptoms of depression or dementia. Abstract Hypothyroidism is an important cause of depression and potentially reversible cognitive impairment. Whereas the determination of the plasma concentration of thyrotropin (TSH) is generally considered part of the laboratory screening tests for dementia, the measurement of total or free triiodothyronine (T3, FT3), thyroxine (T4, FT4) and cortisol in plasma does not belong to the routine diagnostic workup in patients with depression or suspected dementia. In an 87‐year‐old lady suffering from increasingly poor general health, decreased fluid and food intake, mood depression and lack of energy, three measurements of plasma TSH produced normal values. A cranial computed tomography (cCT) 2 days prior to hospital admission had been assessed as apparently normal. A second cCT performed following a loss of consciousness complicated by tongue bite showed a hypophyseal tumor. Then, low plasma levels of FT3, FT4 and cortisol were found. Following hormone replacement and transsphenoidal tumor resection, the patient recovered rapidly. The present case report illustrates the pitfalls of measuring merely the TSH level in the detection of thyroid and hypophyseal dysfunction.

Key Clinical Message Clinicians should consider autoimmune thyroiditis in patients presenting with neuropsychiatric symptoms and promptly initiate appropriate investigations and treatment, such as corticosteroids, to improve clinical outcomes.

Abstract Thyroid hormones regulate metabolic rate, nutrient utilization, growth, and development. Swine are susceptible to thyroid suppression in response to disease or environmental conditions, but the physiological impact of such disruption has not been established. The objective of this study was to evaluate the impact of hypothyroidism induced with the antithyroid medication methimazole (MMI). 10 mg/kg MMI significantly decreased circulating triiodothyronine (T3) for the duration of treatment but had only a transient effect on circulating thyroxine (T4). Thyroid tissue weight was significantly increased by more than 3.5‐fold in response to MMI treatment. Histologically, the eosinophilic colloid was largely absent from the thyroid follicle which displayed a disorganized columnar epithelium consistent with goiter. MMI induced hypothyroidism has no effect on growth rate over 28 days. Hepatic expression of genes associated with thyroid metabolism (DIO1, DIO2, and DIO3), lipid utilization (CD36, FASN, and ACACA), apoptosis (TP53, PERP, SIVA1, and SFN) and proliferation (CDK1, CDK2, CDK4, and CDKN1A) were unaffected by treatment. Collectively these results demonstrate that MMI induces mild systemic hypothyroidism and pronounced goiter, indicating a strong homeostatic central regulation within the hypothalamic pituitary thyroid axis. This combined with limited peripheral effects, indicates resilience to hypothyroidism in modern swine.

Abstract EFSA updated its previous work on the establishment of specific effects that are considered relevant for grouping pesticide residues targeting the thyroid and for performing the retrospective assessment of dietary cumulative risk (CRA). The two specific effects already selected in 2019 leading to the two cumulative assessment groups (CAGs) ‘hypothyroidism’ and ‘C‐cell hypertrophy, hyperplasia and neoplasia’ were reconfirmed. Compared to 2019, the list of indicators that can be used to identify these specific effects was refined to only include histopathological changes. In a second phase of the work, data will be extracted on indicators of the specific effects from the dossiers on active substances (a.s.) used as plant protection products. The criteria for including a.s. into CAGs were also updated, together with the hazard characterisation methodology and the lines of evidence for assessing CAG‐membership probabilities. The tasks related to the data extraction and the establishment of the CAGs on hypothyroidism and on C‐cell hypertrophy, hyperplasia and neoplasia are beyond the scope of this report. This part of the CRA process has been outsourced and will be the subject of a separate report.

Key Clinical Message We are reporting a case of hypothyroidism presenting as fissured tongue, demonstrating significant resolution of fissure tongue upon thyroid hormone replacement therapy.

Abstract Background Hyperthyroid cats often have urine specific gravity (USG) values

Abstract Objectives Thyroid dysfunction carries large burden during pregnancy and untreated thyroid dysfunction is associated with poor maternal and foetal outcome. The exact burden of thyroid dysfunction during pregnancy in Nepal is not well established. This is descriptive cross‐sectional study done in tertiary care centre of Nepal to know burden of thyroid dysfunction and establish possible need of universal thyroid function screening during pregnancy. Methods A descriptive cross‐sectional study was conducted from 4 September 2020 to 3 September 2021 on pregnant women attending to ANC clinic during their first trimester after obtaining ethical approval. Among eligible patients, after taking informed consent, a total of 385 pregnant women were included in the study. Thyroid function status was assessed by measuring serum levels of thyroid stimulating hormone (TSH), free thyroxine (FT4), and free tri‐iodothyronine (FT3). Women with pre‐existing thyroid disorders were excluded. Serum thyroid function was used to detect thyroid disorder based on American Thyroid Association 2011 criteria. A convenience sampling method was used. Point estimate and 95% confidence interval (CI) were calculated. Results Among 385 pregnant women, 152 (39.48%) (39.20–39.70, 95% CI) had thyroid disorders. Among thyroid disorders (n = 152), 111 (28.83%) had subclinical hypothyroidism, 37 (9.61%) overt hypothyroidism, 3 (0.78%) subclinical hyperthyroidism and 1 (0.26%) had overt hyperthyroidism. Conclusion Around four in every 10 pregnant women had thyroid disorder. Thyroid dysfunction is easily detectable and can be effectively, inexpensively treated, which can prevent adverse maternal and foetal outcome. Thus, we should consider universal screening of pregnant women for thyroid disorder especially in a country like Nepal where there is a high prevalence of undiagnosed thyroid disorder.

Introduction Although the incidence of hyperammonemia as an adverse event of tyrosine kinase inhibitors is quite low, several cases of tyrosine kinase inhibitor associated hyperammonemia have been reported. We report a case of hyperammonemia, that occurred during combined treatment with axitinib and pembrolizumab in a metastatic renal cell carcinoma patient without hepatic disorder or liver metastases. Case presentation A 77‐year‐old Japanese woman was diagnosed with metastatic renal cell carcinoma and was treated with pembrolizumab and axitinib. Both agents were subsequently discontinued due to hyperammonemia with hypothyroidism. After recovery, the patient resumed single‐agent therapy with axitinib. However, hyperammonemia and hypothyroidism occurred again, suggesting axitinib‐inducible adverse event. After nephrectomy, a lower dose of axitinib was restarted and continued safely for residual metastases under prophylactic treatment with aminoleban, lactulose, and levothyroxine. Conclusion The rare occurrence of hyperammonemia should be considered during treatment with VEGFR‐ targeted tyrosine kinase inhibitor including axitinib, and supportive prophylactic medication may be useful.

Abstract Background The pathogenesis of gallbladder (GB) mucoceles in dogs is unknown. It has been proposed that hyperlipidemia could impair GB motility and contribute to GB mucocele formation. Hypothesis/Objectives The objective of this study was to compare GB motility in dogs with hyperlipidemia to control dogs using ultrasonography. We hypothesized that hyperlipidemic dogs will have decreased GB motility compared with controls. Animals Twenty‐six hyperlipidemic and 28 healthy, age‐matched control dogs were prospectively enrolled. Methods Cholesterol and triglyceride concentrations were measured in all dogs. Hyperlipidemia was defined as hypercholesterolemia (>332 mg/dL) and/or hypertriglyceridemia (>143 mg/dL) using a biochemical analyzer. Ultrasound was performed before feeding, and 60 and 120 minutes after ingestion of a high fat diet. Gallbladder volumes (GBV) and ejection fractions (EF) were calculated. Results Hyperlipidemic dogs had significantly larger GBVs (ml/kg) before feeding and 60 minutes after feeding of 1.2 (0.4‐7.5; P = .008) and 0.6 (0.1‐7.2; P = .04) compared with controls 0.6 (0.2‐2.6) and 0.4 (0.1‐1.9), respectively. Severely hyperlipidemic dogs had significantly larger GBV at baseline, 60 minutes, and 120 minutes of 1.7 (0.6‐7.5; P = .03), 1.3 (0.4‐7.2; P = .02), and 1.3 (0.2‐8.2; P = .04), respectively compared with mildly hyperlipidemic dogs. EFs at 60 and 120 minutes between controls, hyperlipidemic, and severely hyperlipidemic were all 0.3 at 60 minutes and 0.5, 0.3, and 0.3 at 120 minutes, respectively which were not statistically different. Conclusions and Clinical Importance Hyperlipidemia leads to GB distention in dogs which could lead to retention of bile and gallbladder disease.

Abstract Background and Aims Hypothyroidism is the most common disease of the thyroid gland. Thyroid hormone plays a crucial role in regulating tissue growth and metabolism. Additionally, patients with thyroid dysfunction have a higher incidence of caries and periodontal problems. The presence of calcium and phosphate ions seems to be effective in remineralizing teeth and reducing caries. The aim of this study was to evaluate the salivary level of calcium in patients with hypothyroidism. Results The results of this study showed that saliva calcium concentration in patients with hypothyroidism is significantly lower than healthy subjects. Also, no significant association was found between salivary calcium levels and TSH and T4 hormones level of blood. Conclusion The increased prevalence of dental caries in patients with hypothyroidism may be related to a decrease in their calcium levels.

Background Although most individuals can adapt to a large iodine load and remain euthyroid, hypothyroidism can develop after iodine exposure. Hypothyroidism is associated with adverse cardiovascular consequences, including heart failure. This study was performed to investigate the relationships between iodine‐induced hypothyroidism and incident heart failure. Methods and Results This cohort study of the US Veterans Health Administration (1998–2021) included adults aged ≥18 years with a serum thyroid‐stimulating hormone (thyrotropin)

Abstract Introduction Spermatogenesis is significantly influenced by the thyroid gland. Thyroid disorders can be caused by a variety of factors. Traditionally, Ellettaria cardamomum has been used to treat a variety of ailments. The effects of E. cardamomum extract (ECE) on spermatogenesis in hypothyroid mice were investigated in this study. Methods In this study 42 male mice, weighing (25–35 g) were randomly divided in six groups: control group (taking normal saline, 0.5 mL/day, by oral gavage [P.O.]), hypothyroid group (taking 0.1% propylthiouracil in drinking water for 2 weeks), hypothyroid groups treated by levothyroxine (15 mg/kg/day, P.O.) and hypothyroid groups treated by ECE (100, 200 and 400 mg/kg/day, P.O.). After the end of experiments the mice were anaesthetised and blood samples were collected for hormonal analysis. Results The sperm count and microscopic studies of testes were done also. Our results showed that the T3, T4, testosterone levels and spermatogenesis in hypothyroid animals decreased and thyroid‐stimulating hormone, follicle‐stimulating hormone and luteinizing hormone increased compared with control group. Treatment by ECE reverse these effects in comparison with hypothyroid group. Conclusions According to our findings, the ECE may stimulates thyroid gland function and increases testosterone and spermatogenesis.

Abstract Purpose This paper aimed to assess the incidence of radiotherapy‐induced hypothyroidism (RIHT) in breast cancer patients and correlate it with different factors. Methods Patients with nonmetastatic breast cancer who received supraclavicular lymph node irradiation as a part of adjuvant radiotherapy from October 2019 to July 2020 were recruited and followed up for 18 months. All patients underwent three‐dimensional conformal radiotherapy and underwent computed tomography simulation. The levels of serum thyroid‐stimulating hormone (TSH), free triiodothyronine and free thyroxine levels were assessed at baseline (before starting radiotherapy) and 9,12, and 18 months after radiotherapy using immunochemilluminescence. Univariate and multivariate analyses were performed to identify significant factors associated with developing hypothyroidism. Results Twenty patients out of 96 (20.8%) developed hypothyroidism. Baseline TSH (cutoff value >1.42 μIU/ml) was significantly correlated with hypothyroidism. Conclusion Routine thyroid function tests assessment is recommended for all breast cancer patients at baseline and after radiotherapy.

Abstract Background Allergic rhinitis (AR) is characterized by mucosal inflammation that leads to a variety of symptoms, such as nasal congestion, rhinorrhea, and sneezing. This rhinitis is triggered by inhalation of allergens, such as pollen, and this condition has a negative impact on the quality of life. AR was shown to be associated with a number of co‐morbidities, including hypothyroidism, asthma, and chronic sinusitis. Objective This study aimed to assess AR‐associated comorbidities in patients presenting symptoms and paranasal sinus computed tomography (CT) scan findings in Taif City, Saudi Arabia. Methods This cross‐sectional study evaluated medical and radiological records of AR patients retrospectively from the period of December 2018 to September 2019 in Al‐Hada Armed Forces Military Hospital, Taif City, Saudi Arabia. Results A total of 103 AR patients with a mean age of 39.0 ± 15.6 years with 55.3% males and 44.7% females. The three most common associated comorbidities in allergic rhinitis patients were chronic sinusitis (28.2%), hypothyroidism (21.4%), and asthma (8.7%). Nasal obstruction (30.1%) was the symptom most frequently presented by all patients. Mucosal thickening occurred most frequently in patients with associated chronic sinusitis, while bilateral osteomeatal complex obliteration was observed mostly in asthmatic patients, and bony boundary thinning was more prevalent among patients with associated hypothyroidism. Conclusion The gender distribution of AR was 10% more common among males; however, the most common three comorbidites in allergic rhinitis patients were chronic sinusitis, hypothyroidism, and asthma, and most of those patients were females. Hypothyroidism can be a hidden predisposing factor for AR, while chronic sinusitis can be caused by AR due to secretion stasis or immune system activation.

Key Clinical Messages The diagnosis of polyserositis due to tuberculosis (TB) is complex and challenging, which may cause delays in treatment. TB should be ruled out first before attributing polyserositis to any other cause like hypothyroidism, particularly in high TB burden countries. Abstract Polyserositis has numerous causes and frequently occurs in neoplasia, autoimmune disorders, endocrine conditions like hypothyroidism, and infectious diseases like tuberculosis (TB). The diagnosis of TB polyserositis is complex and challenging, which may cause the start of definitive therapy to be delayed. Here, we report the case of a 32‐year‐old female patient who presented with abdominal distension for 3 weeks associated with shortness of breath, cough, excessive fatigue, and loss of appetite. Thyroid function tests were suggestive of primary hypothyroidism, and later on, sputum GeneXpert MTB/RIF test turned out to be positive. She was initially started on oral levothyroxine and then anti‐TB medications. The polyserositis resolved a month after the initiation of anti‐TB drugs. TB should be ruled out first before attributing polyserositis to any other cause like hypothyroidism, particularly in high TB burden countries. Microbiologic tests, such as GeneXpert, remain the most important tools to make a diagnosis of TB and start anti‐TB medications early.

Abstract Background and Aims Alopecia areata (AA) is a common autoimmune nonscarring hair disorder with strong genetic links. It seems to be associated with several comorbidities affecting the AA treatment plan. On the other hand, the prevalence of comorbidities in different populations can be different based on genetic differences. This study aimed to clarify the association between age and sex with various comorbidities in AA patients. Methods This cross‐sectional study was conducted on 402 patients suffering from AA referred to our hospitals between 2018 and 2021. The clinical records of the patients were reviewed, including demographic and clinical information. Results The most common diseases associated with AA were anxiety (36%), dermatitis (30%), hypothyroidism (9%), hyperlipidemia (5%), and vitamin D deficiency (4%). The most common comorbidities in AA patients over 18 years were allergic rhinitis, psychological problems, diabetes, hypertension, and hypothyroidism (p

Key Clinical Message Myopathy‐related symptoms are rare manifestations of hypothyroidism. Clinicians should consider hypothyroid myopathy as one of the possible diagnoses for patients with proximal weaknesses. Abstract Myopathy‐related symptoms are rare manifestations of hypothyroidism. Clinicians should consider hypothyroid myopathy as one of the possible diagnoses for patients with proximal weaknesses. We report a 34‐year‐old woman, presenting with a new atypical musculoskeletal manifestation of hypothyroidism mimicking polymyositis.

Abstract Objective Hypothyroidism has a significant effect on the patients' voices. This study evaluated the histopathological characteristics of larynx following hypothyroidism in an experimental rabbit model. Methods Eleven male Dutch rabbits were included. Methimazole‐induced hypothyroidism was done for nine rabbits. The remaining two rabbits were assigned as controls. Six weeks after starting methimazole, a histological examination was performed with parameters of inflammation, ulceration, hemorrhage, and thickness of epithelium, Reinke's space, vocal ligament, thyroarytenoid muscle, collagen deposition, and periodic acid‐Schiff (PAS)‐positive materials, as well as confirmation of hypothyroidism by T4 measurement. Results Histologic examination showed a significant thickening of epithelium, Reinke's space, vocal ligament, and collagen PAS‐positive materials deposition in hypothyroid rabbits (p

Abstract Hypothyroidism can induce oxidative stress. Nano‐selenium (Nano Sel) has antioxidant effects. The current research explored Nano Sel effects on hepatic and renal oxidative damage induced by hypothyroidism in rats. Animals were grouped into (1) Control; (2) Propylthiouracil (PTU) group which received water mixed with 0.05% of PTU; (3) PTU‐Nano Sel 50; (4) PTU‐Nano Sel 100; and (5) PTU‐Nano Sel 150. Besides PTU, the PTU‐Nano Sel groups were treated with 50, 100, or 150 μg/kg of Nano Sel intraperitoneally. Treatments were done for 6 weeks. The serum level of T4, aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), albumin, total protein, creatinine, and blood urea nitrogen (BUN) was evaluated. Malondialdehyde (MDA) and total thiol concentration and the activity of catalase (CAT) and superoxide dismutase (SOD) in hepatic and renal tissues also were checked. Hypothyroidism induced by PTU significantly increased AST, ALT, ALP, creatinine, BUN, and MDA concentration and noticeably reduced albumin, total protein, total thiol level, and SOD and CAT activity. Administration of Nano Sel ameliorated the adverse effects of hypothyroidism on liver and kidney function. Nano Sel applied protective effects against hepatic and renal damage resulting from hypothyroidism via ameliorating the oxidative stress status. More cellular and molecular experiments need to be done to understand the exact mechanisms.

Abstract Introduction Therapy for hypothyroid obese patients is still under definition since the thyrotropin‐stimulating hormone (TSH) level is a less reliable marker of euthyroidism than nonobese patients. Indeed, TSH levels positively correlate with body mass index (BMI), and this increase may be a compensatory mechanism aimed at increasing energy expenditure in obese people. In contrast, the correlation of BMI with thyroid hormone levels is not completely clear, and conflicting results have been obtained by several studies. The L‐T4 replacement dose is more variable in obese hypothyroid patients than in nonobese patients, and a recent study indicated that the L‐T4 replacement dose is related to lean body mass in obese thyroidectomized patients. We aimed to study the correlations of L‐T4‐administered dose, thyroid hormone levels and TSH secretion with basal metabolic rate (BMR) and total calculated deiodinase activity (GD) in obese and nonobese athyreotic patients. We also looked for individualized L‐T4 replacement dose set points to be used in clinical practice. Methods We studied retrospectively 160 athyreotic patients, 120 nonobese and 40 obese. GD was calculated by SPINA Thyr 4.2, the responsiveness of the hypothalamic/pituitary thyrotrope by Jostel's thyrotropin (TSH) index and BMR by the Mifflin‐St. Jeor formula, the interplay of GD and BMR with L‐T4, thyroid hormones and TSH index (TSHI) was also evaluated. Results In our study, the L‐T4 dose was an independent predictor of GD, and approximately 30% of athyreotic patients under L‐T4 therapy had a reduced GD; FT4 levels were higher and negatively modulated by BMR in obese athyreotic patients respect to nonobese, in these patients a T4 to T3 shunt, in terms of TSHI suppression is observed suggesting a defective hypothalamic pituitary T4 to T3 conversion and a resistance to L‐T4 replacement therapy. Conclusions L‐t4 dose is the most important predictor of GD, BMR modulates T4 levels in obese athyreotic patients that are resistant to L‐T4 replacement therapy.

Abstract Background Radioiodine (131I) is the treatment of choice for cats with hyperthyroidism. After 131I, however, euthyroidism is not always achieved, with 5% to 10% of cats remaining persistently hyperthyroid and 20% to 50% developing iatrogenic hypothyroidism. Objectives To identify pretreatment factors that may help predict persistent hyperthyroidism and iatrogenic hypothyroidism after treatment of cats using a novel 131I dosing algorithm. Animals One thousand and four hundred hyperthyroid cats treated with 131I. Methods Prospective, before‐and‐after study. Pretreatment predictors (clinical, laboratory, scintigraphic, 131I dose, 131I uptake measurements) of treatment failure or iatrogenic hypothyroidism were identified by multivariable logistic regression analysis. Results Cats that developed iatrogenic hypothyroidism were more likely to be older (odds ratio [OR] = 1.10; 95% confidence interval [CI], 1.04‐1.17; P = .001), female (OR = 2.04; 95% CI, 1.54‐2.70; P

Abstract Necrolytic acral erythema (NAE) is a rare cutaneous sign of hepatitis C virus (HCV), which generally presents as circumscribed keratotic plaques on the extremities. Many studies reported NAE in the absence of HCV. This case presents a female diagnosed with NAE and hypothyroidism in the absence of HCV infection.

Background Myxedema coma is an extremely rare but fatal endocrine emergency that requires urgent recognition and treatment. We describe a case of severe hypothermia that rapidly deteriorated to cardiac arrest that was attributed to myxedema coma. Case Presentation A 52‐year‐old man without a history of hypothyroidism was transferred to our emergency department due to coma and profound hypothermia. The patient developed cardiac arrest immediately after hospital arrival but return of spontaneous circulation was achieved shortly after resuscitation. The patient was noted to have generalized, nonpitting edema, dry skin, severe respiratory acidosis, hyponatremia, and elevated creatinine kinase, which was indicative of hypothyroidism. Myxedema coma was confirmed by a thyroid profile. The patient was successfully treated with intravenous levothyroxine and glucocorticoid. Conclusion Although myxedema coma is a rare cause of severe hypothermia, emergency physicians should be familiar with its clinical features and management.

Abstract Introduction The aim of this study was to investigate the effects of hypothyroidism on visual functions such as visual acuity, refractive errors, colour vision, and contrast sensitivity, among hypothyroid adults. Methods Forty‐three patients with clinical hypothyroidism along with 43 age‐ and sex‐matched healthy individuals underwent visual examinations, including visual acuity, refractive errors, eye deviations with the cover test, colour vision with the D15 test, and contrast sensitivity with Pelli‐Robson test. Results It was indicated that visual acuity, refractive errors, phoria, and colour vision had no significant difference between the hypothyroid and control groups. Contrast sensitivity decreased in hypothyroid subjects as compared with controls. The mean values of binocular contrast sensitivity were 1.85 ± 0.09 log in the hypothyroid group and 1.93 ± 0.09 log in controls, which showed a statistically significant difference (p = .03). Conclusions Our findings illustrated a reduced contrast sensitivity in adult hypothyroidism. Since CS is related to functioning and quality of life, a comprehensive and detailed eye examination may be beneficial for hypothyroidism patients.

Background: FOXE1 mutations in humans are associated with cleft palate and hypothyroidism. We previously developed a foxe1 mutant zebrafish demonstrating mineralization defects in larvae. In the present study, we investigate the thyroid status and skeletal phenotype of adult foxe1 mutants., Results: Mutant fish have increased expression of tshβ in the pituitary, and of hepatic dio1 and dio2. In plasma, we found higher Mg levels. Together these findings are indicative of hypothyroidism. We further observed mineralization defects in scales due to enhanced osteoclast activity as measured by increased expression levels of tracp, ctsk, and rankl. Gene-environment interactions in the etiology of FOXE1-related craniofacial abnormalities remain elusive, which prompts the need for models to investigate genotype-phenotype associations. We here investigated whether ethanol exposure increases the risk of developing craniofacial malformations in foxe1 mutant larvae that we compared to wild types. We found in ethanol-exposed mutants an increased incidence of developmental malformations and marked changes in gene expression patterns of cartilage markers (sox9a), apoptotic markers (casp3b), retinoic acid metabolism (cyp26c1), and tissue hypoxia markers (hifaa, hifab)., Conclusion: Taken together, this study shows that the foxe1 mutant zebrafish recapitulates phenotypes associated with FOXE1 mutations in human patients and a clear foxe1-ethanol interaction., (© 2024 The Author(s). Developmental Dynamics published by Wiley Periodicals LLC on behalf of American Association for Anatomy.)

Abstract Purpose Does the OPtimization of Thyroid function, Thrombophilia, Immunity, and Uterine Milieu (OPTIMUM) treatment strategy, developed for treating repeated implantation failure (RIF), contribute to improving pregnancy outcomes in patients with a history of recurrent pregnancy loss (RPL)? Methods Between 2018 and 2019, women with RPL after two or more clinical pregnancy losses underwent RPL testing. We treated chronic endometritis with antibiotics, high Th1/Th2 cell ratios with vitamin D and/or tacrolimus, overt/subclinical hypothyroidism with levothyroxine, and thrombophilia with low‐dose aspirin. Of 168 consecutive women aged ≤43 years, 115 underwent RPL testing. We compared 100 pregnancies (90 women) and 46 pregnancies (41 women) with and without the OPTIMUM treatment strategy, respectively. Results RPL testing identified intrauterine abnormalities in 66 (57.4%), elevated Th1/Th2 cell ratios in 50 (43.5%), thyroid dysfunction in 33 (28.7%), and thrombophilia in 33 (28.7%). The live birth rate in the OPTIMUM group was significantly higher than that in the control group among women aged

Abstract Background Radioiodine (131I) is the treatment of choice for hyperthyroidism in cats, but current 131I‐dosing protocols can induce iatrogenic hypothyroidism and expose azotemia. Objectives To develop a cat‐specific algorithm to calculate the lowest 131I dose to resolve hyperthyroidism, while minimizing risk of iatrogenic hypothyroidism and subsequent azotemia. Animals One thousand and four hundred hyperthyroid cats treated with 131I. Methods Prospective case series (before‐and‐after study). All cats had serum concentrations of thyroxine (T4), triiodothyronine (T3), and thyroid‐stimulating hormone (TSH) measured (off methimazole ≥1 week). Using thyroid scintigraphy, each cat's thyroid volume and percent uptake of 99mTc‐pertechnatate (TcTU) were determined. An initial 131I dose was calculated by averaging dose scores for T4/T3 concentrations, thyroid volume, and TcTU; 80% of that composite dose was administered. Twenty‐four hours later, percent 131I uptake was measured, and additional 131I administered, as needed, to deliver an adequate radiation dose to the thyroid tumor(s). Serum concentrations of T4, TSH, and creatinine were determined 6 to 12 months later. Results The median calculated 131I dose was 1.9 mCi (range, 1.0‐10.6 mCi); 1380 cats required additional 131I administration on day 2. Of the cats, 1047 (74.8%) became euthyroid, 57 (4.1%) became overtly hypothyroid, 240 (17.1%) became subclinically hypothyroid, and 56 (4%) remained hyperthyroid. More overtly (71.9%) and subclinically (39.6%) hypothyroid cats developed azotemia than euthyroid cats (14.2%; P

Abstract Graves' disease is characterized by the presence of circulating autoantibodies that stimulate the TSH receptor, inducing hyperthyroidism and goiter. Hashimoto's thyroiditis is an autoimmune disease leading to thyroid tissue destruction by cell and antibody‐mediated immune processes. The occurrence of Hashimoto's thyroiditis following Graves' disease has been rarely reported. Its pathogenesis is not clear. Herein, we report the case of a 40‐year‐old woman who was referred to our department for thyrotoxicosis. Laboratory tests revealed overt hyperthyroidism. Thyroid scintigraphy showed an enlarged gland with diffusely increased tracer uptake, confirming the diagnosis of Graves's disease. The patient was treated with propranolol and thiamazole. Two months later, she received radioactive iodine therapy. Three years and 9 months later, the patient presented with hypothyroidism and very high levels of thyroperoxidase antibodies consistent with the diagnosis of Hashimoto's thyroiditis. She was treated with levothyroxine. The shift from Graves' disease to Hashimoto's thyroiditis was reported in the literature. However, its pathogenesis has not been clearly elucidated.

Abstract Introduction Endocrine disorders such as polycystic ovary syndrome (PCOS) and hypothyroidism can cause infertility. There are evidence that they happen jointly in some circumstances. It still remains unknown, how these two illnesses interact and influence the body. Methods Accordingly, a five‐group was designed, first is the control group, followed by the PCOS group. Estradiol valerate (EV) induced PCOS, the second group had only PCOS and the third, fourth and fifth groups were given varied dosages of propylthiouracil (PTU) to cause hypothyroidism after induction of PCOS. Steroidogenic acute regulatory protein (StAR) expression was measured in the ovaries, and serum was obtained to determine testosterone levels, as well as superoxide dismutase (SOD) as an antioxidant and malondialdehyde (MDA) as an oxidant. Results Based on radioimmunoassay data, testosterone levels were significantly higher in the PCOS group than the control group, and significantly lower (p ˂ .05) in PTU groups comparing with the PCOS group. According to the quantitative real‐time polymerase chain reaction (qRT‐PCR) data, the same results were obtained for the StAR gene as well. The data also indicated a positive correlation between these two. Although both oxidant and antioxidant level increased in PCOS group compared than control group, after hypothyroidism, oxidant level increased significantly (p ˂ .05), meanwhile antioxidant level decreased significantly (p ˂ .05). Conclusions The results of this study illustrate that the presence of both PCOS and hypothyroidism alters the situation more than just PCOS. They also indicate that this situation is associated with imbalanced oxidative/antioxidative status.

Abstract This study aimed to evaluate the association between thyroid dysfunction and breast cancer risk. We included 239,436 females of the UK Biobank cohort. Information on thyroid dysfunction, personal and family medical history, medications, reproductive factors, lifestyle, and socioeconomic characteristics was retrieved from baseline self‐reported data and hospital inpatient databases. Breast cancer diagnoses were identified through population‐based registries. We computed Cox models to estimate hazard ratios (HRs) of breast cancer incidence for thyroid dysfunction diagnosis and treatments, and examined potential confounding and effect modification by comorbidities and breast cancer risk factors. In our study, 3,227 (1.3%) and 20,762 (8.7%) women had hyper‐ and hypothyroidism prior to the baseline. During a median follow‐up of 7.1 years, 5,326 (2.2%) women developed breast cancer. Compared to no thyroid dysfunction, there was no association between hypothyroidism and breast cancer risk overall (HR = 0.93, 95% confidence interval (CI): 0.84–1.02, 442 cases), but we found a decreased risk more than 10 years after hypothyroidism diagnosis (HR=0.85, 95%CI 0.74–0.97, 226 cases). There was no association with hyperthyroidism overall (HR=1.08, 95%CI 0.86–1.35, 79 cases) but breast cancer risk was elevated among women with treated hyperthyroidism (HR=1.38, 95%CI: 1.03–1.86, 44 cases) or aged 60 years or more at hyperthyroidism diagnosis (HR=1.74, 95%CI: 1.01–3.00, 113 cases), and 5–10 years after hyperthyroidism diagnosis (HR=1.58, 95%CI: 1.06–2.33, 25 cases). In conclusion, breast cancer risk was reduced long after hypothyroidism diagnosis, but increased among women with treated hyperthyroidism. Future studies are needed to determine whether the higher breast cancer risk observed among treated hyperthyroidism could be explained by hyperthyroidism severity, type of treatment or aetiology.

Abstract In order to improve the diagnosis and treatment of senile thyroid diseases in China and to promote healthy aging, the Endocrine Metabolic Diseases Group of the Chinese Geriatrics Society, and the Thyroid Group of the Chinese Society of Endocrinology jointly drafted the “Expert consensus on diagnosis and treatment for Chinese elderly with thyroid diseases” (referred to as consensus). The Consensus consists of five parts that set 40 recommendations on main clinical issues. The consensus emphasizes clinical focus on the age‐related changes of the hypothalamus‐pituitary‐thyroid axis in the elderly, and it recommends application of comprehensive geriatric assessment to thoroughly evaluate the impact of thyroid diseases and relevant intervention on overall health condition. Meanwhile, it recommends generalization of screening for hypothyroidism during admission to nursing institution or hospital, and routine health check‐ups. Furthermore, it develops individualized stratified management on hyperthyroidism, hypothyroidism, thyroid nodules, and differentiated thyroid carcinoma in the elderly distinguished from the youngers, including treatment regimen, control ranges, and flowcharts for diagnosis and treatment. The Consensus will provide the basis for clinical decisions and health management of thyroid diseases in the elderly by geriatrician, endocrinologist, and general practitioners.

Abstract Pituitary hyperplasia due to hypothyroidism can be treated medically. This condition should not be mistaken for adenoma and surgery should be avoided.

Abstract We report a 54‐year‐old man with treatment‐resistant depression (TRD) and hypothyroidism who responded to LT3/LT4 combination, rather than LT4 alone. He was able to discontinue all antidepressant medications eventually. Interestingly, the patient has a DIO2 polymorphism.

Background and Aim Hypothyroidism might play a crucial role in the pathogenesis of non‐alcoholic fatty liver disease (NAFLD). The association of subclinical hypothyroidism with NAFLD has been inconsistent. The relationship of NAFLD with thyroid function parameters and subclinical hypothyroidism was determined. Methods This cross‐sectional study included 70 patients with subclinical hypothyroidism and 70 controls with euthyroidism matched according to gender, age, and body mass index (BMI). NAFLD was diagnosed via abdominal ultrasonography. The association between NAFLD and subclinical hypothyroidism was analyzed. Results The prevalence of NAFLD was significantly higher in patients with subclinical hypothyroidism than in those with euthyroidism. Multivariate analysis showed that subclinical hypothyroidism was an independent risk factor of NAFLD adjusted by metabolic‐related factors, such as BMI, triglyceride, high‐density lipoprotein‐cholesterol, hypertension, and diabetes. Thyroid‐stimulating hormone (TSH) was an independent risk factor of NAFLD adjusted by the same metabolic‐related factors, but free thyroxine (FT4) was not a risk factor. The FIB‐4 index, a noninvasive marker of liver fibrosis was significantly higher in patients with subclinical hypothyroidism than in those with euthyroidism. Compared with patients with euthyroidism, the proportion of the FIB‐4 index ≥2.67 was significantly higher, and the proportion of the FIB‐4 index

Abstract Background No gold standard assay for serum total thyroxine (TT4) concentration in small animals exists. The Microgenics DRI TT4 (MTT4) assay is used by most reference laboratories. Hypothesis/Objectives IDEXX Catalyst Total T4 (CTT4) and Immulite 2000 TT4 (ITT4) results will agree with MTT4 results. Animals Residual small animal sera were randomized before reanalysis (dogs, CTT4 versus MTT4: n = 176, ITT4 versus MTT4: n = 74; cats, CTT4 versus MTT4: n = 319, ITT4 versus MTT4: n = 79). Methods Validation and method comparison study. Serum TT4 concentration was measured on all analyzers. Pairwise Pearson correlation, cumulative sum linearity test, regression, and Bland‐Altman method were performed. Results CTT4 versus MTT4 in dogs: constant bias (y‐intercept) was 0.10 μg/dL (95% confidence interval [CI], 0.05‐0.15), proportional bias (slope) was 0.86 μg/dL (95% CI, 0.83‐0.89); in cats, constant bias was 0.13 μg/dL (95% CI, 0.08‐0.20) and proportional bias was 1.01 μg/dL (95% CI, 0.98‐1.03), but the test for linearity failed. Bland‐Altman plots identified increasing disagreement with increasing serum TT4 concentrations. ITT4 versus MTT4 in dogs, constant bias was 0.14 μg/dL (95% CI, 0.04‐0.22) and 0.22 μg/dL (95% CI, 0.09‐0.33) for cats; proportional bias was 0.76 (95% CI, 0.72‐0.80) for dogs and 0.71 (95% CI, 0.69‐0.74) for cats. Conclusions and Clinical Importance Differences in CTT4 and MTT4 results affect interpretation at higher serum TT4 concentrations. The ITT4 proportional bias will underestimate serum TT4 concentrations in dogs and cats, compared to MTT4. Serial TT4 measurements should be done using the same assay.

Abstract Aim The objective of this study was to assess the existing literature to determine if a relationship exists between hypothyroidism and periodontitis. Methods We used a modified approach to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses by searching five databases in addition to the gray literature. Keywords in the title and abstract fields, as well as subject headings for both periodontal disease and hypothyroidism, were used to search the existing literature for publications relevant to evaluation of the thyroid–periodontitis relationship. Results The authors screened 847 unique publications which, after applying inclusion and exclusion criteria, yielded 29 publications, which were further analyzed for relevance and applicability. Most of the included papers were cross‐sectional studies and retrospective chart reviews. Following critical analysis, four publications, including one abstract, were used to further assess the hypothyroid–periodontitis relationship. Conclusions There are very few high‐quality studies describing the potential association between hypothyroidism and periodontitis. In general, and among the included papers with the fewest confounding factors, a positive relationship between hypothyroidism and periodontitis was found. Further well‐controlled, prospective clinical and immunologic studies will be required to confirm that relationship.

Abstract Methylene tetrahydrofolate reductase (MTHFR) gene mutations could be the cause of infertility in hypothyroid patients. Hence, it is worthy to screen for MTHFR gene mutations in infertile hypothyroid females and their partners if infertility persists after optimizing thyroid function.

Abstract Background Evidence suggests that hypothyroidism and thyroid autoimmunity (TAI) are possibly associated with ovarian dysfunction. This meta‐analysis aimed to investigate whether hypothyroidism and/or TAI affect the ovarian reserve and evaluated using the anti‐Mullerian hormone (AMH). Methods PubMed, EMBASE, Web of Science, and Cochrane Controlled Trials Register databases from inception to October 2020 were searched to identify relevant studies. Studies comparing the AMH levels between the control and the affected groups were included in the data synthesis. The primary endpoint in the meta‐analysis was AMH levels compared with the controls. Main findings Nine trials were included in the analysis. The AMH levels were significantly lower in the adults with euthyroid TAI (mean difference −0.12, [95% CI: −0.18 to −0.06]). The AMH levels tended to be lower in subclinical hypothyroidism and overt hypothyroidism than in the control group, although the differences were not significant. The AMH levels were significantly higher in the euthyroid TAI group in the adolescents (mean difference 2.51, [95% CI 1.82 to 3.21]). Conclusion TAI and hypothyroidism may affect the ovarian reserve. The opposite effects on AMH levels depending on age suggest that TAI may be implicated in the depletion of follicles in adults following extensive activation of primordial follicles in adolescence.

Abstract Hypothyroidism causing rhabdomyolysis is a known but an uncommon entity. Hashimoto's thyroiditis causing rhabdomyolysis in the absence of precipitating factors is even rarer. Here, we report a 42‐year‐old previously healthy man with hypothyroidism due to Hashimoto's thyroiditis complicated by severe rhabdomyolysis and acute kidney injury in the absence of precipitating factors. The diagnosis was based on his clinical presentation and laboratory investigations, and he was successfully treated with intravenous fluid therapy and oral levothyroxine.

Abstract Pericardial effusion may be the tipping point to unravel hypothyroidism. Large effusions may not correlate with severity of cardiovascular compromise. Medical therapy over surgical intervention is appropriate if no evidence of cardiac tamponade.

Abstract Rectal stenosis is a rare variety of rectal atresia. A membrane separates the rectum from the anal canal in the presence of a normal anus. We report a case of rectal stenosis associated with Down's syndrome and hypothyroidism in whom rectal stenosis was diagnosed at the age of 17 years.

Abstract Background: Celiac disease, an immune‐mediated inflammation of the small intestine, occurs in genetically predisposed individuals, and is caused by sensitivity to dietary gluten and related proteins. The global prevalence is approximately 1%. Celiac disease is frequently associated with extra‐intestinal manifestations, including iron deficiency anemia, dermatologic eruptions, type 1 diabetes mellitus, thyroid disease, and connective tissue disorders, but is rarely associated with cardiomyopathy.Case presentation: Our case describes a 33‐year‐old woman, who presented with exertional dyspnea and fatigue, and was diagnosed with severe iron deficiency anemia and dilated cardiomyopathy, secondary to celiac disease. Conclusion: High clinical suspicion is needed to identify celiac disease in patients diagnosed with dilated cardiomyopathy, as an improvement in cardiac function has been reported with strict adherence to a gluten‐free diet.

Abstract Indications and administration of intra‐amniotic infusions of L‐thyroxine in the context of non‐immune fetal hypothyroidism with goiter lack of standardization. Systematic follow‐up of clinical features related to thyroid hormonal homeostasis may be useful to evaluate their efficiency and develop standardized management guidelines.

Abstract We are reporting a case report of Behcet's disease with autoimmune dysfunction that affected the thyroid and adrenal glands and the patient also had sub‐clinical celiac disease. However, the correlation between Bechet's disease and autoimmune disease is still controversial.

Abstract Thyroid lymphoma should be suspected in case of rapid enlargement of the thyroid gland even in a young patient with no history of Hashimoto thyroiditis. The confirmation is based on histopathology and immunohistochemistry.

Abstract Early and frequent evaluation of thyroid profile in COVID‐19 infected patients is crucial as it will influence thyroid disease sequelae and management in those patients; moreover, it will facilitate setting an appropriate management plan.