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Neonatal Graves disease is the most common cause of hyperthyroidism during the newborn period. Maternal Graves disease increases the risk of intrauterine growth restriction, small for gestational age, and neonatal Graves disease. Intrauterine growth restriction and small for gestational age are associated with hypoglycemia and transient neonatal hyperinsulinism. Neonatal Graves disease with severe persistent hypoglycemia has not been well described. We present the case of a female patient born at 34 weeks and 3 days with a birth weight of 1.6 kg (fifth percentile) to a mother with recent treatment for Graves disease. Prenatal ultrasounds were significant for intrauterine growth restriction and small for gestational age. The mother did not begin hyperthyroidism medical therapy until 23 weeks and 2 days of gestation. After the infant was born, the infant not only had symptoms of hyperthyroidism such as tachycardia and abnormal thyroid values but also had persistent hypoglycemia, which could be due to maternal propranolol usage, prematurity, IUGR, increased metabolism due to neonatal Graves, and transient stress-induced hyperinsulinism. The infant was started on methimazole for hyperthyroidism and propranolol for tachycardia. She was also started on diazoxide for persistent hypoglycemia. By 6 months of age, the hyperthyroidism and hypoglycemia had resolved. This is an interesting case of neonatal Graves disease with severe persistent hypoglycemia which we suspect is due to transient neonatal hyperinsulinism induced by multiple stress responses.

OBJECTIVE: To examine the relationship between thyroid status and incident kidney dysfunction/chronic kidney disease (CKD) progression. PATIENTS AND METHODS: We examined incident thyroid status, ascertained by serum thyrotropin (TSH) levels measured from January 1, 2007, through December 31, 2018, among 4,152,830 patients from the Optum Labs Data Warehouse, containing deidentified retrospective administrative claims data from a large national health insurance plan and electronic health record data from a nationwide network of provider groups. Associations of thyroid status, categorized as hypothyroidism, euthyroidism, or hyperthyroidism (TSH levels >5.0, 0.5-5.0, and 5.0-10.0, >10.0-20.0, and >20.0 mIU/L, respectively) were associated with increasingly higher risk of the composite end point (reference: TSH level, 0.5 to

Introduction: Graves' disease (GD) is an autoimmune disorder characterized by hyperthyroidism due to increased thyroid-stimulating hormone receptor antibodies (TRAb).The treatment of GD often consists of radioactive iodine therapy, anti-thyroid drugs (ATD), or thyroidectomy. Since few studies have collected data on remission rates after treatment with ATD in Saudi Arabia, our study aimed to assess the efficacy and the clinical predictors of GD long-term remission with ATD use. Method: We conducted a retrospective chart review study of 189 patients with GD treated with ATD between July 2015 and December 2022 at the endocrine clinics in King Abdulaziz Medical City in Riyadh. All GD patients, adults, and adolescents aged 14 years and older who were treated with ATD during the study period and had at least 18 months of follow-up were included in the study. Patients with insufficient follow-up and those who underwent radioactive iodine (RAI) therapy or thyroidectomy as first-line therapy for GD were excluded from the study. Results: The study sample consisted of 189 patients, 72% of whom were female. The patients' median age was 38years (33, 49). A total of 103 patients (54.5%) achieved remission. The median follow-up period for the patients was 22.0 months (9, 36). Patients who achieved remission had lower mean free T4 levels (25.8pmol/l ± 8.93 versus 28.8pmol/l ± 10.82) (P value = 0.038) and lower median TRAb titer (5.1IU/l (2.9, 10.7)) versus (10.5IU/l (4.2, 22.5)) (P value = 0.001) than patients who did not achieve remission. Thirty-five out of 103 patients who achieved remission (34%) relapsed after ATD discontinuation. The patients who relapsed showed higher median thyroid uptake on 99mTc-pertechnetate scan than patients who did not relapse: 10.3% (5.19, 16.81) versus 6.0% (3.09, 12.38), with a P value of 0.03. They also received ATD for a longer period, 40.0 months (29.00, 58.00) versus 25.0 months (19.00, 32.50), with a P value of < 0.0001. Conclusion: The remission of GD was achieved in approximately half of the patients treated with ATD; however, approximately one-third of them relapsed. Lower Free T4 and TRAb levels at diagnosis were associated with remission. Longer ATD use and higher thyroid uptake upon diagnosis were associated with relapse after ATD discontinuation. Future studies are necessary to ascertain the predictors of ATD success in patients with GD. [ABSTRACT FROM AUTHOR]

Background: Mitochondria are known to be involved in mediating the calorigenic effects of thyroid hormones. With an abundance of these hormones, alterations in energy metabolism and cellular respiration take place, leading to the development of cardiac hypertrophy. Vitamin D has recently gained attention due to its involvement in the regulation of mitochondrial function, demonstrating promising potential in preserving the integrity and functionality of the mitochondrial network. The present study aimed to investigate the therapeutic potential of Vitamin D on cardiac hypertrophy induced by hyperthyroidism, with a focus on the contributions of mitophagy and apoptosis as possible underlying molecular mechanisms. Methods and results: The rats were divided into three groups: control; hyperthyroid; hyperthyroid + Vitamin D. Hyperthyroidism was induced by Levothyroxine administration for four weeks. Serum thyroid hormones levels, myocardial damage markers, cardiac hypertrophy indices, and histological examination were assessed. The assessment of Malondialdehyde (MDA) levels and the expression of the related genes were conducted using heart tissue samples. Vitamin D pretreatment exhibited a significant improvement in the hyperthyroidism-induced decline in markers indicative of myocardial damage, oxidative stress, and indices of cardiac hypertrophy. Vitamin D pretreatment also improved the downregulation observed in myocardial expression levels of genes involved in the regulation of mitophagy and apoptosis, including PTEN putative kinase 1 (PINK1), Mitofusin-2 (MFN2), Dynamin-related Protein 1 (DRP1), and B cell lymphoma-2 (Bcl-2), induced by hyperthyroidism. Conclusions: These results suggest that supplementation with Vitamin D could be advantageous in preventing the progression of cardiac hypertrophy and myocardial damage. [ABSTRACT FROM AUTHOR]

Background Hypothesis Animals Methods Results Conclusions Exogenous iodine interferes with the uptake of radioactive iodine (131I) by the thyroid gland. This has potential implications for the treatment of cats with hyperthyroidism that have recently undergone computed tomography (CT) with IV administration of iodinated contrast medium (ICM).To determine the time to normalize urinary iodine clearance after administration of ICM. We hypothesized that it would require 4 weeks for urinary iodine concentration (UIC) to decrease to baseline after IV administration of ICM.Ten healthy adult neutered male cats.All cats were sedated and received Iopamidol at a dose of 2 mL/kg (600 mg/kg). Urinary iodine and creatinine concentrations were measured before administration of Iopamidol and on days 1, 2, 3, 7, 10 and weeks 2 to 6 after administration. The urinary iodine‐to‐creatinine ratio (UICR) was calculated. Outcome variables were modeled using a linear mixed‐effects model.Urinary iodine concentration increased 37‐ to 884‐fold on Day 1 after ICM injection and returned to baseline during Week 2. Compared with baseline, UIC was significantly increased for Days 1 to 7 (all P < .001); UC was significantly lower for Days 1 to 10 (all P < .03); and UICR was significantly increased from Days 1 to 10 (all P < .001, except Day 10 P = .05).Urinary clearance of iodine after IV administration of ICM requires 10 days to return to baseline in healthy cats. A 2‐week interval between the iodinated contrast study and 131I treatment could be appropriate but needs to be confirmed in hyperthyroid cats. [ABSTRACT FROM AUTHOR]

Introduction: Myocardial ischemia can occur due to several causes, which result in an imbalance between the supply and demand of oxygen to cardiac muscles. One potential reason for this condition is the overwork of the heart due to hyperstimulated thyroid function. Case presentation: The patient was a 36-year-old woman who presented with left-sided chest pain, dyspnea, palpitation, and tremor. The initial evaluation showed evidence of myocardial ischemia (positive high-sensitivity troponin) caused by a hyperactive thyroid gland. The treatment for myocardial infarction, along with anti-thyroid medications, improved the patient's condition and subsided the symptoms. The coronary angiography revealed no pathologic finding, and the hypokinetic left ventricle, observed in the first echocardiogram, was resolved. The patient was discharged with an excellent clinical condition, and after the 4-month taking of a calcium channel blocker and tapering carbimazole, the thyroid function became normal, and her symptoms resolved completely. Conclusion: Patients without evident risk factors for ischemic heart disease, such as non-diabetic, nonsmoker, and young individuals who presented with acute coronary syndrome, should be evaluated for a potential background reason for the imbalance between the oxygen demand and supply of the myocardium. The presence of palpitation, weight loss, tremors, insomnia, and anxiousness, along with ischemic signs, should make the physician think about the probability of the hyperthyroid-induced cardiovascular disorder. Clinical key point: The initial presentation of hyperthyroidism might be accompanied by severe cardiac symptoms. When the demographic features are not aligned with usual ischemic heart disease, other probable symptoms and signs should be investigated, and thyroid function should be checked. The control of thyroid hyperactivity would result in the resolution of both cardiac and non-cardiac symptoms. [ABSTRACT FROM AUTHOR]

Background: Thyroid disorders, including hypothyroidism, hyperthyroidism, and autoimmune thyroid diseases (AITDs) such as Hashimoto's thyroiditis and Graves' disease, are prevalent endocrine disorders with significant global health impacts. Emerging evidence suggests that vitamin D, known for its role in bone health and calcium metabolism, may also influence immune function and thyroid health. Objective: This study aimed to evaluate the efficacy of vitamin D supplementation in improving thyroid function and reducing autoimmune activity in individuals with thyroid disorders. Methods: This double-blind, randomized controlled trial (RCT) involved 200 participants diagnosed with thyroid disorders, including hypothyroidism, hyperthyroidism, and AITDs. Participants were randomly assigned to receive either vitamin D supplementation (50,000 IU/week for 8 weeks, followed by 2,000 IU/day for 10 months) or a placebo for 12 months. Primary outcomes included changes in serum 25-hydroxyvitamin D [25(OH)D] levels, thyroid function tests (TSH, Free T4, Free T3), and thyroid autoantibodies (anti-TPO, antiTG). Secondary outcomes included improvements in clinical symptoms and quality of life. Data were analyzed using SPSS version 25.0. Results: Participants in the intervention group exhibited a significant increase in serum 25(OH)D levels (from 18.5 ± 4.3 ng/mL to 35.2 ± 6.2 ng/mL, p < 0.001). This increase was associated with significant reductions in TSH levels (-1.2 ± 0.8 mIU/L, p < 0.001) and thyroid autoantibodies (anti-TPO: -30 ± 12 IU/mL, p < 0.001; anti-TG: -25 ± 10 IU/mL, p < 0.001). Improvements in Free T4 and Free T3 levels were also observed in the intervention group (p < 0.001). The control group showed no significant changes in these parameters. Participants in the intervention group reported greater improvement in clinical symptoms and quality of life. Conclusion: Vitamin D supplementation significantly improves thyroid function and reduces autoimmune activity in individuals with thyroid disorders, particularly those with hypothyroidism and AITDs. These findings suggest that vitamin D may serve as an effective adjunctive therapy in managing thyroid disorders. Further research is needed to confirm these results and explore the long-term benefits of vitamin D supplementation in this population. [ABSTRACT FROM AUTHOR]

Objective: Point-of-Care Ultrasound (POCUS) refers to the use of portable ultrasound machines to perform quick and focused ultrasound examinations at a patient's bedside or point-of-care. POCUS can be performed by all health workers with specific training to use POCUS. The aim of this study was to investigate the radiological performance and feasibility of POCUS using a handheld ultrasound device (HHUSD) in children for examining the thyroid gland. Methods: A pediatric endocrinologist performed thyroid imaging in children referred to our hospital with suspected thyroid disease using an HHUSD. The same children underwent ultrasonography (US) imaging using the same device by the first radiologist, and a second radiologist performed thyroid US using an advanced high-range ultrasound device (AHUSD) (defined as the gold-standard method) within two hours. The data obtained by the three researchers were compared with each other. Results: This study included 105 patients [68.6% girls (n=72)] with a mean age 12.8±3.6 years. When the thyroid volume was evaluated, a strong correlation was found between the measurements of the three researchers (AA vs. MG: r=0.963, AA vs. GT: r=0.969, MG vs. GT: r=0.963, p<0.001). According to the Bland-Altman analysis for total thyroid volume, AA measured 0.43 cc [95% confidence interval (CI): -0.89-0.03] smaller than MG, and 0.11 cc (95% CI: -0.30-0.52) larger than GT, whereas MG measured 0.52 cc (95% CI: 0.09-0.94) larger than GT. When evaluated for the presence of goiter and nodules, a near-perfect agreement was found between the results of the three researchers (AA vs. GT; κ=0.863, MG vs. GT; κ=0.887, p<0.001, and AA vs. GT; κ=1.000, MG vs. GT; κ=0.972, p<0.001, respectively). When evaluated in terms of the longest axis of nodules, a high correlation was found between the measurements of the three researchers (AA vs. MG; r=0.993, AA vs. GT; r=0.996, MG vs. GT; r=0.996, p<0.001). When evaluated in terms of the final diagnosis, the evaluations of the three researchers showed excellent agreement with each other (AA vs. GT; κ=0.893, MG vs. GT; κ=0.863, p<0.001, accuracy rate AA vs. GT: 93.3%; MG vs. GT: 91.4%). Conclusion: A pediatric endocrinologist, equipped with sufficient training in thyroid US evaluation, incorporated HHUSD examination as a routine clinical tool in an outpatient setting. It was shown that, they could effectively assess normal thyroid tissue in pediatric patients. Moreover, the HHUSD proved to be useful in detecting thyroid pathologies. However, it is important to note that for a more comprehensive evaluation of thyroid nodules, including detailed assessment and Thyroid Imaging Reporting and Data System (TIRADS) classification, patients should be referred to radiology departments equipped with AHUSD systems. These specialized devices, along with the expertise of radiologists, are essential for in-depth evaluations and accurate classification of thyroid nodules. [ABSTRACT FROM AUTHOR]

We describe the clinical presentation and evaluation of a 10-year-old boy who presented to our medical center with years of progressive proximal muscle weakness, muscle atrophy, and weight loss. In addition to a myopathic phenotype, he was found to have tachycardia, tremor, and learning difficulties. Electromyography revealed chronic myopathic changes and laboratory screening was notable for undetectable thyroid stimulating hormone. Follow-up testing revealed elevated thyroid peroxidase antibodies and thyroid stimulating immunoglobulins. Ultrasound examination revealed an enlarged heterogeneous thyroid gland. Four weeks after treatment with atenolol and methimazole, his strength and cognition began to improve. This case highlights the importance of evaluating for potentially reversible toxic-metabolic etiologies in children presenting with any progressive neurologic symptoms. [ABSTRACT FROM AUTHOR]

Background: Thyroid dysfunction evaluation during pregnancy is important for the mother's health, obstetric outcomes, and the child's cognitive development. This study is conducted to know various thyroid disorders that can occur during antenatal and their impact on mother and fetus outcomes. Materials and Methods: This observational research was conducted over two years at a tertiary center in Western Rajasthan, India. Seven hundred and seventy-two low-risk singleton pregnant patients who met the inclusive criteria were recruited. The estimation of T3, T4, and TSH was done along with a routine investigation in antenatal women. Antenatal having abnormal thyroid profiles were then analyzed for mother and fetus problems. Results: The prevalence of thyroid dysfunction in antenatal women is 16.5%. Subclinical hypothyroidism (SCH) was seen in 12.5% of cases, overt hypothyroidism in 3.36%, and subclinical hyperthyroidism in only 0.51% of cases. Anti-TPO was positive in 46 (41.44%) women with hypothyroidism and 1 (25%) with hyperthyroidism. Compared to euthyroid women, women with overt hypothyroid (19.23% vs 3.1%, P = 0.002) and subclinical hypothyroid (9.27% vs 3.1%, P = 0.003) were found to be associated with a higher risk of hypertensive disease. Concerning fetal outcomes. There was a high risk for preterm (12.37% v/s 4.9%, P = 0.004) and fetal growth retardation (FGR) in patients with SCH (7.21% v/s 3.1%, P = 0.04). Conclusion: Considering the significant influence of thyroid disorders on mother and fetus outcomes, the screening for thyroid during pregnancy should be considered universally, particularly in developing countries with high prevalent rates, such as India. [ABSTRACT FROM AUTHOR]

Postiodization era has experienced a change in pediatric thyroid disorders with autoimmune disorders and subclinical hypothyroidism (SCH) now more frequently diagnosed. The aims of this study were to evaluate the clinical spectrum of thyroid disorders among children referred to us, to ascertain characteristics that influence treatment, and to follow them for various outcome measures. An observational longitudinal study where all treatment-naïve children (<18 years) with suspected thyroid disorders were recruited. Data collected were anthropometry, serum TSH, TT4, TT3, antithyroid autoantibodies, family history, and clinical symptoms. The management was based on the clinical judgment of the endocrinologist with the first follow-up at six weeks and subsequent visits three monthly for one year. A total of 241 subjects aged 28 days to 17 years were included. Overall, SCH was the most common abnormality (39%) detected among subjects, followed by overt hypothyroidism (OH) (33%), congenital hypothyroidism (CH) (18%), and overt thyrotoxicosis (5%). A total of 85.5% (n = 204) of subjects were treated and in follow-up, 81% of them were found to be adequately managed. Comparative analysis of OH and SCH revealed pubertal age, female predominance, and the presence of autoimmunity (positive anti-TPO and anti-TG Ab) statically significant variables in the OH group. A major independent predictor of treatment in treated SCH (72/96) in comparison with nontreated SCH (24/96) was anti-TPO positivity (P = 0.029). Eight of 24 nontreated SCH were eventually treated in follow-up and positive family history was observed as a significant variable among them (P < 0.05). Subjects with CH presented at a mean age of 6 months (28 days to 2 years). However, guidelines for the management of SCH are still evolving, autoimmunity and positive family history should be considered as decisive factors while initializing treatment. Delayed presentation of CH in our study warrants active surveillance of children at birth for thyroid disorders for their mental well-being. [ABSTRACT FROM AUTHOR]

Background: The association between psoriasis and hyperthyroidism/hypothyroidism remains inconclusive, with conflicting findings in prior studies. Objectives: This study employs Mendelian randomization methods to assess the potential relationship. Methods: Given the inability to accurately observe the link between psoriasis and thyroid dysfunction, we prioritized utilizing known genetic variants to investigate the potential impacts of the disease.We analyzed data from genome-wide association studies (GWASs), FinnGen, and UK Biobank to extract information on psoriasis, hyperthyroidism, and hypothyroidism. Three MR approaches (MR Egger, weighted median, and inverse variance weighted) were used to scrutinize the causal link. Results: Our analysis revealed no correlation between psoriasis and hyperthyroidism/hypothyroidism. However, vulgar psoriasis and guttate psoriasis were associated with hypothyroidism/myxedema (IVW odds ratio (OR) = 1.00, 95% confidence interval (CI) = 1.00–1.00, P = 2.53E-03), and Graves’ disease (IVW OR = 0.86, 95% CI = 0.72–1.01, P = 4.75E-02).In a subsequent analysis, we observed that hypothyroidism with mucinous edema showed no correlation with Graves’ disease in the opposite(P = 9.33E-01). Conclusion: This MR analysis suggests no association between psoriasis and thyroid dysfunction, but highlights associations of vulgar/guttate psoriasis with hypothyroidism/myxedema and Graves’ disease. In clinical practice, diagnosing guttate psoriasis requires vigilance for associated risks from hypothyroidism and Graves’ disease. For patients with both vulgar psoriasis and hypothyroidism, careful monitoring for mucinous edema is crucial, as it may signal a hypothyroid crisis. [ABSTRACT FROM AUTHOR]

Background: Prunella vulgaris L. (Lamiaceae) is a perennial medicinal plant commonly used to treat thyroid dysfunction, infectious hepatitis, and mastitis in north-east Asia and Europe. In China, there has been a historical change in the medicinal use of P. vulgaris from the use of whole plants to the use of the spicas. Purpose: This study aimed to evaluate the protective effects of whole plant P. vulgaris water extracts and spicas on hyperthyroidism with liver-yang hyperactivity syndrome and to preliminarily explain the mechanism of action of these water extracts. Materials and Methods: Rats were induced with aconite decoction and levothyroxine and treated with P. vulgaris whole plant and spicas water extract for 28 days at the same time. Body weight, food intake, and rectal temperature were monitored. The serum thyroid function indicators thyroid stimulating hormone (TSH), thyroid hormone-free triiodothyronine (FT3) and free thyroxine (FT4), liver function index alanine aminotransferase (ALT) and aspartate aminotransferase (AST), oxidative damage index malondialdehyde (MDA), and superoxide dismutase (SOD) were detected. Liver and thyroid tissues were taken for sectioning and observation. The liver inflammatory factors human tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were detected by immunohistochemistry, and the expression levels of the apoptotic proteins caspase-3 and B-cell lymphoma-2 (Bcl-2) were detected. Results: Both P. vulgaris whole plant and spica water extract groups exhibited markedly reduced FT3 and FT4 contents, increased the TSH content, and decreased ALT and AST activities. Furthermore, these agents improve thyroid and liver lesion tissue; reduce MDA content; increase SOD activity; reduce IL-6, TNF-α, and caspase-3 expression; and increase Bcl-2 expression. Conclusion: The whole plant and spicas water extracts of P. vulgaris have obvious protective effects on hyperthyroidism and hyperactivity in liver yang, and the protective effect of the water extract of spicas is greater than that of the whole plant water extract. [ABSTRACT FROM AUTHOR]

To report an unusual case of thyroid abscess associated with thyroid dysfunction in an adolescent girl who has a normal anatomic structure of the thyroid gland. A 15-year-old adolescent girl presented with a history of fever, sore throat, and neck swelling for 10 days duration. Contrast-enhanced computed tomography neck showed findings suggestive of an abscess involving the left lobe of the thyroid gland. She had low TSH and elevated T3 and T4 levels. Here, we report a case of thyroid abscess associated with transient hyperthyroidism in an immunocompetent girl who was successfully managed with parental antibiotics without incision and drainage. Thyroid abscess can present with hyperthyroidism in children. So it is important to monitor all children who have thyroid abscesses for the development of permanent hypothyroidism later on. It's important to diagnose this condition as soon as possible and begin antibiotic therapy appropriately. [ABSTRACT FROM AUTHOR]

Background/Aim: Thyroid diseases are prevalent endocrine disorders that significantly affect overall health. Although the impact of pre-existing thyroid dysfunction on total knee replacement (TKR) outcomes has been studied, the potential for TKR to increase the risk of developing thyroid disorders remains unexplored. Patients and Methods: We examined electronic medical records from a large U.S. research network in the TriNetX research network. The study focused on patients with osteoarthritis, comparing those who had total knee replacement surgery (TKR) between 2005 and 2018 to a non-TKR group who did not have the surgery. Propensity score matching was employed to control for critical confounders. The hazard ratios (HRs) for the risk of thyroid diseases in TKR patients versus non-TKR controls were assessed. Results: Postmatching, the TKR cohort demonstrated a significantly higher risk of developing thyroid diseases compared to the non-TKR cohort (unadjusted HR=1.218, 95%CI=1.169-1.269). This elevated risk persisted after adjusting for confounders (adjusted HR=1.126, 95%CI=1.061-1.196). Stratification analysis indicated that female TKR patients and those aged ≥65 years were at higher risk of developing thyroid diseases than their respective control groups. Conclusion: This study suggests a potential link between TKR and an increased risk of thyroid diseases, particularly among older adults and females. Potential mechanisms include inflammatory processes, surgical stress, autoimmune responses, and pharmacological effects. Healthcare providers should be vigilant in monitoring and managing thyroid dysfunction in TKR patients. Further research is necessary to elucidate the underlying mechanisms and develop preventive strategies. [ABSTRACT FROM AUTHOR]

The frequency of thyrotoxicosis may vary between countries and some laboratory test results may be used in etiology research. This study aimed to evaluate the prevalence of thyrotoxicosis diagnoses and laboratory test results. 3246 patients with overt thyrotoxicosis were included in this study. Laboratory test results, epicrisis, thyroid ultrasonography, thyroid scintigraphy, and radioactive iodine uptake test reports of the patients were examined in the study. Thyrotoxicosis was found due to levothyroxine overdose in 58.1% of the patients. When this group was excluded, 36.1% of the patients were diagnosed with toxic multinodular goiter most frequently. TRab levels were 8.5 times higher in Graves' disease than in other diagnostic groups. Anti-TPO levels were found to be the highest in the Graves' disease and Hashitoxicosis groups compared to other diagnostic groups (p<0.001). Anti-Tg levels were found to be highest in Graves' disease, Postpartum thyroiditis, and Hashitoxicosis patients (p<0.001). The free triiodothyronine / free thyroxine ratio was significantly higher, a cut-off value of >2.94 provided a sensitivity of 66% and specificity of 64% in diagnosing Graves' disease. The causes of thyrotoxicosis show some differences between countries. Patients using levothyroxine should be informed about drug use and dose titration. The free triiodothyronine / free thyroxine ratio can be used in addition to other tests during diagnosis. [ABSTRACT FROM AUTHOR]

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Objective: Rare disease. Background: Gitelman syndrome (GS) is an uncommon autosomal recessive inherited disease caused by inactivating mutations in the SLC12A3 gene located on chromosome 16q13, resulting in distal tubular dysfunction. Most cases are detected during routine examinations in adulthood, due to hypokalemia and alkalosis. GS needs to be distinguished from diseases that cause hypokalemia, such as Classic Bartter syndrome and hyperthyroidism. In individual cases, GS and hyperthyroidism occur simultaneously, which is prone to misdiagnosis. Case Report: A 51-year-old woman with intermittent palpitations and lower limb fatigue for 4 years received a diagnosis of hypokalemia at a local hospital. Treatment with potassium supplementation did not improve the patient's palpitations and fatigue. After coming to our hospital for examination, it was found that the patient had hyperthyroidism. After receiving treatment of hyperthyroidism remission and sufficient potassium replacement, the patient's serum potassium level remained low. Meanwhile, the patient had hypomagnesemia and metabolic alkalosis. Subsequently, according to our suggestion, the patient continued to take oral supplements of potassium and magnesium, while also started on spironolactone. We convinced the patient to undergo genetic testing and discovered compound heterozygous mutations in the SLC12A3 gene, which presented a definitive diagnosis of GS. In the following 3 months, the patient's serum potassium level was within the normal range, and the dose of methimazole was reduced. Conclusion: As a rare disease, GS may have only mild or occasional manifestations, making it prone to misdiagnosis. GS remains therapeutically challenging, and future progress in treatment will depend on further research of the disease. [ABSTRACT FROM AUTHOR]

Gestational diabetes mellitus (GDM) and thyroid disorders during pregnancy pose significant health concerns, impacting a substantial number of mothers globally. Globally, about 14% of pregnant women develop GDM, while thyroid disorders impact approximately 2%–3%. Both conditions contribute to adverse outcomes, including gestational hypertension, excessive fetal growth, and heightened perinatal morbidity. The central focus of this literature review is to examine the relationship between vitamin A, a crucial fat-soluble micronutrient in fetal development, and the occurrence of GDM and thyroid disorders during pregnancy. The primary research question investigates the association between vitamin A, GDM, and thyroid disorders, analyzing their combined impact on maternal, fetal, and neonatal outcomes. The review underscores the potential of vitamin A to modulate the risk and outcomes of GDM and thyroid disorders during gestation, emphasizing its role in GDM development and resolution and its influence on thyroid function in pregnancy. [ABSTRACT FROM AUTHOR]

Thyrotoxicosis during pregnancy is rare but can have severe adverse consequences for the mother or foetus if left undiagnosed and untreated. It can be caused by an underlying thyroid disease or develop as gestational transient thyrotoxicosis. Molar pregnancy stands out as a pathological condition characterized by abnormal trophoblastic cell growth, which can manifest in benign or malignant forms, and is diagnosed with a disproportionate elevation of β‐hCG (beta‐human chorionic gonadotrophin) and specific features on ultrasonography including absent sac and large multicystic or honeycomb appearance. A pronounced increase in β‐hCG levels can trigger hyperthyroidism, due to the structural resemblance between β‐hCG and thyroid‐stimulating hormone (TSH), although the thyrotrophic effects of β‐hCG could vary between patients diagnosed with gestational trophoblastic disease (GTD). In this report, we present two cases (Patient 1: 43 years, Patient 2: 31 years) who came to emergency department following a history of vaginal spotting, palpitations, and hyperemesis. In both patients, blood tests indicated disproportionately elevated β‐hCG levels along with high levels of Free T4 (FT4) and Free T3 (FT3), as well as suppressed TSH levels. Ultrasonography showed nonviable products of conception with large multicystic hemorrhagic lesions and empty gestational sacs, thereby confirming GTD. The Burch–Wartofsky Point Scale scores were 20 and 15 points, respectively, suggesting that they were less likely to be in thyroid storm at presentation. Antithyroid medications were administered, followed by evacuation of the products of conception. Postoperatively, their thyroid function was normalized. These cases underscore the importance of ruling out thyroid storm, monitoring thyroid function, and treating hyperthyroidism appropriately before undergoing surgical treatment. It is also important to consider the variability in the thyrotrophic effects of β‐hCG among individuals diagnosed with GTD. In addition to monitoring free thyroid hormone levels, it is crucial to consider clinical symptoms to effectively manage such cases. [ABSTRACT FROM AUTHOR]

Background: Hyperthyroidism is an endocrine disorder with a relatively low global prevalence but significantly higher incidence among females compared to males. The onset age primarily ranges from 30 to 50, although it is not limited to this age group. Challenges in the treatment of hyperthyroidism include individualized treatment plan formulation, management of side effects, and prediction of disease progression, necessitating comprehensive consideration to achieve more effective therapy and management. Mendelian randomization studies can reveal more precise therapeutic targets between blood and urine biomarkers and hyperthyroidism, providing more decadent treatment options for the condition. Methods: The study will build upon the omics Mendelian randomization (MR) framework by conducting MR analysis using 35 blood and urine biomarkers separately for two distinct databases of hyperthyroidism. Subsequently, the results will undergo meta-analysis and multiple corrections to ensure accuracy and reliability. Finally, positive findings will undergo reverse MR validation to verify causal relationships with hyperthyroidism. Results: In the British database, the MR analysis of Total bilirubin levels about hyperthyroidism yielded an odds ratio (OR) of 1.097 (95% CI: 0.951-1.265, P = 0.205). Conversely, in the Thyroid Omics Association database, the MR analysis revealed an OR of 1.283 (95% CI: 1.122-1.467, P = 0.0002) for the same relationship. Meta-analysis of the MR analysis results from both databases, following multiple corrections, resulted in an OR of 1.192 (95% CI: 1.081-1.314, P = 0.015). Additionally, the direction of beta values in the MR analysis results from both databases was consistent. Conclusion: The urine biomarker total bilirubin levels may contribute to an increased risk of hyperthyroidism and accelerate its progression, thus representing a risk factor for the condition. [ABSTRACT FROM AUTHOR]

Studies have been conducted on the relationship between depression and thyroid diseases and function, its causal relationship remains unclear. Using summary statistics of genome-wide association studies of European and East Asian ancestry, we conducted 2-sample bidirectional Mendelian randomization to estimate the association between MDD and thyroid function (European: normal range TSH, T4, T3, fT4, TPOAb levels and TPOAb-positives; East Asian: T4) and thyroid diseases (hypothyroidism, hyperthyroidism, and Hashimoto's thyroiditis), and used Mediation analysis to evaluate potential mediators (alcohol intake, antidepressant) of the association and calculate the mediated proportions. It was observed a significant causal association between MDD on hypothyroidism (P = 8.94 × 10−5), hyperthyroidism (P = 8.68 × 10−3), and hashimoto's thyroiditis (P = 3.97 × 10−5) among European ancestry, which was mediated by Alcohol intake (alcohol intake versus 10 years previously for hypothyroidism (P = 0.026), hashimoto's thyroiditis (P = 0.042), and alcohol intake frequency for hypothyroidism (P = 0.015)) and antidepressant (for hypothyroidism (P = 0.008), hashimoto's thyroiditis (P = 0.010)), but not among East Asian ancestry (P MDD-hypothyroidism = 0.016, but β direction was different; P MDD-hyperthyroidism = 0.438; P MDD-hashimoto ' s thyroiditis = 0.496). There was no evidence for bidirectional causal association between thyroid function mentioned above and MDD among both ancestry (all P > 0.05). We importantly observed a significant causal association between MDD on risk of hypothyroidism, hyperthyroidism, and hashimoto's thyroiditis among European ancestry, and Alcohol intake and antidepressant as mediators for prevention of hypothyroidism, hashimoto's thyroiditis attributable to MDD. • We conducted 2-sample bidirectional Mendelian randomization to estimate the association between MDD and thyroid diseases among European and East Asian ancestry and Mediation analysis to evaluate potential mediators (alcohol intake and antidepressant). • It was observed a significant causal association between MDD on hypothyroidism, hyperthyroidism, and hashimoto's thyroiditis among European ancestry, in which MDD on hypothyroidism and hashimoto's thyroiditiswas were mediated by Alcohol intake and antidepressant, but not among East Asian ancestry. • These findings may lead to a shift in personalizing treatment in the future. [ABSTRACT FROM AUTHOR]

Purpose: Preoperative iodine therapy in toxic nodular goiter (TNG) is discouraged as iodine may cause aggravation of hyperthyroidism. We aimed to examine if a short course of iodine treatment is safe to administer in TNG. Methods: Patients with TNG (n=20) and subclinical to mild hyperthyroidism (free (f)T4 <30 pmol/L) without complicating illnesses were included in this pre-postintervention study at Karolinska University Hospital. All participants received Lugol's solution 5%, three oral drops thrice daily for 10 days. Heart rate, TSH, fT4, fT3 concentrations were collected before (day 0) and after treatment (day 10). Thyroid hormone concentrations were also measured at two time points during treatment to discover aggravations of hyperthyroidism. ThyPRO39se, a quality-of-life questionnaire, was filled out day 0 and day 10. Differences in heart rate, thyroid hormone concentrations, and quality-of-life before and after treatment were compared. Adverse reactions were reported. Results: The median age was 63.5 years. Female to male ratio 19:1. FT4 and fT3 concentrations decreased (both p<0.001), and TSH concentration increased (p<0.001) after 10 days of treatment. There was no difference in heart rate. No aggravations of thyrotoxicosis were noticed in any of the participants. ThyPRO39se scores improved on three scales, including hyperthyroid symptoms, while the remaining scale scores were unchanged. Mild and transient symptoms related to or possibly related to treatment were observed in six participants. Conclusion: A short course of Lugol's solution improved thyroid hormone concentrations, reduced patient-reported hyperthyroid symptoms and was safe in TNG. Lugol's solution might be an option for preoperative treatment in TNG. [ABSTRACT FROM AUTHOR]

The heart and the thyroid gland are two of the most vital organs of the human body. The optimum functioning of these two organs is essential for the well-being of the body. These two organs share a twin-way relationship. Mild deviation from the normal range of thyroid hormone levels affects the heart. Hence, thyroid disorders (TD) are suspected to be strongly associated with cardiovascular diseases (CVD), especially in cases undergoing coronary artery bypass grafting (CABG). Usually, thyroid disorders pose very subtle symptoms that go unnoticed and remain undiagnosed for a long period of time. In this study, we analyze the effect of thyroid disorder (hypothyroid and hyperthyroid) on the clinical vitals, and pre-operative, intraoperative and post-operative parameters of the subjects who had undergone CABG. Our analysis establishes that thyroid disorders, if not controlled, can be indicators of poor outcomes in subjects undergoing CABG. Regular monitoring and maintenance of thyroid hormones is imperative in subjects undergoing CABG. [ABSTRACT FROM AUTHOR]

Characteristic symptoms of hyperthyroidism include weight loss, heart palpitation, and sweating. Thyroid hormones (TH) can stimulate thermogenesis through central and peripheral mechanisms. Previous studies have shown an association between dysfunction of cardiotrophin-like cytokine factor 1 (CLCF1) and cold-induced sweating syndrome, with recent research also indicating a link between CLCF1 and brown adipose tissue thermogenesis. However, it remains unclear whether CLCF1 and TH have synergistic or antagonistic effects on thermogenesis. This study aims to investigate the influence of thyroid hormone on circulating CLCF1 levels in humans and explore the potential possibilities of thyroid hormone in regulating energy metabolism by modulating Clcf1 in mice. By recruiting hyperthyroid patients and healthy subjects, we observed significantly lower serum CLCF1 levels in hyperthyroid patients compared to healthy subjects, with serum CLCF1 levels independently associated with hyperthyroidism after adjusting for potential confounders. Tissue analysis from mice treated with T3 revealed a decrease in CLCF1 expression in BAT and iWAT of C57BL/6 mice. These findings suggest that TH may play a role in regulating CLCF1 expression in adipose tissue. [ABSTRACT FROM AUTHOR]

Background: Serum thyroid-stimulating hormone (TSH) measurement is the diagnostic cornerstone for primary thyroid dysfunction. There is high inter-individual but limited intra-individual variation in TSH concentrations, largely due to genetic factors. The currently used wide population-based reference intervals may lead to inappropriate management decisions. Methods: A polygenic score (PGS) including 59 genetic variants was used to calculate genetically determined TSH reference ranges in a thyroid disease-free cohort (n = 6,834). Its effect on reclassification of diagnoses was investigated when compared to using population-based reference ranges. Next, results were validated in a second independent population-based thyroid disease-free cohort (n = 3,800). Potential clinical implications were assessed in a third independent population-based cohort including individuals without thyroid disease (n = 26,321) as well as individuals on levothyroxine (LT4) treatment (n = 1,132). Results: PGS was a much stronger predictor of individual TSH concentrations than FT4 (total variance in TSH concentrations explained 9.2–11.1% vs. 2.4–2.7%, respectively) or any other nongenetic factor (total variance in TSH concentrations explained 0.2–1.8%). Genetically determined TSH reference ranges differed significantly between PGS quartiles in all cohorts, while the differences in FT4 concentrations were absent or only minor. Up to 24.7–30.1% of individuals, previously classified as having subclinical hypo- and hyperthyroidism when using population-based TSH reference ranges, were reclassified as euthyroid when genetically determined TSH reference ranges were applied. Individuals in the higher PGS quartiles had a higher probability of being prescribed LT4 treatment compared to individuals from the lower PGS quartiles (3.3% in Q1 vs. 5.2% in Q4, Pfor trend =1.7 × 10−8). Conclusions: Individual genetic profiles have the potential to personalize TSH reference ranges, with large effects on reclassification of diagnosis and LT4 prescriptions. As the currently used PGS can only predict approximately 10% of inter-individual variation in TSH concentrations, it should be further improved when more genetic variants determining TSH concentrations are identified in future studies. [ABSTRACT FROM AUTHOR]

Total thyroidectomy (TTx) has been reported to be more challenging in patients with Graves' disease, especially in those who are hyperthyroid at the time of surgery. Our aim was to compare outcomes in patients undergoing TTx for Graves' disease compared to other thyroid diseases at a large academic institution with high-volume fellowship-trained endocrine surgeons. In our retrospective analysis from December 2015 to May 2023, patients undergoing TTx for Graves' disease were compared to those undergoing TTx for all other indications excluding advanced malignancy (poorly differentiated thyroid cancer and concomitant neck dissections). Patient demographics, biochemical values, and postoperative outcomes were compared. A subgroup analysis was performed comparing hyperthyroid to euthyroid patients at the time of surgery. There were 589 patients who underwent TTx, of which 227 (38.5%) had Graves' disease compared to 362 (61.5%) without. Intraoperatively in Graves' patients, nerve monitoring was used more frequently (65.6% versus 57.1%; P = 0.04) and there was a higher rate of parathyroid autotransplantation (32.0% versus 14.4%; P < 0.01). Postoperatively, transient voice hoarseness occurred less frequently (4.8% versus 13.6%; P < 0.01) and there was no difference in temporary hypocalcemia rates or hematoma rates. In our subgroup analysis, 83 (36%) of Graves' patients were hyperthyroid (thyroid-stimulating hormone < 0.45 and free T4 > 1.64) at the time of surgery and there were no differences in postoperative complications compared to those who were euthyroid. At a high-volume endocrine surgery center, TTx for Graves' disease can be performed safely without significant differences in postoperative outcomes. Hyperthyroid patients demonstrated no differences in postoperative outcomes. [ABSTRACT FROM AUTHOR]

Previous observational studies found associations between Helicobacter pylori infection and autoimmune thyroid diseases (AITDs), but the causal nature of this association is still uncertain. We investigated the causal effect of six crucial antibodies against H. pylori on AITDs using a bidirectional Mendelian randomization (MR). We found that anti-H. pylori outer membrane protein (OMP) significantly increased the risk of hyperthyroidism and Graves' disease (GD). In addition, our reverse MR analysis indicated that hyperthyroidism could increase the levels of cytotoxin-associated gene A and OMP antibodies. We also observed causal roles of GD on anti-H. pylori OMP. Our analyses indicate the mutual effects of H. pylori infection and AITDs, suggesting the existence of a gut-thyroid axis. These results also provide evidence of the bidirectional causal association between anti-H. pylori OMP with hyperthyroidism and GD, resulting in a vicious circle. [ABSTRACT FROM AUTHOR]

Purpose: Patients hospitalized for community-acquired pneumonia (CAP) may have a higher risk of new-onset atrial fibrillation (NOAF). The C2HEST score was developed to evaluate the NOAF risk in the general population. Data on the value of the C2HEST score in acute patients admitted with CAP are lacking. We want to establish the predictive value of C2HEST score for NOAF in patients with CAP. Methods: Patients with CAP enrolled in the SIXTUS cohort were enrolled. C2HEST score was calculated at baseline. In-hospital NOAF was recorded. Receiver-operating Characteristic (ROC) curve and multivariable Cox proportional hazard regression analysis were performed. Results: We enrolled 473 patients (36% women, mean age 70.6 ± 16.5 years), and 54 NOAF occurred. Patients with NOAF were elderly, more frequently affected by hypertension, heart failure, previous stroke/transient ischemic attack, peripheral artery disease and hyperthyroidism. NOAF patients had also higher CURB-65, PSI class and CHA2DS2-VASc score. The C-index of C2HEST score for NOAF was 0.747 (95% confidence interval [95%CI] 0.705–0.786), higher compared to CURB-65 (0.611, 95%CI 0.566–0.655, p = 0.0016), PSI (0.665, 95%CI 0.621–0.708, p = 0.0199) and CHA2DS2-VASc score (0.696, 95%CI 0.652–0.737, p = 0.0762). The best combination of sensitivity (67%) and specificity (70%) was observed with a C2HEST score ≥ 4. This result was confirmed by the multivariable Cox analysis (Hazard Ratio [HR] for C2HEST score ≥ 4 was 10.7, 95%CI 2.0–57.9; p = 0.006), independently from the severity of pneumonia. Conclusion: The C2HEST score was a useful predictive tool to identify patients at higher risk for NOAF during hospitalization for CAP. Clinical Trial Registration: www.clinicaltrials.gov (NCT01773863) [ABSTRACT FROM AUTHOR]

Aim and Background. This study aims to explore alternative diagnostic methods to assess thyroid function in patients unable to undergo blood tests for thyroid-stimulating hormones (TSH) and thyroxine (T4), such as individuals with trypanophobia, severe medical conditions, or coagulopathy. Considering the impact of thyroid dysfunction on mitochondrial metabolism and the essential role of proper mitochondrial function in ciliary motility, we postulate that assessing nasal ciliary function could serve as a surrogate diagnostic approach for thyroid dysfunction. Methods. This cross-sectional study was performed on individuals with no history of thyroid diseases. The primary endpoint was the diagnostic value of the nasal mucociliary (NMC) test using Iranica Picris (Asteraceae) aqueous extract in differentiating hypo- or hyperthyroidism cases from euthyroid cases. Results. 232 individuals were recruited (71% females, 86% euthyroid). Receiver operating characteristic (ROC) analysis showed a good diagnostic value for the NMC test in differentiating overt hypothyroidism (area under the ROC curve [AUROC] = 0.82, p = 0.004) and its fair value in diagnosing subclinical hyperthyroidism (AUROC = 0.78, p = 0.01) from the euthyroid condition. The NMC test had a significant positive correlation with TSH (r = 0.47, p < 0.001) and a significant negative correlation with T4 (r = −0.32, p < 0.001). The NMC rate was significantly different in distinct thyroid function groups (p < 0.001). Compared with euthyroid cases, the post-hoc analysis showed that the NMC test is significantly higher in overt hypothyroidism (15.06 vs. 21.07 min, p = 0.003) and significantly lower in subclinical hyperthyroidism (15.05 vs. 10.9 min, p = 0.02). Conclusions. The Iranica Picris-based NMC test might serve as a diagnostic method to distinguish overt hypothyroidism and subclinical hyperthyroidism. [ABSTRACT FROM AUTHOR]

Fetal and neonatal thyrotoxicosis occurs in up to 5% of pregnancies in mothers with Graves' disease (GD). This condition is caused by stimulating antibodies against the thyrotropin receptor (TRAbs) that cross the placenta and may stimulate the fetal thyroid, typically in the second half of pregnancy. GD is often treated with radioiodine, resulting in hypothyroidism in most patients, but TRAbs can persist for several years. Even if a pregnant mother is hypothyroid after radioiodine therapy or surgery, her TRAbs can still, although rarely, induce fetal hyperthyroidism. In this review, we first present two cases of neonatal hyperthyroidism in mothers with GD who became hypothyroid after prior radioiodine therapy, identified through a 10-year analysis of the National Perinatal System in Slovenia. Based on these cases, we provide an overview of existing data on this rare clinical condition in neonates. We also discuss the underlying mechanisms and clinical outcomes based on currently available data. In conclusion, our review highlights the importance of careful monitoring during pregnancy in all women with GD, even in those well managed after radioiodine therapy or surgery. [ABSTRACT FROM AUTHOR]

Purpose: SARS-CoV-2 can invade the thyroid gland. This study was to delineate the risk of thyroid dysfunction amidst the prevalence of the Omicron variant, and to investigate the correlation between thyroid function and Coronavirus disease 2019 (COVID-19) outcomes. The study also aimed to ascertain whether thyroid dysfunction persisted during COVID-19 recovery phase. Methods: This was a retrospective cohort study. COVID-19 patients from the Renmin Hospital of Wuhan University, China during the epidemic of Omicron variants were included, and their thyroid function were analyzed in groups. Results: A history of thyroid disease was not associated with COVID-19 outcomes. COVID-19 can lead to a bimodal distribution of thyroid dysfunction. The severity of COVID-19 was inversely proportional to the levels of thyroidstimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4), leading to a higher prevalence of thyroid dysfunction. Severe COVID-19 was a risk factor for euthyroid sick syndrome (ESS) (OR=22.5, 95% CI, 12.1 - 45.6). Neutrophil to lymphocyte ratio mediated the association between severe COVID-19 and ESS (mediation effect ratio = 41.3%, p < 0.001). ESS and decreased indicators of thyroid function were associated with COVID-19 mortality, while high levels of FT3 and FT4 exhibited a protective effect against death. This effect was more significant in women (p < 0.05). During the recovery period, hyperthyroidism was quite uncommon, while a small percentage of individuals (7.7%) continued to exhibit hypothyroidism. Conclusion: COVID-19 severity was linked to thyroid dysfunction. Severe COVID-19 increased the risk of ESS, which was associated with COVID-19 mortality. Post-recovery, hyperthyroidism was rare, but some individuals continued to have hypothyroidism. [ABSTRACT FROM AUTHOR]

Background: The relationship between thyroid hormone (TH) levels in vivo and osteoarthritis (OA) remains inconclusive. This study aims to investigate the association between TH levels and OA, analyze the effect of triiodothyronine on hypertrophic chondrocyte differentiation and OA progression, and identify potential target genes of triiodothyronine in OA to evaluate its diagnostic value. Methods: Two-sample mendelian randomization method was used to probe the causal links between hyperthyroidism and OA. Differentially expressed genes (DEGs) from two RNA-sequencing data in Gene Expression Omnibus (GSE199847 and GSE114007) and enrichment analysis of DEGs (166 commonly upregulated genes and 71 commonly downregulated genes of GSE199847 and GSE114007) was performed to analyze the effect of triiodothyronine (T3) on hypertrophic chondrocyte differentiation and OA. C28/I2 cells treated with T3 and reverse transcription and quantitative real-time polymerase chain reaction were used to validate T3 targeted genes. The diagnostic performance of target genes was assessed by the receiver operating characteristic (ROC) curve and area under the curve (AUC). Results: There was a positive causal association between hyperthyroidism and OA (IVW result, OR = 1.330, 95% CI 1.136–1.557, P = 0.0004). Weighted median and Weighted mode analysis also demonstrated that hyperthyroidism had a positive causal association with OA (p < 0.05, OR > 1). Bioinformatics analysis indicated T3 can partially induce the emergence of late hypertrophic chondrocyte and promote OA through extracellular matrix organization, blood vessel development, skeletal system development and ossification. Post-T3 treatment, MAFB, C1QTNF1, COL3A1 and ANGPTL2 were significantly elevated in C28/I2 cells. ROC curves in GSE114007 showed that AUC of all above genes were ≥ 0.7. Conclusions: This study identified that hyperthyroidism has a positive causal association with OA by MR analysis. T3 induced hypertrophic chondrocytes promote OA progression by upregulating genes such as MAFB, C1QTNF1, COL3A1 and ANGPTL2, which can also serve as OA diagnosis. [ABSTRACT FROM AUTHOR]

Coronary spasm related to thyrotoxicosis is a complication rarely reported in the literature. Its initial clinical presentation is often more severe with more diffuse involvement and resistance to medical treatment compared to classic coronary spasm. Its diagnosis relies on a careful clinical analysis and a comparative study of electrocardiographic data. Coronary angiography should be avoided as much as possible as well as treatment by nonselective beta-blocking agents because of the risk of worsening hyperthyroidism and coronary vasoconstriction. We report a case of coronary spasm secondary to Graves' disease whose management was inspired by lessons learned from clinical cases reported in the literature. [ABSTRACT FROM AUTHOR]

Cardiac hypertrophy (CH) is an adaptive response to maintain cardiac function; however, persistent stress responses lead to contractile dysfunction and heart failure. Although inflammation is involved in these processes, the mechanisms that control cardiac inflammation and hypertrophy still need to be clarified. The NLRP3 inflammasome is a cytosolic multiprotein complex that mediates IL-1β production. The priming step of NLRP3 is essential for increasing the expression of its components and occurs following NF-κB activation. Hyperthyroidism triggers CH, which can progress to maladaptive CH and even heart failure. We have shown in a previous study that thyroid hormone (TH)-induced CH is linked to the upregulation of S100A8, leading to NF-κB activation. Therefore, we aimed to investigate whether the NLRP3 inflammasome is involved in TH-induced CH and its potential role in CH pathophysiology. Hyperthyroidism was induced in NLRP3 knockout (NLRP3-KO), Caspase-1-KO and Wild Type (WT) male mice of the C57Bl/6J strain, aged 8–12 weeks, by triiodothyronine (7 μg/100 g BW, i.p.) administered daily for 14 days. Morphological and cardiac functional analysis besides molecular assays showed, for the first time, that TH-induced CH is accompanied by reduced NLRP3 expression in the heart and that it occurs independently of the NLRP3 inflammasome and caspase 1-related pathways. However, NLRP3 is important for the maintenance of basal cardiac function since NLRP3-KO mice had impaired diastolic function and reduced heart rate, ejection fraction, and fractional shortening compared with WT mice. [ABSTRACT FROM AUTHOR]

Hyperthyroidism-induced cardiac disease is an evolving health, economic, and social problem affecting well-being. Sodium-glucose cotransporter protein 2 inhibitors (SGLT2-I) have been proven to be cardio-protective when administered in cases of heart failure. This study intended to investigate the potential therapeutic effect of SGLT2-I on hyperthyroidism-related cardiopulmonary injury, targeting the possible underlying mechanisms. The impact of the SGLT2-I, dapagliflozin (DAPA), (1 mg/kg/day, p.o) on LT4 (0.3 mg/kg/day, i.p)-induced cardiopulmonary injury was investigated in rats. The body weight, ECG, and serum hormones were evaluated. Also, redox balance, DNA fragmentation, inflammatory cytokines, and PCR quantification in heart and lung tissues were employed to investigate the effect of DAPA in experimentally induced hyperthyroid rats along with histological and immunohistochemical examination. Coadministration of DAPA with LT4 effectively restored all serum biomarkers to nearly average levels, improved ECG findings, and reinstated the redox balance. Also, DAPA could improve DNA fragmentation, elevate mtTFA, and lessen TNF-α and IGF-1 gene expression in both organs of treated animals. Furthermore, DAPA markedly improved the necro-inflammatory and fibrotic cardiopulmonary histological alterations and reduced the tissue immunohistochemical expression of TNF-α and caspase-3. Although further clinical and deep molecular studies are required before transposing to humans, our study emphasized DAPA's potential to relieve hyperthyroidism-induced cardiopulmonary injury in rats through its antioxidant, anti-inflammatory, and anti-apoptotic effects, as well as via antagonizing the sympathetic over activity. [ABSTRACT FROM AUTHOR]

The medicinal nature of traditional Chinese medicine (TCM) mainly plays a role in regulating the energy and material metabolism of the body. The energy metabolism of the body is also regulated by the nervous and endocrine systems, and the hormones are an important component of the endocrine system to realize the coordinated action. Therefore, the medicinal nature of TCM is inextricably linked with the metabolism of hormones. Hyperthyroidism, qi-yin deficiency syndrome is regarded as the classic heat syndrome category in Chinese medicine, which can be used as model to reflect the mechanism and difference of qi tonifying of ginseng herbs with different medicinal natures. Steroid hormones are synthesized in the adrenal cortex, mitochondria of placental cells, smooth endoplasmic reticulum, and gonads of the human body by the participation of various metabolic enzymes. Meanwhile, most of the patients with hyperthyroidism have adrenocortical dysfunction in the clinic, and the corresponding clinical symptoms are closely related to the hypothalamic-pituitary-thyroid axis (HPT), the hypothalamic-pituitary-adrenal axis (HPA), and the hypothalamic-pituitary-gonadal axis (HPG). When hyperthyroidism occurs, the production and release of steroid hormones will be affected to a certain extent. To explore the correlation between the level of steroid hormones and hyperthyroidism, and the ameliorative effects of red ginseng and ginseng leaves of different types of the genus Ginseng on hypermetabolism of hyperthyroidism and the changes of related indexes, a method of ultra-high performance liquid chromatography coupled to triple quadrupole tandem mass spectrometry (UPLC-QqQ-MS/MS) was established for rapid identification and quantification of chemical components, including adrenaline, androstenedione, testosterone, dehydroepiandrosterone, estriol, progesterone, 17α-hydroxypregnenolone, corticosterone, and cortisol in rat serum. Then, multivariate analysis method, principal component analysis (PCA), and Spearman test were used to analyze the correlation among adrenaline, steroid hormones, and thyroid function. The results showed that the contents of steroid hormone in the serum of the model group of rats decrease to different degrees, compared with the control group, and increase after the administration of different types of ginsengs. Meanwhile, it was proved that the established method has high sensitivity, good reproducibility, high accuracy, and fast analysis, which can screen a large number of steroid hormones in complex samples in a short time, for accurately investigation of the effects of ginsengs on the content of 9 types of steroid hormones in hyperthyroidism rats. The abnormal levels of steroid hormones are related to thyroid hormones. Corticosterone and adrenaline can serve as key indicators for regulating steroid hormone metabolism of TCMs like ginsengs. Testosterone can be used as the biomarker for regulating steroid hormones of the cold nature herbs. Adrenaline and androstenedione can be used as biomarkers for regulating steroid hormones of the warm nature herbs. This method can conveniently, quickly, accurately, and efficiently complete the analysis of target components in samples. The average recoveries of steroid hormones in rat serum range from 88.75% to 106.94%, and the relative standard deviation is less than 1.99%. This can be used for the determination of steroid hormones in rat serum systematically, rapidly, accurately and efficiently, and provides a methodological reference for the analysis and determination of steroid hormones. [ABSTRACT FROM AUTHOR]

Introduction Benign paroxysmal positional vertigo (BPPV) is the peripheral vestibular dysfunction that most affects people worldwide, but its etiopathogenesis is still not fully understood. Considering the etiological diversity, some studies highlight the association between BPPV and thyroid diseases. Objective To investigate the association between thyroid diseases and BPPV. Data Synthesis Systematic review and meta-analysis of epidemiological studies searched in the PubMed, Web of Science, Embase, Cochrane Library, and Scopus databases. Studies that were fully available and investigated the association between BPPV and thyroid diseases were selected. The articles that composed the meta-analysis were analyzed using the dichotomous model, the Mantel-Haenszel statistical test, odds ratio (OR), and a 95% confidence interval (CI). Of the 67 articles retrieved from the databases, 7 met the eligibility criteria of the systematic review, and 4 had data necessary to perform the meta-analysis. Qualitative analysis revealed that the studies were conducted in the European and Asian continents. The predominant methodological design was the case-control type, and thyroid dysfunctions, hypothyroidism, and Hashimoto thyroiditis occurred more frequently. The meta-analysis showed no association between hypothyroidism and BPPV; however, there was a statistically significant relationship between Hashimoto thyroiditis and BPPV. Conclusion The meta-analysis results suggest a possible association between BPPV and Hashimoto thyroiditis. Nevertheless, we emphasize the need for further studies to elucidate the evidence obtained. [ABSTRACT FROM AUTHOR]

Background: Although regular health screening is recommended, long‐term follow‐up data in healthy aged cats are lacking. Objectives: Determine the most common conditions in a large group of apparently healthy older cats and which diseases are manifested within 2 years in cats confirmed to be healthy based on extensive health screening. Animals: Client‐owned cats. Methods: Prospective study. Thorough history, physical examination, blood tests, and urinalysis were performed in 259 apparently healthy mature adult (7‐10 years) and senior (>10 years) cats. Semi‐annual follow‐up examinations were performed in 201 confirmed healthy cats. Results: At baseline, 21% of apparently healthy cats were not considered healthy but were diagnosed with International Renal Interest Society (IRIS) ≥ stage 2 chronic kidney disease (CKD; 7.7%) or hyperthyroidism (4.6%), among other disorders. Disease occurred significantly more frequently in senior cats compared with mature adult cats. In addition, 40% cats were overweight, 35% had moderate to severe dental disease, and 22% had abnormal cardiac auscultation findings. Within 2 years, 28% of mature adult and 54% of senior cats that were confirmed healthy at inclusion developed new diseases, most commonly IRIS ≥ stage 2 CKD (cumulative incidence, 13.4%), hyperthyroidism (8.5%), chronic enteropathy, hepatopathy or pancreatitis (7.5%), or neoplasia (7%). Conclusions and Clinical Importance: The high prevalence and 2‐year incidence of physical examination abnormalities and systemic diseases in apparently healthy older cats argue for regular health screening in cats ≥7 years of age. Although more common in senior cats, occult disease also occurs in mature adult cats, and owners should be informed accordingly. [ABSTRACT FROM AUTHOR]

Background: Function of thyroid gland is regulated by the axis hypothalamic- pituitarythyroid through these hormones: Thyrotrophin releasing hormone (TRH), thyroid stimulating hormone (TSH), tetraiodothyronine hormone (T4) and triiodothyronine hormone (T3). Thyroid disorders(hyperthyroidism or hypothyroidism) are common around the world and are common diseases in Iraq. Thyroid disorders are states that initially affect on amount of hormones that produced by the thyroid, and affects on all physiological systems including central nervous system, cardiovascular system, blood, and others. Afamin (AFM) is an 87 Kilodalton (kDa) glycoprotein that shares 55% of the amino acid sequence of albumin and contains 15% of carbohydrates. Vimentin (VIM) is a protein among 70 types of intermediate filaments, including Vimentin, Keratin, Desmin and Lamin. Vimentin is a cytoskeleton is an intermediate filament protein that makes up the nucleus and muscle cells. Aimes of study: We aimed to evaluate levels of Afamin, Vimentin and number of biochemical variables (TRH,TSH,T3 and T4) with Body mass index (BMI) in females patients with thyroid disorders. Methods: The study groups include 30 women with hyperthyroidism, 30 women with hypothyroidism and a control group of 30 healthy women with ages between(18-45) years, From September 2023 until March 2024. Protein assays include Afamin, Vimentin levels and number of biochemical variables( TRH,TSH,T3 and T4) in females patients with thyroid disorders . Results: The results of current study showed a significant increase at (P≤ 0.05) in AFM (227.67 ± 32.31), VIM(40.00 ± 4.39) levels with TRH(225.04± 57.08), TSH (11.71 ± 2.77) and BMI (29.70 ± 2.86) in patients with hypothyroidism group compared to (hyperthyroidism and healthy) groups. Levels of T3 (0.76 ± 0.14) and T4 (3.33 ± 0.79) showed a significant decrease at (P≤0.05) in hypothyroidism group compared to hyperthyroidism and healthy groups, While TSH (0.25 ± 0.08) levels showed a significant decrease at (P≤ 0.05) in hyperthyroidism group compared to hypothyroidism group and healthy group. Concentrations of T4 (13.42 ± 1.36) with T3 (2.16 ± 0.42) showed a significant increase at (P≤ 0.05) in hyperthyroidism group compared to hypothyroidism and healthy groups. Conclusions: We conclude from results of current study that high levels of AFM and VIM are associated with high levels of TRH,TSH and BMI in hypothyroidism group . Serum levels of AFM and VIM may be a new biomarkers for detecting and monitoring thyroid disorders, and may be an important useful clinical tools for detecting and monitoring thyroid disturbances. [ABSTRACT FROM AUTHOR]

Background: Thyroid hormones play a crucial role in major metabolic pathways in the body and dyslipidemia is a major metabolic abnormality seen in thyroid disorders. Cardiovascular diseases (CVDs) are now emerging as the leading cause of morbidity and mortality worldwide and the most important risk factor for CVDs is dyslipidemia. The lipid ratios that have a positive association with CVD risk are atherogenic index of plasma (AIP), Castelli’s risk index (CRI)-I and II, and atherogenic coefficient (AC). Clinically, both an excess and deficiency of thyroid hormones can exacerbate or induce CVDs and lipid ratio can be used as an inexpensive marker for predicting CVD risk. Aims and Objectives: This study aims to evaluate the lipid ratios (AIP, CRI-I, CRI-II, AC) in patients with thyroid dysfunction and compare the results with lipid ratios in euthyroid individuals. This study also aims to find any correlation, if exists, between lipid ratios and serum thyroid-stimulating hormone (TSH) levels in thyroid dysfunction. Materials and Methods: The serum TSH and lipid profile were evaluated in fifty euthyroid, fifty hypothyroid, fifty subclinical hypothyroid, and fifty hyperthyroid patients. The lipid ratios (AIP, CRI-I, CRI-II, AC) were calculated from the lipid profile. Results: The mean lipid ratios were higher in hypothyroid, followed by subclinical hypothyroid cases when compared to euthyroid controls and hyperthyroid patients. A positive correlation was observed between the TSH and lipid ratios in euthyroid, hypothyroid, and subclinical hypothyroid subjects. There was no significant correlation between TSH and lipid ratios in hyperthyroid patients. Conclusion: This study demonstrates that the evaluation of lipid ratios along with TSH can provide an effective screening tool to assess the cardiovascular risk in patients with subclinical and overt hypothyroidism, especially in the absence of imaging techniques in resource-limited centers. [ABSTRACT FROM AUTHOR]