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We collected thyroid-related hormone index levels, sleep duration, and other basic characteristics of the population with depression from the NHANES 2009–2012 cycles and evaluated the association of Thyroid-Stimulating Hormone Index (TSHI) with sleep duration in the euthyroid population with depression via different analysis methods. We found that the association between TSHI and sleep duration was only found in patients with depression degree < Moderate (score: 1–14) rather than > Moderate group. Among the populations with degree < Moderate (N = 1918), only 4 indexes (parametric Thyroid Feedback Quantile Index, PTFQI, Thyrotroph Thyroxine Resistance Index, TT4RI, Thyroid-Stimulating Hormone TSH, and TSHI) reflecting the sensitivity to thyroid hormones were related to the sleep duration, with a significant non-linear relationship after adjusting for potential confounders (all P < 0.05). Trend analysis indicated that with the level increase of these 4 indexes, the sleep duration increased (all P for trend < 0.001). Further, we found that TSHI was relatively more important among the 4 indexes. Sum up, sensitivity to thyroid hormones is associated with sleep duration in the euthyroid population with depression degree lower than Moderate. Poor sensitivity referred to a longer sleep duration. [ABSTRACT FROM AUTHOR]

Simple Summary: Immune-related adverse events (irAEs) are one of the most common complications after cancer treatment caused by immune checkpoint inhibitors (ICIs). We performed an extensive review of the potential tests to predict irAEs in patients who receive ICIs. Approximately 40% of patients who receive ICIs experience irAEs. Despite this, only thyroid function tests are currently in mainstream use for predicting who will experience the adverse effects (namely, thyroid function abnormalities) from ICI treatment. A significant amount of research has paved the way for further potential tests that can be used in the clinic, but none have been meaningfully implemented in clinical practice. Nonetheless, further research on identifying these tests and incorporating them into clinical practice to help predict irAEs for patients with cancer will be significant in the field of ICI therapy. Immune-related adverse events (irAEs) are the most common complication of immune checkpoint inhibitor (ICI) therapy. With the widespread use of ICIs in patients with solid tumors, up to 40% of the patients develop irAEs within five months of treatment, and 11% develop severe irAEs requiring interventions. A predictive test for irAEs would be a crucial tool for monitoring for complications during and after ICI therapy. We performed an extensive review of potential predictive biomarkers for irAEs in patients who received ICI therapy. Currently, only thyroid-stimulating hormone is utilized in common clinical practice. This is due to the unavailability of commercial tests and unclear predictive values from various studies. Given the lack of single strong predictive biomarkers, some novel approaches using composite scores using genomic, transcriptomics, cytokine levels, or clinical parameters appear appealing. Still, these have yet to be validated and incorporated into clinical practice. Further research conducted to validate the models before implementing them into real-world settings will be of the utmost importance for irAE prediction. [ABSTRACT FROM AUTHOR]

Purpose: The Swiss voluntary salt iodisation programme has successfully prevented iodine deficiency for 100 years, but dietary habits are changing and today only one-third of processed foods contain iodised salt. We aimed to monitor the current iodine status in children and pregnant women. Methods: We conducted a nationwide cross-sectional study in children (6–12 years) and pregnant women and measured the urinary iodine concentration (UIC) in spot urine samples. We estimated the iodine intake using UIC and urinary creatinine concentration (UCC) and determined the prevalence of intakes below the average requirement (AR) using the SPADE method. We measured dried blood spot (DBS) thyroglobulin (Tg), TSH and total T4 in pregnant women. Results: The median UIC was 127 μg/L (bootstrapped 95% CI 119, 140, n = 362) in children and 97 μg/L (bootstrapped 95% CI 90, 106, n = 473) in pregnant women. The estimated prevalence of inadequate iodine intake (< 65 μg/day) was 5.4% (bootstrapped 95% CI 0.0, 14.6) in children. Half (47%) of the women consumed iodine-containing multivitamin and mineral supplements (≥ 150 μg/day). Compared to non-users, users had higher median UIC (129 vs. 81 μg/L, P < 0.001), lower prevalence of inadequacy (< 160 μg/day; 0.2 vs. 31%) and lower DBS-Tg (23 vs. 29 μg/L, P < 0.001). All women were euthyroid. Conclusions: The Swiss diet and current salt fortification provides adequate iodine intake in children, but not in all pregnant women. Iodine supplements cover the dietary gap in pregnancy but are not universally consumed. Therefore, improved use of iodised salt in processed foods is desired to ensure adequate iodine intake in all population groups. This trial was registered at clinicaltrials.gov as NCT04524013. [ABSTRACT FROM AUTHOR]

Background: Polycystic ovarian syndrome (PCOS) can be diagnosed when the anti-Müllerian hormone (AMH) levels are high, but in clinic, women who do not meet the diagnosis of PCOS but have elevated AMH levels are often seen. This study aimed to compare the differences in menstrual cycle patterns and hormone levels in women with regular menstrual cycles, but not PCOS, by dividing them into high and low AMH groups. Material and Methods: This multicenter prospective study included 68 healthy women. Participants with regular menstrual cycles were divided into two groups according to their AMH levels. The main outcome measures were menstrual cycle pattern, body mass index, and hormone levels (thyroid stimulating hormone, prolactin, testosterone, sex hormone-binding globulin, and free androgen index), which were compared between the groups according to AMH levels. The ovulation was assessed by performing pelvic ultrasound, and by assessing the hormone levels of the luteinizing hormone and progesterone. Results: The criteria for determining normal and high AMH levels were based on previous literatures. The participants were divided into normal (39 people) and high (29 people) AMH group. No differences were found in age or BMI between the two groups, and no other differences were observed in TSH, prolactin, testosterone, or free androgen index. However, the high AMH group had significantly higher SHBG levels than the normal group (normal group: 65.46 ± 25.78 nmol/L; high group: 87.08 ± 45.05 nmol/L) (p = 0.025). Conclusions: This study is the first to analyze the association between SHBG and AMH levels in women with regular menstrual cycles. Elevated AMH levels are associated with increased levels of SHBG levels. [ABSTRACT FROM AUTHOR]

Sodium nitrite and quercetin are frequently employed as protective agents on glucose levels, levels of thyroid hormones, and lipid profile. The present study aimed to see the quercetin effect on some biochemical parameters in adult rats treated with sodium nitrite. A total of twenty-one laboratory animals (Wistar albino rats) were used in this experiment, separated into three groups of seven animals each. During the trial, Group I was given water only to drink and Group II received sodium nitrite directly by oral feeding needle. The study used 80 mg.kg-1/body weight (BW) of sodium nitrite, while Group IIIreceived drinking water containing sodium nitrite orally in doses of up to 80 mg.kg-1 BW and quercetin with a (50 mg/kg). After blood was drawn and serum extracted, the parameters determined were thyroid hormones, lipids, Homeostasis Model Evaluation for Insulin Resistance (HOMA-IR) and glucose level. The study observed that compared to the controls, the insulin (HOMA-IR) and sugar levels and lipid profile of the sodium-nitrite treated group were much higher. The sodium nitrite-treated group also had a substantial drop in thyroid hormone concentrations and a rise in Thyroid Stimulated Hormone (TSH), whereas the quercetin alleviated the harmful effects of sodium nitrate by lowering blood sugar, insulin, HOMA-IR, and improved the lipid profile. There was an improvement in glucose, insulin resistance, lipidemia, and TSH hormone levels, which increased as a result of exposure to nitrite. Thus, the present study demonstrated how quercetin protected against sodium nitrite-induced toxicity by improving several biochemical parameters in adult rats. [ABSTRACT FROM AUTHOR]

The objective of this study was to observe the clinical efficacy of apatinib (AP) combined with 131I in the treatment of radioiodine-refractory differentiated thyroid cancer (RAIR-DTC) and the prognostic significance of MIP-1α after treatment, and to provide reference and guidance for future treatment and disease assessment of RAIR-DTC. One hundred and six patients with RAIRDTC admitted to our hospital from January 2019 to October 2020 were selected for the study. All the patients were treated with TC surgery with 131I at our hospital, and 58 of them were subsequently transferred to AP treatment, which was considered as the research group; the other 48 patients were transferred to thyroid stimulating hormone (TSH) suppression treatment, which was considered as the control group. The clinical efficacy of the research group was better than that of the control group (P < 0.05), while no difference was seen in the comparison of the incidence of adverse effects and thyroid function (P > 0.05). After treatment, Tg, TL, maximum diameter of C/B lymph nodes, number of lymph nodes and number of calcified spots were lower in the research group than in the control group (P < 0.05). ROC analysis revealed that the predictive sensitivity of MIP-1α for prognosis of 3-year RAIR-DTC death in the research group of patients was 84.63 % and the specificity was 72.16 %. AP combined with 131I is effective in the treatment of RAIR-DTC and is worth using in the clinical practice. In addition, elevated levels of MIP-1α predicted a poor prognosis for patients with RAIR-DTC. [ABSTRACT FROM AUTHOR]

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

This study aimed to evaluate whether there is a causal relationship between autoimmune thyroid disorders (AITDs) and telomere length (TL) in the European population and whether there is reverse causality. In this study, Mendelian randomization (MR) and colocalization analysis were conducted to assess the potential causal relationship between AITDs and TL using summary statistics from large‐scale genome‐wide association studies, followed by analysis of the relationship between TL and thyroid stimulating hormone and free thyroxine (FT4) to help interpret the findings. The inverse variance weighted (IVW) method was used to estimate the causal estimates. The weighted median, MR‒Egger and leave‐one‐out methods were used as sensitivity analyses. The IVW method results showed a significant causal relationship between autoimmune hyperthyroidism and TL (β = −1.93 × 10−2; p = 4.54 × 10−5). There was no causal relationship between autoimmune hypothyroidism and TL (β = −3.99 × 10−3; p = 0.324). The results of the reverse MR analysis showed that genetically TL had a significant causal relationship on autoimmune hyperthyroidism (IVW: odds ratio (OR) = 0.49; p = 2.83 × 10−4) and autoimmune hypothyroidism (IVW: OR = 0.86; p = 7.46 × 10−3). Both horizontal pleiotropy and heterogeneity tests indicated the validity of our bidirectional MR study. Finally, colocalization analysis suggested that there were shared causal variants between autoimmune hyperthyroidism and TL, further highlighting the robustness of the results. In conclusion, autoimmune hyperthyroidism may accelerate telomere attrition, and telomere attrition is a causal factor for AITDs. [ABSTRACT FROM AUTHOR]

Thyroid eye disease is an autoimmune disorder characterized by inflammation of the orbital and periorbital tissues. This condition can lead to vision impairment, which is a notable manifestation of thyroid disease. The symptoms of thyroid disease reflected the level of inflammatory activity, whereas the clinical activity score was indicative of active and inactive phases. This retrospective analysis explored the intricate association between thyroid status and clinical activity score in thyroid eye disease patients, with the hope of providing a foundation for further research on the association between thyroid status and the occurrence of TED. This study utilized medical records from the years 2019 to 2022 from the Outpatient Department of Ophthalmic Oncology of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. The variables examined in this study were thyroid status and the clinical activity score of thyroid eye disease. The statistical analysis was performed using Phi and Cramer's V as well as Spearman's correlation test (p<0.05). A total of 88 patients were diagnosed with thyroid eye disease during the study period. Thyroid eye disease primarily affected female patients (58%) and those who had a mean age of ≥41 years (58%). The Phi and Cramer's V analyses indicated no significant association (p > 0.05) between thyroid status and clinical activity score in thyroid eye disease patients. Intriguingly, the results exhibited the presence of euthyroidism as well as both overt and subclinical hypothyroidism and hyperthyroidism, regardless of the clinical activity score. Additionally, the Spearman test that incorporated the levels of thyroid hormones, i.e., triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), and free thyroxine (FT4), showed a significant negative correlation (p<0.05) between TSH and clinical activity score. In conclusion, THS plays a crucial role in determining the clinical activity score of thyroid eye disease patients. This study underscores the imperative for further research to comprehensively elucidate the intricate correlation between TSH and clinical activity score. [ABSTRACT FROM AUTHOR]

Background & Objective: Occurrence of maternal or fetal complications during pregnancy may be related to development of postpartum thyroid dysfunction based on the underlying thyroid autoimmune status. The purpose of this study was to investigate the incidence of thyroid dysfunction after delivery in euthyroid mothers who have experienced adverse pregnancy outcomes. Materials & Methods: Among 387 euthyroid pregnant women, 118 experienced adverse pregnancy outcomes out of which only 96 subjects completed the study. The level of thyroperoxidase antibody in the first week after delivery and thyroid function tests including Total T4, T3RU and TSH three months after delivery were measured by electrochemiluminescence immunoassay method. SPSS version 22 was used to analyze the data and the significance level was defined as p<0.05. Results: Thyroperoxidase antibody was positive in 14 participants (14.6%). Overall maternal and fetal complications in the group with positive thyroperoxidase antibody were more than the group without this antibody (p<0.001). Total T4 level was significantly (p=0.02) higher in the group with negative thyroperoxidase antibody (8.03±1.91) comparing with the positive antibody group (6.72±1.96). Overt hypothyroidism was the only thyroid dysfunction that had a significant relationship with thyroid autoimmune status three months after delivery (p=0.02). Conclusion: This study indicates the possible occurrence of thyroid dysfunction after delivery in euthyroid mothers who have experienced maternal or fetal pregnancy complications. [ABSTRACT FROM AUTHOR]

Context: Thyroid-stimulating hormone (TSH) is one of the most ordered laboratory tests. Objective: Determine trends of TSH testing rates and components of thyroid function testing. Methods: This was a retrospective analysis of adults 18-64 years old without evidence of thyroid disease with at least 365 days of continuous enrollment between 2006 and 2020 in the IBM MarketScan Claims Database. The main outcome measures were trends of TSH tests/1000 eligible patient-months stratified by age, sex, and region and composition of thyroid function testing. Results: Among 67 353 280 patients meeting eligibility criteria, we identified 25 606 518 TSH tests and 15 138 211 patients with ≥1 TSH test. Patients contributing an episode of TSH testing were most commonly 45-54 years old (29.8%) and female (63.6%). TSH testing rates remained consistent throughout the study period with 11.4 and 11.7 TSH tests/1000 person-months in the first and last study months, respectively (mean 12.2 TSH tests/1000 person-months). TSH testing rates dropped sharply in the spring of 2020 (4.2 TSH tests/1000 person-months). Females showed a nearly 2-fold higher rate of TSH testing than males (16.1 TSH tests/1000 person-months vs 8.6 TSH tests/1000 person-months). TSH testing rates increased with age (8.2 TSH tests/1000 person-months among individuals 18-34 years old vs 15.4 TSH tests/1000 personmonths among individuals 55-64 years old). No difference in TSH testing rates was noted between regions. Thyroid function testing episodes included only TSH in most cases (70.8%). Conclusion: TSH testing rates among commercially insured individuals without known thyroid disease appears stable over time, with higher frequency in females and with increasing age. [ABSTRACT FROM AUTHOR]

Context: With age, the prevalence of subclinical hypothyroidism rises. However, incidence and determinants of spontaneous normalization remain largely unknown. Objective: To investigate incidence and determinants of spontaneous normalization of TSH levels in older adults with subclinical hypothyroidism. Design: Pooled data were used from the (1) pretrial population and (2) in-trial placebo group from 2 randomized, double-blind, placebo-controlled trials (Thyroid Hormone Replacement for Untreated Older Adults With Subclinical Hypothyroidism Trial and Institute for Evidence-Based Medicine in Old Age thyroid 80-plus thyroid trial). Setting: Community-dwelling 65+ adults with subclinical hypothyroidism from the Netherlands, Switzerland, Ireland, and the United Kingdom. Participants: The pretrial population (N = 2335) consisted of older adults with biochemical subclinical hypothyroidism, defined as ≥1 elevated TSH measurement (≥4.60 mIU/L) and a free T4 within the laboratory-specific reference range. Individuals with persistent subclinical hypothyroidism, defined as ≥2 elevated TSH measurements ≥3 months apart, were randomized to levothyroxine/placebo, of which the intrial placebo group (N = 361) was included. Main Outcome Measures: Incidence of spontaneous normalization of TSH levels and associations between participant characteristics and normalization. Results: In the pretrial phase, TSH levels normalized in 60.8% of participants in a median follow-up of 1 year. In the in-trial phase, levels normalized in 39.9% of participants after 1 year of follow-up. Younger age, female sex, lower initial TSH level, higher initial free T4 level, absence of thyroid peroxidase antibodies, and a follow-up measurement in summer were independent determinants for normalization. Conclusion: Because TSH levels spontaneously normalized in a large proportion of older adults with subclinical hypothyroidism (also after confirmation by repeat measurement), a third measurement may be recommended before considering treatment. [ABSTRACT FROM AUTHOR]

Context: Guidelines recommend use of population- and trimester-specific thyroid-stimulating hormone (TSH) and free thyroxine (FT4) reference intervals (RIs) in pregnancy. Since these are often unavailable, clinicians frequently rely on alternative diagnostic strategies. We sought to quantify the diagnostic consequences of current recommendations. Methods: We included cohorts participating in the Consortium on Thyroid and Pregnancy. Different approaches were used to define RIs: a TSH fixed upper limit of 4.0 mU/L (fixed limit approach), a fixed subtraction from the upper limit for TSH of 0.5 mU/L (subtraction approach) and using nonpregnancy RIs. Outcome measures were sensitivity and false discovery rate (FDR) of women for whom levothyroxine treatment was indicated and those for whom treatment would be considered according to international guidelines. Results: The study population comprised 52 496 participants from 18 cohorts. Compared with the use of trimester-specific RIs, alternative approaches had a low sensitivity (0.63-0.82) and high FDR (0.11-0.35) to detect women with a treatment indication or consideration. Sensitivity and FDR to detect a treatment indication in the first trimester were similar between the fixed limit, subtraction, and nonpregnancy approach (0.77-0.11 vs 0.74-0.16 vs 0.60-0.11). The diagnostic performance to detect overt hypothyroidism, isolated hypothyroxinemia, and (sub)clinical hyperthyroidism mainly varied between FT4 RI approaches, while the diagnostic performance to detect subclinical hypothyroidism varied between the applied TSH RI approaches. Conclusion: Alternative approaches to define RIs for TSH and FT4 in pregnancy result in considerable overdiagnosis and underdiagnosis compared with population- and trimester-specific RIs. Additional strategies need to be explored to optimize identification of thyroid dysfunction during pregnancy. [ABSTRACT FROM AUTHOR]

Aim: This study investigated the sex-specific association between thyroid function and various insulin resistance (IR) indices, including noninsulin-based IR indices, in euthyroid adolescents. Methods: A total of 465 adolescents (aged 12–18 years; 255 boys and 210 girls) based on data from the 2014–2015 Korea National Health and Nutrition Examination Survey were included. Serum thyrotropin (thyroid-stimulating hormone [TSH]) and free thyroxine (fT4) were used to assess thyroid function, whereas the homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin-sensitivity check index (QUICKI), glucose/insulin ratio (GIR), triglyceride–glucose (TyG) index, and triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio were used to assess IR. The relationship between thyroid function and IR was analyzed using multiple linear regressions stratified by sex, considering obesity status. Results: The relationship between thyroid function and IR varied depending on sex and was more pronounced in the overweight/obesity subgroup for both boys and girls. In overweight and obese boys and girls, fT4 was significantly associated with HOMA-IR and QUICKI with conflicting association directions. TSH was also positively associated with the TyG index in both sexes. Conclusions: The findings suggest that the relationship between thyroid function and IR in adolescents might vary depending on sex, and the degree of association was significant in obese adolescents. [ABSTRACT FROM AUTHOR]

Traumatic brain injury is often accompanied by defects in hormone levels, caused by either peripheral gland dysfunctions or by an insufficient central stimulation of hormone production. The epidemiology of endocrinological defects after traumatic brain injury is quite well described, but the consequences of hormone defects are largely unknown, especially in paediatric patients undergoing neurological rehabilitation. Only one previous study reported on a cohort of 20 children with traumatic brain injury and found a low incidence of hormone defects and a correlation between some hormone levels and neurological recovery. In this study, we performed a retrospective chart review on patients affected by severe subacute traumatic brain injury. Their levels of cortisol, ACTH, IGF-1, TSH, free T4, free T3, and prolactin were collected and compared with reference ranges; we then used regression models to highlight any correlation among them and with clinical variables; last, we probed with regression models whether hormone levels could have any correlation with clinical and rehabilitation outcomes. We found eligible data from the records of 52 paediatric patients with markedly severe traumatic brain injury, as shown by an average GCS of 4.7; their age was 10.3 years, on average. The key results of our study are that 32% patients had low IGF-1 levels and in multiple regression models, IGF-1 levels were correlated with neurological recovery, indicating a possible role as a biomarker. Moreover, 69% of patients had high prolactin levels, possibly due to physical pain and high stress levels. This study is limited by the variable timing of the IGF-1 sampling, between 1 and 2 months after injury. Further studies are required to confirm our exploratory findings. [ABSTRACT FROM AUTHOR]

Objectives: Blood tests for endocrinological derangements are frequently requested in general medical inpatients, in particular those in the older age group. Interrogation of these tests may present opportunities for healthcare savings. Methods: This multicentre retrospective study over a 2.5‐year period examined the frequency with which three common endocrinological investigations [thyroid stimulating hormone (TSH), HbA1c, 25‐hydroxy Vitamin D3] were performed in this population, including the frequency of duplicate tests within a given admission, and the frequency of abnormal test results. The Medicare Benefits Schedule was used to calculate the cost associated with these tests. Results: There were 28,564 individual admissions included in the study. Individuals ≥65 years old were the majority of inpatients in whom the selected tests were performed (80% of tests). TSH was performed in 6730 admissions, HbA1c was performed in 2259 admissions, and vitamin D levels were performed in 5632 admissions. There were 6114 vitamin D tests performed during the study period, of which 2911 (48%) returned outside the normal range. The cost associated with vitamin D level testing was $183,726. Over the study period, 8% of tests for TSH, HbA1c, and Vitamin D were duplicates (where a second test was performed within a single admission), which was associated with a cost of $32,134. Conclusions: Tests for common endocrinological abnormalities are associated with significant healthcare costs. Avenues by which future savings may be pursued include the investigation of strategies to reduce duplicate ordering and examining the rationale and guidelines associated with ordering tests such as vitamin D levels. [ABSTRACT FROM AUTHOR]

Background: Although attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, its aetiology remains unclear. We aimed to establish a relationship between ADHD diagnosis and serum levels of glucose, free thyroxine (FT4), and thyroid stimulating hormone (TSH) in primary school aged boys. Methods: In a cross-sectional study, we enrolled 133 participants aged 6.5–12.5 years, 67 of whom met DSM-5 criteria for ADHD and 66 healthy age-matched boys. The ADHDT test (ADHDT) was used to assess ADHD symptoms and the Wechsler Intelligence Scale for Children – Revised was used to exclude participants with cognitive deficits. The ADHD participants were tested using the Iowa Conners' Teacher Rating Scale. Results: The ADHD participants had lower glucose levels, higher TSH values, and significantly lower FT4 values than the control group. The multiple logistic regression analysis showed that TSH is a parameter that is 2.7% more likely to occur in the ADHD group. We found a significant correlation between the TSH level and the symptoms of hyperactivity (r = 0.318, p = 0.009) and impulsivity (r = 0.275, p = 0.024) as well as between the glucose level and the symptoms of hyperactivity (r = 0.312, p = 0.010). Conclusions: Certain ADHD symptoms may correlate with certain hormonal patterns. Our results suggest that the likelihood of suffering from ADHD was lower when FT4 levels were elevated. One biochemical parameter that was significantly and independently associated with the diagnosis of ADHD was the serum TSH level. Trial registration: On June 26, 2018, at its VI session in 2018, the Ethics Committee of the Institute for Mental Health in Belgrade, Serbia, has considered and unanimously approved the conduct of the research, under the number 1704/1. [ABSTRACT FROM AUTHOR]

Background: The role of thyroid health in temporomandibular disorders (TMDs) has been emphasized in observational studies. However, whether the causation exists is unclear, and controversy remains about which specific disorder, such as hypothyroidism or hyperthyroidism, is destructive in TMDs. This study aims to investigate the overall and specific causal effects of various thyroid conditions on TMDs. Methods: Mendelian randomization (MR) studies were performed using genetic instruments for thyrotropin (TSH, N = 119,715), free thyroxine (fT4, N = 49,269), hypothyroidism (N = 410,141), hyperthyroidism (N = 460,499), and TMDs (N = 211,023). We assessed the overall effect of each thyroid factor via inverse-variance weighted (IVW), weighted median, and MR-Egger methods, and performed extensive sensitivity analyses. Additionally, multivariable MR was conducted to evaluate the direct or indirect effects of hypothyroidism on TMDs whilst accounting for TSH, fT4 and hyperthyroidism, and vice versa. Results: Univariable MR analyses revealed a causal effect of hypothyroidism on an increased risk of TMDs (IVW OR: 1.12, 95% CI: 1.05–1.20, p = 0.001). No significant association between genetically predicted hyperthyroidism, TSH, or fT4 and TMDs. In the multivariable MR analyses, the effects of hypothyroidism on TMDs occurrence remained significant even after adjSusting for TSH, fT4 and hyperthyroidism (multivariable IVW OR: 1.10, 95% CI: 1.03–1.17, p = 0.006). No pleiotropy and heterogeneity were detected in the analyses (p > 0.05). Conclusions: Hypothyroidism might causally increase the risk of TMDs through a direct pathway, highlighting the critical role of managing thyroid health in the prevention of TMDs. Clinicians should give heightened attention to patients with hypothyroidism when seeking medical advice for temporomandibular discomfort. However, caution is warranted due to the potential confounders, pleiotropy, and selection bias in the MR study. [ABSTRACT FROM AUTHOR]

We present a comprehensive overview of changes in thyroxine (T4) and thyroid stimulating hormone (TSH) serum concentrations after pre-gestational, gestational and/or lactation exposures of rodents to various chemicals that affect the thyroid hormone system. We show that T4 and TSH changes consistent with the idealized view of the hypothalamic-pituitary-thyroid (HPT) feedback loop (T4 decrements accompanied by TSH increases) are observed with only a relatively small set of chemicals. Most substances affect concentrations of various thyroid hormones without increasing TSH. Studies of altered T4 concentrations after gestational exposures are limited to a relatively small set of chemicals in which pesticides, pharmaceuticals and industrial chemicals are under-represented. Our risk-of-bias analysis exposed deficits in T4/TSH analytics as a problem area. By relating patterns of T4 - TSH changes to mode-of-action (MOA) information, we found that chemicals capable of disrupting the HPT feedback frequently affected thyroid hormone synthesis, while substances that produced T4 serum decrements without accompanying TSH increases lacked this ability, but often induced liver enzyme systems responsible for the elimination of TH by glucuronidation. Importantly, a multitude of MOA leads to decrements of serum T4. The current EU approaches for identifying thyroid hormone system-disrupting chemicals, with their reliance on altered TH serum levels as indicators of a hormonal mode of action and thyroid histopathological changes as indicators of adversity, will miss chemicals that produce T4/T3 serum decreases without accompanying TSH increases. This is of concern as it may lead to a disregard for chemicals that produce developmental neurotoxicity by disrupting adequate T4/T3 supply to the brain, but without increasing TSH. [ABSTRACT FROM AUTHOR]

Background: Autoimmune thyroid disease (AITD) is the main cause of hypothyroidism in women of childbearing age. Bisphenol A (BPA) is an environmental factor affecting AITD. This study aims to investigate relationship between BPA and AITD in women of childbearing age, thereby contributing novel evidence for the prevention of hypothyroidism in this specific demographic. Methods: A total of 155 women of childbearing age were enrolled in this study, including the euthyroid group comprised 60 women with euthyroidism and thyroid autoantibodies negativity and the AITD group consisted of 95 women with euthyroidism and at least one thyroid autoantibody positivity. The general information, thyroid function, thyroid autoantibodies, and thyroid ultrasound results of the two groups of women of childbearing age were recorded. Urinary BPA and urinary BPA/creatinine were detected. The difference of BPA levels between the two groups was compared. logistic regression was used to analyze the correlation between BPA and AITD. Results: The proportion of multiparous and serum thyroid stimulating hormone levels were significantly higher in the AITD group compared to the euthyroid group. Logistic regression analysis revealed that BPA levels did not exhibit a statistically significant association with AITD. Spearman correlation analysis revealed a statistically significant correlation between BPA and urinary iodine levels (r=0.30, P < 0.05), as well as a correlation between urinary BPA and free tetraiodothyronine (FT4) levels (r=0.29, P < 0.05). Conclusion: This study revealed a correlation between urinary BPA levels and FT4 levels. However, it did not establish a relationship between BPA and AITD in women of childbearing age. [ABSTRACT FROM AUTHOR]

Objective: The treatment of bipolar disorder (BD) remains challenging. The study evaluated the impact of the hypothalamic-pituitary-adrenal (HPA) axis/hypothalamic-pituitary-thyroid (HPT) axis and glucose metabolism on the clinical outcomes in patients with bipolar depression (BD-D) and manic bipolar (BD-M) disorders. Methods: The research design involved a longitudinal prospective study. A total of 500 BD patients aged between 18 and 65 years treated in 15 hospitals located in Western China were enrolled in the study. The Young Mania Rating Scale (YMRS) and Montgomery and Asberg Depression Rating Scale (MADRS) were used to assess the BD symptoms. An effective treatment response was defined as a reduction in the symptom score of more than 25% after 12 weeks of treatment. The score of symptoms was correlated with the homeostatic model assessment of insulin resistance (HOMA-IR) index, the HPA axis hormone levels (adrenocorticotropic hormone (ACTH) and cortisol), and the HPT axis hormone levels (thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), free triiodothyronine (fT3), and free thyroxine (fT4)). Results: In the BD-M group, the YMRS was positively correlated with baseline T4 (r = 0.349, p = 0.010) and fT4 (r = 0.335, p = 0.013) and negatively correlated with fasting insulin (r = -0.289, p = 0.013). The pre-treatment HOMA-IR was significantly correlated with adverse course (p = 0.045, OR = 0.728). In the BD-D group, the baseline MADRS was significantly positively correlated with baseline fT3 (r = 0.223, p = 0.032) and fT4 (r = 0.315, p = 0.002), while baseline T3 (p = 0.032, OR = 5.071) was significantly positively related to treatment response. Conclusion: The HPT axis and glucose metabolism were closely associated with clinical outcomes at 12 weeks in both BD-D and BD-M groups. If confirmed in further longitudinal studies, monitoring T3 in BD-D patients and HOMA-IR for BD-M could be used as potential treatment response biomarkers. [ABSTRACT FROM AUTHOR]

Introduction: The regulation of thyroid-stimulating hormone (TSH) synthesis involves neurotransmitters, with melatonin being a subject of ongoing debate. TSH transcription, synthesis, and secretion from the pituitary pars distalis (PD) is primarily regulated in a photoperiodic manner by thyrotropin-releasing hormone (TRH). In contrast, in the pituitary pars tuberalis (PT), mRNA transcription and alpha/beta chain synthesis, but not secretion, of a TSH-like product is regulated by melatonin. Conversely, non-photoperiodic melatonin might also affect the secretion of a TSH-like product from the PT. Nevertheless, the impact of exogenous melatonin on the underlying PD-TSH synthesis remains unclear. Casein kinase 1α (CK1α) plays a negative regulatory role in TSH synthesis in the mouse pituitary. Objective: We investigated whether non-photoperiodic melatonin affects PD-TSH synthesis through its interaction with CK1α. Methods: Immunohistochemistry and immunofluorescence staining detected the colocalization of the melatonin receptor MT1 with CK1α and TSH-β in the PD. RT-qPCR, western blotting, and ELISA revealed the effect of melatonin on Tshb mRNA, MTNR1A mRNA, Csnk1a1 mRNA, CK1α protein, MT1 protein, and TSH levels. Results: Robust colocalization of the melatonin receptor MT1 with CK1α and TSH-β in the PD. Tshb mRNA and CK1α protein expression levels peaked at opposite phases of the 24-h light:dark cycle. Exogenous melatonin administration promoted pituitary TSH synthesis, while concurrently inhibiting CK1α activity. The upregulation of endogenous CK1α activity in primary pituitary cells significantly blunted the melatonin stimulatory impact on Tshb mRNA and TSH levels. Mechanistically, the CK1α agonist pyrvinium abrogated melatonin-induced activation of p-PKC and p-CREB expression in vitro. Conclusion: The CK1α/PKC signaling pathway mediates the regulation of melatonin in pituitary TSH synthesis. We demonstrate an important theoretical and experimental basis for understanding the mechanism of endocrine system diseases caused by abnormal TSH synthesis in the pituitary [ABSTRACT FROM AUTHOR]

Background: Tanycytes are specialized glial cells within the mediobasal hypothalamus that have multiple functions, including hormone sensing and regulation of hypophysiotropic hormone secretion. There are ongoing discussions about the role of tanycytes in regulating the supply of hypothalamic thyroid hormones (THs) through the expression of TH transporters (Slc16a2, Slco1c1) and deiodinases (Dio2, Dio3). In this study, we investigated the potential feedback effect of thyrotropin (TSH) on the transcription of these gatekeeper genes on tanycytes. Methods: We analyzed the changes in the expression of TH-gatekeeper genes, in TSH-stimulated primary tanycytes, using quantitative polymerase chain reaction (qPCR). We also used RNAScope® in brain slices to further reveal the local distribution of the transcripts. In addition, we blocked intracellular pathways and used small-interfering RNA (siRNA) to elucidate differences in the regulation of the gatekeeper genes. Results: TSH elevated messenger RNA (mRNA) levels of Slco1c1, Dio2, and Dio3 in tanycytes, while Slc16a2 was mostly unaffected. Blockade and knockdown of the TSH receptor (TSHR) and antagonization of cAMP response element-binding protein (CREB) clearly abolished the increased expression induced by TSH, indicating PKA-dependent regulation through the TSHR. The TSH-dependent expression of Dio3 and Slco1c1 was also regulated by protein kinase C (PKC), and in case of Dio3, also by extracellular signal-regulated kinase (ERK) activity. Importantly, these gene regulations were specifically found in different subpopulations of tanycytes. Conclusions: This study demonstrates that TSH induces transcriptional regulation of TH-gatekeeper genes in tanycytes through the Tshr/Gαq/PKC pathway, in parallel to the Tshr/Gαs/PKA/CREB pathway. These differential actions of TSH on tanycytic subpopulations appear to be important for coordinating the supply of TH to the hypothalamus and aid its functions. [ABSTRACT FROM AUTHOR]

To examine correlation between elevated levels of thyrotropin with the frequency of miscarriages. A cross-sectional study was conducted on the 380 respondents and it investigated TSH (thyrotropin), thyroid peroxidase antibody(anti-TPO) and free thyroxine (FT4) in pregnant women who had a miscarriage (N = 179) and pregnant women with normal pregnancies (N = 201). The incidence of subclinical hypothyroidism in the miscarriages group was higher than in control group (61.4% vrs 15.79% (p < 0.001). In the miscarriages group with hypothyroidism (first trimester) mean value of TSH was significantly higher 4.31 ± 2.55 mIU/L compared to the control group 1.95 ± 0.86mIU/L (p < 0.001). Logistic multivariate regression revealed that TSH and body mass index (BMI) have a significant influence on the miscarriage; TSH level has a higher odds ratio (OR) 1.47 CI (95% 1.22–1.78) than BMI (OR) 1.14 CI (95% 1.06–1.23)) (p < 0.001). The combination of thyroid autoimmunity and TSH > 2.5mIU/L increase the risk of miscarriage (65.75%) compared to positive anti-TPO antibodies and TSH < 2.5mIU/L(14.15%)(p < 0.001). Higher TSH levels correspond with obesity during early pregnancy and may be a sign of maternal thyroid dysfunction. Physiological thyroid function in the first trimester of pregnancy is important for perinatal outcome. [ABSTRACT FROM AUTHOR]

Objective: Prevalence of subclinical thyroid disease increases with age, but optimal detection and surveillance strategies remain unclear particularly for older men. We aimed to assess thyroid stimulating hormone (TSH) and free thyroxine (FT4) concentrations and their longitudinal changes, to determine the prevalence and incidence of subclinical thyroid dysfunction in older men. Design, Participants and Measurements: Longitudinal study of 994 community‐dwelling men aged ≥70 years without known or current thyroid disease, with TSH and FT4 concentrations assessed at baseline and follow‐up (after 8.7 ± 0.9 years). Factors associated with incident subclinical thyroid dysfunction were examined by logistic regression and receiver operating characteristic analyses. Results: At baseline, 85 men (8.6%) had subclinical hypothyroidism and 10 (1.0%) subclinical hyperthyroidism. Among 899 men euthyroid at baseline (mean age 75.0 ± 3.0 years), 713 (79.3%) remained euthyroid, 180 (20.0%) developed subclinical/overt hypothyroidism, and 6 (0.7%) subclinical/overt hyperthyroidism. Change in TSH correlated with baseline TSH (r =.16, p <.05). Change in FT4 correlated inversely with baseline FT4 (r = −0.35, p <.05). Only higher age and baseline TSH predicted progression from euthyroid to subclinical/overt hypothyroidism (fully‐adjusted odds ratio [OR] per year=1.09, 95% confidence interval [CI] = 1.02‐1.17, p =.006; per 2.7‐fold increase in TSH OR = 65.4, CI = 31.9‐134, p <.001). Baseline TSH concentration ≥2.34 mIU/L had 76% sensitivity and 77% specificity for predicting development of subclinical/overt hypothyroidism. Conclusions: In older men TSH concentration increased over time, while FT4 concentration showed little change. Subclinical or overt hypothyroidism evolved in one fifth of initially euthyroid men, age and higher baseline TSH predicted this outcome. Increased surveillance for thyroid dysfunction may be justified in older men, especially those with high‐normal TSH. [ABSTRACT FROM AUTHOR]

Objective: Unexplained infertility affects nearly one‐third of infertile couples. Women with unexplained infertility are more likely to have a high‐normal thyroid‐stimulating hormone level (TSH: 2.5–5 mIU/L) compared to women with severe male factor infertility. Practice guidelines vary on whether treatment should be initiated for TSH levels >2.5 mIU/L in women attempting conception because the effects of treating a high‐normal TSH level with levothyroxine are not known. We evaluated conception and live birth rates in women with unexplained infertility and high‐normal TSH levels. Design, Patients and Measurements: Retrospective study including 96 women evaluated for unexplained infertility at a large academic medical centre between 1 January 2000 and 30 June 2017 with high‐normal TSH (TSH: 2.5–5 mIU/L and within the normal range of the assay) who were prescribed (n = 31) or not prescribed (n = 65) levothyroxine. Conception and live birth rates were assessed. Results: The conception rate in the levothyroxine group was 100% compared to 90% in the untreated group (p =.086 unadjusted; p <.05 adjusted for age; p =.370 adjusted for TSH; p =.287 adjusted for age and TSH). The live birth rate was lower in the levothyroxine group (63%) compared to the untreated group (84%) (p =.05 unadjusted; p =.094 adjusted for age; p =.035 adjusted for TSH; p =.057 adjusted for age and TSH). Conclusions: Women with unexplained infertility and high‐normal TSH levels treated with levothyroxine had a higher rate of conception but lower live birth rate compared to untreated women, with the limitation of a small sample size. These findings assert the need for prospective, randomized studies to determine whether treatment with levothyroxine in women with unexplained infertility and high‐normal TSH is beneficial. [ABSTRACT FROM AUTHOR]

Sporadic thyrotoxic periodic paralysis (TPP) is a rare muscle disorder that manifests with abrupt muscle weakness and hypokalemia associated with hyperthyroidism. It is mostly reported in the Asian population, and rare in Caucasians. Only few cases have been reported in people with black ancestry. Here, we report a rare case of thyrotoxic periodic paralysis revealing Graves' disease in a young Malian. A 17‐year‐old man was admitted in the Neurology clinic with rapid proximal tetraplegia that started after strenuous physical activities at the school. Clinical examination confirmed the proximal weakness. In addition, he had bilateral ptosis, exophthalmia, and horizontal ophthalmoplegia. Laboratory testing showed normal serum potassium and creatinine, low calcium and TSH levels. However, CK, FT4, thyroid stimulating hormone antibody, and acetylcholine receptor antibody levels were high. In addition, electrocardiogram was normal while thyroid Doppler‐ultrasound showed heterogeneous, hypoechogenic, hypertrophic, and hyper vascularized gland. Patient had completely recovered his limb weakness within the following hours with symptomatic treatment. The clinical findings were consistent with Graves' disease, and he was put on Neomercazole. He did not present another episode of paralysis after 4‐years of follow up. This is a first case of thyrotoxic periodic paralysis reported in Mali and one of the rare cases in sub‐Saharan Africa. Despite its scarcity, all patients with acute weakness consecutive to effort, whether recurring or not, should be screened for TPP. [ABSTRACT FROM AUTHOR]

This research was designed to study some hormonal and physiological aspects of women with Premature Ovarian Insufficiency (POI). Blood samples were collected from the Infertility and Gynecology Unit at Al-Batoul Teaching Hospital in Baqubah and private women's clinics, including ages between 20 and 40. The study took place from 12/1/2022 until 5/1/2023, and informed consent was obtained from all patients. The study included 45 women with premature ovarian insufficiency. It was compared to a control group that consisted of 45 healthy women after confirming their fertility, at ages ranging from 20 to 40 years. The study investigated the effects of specific physiological and biochemical parameters on the disease. This was done by examining hormone levels and various biochemical levels in women with premature ovarian insufficiency. Some of the hormones examined were anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), progesterone, and thyroid hormone. The levels of vitamin D, calcium, and magnesium were also measured. The results of the current investigation showed that the age groups had a significant difference (P<0.05) with the study groups. (patients and healthy people). The age groups 31-35 and >35 years recorded the highest percentages (33.3% and 31.1%) in female patients compared to the groups <20-25 and 26-30 years, which recorded the lowest percentages (15.6% and 20.0%), respectively. The outcomes of the current investigation regarding the concentration of reproductive hormones showed a significant difference. (P<0.05) between the AMH, FSH, and LH hormone levels in the two study groups (patients and healthy individuals). The levels of FSH and LH were higher in patients (6.780 ± 15.54 and 5.44 ± 12.40) compared to healthy individuals (4.75± 6.51 and 4.04 ± 0.94), respectively. On the other hand, AMH levels were lower in patients (0.18 ± 0.42) compared to healthy individuals (0.92 ± 3.15). In terms of TSH, E2, and Progesterone hormone levels, there were no significant differences (P>0.05) between the two study groups. About the physiological investigation that included measuring the concentration of magnesium, calcium, and vitamin D, the current study demonstrated a significant difference (P<0.05) in the concentration of magnesium between the two groups. (patients and healthy people). The level of magnesium was low in patients (0.29 ± 0.75) compared to healthy people (0.30 ± 2.07). There was also a statistically significant difference (P<0.05) in the level of calcium concentration between the two study groups (patients and healthy people). The calcium level was high in patients (0.45 ± 8.33) compared to healthy people (0.58 ± 8.02). Also, significant differences (P<0.05) in the levels of vitamin D were observed between the two groups of study (patients and healthy individuals). The levels of vitamin D were low in the patients (8.62 ± 18.88) compared to the healthy people (11.53 ± 44.15). [ABSTRACT FROM AUTHOR]

Introduction: Women with a current diagnosis or past history of Graves' disease (GD) are at risk of developing fetal thyrotoxicosis (FT) during pregnancy when they are inadequately treated, or because of placental passage of TSH receptor antibodies (TRAb). It is known that FT induced by high maternal thyroid hormone concentrations may result in infant (central) hypothyroidism. Case Presentation: In a euthyroid woman with a history of GD treated with radioactive iodide (I131), persistently high levels of maternal TRAb resulted in recurrent FT during two separate pregnancies, followed by neonatal hyperthyroidism and infant central hypothyroidism. Discussion: This case demonstrates the novel insight that FT due to high fetal thyroid hormone concentrations stimulated by high maternal TRAb levels might also result in (central) hypothyroidism, requiring long-term evaluation of the hypothalamus-pituitary-thyroid axis in these children. [ABSTRACT FROM AUTHOR]

Background and Objectives: The interaction between thyroid and SARS-CoV-2 is complex and not yet fully understood. This study aimed to identify a predictive value of serum TSH levels on the short-term and middle-term outcomes of patients hospitalized for COVID-19. Materials and Methods: We retrospectively analyzed electronic records (ERs) data for hospitalized COVID-19 patients between March 2020 and June 2021 and their ERs during outpatient visits, 6–8 weeks post-discharge, in cases of known serum TSH levels and no previous thyroid disorder. The short-term (length of hospital stay, MSCT findings of lung involvement, required level of oxygen supplementation, admission to the ICU, and death) and middle-term outcomes after 6 to 8 weeks post-discharge (MSCT findings of lung involvement) were analyzed. Results: There were 580 patients included: 302 males and 278 females, average age of 66.39 ± 13.31 years, with no known thyroid disease (TSH mean 1.16 ± 1.8; median 0.80; no value higher than 6.0 mIU/L were included). Higher TSH was observed in patients with less severe outcomes and was associated with significantly higher SpO2 during hospitalization. Patients who required overall more oxygen supplementation or HFOT, mechanical ventilation, and patients who were more frequently admitted to the ICU or were more often treated with corticosteroids had lower TSH than those who did not show these indicators of disease severity. Lower TSH was also present in non-survivors when compared to survivors (all p < 0.01). Patients with low TSH during hospitalization more often had persistent lung involvement during the post-COVID-19 period (p = 0.028). In the post-COVID-19 period, there was an overall, statistically significant increase in the TSH levels when compared to TSH during hospitalization (p < 0.001). Conclusions: Low/suppressed serum TSH levels during acute COVID-19 may be an additional laboratory test that should be included in the prediction of unfavorable short- and middle-term outcomes. [ABSTRACT FROM AUTHOR]

Background and Aim: Metabolic dysfunction‐associated steatotic liver disease (MASLD) is recently introduced to better highlight the pathogenic significance of cardiometabolic dysfunction, as compared with non‐alcoholic fatty liver disease. This study aimed to investigate the association between low thyroid function and MASLD in the new context. Methods: We recruited 2901 participants for our retrospective cohort study from 2016 to 2021. Participants were divided into strict‐normal thyroid function and low thyroid function groups (low‐normal thyroid function, subclinical hypothyroidism) based on initial thyroid stimulating hormone (TSH) levels, respectively. Cox regression models were used to estimate the hazard ratios (HRs) and 95% CI. Results: During a median follow‐up of 15.6 months, 165 (8.9%) strict‐normal thyroid function subjects and 141 (13.4%) low thyroid function subjects developed MASLD; this result was statistically relevant (P < 0.05). Univariate regression analysis showed that low thyroid function and subclinical hypothyroidism were statistically significantly associated with MASLD (low thyroid function: HR1.53; 95% CI 1.22–1.92; subclinical hypothyroidism: HR1.95; 95% CI 1.47–2.60). Conclusions: MASLD is associated with low thyroid function and the relationship between MASLD and low thyroid function is independent. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to investigate the relationship between thyroid and type 1 diabetic nephropathy (T1DN) in euthyroid populations, focusing on thyroid hormone sensitivity. Methods: A cross-sectional study was conducted between January 2016 and December 2021, including 357 euthyroid patients with type 1 diabetes mellitus (T1DM). Parameters representing thyroid hormone sensitivity were assessed, including the thyroid feedback quantile-based index (TFQI), parameter thyroid feedback quantile index (PTFQI), thyroid stimulating hormone index (TSHI), thyrotropin thyroxine resistance index (TT4RI), and free triiodothyronine/free thyroxine (FT3/FT4). Logistic regression and restricted cubic spline regression were performed to detect the association between thyroid hormone sensitivity and the risk of T1DN. Results: The study found a negative correlation between the risk of T1DN and FT3/FT4 in euthyroid T1DM patients (OR 0.71, 95% CI 0.51– 0.97, P < 0.01). PTFQI (P< 0.05), TSHI (P< 0.05), and TT4RI (P< 0.01) showed an M-shaped nonlinear relationship with the risk of T1DN. Elevated risk of T1DN was associated with PTFQI, TSHI, and TT4RI values outside the range of zero, 2.3– 3.88, and 27.56– 32.19, respectively. Conclusion: This study confirms the relationship between impaired thyroid hormone sensitivity and the risk of T1DN in euthyroid patients. It emphasizes the importance of evaluating thyroid hormone sensitivity in T1DM patients, even when their thyroid function appears normal, to promptly prevent the occurrence of T1DN. [ABSTRACT FROM AUTHOR]

Hyperthyroidism is associated with the alteration in molecular pathways involved in the regulation of mitochondrial mass and apoptosis, which contribute to the development of cardiac hypertrophy. Diminazene (DIZE) is an animal anti-infection drug that has shown promising effects on improving cardiovascular disease. The aim of the present study was to investigate the therapeutic effect of DIZE on cardiac hypertrophy and the signaling pathways involved in this process in the hyperthyroid rat model. Twenty male Wistar rats were equally divided into four groups: control, hyperthyroid, DIZE, and hyperthyroid + DIZE. After 28 days of treatment, serum thyroxine (T4) and thyroid stimulating hormone (TSH) level, cardiac hypertrophy indices, cardiac damage markers, cardiac malondialdehyde (MDA), and superoxide dismutase (SOD) level, the mRNA expression level of mitochondrial and apoptotic genes were evaluated. Hyperthyroidism significantly decreased the cardiac expression level of SIRT1/PGC1α and its downstream involved in the regulation of mitochondrial biogenesis, mitophagy, and antioxidant enzyme activities including TFAM, PINK1/MFN2, Drp1, and Nrf2, respectively, as well as stimulated mitochondrial-dependent apoptosis by reducing Bcl-2 expression and increasing Bax expression. Treatment with DIZE significantly reversed the downregulation of SIRT1, PGC1α, PINK1, MFN2, Drp1, and Nrf2 but did not significantly change the TFAM expression. Moreover, DIZE suppressed apoptosis by normalizing the cardiac expression levels of Bax and Bcl-2. DIZE is effective in attenuating hyperthyroidism-induced cardiac hypertrophy by modulating the mitophagy-related pathway, suppressing apoptosis and oxidative stress. [ABSTRACT FROM AUTHOR]

Background: There are conflicting results in the existing studies regarding the association between depression and subclinical hypothyroidism in adolescents. Subclinical hypothyroidism is defined as elevated thyroid stimulating hormone (TSH) levels above the reference range without signs or symptoms of hypothyroidism. Objectives: The focus of this study is to determine whether there is any association between depression and subclinical hypothyroidism, (as defined by the serum TSH levels) in a population of healthy adolescents. Design: Quantitative-based cross-sectional study of a representative subset of the adolescent population. Methods: We carried out a cross-sectional study to determine the association between major depressive disorder (MDD) and subclinical hypothyroidism, in adolescents presenting for annual physical examinations during the peak period of the COVID-19 pandemic in the USA, a period deemed high for adolescent depression. All the adolescents were screened for depression by the PHQ-9 screening tool and had their TSH measured. Results: Of the 304 subjects analyzed, 179 (58.88%) were minimally or not depressed according to the Patient Health Questionnaire (PHQ-9) screening tool (mean PHQ 1.80 ± 1.49). 70 (23.03%) had mild depression (mean PHQ 6.59 ± 1.46), 50 (16.45%) had moderate depression (mean PHQ 13.70 ± 2.75), and 5 (1.64%) had severe depression (mean PHQ 21.40 ± 1.67). Mean TSH values were 1.93 ± 0.99, 1.77 ± 1.05, 2.10 ± 0.98, and 1.57 ± 0.32 mIU/L, respectively in the four groups. All values were within the recommended range of 0.50 to 4.30 mIU/L, without statistically significant inter-group differences. Conclusion: We conclude that there is no statistically significant association between depression and subclinical hypothyroidism, in a population of adolescents presenting for physical examinations, and if the screening for depression by the PHQ-9 tool indicates depression, a screening TSH test for subclinical hypothyroidism is not justified. [ABSTRACT FROM AUTHOR]

Simple Summary: Thyroid nodules are commonly detected in daily clinical practice, and their diagnosis and therapy usually involve different specialists and various diagnostic and therapeutic methods. Thyroid nodule management requires the integration of laboratory, imaging, and pathology examinations to achieve a proper diagnosis. It enables the elimination of unnecessary therapeutic procedures in many individuals and the timely identification of patients who require specific therapies. Furthermore, bioinformatics may change the current management of clinical data, enabling more personalized diagnostic approaches for patients with thyroid nodules. The clinical impact of artificial intelligence needs to be determined in further large-sample studies, especially in indeterminate cytology findings, that require "diagnostic surgery" to provide a definitive diagnosis. Thyroid nodules are common findings, particularly in iodine-deficient regions. Our paper aims to revise different diagnostic tools available in clinical thyroidology and propose their rational integration. We will elaborate on the pros and cons of thyroid ultrasound (US) and its scoring systems, thyroid scintigraphy, fine-needle aspiration cytology (FNAC), molecular imaging, and artificial intelligence (AI). Ultrasonographic scoring systems can help differentiate between benign and malignant nodules. Depending on the constellation or number of suspicious ultrasound features, a FNAC is recommended. However, hyperfunctioning thyroid nodules are presumed to exclude malignancy with a very high negative predictive value (NPV). Particularly in regions where iodine supply is low, most hyperfunctioning thyroid nodules are seen in patients with normal thyroid-stimulating hormone (TSH) levels. Thyroid scintigraphy is essential for the detection of these nodules. Among non-toxic thyroid nodules, a careful application of US risk stratification systems is pivotal to exclude inappropriate FNAC and guide the procedure on suspicious ones. However, almost one-third of cytology examinations are rendered as indeterminate, requiring "diagnostic surgery" to provide a definitive diagnosis. 99mTc-methoxy-isobutyl-isonitrile ([99mTc]Tc-MIBI) and [18F]fluoro-deoxy-glucose ([18F]FDG) molecular imaging can spare those patients from unnecessary surgeries. The clinical value of AI in the evaluation of thyroid nodules needs to be determined. [ABSTRACT FROM AUTHOR]

Background: Microbiome-directed therapies are increasingly utilized to optimize thyroid function in both healthy individuals and those with thyroid disorders. However, recent doubts have been raised regarding the efficacy of probiotics, prebiotics, and synbiotics in improving thyroid function. This systematic review aimed to investigate the potential relationship between probiotics/prebiotics and thyroid function by analyzing the impact on thyroid hormone levels. Methods: We conducted a comprehensive systematic review and meta-analysis of randomized controlled trials that investigated the effects of probiotics, prebiotics, and synbiotics on free triiodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), and thyroid stimulating hormone receptor antibody (TRAb) levels. We searched for articles from PubMed, Scopus, Web of Science, and Embase up until April 1st, 2023, without any language restriction. Quantitative data analysis was performed using a random-effects model, with standardized mean difference (SMD) and 95% confidence interval as summary statistics. The methods and results were reported according to the PRISMA2020 statement. Results: A total of eight articles were included in this review. The meta-analysis showed no significant alterations in TSH (SMD: -0.01, 95% CI: −0.21, 0.20, P = 0.93; I2: 0.00%), fT4 (SMD: 0.04, 95% CI: −0.29, 0.21, P = 0.73; I2: 0.00%) or fT3 (SMD: 0.45, 95% CI: −0.14, 1.03, P = 0.43; I2: 78.00%), while a significant reduction in TRAb levels was observed (SMD: -0.85, 95% CI: -1.54, -0.15, P = 0.02; I2: 18.00%) following probiotics/prebiotics supplementation. No indication of publication bias was found. Conclusions: Probiotics/prebiotics supplementation does not influence thyroid hormone levels, but may modestly reduce TRAb levels in patients with Graves' disease. [ABSTRACT FROM AUTHOR]

Purpose: Subclinical hypothyroidism is an early, mild form of hypothyroidism that may progress to overt hypothyroidism if untreated. The current study aimed to assess the effects of vitamin D supplementation on hormonal (thyroid stimulating hormone [TSH], triiodothyronine, thyroxine, and free thyroxine) parameters, lipid profiles, serum irisin, and obesity indices in women with subclinical hypothyroidism. Methods: The present randomized, double-blind, placebo-controlled clinical trial was carried out on 44 women with subclinical hypothyroidism. The participants were allocated to two groups (22 patients in each group) that received vitamin D (50,000 IU/week) or placebo for 12 weeks. Fasting blood samples, anthropometric and body composition measurements, physical activity levels, and dietary intakes were collected at baseline and at the end of the study. Results: Vitamin D supplementation significantly decreased TSH, total cholesterol, and fat mass percentage, and significantly increased serum vitamin D and irisin levels and fat-free mass percentage compared to the control group (all, p<0.05). Changes in thyroid hormones, other lipid profiles, and anthropometric indices were not significantly different between the groups. Conclusion: Our study indicates that vitamin D administration improves serum TSH, total cholesterol, irisin, and body composition in women with subclinical hypothyroidism. More well-designed clinical trials are required to confirm these findings and clarify the effects of vitamin D supplementation on both genders of patients. [ABSTRACT FROM AUTHOR]

Infertility affects millions of people of reproductive age worldwide. Thyroid hormones and prolactin (PRL) affect reproduction and pregnancy; therefore, these two hormones influence fertility. This systematic review and meta-analysis aimed to summarise the strength of the correlation between serum PRL and thyroid stimulating hormone (TSH) in infertile women and to explore selected factors influencing the correlation. We conducted a systematic search of online databases (PubMed, Scopus, ScienceDirect, SAGE and Google Scholar) from inception until March 2021 and a manual search of the bibliographies of the included studies to identify relevant publications. The original research paper describing the correlation between PRL and TSH in reproductive-age women with infertility (primary and secondary) was included. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. A random effect model was used to estimate the pooled correlations of PRL and TSH, followed by an assessment of heterogeneity and a sensitivity analysis. From a total of 822 relevant articles identified, 11 were eligible and included in this systematic review and meta-analysis. The random effect pooled correlation estimates between PRL and TSH was 0.431 (95% CI: 0.251, 0.582), with substantial heterogeneity between the included studies (I² = 80%, τ ² = 0.067, P < 0.001). No significant publication bias was observed. Study region, types of infertility, sample size and year of the study did not influence the correlation estimates. Our results highlighted a significant positive moderate correlation between serum PRL and serum TSH in infertile women. [ABSTRACT FROM AUTHOR]

Aims: We aim to explore the cumulative predictive value of elevated serum thyroid stimulating hormone (TSH) and visceral fat area (VFA) for metabolic syndrome (MS) development in postmenopausal women. Methods: A total of 1006 postmenopausal females were enrolled in a 10‐year prospective longitudinal study from 2011 to 2021 in the community of Banknote Printing Company of Chengdu. The sociodemographic information collection and anthropometric measurements were made by a professional nurse. Fasting blood samples were drawn for chemical analysis of fasting plasma glucose, triglycerides, low‐density lipoprotein cholesterol, high‐density lipoprotein cholesterol, and TSH. Magnetic resonance imaging was performed to measure VFA. All the participants were categorized into four groups according to median VFA and serum level of TSH. Results: A total of 793 postmenopausal females without MS underwent a 10‐year follow‐up study grouping by TSH and VFA: Group 1 (TSH level <4.2 μIU/mL, and VFA < 70 cm2), Group 2 (TSH level ≥4.2 μIU/mL, and VFA < 70 cm2), Group 3 (TSH level <4.2 μIU/mL, and VFA ≥70 cm2) and Group 4 (TSH level ≥4.2 μIU/mL, and VFA ≥70 cm2). During the 10‐year follow‐up, MS was newly developed in 326 (41.1%) subjects. The incidence of MS was 29.8% (n = 53), 35.2% (n = 63), 41% (n = 87), and 55% (n = 123) from Group 1 to Group 4 (Group 4 vs other groups, p <.001). Cox regression analysis for MS prediction demonstrated that both TSH (Model 3, hazard ratio [HR] = 1.07 [95% confidence interval, 1.05–1.09]) and VFA (Model 4, HR = 1.02 [95% confidence interval, 1.01–1.08]) were not only independent predictors of MS but also involved some interaction between each other (p for interaction =.021). Conclusion: Our findings suggested that mutual interaction between higher TSH and VFA contributed to the development of MS. Further studies are needed to clarify these contributions. [ABSTRACT FROM AUTHOR]

Background: There are no guidelines on individualized initial levothyroxine dosage in primary hypothyroidism. This prospective observational study was done to assess whether a predetermined dose of levothyroxine based on Thyroid Stimulating Hormone (TSH) levels would be able to make the patient euthyroid during a period of six weeks and to find other factors which influence the levothyroxine requirement. Materials and Methods: Newly diagnosed patients with primary hypothyroidism or those patients who were not on levothyroxine therapy were divided into TSH-based groups--Group 1, 5-9.99, Group 2, 10-29.99, Group 3, 30-99.99 and Group 4, >100 µIU/ml and treated with an initial levothyroxine dose of 25,50,75 and100 µg/day for next six weeks. Factors correlating with levothyroxine requirement were determined. Results: Of the 171 patients who were included 142 completed the study, 34,46,28 and 34 patients were included in groups 1 to 4, respectively. Normalization of TSH with the above criteria was achieved in 111 (78.7%) out of 141 patients, and 91%, 67%, 75%, and 82% respectively in the 4 groups. Among adequately replaced patients pre-treatment TSH level (r = 0.81), T4 level (r = 0.61), and body weight (r = 0.19) correlated with the levothyroxine requirement. Based on these factors predicted initial dose (µg/day) was found to be 0.54 (Body Weight [Kg]) +0.47 (TSH [µIU/m]) - 1.4 (Total T4 [µg/dl]) +17.79 or 0.27 (Body Weight) +0.553 (TSH) +21. Conclusion: Serum thyrotropin-based categorization for initial levothyroxine dose leads to euthyroidism in nearly four of five patients with primary hypothyroidism. The dose required for adequate replacement of levothyroxine has correlation with pre-treatment serum TSH levels serum thyroxine levels and body weight. [ABSTRACT FROM AUTHOR]

Thyroid hormone synthesis is vital for all body organs to develop, grow, and function healthily. All cells, including hepatocytes, have these hormones that control their resting metabolic rates. Between both the thyroid and the liver, there are complicated interactions. When thyroid dysfunction is treated and thyroid hormones return to normal, the body's metabolism changes. This temporary shift can affect liver function, potentially influencing liver test results and making them appear abnormal even if the liver itself is healthy. Thyroid dysfunction can sometimes lead to abnormal liver function, but treatment may not always be necessary for the liver, depending on the specific cause and severity. This study was done to assess the relationship between serum enzymes of liver functions and direct bilirubin in thyroid disorders. 90 subjects including 38 healthy controls, 27 hyperthyroidism patients, and 25 hypothyroidism patients were quickly tested for alkaline phosphatase (ALP), alanine transaminase (ALT), and aspartate transaminase (AST) using the calorimetric method and standard reagent kits. To measure the serum levels of T3, T4, and TSH, ELISA kits were employed. The results showed that serum AST, ALT, and ALP levels were 38, 50, and 150 U/L for hyperthyroid patient and 70, 78, and 110 U/L for hypothyroid patient compared to the control groups of 25, 28, and 95 U/L, respectively. On the other hand, serum T3, T4, and TSH were 3.2 ng/mL, 18.5 mg/dL, and 0.94 µIU/L for hyperthyroid patient. In a study comparing liver function in hypothyroid patients and healthy controls, AST, ALT, and ALP levels were 0.8, 4.9, and 25.7 U/L in the hypothyroid group compared to 1.1, 6.3, and 2.5 U/L in the control group. The findings of this study demonstrated that there was a correlation between the concentrations of ALP and AST in hypothyroid and hyperthyroid patients. [ABSTRACT FROM AUTHOR]

Introduction: The accurate diagnosis of thyroid disease relies on the sensitivity and specificity of laboratory tests, which require specific reference intervals. Thyroid hormone levels can be influenced by factors such as age, gender, iodine intake and geographical region. Therefore, it is recommended for clinical laboratories to establish their own reference intervals. Aim: To establish reference intervals for Thyroid Stimulating Hormone (TSH), Free Thyroxine (FT4), Anti-thyroglobulin antibody (anti-TG), and Anti-Thyroid Peroxidase Antibody (anti-TPO) in males and and females. Materials and Methods: A cross-sectional study was conducted in the Department of Biochemistry, Amrita Institute of Medical Sciences (AIMS), Kochi, India, from December 2021 to July 2022. The study included 217 apparently healthy subjects aged between 18 years and 60 years. TSH, FT4, anti-TPO, and anti-TG levels were analysed to establish reference values for males and females in the two age groups: 18-40 years and 41-60 years. Reference intervals for thyroid parameters were expressed as mean±Standard Deviation (SD), median, 2.5th and 97.5th percentiles. The Mann-Whitney U test was used to assess the statistical significance of thyroid parameters between gender and age groups. Results: The mean age in the female population was 38.24±11.64 years, while in the male population, it was 39.24±10.98 years. The reference intervals and cut-offs for TSH, FT4, anti-TG and anti-TPO in females were determined as 0.80-4.12 μIU/mL, 0.99-1.57 ngm/mL, <85.33 IU/mL and <45.13 IU/mL, respectively. In males, the reference intervals and cut-offs for TSH, FT4, anti-TG and anti-TPO were determined as 0.51-5.09 μIU/mL, 1.03-1.79 ng/mL, <87.09 IU/mL and <33.88 IU/mL, respectively. There was a significant difference in anti-TPO (p-value=0.017) in males between the two age groups. A significant difference was also observed in FT4 (p-value=0.010) and anti-TPO (p-value=0.034) between males and females. Conclusion: The study successfully established reference intervals and cut-off values for TSH, FT4, anti-TG, and anti-TPO. It was found that anti-TPO levels decrease significantly with age progression. Additionally, the reference interval for TSH was wider in the 41-60 years age group compared to the younger age group. [ABSTRACT FROM AUTHOR]

This study aims to investigate the effect of serum Bisphenol A (BPA) levels on thyroid hormones and some biochemical parameters in children with newly diagnosed type 1 diabetes mellitus (T1DM). A total of 139 people, including 74 patients aged 0-18 years who were newly diagnosed with T1DM, 30 healthy siblings of these patients, and 35 healthy children, were included in the study. BPA, apelin, thyroid stimulating hormone (TSH), free T3 (T3), free T4 (T4), thyroglobulin antibody (anti-TG), thyroid peroxidase antibody (anti-TPO), total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride, C-peptide and glycosylated haemoglobin (HbA1c) levels were measured in the samples obtained from the volunteers. Serum BPA concentrations were higher in children with T1DM compared to their siblings and healthy children (p<0.05). The apelin levels in the patient group were observed to be lower than those in their siblings and the healthy children (p<0.05). In all three groups, a negative correlation was identified between BPA and apelin. There was no correlation between BPA and TSH, T3 and T4 levels in all three groups (p>0.05). Similarly, no correlation was detected between BPA and total cholesterol, LDL, HDL, triglyceride, C-peptide, HbA1c, anti-TG and anti-TPO (p>0.05). In summary, this study shows that BPA levels were increased and apelin levels were decreased in children with T1DM, with a negative relationship between the two. Taken together, our results suggest that BPA may have a role in the pathogenesis or progression of T1DM. Low apelin may be associated with the progression of T1DM. [ABSTRACT FROM AUTHOR]

Background: Its well known that thalassemia is the most prevalent genetic disorder worldwide. β thalassemia major is the basic form of thalassemia major that requires lifelong blood transfusions. one of the most prevalent endocrine issues in beta-thalassemia major is hypothyroidism. The current study was aimed to assess the thyroid function status in chronically transfused Beta thalassemia major patients. Methods: A cross-sectional study included 278 patients diagnosed with beta thalassemia major. The study lasted for 12 months interval, from January 2021 to January 2022. Serum free thyroxine, thyroid stimulating hormone and Ferritin levels were measured for all patients using Roche Cobas 6000 analyzer. Results: The study observed a high prevalence rate of subclinical hypothyroidism (41.2%) and as well as, (2.9%) had overt hypothyroidism. There was insignificant high level of serum ferritin among hypothyroid patients. Nineteen of the subclinical hypothyroid patients (16.5%) had splenectomy, whereas, no one with clinical hypothyroidism had splenectomy. Conclusion: The study conclude that near half of beta thalassemia major patients were had overt hypothyroidism and subclinical hypothyroidism. [ABSTRACT FROM AUTHOR]

Introduction: In addition to boosting calcium absorption in the small intestine and preserving sufficient levels of calcium and phosphate in the serum to support proper bone mineralization, Vitamin D3 fortifies the immune system. Vitamin D3 deficiency can occur when regular intakes are gradually below recommended levels and when people get little sunshine exposure. Materials and Methods: The study was conducted using a case series study approach. A structured checklist was utilized on 107 individuals who had recovered from corona disease to identify the causes behind the unfavorable health effects they continue to experience. In addition, the patients underwent extensive laboratory blood testing in a specialized laboratory and received follow-up care for a period of 6 months. The results were analyzed using the Chi-square test and the Paired t-test using the SPSS software. Results: Despite the finding that 84.1% of the study group had Vitamin D3 levels below the normal range, their physical health conditions had considerably improved as a result of the treatment they received. Conclusion: The study found that patients with coronavirus infection had a high prevalence of Vitamin D3 deficiency. After 6 months, this percentage dropped considerably, raising the possibility that the coronavirus may have contributed to the drop in plasma Vitamin D3 levels. To find out how long-lasting COVID-19 symptoms are related to Vitamin D3 deficiency, more research is required. [ABSTRACT FROM AUTHOR]

Objective To investigate the association between maternal TSH, free thyroxine (FT4), and children's body mass index (BMI) trajectories and obesity. Method Based on the Ma'anshan Birth Cohort in China, we repeatedly assayed maternal thyroid functions in 3 trimesters of pregnancy. Children's height and weight were measured 15 times before they were age 6 years. Body fat was assessed when children were aged 6 years. Mplus software was used to fit maternal thyroid hormone trajectories and BMI trajectories. Multivariate logistic regression models and generalized linear models were used in data analysis. Results Low maternal FT4 trajectory was observed to be related to an increased risk of a high children's BMI trajectory and overweight, with an odds ratio and 95% CI of 1.580 (1.169-2.135) and 1.505 (1.064-2.129), respectively. Increased maternal FT4 concentrations in the first, second, and third trimesters were associated with a decreased risk of high children's BMI trajectories and obesity. There was a positive association between low maternal FT4 trajectory and 6-year-old children's body fat ratio with β and 95% CI of 0.983 (0.138-1.829). Furthermore, negative correlations between maternal FT4 concentration in the first, second, and third trimesters of pregnancy and body fat ratio were observed. Conclusions Low maternal FT4 trajectory during pregnancy may predict a high BMI trajectory in children and relate to overweight and high body fat ratio in 6-year-old children. High maternal FT4 concentrations throughout pregnancy may be associated with the decreasing risk of obesity and low body fat ratio in 6-year-old children. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Telogen effluvium (TE) is a type of alopecia that is frequently seen in women. Among factors resulting in hair loss, many reasons such as endocrine diseases, nutrition disorders, stress, anemia, low ferritin levels, vitamin B12 deficiency, and thyroid diseases are found. A digital phototrichogram is one of the non-invasive methods of diagnosis in the evaluation of alopecia. In this study, it was aimed to compare biochemical parameters of female patients with diffuse hair loss with phototrichogram findings. METHODS: 108 female patients with diffuse hair loss were included in the study. Patients were divided into two groups: acute and chronic TE, and a hair pull test was applied. Total blood count, blood biochemistry, iron, iron binding capacity, ferritin, thyroid stimulating hormone (TSH), sT3, sT4, folic acid, and vitamin B12 levels were examined. The telogen/anagen ratios and hair densities of patients were determined with a phototrichogram. RESULTS: The serum biochemical parameters (aspartate aminotransferase, alanine aminotransferase, urea, creatinine), TSH, sT3, sT4, and folic acid levels of patients were within normal limits. Telogen ratio, anagen ratio, hair density, number of shed hairs, family history, blood ferritin, TSH, and vitamin B12 levels were found to be similar between groups having acute and chronic TE. In our study, while mean anagen and telogen ratios with trichoscan were similar to literature data, no statistically significant correlation was determined between patients' ages and examined trichoscan findings (p>0.05). The hair pull test positivity of patients with chronic TE was higher compared to patients with acute TE (p<0.05). In patients with positive hair pull tests, the telogen ratio and hair density were found to be higher. In the group with <40 ng/mL ferritin level, the mean telogen ratio was detected to be significantly higher than the mean anagen ratio (p<0.05). No significant correlation was determined between vitamin B12 and TSH levels in patients and phototrichogram findings (p>0.05). CONCLUSION: The findings of this study showed that ferritin has an important role in diffuse hair loss, and the phototrichogram method is an auxiliary method for the physician in the diagnosis of TE. [ABSTRACT FROM AUTHOR]

Background: Immune checkpoint inhibitors (ICI) have revolutionized the treatment of many advanced cancers but are recognized to cause treatment-limiting immune-related adverse events (IrAE). ICI-associated thyroiditis is the most common endocrine IrAE and usually resolves to permanent hypothyroidism. Optimal thyroid hormone replacement in these patients remains unclear. We report the levothyroxine (LT4) dose needed to achieve stable euthyroid state in patients with hypothyroidism from ICI-associated thyroiditis, with comparison to patients with Hashimoto's thyroiditis (HT) and athyreotic state. Methods: We conducted a retrospective study of adults with ICI-associated hypothyroidism treated with LT4 at an academic medical center. Patient data were collected from the electronic medical record. Cases had ICI exposure followed first by hyperthyroidism and then subsequent hypothyroidism. Controls were HT (positive thyroid autoantibodies, requiring LT4) and athyreotic (total thyroidectomy or radioiodine ablation, requiring LT4) patients. Patients with central hypothyroidism, thyroid cancer, pregnancy, gastrointestinal stromal tumors, and use of L-triiodothyronine were excluded. Our primary outcome compared LT4 dose needed to achieve euthyroid state (thyrotropin 0.3-4.7 mIU/L over >6 consecutive weeks) for ICI-associated hypothyroidism, HT, and athyreotic patients, considering the impact of age and possible interfering medications by linear regression modeling. Secondary analysis considered the impact of endocrine specialty care on the time to euthyroid state. Results: One hundred three patients with ICI-associated thyroiditis were identified. Sixty-six of the 103 patients achieved euthyroid state; 2 with intrinsic thyroid gland function recovery and 64 on LT4. The mean LT4 dose achieving stable euthyroid state was 1.45 ± standard deviation (SD) 0.47 mcg/[kg·day] in ICI-associated hypothyroidism, 1.25 ± SD 0.49 mcg/[kg·day] in HT, and 1.54 ± SD 0.38 mcg/[kg·day] in athyreotic patients, using actual body weight. The difference in dose between ICI-associated hypothyroidism and HT was statistically significant (p = 0.0093). Dosing differences were not explained by age or use of interfering medications. Conclusions: ICI-associated thyroiditis represents an increasingly recognized cause of hypothyroidism. Our study demonstrates that patients with ICI-associated hypothyroidism have different thyroid hormone dosing requirements than patients with HT. Based on our findings and prior reports, we recommend that in patients with ICI-associated thyroiditis LT4 therapy be started at an initial weight-based dose of 1.45 mcg/[kg·day] once serum free thyroxine levels fall below the reference range.