Emerging research themes in maternal hypothyroidism: a bibliometric exploration.

Background: Hypothyroidism, a prevalent endocrine disorder, carries significant implications for maternal and infant health, especially in the context of maternal hypothyroidism. Despite a gradual surge in recent research, achieving a comprehensive understanding of the current state, focal points, and developmental trends in this field remains challenging. Clarifying these aspects and advancing research could notably enhance maternal-infant health outcomes. Therefore, this study employs bibliometric methods to systematically scrutinize maternal hypothyroidism research, serving as a reference for further investigations. Objective: Through bibliometric analysis, this study seeks to unveil key research focus areas, developmental trends, and primary contributors in Maternal Hypothyroidism. The findings offer insights and recommendations to inform future research endeavors in this domain. Methods: Literature metrics analysis was performed on data retrieved and extracted from the Web of Science Core Collection database. The analysis examined the evolution and thematic trends of literature related to Maternal Hypothyroidism. Data were collected on October 28, 2023, and bibliometric analysis was performed using VOSviewer, CiteSpace, and the Bibliometrix software package, considering specific characteristics such as publication year, country/region, institution, authorship, journals, references, and keywords. Results: Retrieved from 1,078 journals, 4,184 articles were authored by 18,037 contributors in 4,580 institutions across 113 countries/regions on six continents. Maternal Hypothyroidism research publications surged from 44 to 310 annually, a 604.54% growth from 1991 to 2022. The USA (940 articles, 45,233 citations), China Medical University (82 articles, 2,176 citations), and Teng, Weiping (52 articles, 1,347 citations) emerged as the most productive country, institution, and author, respectively. "Thyroid" topped with 233 publications, followed by "Journal of Clinical Endocrinology & Metabolism" (202) with the most citations (18,513). "Pregnancy" was the most cited keyword, with recent high-frequency keywords such as "outcome," "gestational diabetes," "iodine intake," "preterm birth," "guideline," and "diagnosis" signaling emerging themes in Maternal Hypothyroidism. Conclusions: This study unveils developmental trends, global collaboration patterns, foundational knowledge, and emerging frontiers in Maternal Hypothyroidism. Over 30 years, research has predominantly focused on aspects like diagnosis, treatment guidelines, thyroid function during pregnancy, and postpartum outcomes, with a central emphasis on the correlation between maternal and fetal health.

Relationship of thyroid dysfunction and its manifestations in diabetes mellitus patients in the Kingdom of Saudi Arabia.

OBJECTIVE: Both diabetes mellitus (DM) and thyroid dysfunction (TD) are endocrinopathies that are frequently inclined to coexist in patients. Most studies avoid explicitly supporting or opposing testing thyroid function for diabetic patients as a baseline. The association between hypothyroidism and diabetes is considerable when assessing thyroid functions in diabetic individuals based on clinical suspicion. Therefore, this study aimed to assess the relationship between thyroid dysfunction and its manifestations in DM patients in the Kingdom of Saudi Arabia. SUBJECTS AND METHODS: The study included 301 DM subjects. A questionnaire divided into two sections was administered to all participants. The first section involved questions about diabetes control, monitoring, and disease severity. The second section included questions about thyroid disease and the 14-item Hypothyroidism Clinical Prediction (HCP) score we created for our research. The HCP score was obtained by summing up all discrete scores for different symptoms of hypothyroidism. ROC curve analysis was used to assess the predicted hypothyroidism cases based on the most precise cut-off point for the HCP overall score (highest sensitivity and specificity). HCP discriminant ability for detecting hypothyroid cases was assessed considering the Area Under the Curve (AUC) as a measurement. RESULTS: Almost 53 (17.6%) diabetes mellitus subjects were previously diagnosed with hypothyroidism. Comparatively, regarding the given cut-off point, the total number of predicted hypothyroidism cases using the HCP score was 149 (49.5%). The most reported symptoms included tiredness (75%), followed by irritability (72%), and difficulty in losing weight (65%). Hypothyroidism was detected/predicted among 60.1% of female diabetics vs. 44.2% of males with recorded statistical significance (p=.006). CONCLUSIONS: This study further proves a significant association between diabetes and hypothyroidism in Saudi Arabia. We recommend periodic screening for thyroid dysfunction in the diabetic population in specific cases; since some patients with diabetes are more likely to have hypothyroidism based on their clinical presentation.

Prevalence of Thyroid Dysfunction in Type 2 Diabetes Mellitus.

The level of thyroid hormones is often changed in uncontrolled diabetic patients. Screening for Thyroid dysfunction (TD) among patients with Type 2 Diabetes mellitus (T2DM) should be performed considering the increased prevalence of thyroid disorders. This cross-sectional comparative study was conducted in outpatient department of Endocrinology and Medicine, Mymensingh Medical College Hospital, Mymensingh (MMCH) from 1st March 2020 to 30th August 2021. One hundred (100) patients with type 2 diabetes along with 100 (hundred) non-diabetic controls of same age group were enrolled in the study. After taking clinical data, patients were investigated to estimate Fasting plasma glucose (FPG), serum free tri-iodothyronine (FT3), free thyroxin (FT4) and thyroid stimulating hormone (TSH) level to see thyroid dysfunction. Patients were selected with purposive sampling. Thyroid dysfunction was found to be more in T2DM (15.0%) in comparison with non-diabetic controls (5.0%) and this difference was statistically significant (p=0.018). In both diabetic and non-diabetic groups, subclinical hypothyroidism and hypothyroidism were the most common thyroid dysfunction. Thyroid dysfunction was found more in 40-60 years that suggests the prevalence of thyroid dysfunction are increasing in diabetic patients with advancing age. Thyroid dysfunction was found more among overweight and obese patient in both groups. Mean BMI was found higher among diabetic patient with thyroid dysfunction. Logistic regression showed significant association of Thyroid dysfunction with age >50 years and high FPG level. We found thyroid dysfunction was more prevalent in patients with T2DM than non-diabetics. So, screening for thyroid dysfunction among type 2 diabetic patients by estimating Serum TSH, FT4 level should be performed.

Possible association between subclinical hypothyroidism and age at menopause in Colombian women.

OBJECTIVE: To evaluate the association between subclinical hypothyroidism with early menopause, premature menopause, and last menstrual bleeding before the natural age of menopause. METHODS: This was a cross-sectional study conducted in 643 postmenopausal women aged 40-69 years. Groups were formed according to last menstrual episode: ≥45 [Natural age at menopause], 40-44 and [Early menopause], <40 [Premature menopause], and <45 [last menstrual episode before the natural age of menopause]. The Zulewski scale was applied to identify manifestations related to hypothyroidism and subclinical hypothyroidism, diagnosed with a serum TSH > 4.5 µIU/mL plus T4-free between 0.7 and 1.9 ng/dL. RESULTS: It was found that 24.4% had the last menstrual episode before the natural age of menopause, 18.6% had early menopause, and 5.7% had premature menopause. Subclinical hypothyroidism was diagnosed in 4.5% of patients. Among women with subclinical hypothyroidism, there was a higher frequency of early menopause, premature menopause, and last menstrual episode before the natural age of menopause, than in women without subclinical hypothyroidism (p < 0.05). Paresthesia (50%) and dry skin (40.7%) were the most reported hypothyroidism-related manifestations. Early menopause, premature menopause, and last menstrual episode before the natural age of menopause were associated with subclinical hypothyroidism, OR: 3.37 [95% CI: 1.40-8.10], OR: 4.31 [95% CI: 1.24-14.97], and OR: 3.57 [95% CI: 1.57-8.10], respectively. CONCLUSIONS: The last menstrual episode before the natural age of menopause, early menopause, and premature menopause were significantly associated with a higher chance of subclinical hypothyroidism.

Diagnoses of obstetric and postpartum thyroid disease: a Danish validation study.

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.

Growth and endocrinopathies among children with ß-Thalassemia major treated at Dubai Thalassemia centre.

BACKGROUND: ß-Thalassemia major (BTM) is one of the most common hereditary anemias worldwide. Patients suffer from iron overload that results from repeated blood transfusion This in turn leads to multiple organ damage and endocrinopathies. This study aims to assess the prevalence of growth retardation, hypothyroidism, and diabetes mellitus in children and adolescents with BTM treated at Dubai Thalassemia Centre. METHODS: A total of 105 children and adolescents were included in this retrospective observational study. RESULTS: 39 children and 66 adolescents' data were analyzed. Females composed 51.3% (n = 20) of children and 53.0% (n = 35) of adolescents. Pretransfusion hemoglobin below 9 gm/dl was observed in 10.8% (n = 4) and 10.6% (n = 7) in children and adolescents, respectively. The mean age of menarche was 13.5 years. Among all study participants, 22.6% (n = 14) had normal height velocity whereas 37.1% (n = 23) had reduced height velocity in one year and 40.3% (n = 25) had reduced height velocity in two consecutive years. The proportion of children and adolescents showing reduced height velocity was significantly higher in females compared to the males (90.6% versus 63.3%, respectively, Chi-square = 6.597, p-value = 0.010). Although none of the study participants had diabetes mellitus, 26.1% (n = 12/46) had pre-diabetes. Elevated TSH was observed in 14.7% (n = 5) children and 8.1% (n = 5) adolescents while low FT4 was reported in one child and one adolescent. CONCLUSION: Of all endocrinopathies seen among children and adolescents with BTM, growth delay remains the main concern for this group of patients. Effective treatment is key to further reducing endocrinopathies. Although the sample size is limited, we postulate that the low percentage of endocrinopathies among children with BTM treated at Dubai thalassemia center and the low level of pretransfusion anemia reflect the effective transfusion and chelation at the center.

Burden of Thyroid Dysfunction Among Type 2 Diabetes Mellitus Patients in South East Nigeria with Emphasis on its Prevalence and Pattern of Presentation: A Case-Controlled Study.

BACKGROUND: Studies from different parts of the world on thyroid dysfunction have shown it to be widespread in patients with type 2 diabetes mellitus (T2DM); however, there is insufficient local data to support this observation. AIM: To determine the burden of thyroid dysfunction among patients with T2DM at a Tertiary Hospital in Southeast Nigeria with emphasis on its prevalence and pattern of presentation. METHODS: Four hundred and seventy-two subjects were recruited for the study. All the subjects (100%) were of African descent. Three hundred and fifty-four (354) of them were patients with T2DM, while 118 subjects who did not have T2DM served as the controls. This study is a descriptive cross-sectional study involving patients with type 2 diabetes mellitus attending the Diabetes Clinic or receiving treatment in the Medical Wards. Subjects were recruited using systematic sampling. The first patient was selected by simple random sampling, and subsequently, every consecutive subject was selected. Blood samples were tested for HbA1c, fT3, fT4, thyrotropin, and thyroid stimulating hormone. Socio-demographic information was retrieved from patient medical records. We used the Student's t-test for statistical comparison of quantitative variables such as weight, height, blood pressure, serum TSH, and serum T3; while for comparison of proportions, we used a Chi-squared test. We set a p-value of less than 0.05 to be statistically significant. RESULTS: Females formed the majority of the study population accounting for 56.5% of the type 2 DM patients and 62.7% of the controls. We observed that the mean age of the type 2 DM patients was 57.5 (±9.3) years, which was similar to the mean age of controls: 57.7±8.9 (p=0.17). We also observed that the mean age at diagnosis of DM was 54±7.6 years, while the mean duration of DM for all the type 2 DM patients was 6.5±2.8 years. We observed that in patients with T2DM, the prevalence of thyroid dysfunction was 12.4% and among the controls, a prevalence of 1.7% was observed (P <0.05). Females formed the majority (75%) of T2DM patients with thyroid dysfunction and hypothyroidism was the most common type of thyroid dysfunction (93.2%) observed in this study. CONCLUSION: The prevalence of thyroid dysfunction in T2DM patients in this study was 12.4% which was high compared to 1.7% observed in the controls (P = 0.001). The majority of those who had thyroid dysfunction were females. About 9 in 10 of all subjects with thyroid dysfunction had hypothyroidism.

CONTEXTE: Des études menées dans différentes régions du monde sur la dysfonction thyroïdienne ont montré qu'elle est répandue chez les patients atteints de diabète sucré de type 2 (T2DM) ; cependant, il existe des données locales insuffisantes pour étayer cette observation. OBJECTIF: Déterminer la charge de la dysfonction thyroïdienne chez les patients atteints de T2DM dans un hôpital tertiaire du sud-est du Nigeria, en mettant l'accent sur sa prévalence et son modèle de présentation. MÉTHODES: Quatre cent soixante-douze sujets ont été recrutés pour l'étude. Tous les sujets (100 %) étaient d'origine africaine. Trois cent cinquante-quatre (354) d'entre eux étaient des patients atteints de T2DM, tandis que 118 sujets ne présentaient pas de T2DM et servaient de témoins. Cette étude est une étude transversale descriptive impliquant des patients atteints de diabète sucré de type 2 fréquentant la clinique du diabète ou recevant un traitement dans les services de médecine. Les sujets ont été recrutés par échantillonnage systématique. Le premier patient a été sélectionné par échantillonnage aléatoire simple, et par la suite, chaque sujet consécutif a été sélectionné. Des échantillons de sang ont été testés pour l'HbA1c, le fT3, le fT4 et la thyrotropine, hormone stimulant la thyroïde. Les informations sociodémographiques ont été récupérées à partir des dossiers médicaux des patients. Nous avons utilisé le test t de Student pour la comparaison statistique des variables quantitatives telles que le poids, la taille, la pression artérielle, la TSH sérique et la T3 sérique ; tandis que pour la comparaison des proportions, nous avons utilisé un test du Chi-carré. Nous avons fixé une valeur de p inférieure à 0,05 pour être statistiquement significative. RÉSULTATS: Les femmes formaient la majorité de la population étudiée, représentant 56,5 % des patients atteints de DM de type 2 et 62,7 % des témoins. Nous avons observé que l'âge moyen des patients atteints de DM de type 2 était de 57,5 (±9,3) ans, ce qui était similaire à l'âge moyen des témoins: 57,7±8,9 (p=0,17). Nous avons également observé que l'âge moyen au diagnostic du DM était de 54±7,6 ans, tandis que la durée moyenne du DM pour l'ensemble des patients atteints de DM de type 2 était de 6,5±2,8 ans. Nous avons observé que chez les patients atteints de T2DM, la prévalence de la dysfonction thyroïdienne était de 12,4 % et parmi les témoins, une prévalence de 1,7 % a été observée (P <0,05). Les femmes formaient la majorité (75 %) des patients atteints de T2DM avec une dysfonction thyroïdienne et l'hypothyroïdie était le type le plus courant de dysfonction thyroïdienne (93,2 %) observé dans cette étude. CONCLUSION: La prévalence de la dysfonction thyroïdienne chez les patients atteints de T2DM dans cette étude était de 12,4 %, ce qui était élevé par rapport à 1,7 % observé chez les témoins (P = 0,001). La majorité de ceux qui avaient une dysfonction thyroïdienne étaient des femmes. Environ 9 sujets sur 10 présentant une dysfonction thyroïdienne avaient une hypothyroïdie. MOTS-CLÉS: Dysfonction thyroïdienne; Diabète sucré de type 2; Hypothyroïdie; Sud-est du Nigeria; Prévalence.

THE RELATION OF THYROID DISTURBANCE AND ISCHEMIC HEART DISEASE IN IRAQI PATIENTS.

This study conducted in Baghdad focused on patients with coronary heart disease admitted to three hospitals. The study included 60 Iraqi patients with coronary heart disease and a control group of 30 healthy individuals. Blood samples were collected from both groups after fasting. The study analyzed the demographic characteristics of the patients and control group, including age groups, sex distribution, and BMI. The majority of patients had hypertension, while 58.33% had diabetes. The study found that IHD patients had significantly higher T3 and T4 levels compared to the control group. However, there was no significant difference in TSH levels. The study also examined thyroid function parameters among different age groups and found no significant differences in individuals with hypothyroidism. The highest prevalence of hyperthyroidism was among individuals with hypertension, while the highest spread of hypothyroidism was among individuals with diabetes. The study observed significant differences in mean HbA1c levels among the three groups, with the highest levels in patients with hypothyroidism. In conclusion, this study suggests potential alterations in thyroid function associated with ischemic heart disease and emphasizes the need for further research on the clinical implications and underlying mechanisms involved.

Dietary Patterns and Hypothyroidism in U.S. Adult Population.

The thyroid gland produces hormones that are essential for various body functions. Hypothyroidism is defined as insufficient thyroid hormone production. Several studies have found associations between specific micronutrients and overall thyroid function; however, the amount of evidence regarding the relationship between dietary patterns and hypothyroidism among the U.S. population is limited. Data from three cycles of National Health and Nutrition Examination Surveys (NHANES), 2007-2008, 2009-2010, and 2011-2012, were used (n = 8317). Subjects with serum thyroid stimulating hormone >4.5 mIU/L or on levothyroxine were considered to have hypothyroidism. Age, sex, race/ethnicity, body mass index, and several lifestyle factors were considered as covariates. Three patterns were extracted using factor analysis. These were labeled as fat-processed grains-sugars-meats (FPSM), oils-nuts-potatoes-low-fat meats (ONPL), and fruits-whole grains-vegetables-dairy (FWVD) patterns. In a weighted multiple logistic regression, FPSM and ONPL were inversely associated with hypothyroidism (OR, 0.75; 95% CI, 0.57-1; p = 0.049 and OR, 0.81; 95% CI, 0.67-0.97; p = 0.025, respectively). However, FWVD demonstrated no association with hypothyroidism (p = 0.63). In conclusion, FPSM and ONPL patterns but not FWVD patterns were associated with hypothyroidism in U.S. adults. Nutrient deficiencies and their interactions may be linked to hypothyroidism.

A Role for Thyroid Testing in Slipped Capital Femoral Epiphysis? 32% Rate of Abnormal Values in Tested Patients.

BACKGROUND: Hypothyroidism is a known risk factor for slipped capital femoral epiphysis (SCFE), and prior studies of hypothyroid-associated SCFE have demonstrated an incidence of up to 6%. However, there is limited evidence and no formal practice guidelines regarding whether patients presenting with SCFE should undergo screening for endocrine disorders. This study aims to investigate the incidence of abnormal thyroid function studies in patients presenting with SCFE. METHODS: This was a retrospective review of all patients aged 0 to 18 years treated for SCFE at a single pediatric hospital from January 2015 to July 2022. On presentation, patients' BMI, thyroid-stimulating hormone (TSH), free T4, vitamin D, creatinine, BUN, and HbA1c levels were documented. Follow-up and treatment for any identified endocrinopathies were noted. In addition, the chronicity, stability, and severity of their slips were recorded. RESULTS: Ninety-eight patients with 106 hips were included in this study. TSH was obtained at the time of initial presentation in 66% (n=65/98) of patients. Median TSH was 2.99 (range: 0.02 to 919, std dev: 132.4). The normal reference range for our institution is 0.5 to 4.5 mcIU/mL. Thirty-two percent (n=21/65) of patients with a documented TSH had an abnormal value. Of those patients who had an elevated TSH, 3 were diagnosed with clinical hypothyroidism and went on to treatment with levothyroxine (n=3/19, 16%), 2 patients had been started on levothyroxine before presentation (n=2/19, 11%), and 2 patients were followed in endocrinology clinic until their TSH levels had normalized without further intervention (n=2/19, 11%). CONCLUSIONS: Screening of our SCFE population revealed a 32% incidence of thyroid abnormalities which affected treatment in 24% of those patients. This is a much higher incidence of hypothyroid-associated SCFE than previously demonstrated in the literature and has prompted us to start including thyroid screening studies as a routine part of our workup for all patients with SCFE. LEVEL OF EVIDENCE: Level III.

Does thyroid diseases contribute to the natural history of idiopathic adult-onset dystonia? Data from the Italian Dystonia Registry.

A few earlier observations and recent controlled studies pointed to the possible contribution of thyroid diseases in idiopathic adult-onset dystonia (IAOD). The aim of this study was to investigate the association between thyroid status and clinical characteristics of IAOD, focusing on dystonia localization, spread, and associated features such as tremors and sensory tricks. Patients were identified from those included in the Italian Dystonia Registry, a multicentre dataset of patients with adult-onset dystonia. The study population included 1518 IAOD patients. Patients with hypothyroidism and hyperthyroidism were compared with those without any thyroid disease. In the 1518 IAOD patients, 167 patients (11%; 95% CI 9.5-12.6%) were diagnosed with hypothyroidism and 42 (2.8%; 95% CI 1.99-3.74) with hyperthyroidism. The three groups were comparable in age at dystonia onset, but there were more women than men in the groups with thyroid disease. Analysing the anatomical distribution of dystonia, more patients with blepharospasm were present in the hyperthyroidism group, but the difference did not reach statistical significance after the Bonferroni correction. The remaining dystonia-affected body sites were similarly distributed in the three groups, as did dystonia-associated features and spread. Our findings provided novel information indicating that the high rate of thyroid diseases is not specific for any specific dystonia subpopulation and does not appear to influence the natural history of the disease.

Iodine status in children with intestinal failure.

OBJECTIVES: Children on long-term parenteral nutrition (PN) are at high risk of iodine deficiency (ID). However, most available information comes from cross-sectional studies. We investigated the iodine status, associated factors, and prevalence of hypothyroidism in children with intestinal failure (IF) who were followed up longitudinally. METHODS: This was a cohort study of children with IF monitored for urine iodine concentration (UIC), iodine intake, serum selenium concentration, and thyroid function in an intestinal rehabilitation program. The outcome variable ID was defined as a UIC value < 100 µg/L. Adjusted generalized estimating equations were used to assess the effects of the exposure variables on the UIC. RESULTS: Twenty-four patients aged 62.7 (39.1; 79.7) months who received PN for 46.5 (21.5) months were included. The average energy supply was 81.2 kcal/kg/day, 77.6% of which was provided by PN. An average of 5.2 UIC measurements per patient were performed. ID prevalence decreased from baseline (83.3%) to the last assessment (45.8%). Three patients had hypothyroidism secondary to iodine and selenium combined severe deficiency. Iodine intake from enteral or oral nutritional formulas was positively associated with UIC (ß = 0.71 [0.35, 1.07]; p < 0.001). Meeting approximately 80% of the estimated average requirement for iodine from nutritional formulas resulted in a greater probability of normal UIC values. CONCLUSION: ID is highly prevalent in children with IF who receive long-term PN and its frequency decreases with iodine intake from nutritional formulas. Severe combined iodine and selenium deficiencies are associated with the development of hypothyroidism in these patients.

Hypothyroidism among Children with Nephrotic Syndrome Admitted to a Tertiary Care Centre.

Introduction: Nephrotic syndrome is a glomerular disease characterized by massive urinary protein loss occurring in children. Proteinuria also leads to loss of thyroid binding globulin affecting thyroid function. This study aimed to find out the prevalence of hypothyroidism among children with nephrotic syndrome admitted to a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among children with nephrotic syndrome admitted to a tertiary care centre from 06 July 2020 to 06 June 2021 after obtaining ethical approval from the Ethical Review Committee. They were tested for free T3, free T4 and TSH. A convenience sampling method was used. The point estimate was calculated at a 90% Confidence Interval. Results: Among 69 children with nephrotic syndrome, the prevalence of hypothyroidism was 49 (71.01%) (62.03-80.00, 90% Confidence Interval). Conclusions: The prevalence of hypothyroidism among children with nephrotic syndrome was higher than other studies done in similar settings. Keywords: children; hypothyroidism; nephrotic syndrome; prevalence.

Autoimmune thyroid disease and myasthenia gravis: a study bidirectional Mendelian randomization.

Background: Previous studies have suggested a potential association between AITD and MG, but the evidence is limited and controversial, and the exact causal relationship remains uncertain. Objective: Therefore, we employed a Mendelian randomization (MR) analysis to investigate the causal relationship between AITD and MG. Methods: To explore the interplay between AITD and MG, We conducted MR studies utilizing GWAS-based summary statistics in the European ancestry. Several techniques were used to ensure the stability of the causal effect, such as random-effect inverse variance weighted, weighted median, MR-Egger regression, and MR-PRESSO. Heterogeneity was evaluated by calculating Cochran's Q value. Moreover, the presence of horizontal pleiotropy was investigated through MR-Egger regression and MR-PRESSO. Results: The IVW method indicates a causal relationship between both GD(OR 1.31,95%CI 1.08 to 1.60,P=0.005) and autoimmune hypothyroidism (OR: 1.26, 95% CI: 1.08 to 1.47, P =0.002) with MG. However, there is no association found between FT4(OR 0.88,95%CI 0.65 to 1.18,P=0.406), TPOAb(OR: 1.34, 95% CI: 0.86 to 2.07, P =0.186), TSH(OR: 0.97, 95% CI: 0.77 to 1.23, P =0.846), and MG. The reverse MR analysis reveals a causal relationship between MG and GD(OR: 1.50, 95% CI: 1.14 to 1.98, P =3.57e-3), with stable results. On the other hand, there is a significant association with autoimmune hypothyroidism(OR: 1.29, 95% CI: 1.04 to 1.59, P =0.019), but it is considered unstable due to the influence of horizontal pleiotropy (MR PRESSO Distortion Test P < 0.001). MG has a higher prevalence of TPOAb(OR: 1.84, 95% CI: 1.39 to 2.42, P =1.47e-5) positivity and may be linked to elevated TSH levels(Beta:0.08,95% CI:0.01 to 0.14,P =0.011), while there is no correlation between MG and FT4(Beta:-9.03e-3,95% CI:-0.07 to 0.05,P =0.796). Conclusion: AITD patients are more susceptible to developing MG, and MG patients also have a higher incidence of GD.

Hypothyroidism among children and adolescents with nephrotic syndrome in Mulago National Referral Hospital, Kampala, Uganda; a cross-sectional study.

BACKGROUND: Nephrotic syndrome (NS) is the commonest glomerular disease among children. It is characterized by heavy proteinuria and is a risk factor for hypothyroidism in the affected children. Hypothyroidism is of concern because it affects the physical and intellectual development of children and adolescents. This study sought to establish the prevalence and factors associated with hypothyroidism among children and adolescents with NS. METHODS: A cross-sectional design was used to study 70 children and adolescents aged 1-19 years diagnosed with nephrotic syndrome and being followed up in the kidney clinic in Mulago National Referral Hospital. Questionnaires were used to collect patients' socio-demographics and clinical information. A blood sample was taken for analysis for thyroid stimulating hormone (TSH) and free thyroxine (FT4), renal function tests and serum albumin. Hypothyroidism included both overt and subclinical forms. Overt hypothyroidism was defined as TSH level > 10 mU/L and FT4 < 10pmol/L, or FT4 < 10pmol/l with normal TSH, or TSH < 0.5mU/l. Sub-clinical hypothyroidism was defined as TSH ranging between 5 and10 mU/L with normal age appropriate FT4 levels. Urine samples were collected and taken for a dipstick examination. The data was analyzed using STATA version 14. The Bayesian Logistic regression analysis approach was used to estimate odds ratios (OR) and their associated 95% credible intervals. All predictor variables with p value < 0.05 at frequentist statistical analysis were considered significant. RESULTS: The mean age (standard deviation) of participants was 9 years (3.8). There were more males; 36 of 70 (51.4%). The prevalence of hypothyroidism was 23% (16/70 participants). Of the 16 children with hypothyroidism, 3 (18.7%) had overt hypothyroidism while 13 had subclinical hypothyroidism. Only low serum albumin was found to be strongly associated with hypothyroidism; Bayesian OR 132.57 (CI 9.13-567.10) with a frequentist OR of 37 and a p value of 0.001. CONCLUSION: The prevalence of hypothyroidism among children and adolescent with nephrotic syndrome attending Mulago Hospital paediatric kidney clinic was 23%. Hypoalbuminemia was found to be associated with hypothyroidism. Therefore, children and adolescents that have severely low levels of serum albumin should be screened for hypothyroidism and linked to endocrinologists for care.

Hypoxia-inducible Factor Prolyl Hydroxylase Inhibitors and Hypothyroidism: An Analysis of the Japanese Pharmacovigilance Database.

BACKGROUND/AIM: Hypothyroidism induced by roxadustat, a hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitor, was recently reported; however, information regarding roxadustat-associated hypothyroidism is still lacking. We explored the risk and time to onset of hypothyroidism associated with HIF-PH inhibitors using the Japanese Adverse Drug Event Report (JADER), a pharmacovigilance database. PATIENTS AND METHODS: The participants of this study were registered in the JADER database between April 2004 and March 2023. The association between HIF-PH inhibitors and hypothyroidism was evaluated using the reporting odds ratio (ROR) and information component (IC). We also calculated the period from the start of drug administration to the onset of hypothyroidism and determined the onset pattern using Weibull distribution. RESULTS: Roxadustat had positive signals for hypothyroidism among the HIF-PH inhibitors based on the ROR [31.03, 95% confidence interval (CI)=27.81-34.62] and IC (4.51, 95%CI=4.36-4.67) values, and a strong relationship was confirmed. In addition, the median time to roxadustat-associated hypothyroidism onset was 92 days, and over 50% of cases occurred within 100 days of starting treatment. Furthermore, the onset pattern was an early failure type. CONCLUSION: There is a possible association between roxadustat and hypothyroidism. Therefore, enhanced thyroid function testing within 100 days of treatment initiation may help detect roxadustat-associated hypothyroidism. However, further research is required to confirm these findings, considering study limitations using databases of spontaneous adverse event reports.

Associated factors of depression in primiparas with hypothyroidism during pregnancy.

This cross-sectional study aimed to explore the associated factors of depression in primiparas with hypothyroidism during pregnancy. The research subjects were 200 primiparas with hypothyroidism during pregnancy who were admitted to our hospital between December 2016 and December 2019. Self-rating depression scale scores were used to evaluate the depression, and the incidence of depression were examined. The data from all the subjects were collected to compare the differences between primiparas with hypothyroidism during pregnancy with and without depression. A logistic regression equation was used to analyze the influencing factors of depression in these patients. Of the 200 primiparas who took part in this study, 27 suffered from depression, accounting for 13.50%. There were differences in age, education level, economic income, sleep quality, and conjugal relations between the depressed and the nondepressed participants. When the above factors were included in the logistic regression equation, it was found that the odds ratio values for these factors were all >1, which indicated that they had an influence on maternal depression in primiparas with hypothyroidism during pregnancy. This study demonstrated that pregnancy-associated hypothyroidism in primiparas is affected by age, education level, economic income, sleep quality, and conjugal relations, all of which increase the incidence of depression. Relevant preventive measures should be provided in clinical practice to avoid the occurrence of depression.

Adherence to thyroid therapy and depressive status among patients with hypothyroidism in the northern of Jordan: A cross-sectional study.

Hypothyroidism is a chronic and progressive medical condition that requires extreme adherence to medication in order to effectively manage the disease. The aim of this study was to examine patients' adherence to their thyroid therapy and their depressive status and their associated predictors. This is a cross-sectional study that was conducted between April and June 2023 using a sample of chronic hypothyroidism patients visiting the Jordan University of Science and Technology Health Center in Irbid, along with the Family Medicine and Endocrine clinic at King Abdullah University Hospital. The 8-item Morisky Medication Adherence Scale (MMAS-8) and Patient Health Questionnaire (PHQ)-2 were used to examine patients' adherence level and mental status. A total of 296 patients were involved in this study. Around 35.5% of the patients found to have high level of adherence. Around 27.4% of the patients demonstrated a low level of adherence. The mean PHQ-2 score for the study sample was 2.00 (SD: 1.7) out of 6. Using a cutoff point of 3, we identified that 29.7% of the patients are at risk of developing major depressive disorder. Patients aged 31 to 50 years and married patients were identified to have higher adherence level compared to other patients (P < .05). This study observed a notable low to moderate level of adherence among patients diagnosed with hypothyroidism in Jordan with regards to their prescribed therapeutic regimen. Furthermore, a significant part of the individuals had a susceptibility to the development of major depressive disorder.

Hypothyroidism is a causal determinant of age-related cataract risk in European population: a Mendelian randomization study.

Objective: To determine whether there is a causal relationship between thyroid dysfunction and the risk of age-related cataract (ARC) in the European population. Design: A two-sample Mendelian randomization (MR) study. Methods: Hypothyroidism, hyperthyroidism, free thyroxine (fT4), and thyrotropin (TSH) were selected as exposures. The single nucleotide polymorphisms (SNP) of hypothyroidism and hyperthyroidism were obtained from the genome-wide association studies (GWAS) of the IEU database, including 337,159 subjects. Data for fT4 and TSH (72,167 subjects) were extracted from the ThyroidOmics Consortium. ARC was used as the outcome. The SNPs associated with ARC were selected from a GWAS of 216,362 individuals in the FinnGen database. The main method used was the inverse variance-weighted method, together with four complementary methods. Sensitivity analyses were performed using Cochran's Q test, MR-PRESSO, MR-Egger regression and leave-one-out test. MR pleiotropy was used to test for pleiotropy. MR Steiger test was used to test for the directionality. Results: Two-sample MR analysis revealed a positive association between genetically predicted hypothyroidism and risk of ARC (OR = 2.501, 95% CI: 1.325-4.720; P = 0.004). Hyperthyroidism, circulating fT4 and TSH levels did not have a significant causal effect on ARC (P > 0.05). The results were robust and reliable, and no horizontal pleiotropy was found after sensitivity analyses. In the MR Steiger test, we found no reverse causal effects of hypothyroidism on the ARC (P <0.001). Conclusions: Our study provides strong evidence that hypothyroidism is a causal determinant of ARC risk.

Late endocrine diseases in survivors of adolescent and young adult cancer in California: a population-based study.

BACKGROUND: Cancer survivors have increased risk of endocrine complications, but there is a lack of information on the occurrence of specific endocrinopathies at the population-level. METHODS: We used data from the California Cancer Registry (2006-2018) linked to statewide hospitalisation, emergency department, and ambulatory surgery databases. We estimated the cumulative incidence of and factors associated with endocrinopathies among adolescents and young adults (AYA, 15-39 years) who survived ≥2 years after diagnosis. RESULTS: Among 59,343 AYAs, 10-year cumulative incidence was highest for diabetes (4.7%), hypothyroidism (4.6%), other thyroid (2.2%) and parathyroid disorders (1.6%). Hypothyroidism was most common in Hodgkin lymphoma, leukaemia, breast, and cervical cancer survivors, while diabetes was highest among survivors of leukaemias, non-Hodgkin lymphoma, colorectal, cervical, and breast cancer. In multivariable models, factors associated with increased hazard of endocrinopathies were treatment, advanced stage, public insurance, residence in low/middle socioeconomic neighbourhoods, older age, and non-Hispanic Black or Hispanic race/ethnicity. Haematopoietic cell transplant was associated with most endocrinopathies, while chemotherapy was associated with a higher hazard of ovarian dysfunction and hypothyroidism. CONCLUSIONS: We observed a high burden of endocrinopathies among AYA cancer survivors, which varied by treatment and social factors. Evidence-based survivorship guidelines are needed for surveillance of these diseases.