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In China, the clinical prevalence of hyperthyroidism is 0.78%, subclinical hyperthyroidism is 0.44%, and Graves' disease hyperthyroidism is 0.53%. Untreated hyperthyroidism and subclinical hyperthyroidism may increase the risk of atrial fibrillation, stroke, and other cardiovascular events, as well as osteoporosis and fractures. In special populations (such as pregnant women and the elderly), both the diagnosis and treatment of hyperthyroidism require special conside-rations. Although China has made some progress in the standardized diagnosis and treatment of hyperthyroidism, challenges remain. Despite established guidelines for diagnosis and differential diagnosis, clinical practice faces obstacles, notably due to limited access to thyroid radionuclide imaging and 131 iodine uptake rate in some hospitals. Additionally, the peak systolic velocity (PSV) in the thyroid obtained by thyroid ultrasound is not widely adopted. While clinical treatment methods align with international standards in China, there is a lack of specific guidelines on the initial dose and dose adjustment during the reduction period of antithyroid drugs (ATD). Currently, most clinicians follow the initial dose regimen re-commended by the guidelines established by the American Thyroid Association. Furthermore, indicators in both domestic and international guidelines for predicting adverse reactions to ATD remain unclear. During the ATD treatment of hyperthyroidism, the incidence of transient neutropenia is 1%-5%, and follow-up of baseline blood routine and liver function is ne-cessary. At present, there is a lack of monitoring frequency regulations and high-quality evidence-based medical support for above indice, and clinical practice has not yet established feasible indicators for predicting ATD adverse reactions. ATD-induced agranulocytosis is related to genetic susceptibility, age, drug type and dosage. HLA-B*27:05, HLA-B*38:02 and HLA-DRB1*08:03 on chromosome 6 in Chinese Han population may be susceptibility genes. Progress has been made in the diagnosis and treatment of thyroid associated ophthalmopathy (TAO) in China, with 36.7% of doctors adopting a multidisciplinary approach. Due to accessibility issues, less than 10% of patients receive biological agents to treat TAO, which is significantly lower than that in Western countries. Given these current status and challenges in China, further measures are necessary to improve the diagnosis and treatment of hyperthyroidism.

The syndrome of resistance to thyroid hormone(RTH) is a rare syndrome caused by the mutation of thyroid hormone receptor (TR) gene, which reduces the sensitivity of target organs to thyroid hormone (TH) and leads to the dysfunction of TH. Thyroid hormone resistance syndrome β (RTHβ) is caused by the mutations in the THRB gene. The main characteristics of RTHβ are increased thyroxine (T4) in the circulating blood, normal or elevated levels of triiodothyronine(T3), paired with normal or high thyroid-stimulating hormone (TSH) concentration. Clinically, it is easy to misdiagnose RTHβ as hyperthyroidism, and give anti-thyroid drugs, radioactive 131I therapy or surgery, which then leads to the aggravation of TH resistance, so the correct diagnosis of the disease is critical. In this paper, the molecular mechanism, clinical characteristics, diagnosis and treatment of RTHβ are summarized.

Clinicians often consider the use of dietary supplements to assist in lowering thyroid autoantibody titres in patients with Hashimoto's thyroiditis (HT). Currently, different supplements differ in their ability to reduce autoantibody levels. The purpose of this article is to compare the ability of different supplements to lower autoantibody titres and restore TSH levels through a systematic literature review. We obtained information from the PubMed, Web of Science, Embase, and Cochrane databases, as well as the China National Knowledge Infrastructure (CNKI). Selected studies included those using selenium, Vitamin D, Myo-inositol, and Myo-inositol in combination with selenium for the treatment of HT patients with euthyroidism. These data were combined using standardised mean differences (SMDs) and assessed using a random effects model. A total of 10 quantitative meta-analyses of case-control studies were selected for this meta-analysis. Compared to the placebo group, the use of selenium supplements was able to significantly reduce the levels of thyroid peroxidase autoantibodies (TPOAb) (SMD: -2.44, 95% CI: -4.19, -0.69) and thyroglobulin autoantibodies (TgAb) (SMD: -2.76, 95% CI: -4.50, -1.02). During a 6-month treatment, the use of Myo-inositol, Vitamin D alone, and the combination of selenium, and Myo-inositol did not effectively reduce TPOAb (Myo-inositol: SMD:-1.94, 95% CI: -6.75, 2.87; Vitamin D: SMD: -2.54, 95% CI: -6.51,1.42; Se+Myo-inositol: SMD: -3.01, 95% CI: -8.96,2.93) or TgAb (Myo-inositol: SMD:-2.02, 95% CI: -6.52, 2.48; Vitamin D: SMD: -2.73, 95% CI: -6.44,0.98; Se+Myo-inositol: SMD: -3.64, 95% CI: -9.20,1.92) levels. Therefore, we recommend that patients with HT(Hashimoto's Thyroiditis) be given an appropriate amount of selenium as an auxiliary treatment during standard-of-care treatment. [ABSTRACT FROM AUTHOR]

Objectives: Observational research shows associations of the gut microbiota and its metabolites with autoimmune thyroid disease (AITD), but the causality is undetermined. Methods: Two-sample Mendelian randomization (MR) was employed to analyze the association of the gut microbiota and its metabolites with AITD. A total of 119 gut microbiotas and nine fecal/circulating metabolites were the exposures. AITD, Graves' disease (GD), and Hashimoto's thyroiditis (HT) were the outcomes. Inverse-variance weighting (IVW) was primarily used to assess causality; Cochran's Q was used to assess heterogeneity. Sensitivity analyses (weighted median, MRPRESSO regression, MRPRESSO intercept, MRPRESSO global, Steiger filtering, leave-one-out) were conducted to assess causal estimate robustness. Multivariable MR (MVMR) was used to estimate the effects of body mass index (BMI) and alcohol consumption frequency on causality. Results: The outcomes were potentially causally associated with 22 gut microbiotas and three metabolites. After multiple-test correction, 3-indoleglyoxylic acid retained significant causality with AITD (IVW: odds ratio [OR] = 1.09, 95% confidence interval [CI] = 1.05–1.14, p = 2.43 × 10−5, FDR = 0.009). The sensitivity analyses were confirmatory (weighted median: OR = 1.06, 95% CI = 1.01–1.12, p = 0.025; MRPRESSO: OR = 1.09, 95% CI = 1.15–1.14, p = 0.001). MVMR revealed no confounding effects on this association (BMI: OR = 1.21, 95% CI =1.08–1.35, p = 0.001; drinks/week: OR = 1.22, 95% CI = 1.04–1.43, p = 0.014). Conclusions: MR revealed no significant causal effects of the gut microbiota on the outcomes. However, MR revealed the causal effects of 3-indoleglyoxylic acid on the risk of AITD. [ABSTRACT FROM AUTHOR]

Objective: Acute or chronic exposure to excess iodine has detrimental effects on thyroid physiology; therefore, this study aimed to determine the prevalence of overt hypothyroidism (OH) and subclinical hypothyroidism (SCH) in an elderly population residing in geographical areas with chronic exposure to excess iodine intake and to analyse contributing risk factors. Design: This cross‐sectional study was conducted from 2016 to 2017 in areas of Jiangsu Province that have documented chronic exposure to high iodine intake. Patients: We enroled 2559 adult participants using a multistage, stratified sampling method. Measurements: Urinary iodine concentration (UIC), serum thyroid‐stimulating hormone (TSH) level and other relevant parameters were measured. Demographic information was recorded using a standardized questionnaire. The age‐specific TSH references were determined by the National Academy of Clinical Biochemistry guidelines. Univariate and multivariate logistic regression analyses were performed to identify risk factors for hypothyroidism in the study population. Results: The median UIC of participants was 307.3 µg/L (interquartile range: 200.7, 469.8 μg/L). The prevalence of OH in subjects ≥70 years using laboratory reference ranges was 2.37%; however, it decreased to 1.78% with the use of an age‐specific reference range. Similarly, the prevalence of SCH also declined drastically from 29.59% to 2.96% with the application of an age‐specific reference range. In both univariate and multivariate models, advanced age, female gender and high UIC were identified as risk factors for hypothyroidism. Conclusions: Usage of age‐specific TSH reference ranges led to a significantly lower prevalence of OH and SCH in the study population, thus preventing unnecessary over‐diagnosis and over‐treatment. [ABSTRACT FROM AUTHOR]

Background: Research on serum metabolite profiles in thyroid autoimmunity (TAI) patients during early pregnancy is currently limited. Aim & Methods: The current study aimed to identify differential serum metabolites and assess the relationship between pregnancy outcomes and metabolic abnormalities in individuals with TAI. This research included 26 pregnant women with TAI and 30 healthy controls (HC). We employed a liquid chromatograph mass spectrometer (LC-MS) to analyze changes between the two groups. Results: Newborns in the TAI patients had lower birth weights than those in the control group (P = 0.007). We identified 92 differential metabolites (including 50 upregulated and 42 downregulated) belonging to amino acids, fatty acyls, glycerophosphocholines, steroid and other categories and four significantly enrichment Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways including taurine and hypotaurine metabolism, citrate cycle (TCA cycle), glyoxylate and dicarboxylate metabolism and 2-oxocarboxylic acid metabolism. We further identified 15 characteristic metabolites (6-Methylquinoline, D-erythrose 4-phosphate, 4-Hydroxyisoleucine, phosphatidylcholine (PC)(16:2e/16:0), N3,N4-Dimethyl-L-arginine, N-desmethyltramadol, 3-Methoxybenzaldehyde, sphingomyelin (SM)(d14:3/28:2), gamma-Glutamylleucine, NSI-189, 3-(1-cyano-1,2-dihydroisoquinolin-2-yl)-3-oxopropyl propionate, lysophosphatidylinositol (LPI) 16:0, cis-Aconitic acid, polyamide (PA)(18:1/18:2) and fatty acyl esters of hydroxy fatty acid (FAHFA)(17:0/18:0)) using least absolute shrinkage and selection operator (LASSO) regression. Correlation analyses revealed that 6-Methylquinoline, D-erythrose 4-phosphate, gamma-Glutamylleucine, and LPI 16:0 exhibited a positive correlation with anemia before delivery, while 3-(1-cyano-1,2-dihydroisoquinolin-2-yl)-3-oxopropyl propionate had a negative correlation. LPI 16:0 displayed a positive correlation with uric acid (UA) during both middle and late pregnancy, whereas 3-Methoxybenzaldehyde exhibited a negative correlation with UA in late pregnancy. Cis-Aconitic acid showed a positive correlation with fasting blood glucose (FBG) in middle pregnancy. Conversely, 6-Methylquinoline and 4-Hydroxyisoleucine had a negative correlation with birth weight. Thyroid autoantibodies were found to be associated with 14 metabolites identified using LASSO, with the exception of PA (18:1/18:2). Conclusions: Our findings provide new evidence supporting the early screening of serum metabolites and their potential for predicting adverse pregnancy outcomes in women with TAI. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to examine the urinary iodine concentration (UIC)–thyroid autoimmunity (TAI) association and UIC–selenium intake interaction in U.S. adults. Methods: We analyzed 2007–2012 National Health and Nutrition Examination Survey (NHANES) data on ≥20-year-old adults (n = 6612). Their food and supplemental selenium intake was measured. The associations of the UIC and selenium intake with thyroid peroxidase antibody (TPOAb) positivity, thyroglobulin antibody (TgAb) positivity, and TAI were assessed via weighted multivariable logistic regression. Interaction and subgroup analyses were conducted. Nonlinear relationships were explored and visualized via restricted cubic splines (RCSs). Results: Compared with a UIC 100~200 μg/L, a UIC 500~800 μg/L was associated with a 57% increased TPOAb positivity risk (OR = 1.57 [CI = 1.07–2.30]; p = 0.022), a one-fold greater TgAb positivity risk (OR = 2.00 [CI = 1.10–3.65]; p = 0.025), and a 62% increased TAI risk (OR = 1.62 [CI = 1.07–2.45]; p = 0.024). Nonlinear relationships between the UIC and thyroid antibody positivity were observed. According to the univariate models, each 1 μg increase in selenium intake was associated with a 0.049 IU/mL decrease in the TPOAb levels (β [95% CI] = −0.049 [−0.092–−0.005]; p = 0.028). In the low-selenium group, a UIC of 200~300 μg/L was a risk factor for TPOAb positivity (p = 0.046). At a moderate level of selenium intake, a UIC of 300~800 μg/L significantly increased the TPOAb positivity risk (all p < 0.05). At a high level of selenium intake, the UIC and TPOAb positivity risks were not significantly associated (all p > 0.05). Conclusions: A UIC of 500~800 μg/L is an independent TAI risk factor. The selenium intake modifies the UIC–thyroid antibody positivity relationship, with the association disappearing at high selenium levels. [ABSTRACT FROM AUTHOR]

Background: Exposure to particles with an aerodynamic diameter of ≤2.5 μm (PM2.5) is associated with the occurrence of thyroid dysfunction among pregnant women and neonates, but it is not known if this association occurs in the general population. We aimed to determine the association of prolonged exposure to PM2.5 with the prevalence of thyroid disorders among adults in China. Methods: A nationally representative cross-sectional study of thyroid disorders, iodine status, and diabetes status was carried out in all 31 provinces across China from 2015 to 2017. In total, 73,900 adults aged 18 years and older were included. Serum concentrations of thyroid hormones, thyrotropin, and thyroid antibodies and the urine iodine concentration were measured. The environmental concentration of PM2.5 for each participant's residential address at a spatial resolution of 1 × 1 km was estimated. Results: The average long-term exposure to PM2.5 at residential addresses was 66.41 μg/m3, ranging from 17.58 μg/m3 to 120.40 μg/m3. Compared with that of individuals with lower exposure levels, the prevalence of thyroid diseases such as autoimmune thyroiditis and subclinical hypothyroidism was greater in those with PM2.5 concentrations within the third quartile range (60.18 to 73.78 μg/m3). Compared with those in the first quartile (17.58 to 46.38 μg/m3), participants in the highest PM2.5 quartile (73.78 to 120.40 μg/m3) presented an increased risk of overt hypothyroidism (OR 1.23 [CI 0.94–1.61]), subclinical hypothyroidism (1.10 [1.01–1.21]), autoimmune thyroiditis (1.09 [1.00–1.18]), and thyroglobulin antibody positivity (1.17 [1.07–1.29]). However, there was no association between PM2.5 exposure and overt hyperthyroidism, subclinical hyperthyroidism, Graves' disease, or thyroid peroxidase antibody positivity (p > 0.05). Each 10 μg/m³ increase in the PM2.5 concentration was associated with an increased risk of overt hypothyroidism (OR 1.05 [1.00–1.11]), subclinical hypothyroidism (1.02 [1.00–1.03]), and thyroglobulin antibody positivity (1.02 [1.00–1.04]). Furthermore, a nearly linear exposure–response relationship was observed between long-term PM2.5 exposure and thyroglobulin antibody positivity. Conclusions: PM2.5 exposure was associated with thyroid disorders among Chinese adults. A dose–response relationship between PM2.5 exposure and autoimmune thyroiditis, as well as thyroglobulin antibody positivity, was also observed. [ABSTRACT FROM AUTHOR]