Impact of levothyroxine therapy for maternal subclinical and overt hypothyroidism on early child neurodevelopment: A prospective cohort study.

OBJECTIVE: Treatment indication of maternal subclinical hypothyroidism (SCH) is undetermined, despite the wide administration of levothyroxine for maternal overt hypothyroidism (OH). This study aimed to evaluate the therapeutic effect of levothyroxine for maternal SCH and OH in real-world practice, with a focus on early child neurodevelopment. DESIGN: Prospective cohort study. PATIENTS AND MEASUREMENTS: Pregnant women diagnosed with SCH at the first antenatal visit were enroled and compared to those diagnosed with OH. Thyroid follow-ups were conducted during pregnancy. Early child neurodevelopment was assessed using the Gesell Development Diagnosis Scale (GDDS) at 1, 3, 6, 12 and 24 months of age. RESULTS: From January 2012 to December 2013, a total of 442 pregnant women were included in final analysis, among whom 194 and 248 were assigned to the SCH and OH groups, respectively. The percentage of levothyroxine therapy at the first antenatal visit was significantly lower in the SCH group than that in the OH group (91.24% vs. 97.58%, p < .01), with a similar treatment rate at delivery (99.4% vs. 100%, p > .05). Notably, GDDS scores were lower in the SCH group than those in the OH group at 6 months to 2 years of age, which was confirmed by subgroup analyses and sensitivity analyses. CONCLUSIONS: Children born with maternal SCH demonstrated slightly lower neuropsychological scores at 6 months to 2 years of age compared to those with maternal OH in the clinical practice. The therapeutic effect of maternal SCH on the child neurodevelopment requires further exploration.

Natural history of subclinical hypothyroidism and prognostic factors for the development of overt hypothyroidism: Tehran Thyroid Study (TTS).

OBJECTIVE: The significance of subclinical hypothyroidism (SCH) is largely due to its potential risk for developing overt hypothyroidism (OH). Investigations are still exploring predictive factors contributing to the progression of SCH to OH, particularly in patients with mildly elevated serum thyrotropin (TSH). We aimed to clarify the natural history of SCH and the predictive factors of its progression, based on the grade of SCH severity. METHODS: This study was conducted within the framework of the Tehran Thyroid Study (TTS), in which 5783 individuals aged ≥ 20 years were followed. After applying exclusion criteria, data of 270 SCH subjects remained for the analysis. Thyroid function tests were assessed at baseline and every 3 years. RESULTS: Of 270 participants with SCH, 239 (88.5%) had TSH level between 5.06 and 10 mU/L, and 31 (11.4%) had TSH ≥ 10 mU/L. During a median follow-up of 10 years, 40% had TSH within the reference range, 44% maintained elevated TSH, and 16% had added low T4 to the elevated TSH. The annual incidence rate of progression to OH was 22.3 (16.5-101.9) per 1000 person-years [18 (12.6-25.6) for those with TSH 5.07-9.9 mU/L and 57.8 (22.8-101.9) for patients with TSH ≥ 10 mU/L per 1000 person-years (P = 0.001)]. After adjusting age, sex, body mass index (BMI), thyroid peroxidase antibody (TPOAb), and serum TSH, only TPOAb positivity (HR: 2.31; 95% CI 1.10-4.83, P = 0.026) and baseline TSH level ≥ 10 mU/L (HR: 5.14; 95% CI 2.14-12.3, P < 0.001) remained as predictors for development of OH. In patients with TSH 5.07-9.9 mU/L, TPOAb positivity was associated with an increased risk of OH (HR: 2.41; 95% CI 1.10-5.30, P = 0.027). However, in patients with TSH ≥ 10 mU/L, TPOAb positivity was not a predictor (P = 0.49). CONCLUSION: TPOAb and not TSH are associated with the development of OH in individuals with serum TSH below 10 mU/L, and follow-up at regular intervals is recommended in TPOAb-positive individuals with TSH between 5 and 10 mU/L.

Age-specific thyrotropin references decrease over-diagnosis of hypothyroidism in elderly patients in iodine-excessive areas.

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.

Association of Thyroid Function During Pregnancy With the Risk of Pre-eclampsia and Gestational Diabetes Mellitus.

OBJECTIVE: To estimate the association of maternal thyroid dysfunction with the risk of gestational hypertension and diabetes. Whether the association was affected by gestational age at diagnosis and thyroid autoimmunity was further explored. METHODS: A cohort study of 41 647 participants was conducted. Thyroid function (ie, thyroid-stimulating hormone [TSH] and free thyroxine [FT4]) was measured by electrochemiluminescence immunoassay. Thyroid antibody positivity (eg, thyroperoxidase, thyroglobulin, and TSH receptor antibody) was indicated if the values of these antibodies exceeded the upper targets of the reference range. The relationship between maternal thyroid dysfunction and the risk of pre-eclampsia (PE) and gestational diabetes mellitus (GDM) was assessed by multivariate logistic regression. RESULTS: Isolated hypothyroxinemia (defined as 5th ≤ TSH ≤ 95th percentile, FT4 < 5th percentile) was associated with the risk of PE (odds ratio [OR], 1.32; 95% CI, 1.10-1.58). Overt hypothyroidism (TSH > 95th percentile; FT4 < 5th percentile) was related to the risk of severe PE (OR, 2.59; 95% CI, 1.05-6.37). Being positive for TSH receptor antibody was associated with a decreased risk of GDM (OR, 0.49; 95% CI, 0.35-0.70). A marginally significant association between overt hypothyroidism detected at the first trimester and the risk of GDM was found (OR, 1.60; 95% CI, 1.00-2.83). The association of thyroid dysfunction with the risk of PE and GDM was stronger among pregnant women who were negative for autoantibodies. CONCLUSION: Some types of thyroid dysfunction during pregnancy were associated with the risk of PE and GDM. The associations varied by gestational age at diagnosis and by thyroid autoantibody status.

Hypothyroidism and pregnancy: still a controversial issue.

Subclinical hypothyroidism (SCH) in pregnancy is common, according to literature, affecting up to 15% of pregnancies. It still represents a controversy weather levothyroxine has beneficial effects on pregnancy outcomes. In this retrospective and prospective cohort study, we assessed fetal and maternal outcomes in women with known thyroid status pre-pregnancy, and hypothyroidism during pregnancy. We included 393 pregnant women, 90 (22.9%) diagnosed with overt and 303 with SCH (77.1%). A total of 94 (56%) had positive anti-TPO antibodies. Levothyroxine substitution across all observational periods was suboptimal, mostly during first trimester in both groups of patients (85.4%). There was a difference in the number of live births in favor of group with SCH (p = .004). Women with overt hypothyroidism were more likely to develop complications during pregnancy (RR = 1.153, 95%CI = 0.775 - 1.714) and had positive TPO-antibodies more often (p = .022). The only significant association was found between fetal outcomes in women with SCH and positive TPO-antibodies (p = .018), while positive Tg-antibodies did not affect the pregnancy outcomes of women with SCH. Moreover, no correlation was observed between outcomes and adequacy of levothyroxine substitution. These results indicate that TPO-antibody positivity could be the most important factor of pregnancy outcomes independent of the TSH levels or adequacy of levothyroxine therapy.

Prevalences of subclinical and overt hypothyroidism with universal screening in early pregnancy.

PURPOSE: To reveal the prevalence of subclinical and overt hypothyroidism among Turkish population during pregnancy. Also to investigate the prevalence of hypothyroidism using ATA 2017 criteria. METHODS: This is a cross-sectional study. Patients were consisted of 1416 consecutive pregnant women who were universally screened for thyroid disease in their first trimester between 2013 and 2015. Thyroid-stimulating hormone (TSH) and free T4 (FT4) levels were analyzed during the first antenatal visit (before 12 weeks of gestation). We compared different cutoffs for TSH. We further determined the 2.5th and 97.5th percentiles for TSH and FT4. RESULTS: Initially, the cutoff of 2.5 IU/ml was selected. Accordingly, 305 women (22.3%) had subclinical hypothyroidism and 22 (1.6%) was diagnosed with overt hypothyroidism. When the cutoff was increased to 4 IU/ml, only 40 (2.9%) women were diagnosed with hypothyroidism. Prevalences of overt hypothyroidism and subclinical hypothyroidism were 0.6% and 2.3%, respectively. CONCLUSION: Universal screening of pregnant women with TSH, using the 2.5 mIU/L cutoff; one in four women was found to be a candidate for thyroid hormone replacement in our cohort. When the cutoff was determined to be 4 mIU/L, prevalence of hypothyroidism decreased approximately 10 times.

Prevalence of hypothyroidism in Japanese chronic kidney disease patients.

Background: Major symptoms of progressive chronic kidney disease (CKD) are similar to those of hypothyroidism. Hidden symptoms of hypothyroidism underlying CKD are often observed in clinical practice. This study aimed to ascertain the frequency of hypothyroidism complicated by CKD, and to analyze factors impacting thyroid function.Methods: During the period from April 2012 through October 2016, 510 CKD patients at our outpatient clinic were measured thyroid and kidney function for diagnosing hypothyroidism (overt hypothyroidism, OH; subclinical hypothyroidism, SH; non-thyroidal illness, NTI) and evaluating the stage of CKD. All patients were over 15 years of age.Results: There were significant differences in age, estimated glomerular filtration rate (eGFR), urinary protein (UP), and serum albumin (Alb) among patients with OH, SH, and NTI compared to the normal group in univariate and multivariate analyses. UP showed the highest odds ratio of OH, SH, and NTI but no differences were recognized in gender in each group. Frequency distribution showed that the prevalence of thyroid dysfunction was greater among more severe stage of CKD with higher amount of UP. OH and SH did not show high positive ratio of anti-thyroglobulin antibody (TgAb) and anti-thyroid peroxidase antibody (TPOAb). NTI and normal subjects showed higher positive ratio as 50.0% and 42.9% of TgAb and TPOAb than OH and SH.Conclusions: Hypothyroidism complicated by CKD exhibited a high prevalence. Age, eGFR, UP, and serum Alb were related to the prevalence of hypothyroidism, whereas gender was not and this was contradicted to the prevalence of hypothyroidism in general population. The prevalence of OH and SH was higher among patients with higher stage of CKD with increased UP. Hypothyroidism complicated by CKD may involve different onset mechanisms unrelated to antithyroid antibodies (ATAb). In CKD patients, assessments of OH and SH, as well as NTI, are needed for proper diagnosis.

Irisin levels increase after treatment in patients with newly diagnosed Hashimoto thyroiditis.

PURPOSE: Irisin is a newly identified myokine secreted by skeletal muscle and has significant effects on body metabolism. Thyroidal functional state has a profound influence on the metabolism of human body. Therefore, the aim of this study was to investigate the possible changes in serum irisin concentrations before and after treatment in hypothyroid subjects. METHODS: The study included 26 patients with overt hypothyroidism due to Hashimoto thyroiditis and 19 healthy subjects. Baseline serum thyroid function tests and presence of thyroid autoantibodies and levels of creatine kinase (CK) and irisin were measured in both groups. All measurements in the hypothyroid group were repeated after euthyroidism was achieved. RESULTS: Serum irisin levels were significantly lower in the hypothyroid groups than the control group (p < 0.001). Negative correlation between irisin and thyroid stimulating hormone and CK levels (r = - 0.623, p < 0.001 and r = - 0.389, p = 0.008, respectively) and a positive correlation between irisin and free thyroxine (fT4) levels (r = 0.570, p < 0.001) was found. Serum CK levels decreased significantly after treatment (p < 0.001). Serum irisin levels significantly increased (from 57.4 to 99.8 U/L, p < 0.001) when the hypothyroid patients were treated to achieve euthyroidism. CONCLUSIONS: To the best of our knowledge, this is the first study providing insight that low serum irisin levels significantly increased following treatment to euthyroid state in overt hypothyroid patients with Hashimoto thyroiditis. Larger scale studies are needed to confirm these results and to ensure irisin as a possible biomarker of Hashimoto's thyroiditis.

Visceral Adiposity Index Levels in Patients with Hypothyroidism.

OBJECTIVE: To assess visceral adiposity index (VAI) as a sign of cardio-vascular diseases (CVD) in hypothyroidism patients and to compare CVD risks in overt or subclinical hypothyroidism patients. MATERIALS AND METHODS: Sixty-eight hypothyroidism patients (29 with overt and 39 with subclinical hypothyroidism) and 33 age- and gender-matched control patients were included. VAI levels were calculated with the following formula: (waist circumference (WC)/[36.58+(1.89xbody mass index (BMI))])x[(triglyceride (TG) (mmol/L)/0.81)x(1.52xhigh-density lipoprotein cholesterol (HDL-cholesterol) (mmol/L))] and (WC/[39.68+(1.88xBMI)])x[(TG (mmol/L)/1.03)x(1.31xHDL-cholesterol (mmol/L))], respectively. RESULTS: While body weight (p < 0.01), BMI (p < 0.01), TG and VAI levels (p < 0.01) were higher in hypothyroidism patients than controls, HDL-cholesterol levels were lower (p = 0.02). When patients were divided to groups as subclinical (n = 39) and overt hypothyroidism (n = 29) and compared with each other and controls (n = 33), body weight (p = 0.02 and p = 0.02, respectively), BMI (p = 0.01 and p < 0.01, respectively) and TG (p < 0.01 and p = 0.03, respectively) were higher in overt and subclinical hypothyroidism groups than controls. HDL-cholesterol was lower only in the group with overt hypothyroidism than controls (p = 0.01). Although found similar to each other in overt and subclinical hypothyroidism groups, VAI levels were observed to be higher in both groups than controls (p < 0.01 and p = 0.02, respectively). In correlation analysis, a positive correlation was determined between thyroid stimulating hormone (TSH), BMI and VAI levels (p = 0.03 and p < 0.01, respectively). CONCLUSIONS: Due to the association between increased VAI levels, and metabolic syndrome and CVDs, we consider that several measures should be promptly taken to decrease these risk factors, and further studies with a larger sample size should be performed.

Vitamin D status in children and adolescents with autoimmune thyroiditis.

BACKGROUND: Vitamin D deficiency is a global health problem. Its role as an immune modulator has been recently emphasized. There is increasing evidence for the significant role of vitamin D in reducing the incidence of autoimmune diseases. However, little is known about the status of vitamin D in children and adolescents with autoimmune thyroiditis (AIT). OBJECTIVE: The goal of the present study was to assess vitamin D status in Egyptian children and adolescents with AIT and to explore its relation to biomarkers of autoimmunity and thyroid function. DESIGN: A prevalence case-control study that included 56 children with AIT and 56 healthy, age- and sex-matched subjects that served as the control group. The following was done for all participants: thorough history, physical examination, thyroid ultrasound, measurement of thyroid-stimulating hormone (TSH), free thyroxin (FT4), anti-thyroid peroxidase antibodies (TPOAb), anti-thyroglobulin antibody (TgAb) and assessment of serum 25-hydroxy vitamin D (25OHD) level. RESULTS: Overt hypothyroidism was detected in 42/56 while subclinical hypothyroidism was detected in 14/56 of the studied patients. Vitamin D deficiency rate was significantly higher in the AIT group compared to the control subjects (71.4 vs 21.4 %, P < 0.001). In AIT group, the mean level of 25OHD was significantly lower compared to the control group (16.2 ± 8.2 vs 33.9 ± 12.7 nmol/L, P < 0.001). The difference was more evident in patients with overt hypothyroidism than those with subclinical hypothyroidism (P < 0.01). There were significant negative correlations between serum 25OHD and age, duration of the disease, BMI, anti-TPOAb, anti-TGAb and TSH (P < 0.001 each). On the other hand, serum 25OHD correlated positively with FT4 levels. While 25OHD level was an independent risk factor for AIT, it failed to qualify as an independent risk for the progression of AIT to overt hypothyroidism after adjustment for other potential confounding factors; age, sex and BMI. CONCLUSIONS: Low serum vitamin D is significantly associated with AIT in Egyptian children. However, vitamin D level is not an independent risk for the progression of AIT to overt hypothyroidism. BMI may have an influence on serum 25OHD levels.

Prevalence of hypothyroidism during pregnancy in a highly specialised referral centre in Mexico.

In order to determine the prevalence of overt and subclinical hypothyroidism, and isolated hypothyroxinemia during pregnancy, thyroid hormone reference values established by UMAE HGO4, IMSS in Mexico City and those suggested by the American Thyroid Association (ATA) were used. All pregnant patients, whose thyroid function was measured and whose pregnancy was monitored and resolved in UMAE HGO4, IMSS from 1 January to 31 December 2013, were included. Significant differences (p = .00419) were observed in the frequency of subclinical hypothyroidism, being higher when using ATA criteria (18.21% vs. 9.66%). The prevalence rate (UMAE HGO4 vs. ATA) for overt hypothyroidism was 1.11 vs. 1.63, for subclinical hypothyroidism 0.84 vs. 1.41 and for isolated hypothyroxinemia 3.17 vs. 2.79 per 1000 consults during the study period. Independently of prevalence rate, it is essential to provide information on the possible risks involved in pregnancy to all women of childbearing age at the time of hypothyroidism diagnosis.

Protective Role of Bilirubin Against Increase in hsCRP in Different Stages of Hypothyroidism.

In conjunction with thyroxine, bilirubin may play an important role for regulation of hsCRP level and a consequent pro-inflammatory condition in hypothyroidism. In present study we evaluated the dependence of hsCRP changes on total bilirubin (BT) and fT4 level in thirty overt (OH) and thirty subclinical hypothyroidism (SH). Serum BT, hsCRP, thyroxine and TSH were measured in both groups and compared with forty control subjects. Serum values of TSH, hsCRP showed raised (P < 0.001 for both) values with lower levels for fT4 and BT (P < 0.001 and 0.03 respectively) in hypothyroid patients compared to the controls. ANOVA showed significant increments in TSH and hsCRP values with decreases in fT4 among the control, SH and OH groups respectively (P < 0.001). BT values showed decrease in OH group only in comparison to controls (P = 0.04). Regression analysis revealed that hsCRP was negatively dependent on fT4 (ß = -0.35, P = 0.002) and serum bilirubin (ß = -0.40 and P < 0.001 respectively). Univariate general linear model analysis showed this dependence persisted even when carried out distinctly in SH and OH groups separately (P < 0.001). TSH did not show any significant predictive value on the hsCRP level in either of these two tests. From these analyses we suggest that serum hsCRP is closely integrated to a lowered synthesis of bilirubin and fT4 in hypothyroid patients. Furthermore, this causal relationship is not only limited to overt but also extends to the SH.

An analysis of population-based prenatal screening for overt hypothyroidism.

OBJECTIVE: The purpose of the study was to evaluate pregnancy outcomes of hypothyroidism that were identified in a population-based prenatal screening program. STUDY DESIGN: This is a secondary analysis of a prospective prenatal population-based study in which serum thyroid analytes were obtained from November 2000 to April 2003. Initial screening thresholds were intentionally inclusive (thyroid-stimulating hormone [TSH], >3.0 mU/L; free thyroxine, <0.9 ng/dL); those who screened positive were referred for confirmatory testing in a hospital-based laboratory. Hypothyroidism was identified and treated if TSH level was >4.5 mU/L and if fT4 level was <0.76 ng/dL. Perinatal outcomes in these women and those who screened positive but unconfirmed to have hypothyroidism were compared with women with euthyroidism. Outcomes were then analyzed according to initial TSH levels. RESULTS: A total of 26,518 women completed initial screening: 24,584 women (93%) were euthyroid, and 284 women (1%) had abnormal initial values that suggested hypothyroidism. Of those referred, 232 women (82%) underwent repeat testing, and 47 women (0.2% initially screened) were confirmed to have hypothyroidism. Perinatal outcomes of women with treated overt hypothyroidism were similar to women with euthyroidism. Higher rates of pregnancy-related hypertension were identified in the 182 women with unconfirmed hypothyroidism when compared with women with euthyroidism (P < .001); however, this association was seen only in women with initial TSH >4.5 mU/L (adjusted odds ratio, 2.53; 95% confidence interval, 1.4-4.5). CONCLUSION: The identification and treatment of overt hypothyroidism results in pregnancy outcomes similar to women with euthyroidism. Unconfirmed screening results suggestive of hypothyroidism portend pregnancy risks similar to women with subclinical hypothyroidism, specifically preeclampsia; however, this increased risk was seen only in women with initial TSH levels of >4.5 mU/L and suggests that this is a more clinically relevant threshold than 3.0 mU/L.

Efficacy of homeopathic intervention in subclinical hypothyroidism with or without autoimmune thyroiditis in children: an exploratory randomized control study.

INTRODUCTION: The decision to treat subclinical hypothyroidism (SCH) with or without autoimmune thyroiditis (AIT) in children, presents a clinical dilemma. This study was undertaken to evaluate the efficacy of individualized homeopathy in these cases. METHODS: The study is an exploratory, randomized, placebo controlled, single blind trial. Out of 5059 school children (06-18 years) screened for thyroid disorders, 537 children had SCH/AIT and 194 consented to participate. Based on primary outcome measures (TSH and/or antiTPOab) three major groups were formed: Group A - SCH + AIT (n = 38; high TSH with antiTPOab+), Group B - AIT (n = 47; normal TSH with antiTPOab+) and Group C - SCH (n = 109; only high TSH) and were further randomized to two subgroups-verum and control. Individualized homeopathy or identical placebo was given to respective subgroup. 162 patients completed 18 months of study. RESULTS: Baseline characteristics were similar in all the subgroups. The post treatment serum TSH (Group A and C) returned to normal limits in 85.94% of verum and 64.29% of controls (p < 0.006), while serum AntiTPOab titers (Group A and B) returned within normal limits in 70.27%of verum and 27.02%controls (p < 0.05). Eight children (10.5%) progressed to overt hypothyroidism (OH) from control group. CONCLUSION: A statistically significant decline in serum TSH values and antiTPOab titers indicates that the homeopathic intervention has not only the potential to treat SCH with or without antiTPOab but may also prevent progression to OH.

Hypothyroidism and metabolic cardiovascular disease.

Cardiovascular disease (CVD) remains the leading cause of death worldwide, representing a major health issue of social and economic relevance. Both hyperthyroidism and hypothyroidism are very common in the adult population, and both disorders may contribute to the onset and progression of CVD. After a brief description of the role of thyroid hormones (THs) on the physiology of the cardiovascular system and the potential mechanism that links THs alterations with changes in cardiac function, blood pressure, endothelial function, and lipid levels, we review updated data about the clinical impact of overt hypothyroidism (OH) and subclinical hypothyroidism (SCH) on CV risk, CVD, and mortality. Furthermore, we summarize the current evidence for treating SCH with levothyroxine (L-T4). Several guidelines of distinguished endocrine societies recommend treatment for SCH with TSH higher than 10 mIU/L, where the benefit of L-T4 therapy is more evident for younger people, but still controversial in those aged over 65 years. Based on current knowledge, more research efforts are needed to better address the clinical management of CV risk and CVD in the elderly affected by SCH.

Eyelash Loss: An Unusual Manifestation of Uncontrolled Hypothyroidism.

Hypothyroidism commonly presents with dermatological and hair-related symptoms, although the loss of eyelashes and eyebrows is considered uncommon in clinical practice. Here, we present a case of milphosis secondary to uncontrolled hypothyroidism. A 24-year-old female with a history of hypothyroidism following total thyroidectomy and poor medication adherence presented with significant eyelash loss, accompanied by symptoms of dysphonia, bradyphrenia, bradylalia, constipation, pronounced fatigue, and drowsiness. Physical examination revealed periorbital edema and extensive eyelash loss affecting the upper eyelids. Laboratory analysis demonstrated a markedly elevated thyroid-stimulating hormone (TSH) level of 240.8 µIU/mL (normal range 0.38 to 5.33 µIU/L), confirming severe uncontrolled hypothyroidism. Levothyroxine treatment was reintroduced, leading to complete resolution of periorbital edema and regrowth of eyelashes after 12 weeks, coinciding with improvement in TSH levels. This clinical case adds to the limited literature on madarosis and milphosis as manifestations of hypothyroidism, emphasizing the importance of clinician awareness regarding their potential presentation in the context of the disease. Understanding these manifestations and their differential diagnoses is crucial for ensuring prompt and accurate diagnosis and treatment.

Hypothyroidism in Patients with Down Syndrome: Prevalence and Association with Congenital Heart Defects.

This population-based study aimed to assess the prevalence of congenital hypothyroidism (CH) and overt hypothyroidism (OH) and their association with congenital heart defects (CHDs) in patients with Down syndrome (DS). The population included all live births residing in Tuscany (Italy) diagnosed with DS recorded in the Registry of Congenital Defects and in the Registry of Rare Diseases of Tuscany in the years 2003-2017. The prevalence of CH and OH in DS patients was calculated by sex and by period. The association of CH and OH with CHDs in DS patients was assessed using multivariate logistic regression. The cohort included 228 subjects. The prevalence of CH and OH was 11.4% (95%CI: 7.4-16.7%) and 12.7% (95%CI: 8.5-12.3%), respectively, with no significant difference by sex. A significant increase in the prevalence of CH (p < 0.0001) was found in the years 2010-2017 compared to the previous period, and among preterm infants (p = 0.009). The presence of CH was associated with a higher prevalence of CHDs (adjusted OR = 2.24, p = 0.082). A significant association between ventricular septal defects (VSDs) and the occurrence of OH (adjusted OR = 3.07, p = 0.025) was also observed. This study confirmed the higher prevalence of both CH and OH in DS compared to the general population. Furthermore, the risk of association between DS and CHDs was higher in the presence of CH, while VSDs are associated with OH, providing relevant insights into the epidemiology of hypothyroidism in DS and associated anomalies.

Uncontrolled Primary Hypothyroidism Precipitating Non-cirrhotic Hyperammonemia: A Unique Interplay Between the Liver and Thyroid.

Hepatic encephalopathy is typically seen in advanced liver disease and in patients with a transjugular intrahepatic portosystemic shunt. Common triggers include infections, gastrointestinal bleeding, electrolyte disturbances, dehydration, and drug/toxin use such as benzodiazepines and alcohol. In rare instances, other metabolic abnormalities such as hypothyroidism may also exacerbate hyperammonemia in patients with underlying liver disease due to hypothyroidism-induced myopathy, which increases urea production and decreases clearance through reduced glutamine synthetase activity. We present the case of a 60-year-old female who presented with markedly elevated thyroid stimulating hormone, reduced free thyroxine, and elevated serum ammonia levels. Although lactulose and rifaximin were initially started, her symptoms did not clinically improve until the underlying cause of her hyperammonemia was treated. Levothyroxine was initiated, and she reported rapid clinical improvement in her symptoms. Hyperammonemia carries a 40% mortality rate, and therefore clinicians need to be aware of this rare but intricate relationship between advanced liver disease and hypothyroidism for the prompt diagnosis and management of this condition.

Prevalence and Determinants of Hypothyroidism in Patients on Routine Hemodialysis in Somalia: A Cross-Sectional Study.

Introduction: In recent decades, the relationship between thyroid and kidney disease has drawn considerable attention. We aim to assess the prevalence and the determinants of hypothyroidism in hemodialysis patients in Somalia. Materials and Methods: This is a cross-sectional study which was conducted in the hemodialysis unit of Mogadishu Somalia Turkish Training and Research Hospital, between June 1 and July, 31 2022. A total of 301 patients who are routinely going to hemodialysis were included in the study. Demographic data including age, gender, and data regarding hemodialysis were extracted from hospital information system (HIS). All participants had their thyroid function test measured before hemodialysis sessions. Results: A total of 301 patients were examined. Their ages ranged from 40 to 66 years, with the median age being 54 (IQR= 40-66). Males were 167 (55.5%) compared to females 134 (44.5%). Hypertension was the most common comorbidity among the patients with 137 (45.5%). Diabetic kidney disease was the most common cause of renal failure in 138 patients (45.84%) followed by hypertensive kidney disease 100 (33.22%). The prevalence rate of hypothyroidism in hemodialysis patients in our study was 28%. In hypothyroidism patients 57.8% had subclinical hypothyroidism and 42.2% had overt hypothyroidism. 70.8% of our patients were in euthyroid status. Subclinical hypothyroidism was commonly seen in patients with diabetes, hypertension, and heart disease. We found that increasing age, decreased albumin level were related to higher risk of subclinical hypothyroidism. We also found that increasing creatinine levels were associated with lower risk of overt hypothyroidism. Conclusion: The prevalence rate of hypothyroidism in hemodialysis patients was 28%, with 57.8% showing subclinical hypothyroidism and 42.2% overt hypothyroidism. Increased age and low albumin level was associated with the prevalence of subclinical hypothyroidism in hemodialysis patients. Also low creatinine level was observed in overt hypothyroidism patients.

Age-specific association between thyroid autoimmunity and hypothyroidism in Chinese adults aged over 65 years: a cross-sectional study.

Background: The correlation between thyroid autoimmune (TAI) disease and hypothyroidism in the elderly of different ages remains unclear. This study aimed to investigate the epidemiological characteristics of hypothyroidism, including subclinical hypothyroidism (Shypo) and overt hypothyroidism (Ohypo) in those aged ≥65 years from iodine-adequate areas and reveal the correlation between TAI and hypothyroidism in the elderly of different ages. Methods: It was a cross-sectional study involving 2,443 subjects aged ≥65 years from two iodine-adequate areas in China by cluster sampling. They were assigned to the 65-69-, 70-79-, and ≥80-year-old age group. All subjects were surveyed by questionnaires and received physical examinations, laboratory testing, and thyroid ultrasound. Epidemiological characteristics of thyroid diseases in the elderly were compared among the three groups. Risk factors for hypothyroidism were predicted by binary logistic regression analysis. Results: The median urinary iodine level was 238.70 (197.00, 273.70) µg/L. Thyroid peroxidase antibody or thyroglobulin antibody positivity (11.87%) and Shypo (9.13%) were common in the elderly. The prevalence of hypothyroidism in the elderly increases with age. TAI was a risk factor for Shypo (OR, 1.94; 95% CI, 1.35, 2.80; p < 0.01) and Ohypo (OR, 7.64; 95% CI, 3.40, 17.19; p < 0.01) in elderly Chinese. There was an age-specific correlation between TAI and hypothyroidism in the elderly. However, a significant correlation was not identified between TAI and hypothyroidism in ≥80-year-old age group (p > 0.05). Conclusion: Hypothyroidism, particularly Shypo, is common in the elderly from iodine-adequate areas in China. TAI serves as a risk factor for hypothyroidism in the elderly, with an age-specific correlation with hypothyroidism.