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Summary: A retrospective analysis was conducted using data from the NHANES. Bone mineral density (BMD) was compared in different thyroid-specific autoantibodies groups. Strengths of associations were calculated by using binary logistic regression models. Higher titers of thyroid-specific autoantibodies (TgAb and/or TPOAb) may lead to decreased BMD. Higher prevalence of TgAb and TPOAb significantly associated with fractures in females but not in males. Purpose: Hashimoto's thyroiditis is characterized by elevated thyroid-specific autoantibodies. It is currently believed that osteoporosis is not only a disease with abnormal mineral metabolism but also with immune abnormalities. This study investigated the relationship between thyroid-specific autoantibodies and osteoporosis, including the bone mineral density (BMD) values and fractures. Methods: A retrospective analysis was conducted using data from the National Health and Nutrition Examination Survey (2007–2010). BMD was compared in different thyroid-specific autoantibodies groups. The associations between thyroid-specific autoantibodies and fractures were explored. Strengths of associations were calculated by binary logistic regression models. Candidate variables for binary logistic regression model were selected after screened in univariate analysis (variables with P < 0.05). Results: A total of 3865 study participants were included in this analysis; 224 participants were TgAb positive and 356 were TPOAb positive. A total of 392 participants reported hip, spine or wrist fractures. Participants with higher prevalence of TgAb or TPOAb had lower BMD. In females, significant cigarettes use, higher prevalence of TgAb and TPOAb, and the BMD of the total femur and femoral neck were significantly associated with fractures. Higher prevalence of TPOAb was particularly associated with a higher possibility of hip or spine fractures. In males, significant cigarettes use, 25OHD3, the BMD values of the total femur, femoral neck and total spine were significantly associated with fractures. Conclusion: Higher prevalence of thyroid-specific autoantibodies may lead to decreased BMD. In females, higher prevalence of TgAb and TPOAb significantly associated with fractures and TPOAb especially relating to the fractures of hip and spine. Males patients with vitamin D deficiency or insufficiency associated a higher possibility of fractures. [ABSTRACT FROM AUTHOR]

Abstract Background The objective was to investigate the efficacy of different doses of levothyroxine therapy among pregnant women exhibiting high-normal thyroid stimulating hormone levels and positive thyroid peroxidase antibodies throughout the first half of pregnancy. Methods Pregnant women exhibiting high-normal thyroid stimulating hormone levels and thyroid peroxidase antibodies positivity throughout the initial half of pregnancy were selected from January 2021 to September 2023. Based on the different doses of levothyroxine, the pregnant women were categorized into the nonintervention group (G0, 122 women), 25 µg levothyroxine intervention group (G25, 69 women), and 50 µg levothyroxine intervention group (G50, 58 women). Serum parameters, gastrointestinal symptoms, small intestinal bacterial overgrowth (SIBO), maternal and neonatal outcomes were compared after the intervention among the three groups. Results After the intervention, in the G25 and G50 groups, the thyroid stimulating hormone, triglyceride and low-density lipoprotein levels were notably less in contrast to those in the G0 group (P

Background: The objective was to investigate the efficacy of different doses of levothyroxine therapy among pregnant women exhibiting high-normal thyroid stimulating hormone levels and positive thyroid peroxidase antibodies throughout the first half of pregnancy. Methods: Pregnant women exhibiting high-normal thyroid stimulating hormone levels and thyroid peroxidase antibodies positivity throughout the initial half of pregnancy were selected from January 2021 to September 2023. Based on the different doses of levothyroxine, the pregnant women were categorized into the nonintervention group (G0, 122 women), 25 µg levothyroxine intervention group (G25, 69 women), and 50 µg levothyroxine intervention group (G50, 58 women). Serum parameters, gastrointestinal symptoms, small intestinal bacterial overgrowth (SIBO), maternal and neonatal outcomes were compared after the intervention among the three groups. Results: After the intervention, in the G25 and G50 groups, the thyroid stimulating hormone, triglyceride and low-density lipoprotein levels were notably less in contrast to those in the G0 group (P < 0.05). The rates of abdominal distension and SIBO in the G25 and G50 groups were notably lower in contrast to the G0 group (P = 0.043 and 0.040, respectively). The G50 group had a lower rate of spontaneous abortion and premature membrane rupture than the G0 group (P = 0.01 and 0.015, respectively). Before 11+ 2 weeks of gestation and at thyroid peroxidase antibodies levels ≥ 117 IU/mL, in contrast to the G0 group, the G50 group experienced a decreased rate of spontaneous abortion (P = 0.008). The G50 group had significantly higher newborn weight than the G0 group (P = 0.014), as well as a notably longer newborn length than the G0 and G25 groups (P = 0.005). Conclusions: For pregnant women with high-normal thyroid stimulating hormone levels and thyroid peroxidase antibodies positive during the first half of pregnancy, supplementation with 50 µg levothyroxine was more effective in improving their blood lipid status and gastrointestinal symptoms, reducing the incidence of SIBO and premature rupture of membranes, and before 11+2 weeks, TPOAb ≥ 117 IU/mL proved more beneficial in mitigating the risk of spontaneous abortion. [ABSTRACT FROM AUTHOR]

Introduction: Anti-thyroid peroxidase autoantibodies (TPO) is an essential diagnostic tool for autoimmune disorders of the thyroid gland. However, TPO results are not always comparable due to differences between methods. Here, we aimed to investigate the differences between two modern laboratory methods for TPO measurement: electrochemiluminescence (ECLIA) and chemiluminescence microparticle (CMIA) immunoassays.

Background and Objectives: Thyroid disease has been associated with autoimmune disorders. As systemic lupus erythematosus (SLE) is a systemic autoimmune disease with diverse manifestations spanning across all organ systems, the relationship of SLE with thyroid disorders needs investigation. In particular, the relationship of SLE with autoimmune thyroid disease has attracted the interest of the research community. The aim was to evaluate the relationship of SLE with autoimmune thyroid disease. Materials and Methods: A cohort of 45 consecutive patients with a mean age of 47.97 years (range 21–79 years) and 45 age- and sex-matched controls were prospectively studied over a period of 12 months for the presence of thyroid disease and the prevalence of antithyroid antibodies. Results: Four patients (8.9%) were found to suffer from primary hypothyroidism, five (11.11%) from subclinical hypothyroidism and one (2.22%) from hyperthyroidism, whereas one (2.22%) of the controls had primary hypothyroidism and one (2.22%) had hyperthyroidism. Five patients (11.11%) had a thyroid hormone profile that was compatible with the presence of euthyroid sick syndrome. Thyroid peroxidase (TPOab) and thyroglobulin (Tgab) antibodies were detected in 20/45 and 15/45 of the SLE population and in 7/45 and 5/45 of the controls, respectively (p < 0.05, chi-square test). Conclusions: In conclusion, the incidence of clinical thyroid disease is greater amongst SLE patients than in a control population, and in a significant number of these patients, antithyroid antibodies are detectable. Thus, a subset of lupus patients appears to be predisposed to the development of thyroid disease, and this should be considered when evaluating patients with SLE. [ABSTRACT FROM AUTHOR]

To compare the rate of positive thyroid peroxidase antibodies (TPO Ab) between women with different polycystic ovary syndrome (PCOS) phenotypes and women without PCOS. This is a retrospective cohort study. Women with PCOS at My Duc Hospital between June 1, 2020, and March 27, 2021, were matched with non-PCOS women by age. TPO Ab (cut-off: 34 IU/mL) and thyroid-stimulating hormone (TSH) levels were measured as markers of Hashimoto thyroiditis and thyroid function, respectively. One thousand eight hundred eight infertile women were included, 904 with PCOS (mean age 29.0 ± 3.58 years) and 904 without PCOS (29.1 ± 3.4 years; controls). Women with PCOS had a higher body mass index (22.8 ± 3.84 vs. 19.9 ± 2.23 kg/m2, p < 0.001), but most were not overweight/obese. Rates of positive TPO Ab in women with versus without PCOS were 8.2% and 8.4%, respectively (p = 0.932). Rates of positive TPO Ab in patients with PCOS phenotype A, B, C, or D were not statistically different (7.5%, 2.9%, 20.0%, and 7.8%, respectively). Median TSH concentrations were similar in the PCOS and control groups (1.84 mIU/L vs. 1.78 mIU/L, respectively; p = 0.194). Based on a linear regression model, there was no correlation between either BMI or the estradiol to progesterone ratio and TPO Ab status. In a large population of infertile women with PCOS who were mostly lean patients, rates of positive TPO Ab across all four PCOS phenotypes did not differ significantly from those in women without PCOS. These findings did not support the hypothesis that PCOS is a risk factor for Hashimoto thyroiditis. [ABSTRACT FROM AUTHOR]

STUDY QUESTION How does subclinical hypothyroidism, defined in infertile women during preconception by thyroid-stimulating hormone (TSH) >2.5 or >4.5 mIU/l, with or without thyroid peroxidase antibodies (anti-TPO) >100 IU/ml, impact thyroid hormone levels during pregnancy and after birth? SUMMARY ANSWER During pregnancy, TSH levels remain similar to those in preconception, even with supplementary thyroxine, whereas the serum levels of anti-TPO progressively decline. WHAT IS KNOWN ALREADY Overt hypothyroidism impacts both pregnancy and offspring but randomized clinical trials and cohort studies failed to detect the benefit of treatment with thyroxine in cases with low-threshold TSH or with anti-TPO during pregnancy. STUDY DESIGN, SIZE, DURATION First, the prevalence and reproducibility of two candidate cut-off levels of subclinical hypothyroidism in a cohort of 177 infertile women was compared with 171 women not aiming for pregnancy. Second, the impact of distinct setpoints of TSH in preconception (with or without anti-TPO) was monitored during pregnancy in 87 previously infertile women by high-frequency monitoring of thyroid function. Both studies were carried out from 2007 to 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS Reproducibility and prevalence of subclinical hypothyroidism were examined in infertile women presenting in the fertility care unit of an academic institution. Women not aiming for pregnancy participated as controls. In both groups, TSH and anti-TPO were measured two times on different occasions. In addition, a group of previously infertile women with known preconception setpoints of TSH (with or without anti-TPO) were followed up prospectively throughout pregnancy and after birth. During pregnancy, serum was sampled weekly until Week 12, then monthly until delivery, and once after birth. Only cases with preconception TSH >4.5 mIU/l were supplemented with thyroxine. After collection of all samples, the serum levels of anti-TPO and the major thyroid hormones were measured. Prolactin with known fluctuations during pregnancy was used as reference. MAIN RESULTS AND THE ROLE OF CHANCE Measures of both TSH and anti-TPO at two different time points were accurate and reproducible. The odds of subclinical hypothyroidism in infertile women and controls were similar. During pregnancy, TSH closely followed preconception TSH levels, whereas serum levels of the thyroid hormones predominantly remained within or above (not below) the reference. Treatment of infertile women with preconception TSH >4.5 mIU/l with thyroxine resulted in higher free thyroxine (fT4) serum levels. The serum levels of anti-TPO declined as pregnancies evolved. LIMITATIONS, REASONS FOR CAUTION The numbers of participants both in the prevalence study and in pregnancy did not reach the a priori estimated numbers. For ethical reasons, the patients with preconception TSH >4.5 mIU/l were treated with thyroxine. The findings apply to infertile women only. WIDER IMPLICATIONS OF THE FINDINGS We propose to use >4.5 mIU/l as the serum TSH threshold for supplementing women with thyroxine before pregnancy. During pregnancy, fT4 may be the better marker to monitor thyroid function. The consistent decrease of anti-TPO antibody levels during ongoing pregnancies must be considered a protective element. STUDY FUNDING/COMPETING INTERESTS The prevalence part of this study was supported by Merck-Serono, Geneva (TH006/EMR200007-603). The hormone measurements of the serum samples collected during the follow-up pregnancies were made possible by financial support of Roche Diagnostica (November 1721, 2017, Rotkreuz, Switzerland). I.D.G. was supported by a grant of the Repronatal Foundation, Basel, Switzerland. All authors declare no conflict of interest. TRIAL REGISTRATION NUMBER Research Database of UniBasel, project no. 576691 (2007). [ABSTRACT FROM AUTHOR]

Persistent organic pollutants (POPs) including polychlorinated biphenyls (PCBs), hexachlorobenzene (HCB), and dichlorodiphenyltrichloroethane (p,p'-DDT) were reported to influence immunological activity. As endocrine-disrupting chemicals (EDC), these pollutants may disrupt normal thyroid function and act as catalysts for development of autoimmune thyroid disease by directly and indirectly affecting levels of thyroid peroxidase antibodies (TPOAbs). Native American communities are disproportionately exposed to harmful toxicants and are at an increased risk of developing an autoimmune disease. The aim of this study was to determine the association between POPs and TPOAbs in serum obtained from Native American women. This assessment was used to measure whether increased risk of autoimmune thyroid disease occurred as a result of exposure to POPs. Data were collected from 183 Akwesasne Mohawk women, 21–38 years of age, between 2009 and 2013. Multivariate analyses were conducted to determine the association between toxicant exposure and levels of TPOAbs. In multiple logistic regression analyses, exposure to PCB congener 33 was related to elevated risk of individuals possessing above normal levels of TPOAbs. Further, HCB was associated with more than 2-fold higher risk of possessing above normal levels of TPOAbs compared to women with normal levels of TPOAbs. p,p'-DDE was not associated with TPOAb levels within this study. Exposure to PCB congener 33 and HCB was correlated with above normal levels of TPOAbs, a marker of autoimmune thyroid disease. Additional investigations are needed to establish the causes and factors surrounding autoimmune thyroid disease which are multiple and complex. [ABSTRACT FROM AUTHOR]

Objective: The potential predictive value of body mass index, stress management ability, and thiobarbituric acid reactive substances (TBARS) levels for antibody levels in Hashimoto’s thyroiditis (HT) were evaluated. Materials and Methods: Two hundred patients with HT were included in the study. The patients were allocated into four groups as Group 1, patients with a body mass index (BMI) of 30 or higher (n=54); Group 2, patients with stress management difficulties (n=59); Group 3, patients with a BMI higher than 30 and stress management difficulties (n=11), and Group 4 (control, n=76), those without obesity or stress management issues. The mean age of patients, BMI, stress management abilities, anti-thyroid peroxidase (anti-TPO) antibodies levels, weekly T4 drug dosages, duration of levothyroxine usage, quality of life scores, as well as thiobarbituric acid reactive substances (TBARS) were evaluated. Results: The antibody levels were significantly associated with body mass index and stress management. The antibody level increased 533 times (p<0.0001) in the group without stress management difficulties, and was affected 525 times (p<0.0001) in the obesity group. Conclusion: The findings of our investigation revealed that stress management ability and obesity are the important factors influencing antibody levels. [ABSTRACT FROM AUTHOR]

Context: Preconception optimization of thyroid function in women with Hashimoto thyroiditis (HT) is highly recommended to prevent/reduce the risk of thyroid insufficiency at early gestation. Objective: This work aimed to evaluate the prevalence of first-trimester thyroid insufficiency in HT women with preconception thyrotropin (T0-TSH) values consistently less than or equal to 2.5 mIU/L with or without levothyroxine (LT4) treatment, and to calculate T0-TSH cutoffs that best preconceptionally identified HT women requiring first-trimester LT4 adjustment/prescription. Methods: Serum TSH was obtained at 4- to 6-week intervals from 260 HT pregnant women (122 on LT4 [Hypo-HT]; 138 euthyroid without LT4 [Eu-HT]), prospectively followed from preconception up to pregnancy term. Receiver operating characteristic (ROC) curves were plotted to identify T0-TSH cutoffs best predicting first-trimester TSH levels greater than 2.5 mIU/L (diagnostic criterion [DC] 1) and greater than 4.0 mIU/L (DC 2). Results: At first trimester, TSH was greater than 2.5 mIU/L in approximately 30% of both Hypo-HT and Eu-HT women, and greater than 4.0 mIU/L in 19.7% Hypo-HT and 10.1% Eu-HT women (P = .038). The optimal ROC-based T0-TSH cutoffs found were 1.24 mIU/L/1.74 mIU/L in Hypo-HT, and 1.73 mIU/L/2.07 mIU/L in Eu-HT women, for DC 1 and DC 2, respectively. T0-TSH values exceeding these cutoffs resulted in a statistically significantly increased risk of first-trimester thyroid insufficiency (odds ratio [OR] [95% CI)] 15.92 [5.06-50.15] and 16.68 [5.13-54.24] in Hypo- HT; 16.14 [6.47-40.30] and 17.36 [4.30-70.08] in Eu-HT women, for DC 1 and DC 2, respectively). Conclusion: The preconception TSH cutoffs that guaranteed a first-trimester TSH less than 2.5 mU/L in hypothyroid- and euthyroid-HT women were, respectively, almost 50% (1.24 mU/L) and 30% (1.73 mU/L) lower than this gestational target, and 1.74 mU/L and 2.07 mU/L in hypothyroidand euthyroid-HT women, respectively, for a gestational target of 4.0 mU/L. [ABSTRACT FROM AUTHOR]

Objective: We investigated whether a positive thyroid peroxidase antibody (TPO Ab) status before radioactive iodine (RAI) therapy in patients with Graves’ hyperthyroidism is a predictive factor for developing hypothyroidism post RAI. Methods: We performed a retrospective study of patients with Graves’ hyperthyroidism with known TPO Ab status, receiving the first administration of RAI. Patients from four thyroid outpatient centres in Belgium receiving their first RAI therapy between the years 2011 and 2019 were studied. Clinical, laboratory, imaging, and treatment data were recorded from medical charts. Hypothyroidism and cure (defined as combined hypo- and euthyroidism) were evaluated in period 1 (≥2 and ≤9 months, closest to 6 months post RAI) and period 2 (>9 months and ≤24 months post RAI, closest to 12 months post RAI). Results: A total of 152 patients were included of which 105 (69%) were TPO Ab-positive. Compared to TPO Ab-negative patients, TPO Ab-positive patients were younger, had a larger thyroid gland, and had more previous episodes of hyperthyroidism. In period 1, 89% of the TPO Ab-positive group developed hypothyroidism and 72% in the TPO Ab-negative group (P = 0.007). In period 2, the observation was similar: 88% vs 72% (P = 0.019). In the multivariate logistic regression analysis, a positive TPO Ab status was associated with hypothyroidism in period 2 (adjusted OR: 4.78; 95% CI: 1.27–20.18; P = 0.024). In period 1, the aOR was 4.16 (95% CI: 1.0–18.83; P = 0.052). Conclusion: A positive TPO Ab status in patients with Graves’ hyperthyroidism receiving the first administration of RAI is associated with a higher risk of early hypothyroidism.

The aim of the study was to demonstrate gender differences in thyroid function among euthyroid subjects, that had negative values of antibodies, and euthyroid subjects, that had positive antibodies (antibodies to thyroid peroxidase—AntiTPO and/or antibodies to thyroglobulin—AntiTG). A total of 200 clinically healthy people (85 women and 115 men) were enrolled in this study and classified into groups depending on gender and level of autoantibodies in the blood. Group A (59 women and 100 men) had normal values of thyroid hormones and negative values of antibodies according to the test instructions, i.e. AntiTPO < 50 IU/mL and/or AntiTG < 100 IU/mL. Group B (26 women and 15 men) had normal values of thyroid hormones and positive antibodies, i.e. AntiTPO ≥ 50 IU/mL and/or AntiTG ≥ 100 IU/mL. Serum hormones of the pituitary-thyroid system, thyroglobulin and antibodies concentration was measured by enzyme immunoassay. Analysis of gender differences in thyroid function in individuals with positive thyroid antibodies found statistically significantly higher T4 values in women compared to men. Men with positive antibodies had an insignificant increase in thyroid-stimulating hormone (TSH) levels against the background of a statistically significant decrease in the values of the (T3 + T4)/TSH ratio. Women with positive antibodies were characterized by a statistically significant decrease in thyroglobulin levels. In all analyzed groups, thyroglobulin negatively correlated with AntiTG, and in men of Group B this relationship became stronger. In Group B in both men and women AntiTPO had negative correlation with (T3 + T4)/TSH ratio. Our results indicate that the measurement of thyroid indices, in combination with the determination of serum levels of thyroid autoantibodies and thyroglobulin, may be useful in identifying euthyroid subjects at potential risk of developing thyroid disease and thus be helpful in making early treatment decisions to prevent a prolonged course of the disease. [ABSTRACT FROM AUTHOR]

Objective: To investigate preconceptual thyroid peroxidase antibody (TPO‐ab) positivity and/or thyroid stimulating hormone (TSH) levels in the upper range of normal as risk factors for recurrent unexplained first‐trimester miscarriage. Design: A post‐hoc study of a randomized trial, in which acetylsalicylic acid did not affect the risk of a new miscarriage. Patients: Women (n = 483) with at least three unexplained recurrent first‐trimester miscarriages investigated at a Swedish secondary referral center. Measurements: The levels of TPO‐ab and TSH were determined before pregnancy. The occurrence of a new first‐trimester miscarriage was analyzed by logistic regression with adjustments when applicable, for age, number of previous miscarriages, obesity and the investigated covariates levels of TPO‐ab and TSH. Results: Including all first trimester miscarriages, odds ratio (OR) according to presence of TPO‐ab was 1.60 (95% confidence interval [CI]; 0.99–2.57), after adjustment 1.54 (95% CI; 0.94–2.53). Very early (biochemical) pregnancy losses occurred more often in women with than without preconceptual TPO‐ab (6.8% vs. 2.0%), OR 3.51 (95% CI; 1.15–10.71), after adjustment 2.91 (95% CI; 0.91–9.29). There was no association between TSH in the upper range of normal and a new miscarriage, adjusted OR 0.76 (95% CI; 0.32–1.83). A prediction model for a new miscarriage included number of previous miscarriages, woman's age and presence of TPO‐ab. Conclusion: In women with at least three recurrent unexplained pregnancy losses, the presence of TPO‐ab may contribute to an increased risk of a first‐trimester miscarriage, possibly more pronounced in very early pregnancy. TSH levels 2.5–4.0 mU/L do not seem to increase the miscarriage risk. Summary: Thyroid peroxidase antibody antibodies may contribute to an increased risk for a new miscarriage in women with unexplained recurrent pregnancy loss, especially very early in the first trimester, but thyroid stimulating hormone in the upper range of normal does not. [ABSTRACT FROM AUTHOR]

Background: Thyrotoxicosis is a clinical status due to hypersecretion of thyroid hormones by diffuse goiter (Grave's disease [GD]), multinodular goiter, single toxic adenoma, and pituitary adenoma secreting thyroid-stimulating hormone (TSH) rarely. GD: It is diffuse toxic goiter (GD) or (Basedow disease) it is a triad of: Diffuse toxic goiter, hyperthyroidism, and exophthalmos (proptosis). Aims: 1. Positivity of TRAb and TPO in thyrotoxic subjects. 2. Correlation of the titer of these antibodies with the clinical status of the patients. 3. Correlation between TRAb and TPO titer. 4. To find out if TPO titer on enrollment has any correlation with the clinical status of the patients. Methods: A cross-sectional study conducted in the National Diabetes Center-Mustansiriyah University in the period from November 2021 to April 2022 where 93 patients with GD are enrolled to check their thyroid status and check some biochemical variables in their sera as thyrotropin receptor antibody (TRAB), thyroid peroxidase (TPO) antibody, TSH, and free thyroxine (FT4). 44.6% are women and 35.7% are men, at the time of recreuitment 49.4% are toxic while the remaining 58.6% are euthyroid being on anti thyroid drugs. 87 persons are recruited as normal euthyroid, they are sex and age-matched, the control TRAb were negative. Results: GD patients are as follows: 54 (58.06%) euthyroid and 39 (41.94%) toxic at the time of recruitment. Eighty-two percent of toxic patients have goiter and 74.07% of euthyroid GD patients have goiter. Ophthalmopathy is found in (64.1% of toxic GD patients and 42.59% of euthyroid GD patients. TPO median in the control, toxic, and euthyroid GD patients is (22.76%), (75%) and (63.5%) (highest among toxic GD patients) (P < 0.001). TSH in the control group has a mean of (2.18 ± 1.72) and a median of (1.89). The TRAb is the highest in toxic GD patients, followed by euthyroid GD patients and the least in the control, its mean is (9.98 ± 8.42), (7.24 ± 7.8) and (0.93 ± 0.15), respectively. It is recommended to conduct a longitudinal study in which patients with GD are checked at variables times in the course of illness (remission and relapse) studying these biochemical and immunological markers in these variable states of thyroid function. Conclusion: Ninety-three thyrotoxic patients, 39 are toxic and 54 are euthyroid on arrival. Eye sings are more in toxic patients, goiter and eye signs are predictor of GD, TRAb is the highest among toxic patients, TPO are higher among GD patients versus the control. [ABSTRACT FROM AUTHOR]

Context: Thyroid peroxidase antibody (TPOAb) positivity is prevalent in women of reproductive age and predisposes to thyroid dysfunction, particularly hypothyroidism, which has adverse effects on pregnancy. Objective: This study aimed to report the rate of development of abnormal thyroid function among initially euthyroid TPOAb-positive women recruited into the TABLET trial, to identify factors associated with the development of hypothyroidism, and to compare outcomes between euthyroid and treated hypothyroid individuals. Methods: This observational cohort study, conducted at 49 UK hospitals between 2011 and 2016, included euthyroid TPOAb-positive women 16 to 40 years of age with a history of miscarriage or subfertility, planning pregnancy, randomized to levothyroxine 50 mcg daily or placebo. Abnormal thyroid function, conception rate, and live birth rate (LBR) ≥34 weeks were analyzed. Results: Among the women, 70/940 (7.4%) developed subclinical (SCH) or overt (OH) hypothyroidism: 27/470 taking levothyroxine and 43/470 placebo (relative risk [RR] 0.63; 95% CI, 0.39-1.00; P=0.05); 83% of cases emerged prepregnancy. Baseline median serum TSH concentrations and TPOAb titers were significantly higher in those who developed hypothyroidism vs those who did not (P<0.001). Treated SCH/OH demonstrated a higher failure-to-conceive rate compared with euthyroid women (adjusted RR 2.02 [1.56-2.62]; P< 0.001). The LBR ≥ 34 weeks was similar in the treated SCH/OH and euthyroid groups (adjusted RR 1.09 [0.77-1.55]; P=0.6). Conclusion: Approximately 7% of euthyroid TPOAb-positive women will develop hypothyroidism within 1 year preconception or in pregnancy. Conception rates are lower in women with treated SCH/OH compared with euthyroid women, but LBR are comparable. Thyroid function in TPOAb-positive women should be monitored regularly, when trying to conceive, to ensure prompt diagnosis and appropriate treatment initiation. [ABSTRACT FROM AUTHOR]

Background and Objectives: Thyroid disease has been associated with autoimmune disorders. As systemic lupus erythematosus (SLE) is a systemic autoimmune disease with diverse manifestations spanning across all organ systems, the relationship of SLE with thyroid disorders needs investigation. In particular, the relationship of SLE with autoimmune thyroid disease has attracted the interest of the research community. The aim was to evaluate the relationship of SLE with autoimmune thyroid disease. Materials and Methods: A cohort of 45 consecutive patients with a mean age of 47.97 years (range 21–79 years) and 45 age- and sex-matched controls were prospectively studied over a period of 12 months for the presence of thyroid disease and the prevalence of antithyroid antibodies. Results: Four patients (8.9%) were found to suffer from primary hypothyroidism, five (11.11%) from subclinical hypothyroidism and one (2.22%) from hyperthyroidism, whereas one (2.22%) of the controls had primary hypothyroidism and one (2.22%) had hyperthyroidism. Five patients (11.11%) had a thyroid hormone profile that was compatible with the presence of euthyroid sick syndrome. Thyroid peroxidase (TPOab) and thyroglobulin (Tgab) antibodies were detected in 20/45 and 15/45 of the SLE population and in 7/45 and 5/45 of the controls, respectively (p < 0.05, chi-square test). Conclusions: In conclusion, the incidence of clinical thyroid disease is greater amongst SLE patients than in a control population, and in a significant number of these patients, antithyroid antibodies are detectable. Thus, a subset of lupus patients appears to be predisposed to the development of thyroid disease, and this should be considered when evaluating patients with SLE.

Introduction: Excessive menstruation outside the normal parameters is one of the most common manifestations of hypothyroidism affecting the females. Thyroid disorders, such as hypothyroidism and hyperthyroidism are associated with late onset puberty, anovulatory cycles and abnormally high incidence of foetal morbidity and mortality. Aim: To study the association of bleeding pattern with thyroid dysfunction among patients with Abnormal Uterine Bleeding (AUB). Materials and Methods: This was a prospective cross-sectional study carried out in the Department of Obstetrics and Gynaecology at Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India, from October 2012 to June 2014, among 140 females with a provisional diagnosis of abnormal uterine bleeding were subjected to testing for serum Triiodothyronine (T3), Thyroxine (T4), Thyroid Stimulating Hormone (TSH) and Thyroid Peroxidase (TPO) antibodies estimation in their serum. Data was analysed using Chi-square test and the p-value <0.05 was considered significant. Results: Total of 140 patients, with maximum number of patients in the study belonged to the age group 31-40 years, 57 (40.71%) and 46 (32.8%) patients were para 2. Among different bleeding patterns observed, most common was menorrhagia, 62 (44.28%). The prevalence of subclinical hypothyroidism was 10 (7.14%), there were five hypothyroid cases (3.5%), and two hyperthyroid cases (1.4%) among 140 cases. The total thyroid disorders associated were 17 (12.14%). Conclusion: In the present study, association of thyroid dysfunction with AUB has been noted. With early diagnosis of thyroid disorders in AUB patients, followed by appropriate treatment, the menstrual irregularities can be resolved and major surgical procedures can be avoided. [ABSTRACT FROM AUTHOR]

Introduction: Thyroid autoimmunity is amore common autoimmune disease among reproductive women. It is proposed that, thyroid peroxidase antibodies pass through the blood follicle barrier during follicular development which damages the growing follicles and oocytes. Previous studies have demonstrated the association between thyroid autoimmunity and ovarian failure. Serum Anti-Müllerian Hormone (AMH) levels are used as a marker of ovarian reserve in clinical practice. Aim: To evaluate ovarian reserve among newly diagnosed Hashimoto's Thyroiditis (HT) related subclinical and overt hypothyroid women. Materials and Methods: A cross-sectional study was conducted at the Department of Biochemistry, Government Medical College Nalgonda, Telangana, India, from August 2020 to July 2021. The study included 180 subjects, 60 in each Overt Hypothyroid (OH group), Subclinical Hypothyroid (SCH group) and Euthyroid subjects (EU group). Socio-demographic details and other parameters age, Body Mass Index (BMI), AMH, Thyroid Stimulating Hormone (TSH), free T4 (fT4), Thyroid Peroxidase Antibodies (TPOAb), Follicular Stimulating Hormone (FSH), Luteinizing Hormone (LH), Estradiol (E2), Antral Follicular Count (AFC) were evaluated and compared in all the three groups. The above data were recorded and analysed using Statistical Package for Social Sciences (SPSS) version 20.0 and the Analysis of Variance (ANOVA) test, Chi-square test, and Spearman's correlation test were performed for statistical analysis. Results: The median age, BMI, and total AFC were not statistically significant (p-value >0.05). Serum TPOAb levels were significantly (p-value <0.001) high in the OH group and SCH group when compared to the EU group. The AMH levels were significantly (p-value=0.015) high inthe EU group compared to the OH group, but there were no statistically significant differences among other groups. The AMH values were negatively correlated with age among all the three groups. There was no significant correlation between AMH and other parameters analysed among different groups. Conclusion: The AMH levels were significantly low in the OH group when compared to the EU group. There were no statistically significant differences among other groups. Age was found to be an independent factor for low AMH levels among all the three groups. [ABSTRACT FROM AUTHOR]

Abstract Evidence in the literature has suggested that there may be an association between thyroid antibodies and depression during pregnancy and in the postpartum period. Thus, this study aims to conduct a systematic review on the prevalence of postpartum depression (PPD) in women with thyroid abnormalities during pregnancy or in the postpartum period. For this review, we used four databases (PubMed, Lilacs, Scielo, and Scopus). Fifteen studies were selected; one study used a case–control design, four used a cross-sectional design and ten utilized prospective cohort designs. All studies were restricted to up to 1 year postpartum, and 46.7% focused on a period between immediate postpartum and 6 months postpartum. Estimates of the prevalence of PPD in pregnant women with thyroid disorders ranged between 8.3% and 36.0%. For follow-up studies, the cumulative incidence of self-reported depression from the primary episode in the first postpartum year was 6.3% in a high-city survey. Although some authors consider the status of positive anti-TPO antibodies to be a possible marker of vulnerability to depression , it is not yet possible to conclude whether thyroid function in the pregnancy-puerperal cycle is involved with the development of PPD.

Introduction: Excessive menstruation outside the normal parameters is one of the most common manifestations of hypothyroidism affecting the females. Thyroid disorders, such as hypothyroidism and hyperthyroidism are associated with late onset puberty, anovulatory cycles and abnormally high incidence of foetal morbidity and mortality. Aim: To study the association of bleeding pattern with thyroid dysfunction among patients with Abnormal Uterine Bleeding (AUB). Materials and Methods: This was a prospective cross-sectional study carried out in the Department of Obstetrics and Gynaecology at Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India, from October 2012 to June 2014, among 140 females with a provisional diagnosis of abnormal uterine bleeding were subjected to testing for serum Triiodothyronine (T3), Thyroxine (T4), Thyroid Stimulating Hormone (TSH) and Thyroid Peroxidase (TPO) antibodies estimation in their serum. Data was analysed using Chi-square test and the p-value

Introduction: Thyroid autoimmunity is a common autoimmune disorder among reproductive women. It is proposed that, thyroid peroxidase antibodies pass through the blood follicle barrier during follicular development which damages the growing follicles and oocytes. Previous studies have demonstrated the association between thyroid autoimmunity and ovarian failure. Serum Anti-Müllerian Hormone (AMH) levels are used as a marker of ovarian reserve in clinical practice. Aim: To evaluate ovarian reserve among newly diagnosed Hashimoto’s Thyroiditis (HT) related subclinical and overt hypothyroid women. Materials and Methods: A cross-sectional study was conducted at the Department of Biochemistry, Government Medical College Nalgonda, Telangana, India, from August 2020 to July 2021. The study included 180 subjects, 60 in each Overt Hypothyroid (EU group) (OH group), Subclinical Hypothyroid (SCH group) and Euthyroid subjects. Socio-demographic details and other parameters age, Body Mass Index (BMI), AMH, Thyroid Stimulating Hormone (TSH), free T4 (fT4), Thyroid Peroxidase Antibodies (TPOAb), Follicular Stimulating Hormone (FSH), Luteinizing Hormone (LH), Estradiol (E2), Antral Follicular Count (AFC) were evaluated and compared in all the three groups. The above data were recorded and analysed using Statistical Package for Social Sciences (SPSS) version 20.0 and the Analysis of Variance (ANOVA) test, Chi-square test, and Spearman’s correlation test were performed for statistical analysis. Results: The median age, BMI, and total AFC were not statistically significant (p-value >0.05). Serum TPOAb levels were significantly (p-value

Objectives: Thyroid autoimmunity is common in pregnant women and associated with thyroid dysfunction and adverse obstetric outcomes. Most studies focus on thyroid peroxidase antibodies (TPOAbs) assessed by a negative–positive dichotomy and rarely take into account thyroglobulin antibodies (TgAbs). This study aimed at determining the association of TPOAbs and TgAbs, respectively, and interdependently, with maternal thyroid function. Methods: This was a meta-analysis of individual participant cross-sectional data from 20 cohorts in the Consortium on Thyroid and Pregnancy. Women with multiple pregnancy, pregnancy by assisted reproductive technology, history of thyroid disease, or use of thyroid interfering medication were excluded. Associations of (log2) TPOAbs and TgAbs (with/without mutual adjustment) with cohort-specific z-scores of (log2) thyrotropin (TSH), free triiodothyronine (fT3), total triiodothyronine (TT3), free thyroxine (fT4), total thyroxine (TT4), or triiodothyronine:thyroxine (T3:T4) ratio were evaluated in a linear mixed model. Results: In total, 51,138 women participated (51,094 had TPOAb-data and 27,874 had TgAb-data). Isolated TPOAb positivity was present in 4.1% [95% confidence interval, CI: 3.0 to 5.2], isolated TgAb positivity in 4.8% [CI: 2.9 to 6.6], and positivity for both antibodies in 4.7% [CI: 3.1 to 6.3]. Compared with antibody-negative women, TSH was higher in women with isolated TPOAb positivity (z-score increment 0.40, CI: 0.16 to 0.64) and TgAb positivity (0.21, CI: 0.10 to 0.32), but highest in those positive for both antibodies (0.54, CI: 0.36 to 0.71). There was a dose–response effect of higher TPOAb and TgAb concentrations with higher TSH (TSH z-score increment for TPOAbs 0.12, CI: 0.09 to 0.15, TgAbs 0.08, CI: 0.02 to 0.15). When adjusting analyses for the other antibody, only the association of TPOAbs remained statistically significant. A higher TPOAb concentration was associated with lower fT4 (p < 0.001) and higher T3:T4 ratio (0.09, CI: 0.03 to 0.14), however, the association with fT4 was not significant when adjusting for TgAbs (p = 0.16). Conclusions: This individual participant data meta-analysis demonstrated an increase in TSH with isolated TPOAb positivity and TgAb positivity, respectively, which was amplified for individuals positive for both antibodies. There was a dose-dependent association of TPOAbs, but not TgAbs, with TSH when adjusting for the other antibody. This supports current practice of using TPOAbs in initial laboratory testing of pregnant women suspected of autoimmune thyroid disease. However, studies on the differences between TPOAb- and TgAb-positive women are needed to fully understand the spectrum of phenotypes. [ABSTRACT FROM AUTHOR]

Objective The absence of specific markers can make the diagnosis of neuroimmune disorders difficult, making other biomarkers such as thyroid peroxidase antibodies (TPO-Abs) more relevant. Laboratory tests are susceptible to interference, especially those tests performed using immunoassay techniques. The effect of treatment with human intravenous immunoglobulin (IVIG) on the results of TPO-Abs assays has not been previously characterized. Materials and Methods We analyzed TPO-Abs levels in 170 children monitored in the neuroimmune disease department of a tertiary hospital. We analyzed the characteristics of patients with increased TPO-Abs values and compared their progress with and without treatment. Results We found that 97% of patients with elevated TPO-Abs had received IVIG. After withdrawal from IVIG, a mean TPO-Abs decrease of 62.5% at 1 month was observed. The IVIG drug preparation was found to contain 1176 U/mL of TPO-Abs. An interferogram confirmed interference. Conclusion It is advisable to measure levels of TPO-Abs before starting immunotherapy and remain vigilant regarding possible interference in the event of unsubstantiated elevations of this analyte. [ABSTRACT FROM AUTHOR]

BackgroundUnexplained recurrent spontaneous abortion is a serious reproductive problem of unknown etiology. Thyroid peroxidase antibodies (TPO-Ab) may be associated with pregnancy outcomes in unexplained recurrent spontaneous abortion with normal thyroid function.ObjectiveThis study aimed to investigate the relationship between TPO-Ab and the first trimester miscarriage rate/live birth rate in women of unexplained recurrent spontaneous abortion with normal thyroid function.MethodsWe retrospectively analyzed the clinical data of 297 women who met our strict inclusion criteria, comparing the first trimester miscarriage rate/live birth rate between the TPO-Ab positive and TPO-Ab negative groups. For the same purpose, we also performed subgroup analysis.ResultsOf the included women, 76 (25.6%) were TPO-Ab positive, and 221 (74.4%) were negative. First trimester miscarriage rate differed between the two groups (36.8% vs 24.0%, RR = 1.54, 95% CI: 1.05–2.24, P = 0.030). In the younger subgroup (

The regulation of the female reproductive system is one of the most relevant actions of thyroid hormones. Adequate thyroid hormones production is essential for normal menstrual function and fertility as well as for the successful maintenance of pregnancy. The relationship between reproductive failure and thyroid disorders is particularly relevant and attracts attention worldwide. Thyroid autoimmunity (TAI), defined by the presence of circulating antithyroid antibodies targeting thyroid peroxidase (TPOAb) and thyroglobulin (TgAb), is prevalent among women of reproductive age and is the most frequent cause of thyroid dysfunction. Several studies addressed the association between TAI, thyroid function, and fertility as well as pregnancy outcome after spontaneous or assisted conception. Infertility, miscarriages, and fetal-maternal complications are described in overt autoimmune hypothyroidism. More debatable is the role of mild thyroid dysfunction, mainly subclinical hypothyroidism (SCH), and TAI in the absence of thyroid dysfunction in infertility and reproductive outcome. Assisted reproductive technology (ART) has become an integral element of care for infertility. Women with TAI undergoing ART are of particular interest since they carry a higher risk of developing hypothyroidism after the ovarian stimulation but whether TAI, in absence of thyroid dysfunction, adversely affects ART outcome is still controversial. Likewise, the role of levothyroxine (LT4) in improving fertility and the success of ART in euthyroid women with TAI is unclear. This review discusses the role of TAI, in the absence of thyroid dysfunction, in infertility and in ART outcome [ABSTRACT FROM AUTHOR]

Evidence in the literature has suggested that there may be an association between thyroid antibodies and depression during pregnancy and in the postpartum period. Thus, this study aims to conduct a systematic review on the prevalence of postpartum depression (PPD) in women with thyroid abnormalities during pregnancy or in the postpartum period. For this review, we used four databases (PubMed, Lilacs, Scielo, and Scopus). Fifteen studies were selected; one study used a case–control design, four used a cross-sectional design and ten utilized prospective cohort designs. All studies were restricted to up to 1 year postpartum, and 46.7% focused on a period between immediate postpartum and 6 months postpartum. Estimates of the prevalence of PPD in pregnant women with thyroid disorders ranged between 8.3% and 36.0%. For follow-up studies, the cumulative incidence of self-reported depression from the primary episode in the first postpartum year was 6.3% in a high-city survey. Although some authors consider the status of positive anti-TPO antibodies to be a possible marker of vulnerability to depression , it is not yet possible to conclude whether thyroid function in the pregnancy-puerperal cycle is involved with the development of PPD. [ABSTRACT FROM AUTHOR]

The influence of diet and different foods in the development of chronic autoimmune lymphocytic thyroiditis (Hashimoto disease) is not clear. Low levels of selenium and vitamin D and high levels of iodine intake may trigger an autoimmune reaction against thyroid. Other studies analyzed the prevalence of self-hypothyroidism in relation to dietary habits, and found a protective role of anti-inflammatory (rich in vegetables, fruits, multigrain, low fat and sugar intake), but data are inconclusive. The aim of our study was to analyze the role of different food groups in Hashimoto disease. The study enrolled newly diagnosed 187 patients with Hashimoto disease defined as cases and 240 individuals with normal thyroid tests. Hashimoto disease was considered for all individuals with positive thyroid peroxidase antibodies (TPO-Ab) and/or thyroglobulin antibodies (Tg-Ab) and TSH value above the upper limit (0.2- 4.5 uUI/mL the reference range). All subject with TSH value within the reference range, negative antibodies and normal thyroid ultrasound were considered as control group. Frequency of different foods consumption in their daily life was evaluated by a questionnaire. Food groups included in the questionnaire were: fish and sea products, meat, beans, eggs, nuts, dairy and animal fat, bakery, snacks and desserts. We used a logistic regression analysis where case/control was considered a dependent variable and foods consumed independent variables to see if there was any association between different foods and positive plasma TPO-Ab and/or Tg-Ab. The statistical data indicate that there was not significant correlation between food consumption and presence of Hashimoto disease (p > 0.05) The group with positive antibodies had more frequent consumption of snacks and desserts compared to control group - odds ratios (OR) > 1, and less frequent consumption of vegetables (OR < 1). Different nutrients may have an impact on the development of thyroid autoimmunity and Hashimoto disease. The most significant result of our study was an increased consumption of desserts and snacks in Hashimoto patients and a less frequent consumption of vegetables. These results may be helpful to nutritionists and physicians who work with thyroid patients. [ABSTRACT FROM AUTHOR]

Introduction and objective. There is a growing interest in a gluten-free diet (GFD) in the management of various autoimmune diseases, including Hashimoto's thyroiditis (HT). Even medical professionals claim that gluten elimination may improve a patient's treatment. Some studies suggest a relationship between gluten intake and HT development or progression. The aim of the study was to analyze and describe available knowledge regarding the effect of gluten or a gluten-free diet on thyroid autoimmunity in HT with or without celiac disease. Brief description of the state of knowledge. Potentially applicable records were obtained through review and analysis of the PUBMED (MEDLINE) and Google Scholar database by using the following phrases: 'hypothyroidism gluten', 'Hashimoto gluten' and 'thyroiditis gluten'. If a record focused on the subject by title and abstrakt, the full paper was screened. Authors' scientific achievements and references of eligible records were screened for possibly omitted studies. The review was focused only on human studies. Discussion. Gluten exclusion might increase the risk of HT development because of the potential nutritional deficiencies related to the low quality of gluten-free products. Gluten intake from crops grown on selenium-depleted soil increases the risk of HT development. Only a few studies suggest that GFD would be beneficial for HT patients, even without the coexistence of CD. The strongest connection between gluten intake and thyroid destruction seems to be based on a mechanism of molecular mimicry between gut and thyroid tissue transglutaminase. Conclusions. Studies conducted so far do not support the claim that HT patients should eliminate gluten from their diet. In view of the limited number of studies, with major limitations and ambiguous results, a gluten-free diet is not recommended. [ABSTRACT FROM AUTHOR]

Abstract Background Thyroid autoimmunity (TAI) and subclinical hypothyroidism (SCH) have been associated with poor pregnancy and fetal outcomes. However, whether euthyroid women with anti-thyroid peroxidase antibody (TPOAb) positivity have a higher risk of poor pregnancy and fetal outcomes is debatable. Therefore, this study aimed to investigate the association between TPOAb positivity and pregnancy-related and fetal outcomes in euthyroid women. Methods In total, 938 pregnant women participated in this prospective cohort study. The euthyroid group included 837 pregnant women and the TPOAb-positive group included 101 euthyroid pregnant women. Serum TPOAb, thyroglobulin antibody (TGAb), thyroid-stimulating hormone (TSH), and free thyroxine (FT4) levels were assessed. Pregnancy and fetal outcomes included gestational diabetes mellitus, spontaneous abortion, premature rupture of membranes, hypertensive disorders of pregnancy, preterm birth, fetal distress, low birth weight, fetal macrosomia, and small for gestational age infant. Results Logistic regression analysis showed TPOAb positivity was not associated with an increased risk of poor pregnancy or fetal outcomes in euthyroid women. However, TPOAb-positive euthyroid women pregnant with a female fetus were independently associated with preterm births (OR: 4.511, 95% CI: 1.075–18.926) after adjustment for potential confounding factors. Conclusions TPOAb positivity was not found to be associated with poor pregnancy-related or fetal outcomes in euthyroid women. However, in euthyroid women with a female fetus, TPOAb positivity was strongly associated with preterm births. The risk of preterm birth in the euthyroid women with TPOAb positivity should be emphasized in clinical practice. Trial registration ClinicalTrials.gov Identifier: NCT02966405 . Registered on October 24th 2016 - Retrospectively registered.

Background: The etiology of Hashimoto's thyroiditis (HT) involves genetic and environmental factors. There is a lack of clarity regarding the relationship between Vitamin D and HT. This study aimed to investigate the effect of Vitamin D and gene polymorphisms on thyroid peroxidase antibody (TPOAb) positivity., Methods: A total of 9,966 participants were included from a survey conducted in East China from 2014 to 2016. We measured the levels of 25(OH)D, thyroid hormones and autoimmune antibodies. rs11675434, rs9277555, and rs301799 were genotyped. Based on these 3 SNPs, a weighted genetic risk score was calculated for TPOAb., Results: The proportion of females in the TPOAb-positive group was greater than that in the TPOAb-negative group (74.2% vs. 57.2%, P<0.001). Vitamin D levels were lower in the TPOAb-positive group than in the TPOAb-negative group (40.07±11.87 vs. 40.80±12.84, P=0.01). The GG genotype of rs9277555 and the TT genotype of rs11675434 were correlated with the risk of TPOAb positivity (OR=1.34, 95% CI 1.13-1.59, P=0.001; OR=1.29, 95% CI 1.06-1.58, P=0.01). TPOAb-GRS was associated with TPOAb positivity (OR=3.17, 95% CI 1.72-5.84; P<0.001). When stratified by Vitamin D group, the association between TPOAb-GRS and TPOAb positivity existed only in the Vitamin D deficiency group (OR=3.41, 95% CI 1.73-6.70 P<0.001) but not in the control group (OR=2.45, 95% CI 0.59-10.19, P=0.22)., Conclusions: This study suggested that TPOAb-GRS was associated with TPOAb positivity in the Han Chinese population, mainly due to rs9277555 and rs11675434. The hereditary effect of TPOAb positivity differed depending on Vitamin D status., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.)

This case report presents a 77-year-old woman who developed subacute thyroiditis following COVID-19. The patient exhibited atypical symptoms, including fever, fatigue, anorexia, significant weight loss, headaches, and palpitations, without the typical neck pain or tenderness associated with thyroiditis. One week later, a follow-up examination showed mild enlargement and tenderness of the thyroid. Laboratory tests indicated elevated thyroid hormone levels and suppressed thyroid-stimulating hormone. Ultrasonography revealed diffuse thyroid enlargement with poor blood flow, consistent with subacute thyroiditis. Despite the absence of typical neck pain, the diagnosis was supported by clinical, laboratory, and imaging findings. This case suggests the importance of considering subacute thyroiditis as a potential secondary condition following COVID-19, even in the absence of typical symptoms. Clinicians should consider that and perform thorough evaluations in patients with recent COVID-19 exposure and nonspecific symptoms., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. 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, Sakai et al.)

Objective: This study examined whether blastocysts transferred on day 5 or day 6 of embryo development, as well as positivity for anti-thyroid peroxidase antibodies, affect gestational outcomes in euthyroid women undergoing in vitro fertilisation., Methods: Of 428 women who underwent in vitro fertilisation assessed in this retrospective cohort study, 212 (49.5%) underwent embryo transfer on day 5 of blastulation and 216 (50.5%) on day 6. Dichotomization based on anti-thyroid peroxidase antibodies status was also performed, with 370 (86.4%) women testing negative and 58 (13.6%) testing positive. Clinical and hormonal data and rates of clinical pregnancy, miscarriage, and live births were compared between the groups., Results: When evaluating gestational outcomes based on the day of blastulation, a statistically significant difference was observed in clinical pregnancy rates [51.4% (day 5) vs. 40.7% (day 6); p=0.033]. However, there was no significant difference in the relative frequencies of miscarriages (p=1.000), live births (p=1.000), or preterm births (p=1.000). Using Cramer's V test, a weak association was found between the day of blastulation and clinical pregnancy outcomes (V2=10.7%; p=0.027). There were no statistically significant differences between the anti-thyroid peroxidase antibodies-negative and -positive groups in terms of clinical pregnancy rates (p=0.396), miscarriages (p=0.129), and live births (p=0.129)., Conclusions: Higher rates of clinical pregnancy were observed in women who underwent embryo transfers performed on day 5 compared to those on day 6. However, no effect was observed with gestational outcomes. Further, anti-thyroid peroxidase antibody positivity did not have a statistically significant impact on gestational outcomes.

Purpose: The pathogenesis of Hashimoto's thyroiditis (HT) is unclear, although some studies have identified an association between vitamin D deficiency and thyroid autoantibody positivity. This study aimed to investigate vitamin D status, and its relationships with thyroid autoantibody positivity and HT, via a large epidemiological survey. Methods: The epidemiological survey was conducted in Tianjin, China. All participants underwent testing for serum 25-hydroxyvitamin D (25OHD), thyroid function, and thyroid autoantibodies, and some participants underwent testing to evaluate CD4+ T-cell differentiation and concentrations of related cytokines. Results: The study included 1812 participants and revealed prevalences of 13.1% for thyroid peroxidase antibodies (i-TPOAb) and 14.0% for thyroglobulin antibodies (i-TgAb). Logistic regression analysis revealed that thyroid autoantibody positivity was associated with sex, age, and 25OHD classification. An increased likelihood of i-TPOAb positivity was associated with 25OHD deficiency (odds ratio [OR]: 2.428, 95% confidence interval [CI]: 1.383–4.261) and 25OHD inadequacy (OR: 1.198, 95% CO: 0.828–1.733; p = 0.008). An increased likelihood of i-TgAb positivity was associated with 25OHD deficiency (OR: 2.366, 95% CI: 1.366–4.099) and 25OHD inadequacy (OR: 1.263, 95% CI: 0.883–1.807; p = 0.009). Relative to healthy subjects, patients with HT had significantly higher proportions of Th1 and Th17 cells, as well as higher concentrations of related cytokines. Conclusions: This study revealed that vitamin D deficiency was associated with thyroid autoantibody positivity, and that vitamin D deficiency seems to be involved in the pathological mechanism underlying HT. Large randomized controlled trials are needed to investigate the effects of vitamin D supplementation on HT. [ABSTRACT FROM AUTHOR]

Depression and bipolar disorder are two major psychiatric illnesses whose pathophysiology remains elusive. Newly emerging data support the hypothesis that the dysfunction of the immune system might be a potential factor contributing to the development of these mental disorders. The most common organ affected by autoimmunity is the thyroid; therefore, the link between autoimmune thyroid disorders and mental illnesses has been studied since the 1930s. The aim of this review is to discuss the associations between thyroid autoimmunity, depression and bipolar disorder.

Introduction The range of normal thyroid functions during pregnancy differs between ethnic groups. Establishment of trimester- and assay-specific reference intervals for every population is recommended. Aim Assessement of the changes in thyroid function tests across the different trimesters in normal pregnant Egyptian females. Subjects and methods The study included 150 normal pregnant Egyptian females, recruited from Cairo university hospital antenatal care clinic, with 100 age-matched non-pregnant females, as a control group. Serum thyroid stimulating hormone (TSH) and free thyroxine (FT4) were measured in the three trimesters of pregnancy for every patient. Thyroid peroxidase antibodies (TPO Abs) were also assessed. Our study showed that TSH reference ranges, using the 2.5th and the 97th percentiles, were 0.6–4.3, 0.9-3.7 and 1.0–4.2 mIU/ml for the first, second and third trimesters respectively. The median TSH concentration (50th percentile) was lower in the first trimester (2.1 mIU/ml) in comparison with the second and third trimesters of (2.6 and 2.9 mIU/ml respectively). FT4 reference ranges, using 2.5th to 97th percentile, were 0.9–2 and 0.7–1.4 and 0.6–1.2 ng/dl for the first, second and third trimesters respectively. The median FT4 concentration was higher in the first trimester (1.5 ng/dl) in comparison with the second and third trimesters of (1.1 and 1.0 ng/dl respectively). The percentage of positive TPO Ab was higher in pregnant women than that of age matched non-pregnant ladies (15.3 vs 2%, P

Background: Immunotherapies targeting peripheral natural killer (pbNK) cells in unexplained recurrent miscarriage (uRM) remain controversial. We hypothesized that the change in pbNK cell count might be a result of innate immune responses rather than a cause., Objective: To explore whether the pbNK count is significantly different in women testing positive than those testing negative for commonly studied autoimmune markers., Methods: Peripheral blood samples were collected from 302 eligible patients with uRM for the antinuclear antibody (ANA) testing determined by the enzyme-linked immunosorbent assay (ELISA), anti-thyroid peroxidase antibody (TPO-Ab) testing and anti-thyroglobulin antibody (Tg-Ab) testing determined by the chemiluminescent immunoassay, and pbNK cell testing determined by flow cytometry. The patients were divided into two groups according to the pbNK normal range, and the comparative analysis entailed an examination of the prevalence rates of autoantibodies within the high pbNK group and the normal pbNK group, followed by a comprehensive investigation into the potential correlations between autoantibodies and pbNK cells., Results: There was a positive association between TPO-Ab positivity and high pbNK cells (p=0.016, OR=5.097, 95% CI 1.356-19.159), while there was a negative association between ANA positivity and high pbNK cells (p=0.013, OR=0.293, 95% CI 0.111-0.773). TPO-Ab-positive patients had a higher pbNK cell count compared with TPO-Ab-negative patients, while ANA-positive patients had a lower pbNK cell count compared with ANA-negative patients., Conclusion: The change in pbNK cell count may be a consequence of immune responses, and there should be careful consideration in applying it as an immunotherapeutic index.

Hashimoto's thyroiditis (HT) poses diagnostic challenges due to its diverse clinical presentation and the intricacies of autoimmune thyroid diseases. This comprehensive narrative review explores the evolving landscape of diagnostic challenges in HT, aiming to provide a thorough understanding of the complexities involved in its diagnosis. The diagnostic criteria for HT involve a multifaceted approach, including clinical features, laboratory findings, and imaging studies. Serum antibodies against thyroid antigens, primarily thyroperoxidase (TPO) and thyroglobulin, play a crucial role in confirming the autoimmune nature of the disease. However, seronegative HT adds complexity by presenting without detectable antibodies. The significance of addressing diagnostic challenges lies in potential delays and misdiagnoses, emphasizing the need for accurate and timely intervention. The review explores future directions, emphasizing molecular and cellular aspects, genetic factors, and the emerging field of thyroid regeneration. Standardized diagnostic criteria are essential, considering the subjective nature of the current process. The heterogeneity of disease manifestations complicates targeted treatments, necessitating a deeper understanding of clinical presentations and underlying pathophysiology. Future research directions and challenges outlined in this review contribute to advancing our understanding and improving diagnostic precision in HT., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Kolanu et al.)

Background: Thyroid autoimmunity (TAI) and subclinical hypothyroidism (SCH) have been associated with poor pregnancy and fetal outcomes. However, whether euthyroid women with anti-thyroid peroxidase antibody (TPOAb) positivity have a higher risk of poor pregnancy and fetal outcomes is debatable. Therefore, this study aimed to investigate the association between TPOAb positivity and pregnancy-related and fetal outcomes in euthyroid women.Methods: In total, 938 pregnant women participated in this prospective cohort study. The euthyroid group included 837 pregnant women and the TPOAb-positive group included 101 euthyroid pregnant women. Serum TPOAb, thyroglobulin antibody (TGAb), thyroid-stimulating hormone (TSH), and free thyroxine (FT4) levels were assessed. Pregnancy and fetal outcomes included gestational diabetes mellitus, spontaneous abortion, premature rupture of membranes, hypertensive disorders of pregnancy, preterm birth, fetal distress, low birth weight, fetal macrosomia, and small for gestational age infant.Results: Logistic regression analysis showed TPOAb positivity was not associated with an increased risk of poor pregnancy or fetal outcomes in euthyroid women. However, TPOAb-positive euthyroid women pregnant with a female fetus were independently associated with preterm births (OR: 4.511, 95% CI: 1.075-18.926) after adjustment for potential confounding factors.Conclusions: TPOAb positivity was not found to be associated with poor pregnancy-related or fetal outcomes in euthyroid women. However, in euthyroid women with a female fetus, TPOAb positivity was strongly associated with preterm births. The risk of preterm birth in the euthyroid women with TPOAb positivity should be emphasized in clinical practice.Trial Registration: ClinicalTrials.gov Identifier: NCT02966405 . Registered on October 24th 2016 - Retrospectively registered. [ABSTRACT FROM AUTHOR]

Does initiating levothyroxine treatment based on thyroid-stimulating hormone (TSH) >2.5 mIU/l or thyroid autoimmunity improve pregnancy continuation rates in recurrent pregnancy loss (RPL) patients? A retrospective cohort study of 1064 RPL patients, in which subjects were classified as either euthyroid (TSH 0.1 to ≤2.5 mIU/l), borderline-subclinical hypothyroid (borderline-SCH, TSH 2.5 to ≤4 mIU/l) or subclinical hypothyroid (SCH, TSH 4 to ≤10 mIU/l). For subjects with ≥2 pregnancy losses and a subsequent pregnancy with known outcome, a comparison was done of the pregnancy continuation rate past 10 weeks of treated and untreated borderline-SCH (n = 98) and untreated euthyroid (n = 279) subjects, and between subjects with positive (n = 18) and negative (n = 206) thyroid peroxidase (TPOAb tests) within the borderline-SCH and euthyroid groups. 72.7% were euthyroid (721/992), 19.4% (192/992) were borderline-SCH, and 5.4% (54/992) were subclinically hypothyroid (SCH). Of 401 women with a subsequent pregnancy of known outcome at 10 gestational weeks, 21% received treatment with levothyroxine. 57.7% of subjects had a TPOAb test, which was positive in 9.25% (37/400) in euthyroid, 16.5% (22/133) in borderline-SCH subjects and 35.3% (12/34) in SCH subjects. Treatment did not improve pregnancy continuation rates in borderline-SCH subjects (P = 0.392). There was no difference in pregnancy outcomes based on TPOAb status and treatment for borderline-SCH subjects (P = 0.4214), or based on TPOAb status for euthyroid subjects (P = 0.2668). Treatment of hypothyroidism in pregnancy should be initiated based on a TSH >4 mIU/l. Treatment initiation based on thyroid autoimmunity or a TSH >2.5 mIU/l may result in overtreatment. [ABSTRACT FROM AUTHOR]

The normal range of thyroid functions during pregnancy differs between ethnic groups. This study assessed the thyroid functions in normal pregnant Egyptian females. Thyroid peroxidase antibodies (TPO Abs) and thyroid volume were also assessed. The study included 150 normal pregnant Egyptian females, recruited from Cairo University Hospital Antenatal Care Clinic (50 in each trimester), with 40 age-matched non-pregnant females, as a control group. Serum thyroid stimulating hormone (TSH) and TPO Abs were measured. Thyroid volume was assessed by ultrasonography. TSH ranges were 0.21–1.7, 0.52–3.2 and 0.72–2.6 mIU/L during first, second and third trimesters, respectively. The mean TSH level in pregnant females was significantly lower than that of non-pregnant women (1.2 ± 0.7 vs 2.7 ± 0.9 mIU/L, p <.001). TPO Abs were significantly higher in the first trimester compared to both second and third trimesters (p <.001 for both). Thyroid volume of pregnant females was non-significantly higher than that of non-pregnant control subjects (p =.126). A significant positive correlation was found between thyroid volume and body mass index in pregnant females (p < 0.001). Our study established trimester-specific reference ranges for thyroid functions in normal pregnant Egyptian females. A larger population-based study would help to confirm those ranges. Thyroid volume was non-significantly higher than that of non-pregnant control subjects. [ABSTRACT FROM AUTHOR]

The article analyzes new recommendations for the management of pregnant women with inflammatory thyroid diseases, compiled by leading experts of the American Thyroid Association (2017).

Background. The results of current numerous scientific researches testify to many-sided influence of vitamin D on different organs and systems of human organism. Purpose of the study — to study the effects of the additional cholecalciferol supplementation on the indexes of thyroid peroxidase (TPO) antibodies in patients with autoimmune hypothyroidism. Materials and methods. There were 65 patients with primary hypothyroidism aged 27–59 years, randomized into 2 groups. Cholecalciferol was additionally prescribed to the patients of the first group (n = 36) in a dose of 4000 IU/day (28000 IU/week) during three months on a background of levothyroxine therapy. The patients of the second group (n = 29) received only levothyroxine therapy. Results. Among inspected patients with hypothyroidism, 61 (93.9 %) had deficiency and insufficiency of vitamin D. As for patients with hypothyroidism, a significant negative correlation was detected between the levels of 25(ОН)D and TPO antibodies (r = –0.17; р = 0.046). The additional administration of vitamin of D results in a significant decline in the level of TPO antibodies (–46.7 %) in patients with hypothyroidism. On the whole, a decrease in TPO antibody level by 25 % or more was achieved in 80.6 % of patients. Conclusions. Use of vitamin of D resulted in a significant increase of 25(OH)D content in the blood serum with the corresponding reduction of parathyroid hormone concentration, decrease of thyroid peroxidase antibodies level.

Introduction: Vitamin D deficiency is one of the major health problems globally, and the role of Vitamin D as an immunomodulator has been recently emphasized. There is increasing evidence to suggest that Vitamin D plays a significant role in reducing the incidence of autoimmune diseases. However, at present, its role in autoimmune thyroid disease is not conclusive. Hence, in our study, we aimed to examine the relationship between thyroid peroxidase antibodies (TPOAbs) and Vitamin D deficiency in the hypothyroid patient. Subjects and Methods: One hundred and four known hypothyroid patients not on Vitamin D supplementation were included in the study. They were divided into two groups with TPOAb positive and TPOAb negative, and serum 25(OH) Vitamin D3 (25[OH] D3) was measured and compared in two groups. Thyroid hormones (TSH and T4) were also evaluated in all patients. Results: Serum 25(OH)D3 was significantly lower in TPOAb-positive patients than in TPOAb-negative patients with P = 0.038. Mean serum TSH was significantly high in TPOAb-positive hypothyroid patients than in TPOAb-negative patients with P = 0.047. Conclusion: Our study shows that patients with TPOAb positivity have more significant 25(OH)D3 deficiency and uncontrolled hypothyroidism. Our study encourages the advisability of screening for Vitamin D deficiency for all hypothyroid patients and 25(OH)D3 supplementation.

Study Question: How does subclinical hypothyroidism, defined in infertile women during preconception by thyroid-stimulating hormone (TSH) >2.5 or >4.5 mIU/l, with or without thyroid peroxidase antibodies (anti-TPO) >100 IU/ml, impact thyroid hormone levels during pregnancy and after birth?, Summary Answer: During pregnancy, TSH levels remain similar to those in preconception, even with supplementary thyroxine, whereas the serum levels of anti-TPO progressively decline., What Is Known Already: Overt hypothyroidism impacts both pregnancy and offspring but randomized clinical trials and cohort studies failed to detect the benefit of treatment with thyroxine in cases with low-threshold TSH or with anti-TPO during pregnancy., Study Design Size Duration: First, the prevalence and reproducibility of two candidate cut-off levels of subclinical hypothyroidism in a cohort of 177 infertile women was compared with 171 women not aiming for pregnancy. Second, the impact of distinct setpoints of TSH in preconception (with or without anti-TPO) was monitored during pregnancy in 87 previously infertile women by high-frequency monitoring of thyroid function. Both studies were carried out from 2007 to 2019., Participants/materials Setting Methods: Reproducibility and prevalence of subclinical hypothyroidism were examined in infertile women presenting in the fertility care unit of an academic institution. Women not aiming for pregnancy participated as controls. In both groups, TSH and anti-TPO were measured two times on different occasions. In addition, a group of previously infertile women with known preconception setpoints of TSH (with or without anti-TPO) were followed up prospectively throughout pregnancy and after birth. During pregnancy, serum was sampled weekly until Week 12, then monthly until delivery, and once after birth. Only cases with preconception TSH >4.5 mIU/l were supplemented with thyroxine. After collection of all samples, the serum levels of anti-TPO and the major thyroid hormones were measured. Prolactin with known fluctuations during pregnancy was used as reference., Main Results and the Role of Chance: Measures of both TSH and anti-TPO at two different time points were accurate and reproducible. The odds of subclinical hypothyroidism in infertile women and controls were similar. During pregnancy, TSH closely followed preconception TSH levels, whereas serum levels of the thyroid hormones predominantly remained within or above (not below) the reference. Treatment of infertile women with preconception TSH >4.5 mIU/l with thyroxine resulted in higher free thyroxine (fT4) serum levels. The serum levels of anti-TPO declined as pregnancies evolved., Limitations Reasons for Caution: The numbers of participants both in the prevalence study and in pregnancy did not reach the a priori estimated numbers. For ethical reasons, the patients with preconception TSH >4.5 mIU/l were treated with thyroxine. The findings apply to infertile women only., Wider Implications of the Findings: We propose to use >4.5 mIU/l as the serum TSH threshold for supplementing women with thyroxine before pregnancy. During pregnancy, fT4 may be the better marker to monitor thyroid function. The consistent decrease of anti-TPO antibody levels during ongoing pregnancies must be considered a protective element., Study Funding/competing Interests: The prevalence part of this study was supported by Merck-Serono, Geneva (TH006/EMR200007-603). The hormone measurements of the serum samples collected during the follow-up pregnancies were made possible by financial support of Roche Diagnostica (November 1721, 2017, Rotkreuz, Switzerland). I.D.G. was supported by a grant of the Repronatal Foundation, Basel, Switzerland. All authors declare no conflict of interest., Trial Registration Number: Research Database of UniBasel, project no. 576691 (2007)., Competing Interests: The prevalence part of this study was supported by Merck-Serono, Geneva (TH006/EMR200007-603). The hormone measurements of the serum samples collected during the follow-up pregnancies were made possible by financial support of Roche Diagnostica (November 1721, 2017, Rotkreuz, Switzerland). I.D.G. was supported by a grant of the Repronatal Foundation, Basel, Switzerland. All authors declare no conflict of interest.All authors declare no conflict of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology.)

Objective: The current understanding regarding the clinical significance of TSH receptor antibodies in chronic autoimmune thyroiditis is controversial. The aim of this study was to examine the frequency of elevated TSH receptor antibodies in euthyroid and hypothyroid autoimmune thyroiditis. Furthermore, their associations with the levels of thyroid hormones and autoantibodies (thyroid peroxidase and thyroglobulin antibodies [TgAb]), and the thyroid volume were also investigated. Material and Methods: This cross-sectional study included recently diagnosed euthyroid (N=86) and hypothyroid (N=54) autoimmune thyroiditis patients along with the patients who were on levothyroxine replacement (N=66). The levels of TSH, free T4, free T3, TSH receptor antibodies, thyroid peroxidase, and thyroglobulin antibodies were measured using ECLIA (Roche Diagnostics, Switzerland). A 9 MHz transducer (Fukuda Corp., Japan) for thyroid ultrasound and a 14 MHz transducer (Ultrasonix Medical Corp., Canada) for Doppler ultrasound were employed. Statistical analyses were done with the help of IBM SPSS 19.0 software. Results: The elevated levels of TSH receptor antibodies were observed in 6.3% of the participants (12 females and 1 male) and exclusively in hypothyroid subjects, who were either untreated (7.4%) or on levothyroxine treatment (7.6%). The highest and the lowest prevalence of positive TSH receptor antibodies were seen in patients with positive thyroglobulin antibodies & negative thyroid peroxidase (17.6%) and positive thyroid peroxidase & negative thyroglobulin antibodies (3.3%), respectively. Higher levels of TSH receptor antibodies were associated with a shorter duration of the disease (22 vs. 36 months), lower titers of thyroglobulin antibodies (281.2 vs. 400.9 UI/L), decreased thyroid volumes (9.4 vs. 14.2 cm3) and an increased prevalence of orbitopathy (23.1 vs. 4.1%). In the whole study population, TSH receptor antibodies levels were related to fT4 (linear R2=0.271, p=0.039), titers of thyroid peroxidase (quadratic, R2=0.048, p=0.034), and thyroid volume (compound R2=0.041, p=0.011). However, in the TSH receptor antibodies positive patients, the correlation was seen only with the levels of thyroid peroxidase (compound R2=0.503, p=0.032). Conclusion: TSH receptor antibodies positivity cannot be considered negligible in Hashimoto's thyroiditis. The elevated levels of TSH receptor antibodies might result in a predisposition to a more unstable thyroid function, lower thyroid volumes, specific profiles of thyroid peroxidase, and thyroglobulin antibodies and a higher prevalence of thyroid-associated ophthalmopathy. [ABSTRACT FROM AUTHOR]

Previous studies assessing the association between thyroid antibodies and the risk of thyroid cancer (TC) have produced inconsistent results. The present study therefore conducted a meta-analysis of the available data. PubMed, Embase and the Cochrane Library were searched for the retrieval of relevant studies and a meta-analysis was conducted to systematically evaluate the association between positive thyroid antibodies and the risk of TC. This search identified 16 articles containing 17 studies on thyroglobulin antibodies (TgAb), which involved a total of 34,488 patients. Positive TgAb was associated with an increased risk of TC [odds ratio (OR)=1.93, 95% confidence interval (CI)=1.64–2.27, I2=67.2%]. Whether to adjust for confounding factors (gender and thyroid nodule number) was the main cause of heterogeneity. A stronger association between positive TgAb and an increased risk of TC was identified in the studies with an unadjusted thyroid nodule number (OR=2.14, 95% CI=1.82–2.52), as compared to those with an adjusted thyroid nodule number (OR=1.61, 95% CI=1.29–2.00; P=0.04). In addition, 12 studies on thyroid peroxidase antibodies (TPOAb) involving 30,007 patients were included. Positive TPOAb was associated with an increased risk of TC (OR=1.50, 95%CI=1.16–1.95, I2=83.0%). No significant heterogeneity was observed in the PTC group. Positive TgAb is an independent risk factor for TC. The association between positive TPOAb and increased risk of TC needs to be further studied. [ABSTRACT FROM AUTHOR]