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Background: Many participants living with hypothyroidism treated with levothyroxine continue to experience challenges with their physical, social, cognitive, and psychological functions. These symptoms may lead to poor quality of life (QoL). Objectives: This study aimed to determine the health-related QoL in participants living with hypothyroidism on levothyroxine therapy and to describe the association between QoL in participants living with hypothyroidism on levothyroxine therapy and various demographic and treatment parameters. Methods: The disease-specific ThyPRO instrument was used to measure the QoL in treated hypothyroid participants at Chris Hani Baragwanath Academic Hospital (CHBAH). The study recruited 127 participants with primary hypothyroidism on levothyroxine therapy for more than six months, who attended the clinic from 1 January 2021 until 30 September 2021. ThyPRO contains 84 items, summarised in 13 scales. Results: Of the 127 participants, the average Overall QoL was 31.4%. The highest ThyPRO scores were recorded for vitality (49.9%), difficulty in coping with the mood (38.5%), tiredness (37.5%), nervousness, and tension (33.3%). No negative impact on mean ThyPRO scores was recorded for sex life among all the respondents. Indian and White descent participants had poorer ThyPRO scores of 44.4% and 39.3%, respectively, as compared with Black participants at 30.7% and mixed origin at 26.0%. Smokers had a poorer ThyPRO score of 40.1% compared with 30.3% among non-smokers. Participants who were on treatment for less than one year had poorer ThyPRO scores of 61.0% as compared with 29.4% of those who received treatment for longer (between one year and four years) and 31.1% for more than five years. Conclusion: Participants who received treatment for an extended period had a better QoL. It is recommend to use ThyPRO to assess the health-related QoL in treated hypothyroid patients for future clinical research and good clinical practice. [ABSTRACT FROM AUTHOR]

Background: Obesity and hypothyroidism are common medical conditions that are associated with each other. Bariatric surgery (BS) is a common approach used to achieve substantial weight loss in obese patients. However, there is limited evidence regarding the need for postsurgery levothyroxine (LT4) dose adjustment in patients with hypothyroidism undergoing BS. Methods: This was a three-year prospective cohort study assessing postsurgery LT4 requirements with attention to body composition changes. The current study included 1030 patients with hypothyroidism, who underwent sleeve gastrectomy (SG) (n = 707, 88.3% women) or one anastomosis gastric bypass (OAGB) (n = 323, 92% women). Patients were followed for 36 months after surgery. A bioelectrical impedance analyzer was used for body composition assessment. LT4 requirements were assessed by generalized estimating equation (GEE) methods adjusted for weight as a time-varying covariate. Results: During the follow-up, TSH (mIU/L) and T4 (ng/dL) measurements did not significantly change in the OAGB group over time. However, in the SG group, TSH measurement decreased over time (ptrend = <0.001). In the third year of the follow-up, 56.1% and 33.3% of patients in the SG and OAGB groups experienced LT4 (μg/day) dose reduction, while 24.4% and 9.1% of the participants experienced LT4 dose increments, respectively. GEE analysis showed a significant increase in the LT4/fat mass (FM) (μg/kg) ratio after 36 months of follow-up compared with the baseline in both the SG [1.8 (1.5–2.2) to 2.7 (2.0–3.5), ptrend = 0.039)] and OAGB [1.7 (1.4–2.2) to 3.2 (2.7–4.8), ptrend = <0.001)] groups. Moreover, patients who underwent OAGB experienced greater LT4/FM (μg/kg) dose adjustments compared to those undergoing SG (pbetween = 0.060). In both groups, after the first year, the increase in LT4/FM (μg/kg) plateaued (pinteraction = 0.009). Conclusion: Most hypothyroid patients experienced either a reduction or no change in LT4 (μg/day) dosage after 36 months in both surgical groups. The LT4/FM (μg/kg) was significantly increased in patients undergoing either SG or OAGB with greater alterations in the latter. Further studies on larger populations and with longer duration of follow-up are needed to confirm our results. [ABSTRACT FROM AUTHOR]

Abstract Primary hypothyroidism (PHT) is associated with an increased risk for the development of atherosclerosis (AS) and other cardiovascular disorders. PHT induces atherosclerosis (AS) through the induction of endothelial dysfunction, and insulin resistance (IR). PHT promotes vasoconstriction and the development of hypertension. However, patients with subclinical PHT with normal thyroid hormones (THs) are also at risk for cardiovascular complications. In subclinical PHT, increasing thyroid stimulating hormone (TSH) levels could be one of the causative factors intricate in the progression of cardiovascular complications including AS. Nevertheless, the mechanistic role of PHT in AS has not been fully clarified in relation to increased TSH. Therefore, in this review, we discuss the association between increased TSH and AS, and how increased TSH may be involved in the pathogenesis of AS. In addition, we also discuss how L-thyroxine treatment affects the development of AS.

Primary hypothyroidism (PHT) is associated with an increased risk for the development of atherosclerosis (AS) and other cardiovascular disorders. PHT induces atherosclerosis (AS) through the induction of endothelial dysfunction, and insulin resistance (IR). PHT promotes vasoconstriction and the development of hypertension. However, patients with subclinical PHT with normal thyroid hormones (THs) are also at risk for cardiovascular complications. In subclinical PHT, increasing thyroid stimulating hormone (TSH) levels could be one of the causative factors intricate in the progression of cardiovascular complications including AS. Nevertheless, the mechanistic role of PHT in AS has not been fully clarified in relation to increased TSH. Therefore, in this review, we discuss the association between increased TSH and AS, and how increased TSH may be involved in the pathogenesis of AS. In addition, we also discuss how L-thyroxine treatment affects the development of AS. [ABSTRACT FROM AUTHOR]

Hypothyroidism is a frequently diagnosed endocrine disorder. Common signs and symptoms include fatigue, cold intolerance, hoarseness, dry skin, constipation, a slow relaxation phase of deep tendon reflexes, and bradycardia. However, some patients may exhibit atypical signs and symptoms, which can result in diagnostic confusion. Pituitary hyperplasia resulting from longstanding primary hypothyroidism was first described by Niepce in 1851. It is usually asymptomatic, but sometimes, in addition to symptoms of overt hypothyroidism, patients may complain of headaches, hypopituitarism, visual field impairment, and hyperprolactinemia. Furthermore, on imaging, pituitary hyperplasia can be mistaken for a pituitary adenoma. Distinguishing between the two is crucial, as their management differs; the former often responds to thyroid hormone replacement therapy, while the latter might need treatment with surgery and/or radiotherapy. Here we describe a patient who developed pituitary hyperplasia in the setting of longstanding uncompensated primary hypothyroidism due to a lack of compliance with levothyroxine replacement therapy. We also review the clinical, laboratory, and radiologic findings of the case reports available in the literature up to now in order to improve the knowledge and the care of the disease. [ABSTRACT FROM AUTHOR]

Background: Hypothyroidism has a wide range of clinical manifestations and general symptoms, including but not limited to obesity, tiredness, poor concentration, depression, widespread muscle soreness, menstruation abnormalities, and constipation. The administration of a daily dosage of levothyroxine is sufficient for the successful management of hypothyroidism, as it facilitates the restoration of serum thyroid stimulating hormone (TSH) levels to their normal range. Several factors can influence the absorption of levothyroxine in the human body, including age, weight, the presence of other medical problems, and dietary intake. The aim of this study was to assess the prevalence of primary hypothyroidism and alteration in clinical presentation associated with replacement therapy. Methods: This was a cross-sectional, observational study conducted over at Al Hassan Metabolism, Endocrine, and Diabetes Center (HMEDC) in Karbala city. The study team created a questionnaire, and data was collected from face-to-face patient interviews, which included various sociodemographic variables, TSH and ferritin levels, drug interactions, as well as signs and symptoms exhibited both prior to and following treatment. Additionally, the patient treatment regimen and the specific doses of levothyroxine administered are also recorded. Results: the total number of cases visited Al Hassan Metabolism, Endocrine, and Diabetes Center (HMEDC) during the study period was (10800). The prevalence of thyroid diseases was 300 (2.8%). The rate of primary hypothyroidism out of the total number of hypothyroid cases was 85.1%. (61%) of the patients had normal levels of TSH whereas (42%) of the patients were found to be undertreatment. A total of (84%) of the patients exhibited normal levels of ferritin. The patients exhibited a reduction in their signs and symptoms following the administration of therapy. Conclusion: treatment with levothyroxine improved sluggish speech, constipation, lack of appetite, cold sensitivity, weight gain, and weariness. There is no observed correlation between the dosage of levothyroxine and the manifestation of signs and symptoms.

Objective: Hypothyroidism is characterized by insufficient production of thyroxine by the thyroid gland. Levothyroxine may not fully alleviate patients' symptoms. This study aimed to assess the impact of a herbal product on weight, body mass index (BMI), thyroid hormones, lipid profile, fasting blood sugar (FBS), depression, and quality-of-life scores in patients.Materials and Methods: 72 patients with primary hypothyroidism, aged between 20 and 65 years old, participated in the trial and they were randomly allocated into two groups. The intervention group received the herbal powder containing Trachyspermum ammi L., Nigella sativa L., and Citrus aurantifolia L. while the control group received Avicel for 8 weeks.Results: Treatment with the herbal product resulted in statistically significant reductions in anthropometric variables such as BMI (p=0.03), hip circumference (HC) (p=0.008), waist circumference (WC) (p

Abstract Background Hypocalcaemia is a rare, but reversible, cause of dilated cardiomyopathy causing heart failure. Several case reports have been reported on reversible cardiomyopathy secondary to hypocalcaemia. Case presentation We report a case of 54-year-old female Sri Lankan patient who presented with shortness of breath and was diagnosed with heart failure with reduced ejection fraction due to dilated cardiomyopathy. The etiology for dilated cardiomyopathy was identified as hypocalcemic cardiomyopathy, secondary to primary hypoparathyroidism, which was successfully treated with calcium and vitamin D replacement therapy. Conclusion This adds to literature of this rare cause of reversible cardiomyopathy secondary to hypocalcemia reported from the South Asian region of the world. This case highlights the impact of proper treatment improving the heart failure in patients with hypocalcemic cardiomyopathy.

Objective: Hypothyroidism is characterized by insufficient production of thyroxine by the thyroid gland. Levothyroxine may not fully alleviate patients' symptoms. This study aimed to assess the impact of a herbal product on weight, body mass index (BMI), thyroid hormones, lipid profile, fasting blood sugar (FBS), depression, and quality-of-life scores in patients. Materials and Methods: 72 patients with primary hypothyroidism, aged between 20 and 65 years old, participated in the trial and they were randomly allocated into two groups. The intervention group received the herbal powder containing Trachyspermum ammi L., Nigella sativa L., and Citrus aurantifolia L. while the control group received Avicel for 8 weeks. Results: Treatment with the herbal product resulted in statistically significant reductions in anthropometric variables such as BMI (p=0.03), hip circumference (HC) (p=0.008), waist circumference (WC) (p<0.001), and waist-to-hip circumference ratio (WHR) (p=0.003) in the intervention group in comparison between intervention and control groups. However, the decrease in weight was not statistically significant (p=0.08) in the intervention group compared the control group. In comparison between two groups, the depression score exhibited a statistically significant decrease in the intervention (p=0.001) and control groups (p=0.01), while there was a statistically significant increase in the quality-of-life score only in the intervention group (p<0.001) in comparison between intervention and control groups. Conclusion: The results indicate the potential beneficial effects of the herbal product on anthropometric variables in patients. Furthermore, the intervention yielded significant improvements in depression symptoms and quality-of-life scores among the patients. [ABSTRACT FROM AUTHOR]

Background: Hypocalcaemia is a rare, but reversible, cause of dilated cardiomyopathy causing heart failure. Several case reports have been reported on reversible cardiomyopathy secondary to hypocalcaemia. Case presentation: We report a case of 54-year-old female Sri Lankan patient who presented with shortness of breath and was diagnosed with heart failure with reduced ejection fraction due to dilated cardiomyopathy. The etiology for dilated cardiomyopathy was identified as hypocalcemic cardiomyopathy, secondary to primary hypoparathyroidism, which was successfully treated with calcium and vitamin D replacement therapy. Conclusion: This adds to literature of this rare cause of reversible cardiomyopathy secondary to hypocalcemia reported from the South Asian region of the world. This case highlights the impact of proper treatment improving the heart failure in patients with hypocalcemic cardiomyopathy. [ABSTRACT FROM AUTHOR]

Primary hypothyroidism, the most common form of hypothyroidism, requires effective patient understanding and management for successful long-term treatment. This study aimed to investigate the influence of patient knowledge, attitude, practice (KAP), depression, and medication adherence on treatment response in primary hypothyroidism. A cross-sectional observational study was conducted at Al Hassan Metabolism, Endocrine, and Diabetes Center (HMEDC) in Iraq between September 2022 and March 2023. We enrolled 111 patients with signs and symptoms of primary hypothyroidism over 6 months. A validated questionnaire assessed patient knowledge, attitude, practice (KAP), depression, and medication adherence. Thyroid-stimulating hormone (TSH) levels were measured to assess treatment response. Data were analyzed using SPSS v26, with categorical variables presented as percentages. The student's t-test was used to assess statistical significance, with P - valuess below 0.05 considered significant and P - values below 0.01 considered highly significant. The mean age of patients was 45 ± 11.9 years. Approximately 34% of patients had insufficient knowledge, and 30% indicated a positive attitude towards their treatment. A total of 35% of patients had excellent practice. There was no statistically significant association between KAP and age or gender. There was a significant positive correlation between higher levels of education and improved KAP scores. A total of 44.1% of participants reported moderate depression, and 58% demonstrated adherence to levothyroxine (LT4) treatment. Despite good adherence, the combination of fair knowledge and moderate-to-severe depression resulted in suboptimal outcomes for replacement treatment. [ABSTRACT FROM AUTHOR]

Objectives: The study assessed gustatory functions in patients with primary hypothyroidism who are euthyroid on supplemental hormone therapy with levothyroxine over six months' duration and to evaluate the association of gustatory dysfunction, if any, with the serum TSH levels. Design: This analytical community-based cross-sectional study was conducted in April 2021, following participants' ethical approval and written informed consent. Setting: The study was conducted in a tertiary health care centre in Bangalore, Karnataka, India. Participants: Sixty-eight subjects participated in this study: 34 primary hypothyroid patients and an equal number of healthy controls. Interventions: Gustatory sensations were assessed by the triple drop test, and scores were given depending on the identification of the tastants (sweet, sour, salty, and bitter). The taste scores were compared, and the association between TSH levels and gustatory parameters were evaluated. Results: Overall taste scores were lesser in hypothyroid patients. This finding depicted that their taste thresholds were increased and were statistically significant (p < 0.001), though the association between the degree of hypogeusia and TSH levels was not statistically significant. Conclusion: Patients with primary hypothyroidism can suffer from hypogeusia, which may revert to normal once they achieve euthyroid status with levothyroxine supplementation. However, this has not been conclusively shown in studies. Our study concluded that hypogeusia was present in primary hypothyroidism despite patients being euthyroid on hormone supplementation, and it was not dependent on the serum TSH levels. [ABSTRACT FROM AUTHOR]

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Hypothyroidism is a frequently diagnosed endocrine disorder. Common signs and symptoms include fatigue, cold intolerance, hoarseness, dry skin, constipation, a slow relaxation phase of deep tendon reflexes, and bradycardia. However, some patients may exhibit atypical signs and symptoms, which can result in diagnostic confusion. Pituitary hyperplasia resulting from longstanding primary hypothyroidism was first described by Niepce in 1851. It is usually asymptomatic, but sometimes, in addition to symptoms of overt hypothyroidism, patients may complain of headaches, hypopituitarism, visual field impairment, and hyperprolactinemia. Furthermore, on imaging, pituitary hyperplasia can be mistaken for a pituitary adenoma. Distinguishing between the two is crucial, as their management differs; the former often responds to thyroid hormone replacement therapy, while the latter might need treatment with surgery and/or radiotherapy. Here we describe a patient who developed pituitary hyperplasia in the setting of longstanding uncompensated primary hypothyroidism due to a lack of compliance with levothyroxine replacement therapy. We also review the clinical, laboratory, and radiologic findings of the case reports available in the literature up to now in order to improve the knowledge and the care of the disease.

Ovarian hyperstimulation syndrome (OHSS) is a syndrome usually related to induction of ovulation for in-vitro fertilization. Its occurrence is rare in pregnant females. To our knowledge, only twelve cases of spontaneous OHSS (without any ovulation induction therapy) in non-pregnant women with primary hypothyroidism exist in the published literature. This case study illustrates the association of spontaneous OHSS with primary hypothyroidism in a 17 year old female, which showed complete resolution after initiation of thyroxine therapy. Hence, we need to emphasize the need for clinicians and radiologists to enlighten themselves with the clinical symptomatology and imaging findings of spontaneous OHSS in primary hypothyroidism, which is still not well-known medical and radiological condition. Sufficient knowledge of the clinical and imaging findings of OHSS helps in prompt diagnosis and avoids advancement to life threatening complications and unwanted surgery.

Abstract Background With the increasing application of immune checkpoint inhibitors (ICI) in cancer therapy, the occurrence of isolated adrenocorticotropic hormone deficiency (IAD), as an adverse effect, is also on the rise. Nevertheless, there are only a few studies regarding IAD induced by ICI. This study aimed at investigating the characteristics of IAD induced by ICI and its relationship with other endocrine adverse events. Methods A retrospective study was conducted in the Endocrinology Department from January 2019 to August 2022 to investigate characteristics of patients with IAD. Clinical features, laboratory findings and treatment information were collected. All patients underwent a follow-up of 3-6-month. Results 28 patients with IAD were enrolled. All patients received treatment with anti-PD-1/ PD-L1. The median occurrence time of IAD was 24 (18–39) weeks after initiation of ICI treatment. Over half of the patients (53.5%) had an additional endocrinopathy, including primary hypothyroidism and fulminant type 1 diabetes mellitus (FT1DM), while other types of endocrinopathies were not identified. The interval between the occurrences of two gland damages was between 4 and 21 weeks or simultaneous. Primary hypothyroidism (46.4%) was more prevalent than FT1DM (7.1%). Fatigue and nausea were common symptoms, with a frequent occurrence of hyponatremia. All patients continued on oral glucocorticoids during follow-up. Conclusions IAD induced by ICI could manifest independently, or more frequently in combination with hypothyroidism or FT1DM. This damage could happen at any point of ICI treatment. Given that IAD can be life-threatening, it is critical to evaluate pituitary function dynamically in patients undergoing immunotherapy.

AbstractObjective The objective was to explore the management of newly diagnosed hypothyroidism in adults regarding laboratory diagnostics and treatment in Region Halland (RH). In addition, to investigate whether current recommendations were followed regarding diagnostics.Design Retrospective observational study.Setting A population-based study utilizing healthcare registry data from all public primary health care (PHC) clinics in RH during 2014-2019.Subjects Newly diagnosed patients with hypothyroidism according to ICD-10, aged ≥18 years when diagnosed and living and receiving health care in RH. There were 2494 patients included in the study.Main outcome measures Registrations of thyroid laboratory values, diagnostic codes, and drug treatment was collected. Demographic data were also recorded. Laboratory values were checked also after 12-24 months after initial diagnosis. The main outcome was the proportion with elevated TSH and TPO and how the TSH value had changed at the follow-up.Results There were 1431 (61%) patients who had elevated TSH at the onset of the disease and TPO was tested in 1133 (46%) of the patients. Elevated TPO was found in 566 (23%) of the patients. After one year, there were 1908 (76%) patients who obtained a prescription for levothyroxine. In 1127 (45%) patients, TSH had normalized within one year.Conclusion There were 39% of the patients diagnosed with hypothyroidism despite normal or subclinical TSH. There was an underuse of TPO in diagnosis and this advocated that the criteria for diagnostics according to current guidelines be followed to avoid unnecessary treatment.

Abstract Background One of the common causes of suboptimal control of thyroid stimulating hormone (TSH) in levothyroxine-treated hypothyroidism is coadministration of proton pump inhibitors (PPIs). Morning administration of pantoprazole has been shown to suppress intragastric pH to a greater extent. We therefore aimed to determine the effect of pantoprazole at different time points of the day on thyroid function test (TFT) in levothyroxine-treated overt primary hypothyroidism. Methods In this single centre, hospital based, prospective, two arm cross-over study (AB, BA), participants were randomized into 2 groups based on morning (6:00 am – 7:00 am simultaneously with the scheduled levothyroxine tablet) (group M) and evening (30 min before dinner) intake of 40 mg pantoprazole tablet (group N). After the initial 6 weeks (period 1), a washout period of 1 week for pantoprazole was given, and then both the groups crossed over for another 6 weeks (period 2). Patients were instructed to continue the same brand of levothyroxine tablet at empty stomach 1-hour before breakfast. Serum TSH was measured at baseline, week 6, and week 13. Results Data from 30 patients, who completed the study with 100% compliance, were analysed. Mean TSH values of the study participants were significantly higher both at week 6 and week 13 compared to the baseline. Mean baseline serum TSH concentrations for groups M and N were 2.70 (± 1.36), and 2.20 (± 1.06) µlU/mL, respectively. Mean serum TSH concentrations at the end periods 1 and 2 for group M were 3.78 (± 4.29), and 3.76 (± 2.77) while the levels in group N were 3.30 (± 1.90), and 4.53 (± 4.590) µlU/mL, respectively. There was a significant rise in serum TSH concentration across periods 1 and 2 in both the groups (F2, 58 = 3.87, p = 0.03). Within group changes in TSH across periods 1 and 2 were not statistically significant. Similarly difference in TSH between the groups, either at 6 weeks or at 13 weeks, were also not statistically significant. Conclusions Concomitant use of pantoprazole, even for 6 weeks, leads to significant elevation in serum TSH in levothyroxine-treated patients who are biochemically euthyroid, irrespective of timing of pantoprazole intake. Early morning and night-time administration of pantoprazole have similar effect on TFT in these patients.

Infants of mothers with Graves’ disease (GD) may develop central hypothyroidism (CH) due to exposure of the foetal hypothalamic-pituitary-thyroid axis to higher-than-normal thyroid hormone concentrations, primary hypothyroidism (PH) due to transplacental passage of maternal thyroid stimulating hormone receptor antibody (TRAb), antithyroid drugs (ATD) or thyroid dysgenesis secondary to maternal uncontrolled hyperthyroidism. We describe two infants with PH and four infants with CH born to mothers with poorly controlled Graves' disease. All infants required levothyroxine and had normal developmental milestones. While national guideline consensus for high thyroid stimulating hormone (TSH) on neonatal screening is well-established, thyroid function tests (TFTs) should be serially monitored in infants with low TSH on screening, as not all mothers with Graves’ disease are diagnosed antenatally.

Objectives: Levothyroxine (LT4) is a commonly used treatment for hypothyroidism. Deiodinase enzymes control the metabolism and homeostasis of thyroid hormones (THs). Deiodinase type 3 gene (DIO3) encodes deiodinase type 3 enzyme (D3), and the genetic polymorphisms of this gene could affect the levels of THs and the response to LT4 treatment. This study aimed to investigate the single-nucleotide polymorphism (SNP), rs1190716; C > T, of DIO3 as a candidate genetic variant that might affect the clinical response to LT4 treatment. Materials and Methods: Two hundred Iraqi hypothyroid female patients aged 40 years were enrolled in this cross-sectional study. All of them were already on the LT4 treatment for at least 4 months. THs [thyroxin (T4), triiodothyronine (T3), reverse triiodothyronine (rT3), and diiodothyronine (T2)] were estimated. An allele-specific polymerase chain reaction technique was performed to detect the rs1190716; C > T SNP. Results: The genotypes distribution of rs1190716; C > T SNP was 10 (4.5%) for the wild type (CC), 50 (22.7%) for the heterozygous mutant type (TC), and 160 (72.7%) for the homozygous mutant type (TT). The patients were divided into three groups according to their genotypes. Significant differences were found in the T4, T3, and T2 levels among the patients (p=0.019, p=0.039, p=0.032, respectively). Conclusion: The rs1190716; C > T SNP could affect the activity of the D3 enzyme and the metabolic homeostasis of the THs; therefore rs1190716; C > T SNP could have an impact on the therapeutic response to LT4 in Iraqi female patients with primary hypothyroidism. Regarding DIO3 gene, this is a novel finding; hence, further studies are needed to confirm it. [ABSTRACT FROM AUTHOR]

A study conducted at a hospital in eastern India investigated the levels of iron and Vitamin B12 in patients with primary hypothyroidism. The study found that there was a significant difference in the levels of these nutrients between the patients and a control group. The authors suggest that routine testing of iron and Vitamin B12 levels should be done in patients with hypothyroidism for early detection and intervention. However, more research is needed to determine the exact relationship between these nutrient levels and the disease. [Extracted from the article]

The objective was to explore the management of newly diagnosed hypothyroidism in adults regarding laboratory diagnostics and treatment in Region Halland (RH). In addition, to investigate whether current recommendations were followed regarding diagnostics. Retrospective observational study. A population-based study utilizing healthcare registry data from all public primary health care (PHC) clinics in RH during 2014-2019. Newly diagnosed patients with hypothyroidism according to ICD-10, aged ≥18 years when diagnosed and living and receiving health care in RH. There were 2494 patients included in the study. Registrations of thyroid laboratory values, diagnostic codes, and drug treatment was collected. Demographic data were also recorded. Laboratory values were checked also after 12-24 months after initial diagnosis. The main outcome was the proportion with elevated TSH and TPO and how the TSH value had changed at the follow-up. There were 1431 (61%) patients who had elevated TSH at the onset of the disease and TPO was tested in 1133 (46%) of the patients. Elevated TPO was found in 566 (23%) of the patients. After one year, there were 1908 (76%) patients who obtained a prescription for levothyroxine. In 1127 (45%) patients, TSH had normalized within one year. There were 39% of the patients diagnosed with hypothyroidism despite normal or subclinical TSH. There was an underuse of TPO in diagnosis and this advocated that the criteria for diagnostics according to current guidelines be followed to avoid unnecessary treatment. One third were diagnosed with hypothyroidism despite normal thyroid blood tests at onset. Thyroid peroxidase antibodies were used in less than half of the patients diagnosed for hypothyroidism at onset. Less than half of the patients had improved TSH level despite high medication ratio after one year. [ABSTRACT FROM AUTHOR]

Abstract Background Primary hypothyroidism is a common endocrine disorder caused by impaired production of thyroid hormones. Recent studies have shown that dietary habits, oxidative stress, and inflammation may play roles in thyroid hypofunction. Thus, the present article aimed to determine the relationship between major dietary patterns and oxidative stress and inflammation in primary hypothyroid patients and healthy people in Iranian adults. Methods This matched case-control study was conducted on 200 participants (100 cases and 100 controls). The presence of primary hypothyroidism was determined by endocrinologists based on American Thyroid Association (ATA) criteria. Dietary intake was assessed using a validated 168-item, semi-quantitative food frequency questionnaire (FFQ). The principal component analysis (PCA) method was used to derive major dietary patterns. Statistical analysis was performed using logistic regression analysis, and the findings were reported using odds ratios (ORs) with 95% CIs. Results We identified 2 major dietary patterns (i.e., healthy and Western dietary patterns). After adjusting for confounding variables, participants in the highest tertile of the healthy eating pattern had lower odds of primary hypothyroidism. Also, there was a significant relationship between total antioxidant capacity (TAC) levels and thyroid hypofunction; however, no significant correlation was seen between the Western dietary pattern and malondialdehyde (MDA) and C-reactive protein (CRP) with hypothyroidism. Conclusions There were statistically direct associations between healthy dietary patterns (loaded with vegetables, nuts and seeds, fruits, dried fruits, olives, garlic, black pepper, starchy vegetables, low-fat dairy, and legumes) and increased TAC levels with a decreased risk of thyroid hypofunction. However, Western dietary patterns and MDA and CRP levels did not associate with an underactive thyroid.

Introduction. Primary hypothyroidism is observed in women of reproductive age in 2–3 % of cases. The most common thyroid pathology during pregnancy is subclinical hypothyroidism (SHT), which is caused by newly diagnosed autoimmune thyroiditis (AIT) or severe iodine deficiency. In some regions of the Russian Federation, the population has a mild iodine deficiency, the average concentration of iodine in the urine being found at 78 µg/L (the normal range is 100–200 µg/L). In women with primary hypothyroidism, complications of pregnancy and childbirth include: premature birth, weakness of labor, eclampsia, premature rupture of premature rupture of membranes (PROM), gestational diabetes mellitus (GDM), intrauterine growth retardation syndrome, fetal macrosomia, congenital hypothyroidism in the fetus, etc.Aim: to study the features of pregnancy and childbirth course in women with primary hypothyroidism.Materials and Methods. In a retrospective study, there were analyzed 62 birth histories, of which 37 were for patients with thyroid diseases. Two groups were formed: the main group – 25 patients with primary hypothyroidism, the comparison group – 25 patients without thyroid pathology. During the study, the next parameters were analyzed: age, number of pregnancies, number of births, term of delivery, body mass index, level of thyroid stimulating hormone (TSH), titer of thyroid peroxidase antibodies, newborn body weight, newborn assessment according to Apgar scale.Results. In the main group, the cause of primary hypothyroidism was as follows: newly diagnosed SHT – in 18 (48.6 %), AIT – in 7 (18.9 %) pregnant women. In the first trimester of pregnancy, TSH level in patients with hypothyroidism was 3.06 ± 0.36 mU/L. The following complications of pregnancy and childbirth course were identified: GDM (32.0 %), anemia of the first degree (12.0 %), large fetus (12.0 %), PROM (12.0 %), perineal rupture of the first degree (16.0 %), anomalies of labor activity with ineffective labor stimulation (8.0 %), pelvic-head disproportion (8.0 %).Conclusion. Timely diagnosis and compensation of hypothyroidism with hormone replacement therapy and iodine preparations, prediction of possible complications and correction of identified complications are the main ways to achieve a successful outcome of pregnancy and childbirth for mother and fetus.

Background: With the increasing application of immune checkpoint inhibitors (ICI) in cancer therapy, the occurrence of isolated adrenocorticotropic hormone deficiency (IAD), as an adverse effect, is also on the rise. Nevertheless, there are only a few studies regarding IAD induced by ICI. This study aimed at investigating the characteristics of IAD induced by ICI and its relationship with other endocrine adverse events. Methods: A retrospective study was conducted in the Endocrinology Department from January 2019 to August 2022 to investigate characteristics of patients with IAD. Clinical features, laboratory findings and treatment information were collected. All patients underwent a follow-up of 3-6-month. Results: 28 patients with IAD were enrolled. All patients received treatment with anti-PD-1/ PD-L1. The median occurrence time of IAD was 24 (18–39) weeks after initiation of ICI treatment. Over half of the patients (53.5%) had an additional endocrinopathy, including primary hypothyroidism and fulminant type 1 diabetes mellitus (FT1DM), while other types of endocrinopathies were not identified. The interval between the occurrences of two gland damages was between 4 and 21 weeks or simultaneous. Primary hypothyroidism (46.4%) was more prevalent than FT1DM (7.1%). Fatigue and nausea were common symptoms, with a frequent occurrence of hyponatremia. All patients continued on oral glucocorticoids during follow-up. Conclusions: IAD induced by ICI could manifest independently, or more frequently in combination with hypothyroidism or FT1DM. This damage could happen at any point of ICI treatment. Given that IAD can be life-threatening, it is critical to evaluate pituitary function dynamically in patients undergoing immunotherapy. [ABSTRACT FROM AUTHOR]

Introduction: Thyroid hormones are not essential for maintenance of vital functions of life, their deficiency causes severe deficit in mental and physical growth and extreme decrease in body metabolism. Aim: To study nerve conduction parameters in primary hypothyroidism patients. Method: study conducted on 84 patients(42 patients in each case group and control group) aged between 20 to 45 years at Department of Medicine, S.M.S. Medical Collage, Jaipur, Rajasthan from May 2020 onwards for one year or till the sample size was achieved and two months for data compilation and analysis. Cases and control fulfilling inclusion and exclusion criteria were taken into study. The study access nerve conduction parameters in primary hypothyroidism patients. Result: mean age for case group was 38.09 years and for control group it was 34.9 years(p >0.05). There was significant difference seen inFT3, FT4, TSH and anti TPO test. Significant difference in FT3 in abnormal nerve conduction and normal nerve conduction patients, FT4, TSH and anti TPO was found non-significant in abnormal nerve conduction and normal nerve conduction patients. Conclusion: Performing electrophysiological studies early in the course of the disease in hypothyroid patients is suggested, in order to detect nervous system involvement. [ABSTRACT FROM AUTHOR]

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Background: One of the common causes of suboptimal control of thyroid stimulating hormone (TSH) in levothyroxine-treated hypothyroidism is coadministration of proton pump inhibitors (PPIs). Morning administration of pantoprazole has been shown to suppress intragastric pH to a greater extent. We therefore aimed to determine the effect of pantoprazole at different time points of the day on thyroid function test (TFT) in levothyroxine-treated overt primary hypothyroidism. Methods: In this single centre, hospital based, prospective, two arm cross-over study (AB, BA), participants were randomized into 2 groups based on morning (6:00 am – 7:00 am simultaneously with the scheduled levothyroxine tablet) (group M) and evening (30 min before dinner) intake of 40 mg pantoprazole tablet (group N). After the initial 6 weeks (period 1), a washout period of 1 week for pantoprazole was given, and then both the groups crossed over for another 6 weeks (period 2). Patients were instructed to continue the same brand of levothyroxine tablet at empty stomach 1-hour before breakfast. Serum TSH was measured at baseline, week 6, and week 13. Results: Data from 30 patients, who completed the study with 100% compliance, were analysed. Mean TSH values of the study participants were significantly higher both at week 6 and week 13 compared to the baseline. Mean baseline serum TSH concentrations for groups M and N were 2.70 (± 1.36), and 2.20 (± 1.06) µlU/mL, respectively. Mean serum TSH concentrations at the end periods 1 and 2 for group M were 3.78 (± 4.29), and 3.76 (± 2.77) while the levels in group N were 3.30 (± 1.90), and 4.53 (± 4.590) µlU/mL, respectively. There was a significant rise in serum TSH concentration across periods 1 and 2 in both the groups (F2, 58 = 3.87, p = 0.03). Within group changes in TSH across periods 1 and 2 were not statistically significant. Similarly difference in TSH between the groups, either at 6 weeks or at 13 weeks, were also not statistically significant. Conclusions: Concomitant use of pantoprazole, even for 6 weeks, leads to significant elevation in serum TSH in levothyroxine-treated patients who are biochemically euthyroid, irrespective of timing of pantoprazole intake. Early morning and night-time administration of pantoprazole have similar effect on TFT in these patients. [ABSTRACT FROM AUTHOR]

Background and Aims: Thyroid hormones play a key role in modulating the cardiac function and structure. Expectedly, thyroid hormone deficiency in primary hypothyroidism has a profound and clinically relevant effect on the cardiac structure and function manifesting in characteristic electrocardiographic and echocardiographic (ECHO) abnormalities. The aim is to evaluate the effects of levothyroxine replacement therapy on the electrocardiographic (ECG) and ECHO changes in patients with primary hypothyroidism by assessing the changes in ECG and ECHO before and after 6 weeks of optimal levothyroxine (LT4) treatment in adults with newly diagnosed primary hypothyroidism. Methodology: Prospective, observational study conducted in the department of medicine in an armed forces tertiary care teaching hospital from October 2018 to April 2021. We studied newly diagnosed adults with primary hypothyroidism who were treated with optimal LT4 replacement. Descriptive statistics along with Student's t-test and Chi-square test were used to determine the statistical significance. Results: In 152 participants, the mean age was 41.0 ± 13.2 years and 79% were female. After 6 weeks of LT4 treatment, the proportion of participants with abnormal ECG findings reduced significantly (from 77% to 14.5%, P < 0.0001) with a significant reduction in those having sinus bradycardia (P < 0.0001) and low-voltage complexes (P < 0.0001). On ECHO, there was a significant improvement in left ventricular ejection fraction (P < 0.001), fractional shortening (P < 0.001), and a significant reduction in myocardial thickness parameters. The systolic and diastolic function improved significantly after 6 weeks of treatment. The proportion of patients without pericardial effusion increased from 34.9% to 79.6%. Conclusion: Replacement therapy with LT4 in newly diagnosed primary hypothyroid patients substantially improves cardiac structure, systolic and diastolic function and has a positive impact on underlying pericardial effusion. A large, prospective, trial is necessary to determine the long-term effects after thyroid hormone replacement.

Kuan Lai,1 Xinyao Zheng,1 Shanshan Wei,2 Huifeng Zhou,1 Xuedan Zeng,1 Guixin Liang,1 Zhiwen Zhang,1 Wenjing Zhang3 1Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China; 2Department of Dermatology, Zhujiang Hospital, Southern Medical University, Guangzhou, People’s Republic of China; 3Department of Dermatology, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of ChinaCorrespondence: Wenjing Zhang, Department of Dermatology, The First Affiliated Hospital of Jinan University, No. 613, West Huangpu Avenue, Tianhe District, Guangzhou, 510630, People’s Republic of China, Email WJ_Z0817@163.comIntroduction: Riehl’s melanosis (RM) is an acquired hyperpigmentation disorder, presenting diffused and reticulate brownish-gray pigmentation, preferentially on the face and neck. RM overlaps with systemic lupus erythematosus (SLE) and Hashimoto’s thyroiditis has never been reported.Case: We report a case of RM patient accompanied with SLE and Hashimoto’s thyroiditis of primary hypothyroidism. Progressing, diffuse, symmetric, and reticular hyperpigmentation was seen on the face, neck, and upper limbs, manifesting as typical melanosis. Skin microscopy showed diffuse black-pepper-like changes and telangiectasias. The diagnosis of SLE and primary hypothyroidism were confirmed by follow-up investigations. The hyperpigmentation turned notably lighter after 14 months of treatment with prednisone, hydroxychloroquine, and L-thyroxine.Discussion: The exact pathogenesis of RM is unclear and exposure to coal tar dyes, ultraviolet, and fragrance fixatives in cosmetics are believed to be contributing factors, while some cases involve no triggers. It is not impossible that RM is a rare skin manifestation of SLE that has never been reported. The skin hyperpigmentation in this patient was not triggered by thyroid disease.Conclusion: RM could be a skin manifestation of autoimmunity. Coexistence of RM, lupus erythematosus and thyroiditis in the same patient is rare and has never been reported.Keywords: case report, melanosis, cutaneous lupus erythematosus, systemic lupus erythematosus, primary hypothyroidism

Background: Primary hypothyroidism is a common endocrine disorder caused by impaired production of thyroid hormones. Recent studies have shown that dietary habits, oxidative stress, and inflammation may play roles in thyroid hypofunction. Thus, the present article aimed to determine the relationship between major dietary patterns and oxidative stress and inflammation in primary hypothyroid patients and healthy people in Iranian adults. Methods: This matched case-control study was conducted on 200 participants (100 cases and 100 controls). The presence of primary hypothyroidism was determined by endocrinologists based on American Thyroid Association (ATA) criteria. Dietary intake was assessed using a validated 168-item, semi-quantitative food frequency questionnaire (FFQ). The principal component analysis (PCA) method was used to derive major dietary patterns. Statistical analysis was performed using logistic regression analysis, and the findings were reported using odds ratios (ORs) with 95% CIs. Results: We identified 2 major dietary patterns (i.e., healthy and Western dietary patterns). After adjusting for confounding variables, participants in the highest tertile of the healthy eating pattern had lower odds of primary hypothyroidism. Also, there was a significant relationship between total antioxidant capacity (TAC) levels and thyroid hypofunction; however, no significant correlation was seen between the Western dietary pattern and malondialdehyde (MDA) and C-reactive protein (CRP) with hypothyroidism. Conclusions: There were statistically direct associations between healthy dietary patterns (loaded with vegetables, nuts and seeds, fruits, dried fruits, olives, garlic, black pepper, starchy vegetables, low-fat dairy, and legumes) and increased TAC levels with a decreased risk of thyroid hypofunction. However, Western dietary patterns and MDA and CRP levels did not associate with an underactive thyroid. [ABSTRACT FROM AUTHOR]

Up to 20% of individuals with primary hypothyroidism treated with L‐thyroxine still suffer from severe symptoms. These are supposedly brain derived and involve both cognitive and emotional domains. Previously, no consistent relationship has been found between thyroid hormones (TH) or TSH levels in blood and quality of life (QoL). Recently, we reported an association between cerebrospinal fluid (CSF)/serum free‐thyroxine (f‐T4) ratio and QoL, in juvenile hypothyroid patients. Here, we investigated if CSF/serum f‐T4 ratio and QoL estimates correlate also during L‐thyroxine treatment. Moreover, the CSF biomarker neurogranin (Ng) was used as a biomarker for synaptic function and integrity in clinical research. Ng is partially controlled by TH and therefore we investigated the relationship between QoL parameters and Ng levels. Patients diagnosed with primary hypothyroidism were investigated using vital parameters, serum and CSF analyses of TH, TSH, Ng and QoL questionnaires. Similar procedures were performed after 6 months of treatment. The most marked associations with QoL were found for CSF/serum f‐T4 ratio, which was strongly related to several QoL parameters such as the mental subscore of SF‐36 (r = 0.83, p <.0005). Ng, which did not differ from that in our healthy controls, was lower in some patients during treatment and higher in others. However, the change in Ng during treatment was significantly correlated with QoL parameters including the mental subscore of SF‐36 (r = −0.86, p <.0001). In addition, the CSF/serum f‐T4 ratio correlated with the change in Ng (r = −0.75, p =.001). Our results suggest that the ratio between CSF and serum f‐T4 is an important biomarker for QoL during treatment of patients with primary hypothyroidism, so far in research, but in the future maybe also in clinical settings. Moreover, this ratio also correlates with the changes in Ng levels during L‐thyroxine treatment, further supporting the impact of the TH balance between serum and CSF on QoL. [ABSTRACT FROM AUTHOR]

Background. This study aimed to assess fractal dimension (FD) and the radiomorphometric indexes on the digital panoramic radiography (DPR) of patient with primary hypothyroidism receiving levothyroxine sodium replacement therapy. Methods. A total of 115 subjects were included in this cross sectional retrospective study. According to the results of the thyroid function tests, the subjects were divided into two groups as primary hypothyroidism (levothyroxine sodium replacement therapy given), (n = 57) and the healthy control group (n = 58). The fractal dimension (FD), panoramic mandibular index (PMI), mandibular cortical width (MCW), gonial index (GI) and mandibular cortical index (MCI) values of all patients were calculated on DPRs. The statistical analysis of all data was performed with SPSS version 22. Results. The distributions of age and gender in the primary hypothroidism group were similar to control group (p = 0.19 and p = 0.62, respectively). The two groups did not differ statistically significantly in terms of FD, PMI, MCW, GI, and MCI. Conclusion. We determined that mandibular cortical and trabecular bone structure did not significantly differ between healthy individuals and patients receiving drug replacement theraphy due to hypothyroidism, but our results should be further supported with the investigation of clinical parameters. [ABSTRACT FROM AUTHOR]

Introduction: Systemic lupus erythematosus (SLE) and hypothyroidism often coexist in observational studies; however, the causal relationship between them remains controversial. Methods: Complementary genetic approaches, including genetic correlation, Mendelian randomization (MR), and colocalization analysis, were conducted to assess the potential causal association between SLE and primary hypothyroidism using summary statistics from large-scale genome-wide association studies. The association between SLE and thyroid-stimulating hormone (TSH) was further analyzed to help interpret the findings. In addition, findings were verified using a validation data set, as well as through different MR methods with different model assumptions. Results: The linkage disequilibrium score regression revealed a shared genetic structure between SLE and primary hypothyroidism, with the significant genetic correlation estimated to be 0.2488 (P=6.00 x 10-4). MR analysis with the inverse variance weighted method demonstrated a bidirectional causal relationship between SLE and primary hypothyroidism. The odds ratio (OR) of SLE on primary hypothyroidism was 1.037 (95% CI, 1.013-1.061; P= 2.00 x 10-3) and that of primary hypothyroidism on SLE was 1.359 (95% CI, 1.217-1.520; P<0.001). The OR of SLE on TSH was 1.007 (95% CI, 1.001-1.013; P=0.032). However, TSH was not causally associated with SLE (P=0.152). Similar results were found using different MR methods. In addition, colocalization analysis suggested that shared causal variants existed between SLE and primary hypothyroidism. The results of the validation analysis indicated a bidirectional causal relationship between SLE and primary hypothyroidism, as well as shared loci. Conclusion: In summary, a bidirectional causal relationship between SLE and primary hypothyroidism was observed with complementary genetic approaches. [ABSTRACT FROM AUTHOR]

Sphingosine-1-phosphate lyase (SGPL1) insufficiency syndrome (SPLIS) is an autosomal recessive multi-system disorder, which mainly incorporates steroid-resistant nephrotic syndrome and primary adrenal insufficiency. Other variable endocrine manifestations are described. In this study, we aimed to comprehensively annotate the endocrinopathies associated with pathogenic SGPL1 variants and assess for genotype–phenotype correlations by retrospectively reviewing the reports of endocrine disease within our patient cohort and all published cases in the wider literature up to February 2022. Glucocorticoid insufficiency in early childhood is the most common endocrine manifestation affecting 64% of the 50 patients reported with SPLIS, and a third of these individuals have additional mineralocorticoid deficiency. While most individuals also have nephrotic syndrome, SGPL1 variants also account for isolated adrenal insufficiency at presentation. Primary gonadal insufficiency, manifesting with microphallus and cryptorchidism, is reported in less than one-third of affected boys, all with concomitant adrenal disease. Mild primary hypothyroidism affects approximately a third of patients. There is paucity of data on the impact of SGPL1 deficiency on growth, and pubertal development, limited by the early and high mortality rate (approximately 50%). There is no clear genotype–phenotype correlation overall in the syndrome, with variable disease penetrance within individual kindreds. However, with regards to endocrine phenotype, the most prevalent disease variant p.R222Q (affecting 22%) is most consistently associated with isolated glucocorticoid deficiency. To conclude, SPLIS is associated with significant multiple endocrine disorders. While endocrinopathy in the syndrome generally presents in infancy, late-onset disease also occurs. Screening for these is therefore warranted both at diagnosis and through follow-up.

Background: Hypothyroidism is a medical condition caused by a low level of thyroid hormones. Thyroid hormone plays an important role in lipid metabolism. Hence it is important to evaluate lipid profile in patients with primary hypothyroidism to evaluate the extent of derangement and intervene at the earliest. Material and Methods: Research conducted in Department of General Medicine, Government Medical College, Ongole, Andhra Pradesh, India. Patients at Government General Hospital, Ongole who met the research's inclusion and exclusion criteria were the subjects of this prospective study. Results: One hundred patients with a recent diagnosis of primary hypothyroidism met the inclusion and exclusion criteria and participated in this prospective trial. They had a clinical examination and any necessary tests performed as detailed in the enclosed proforma. Patients were almost exclusively female (80%), with only 20% male. Conclusion: Patients who were recently diagnosed with Primary Hypothyroidism and were not receiving medication had higher lipid values. Patients were almost exclusively female (80%), with only 20% male. Patients with hypothyroidism tended to be younger, in their twenties and thirties. [ABSTRACT FROM AUTHOR]

Objective. To develop the pattern of early cardiovascular disorders in patients with primary hypothyroidism based on the analysis of relationship between patient’s thyroid status and some functional cardiovascular parameters depending on compensation status. Materials and methods. The examination of 163 women aged 62 [55;67] years with primary hypothyroidism was performed. The patients were divided into groups: 1 group included 54 patients aged 62.0 [57;68] years with subcompensated disease, 2 group consisted of 15 patients aged 59 [53;66] years with non-compensated disease and 3 group included 94 patients aged 63 [53;66] years with compensated hypothyroidism. Physical examination, transthoracic echocardiography, assessment of global left ventricle longitudinal strain by speckle tracking method, endothelial function and laboratory tests were performed to all patients. Regression analysis using thyroid stimulating hormone, free T4, age, duration of the disease, cause of hypothyroidism, menopause presence and natural thyroid stimulating hormone logarithm as predictors and some cardiovascular parameters of heart condition and lipid metabolism as dependent valuables was made. Results. Mathematic modeling demonstrated that the combination such factors as age, duration of disease and thyroid stimulating hormone level is the most important in left ventricle remodeling processes. However, the age only has significant influence on intima media thickness. Conclusion. Left ventricle remodeling, morphologic functional status of blood vessel wall and decrease of glomerular filtration rate are basically determined by such modified and non-modified factors as body mass index, age, duration of hypothyroidism and thyroid stimulating hormone level.

Pericardial effusion is commonly present in patients with moderate-to-severe hypothyroidism. However, large pericardial effusion causing cardiac tamponade (CT) is extremely rare. We report an atypical presentation of primary hypothyroidism (PH) where a young male presented with CT as the first manifestation of PH. The patient was treated with an immediate pericardiocentesis followed by levothyroxine replacement and showed complete resolution of pericardial effusion on follow-up. Hypothyroidism should be suspected as a possible etiology of massive pericardial effusion/CT in patients who have associated signs and symptoms of hypothyroidism and have bradycardia in the setting of CT.

Prompt and precise diagnosis of pituitary hyperplasia secondary to primary hypothyroidism (PHPH) is crucial to avoid unwarranted pituitary surgery and potential permanent impairment. Although PHPH may present similarly to pituitary adenoma, it is responsive to thyroxine therapy, underscoring the critical role of differential diagnosis in the treatment of adolescent patients., Competing Interests: The authors declare that they have no competing interests., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

Background: The association between keratoconus and thyroid gland dysfunction (TGD) remains controversial. We aimed to determine the frequency of keratoconus among patients with laboratory-confirmed, treatment-naive TGD compared with that of age- and sex-matched healthy controls. Moreover, we investigated the potential relationship between TGD and corneal topographic and tomographic parameters., Methods: This multicenter, cross-sectional study recruited individuals with treatment-naive, laboratory-confirmed TGD and sex- and age-matched healthy controls. Demographic and ophthalmic data of all participants were recorded. All participants underwent comprehensive ocular examinations and corneal tomography. Patterns of symmetric bowtie, asymmetric bowtie, asymmetric bowtie/superior steep, asymmetric bowtie/inferior steep, or asymmetric bowtie pattern with a skewed radial axis were documented if present. Furthermore, the maximum simulated keratometry value (Kmax), corneal thinnest thickness (CTT), and back elevation (BE) values were recorded. We measured the serum concentrations of thyroid-stimulating hormone (TSH) and thyroid hormones (free thyroxine [FT4] and free tri-iodothyronine [FT3]) using an immunoassay method., Results: We included 200 eyes of 200 individuals with TGD and 200 eyes of 200 healthy age- and sex-matched controls, with female predominance in both groups. The mean FT4 concentration was significantly higher and the TSH concentration was significantly lower in the TGD group than in the control group (both P < 0.0001), whereas the FT3 level was comparable between groups ( P > 0.05). In the TGD group, the frequencies of hyperthyroidism and hypothyroidism were 190 (95%) and 10 (5%), respectively. We found significantly lower mean CTT, higher Kmax, and greater BE values with a significantly higher frequency of abnormal topographic patterns among eyes in the TGD group than in controls (all P < 0.05). The frequency of eyes with keratoconus was significantly higher in the TGD (7.5%) group than in the control (0.5%) group ( P < 0.0001). Except for a statistically significant correlation of Kmax (r = - 0.23, P < 0.05) and CTT (r = + 0.15, P < 0.05) with TSH level in the TGD group, no significant correlation was found between corneal characteristics and thyroid profile in either group (all P > 0.05)., Conclusions: We observed a higher frequency of keratoconus, with female predominance, in the TGD group. TGD was associated with significant changes in certain corneal topographic and tomographic parameters. Compared with healthy controls, individuals with TGD demonstrated increased Kmax and BE values with more corneal thinning, highlighting the potential association between keratoconus and TGD. However, further large-scale longitudinal studies are essential to confirm our findings., Competing Interests: None., (© Author(s).)

Introduction and aim: Primary hypothyroidism is a common endocrine disorder. While thyroid dysfunction is recognized for impacting numerous bodily systems, the connection between thyroid disorders and sleep function remains unclear. Since sleep disorders seldom manifest as the sole presenting symptom of thyroid dysfunction, it is crucial to examine the interplay between thyroid function and sleep when implementing a comprehensive treatment approach for these individuals. This study aimed to assess sleep dysfunction in patients with primary hypothyroidism using validated questionnaires., Method: This cross-sectional study included 81 participants attending the endocrinology outpatient department. The participants included those with both overt and subclinical primary hypothyroidism who were drug-naive or had a thyroid-stimulating hormone (TSH) level >4.5 µIU/L while on treatment. The study subjects were assessed based on various validated questionnaires for sleep disturbance., Results: The study predominantly comprised 64 (79%) female participants. Overall, poor sleepers in subclinical and overt hypothyroidism were 66.7 and 60.8%. The Berlin Risk Score Questionnaire showed the occurrence of sleep apnea to be 26.7% and 27.5% in subclinical and overt groups, respectively. However, the occurrence of sleep dysfunction did not correlate with TSH values alone., Conclusion: Our findings demonstrate that sleep dysfunction is prevalent in patients with both overt and subclinical primary hypothyroidism. Furthermore, the severity of sleep disruption appears independent of the degree of thyroid dysfunction., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committee of MS Ramaiah Medical College issued approval #MSRMC/EC/SP-04/04-2021. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. 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, Acharya et al.)

Helicobacter pylori (H. pylori) infection leads to a systemic low-grade inflammatory state and has been associated causally with a diverse spectrum of extra-gastric disorders. Among them, the infection has been involved in the pathogenesis of autoimmune thyroid disease (ATD), but only one study had evaluated children. Therefore, a cross-sectional study was conducted in a cohort of 142 children and adolescents, randomly assessed among those followed up for thyroid diseases in a university pediatric endocrinology service: 106 with congenital hypothyroidism (CH) and 36 with ATD. All children were asymptomatic, under strict control on levothyroxine replacement, and reported no other diseases or use of drugs. Helicobacter pylori status was evaluated by the 13C-Urea Breath Test (13C-UBT). Antithyroid antibodies (ATPO, antiTg, and TRAb) and serum thyroid hormones (TSH, free T4, and T3) were assessed by standard assays. Data were analyzed in logistic models by the SPSS statistical software package, and a p-value ≤ 0.05 was considered statistically significant. The prevalence of H. pylori infection was 19.44% in children with ATD. Neither the gender nor the serum levels of thyroid hormones and antithyroid antibodies were associated with the H. pylori-positive status. Thirty-seven (34.90%) children with CH were infected with H. pylori. The mean T3 serum level (3.59 ± 0.84) was significantly lower (p = 0.001) in the infected children than in those free from the infection (3.95 ± 0.89), association that remained after adjustment for the other variables in the multivariate analysis. Because no difference was observed in the levels of TSH and T4, the results indicate that the infection may lead to impairment in the thyroid hormonal balance, but not in the hypothalamic-pituitary-thyroid axis function. In as much as H. pylori infection is highly widespread and the prevalence of CH is also not negligible, additional studies are required to confirm our results and to identify the involved mechanisms.

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

Hypothyroidism is the most common disorder arising from hormone deficiency. It frequently affects women than men. The prevalence of overall hypothyroidism has been reported to be 4.8–11%. Levothyroxine is the treatment of choice for all types of hypothyroidism. The purpose of this pilot study was to evaluate the efficacy and safety of Barg-e-Sahajna (Leaves of Moringa oleifera Lam.) among diagnosed patients of primary hypothyroidism. This study was an open observational study. A total of 22 patients were screened, out of which 10 were excluded (did not meet inclusion criteria) and 2 refused to consent to be part of the study, rest 10 participants were enrolled after obtaining written informed consent finally 8 subjects completed the study and 2 are dropout in last follow up. The drug was given in the form of decoction at the dose of 5 g fresh leaves twice a day after meal for 45 days. The study effects on objective parameter thyroid stimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4) were found extremely significant when compared before (16.62 ± 11.49, 132 ± 19.32, 9.28 ± 1.46) and after (4.75 ± 3.12, 150.37 ± 20.68, 11.84 ± 3.81) treatment with a significant decrease in serum TSH level (p<0.0246) and an increase in serum T3 (p<0.0005) and T4 (p<0.0438) levels. The results were analyzed using paired "t" test. The improvements in thyroid profiles (TSH, T3 and T4) after consuming 'Barg-e-Sahajna' show that the test drug is effective in primary hypothyroidism and the relief was considerable. No significant effect on safety parameters (serum-glutamic-oxaloacetic-transaminase [SGOT], serum glutamic-pyruvic transaminase [SGPT], blood urea, and serum creatinine) was observed. Therefore, it may be concluded that the Barg-e-Sahajna is preliminarily safe and effective in the management of primary hypothyroidism. [ABSTRACT FROM AUTHOR]

Background: Data on primary hypothyroidism and its long‐term impact on the health, cognition, and quality of life (QOL) of childhood cancer survivors are limited. This study examined the prevalence of and risk factors for primary hypothyroidism and its associations with physical, neurocognitive, and psychosocial outcomes. Methods: This was a retrospective study with a cross‐sectional health outcome analysis of an established cohort comprising 2965 survivors of childhood cancer (52.8% male; median current age, 30.9 years, median time since cancer diagnosis, 22.3 years). Multivariable logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for associations between primary hypothyroidism and cancer‐related risk factors, cardiovascular disease risk factors, frailty, neurocognitive and QOL outcomes, social attainment, and subsequent thyroid carcinoma. Associations between serum free thyroxine and thyrotropin levels at assessment and health outcomes were explored. Results: The prevalence of primary hypothyroidism was 14.7% (95% CI, 13.5%‐16.0%). It was more likely in females (OR, 1.06; 95% CI, 1.03‐1.08), was less likely in non‐Whites (OR, 0.96; 95% CI, 0.93‐0.99), was associated with thyroid radiotherapy (higher risk at higher doses), and was more common if cancer was diagnosed at an age ≥ 15.0 years versus an age < 5 years (OR, 1.05; 95% CI, 1.01‐1.09). Primary hypothyroidism was associated with frailty (OR, 1.54; 95% CI, 1.05‐2.26), dyslipidemia (OR, 1.52; 95% CI, 1.14‐2.04), impaired physical QOL (OR, 1.66; 95% CI, 1.12‐2.48), and having health care insurance (OR, 1.51; 95% CI, 1.07‐2.12). Conclusions: Primary hypothyroidism is common in survivors and is associated with unfavorable physical health and QOL outcomes. The impact of thyroid hormone replacement practices on these outcomes should be investigated further. In this study, primary hypothyroidism affects 14.7% of 2965 survivors of childhood cancer, and it is associated with adverse health and quality of life. Associations between thyroid function tests and health outcomes are explored. [ABSTRACT FROM AUTHOR]

Objective: Hypothyroidism is a common endocrine disorder affecting various systems of the body. Only a few studies have focused on the effect of primary hypothyroidism on voice with objective parameters, and none of them compared the effect of subclinical and overt hypothyroidism on voice. The aim of the present study is to evaluate and compare the acoustic and perceptual parameters of voice in patients newly diagnosed with subclinical and overt hypothyroidism.Methods: The study included 26 subclinical hypothyroidism, 26 overt hypothyroidism patients and 30 euthyroid control participants. Perceptual evaluation of voice with GRBAS (grade, roughness, breathiness, asthenia, strain) scale, voice handicap index (VHI)-10, and acoustic voice analysis by using Multi-Dimensional Voice Program were performed for all the participants.Results: The voice parameters which showed a statistically significant difference between the groups were frequency parameters (Fo; p= 0.003, Fhi; p=0.010, Flo; p= 0.002) and VHI-10 (p= 0.047). A statistically significant decrease in frequency parameters and a statistically significant increase in VHI-10 were found in overt hypothyroidism group comparing with control group (Fo; p= 0.002, Fhi; p=0.009, Flo; p= 0.001 and VHI-10; p= 0.046). Voice parameters in subclinical hypothyroidism group did not show a statistically significant difference comparing with both control and overt hypothyroidism groups.Conclusion: In the present study, overt hypothyroidism is found to affect frequency parameters and patients' own subjective assessment of voice. Primary hypothyroidism does not seem to have significant effect on voice parameters until thyroxine levels are affected. [ABSTRACT FROM AUTHOR]

Decreased thyroid function occurs among 0,2–1% of men and 1,4–5% of women in the general population, and among people over 60 years among 2,5% of men and 6% of women. Hypothyroidism in 95% of cases is caused by thyroid disfunction (primary hypothyroidism), only 5% of cases are central hypothyroidism, associated with dysfunction of the pituitary gland (insufficient production of thyroid-stimulating hormone) and hypothalamus (impaired thyroliberin synthesis). Nonspecific clinical manifestations of hypothyroidism are the reason for examining the patient for thyroid hormone levels in primary care. Primary hypothyroidism screening is a common clinical situation in the general practitioner`s practice. According to Guideline 00514. Hypothyroidism of the Finnish Medical Research Society Duodecim Medical Publications Ltd, the use of which is approved by the Order of the Ministry of Health of Ukraine № 1422 of December 29, 2016, diagnosis of hypothyroidism and treatment of primary hypothyroidism are the tasks of primary care professionals. Decreased thyroid function may have subclinical and manifest forms, which are detected in the analysis of the results of thyroid hormones and clinical signs of the disease, require different treatment approaches. There are the differences in the use of levothyroxine replacement therapy in patients of different ages and depending on the causes of hypothyroidism. Patients under 55 years old are prescribed levothyroxine sodium in a daily dose of 1,6–1,8 μg/kg body weight. In patients over 55 years old, the daily requirement of levothyroxine sodium is calculated at 0,9 μg/kg body weight, taking into account existing cardiovascular disease. If patients are obese, the calculation is made on the «ideal» weight. The calculation of the dose and rules of levothyroxine sodium prescription in primary care are presented on the example of four clinical cases. The algorithm for control levothyroxine replacement therapy in patients with primary hypothyroidism is also presented. [ABSTRACT FROM AUTHOR]

Background: Primary hypothyroidism can lead to hyperprolactinemia through several mechanisms in both men and women, manifesting as galactorrhoea, loss of libido, and infertility in both sexes, as oligomenorrhea/amenorrhea in women, and as gynecomastia and erectile dysfunction in men. Case presentation: Here presented is a 28-year-old Nigerian woman with a history of recurrent bilateral painless galactorrhoea of 12 years’ duration and persistent low mood. Physical examination was unremarkable. The hormonal assay revealed elevated thyroid-stimulating hormone, elevated serum prolactin, low thyroxine, and low triiodothyronine levels. Magnetic resonance imaging of the brain revealed normal findings. A diagnosis of hyperprolactinemia secondary to primary hypothyroidism was made. Pharmacological therapy began with thyroid hormone replacement therapy and a dopamine agonist: 75 micrograms of levothyroxine daily and 0.5 micrograms of cabergoline twice weekly for 8 weeks. After 8 weeks of pharmacological therapy, hormonal assay revealed values within the reference range with significant symptomatic improvement evidenced by cessation of galactorrhoea and low mood. Conclusion: Primary hypothyroidism has been proven to be one of the numerous causes of hyperprolactinemia and it could be unheeded in a patient who does not present with the typical signs and symptoms of primary hypothyroidism.

Primary hypothyroidism is one of the most common endocrine diseases. Levothyroxine is the treatment of choice due to its efficacy, good tolerance, simplicity of a dose titration, low cost and long elimination half-life. Replacement therapy for hypothyroidism is simple and convenient, but from 30 to 60% of patients are in a state of decompensation. Over- or underreplacement with L-T4 may lead to serious adverse events such as decreased performance and mood, deterioration of health and quality of life, developing of cardiovascular diseases, cardiac arrhythmias and bone fractures. The most common reasons for failure to compensate for the disease are improper administration of the drug (after eating, drinking coffee and milk immediately after levothyroxine), non-compliance with storage conditions (use after the expiration date, excessive heat), insufficient patient adherence to treatment (skipping the drug), the effect of other medicines drugs (calcium, iron preparations, proton pump inhibitors, etc.), diseases of the gastrointestinal tract (atrophic gastritis, celiac disease). Given many factors influencing the achievement and maintenance of compensation for hypothyroidism, it is necessary to determine and, if possible, eliminate the main factor leading to decompensation before the dose adjustment.