[Arrhythmias in thyroid dysfunction]. / Arrhythmien bei Schilddrüsenerkrankungen.

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).

Exploring the Correlation Between Varied Serum Iodine Nutritional Levels and Anti-Thyroglobulin Antibodies.

Iodine deficiency results in elevated thyroglobulin (Tg) concentrations, with high iodine Tg being more immunogenic than low iodine Tg. The study investigated the correlation between serum iodine concentration and thyroglobulin autoantibody (TgAb) levels across diverse iodine nutritional statuses as determined by urine iodine concentration (UIC). Demographic information was collected from 1,482 participants through a questionnaire. Blood and spot urine were collected to measure thyroid-stimulating hormone (TSH), TgAb, thyroid anti-peroxidase antibody (TPOAb), serum iodine (SIC), serum non-protein-bound iodine (snPBI), urine iodine (UIC), creatinine (UCr). The median UIC and SIC were 146.5 µg/L and 74.9 µg/L, respectively. A linear relationship was observed between SIC, snPBI, and serum-protein-bound iodine (sPBI) (P < 0.001). The 90% reference intervals for SIC, snPBI, and sPBI were 50.7-120.7 µg/L, 21.9-52.9 µg/L, and 19.7-77.9 µg/L, respectively. The prevalence of elevated TgAb levels was significantly higher in women than in men (P < 0.001). Both low and high levels of snPBI and sPBI were associated with an increased risk of elevated TgAb levels. In women, the risk of positive TgAb in the group below the reference value of snPBI (OR = 2.079, 95%CI: 1.166, 3.705) and sPBI (OR = 2.578, 95%CI: 1.419, 4.684) was higher. In men, the risk of positive TgAb in the group below the reference value of SIC was higher (OR = 3.395, 95%CI: 1.286, 8.962). Iodine might exert an influence on TgAb levels through its binding to proteins, primarily Tg, thereby altering the iodine content of Tg. The interplay of gender factors further enhanced the risk of TgAb emergence.

The Relationship Between Thyroid Dysfunction and Sleep Quality Among Population of Saudi Arabia.

Purpose: Thyroid problems and sleep disturbances are common health problems that impact people of all ages, income levels, and genders. The clinical relationship between these conditions is still not well understood, despite their widespread occurrence. The main objectives of the study were to determine the prevalence of thyroid disorders and evaluate the relationship between them and sleep quality in the Saudi Arabian population. Patients and Methods: The study employed an observational cross-sectional design and included a representative Saudi Arabian cohort. The Pittsburgh Sleep Quality Index (PSQI) was included in a digital self-administered survey that participants were asked to complete. Results: There were 1044 responders in the study, most of whom (54%) were between the ages of 21 and 30. Female respondents made up 62% of the sample. Thyroid disorders were diagnosed in 9.2% of cases. A significant correlation was found (p=0.001 and p<0.001, respectively) between thyroid disorders and sleep disturbances as well as the use of sleep medications. Conclusion: The study revealed a significant prevalence of poor sleep quality in the Saudi population as a whole, with thyroid disorder diagnosis and female gender emerging as independent risk factors. More extensive longitudinal studies in the area are desperately needed.

Thyroid disorders and gastrointestinal dysmotility: an old association.

Gastrointestinal motility symptoms may be closely related to thyroid diseases. Sometimes, such symptoms are the only thyroid disease-related clue although the degree of the symptoms may vary. The exact mechanism of action of thyroid hormones on gastrointestinal motility is not completely understood, however, a clue lies in the fact that muscle cell receptors can be directly acted upon by thyroxines. Both hypo- and hyperthyroidism can cause impairment of gastrointestinal motility, modifying structure and function of pharynx and esophagus, and regulating esophageal peristalsis through neuro-humoral interaction. In hyperthyroid patients, alterations of postprandial and basic electric rhythms have been observed at gastro-duodenal level, often resulting in slower gastric emptying. Gastric emptying may also be delayed in hypothyroidism, but an unrelated gastric mucosa-affecting chronic modification may also cause such pattern. Hyperthyroidism commonly show malabsorption and diarrhoea, while hypothyroidism frequently show constipation. In summary, it can be stated that symptoms of gastrointestinal motility dysfunction can be related to thyroid diseases, affecting any of the gastrointestinal segment. Clinically, the typical thyroid disease manifestations may be missing, borderline, or concealed because of intercurrent sicknesses. Motility-linked gastrointestinal problems may easily conceal a misdetected, underlying dysthyroidism that should be carefully analyzed. Here, we aim to elaborate on the associations between thyroid disorders and GI dysmotility and the common clinical manifestations associated with GI dysmotility.

Prevalence and impact of endocrine disorders in advanced metastatic cancer patients undergoing cancer-directed therapy: A prospective observational study.

BACKGROUND: Noncommunicable diseases (NCDs) contribute significantly to global morbidity and mortality, with cancer being one of the leading causes. In this prospective observational study, we aimed to investigate the prevalence and impact of endocrine disorders, specifically diabetes and thyroid dysfunction, in patients with advanced metastatic cancer undergoing cancer-directed therapy. METHODS: Over 15 months, we recruited 100 histologically proven advanced metastatic cancer patients from the Department of Medical Oncology Haematology, All India Institute of Medical Sciences, Rishikesh, and conducted institutional-based prospective observational study. All participants over 18 years of age, treatment-naive, and potential candidates for systemic chemotherapy with an expected clinical survival of at least 6 months were included in the study. Patients with prior therapy, secondary neoplasms, and those unable to complete 3 months of palliative chemotherapy were excluded. Patients were assessed for diabetes and thyroid function at presentation, after 3 and 6 months of cancer-directed standard therapy. These data were analyzed, processed, and presented as results. RESULTS: The mean age of participants was 50.45 years, with a near-equal distribution of males and females. At baseline, 10% of the study population had preexisting endocrine disorders (2% hypothyroidism, 8% diabetes). By the end of 6 months, the prevalence increased to 18%, with females being more affected. Notably, the prevalence of new-onset endocrine disorders during cancer-directed therapy was only 3% for diabetes and 4% for thyroid dysfunction. CONCLUSION: Analysis of sociodemographic and cancer-related characteristics showed no significant association with changes in diabetic and thyroid status at 3 and 6 months. However, substance use, particularly smoking, was associated with an increased risk of diabetes development (p < .05). Cancer type and treatment regimen did not show statistically significant correlations with endocrine dysfunction. IMPLICATIONS: Our study highlights the importance of considering endocrine disorders in advanced metastatic cancer patients undergoing therapy. The prevalence of diabetes and thyroid dysfunction increased during cancer-directed therapy, particularly in females. Careful monitoring and timely intervention are essential to improve the quality of life for these patients. Further research is warranted to explore the long-term effects of cancer-directed therapy on endocrine health and develop tailored management strategies for this vulnerable population.

Goiter in the Qing Dynasty.

Empress Dowager Cixi, the supreme ruler of China's Qing Dynasty, along with Imperial Concubine Jin, may have suffered from goiter. Our suspicions were aroused by two interesting historical photographs. Herein, we provide a medical interpretation of these historical images in an attempt to present the cases of these two historical figures.

Knowledge and Awareness About Risk Factors, Clinical Manifestations, and Prevention of Thyroid Disorders in the Era of COVID-19 and Their Association With Socioeconomic Status Among the General Population in Riyadh, Saudi Arabia.

Background Thyroid dysfunction represents the most commonly observed endocrine illness within the population of Saudi Arabia. Thyroid cancer has been recognized as the second most commonly occurring malignant neoplasm among women in Saudi Arabia. Furthermore, there is evidence suggesting that COVID-19 and, to a certain degree, immunization may have an impact on thyroid function. The aim of this study was to evaluate the level of public knowledge, awareness, and attitudes pertaining to the manifestations and risk factors of thyroid disease. Additionally, the study sought to examine the potential role of COVID-19 as a risk factor and explore preventive measures in the context of Riyadh, Saudi Arabia. Methods A cross-sectional online survey was conducted targeting the Saudi population living in Riyadh aged 18 years and older. A self-administered questionnaire constructed on Google Forms was distributed to the general population using an online platform. The questionnaire consisted of five sections: demographic data, risk factors for thyroid disorders, clinical manifestations, prevention, and history of thyroid disease. Binary logistic regression analysis was used to identify predictors of better knowledge of thyroid diseases.  Results Among the 693 participants enrolled, 57.7% were female, and 31.7% were aged between 18 and 25 years. The overall mean knowledge score was 12.2 (SD = 6.57) out of 23 points. Poor knowledge of the risk factors, clinical manifestations, and prevention was observed in 50.4% of the participants. A total of 27.6% had moderate knowledge, and 22.1% had good knowledge levels. Furthermore, only 33.9% of the participants believed that COVID-19 infection was a risk factor. The results of the binary logistic regression analysis revealed that individuals within the age range of 36-45 years, females, and students had a significantly higher level of knowledge compared to other participants (p<0.05). Conclusion This study revealed that the general population of Riyadh, Saudi Arabia, lacked adequate knowledge, awareness, and attitudes regarding the risk factors, clinical symptoms, and prevention of thyroid problems. However, middle-aged individuals, females, and those who were enrolled as students showed a higher level of knowledge. Regarding the pathogenesis of COVID-19, it was observed that all participants had a limited understanding and a lack of awareness. Insufficient public awareness may result in misunderstandings, insufficient identification, and potential oversight of COVID-19-infected patients with thyroid dysfunction. Therefore, it is imperative that healthcare authorities intensify their efforts to broaden the dissemination of information throughout the population.

Do We Need to Monitor for Graves' Disease After a Diagnosis of Pemphigoid Gestationis?

Pemphigoid gestationis (PG) is a rare autoimmune bullous disease that occurs during pregnancy or the postpartum period. PG has been associated with an increased risk of Graves' disease possibly due to shared genetic factors and immune system fluctuations during pregnancy. However, the evidence supporting the association between PG and Graves' disease is mixed. Although dermatologists are cautioned to watch for Graves' disease in patients with a history of PG, this guidance is based on a single cohort where most patients were diagnosed with Graves' disease prior to PG onset. Recent data failed to find an association between Graves' disease and PG but did not capture the lifetime risk of Graves' disease in these patients. Future studies could focus on long-term follow-up of females with PG, shedding light on the lifetime risk profiles of these patients.

Caregivers' knowledge and medication adherence in children with thyroid disorders: an exploratory study.

OBJECTIVES: Many thyroid disorders in children demand long-term therapy. The parent's understanding of the child's condition is of utmost importance for adherence to treatment. The study objective was to assess the knowledge, medication adherence, reasons for non-adherence, and their relationship with various clinical parameters. METHODS: An exploratory, cross-sectional study with a total enumeration sampling technique was conducted between July 2022 and September 2022. Children and young adults aged ≤18 years who were diagnosed with a thyroid disorder and taking medications for at least 3 months were included. Data were collected by interviewing parents using the Adherence to Refills and Medications Scale (ARMS) and structured knowledge questionnaire. RESULTS: Parents of 102 children were interviewed. The mean age of the children was 9.2 ± 0.4 years; 58 (57 %) were girls. The mean duration of treatment was 5.5 ± 0.3 years. Many (66 %) informants were mothers. Three-fourths (75.5 %) of parents were educated up to senior secondary and above. Most (91.2 %) of parents had poor knowledge about the disease and its management. Poor disease knowledge was significantly linked to lower education (p<0.001). Nonetheless, strong adherence (>80 %) was noted on the ARMS scale. No significant correlation was found between physical growth, thyroid function, and adherence/knowledge (p-values 0.20-0.71). CONCLUSIONS: The caregivers' knowledge of thyroid disorders was poor and related to their educational level. There is a need to use clear language and ensure that parents have an adequate understanding of their child's condition. Healthcare professionals should assess and address gaps in parental knowledge and adherence.

Evaluation of Thyroid Nodules in Patients With Fine-Needle Aspiration Biopsy.

BACKGROUND: The incidence of thyroid nodules has increased in the last 50 years due to the widespread use of imaging methods and incidental detection of small thyroid nodules. Thyroid fine-needle aspiration biopsy (FNAB) is the most accurate, reliable, and cost-effective test to evaluate thyroid nodules. AIM: In this research, we aimed to elucidate thyroid fine-needle aspiration cytology (FNAC) to understand how suspicious cases predict malignancy. MATERIALS AND METHODS: Within this research's scope, 411 patients over 16 years old who were evaluated in Izmir Katip Celebi University, Ataturk Training and Research Hospital Internal Medicine (Izmir, Turkey) outpatient clinic for thyroid nodules between 2018 and 2022 and underwent thyroid FNAC followed by thyroid surgery were analyzed retrospectively. The age, gender, thyroid FNAC, operation type, and histopathology of all the patients were reviewed. Individuals with a history of head and neck cancer were excluded from the analysis. RESULTS: No statistically significant relationship between the pathology results and demographic characteristics was found. A statistically significant correlation existed between the pathology and FNAB results (p<0.05). Although 84.5% of the patients were diagnosed as benign, 14.7% as suspicious, and 0.8% as malignant in FNAC, all of these cases were diagnosed as benign in final histopathology results. Similarly, 21.9% of the patients were diagnosed as benign, 58.8% as suspicious, and 19.4% as malignant in FNAC and all of these cases were diagnosed as malignant in final histopathology results. A correlation was determined between the two measurements (Cohen's kappa (κ)=0.557; p<0.001). The test's sensitivity was 47%, and the specificity was 99.1%. According to the FNAC results, the rate of being diagnosed with malignancy (positive predictive value (PPV)) was 93.9%, and the rate of being diagnosed as benign (negative predictive value (NPV)) was 85.8% for the individuals initially diagnosed as benign. CONCLUSION: Although FNAB remains the most important diagnostic tool to identify benign cases with a high accuracy rate, the operation decision is not clear in suspicious atypia of undetermined significance/follicular lesions of undetermined significance (AUS/FLUS) cytology findings. In conclusion, this study highlights the importance of FNA results and helps in surgical decision-making by emphasizing that the possibility of malignancy in the post-operative final histopathology report is higher, especially in the presence of suspicious FNAC results.

Gallstone Disease and Its Correlation With Thyroid Disorders: A Narrative Review.

Over the years, several studies have revealed an important link between thyroid disorders and gallstone disease. According to these studies, hypothyroidism and hyperthyroidism are associated with cholesterol gallstone disease. This association between thyroid hormone disorders and cholesterol gallstone disease is due to the importance of thyroid hormones on cholesterol synthesis, bile functioning and content, and gallbladder motility. Several genes and receptors have been found on the thyroid gland, liver, and gallbladder to verify this association. These genes affect thyroid hormone secretion, lipid metabolism, and bile secretion. Defects in these various gene expression and protein functions lead to bile duct diseases. Other causes that lead to cholesterol gallstone disease are supersaturation of the bile with cholesterol and impaired gallbladder motility, which leads to bile stasis. This article has discussed these factors in detail while highlighting the association between thyroid hormones and cholesterol gallstone disease.

The relationship of hip fracture and thyroid disorders: a systematic review.

Introduction: Bone density regulation is considered one of the systems affected by thyroid hormones, leading to low bone density that can result in pathologic fractures, including hip fractures. This review aimed to update clinicians and researchers about the current data regarding the relationship between hip fractures and thyroid disorders. Methods: English papers were thoroughly searched in four main online databases of Scopus, Web of Science, PubMed, and Embase. Data extraction was done following two steps of screening/selection using distinct inclusion/exclusion criteria. This study used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist and the Newcastle-Ottawa Scale (NOS) as bias assessment. Results: In total, 19 articles were included in the research. The risk of hip fractures in women with differentiated thyroid cancer (DTC) is higher than hip fractures caused by osteoporosis. Men with hyperthyroidism and subclinical hyperthyroidism are at higher risk for hip fracture. Also, a decrease in serum thyroid stimulating hormone (TSH) may be associated with an increased risk of hip fracture. Conclusion: Reaching a consensus conclusion regarding the association between subclinical thyroid dysfunction and hip fracture is not feasible due to the heterogenicity of evidence; however, there may be a higher risk of fracture in individuals with subclinical hyperthyroidism.

Thyroid Hormones and Cardiometabolic Risk Factors in Saudi Women with Polycystic Ovary Syndrome: A Cross-Sectional Study.

Objective: The PCOS-thyroid nexus has recently drawn the focus of various investigations due to the prevalence of thyroid problems in PCOS. Additionally, risk factors for cardiovascular disease (CVD) are more prevalent in PCOS women. Therefore, we aim to assess the levels of thyroid hormones in Saudi females with polycystic ovary syndrome (PCOS) and to examine the correlation between cardiometabolic risk factors (CMRFs) and thyroid hormones in PCOS patients. Methods: A cross-sectional research with 200 PCOS-diagnosed female patients was conducted from April 2018 to April 2020. In addition to other anthropometric and serum biochemical markers, glycemic status, thyroid function test, lipid profiles, homocysteine, and C-reactive protein levels were detected in patients. Results: In PCOS, hypothyroidism is more common than hyperthyroidism (55 vs 27.5%, p = 0.05). While women with raised TSH (hypothyroidism) had a higher BMI, WC, FBG, and poorer HDL-C (p< 0.05). Significant differences were found in LDL-C, TG, Homocysteine, and CRP levels (all p<0.001 and< 0.05). PCOS women with hypothyroidism at increased risk of CVD, as indicated by AIP (Atherogenic Index of plasma) (0.57±0.42) was found. The elevated TSH levels were favorably linked with TG, Homocysteine, CRP, BMI, AIP, and WC (all p< 0.001, 0.05) but negatively connected with HDL-C and FT4. Conclusion: A strong relationship between PCOS and thyroid dysfunction was detected since PCOS hypothyroid groups had higher TSH levels and CMRFs. This group's CVD risk was elevated due to CRP, homocysteine, triglycerides, and obesity.

The Impact of Hypothyroidism on Diabetes Mellitus and Its Complications: A Comprehensive Review.

Diabetes mellitus (DM) is one of the most prevalent metabolic disorders in the world and is characterized by excessive blood glucose levels, which lead to deranged carbohydrate, protein, and lipid metabolisms. At its core, DM is an impairment of insulin metabolism, leading to a plethora of clinical features. The thyroid gland is another vital cog in the wheel of the endocrine system, and the hormones synthesized by it are heavily involved in the control of the body's metabolism. Hypothyroidism is a state in which thyroid hormones are deficient due to various factors and is characterized by a metabolically hypoactive state. Together, insulin, implicated in DM, and thyroid hormones engage in an intricate dance and serve to regulate the body's metabolism. It is imperative to explore the relationship between these two common endocrine disorders to understand their clinical association and mold treatments specific to patients in which they coexist. Both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) have been shown to have an increased association with hypothyroidism, especially in patients with risk factors including female sex, hyperlipidemia, obesity, and anemia. This review also explores DM's macrovascular and microvascular complications and their association with hypothyroidism. It is of great use to screen for hypothyroidism in diabetic patients. Specific protocols, especially for patients at an elevated risk, provide improved quality of life to patients affected by this highly prevalent disease.

COVID-Induced Hyperthyroidism in a 30-Year-Old Female: A Case Study.

Thyroiditis should be in the differential for hyperthyroidism when thyroid-stimulating hormone (TSH) is suppressed and T3/T4 levels are elevated. Suspicion of hyperthyroidism is further increased when the patient can exhibit symptoms such as weight loss, anxiety, feeling feverish, tremors, shaking, and sweating. Hyperthyroidism is generally classified as being overt or subclinical. In the following case, the patient had overt hyperthyroidism which is considered more severe than subclinical hyperthyroidism. Coronavirus disease is not typically associated with thyroiditis; however, in this case, the patient's disorder was accidentally found on her blood results which were originally taken due to her coronavirus disease 2019 (COVID-19) diagnosis.  In this case study, we present a 30-year-old female patient, with suspicions of COVID-19-induced hyperthyroidism found incidentally on her blood panel. An original diagnosis of thyroiditis was made prior to the visualization of increased release of thyroid hormone. A sonogram was done, and a follow-up blood panel was ordered, confirming the patient's diagnosis of hyperthyroidism post COVID-19 recovery.

Relationship Between Serum 25-Hydroxyvitamin D Deficiency and Thyroid Disease in Postmenopausal Women with Type 2 Diabetes Mellitus.

Purpose: It is unknown whether there is an association between 25-hydroxyvitamin D (25(OH)D) level and thyroid disease in postmenopausal women with type 2 diabetes. This study aimed to evaluate the relationship between blood 25(OH)D levels and thyroid function in postmenopausal women with type 2 diabetes mellitus (T2DM). Methods: This cross-sectional study involved Chinese postmenopausal women who presented to our diabetes clinic from March 2021 to May 2022 and were diagnosed with T2DM collected via a convenience sampling method. Blood samples were obtained from each patient to detect serum thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), free T3 (FT3), free T4 (FT4), thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb) and 25(OH)D levels. Deficiency was defined as a 25(OH)D < 20 ng/mL. Comparative analysis was via t-test or chi-square test. Pearson correlation was then used to estimate the relationship between different thyroid function parameters and 25(OH)D. Multivariate logistic regression analysis was used to explore potential risk factors for 25(OH)D deficiency. Results: In total, 157 out of 230 participants (68.26%) had 25(OH)D deficiency. Compared with patients with normal 25(OH)D levels, patients with 25(OH)D deficiency had shorter medical histories of diabetes mellitus (DM, p = 0.001) and higher rates of hyperthyroidism (p = 0.007), hypothyroidism (p < 0.001), TPOAb positive (p < 0.001) and TgAb positive (p < 0.001). Correlation analysis revealed that TSH (r = -0.144, p = 0.030), FT4 (r = -0.145, p = 0.029), TPOAb (r = -0.216, p = 0.001) and TgAb (r = -0.150, p = 0.024) levels were correlated with serum 25(OH)D levels. Further multivariable logistic regression analyses suggested that the length of DM history, presence of hyperthyroidism, presence of hypothyroidism and positive TPOAb were significantly associated with the presence of 25(OH)D deficiency in postmenopausal women with T2DM. Conclusion: Hyperthyroidism, hypothyroidism and TPOAb positivity were significantly associated with the presence of 25(OH)D deficiency in postmenopausal women with T2DM.

Iodine Status, Thyroid Disorder and Feto-Maternal Outcome among the Tribal Pregnant Women of Eastern Himalayas.

Introduction: Iodine deficiency and thyroid disorder during pregnancy have adverse effects on fetal and neonatal outcomes. Objective: To assess iodine status and thyroid functioning during pregnancy and to evaluate the feto-maternal outcome. Methods: Urinary iodine content (UIC) is determined by arsenic cerium catalytic spectrophotometry method and thyroid hormone analysis was carried out by chemiluminescence assay. Fetal and neonatal outcomes were obtained from hospital records. Results: Among the considered tribal pregnant women 56.75% had insufficient urinary iodine and 24.5% had a thyroid disorder. Thyroid disorder was more common in pregnant women with urinary iodine concentration (UIC) <99 µg/L than UIC >150 µg/L (56.75% vs 41.5%). Pregnant women with UIC<99 µg/L had a higher incidence of anemia (86.36%), gestational diabetes mellitus (GDM) (3.33%), and preeclampsia (5.71%) than UIC >150 µg/L. The fetal outcome with UIC <99 µg/L had a higher incidence of low birth weight (9.09%) and preterm births (1.9%). Stillbirths were distributed equally among different UIC groups. The neonatal outcomes with UIC <99 µg/L between 150-249 µg/L had a higher incidence of respiratory distress (5.23%). Hypothermia was equally distributed among different UIC groups. Subclinical hypothyroid had a high prevalence of anemia (62.96%), preeclampsia (3.7%), and GDM (6.17%) respectively than the euthyroid group. The fetal outcome with low birth weight (LBW) (9.87%), stillbirths (3.7%), and preterm birth (8.64%) was more common in the subclinical hypothyroid than in the euthyroid group. Among the neonatal outcomes respiratory distress (6.17%) and hypothermia (4.93%) were more common in subclinical hypothyroid than euthyroid pregnant women. Conclusion: Insufficient maternal iodine and thyroid disorders during pregnancy were associated with adverse pregnancy outcomes.

Thyroid Disorders and Movement Disorders-A Systematic Review.

Background: There is overlap between movement disorders and neuroendocrine abnormalities. Objectives and methods: To provide a systematic review on the association of thyroid dysfunction and movement disorders. Thyroid physiological function and classical thyroid disorders highlighting typical and atypical manifestations including movement disorders, as well as diagnostic procedures, and treatments are discussed. Results: Hypothyroidism may be associated with hypokinetic and hyperkinetic disorders. There is debate whether their concomitance reflects a causal link, is coincidence, or the result of one unmasking the other. Hypothyroidism-associated parkinsonism may resemble idiopathic Parkinson's disease. Hypothyroidism-associated hyperkinetic disorders mainly occur in the context of steroid-responsive encephalopathy with autoimmune thyroiditis, that is, Hashimoto disease, mostly manifesting with tremor, myoclonus, and ataxia present in 28-80%, 42-65% and 33-65% in larger series. Congenital hypothyroidism manifesting with movement disorders, mostly chorea and dystonia, due to Mendelian genetic disease are rare.Hyperthyroidism on the other hand mostly manifests with hyperkinetic movement disorders, typically tremor (present in three quarters of patients). Chorea (present in about 2% of hyperthyroid patients), dystonia, myoclonus, ataxia and paroxysmal movement disorders, as well as parkinsonism have also been reported, with correlation between movement intensity and thyroid hormone levels.On a group level, studies on the role of thyroid dysfunction as a risk factor for the development of PD remain non-conclusive. Conclusions: In view of the treatability of movement disorders associated with thyroid disease, accurate diagnosis is important. The pathophysiology remains poorly understood. More detailed case documentation and systematic studies, along with experimental studies are needed.

A Literature Review on SARS-CoV-2 and Other Viruses in Thyroid Disorders: Environmental Triggers or No-Guilty Bystanders?

A growing number of findings indicate a relationship between COVID-19 infection and thyroid dysfunction. This association is also strengthened by knowledge on the potential of viral infections to trigger thyroid disorders, although the exact underlying pathogenetic process remains to be elucidated. This review aimed to describe the available data regarding the possible role of infectious agents, and in particular of SARS-CoV-2, in the development of thyroid disorders, summarizing the proposed mechanisms and levels of evidence (epidemiological, serological or direct presence of the viruses in the thyroid gland) by which the infection could be responsible for thyroid abnormalities/diseases. Novel data on the association and mechanisms involved between SARS-CoV-2 vaccines and thyroid diseases are also discussed. While demonstrating a clear causal link is challenging, numerous clues at molecular and cellular levels and the large amount of epidemiological data suggest the existence of this relationship. Further studies should be taken to further investigate the true nature and strength of this association, to help in planning future preventive and therapeutic strategies for more personal and targeted care with attention to the underlying causes of thyroid dysfunction.

Comorbidities and clinical complications associated with SARS-CoV-2 infection: an overview.

The novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes major challenges to the healthcare system. SARS-CoV-2 infection leads to millions of deaths worldwide and the mortality rate is found to be greatly associated with pre-existing clinical conditions. The existing dataset strongly suggests that cardiometabolic diseases including hypertension, coronary artery disease, diabetes and obesity serve as strong comorbidities in coronavirus disease (COVID-19). Studies have also shown the poor outcome of COVID-19 in patients associated with angiotensin-converting enzyme-2 polymorphism, cancer chemotherapy, chronic kidney disease, thyroid disorder, or coagulation dysfunction. A severe complication of COVID-19 is mostly seen in people with compromised medical history. SARS-CoV-2 appears to attack the respiratory system causing pneumonia, acute respiratory distress syndrome, which lead to induction of severe systemic inflammation, multi-organ dysfunction, and death mostly in the patients who are associated with pre-existing comorbidity factors. In this article, we highlighted the key comorbidities and a variety of clinical complications associated with COVID-19 for a better understanding of the etiopathogenesis of COVID-19.