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Background: Thyroid storm (TS) is a critical manifestation of hyperthyroidism. In recent years, the risk of perioperative TS is significantly decreased in patients with hyperthyroidism undergoing thyroid surgeries with adequate preoperative preparations. However, those who undergo non-thyroidal operations have higher risk of TS due to easily ignoring the evaluation of thyroid function. The purpose of this case report is to present a patient with TS during nonthyroidal surgery and review similar cases in the literature. Case presentation: A middle-aged female who received unilateral total knee arthroplasty under general anesthesia developed refractory tachycardia during the operation and was diagnosed with hyperthyroidism via laboratory tests after surgery. She was suggestive of TS based on the Burch and Wartofsky scoring system and relieved after etiological treatments. She was discharged 10 days after surgery and continued to take antithyroid medication. Conclusion: We recommend that a comprehensive history collection is warranted. The clinical manifestations of TS during operation could be versatile and atypical. Any abnormalities during an operation like abnormal heart rate, blood pressure, body temperature, or even the unusual anesthetics needed, should not be ignored. In surgeries with general anesthesia, it is necessary to be cautious about TS with an atypical manifestation of tachycardia. Once suspected, supportive and resuscitative treatment along with antithyroid medication should be promptly initiated. [ABSTRACT FROM AUTHOR]

Objective: Adropin is a unique hormone, which controls metabolism and energy homeostasis. Hyperthyroidism is a disease with a high metabolic rate that affects both glucose and lipid metabolism. We aimed to investigate the change of adropin levels and the association between adropin levels and clinical parameters in patients with hyperthyroidism. Methods: This cross‐sectional study comprised 90 newly diagnosed patients with hyperthyroidism and 90 age‐ and gender‐matched healthy controls. Circulating adropin levels and thyroid hormone levels were evaluated in each participant. Results: Compared with the healthy controls, the hyperthyroid patients had significantly higher levels of serum adropin (p < 0.001). In addition, adropin levels were positively correlated with free triiodothyronine (FT3) and free thyroxine (FT4), whereas they were negatively correlated with thyroid‐stimulating hormone (TSH). A multivariate linear regression analysis showed that serum adropin concentrations were independently correlated with FT3 and TSH after adjustment for age, gender, and other confounding factors (FT3: β = 0.231, p < 0.05; TSH: β = −0.301, p < 0.05). Conclusions: Patients with hyperthyroidism had elevated serum adropin levels. And the serum adropin concentrations were independently correlated with the FT3 and TSH levels. [ABSTRACT FROM AUTHOR]

Maternal Graves' autoantibodies are well known to cause fetal and neonatal thyroid disturbances. Despite radioiodine therapy, Graves' autoantibodies are known to persist, which can cross the placenta and cause hyperthyroidism in the fetus. We present the case of a 26-year-old woman in her first pregnancy, clinically and biochemically euthyroid with history of treated Graves' disease, where the fetus showed signs of hyperthyroidism on antenatal scans. This was confirmed by amniotic fluid testing as fetal blood sampling was not feasible and successfully treated with maternal carbimazole whilst continuing thyroxine for the mother (block-replacement). We discuss the challenges in the diagnosis of fetal hyperthyroidism and treatment whilst maternal thyroid status is maintained on thyroxine. [ABSTRACT FROM AUTHOR]

Purpose: Subclinical thyroid diseases constitute the first stage of clinical thyroid, so it is important to investigate underlying mechanisms. Clinical studies have revealed changes in some adipokines concerning thyroid disorders. Relationship chemerin and vaspin adipokines with thyroid hormones needs to crarify. So, it was aimed to evaluate chemerin, vaspin, oxidative stress, and inflammation markers in subclinical hypothyroidism/hyperthyroidism. Material and Methods: The study included 38 subclinical hyperthyroidism, 31 subclinical hypothyroidism, and 44 healthy controls. Serum chemerin, vaspin, interleukin-10, C-reactive protein, and Oxidized LDL were measured with ELISA method, while total antioxidant status, and total oxidant status were spectrophotometric methods. Results: Serum chemerin levels were higher in the subclinical hypothyroidism group, whereas lower in the subclinical hyperthyroidism compared to the controls. Vaspin levels of subclinical thyroid patients were lower than the controls. Interleukin-10 levels of subclinical hyperthyroidism were lower, conversely C-reactive protein levels were higher in both patient groups than the control group. Total antioxidant status were higher in the subclinical hypothyroidism group; total oxidant status and oxidative stress index were lower in subclinical hyperthyroidism patients. Conclusion: Increased total antioxidant and C-reactive protein levels in the subclinical hypothyroidism group and decreased total oxidants, interleukin-10, and oxidative stress index in the subclinical hyperthyroidism group indicated that oxidant-antioxidant balance is impaired, suggesting that subclinical thyroid diseases may cause changes in inflammation and defense mechanism. The decreases in chemerin levels in the subclinical hyperthyroidism patients and vaspin levels in the both patient groups show that chemerin and vaspin may be candidates as biomarkers in subclinical thyroid diseases. [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]

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The article presents a case study of a 61-year-old man diagnosed with thyroiditis as a novel manifestation of Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic (VEXAS) syndrome, an adult-onset autoinflammatory disease. Topics discussed include the patient's initial symptoms and diagnostic process, identification of the UBA1 gene mutation confirming VEXAS syndrome, and the response to treatment with high-dose prednisolone and tocilizumab.

Objective: Osteoporosis can be followed secondary to hypothyroidism and hyperthyroidism. In this study, we evaluated the awareness and knowledge of osteoporosis in patients with hypothyroidism and hyperthyroidism. Materials and Methods: A total of 148 patients and 148 volunteers, 80 of whom were diagnosed with hypothyroidism and 68 with hyperthyroidism, were included in the study. Demographic information and socioeconomic status of all patients and volunteers were recorded. Participants were evaluated using the osteoporosis knowledge test and osteoporosis awareness scale. For the osteoporosis knowledge questionnaire, correct answers of 13 and above were considered sufficient and answers below 13 were considered insufficient. First, the patient and volunteer groups were compared, and then the patient group was divided into two groups as hypothyroidism and hyperthyroidism. Questionnaires measuring osteoporosis awareness and osteoporosis knowledge levels of hypothyroid and hyperthyroid patients were compared. Results: There was no difference between the patient and control groups in terms of age, gender, education level, and income level (p>0.05). Both the patient and control groups had osteoporosis awareness, but there was no significant difference between the groups (p>0.05). The awareness of osteoporosis was high in the hypothyroid-hyperthyroid patient and control groups. When the osteoporosis knowledge levels of the patient and control groups were compared, a statistically significant difference was found in favor of the control group (p<0.05). No statistically significant difference was found regarding the osteoporosis awareness levels of hyperthyroid and hypothyroid patients (p>0.05). The osteoporosis knowledge level was low in patients with hypothyroidism and hyperthyroidism. Conclusion: Osteoporosis awareness was high in the hypothyroid and hyperthyroid patient and control groups. Considering the osteoporosis knowledge levels of the patient and control groups, although the knowledge level was insufficient in both groups, the decrease in the patient group was significant. [ABSTRACT FROM AUTHOR]

Congenital hypothyroidism is one of the most common causes of preventable intellectual disability in the UK and worldwide. Early diagnosis is critical to allow for early intervention. At present, 1 in 2000 to 1 in 3000 babies born in the UK have congenital hypothyroidism. Of these, most will not display any clinical manifestations or symptoms in the first few weeks of life. In short, babies will develop intellectual disability if they go undiagnosed. It is therefore no surprise that the day 5 blood spot is essential for good outcomes and harm reduction. Diagnosis of thyroid disorder is based on measuring the thyroid hormones and thyroid stimulating hormone levels. The most common cause of congenital hypothyroidism is an abnormality in thyroid gland development (dysgenesis) but it may also be the result of a defect in thyroid hormonogenesis or may be temporary as a result of maternal medications passing through the placenta, maternal blocking antibodies or iodine excess or deficiency. Rarely, it is the result of pituitary or hypothalamic abnormality when it is called central or secondary/tertiary hypothyroidism. This short article offers practical advice on how to diagnose and treat congenital hypothyroidism and how to interpret the results of available biochemical tests. [ABSTRACT FROM AUTHOR]

Introduction: Cardiothyreosis corresponds to the cellular effects of free thyroid hormones on the vascular wall and the myocardium. We aim to describe the clinical, para-clinical and therapeutic aspects of cardiothyreosis and to detail prognostic factors. Methods: We conducted a descriptive retrospective study at the Endocrinology-Diabetology Department of the Hedi Chaker University Hospital in Sfax-Tunisia. We collected medical records of 100 patients with cardiothyreosis between January 1999 and December 2019. We included patients with cardiothyreosis who underwent adequate cardiac evaluation. We excluded patients with cardiac abnormalities related to conditions other than hyperthyroidism, patients who died and patients without cardiothyreosis. Results: We included 100 adult patients (43 men and 57 women). The mean age was 49.3 ±12.9 years (20-79 years). The diagnosis of cardiothyreosis was concomitant with that of hyperthyroidism in 72% of cases. Weight loss and palpitations were the two most frequently reported signs in 91% of cases each. Hypertension was systolic in 15 patients. The average heart rate was 103.1 beats/min (52-182 bpm). The mean TSH and FT4 levels were 0.042 μIU/ml and 59.6 pmol/l, respectively. Rhythm disorders and heart failure were the most common cardiac complications with 81 and 56 cases, respectively. Cardiac ultrasound showed dilatation of the left atrium in 28.3% of patients. Pulmonary arterial hypertension was present in 43% of cases. 57 patients had been treated with benzylthiouracil at a mean dose of 157.45 mg/day. Radical treatment with radioactive iodine was indicated in 81 patients. The evolution of cardiothyreosis was favourable in 58 patients. Conclusion: Cardiothyreosis is a serious complication of hyperthyroidism. Future prospective studies will be of great help to better characterise and manage cardiothyreosis. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the clinical presentations, risk factors, and management outcomes in patients presenting with dysthyroid optic neuropathy (DON).Methods: This is a retrospective, single-center study carried out on consecutive patients presenting with DON over a period of 4 years (2013-2016). The VISA classification was used at the first visit and subsequent follow-ups. The diagnosis was based on optic nerve function tests and imaging features. Demographic profiles, clinical features, risk factors, and management outcomes were analyzed.Results: Thirty-seven eyes of 26 patients diagnosed with DON were included in the study. A significant male preponderance was noted (20, 76.92%). Twenty patients (76.9%, P = 0.011) had hyperthyroidism, and 15 (57.69%, P = 0.02) were smokers. Decreased visual acuity was noted in 28 eyes (75.6%). Abnormal color vision and relative afferent pupillary defects were seen in 24 (64.86%) eyes, and visual field defects were seen in 30 (81.01%) eyes. The visual evoked potential (VEP) showed a reduced amplitude in 30 (96.77%, P = 0.001) of 31 eyes and delayed latency in 20 (64.51%, P = 0.0289) eyes. Twenty-six (70.27%) patients were treated with intravenous methyl prednisolone (IVMP) alone, whereas 11 (29.72%) needed surgical decompression. The overall best-corrected visual acuity improved by 0.2 l logMARunits. There was no statistically significant difference in outcome between medically and surgically treated groups. Four patients developed recurrent DON, and all of them were diabetics.Conclusion: Male gender, hyperthyroid state, and smoking are risk factors for developing DON. VEP, apical crowding, and optic nerve compression are sensitive indicators for diagnosing DON. Diabetics may have a more defiant course and are prone to develop recurrent DON. [ABSTRACT FROM AUTHOR]

Thyrotropinomas (TSHoma) are rare pituitary adenomas. TSHomas can synthesize other hormones simultaneously. Co-secretion of TSH and GH is rarely reported in the literature. In these patients, signs of hyperthyroidism and acromegaly can be observed together. Its clinic is heterogeneous and in some cases, symptoms of thyrotoxicosis may mask the acromegaly symptoms. Some TSHoma patients may also be mistakenly diagnosed with Graves and experience a delay in diagnosis. We aimed to present a unique case with a diagnosis of TSHoma, who was referred to our center when Euthyroidism was not achieved and was followed up with a pre-diagnosis of Graves and also had GH co-secretion. [ABSTRACT FROM AUTHOR]

Background: Previous observational studies have suggested that thyroid function may be associated with functional outcome after ischemic stroke (IS). Nevertheless, the causal relationship remains unclear. This study aimed to explore the causal effect of thyroid function [thyroid-stimulating hormone (TSH), free thyroxine (FT4), hyperthyroidism, and hypothyroidism] on functional outcome (based on the modified Rankin scale) after IS by two-sample Mendelian randomization (MR) analysis., Methods: Inverse variance weighted (IVW) was the primary method for evaluating causal associations. In addition, six additional MR methods (MR-Egger regression, weighted median, maximum likelihood, simple mode, weighted mode, and MR-PRESSO) were employed to supplement IVW. Furthermore, various sensitivity tests were conducted to assess the reliability: (i) Cochrane's Q test for assessing heterogeneity; (ii) MR-Egger intercept test and MR-PRESSO global test for evaluating horizontal pleiotropy; (iii) leave-one-out sensitivity test for determining stability., Results: The results of IVW indicated that elevated TSH levels significantly improved functional outcome after IS (OR = 0.74, 95 % CI: 0.57-0.97, P = 0.028). In addition, six additional MR methods suggested parallel results. However, no causal effect of FT4, hyperthyroidism, and hypothyroidism on functional outcome after IS was identified. In addition, sensitivity tests demonstrated the reliability of the MR analyses, suggesting that the MR analysis was not influenced by significant heterogeneity and horizontal pleiotropy., Conclusions: Our MR study supported that elevated TSH levels might improve functional outcome after IS. Therefore, regular monitoring and maintenance of stable TSH levels may benefit patients recovering from IS., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Context: Serum thyroglobulin (Tg) measured by immunometric assay (IMA) is prone to underestimation due to Tg autoantibody (TgAb) interference, often prompting reflex Tg measurement by liquid chromatography/tandem mass spectrometry (MS) or radioimmunoassay (RIA)., Objective: IMA, MS, and RIA methodologies were used to measure serum Tg in TgAb-negative (TgAb-) and TgAb-positive (TgAb+) patients with either distant metastatic differentiated thyroid cancer (DTC) or hyperthyroidism (HY)-patients in whom a detectable serum Tg would be expected., Results: When TgAb was absent, all methodologies detected Tg in the sera of all DTC and HY patients and reported appropriate Tg trends and treatment responses for DTC patients with progressive distant metastatic disease, albeit with high between-method variability (> 30% coefficient of variability). When TgAb was present, all methodologies reported lower serum Tg levels for both DTC and HY groups vs their respective TgAb- group. No Tg was detected by IMA or MS in ∼50% TgAb+ DTC patients (6% had no Tg detected by RIA). Surprisingly, 5% of TgAb+ HY patients also had no Tg detected by IMA or MS. The inverse log TgAb/log Tg correlations seen for the TgAb+ HY patient group with all methods suggested the presence of a TgAb-associated serum Tg-lowering effect., Conclusion: (i) Between-method Tg variability necessitates method continuity when monitoring the Tg trends of TgAb- DTC patients. (ii) The presence and concentration of TgAb appeared to have a lowering effect on serum Tg measured by all methodologies (IMA, MS, and RIA). (iii) Since the reliability of Tg measured in the presence of TgAb is often uncertain, the TgAb trend (measured by the same method) may be a useful surrogate DTC tumor marker., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)

Purpose: The association between thyroid dysfunction and exudative age-related macular degeneration (AMD) is unknown., Methods: In this Danish longitudinal nationwide registry-based cohort study we included all Danish residents aged 50-100 between 2008 and 2018. Using the Danish national registries, we studied the association between thyroid dysfunction and exudative AMD. Thyroid dysfunction was classified as two consecutive redeemed prescriptions of thyroid hormones (hypothyroidism) or anti-thyroid medication (hyperthyroidism). Exudative AMD was classified as an ICD diagnosis of AMD and a code for anti-VEGF treatment. All patients are treated for exudative AMD in a hospital in Denmark, and we therefore have complete registration of this patient group., Results: We included 2 087 305 individuals, of which 1 072 567 (51.4%) were women; 59 318 (2.8%) had hypothyroidism, and 33 922 (1.6%) had hyperthyroidism. During a median follow-up of 11 years, 26 998 (1.3%) people developed exudative AMD. Hypothyroidism (adjusted hazard ratio [HR]: 1.17; 95% confidence interval [CI] 1.10-1.25; p < 0.001) and hyperthyroidism (HR: 1.23; 95% CI:1.13-1.34; p < 0.001) were both associated with the development of exudative AMD. The age-stratified analyses yielded similar results to the main analyses, except that the risks were exaggerated in the older part of the population., Conclusion: This is the first longitudinal nationwide study showing that both hypo- and hyperthyroidism are associated with an increased risk of exudative AMD. AMD is a quantitative problem in the population and our findings could have a public health impact. Further studies are needed to study the underlying mechanisms of the association., (© 2024 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Background: Thyroid hormones have an effect on every organ system, in particular, the heart responds to minimal changes in serum thyroid hormone level. Thyroid hormone causes a lot of changes in the cardiovascular system, such as increased heart rate, contractility, systolic hypertension, changes in peripheral vascular resistance, atrial fibrillation (AF), and hypercoagulability from the direct effect of thyroid hormone on cardiac myocyte and /or due to increased metabolic state. However, the magnitude of such heart abnormalities and its associated factors were not well studied in Ethiopia., Objective: To determine the magnitude of cardiac abnormality and its associated factors among hyperthyroidism patients on follow-up at Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia, 2022., Methods: An institution-based cross-sectional study was carried out among 318 hyperthyroid patients who were on follow-up at the endocrine clinic of TASH, Addis Ababa, Ethiopia from June to October 2022. The data were collected using a pretested structured interviewer administered questionnaire. The data were entered into the computer using EpiData version 3.1 and analyzed using SPSS version 25 software. Bivariable and multivariable logistic regression models were fitted to determine the association between the independent and dependent variables. Adjusted odds ratio with its 95% confidence interval and p-value < 0.05 were used to declare the presence and strength of statistically significant associations., Result: In this study a total of 318 hyperthyroid patients were participated, most (90.9%) of them were females. The overall prevalence of heart failure among hyperthyroid patients was 17.0% (95% CI = 13.0, 21.6). More than half (52.7%) and one third (33.2%) of the participants showed abnormal electrocardiographic and echocardiographic findings respectively. Marital status (not married) [AOR = 2.37, 95% CI (1.03, 5.44)], pattern of hyperthyroidism [AOR = 13.09, 95% CI (4.70, 36.41)], being Asthmatic [AOR = 7.63, 95% CI (1.55, 37.52)], type of medication [AOR = 3.49, 95% CI (1.11, 11.02)] and duration of treatment [AOR = 4.95, 95% CI (2.05,11.99)] were significantly associated with cardiac abnormality., Conclusion: A significant portion of hyperthyroid patients overburdened by cardiac abnormalities. Being unmarried, overt hyperthyroid, Asthmatic, long stay on treatment and type of treatment were significantly associated with cardiac abnormality. Hence, attention should be given for cardiac abnormalities while treating hyperthyroid patients., (© 2024. The Author(s).)

Purpose: Abnormal liver blood tests (ALBTs), neutropenia (NEU) and thymic hyperplasia (TH) are new features of Graves' disease (GD). Our objectives were: (a) to calculate the accuracy of TH in discriminating between Graves' and non-Graves' thyrotoxicosis, compared to ALBTs, NEU and Graves' orbitopathy (GO); (b) to explore the outcome of GD-associated TH and non-GD-associated TH., Methods: We prospectively analyzed consecutive adult patients with newly diagnosed thyrotoxicosis from January 2018 to June 2023. TH was detected via neck ultrasound (nUS) then confirmed and followed by magnetic resonance imaging (MRI). For GD vs non-GD clinical sensitivity (SE) and specificity (SPEC), accuracy, positive predictive value (PPV) and negative predictive value (NPV) of GO, TH, ALBTs and NEU were calculated., Results: 264 thyrotoxic patients were included. TH was found in 16.4% (20/122) of GD vs 1.4% (2/142) in non-GD (p < 0.001). SE, SPEC, accuracy, PPV and NPV of the four extrathyroidal manifestations of GD were as follows, respectively: GO 26%, 100%, 66%, 100%, 61%; ALBTs 41%, 89%, 69%, 76%, 66%; NEU 5%, 100%, 56%, 100%, 55%; TH 16%, 98%, 61%, 91%, 98%. In 18 of them, TH regressed within 12 months after achieving euthyroidism under anti-thyroid drug therapy, while in the remaining 2, TH regressed 6 months after thyroid surgery. In the two non-GD patients with TH, thymus disappeared along with euthyroidism., Conclusions: TH in the hyperthyroidism scenario provides a high PPV for GD. A conservative approach for the diagnostic work-up and initial management of thyrotoxicosis-associated TH should be adopted., (© 2024. The Author(s).)

Hyperthyroidism in the elderly population is often associated with atypical, blunted, or nonspecific signs and symptoms, also known as apathetic hyperthyroidism (AH). The absence of the classical hyperkinetic clinical presentation can be confused with the normal aging process, or other diseases, and often leads to misdiagnosis, delayed treatment, and negative outcomes for elderly patients. We provide a case study of an elderly patient to illustrate the atypical presentation of AH. The vignette also highlights a diagnostic and treatment approach based on geriatric medicine fundamentals and evidence-based research. We then review the multiple factors and pathogenetic mechanisms contributing to endocrine disruptors and the paucity of hyperadrenergic signs and symptoms in the elderly with hyperthyroidism. Additionally, the article contrasts the symptomatology and diagnostic profile between primary hyperthyroidism and AH. Finally, we provide an evidence-based, patient-centered approach to manage AH in the elderly population. We recommend that nurse practitioners cultivate illness script inclusive of atypical presentations to guide their clinical decision making. Psychomotor retardation with or without cardiovascular symptoms warrant a high degree of suspicion and the initiation of laboratory studies, including thyroid functions to confirm or rule out hyperthyroidism. [ABSTRACT FROM AUTHOR]

Objective: To study whether maternal thyroid disease in pregnancy is associated with pubertal timing in sons and daughters.Design: Cohort study.Setting: National birth cohort and health registers.Patient(s): A total of 15,763 mothers and children from the Danish National Birth Cohort and its Puberty Cohort.Intervention(s): Register-based and self-reported information on maternal thyroid diseases during pregnancy (hyperthyroidism, hypothyroidism, benign goiter, or no thyroid disease [reference group]).Main Outcome Measure(s): The adjusted mean age difference (months) at attaining several self-reported pubertal milestones collected every 6 months using an interval-censored regression and the average difference in age at attaining all pubertal milestones using the Huber-White robust variance estimation (primary outcome).Result(s): Sons of mothers with hyperthyroidism had earlier pubertal development (average difference, -2.9 [95% confidence interval (CI), -5.0 to -0.7] months) than unexposed sons. Maternal hypothyroidism was not associated with pubertal development in sons (average difference, -1.2 [95% CI, -5.1 to 2.7] months). We observed nonstatistically significant indications of earlier pubertal development in sons of mothers with benign goiter (average difference, -1.9 [95% CI, -4.6 to 0.9] months). Maternal thyroid disease was not associated with pubertal development in daughters (average difference (months), hyperthyroidism, -0.8 [95% CI, -2.8 to 1.2]; hypothyroidism, 0.3 [95% CI, -3.1 to 3.8]; and benign goiter, 0.7 [95% CI, -2.0 to 3.4]).Conclusion(s): We found indications of earlier pubertal development in sons of mothers with hyperthyroidism. More research is needed to further investigate the observed sex-specific association. [ABSTRACT FROM AUTHOR]

Background: Extragonadal choriocarcinoma is rare and can be associated with hyperthyroidism when producing very high levels of human chorionic gonadotropin.Case Presentation: A 62-year-old Hispanic female presented with a 3-week history of shortness of breath, palpitations, extreme weakness, new-onset hot flashes, and right flank pain. Her physical examination was remarkable for tachycardia, hepatomegaly, hyperreflexia, and tremor; goiter was absent. Laboratory studies revealed increased lactate dehydrogenase, alkaline phosphatase, suppressed thyroid stimulating hormone, very elevated T4, and absent thyroid stimulating immunoglobulin. 18F-fluorodeoxyglucose positron emission tomography-computed tomography exhibited hepatomegaly with multiple large fluorodeoxyglucose-avid liver masses and a focus of fluorodeoxyglucose avidity in the stomach with no structural correlate. A thyroid scan (99mTcO 4- ) showed diffusely increased tracer uptake. She was started on propranolol and methimazole. Upon stabilization of severe thyrotoxicosis, upper endoscopy was performed, showing a ~ 5 cm bleeding lesion in the greater stomach curvature body; biopsy was consistent with choriocarcinoma; beta-human chorionic gonadotropin hormone was 2,408,171 mIU/mL. The patient received methotrexate followed by etoposide and cisplatin. Methimazole was titrated down, and upon liver failure the medication was stopped. The thyrotoxicosis was effectively controlled with antithyroid drug and concurrent chemotherapy. At ~ 1.5 months after initial diagnosis, the patient died due to bleeding/acute liver failure with coagulation defects followed by multiple organ failure.Conclusions: Severe thyrotoxicosis can represent an unusual initial presentation of metastatic choriocarcinoma in the setting of extreme elevation of beta-human chorionic gonadotropin. Primary gastric choriocarcinoma is an aggressive malignancy with very poor outcomes. The co-occurrence of severe thyrotoxicosis with advanced primary gastric choriocarcinoma and imminent liver failure complicates management options. [ABSTRACT FROM AUTHOR]

Background: Syncope is a common cause of pediatric emergency department visits and carries a broad differential diagnosis, which includes a few rare but critical cardiac conditions.Case Report: We review the case of an adolescent boy who presented to the emergency department after a syncopal event. He was found to have a prolonged QTc interval on electrocardiogram (ECG), without personal or family history or known risk factors. He was screened for thyroid dysfunction on a second ED visit for presyncope and was subsequently diagnosed with hyperthyroidism. The patient was treated with methimazole for 2 weeks and a repeat ECG showed normalization of the QTc interval with a QTc reduction of more than 100 ms; routine thyroid studies showed correction of thyroid stimulating hormone and free thyroxine levels shortly thereafter. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case and review of the medical literature should raise awareness for the emergency physician to consider evaluation of thyroid function in pediatric patients with QT interval prolongation and vice versa, potentially averting dangerous dysrhythmias. [ABSTRACT FROM AUTHOR]

Thyroid orbitopathy (TO) is the most common non-thyroid manifestation of Graves' and Basedow disease. Assessment of the inflammatory activity of TO can be performed using the clinical activity score (CAS) and using imaging methods -- mainly magnetic resonance imaging (MRI). The severity of TO is assessed using a seven-grade NOSPECS classification and a three-grade scale proposed by the European Group on Graves' Orbitopathy (EUGOGO). In moderate to severe and active TO, the recommended standard as first-line treatment is the combined use of methylprednisolone intravenously (i.v.) with concurrent oral (p.o.) administration of mycophenolate sodium. Second-line treatment options are orbital radiotherapy with or without oral or i.v. systemic glucocorticosteroid therapy, cyclosporine, or azathioprine in combination with p.o. glucocorticosteroid, methotrexate monotherapy, and a group of biologic drugs (riuximad, tocilizumab, teprotumumab). All recommended therapies for moderate to severe and active TO involve immunosuppressive and immunomodulatory drugs, which are a risk for the unfavorable course of COVID-19. There are no available recommendations for treating TO in Graves' and Basedow disease patients during the SARS-CoV-2 pandemic. Moderate to severe and active TO patients present a serious dilemma during SARS-CoV-2 pandemic. It seems reasonable that in patients with moderate to severe TO, who are not at risk of sight deterioration, i.v. glucocorticosteroids should be avoided, and an observational strategy should be used, whereas in patients with more severe TO and at risk of sight worsening, i.v. glucocorticosteroids are the therapeutic choice regardless of SARS-CoV-2 infection or clinical signs of COVID-19. [ABSTRACT FROM AUTHOR]

Introduction: previous studies in African populations have not extensively described the spectrum of thyroid dysfunction using the profile of thyroid hormones. Although iodine deficiency is a common thyroid disorder in Africa, it does not represent the entire spectrum of thyroid dysfunction seen in patients. This retrospective study aimed to describe the spectrum of thyroid dysfunction among patients seen at the Korle-Bu Teaching Hospital (KBTH), a tertiary care hospital in Accra, Ghana., Methods: a retrospective analysis of medical records of all consultations on thyroid disorders seen at the Internal Medicine Department of KBTH between January 2019 and December 2021 was conducted. Information on patient demographics, and thyroid hormone profiles (triiodothyronine - FT3, thyroxine - FT4, and thyroid stimulating hormone - TSH) were extracted and subjected to descriptive statistics. The thyroid hormone profiles of the subjects were analyzed and classified into thyroid dysfunction categories using guidelines from the American Thyroid Association (ATA)., Results: out of the 215 patients with thyroid disorders enrolled, 85.1% (n=183) were females and 14.9% (n=32), were males. The mean age of patients was 45±14 years, with most of the patients within the age range of 31-50 years (49.3%; n=106). The most reported thyroid function dysfunction was primary hyperthyroidism (57.7%), followed by primary hypothyroidism (22.3%), subclinical hyperthyroidism (9.3%), euthyroid sick syndrome (6.5%), and subclinical hypothyroidism (4.6%) respectively., Conclusion: primary hyperthyroidism was the most commonly diagnosed thyroid dysfunction. Hyperthyroidism has been associated with cardiac morbidity and mortality. Timely interventions are required to reduce the morbidity risks and burden associated with the hyperthyroid state., Competing Interests: The authors declare no competing interests., (Copyright: Emmanuel Donkoh Aidoo et al.)

Objective: To investigate markers of systemic inflammation and the effect of thyroid dysfunction on these parameters in patients with Hashimoto's thyroiditis (HT)., Methods: Patients with HT and volunteer healthy individuals admitted to the general surgery outpatient clinic between January 2020 and June 2023 were enrolled into the study. Patients with HT were divided into euthyroid, hypothyroid, and hyperthyroid subgroups. All participant data were retrospectively extracted from the hospital database., Results: A total of 268 patients (euthyroid, n  = 131; hypothyroid, n  = 83; and hyperthyroid, n  = 54) and 124 controls were included. The platelet-to-lymphocyte ratio was lower in the euthyroid group versus control group, and the neutrophil-to-lymphocyte ratio was lower in controls than the three patient subgroups. Euthyroid and hypothyroid patients with HT exhibited a higher systemic inflammation index than the control group. The pan-immune inflammation index was lower in controls than in euthyroid, hypothyroid, and hyperthyroid patients with HT. In patients with HT, inflammation markers did not significantly differ between subgroups., Conclusions: Markers of systemic inflammation provide meaningful and reliable information in patients with HT, but do not differentiate between euthyroid, hypothyroid, or hyperthyroid patients., Competing Interests: Declaration of conflicting interestThe authors declare that there are no conflicts of interest.

Background: Accumulating evidence suggests that thyroid dysfunction may be related to the risk of dementia. However, previous studies evaluating the association between subclinical hyperthyroidism and the risk of dementia showed inconsistent results. This systematic review and meta-analysis were performed to evaluate the relationship between subclinical hyperthyroidism and the incidence of dementia in the general population., Methods: Cohort studies relevant were retrieved by searching the electronic databases including PubMed, Web of Science, and Embase. A random-effects model was used to combine the data by incorporating the influence of between-study heterogeneity. Subgroup and meta-regression analyses were performed to investigate the source of heterogeneity., Results: Nine cohort studies including 49,218 community-derived participants were included. Among them, 3177 (6.5%) had subclinical hyperthyroidism at baseline. During a mean follow-up of 10.2 years, 4044 participants developed dementia. The pooled results showed that compared to the participants with euthyroidism, those with subclinical hyperthyroidism had a higher incidence of dementia (risk ratio: 1.38, 95% confidence interval: 1.09 to 1.74, p = .006; I 2  = 47%). Subgroup analyses according to study design, age of the participants, methods for diagnosis of dementia, or analytic model did not significantly change the results. The univariate meta-regression showed that the cutoff of thyroid-stimulating hormone for defining subclinical hyperthyroidism negatively affected the association between subclinical hyperthyroidism and dementia (coefficient: -1.44, p = .009), which completely explained the heterogeneity (residual I 2  = 0%)., Conclusion: Subjects with subclinical hyperthyroidism may have a higher risk of dementia compared to those with euthyroidism., (© 2024 The Author(s). Brain and Behavior published by Wiley Periodicals LLC.)

This article includes a review of information primary care physicians need to know direct their evaluation and treatment of thyroid disorders that include sick euthyroid, hyperthyroidism, hypothyroidism, and subclinical thyroid disorders., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Thyroid dysfunction is associated with characteristic changes in heart rate and arrhythmias. Thyroid hormones act through genomic and non-genomic effects on myocytes and influence contractility, relaxation and action potential duration through a variety of mechanisms. Atrial fibrillation is the most common arrhythmia associated with thyroid dysfunction, it occurs in both euthyroidism and hyperthyroidism in clear association with T4 levels. Mechanistically, in the hyperthyroid state, increased automaticity and triggered activity, together with a shortened refractory period and slowing of the conduction speed, lead to the initiation and maintenance of multiple intraatrial reentry circuits. Influences from the autonomic nervous system and hemodynamics controlled by thyroid hormones act as modulators for arrhythmias, which are promoted by a corresponding substrate (significant impact of comorbidities). Concerning therapy, in addition to treating hyperthyroidism, the initial therapeutic focus is on adequate rate control and anticoagulation in patients with a high risk of thromboembolism. Ablation of atrial fibrillation can be considered later on, although there is an increased likelihood of recurrence compared to patients without hyperthyroidism.Prolongation of the QT interval and increase in QT dispersion are involved in the formation of ventricular arrhythmias. Epidemiological data suggest an association of elevated T4 levels with ventricular arrhythmias and sudden cardiac death. However, this seems to be mainly relevant for patients with underlying cardiac disease (e.g. ICD users)., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

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. CONCLUSIONS 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.

A 40-year-old African-American man was referred to our dermatology clinic for management of his long-standing thyroid dermopathy. The patient was diagnosed with hyperthyroidism at the age of 20, and was treated with radioactive iodine I-131 but subsequently lost to follow-up. He had not consulted physicians again until the age of 30. Then he presented with severe thyroid eye disease, significant weight gain, hypothy-roidism, and painful leg swelling. Levothyroxine was initiated, which stabilized his thyroid levels but had no effect on his exophthalmos and leg swelling.

Background: Thyrotoxic atrial fibrillation (TAF) is a recognized significant complication of hyperthyroidism. Early identification of the individuals predisposed to TAF would improve thyrotoxic patients' management. However, to our knowledge, an instrument that establishes an individual risk of the condition is unavailable. Therefore, the aim of this study is to build a TAF prediction model and rank TAF predictors in order of importance using machine learning techniques. Methods: In this retrospective study, we have investigated 36 demographic and clinical features for 420 patients with overt hyperthyroidism, 30% of which had TAF. At first, the association of these features with TAF was evaluated by classical statistical methods. Then, we developed several TAF prediction models with eight different machine learning classifiers and compared them by performance metrics. The models included ten features that were selected based on their clinical effectuality and importance for model output. Finally, we ranked TAF predictors, elicited from the optimal final model, by the machine learning tehniques. Results: The best performance metrics prediction model was built with the extreme gradient boosting classifier. It had the reasonable accuracy of 84% and AUROC of 0.89 on the test set. The model confirmed such well-known TAF risk factors as age, sex, hyperthyroidism duration, heart rate and some concomitant cardiovascular diseases (arterial hypertension and conjestive heart rate). We also identified premature atrial contraction and premature ventricular contraction as new TAF predictors. The top five TAF predictors, elicited from the model, included (in order of importance) PAC, PVC, hyperthyroidism duration, heart rate during hyperthyroidism and age. Conclusions: We developed a machine learning model for TAF prediction. It seems to be the first available analytical tool for TAF risk assessment. In addition, we defined five most important TAF predictors, including premature atrial contraction and premature ventricular contraction as the new ones. These results have contributed to TAF prediction investigation and may serve as a basis for further research focused on TAF prediction improvement and facilitation of thyrotoxic patients' management. [ABSTRACT FROM AUTHOR]

Background Coronavirus disease (COVID-19) is a systemic illness characterized by raging impact of cytokine storm on multiple organs. This may trigger malignant ventricular arrhythmias and unmask a clinically silent cardiomyopathy. Case summary A 57-year-old gentleman, known case of hyperthyroidism and diabetes, was referred to our emergency department with history of two ventricular tachycardia (VT) episodes requiring direct current cardioversion in last 3 h followed by another episode in our emergency department that was cardioverted. There was no past history of cardiac illness. His 12-lead electrocardiogram (during sinus rhythm) along with screening echocardiography suggested Arrhythmogenic right ventricular cardiomyopathy (ARVC). He was coincidentally found to be COVID-19 positive by reverse transcription-polymerase chain reaction (RT-PCR) as part of our routine screening. However, he had no fever or respiratory complaints. We noted raised systemic inflammatory markers and cardiac troponin T which progressively increased over the next 4 weeks paralleled by an increase in ventricular premature contraction burden and thereafter started decreasing and returned to baseline by 6th week when the patient became COVID-19 negative by RT-PCR. Subsequently, a single-chamber automated implantable cardioverter-defibrillator implantation was done following which there was a transient increase in these biomarkers that subsided spontaneously. The patient is asymptomatic during 6 weeks of follow-up. Discussion COVID-19-associated cytokine surge triggering VT storm and unmasking a clinically silent ARVC has not yet been reported. The case highlights a life-threatening presentation of COVID-19 and indicates a probable link between inflammation and arrhythmogenicity. [ABSTRACT FROM AUTHOR]

Hyperthyroidism is a common disease that often presents with tremors, tachycardia, anxiety, and weight loss. Hyperthyroidism may be caused by several diseases. Ectopic hyperthyroidism that results from excess thyroid hormone synthesis arises from outside the thyroid gland. Struma ovarii is a famous form of this type of hyperthyroidism, which is extremely rare and arises from ectopic thyroid tissue in the ovarian neoplasm. Here, we present a case of a middle-aged woman with established thyrotoxicosis, who was referred owing to the recurrence of thyrotoxicosis after thyroidectomy. Finally, oophorectomy was performed, and she was diagnosed with Struma ovarii. Thus, the clinicians should consider Struma ovarii in women with thyrotoxicosis, without goiter or evidence of Graves' disease. [ABSTRACT FROM AUTHOR]

Dilated cardiomyopathy is a form of heart failure characterized by left ventricular dilation with impaired systolic function. Causes may include ischemic heart disease, hypertensive heart disease, valvular heart disease, endocrine disorders, substance use, and viral diseases. This case report describes a patient with new-onset heart failure, initially diagnosed as idiopathic dilated cardiomyopathy with pericarditis secondary to a virus but later found to be secondary to hyperthyroidism. [ABSTRACT FROM AUTHOR]

Background Differentiating Graves' disease from thyroiditis can be at times clinically challenging. The gold standard test (thyroid nuclear imaging scan) is expensive, not routinely available, and has radiation exposure. Color Doppler ultrasonography of thyroid represents a suitable alternate which can be used for differentiating these conditions by studying thyroid blood flow parameters. Aim We aimed to investigate the use of thyroid blood flow parameters' assessment of the superior thyroid artery (STA) and common carotid artery (CCA) with color Doppler ultrasonography for differentiating Graves' disease from thyroiditis. Materials and Methods This is a cross-sectional study on 111 patients with newly diagnosed thyrotoxicosis (82 with Graves' disease and 29 with thyroiditis) and 45 years of age and sex-matched healthy controls. All patients underwent detailed clinical and necessary investigations. Color Doppler ultrasonography of the thyroid gland and spectral flow analysis of both superior thyroid arteries was done using standard protocol. Sensitivity and specificity for mean peak systolic velocity of STA (STA-PSV) cut-offs were calculated using receiver operating characteristic curves. Results Patients with Graves' disease have significantly higher free tri-iodothyronine (FT3) levels, free thyroxine (FT4) levels, antithyroid stimulating hormone receptor antibody (TRAb) levels, and thyroid volume as compared with those with thyroiditis. The mean STA-PSV of patients with Graves' disease was significantly higher than thyroiditis and control group. Mean STA-PSV greater than 54.3 cm/s had 82.9% sensitivity and 86.2% specificity in diagnosing Graves' disease. Mean PSV-STA/PSV-CCA ratio of 0.40 was 80.5% sensitive and 86.2% specific for Graves' disease. Conclusion Mean STA-PSV has high sensitivity and specificity in differentiating Graves' disease from thyroiditis and can be used routinely in clinical practice as a cheap and invaluable diagnostic tool. [ABSTRACT FROM AUTHOR]

Both hyperthyroidism and hypothyroidism can have adverse effects in pregnancy. The most common causes of thyrotoxicosis in pregnancy are gestational transient thyrotoxicosis and Graves' disease. It is important to distinguish between these entities as treatment options differ. Women of reproductive age who are diagnosed with Graves' disease should be counseled regarding the impact of treatment options on a potential pregnancy. Although the absolute risk is small, antithyroid medications can have teratogenic effects. Propylthiouracil appears to have less severe teratogenicity compared to methimazole and is therefore favored during the first trimester if a medication is needed. Women should be advised to delay pregnancy for at least 6 months following radioactive iodine to minimize potential adverse effects from radiation and ensure normal thyroid hormone levels prior to conception. As thyroid hormone is critical for normal fetal development, hypothyroidism is associated with adverse obstetric and child neurodevelopmental outcomes. Women with overt hypothyroidism should be treated with levothyroxine (LT4) to a thyrotropin (thyroid-stimulating hormone; TSH) goal of <2.5 mIU/L. There is mounting evidence for associations of maternal hypothyroxinemia and subclinical hypothyroidism with pregnancy loss, preterm labor, and lower scores on child cognitive assessment. Although there is minimal risk of LT4 treatment to keep TSH within the pregnancy-specific reference range, treatment of mild maternal thyroid hypofunction remains controversial, given the lack of clinical trials showing improved outcomes with LT4 treatment. [ABSTRACT FROM AUTHOR]

Background: Thyrotoxicosis is a clinical syndrome with high amounts of free thyroid hormone levels causing elevated thyroid hormone function in body tissues. Prolonged effects of free thyroid hormones may lead to cardiac complications such as atrial fibrillation (AF) and heart failure (HF). Case 1: A 31-year-old female, was admitted due to difficulty in breathing, generalised body swelling and jaundice. She was dyspnoeic with an irregular heart rate, and presented with abnormal vitals, liver and thyroid function tests which were diagnostic for thyroid storm. She was managed over 32 days in-hospital stay with carbimazole, propranolol, hydrocortisone, digoxin and furosemide. Unfortunately, she was readmitted 6 months later with worsened HF symptoms and passed away. Case 2: A 57-year-old female, was admitted due to difficulty in breathing, bilateral lower limb swelling and jaundice. She was tachypnoeic with an irregular heart rate, and presented with abnormal liver enzymes and thyroid function tests which were diagnostic for thyrotoxicosis. She was managed with carbimazole, propranolol, digoxin and furosemide, and was discharged on the 6th hospital day. Conclusion: Prolonged untreated thyrotoxicosis increases the risk of AF and HF. Early and monitored treatment and follow-up of hyperthyroidism is key to the management of AF and HF in achieving a better outcome. [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., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

A 49-year-old Japanese woman was admitted to our hospital with weight loss of 15 kg, nephrotic-range proteinuria (4.5 g/g.Cre), and hematuria over a 6-month period. She had received two doses of the coronavirus disease 2019 (COVID-19) vaccine one year before the onset of the disease, after which the estimated glomerular filtration rate increased. Laboratory tests and other tests led to a diagnosis of hyperthyroidism, and a kidney biopsy showed thrombotic microangiopathy-like glomerular microangiopathy comprising mainly glomerular endothelial cell damage. Thiamazole (30 mg) was started for the hyperthyroidism. Three months later, the thyroid function normalized, and two months later, the proteinuria and hematuria disappeared, suggesting that COVID-19 vaccination and these events were related.

Background: Subclinical thyroid diseases are often the subject of debate concerning their clinical significance, the appropriateness of diagnostic testing, and possible treatment. This systematic review addresses the variation in international guidelines for subclinical hyperthyroidism, focusing on diagnostic workup, treatment, and follow-up recommendations., Methods: Following the PRISMA guidelines, we searched PubMed, Embase, and guideline-specific databases and included clinical practice guidelines with recommendations on subclinical hyperthyroidism. Guideline recommendations were extracted, and quality assessment was performed using selected questions of the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument., Results: Of the 2624 records screened, 22 guidelines were included, which were published between 2007 and 2021. Guideline quality was generally intermediate to low. Diagnostic approaches differed substantially, particularly in the extent of recommended testing. Treatment initiation depended on TSH levels, age, and comorbidities, but the level of detail regarding defining precise comorbidities varied. Recommendations for monitoring intervals for follow-up ranged from 3 to 12 months., Conclusion: This review underscores the existing variability in (inter)national guidelines concerning subclinical hyperthyroidism. There isa need for clear recommendations in guidelines considering diagnostic workup, treatment, and follow-up of subclinical hyperthyroidism. In order to establish this, future research should focus on determining clear and evidence-based intervention thresholds.

Introduction: The established association between thyroid disorders (TD) and its two main subtypes-hyperthyroidism and hypothyroidism-and the incidence of oral and oropharyngeal cancer (OCPC) has been substantiated. However, the direct causal relationship and potential intermediary mechanisms linking these conditions have not been clearly defined in prior studies., Material & Methods: This study employed univariate Mendelian randomization (MR) analysis to explore those relationship. Instrumental variables from genome-wide association study (GWAS) datasets for TD (n = 218,792), hyperthyroidism (n = 460,499), hypothyroidism (n = 213,990), and OCPC (n = 12,619), along with 41 intermediary inflammatory cytokines (n = 8293), were analyzed. Inverse variance weighting (IVW) method assessed the causal relationships, while summary MR analysis with pQTL datasets from decode and 91 inflammatory cytokines explored the cytokines' roles as biomarkers and therapeutic targets for OCPC. Multivariable MR (MVMR) analysis quantified the mediation effect of these cytokines in the TD-OCPC relationship., Results: UVMR analysis provided strong evidence for a causal relationship between TD (OR = 1.376, 95 % CI = 1.142-1.656, p = 0.001), hyperthyroidism (OR = 1.319, 95 % CI=1.129-1.541, p = 0.001), hypothyroidism (OR = 1.224, 95 % CI = 1.071-1.400, p = 0.003), and the risk of OCPC. CXCL9 was identified as a significant intermediary in mediating the risk of OCPC from TD and its two subtypes (OR = 1.218, 95 % CI = 1.016-1.461, P = 0.033), suggesting its potential as a predictive biomarker for OCPC. MVMR analysis further revealed that CXCL9 mediated 7.94 %, 14.4 %, and 18 % of the effects of TD, hyperthyroidism, and hypothyroidism on OCPC risk, respectively., Discussion: This study not only elucidated the potential causal relationships between TD including its two subtypes and OCPC risk, but also highlighted CXCL9 as a pivotal mediator in this association., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Hyperthyroidism is a common disease that primarily affects women of all ages, and in addition to physical symptoms, mental symptoms are common, such as mental fatigue, anxiety, difficulty concentrating and mood changes. A common opinion is that the patient is recovered once the thyroid disorder is treated. However, many patients will experience persistent brain fatigue and mental problems, even after normal thyroid function is restored. Patients want to live as good a life as possible despite their illness, and in healthcare, they request interventions for rehabilitation. A new guideline for hyperthyroidism was launched in January 2023 that highlights many of these aspects, including the mental symptoms and the patient's perspective on hyperthyroidism. In this article, we want to address the patient's needs and how we can meet them in healthcare to increase their participation, confidence and quality of life, with continuity throughout the entire care process.

Hyperthyroidism presents with various forms of generalized symptoms. Primary care physicians as well as other specialists should have this in mind when meeting patients with symptoms such as palpitations, sweating, fatigue and weight loss. Thyroid-stimulating hormone (TSH) is a highly specific test and useful in ruling out hyperthyroidism. The severity of the disease determines the pace of management. Primary care is often involved in detection of hyperthyroidism but also takes part in the work of rehabilitation and the lifelong hormonal substitution that is necessary for 2/3 of all patients. Subclinical hyperthyroidism, characterized by low TSH levels but normal levels of T4 and T3, is associated with increased mortality by 24 percent and risks of cardiovascular disease, atrial fibrillation and osteoporosis. Treatment depends on age, presence of comorbidity and TSH-levels. In addition to specific endocrinological treatment, person-centered care is crucial during active disease and rehabilitation. The first Swedish care program for hyperthyroidism aims to enhance care efficiency and equity.

Fever is usually thought to be of an infectious or inflammatory etiology. In this brief communication, we explore the multifaceted connections between fever and endocrine dysfunction. Impaired resistance to infection often leads to fever in conditions like diabetes and Cushing's syndrome. Additionally, several endocrine disorders, including hyperthyroidism, subacute thyroiditis, carcinoid syndrome, and pheochromocytoma, can manifest as fever. Furthermore, fever can be an adverse effect of various endocrine treatments, such as bisphosphonates and antithyroid drugs. We refer to these scenarios as 'endocrine fever.' Increased awareness of these clinical associations can aid in prompt diagnosis and management of these conditions.

Objective: Iodine fortification (IF) induces an initial increase followed by a decrease in the incidence of hyperthyroidism in the general population. Within the population of hyperthyroid patients, the sex-, age- and subtype distribution changes after IF. The risk of atrial fibrillation (AF) in hyperthyroid patients may be influenced by these factors. Therefore, we aimed to examine how the association between incident hyperthyroidism and AF was affected by IF increasing the population iodine intake from moderate-mild iodine deficiency to low adequacy. DESIGN, PATIENTS AND MEASUREMENTS: Incident hyperthyroid patients were included at the date of first inpatient or outpatient diagnosis, and AF diagnoses within 3 months before to 6 months after the index date were identified in Danish nationwide registers, 1997-2018. The relative risk (RR) of AF each calendar year (reference: 1997; IF introduced: 2000) was analyzed in Poisson regression models adjusted for age, sex, educational level, geographic region, and comorbidities., Results: Overall, in 62,201 patients with incident hyperthyroidism 7.9% were diagnosed with AF. There was a minor nonsignificantly increased risk of AF during the first years after IF followed by a gradual decrease to RR 0.76 (0.62-0.94) in 2017. There were no statistically significant differences in the development in the risk of AF by sex, age group, or geographic region., Conclusions: Results indicate that IF may reduce the risk of concomitant AF in hyperthyroid patients. If these results are confirmed, IF may not only reduce the population incidence of hyperthyroidism but also reduce the burden of morbidity in the remaining hyperthyroid patients., (© 2024 The Authors. Clinical Endocrinology published by John Wiley & Sons Ltd.)

Background: Thyrotoxic periodic paralysis is a rare and serious complication of hyperthyroidism., Case Presentation: A man in his thirties of Asian descent, with non-compliant Graves' disease, presented with extremity paresis. Emergency blood tests revealed severe hypokalaemia, leading to a diagnosis of thyrotoxic periodic paralysis. The combination of uncontrolled hyperthyroidism, Asian ethnicity, paralysis, and severe hypokalaemia without other causes defined the diagnosis. Acute treatment involves non-selective beta-blockers, addressing hyperthyroidism, and potassium supplements., Interpretation: Swift recognition of thyrotoxic periodic paralysis is crucial for timely and life-saving treatment. If triggered by hyperthyroidism, as in Graves' disease, surgery or radioiodine is strongly indicated for definitive treatment. It is noteworthy that euthyroid patients cannot develop thyrotoxic periodic paralysis.

Objectives: Fetal and neonatal hyperthyroidism are most commonly seen in patients whose mothers have Graves' disease. Rarely, it can be caused by non-autoimmune conditions. As these conditions are rare, the workup and treatment is not uniform and can lead to persistent symptoms and long-term negative health effects., Case Presentation: This report describes a patient with congenital hyperthyroidism from a toxic adenoma presenting with fetal tachycardia. The patient was initially managed medically after birth, but was eventually treated with thyroidectomy., Conclusions: This case report highlights an additional, important, differential diagnosis for fetal hyperthyroidism when maternal Graves' disease has been ruled out., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

Different diagnoses of thyroid disease are available in the 10th International Classification of Diseases (ICD-10), but the validity of diagnoses related to obstetric and postpartum thyroid disease is unknown. This was a retrospective cohort study of all patients in the North Denmark Region with a diagnosis of postpartum thyroiditis (PPT) (ICD-10: O905) from 2016 to 2019 or obstetric thyroid disease in 2019 (ICD-10: O992B (hypothyroidism) or O992C (hyperthyroidism)) registered in the Danish National Hospital Register. Information from nationwide registers and medical records were used to assess the validity. Among patients with an O905-diagnosis (n = 40), abnormal thyroid function test results were seen in all cases. A total of eight patients (20.0%) were positive for thyrotropin receptor antibodies postpartum, however, in low titers, and PPT was verified in 39 of 40 cases (97.5%). Altogether 45 of 50 patients with an O992B-diagnosis (90.0%) correctly had hypothyroidism, whereas hyperthyroidism was found in 25 of 39 patients with an O992C-diagnosis (64.1%). This is the first study to validate ICD-10 diagnoses of obstetric and postpartum thyroid disease. A high validity was seen for PPT (O905) and obstetric hypothyroidism (O992B), whereas for obstetric hyperthyroidism (O992C), the diagnosis could not be verified in one third of the cases., (© 2024. The Author(s).)