Thyroid Function in Molar Pregnancies

Introduction: Molar pregnancies represent a significant burden of disease on the spectrum of gestational trophoblastic diseases. Vaginal bleeding being the most common occasionally, molar pregnancy is complicated by hyperthyroidism, which may require treatment. Aims: To determine thyroid function test and association of hyperthyroidism among the cases of molar pregnancy. Methods: This is a hospital-based cross-sectional study conducted in the department of Obstetrics and Gynecology, Nepalgunj Medical College and Teaching Hospital, Kohalpur. Sixty cases of molar pregnancy were included during the study period from February 2020 to January 2021.Patients having history of known thyroid disorders were excluded. Results: Prevalence of molar pregnancy in our study was 5.4 per thousand pregnancies in our hospital. Molar pregnancy and hyperthyroidism, both were common in the age group of 21-35 years. Hyperthyroidism was present in 10% patients. Enlarged thyroid was seen in 3.3%, tremor was present in 3.3%, and palpitation in 21.5%. Five (8.3%) patients with hyperthyroidism were underweight. Majority of patients with hyperthyroidism, beta humanchorionic gonadotrophhin level was more than three lakhs and it was mostly associated with complete hydatidiform mole compared to partial hydatidiform mole. Thyroid storm was not experienced in any of the patients. Conclusion: The rate of molar pregnancy is high. Hyperthyroidism in molar pregnancy is not uncommon. High levels of human chorionic gonadotropin, complete hydatiform mole are directly associated with hyperthyroidism. Awareness of this condition is important for diagnosis and treatment to prevent life threatening complications.

Prevalence of undiagnosed hypothyroidism in patients with gall bladder stones in Belagavi

Background: Contribution of hypothyroidism to gallstone formation is debated over years. With this background, the study intended to analyze the prevalence of undiagnosed hypothyroidism in patients with cholelithiasis. The aim is to understand the prevalence of hypothyroidism in patients with gallstones.Methods: A prospective, hospital-based study was done on 100 patients admitted for the management of gall stone disease in Belagavi. After initial screening, a detailed history was obtained with special reference to symptomatology and the risk factors as per proforma from patients meeting selection criteria. Thyroid function test was done on all eligible patients. Patients were divided into three groups of Euthyroid, Subclinical hypothyroid and clinical hypothyroidism. Statistical analysis used. Percentage of gall stones in different age groups and gender of the study population was calculated followed by prevalence of hypothyroidism and subclinical hypothyroidism in all the patients included.Results: Among the study population, 40% were male and 60% were female. 23 of them have subclinical hypothyroidism and 6 of them were diagnosed with hypothyroidism. Majority of subclinical hypothyroid patients (39.13%) were aged 41-60 years. Hypothyroid symptoms were shown by the study population with unknown thyroid status.Conclusions: The prevalence of hypothyroidism in cholelithiasis is 29% in the study and is significant. The study demands further studies to consider hypothyroidism as a cause /risk factor for biliary calculus.

Establishment of trimester-specific reference intervals for thyroid stimulating hormone and free thyroxine during pregnancy in southwest China by indirect method

Objective A series of physiological changes in thyroid function occur during pregnancy and differ from those non-pregnant women. This study aimed to establish the pregnancy-specific reference intervals of TSH and FT4 using an indirect method based on the healthy pregnant women from southwest China population. Methods Thyroid function test results which available on the Laboratory Information System (LIS) were collected from the pregnancies who visited the Obstetric Clinic or the Department of Gynecology between 1 January 2015, and 30 December 2020. We grouped the data by trimesters to establish the reference intervals (RIs) based on the clinical consensus of different levels of TSH and FT4 at different weeks of gestation. All arrangements were referenced to the document CLSI EP28-A3C. Results A total of 33,040 thyroid function test results of pregnant women, aged 31 (28,33) years were statistical analyzed. Estimated RIs for TSH and FT4 in the first, second and third trimesters corresponding to the 2.5th and 97.5th percentiles in TPOAb negative were 0.02–5.23, 0.03–5.24, 0.37–5.68 mIU/L, 11.66–20.69, 10.1–18.59, 9.85–16.86pmol/L, respectively. Conclusion This study provides trimester-specific RIs for TSH and FT4 among healthy pregnant women in southwest China which guides clinicians to diagnosis and screen for thyroid disorders in this region.

A Novel Mutation Diagnosing in Allan–Herndon–Dudley's Syndrome

Allan–Herndon–Dudley's syndrome (AHDS) is a rare X-linked recessive disease that causes abnormal serum thyroid function tests, severe hypotonia, intellectual disability, and motor deficit due to a mutation in the monocarboxylate transporter 8, which is a thyroid hormone transporter. A 6-month-old male patient presented to our outpatient clinic with a serious hypotonia complaint. With a preliminary diagnosis of AHDS, a molecular genetic examination was performed. The molecular genetic analysis detected a new previously unidentified variant in the SLC16A2 gene. This case has been presented to report the AHDS, which is a rare cause of hypotonia in patients presenting/consulting with severe hypotonia, global developmental delay, and abnormal thyroid function test results. Besides, a novel pathogenic mutation in the SLC16A2 gene has been described in the present article.

Thyroid Function Test in Patients with Chronic Kidney Disease

Background: Kidneys have a significant role in the metabolism, degradation and excretion of thyroid hormones. Both thyroid hormones and kidney functions have a multifaceted mutual interdependence. Objectives: To find out the possible association between the severity of chronic kidney disease and thyroid dysfunction; To estimate the correlation between thyroid dysfunction and various stages of chronic kidney disease. Materials and Methods: A prospective Cross-sectional study was done on 50 patients with Chronic kidney disease who were not on dialysis and fulfilled all the inclusion criteria at Saveetha medical college over a period of 6 months. Free T3, Free T4 and TSH levels were estimated for those patients. Results: Results of this study showed that majority of subjects included in our study were in the age group of 50-60 years with Male predominance. Out of 50 patients included in our study, 8 patients(16%) were found to hypothyroidism; 5 patients (10%) were having subclinical hypothyroidism; 20 patients (40%) were having low T3 syndrome and 17 patients (34%) were having normal functioning thyroid gland. Staging of CKD was done in relation to the glomerular filtration rate .Most of the patients(n=20) were in Stage 5 of Chronic kidney disease out of which 18 patients were having thyroid disorders. Conclusion: There is a positive correlation between the severity of CKD and thyroid dysfunction. Hence a routine thyroid function status should be evaluated in each and every patient of CKD to reduce the morbidity and mortality rate of CKD patients as well as reduce the social burden and health expenditure.

Trimester-specific reference ranges for thyroid hormones of pregnant females at tertiary care hospitals in Lahore, Pakistan

Background The significance of investigation for diagnosing and managing thyroid dysfunction in pregnant females has been extensively documented in the medical literature. This study aimed to determine trimester-specific reference ranges for thyroid-stimulating hormones (TSH), free T3 (FT3), and free T4 (FT4) in apparently healthy pregnant women attending tertiary care hospitals in Lahore. Methods This cross-sectional study was conducted at two tertiary care Hospitals in Lahore, Pakistan. In this multi-centric study, 500 pregnant females were initially enrolled from September 2019 to December 2019 who fulfilled the inclusion criteria. For measurement of serum FT3, FT4, thyroid stimulating hormone (TSH), anti-thyroid peroxidase (anti-TPO), and thyroglobulin antibodies, 5 ml of the blood sample was drawn, under aseptic conditions, from each subject using Maglumi 800 chemiluminescence immunoassay (CLIA) system. Results Out of 500 subjects, 23 subjects with positive anti-TPO, 19 subjects with anti-TG antibodies, and 12 subjects due to less volume of serum yielded from whole blood (serum less than 3 ml) were excluded from the analysis. Ten samples were hemolyzed and not included in the analysis. A total of 436 samples were examined for analysis. Of the remaining 436 subjects, 133 (30.5%) were from 1st trimester, 153 (35.1%) from 2nd trimester, and 150 (34.4%) from 3rd trimester. As the data were non-normal, the 2.5th, 50th, and 97.5th percentiles were calculated to express each group's results. Trimester specific range of TSH 0.168-4.294, 0.258-4.584 and 0.341-4.625 mIU/mL, FT31.857-4.408, 1.958-4.621 and 2.025-4.821 pmol/L and FT4 8.815-18.006, 8.306-17.341 and 7.402-17.292 pmol/L. Conclusion In this study, we established a trimester-specific reference range for our local population's thyroid function test. The results of this study have complemented the results of previous studies.

POLYMORPHOUS LIGHT ERUPTION AND ITS ASSOCIATION WITH HYPOTHYROIDISM AND AUTOIMMUNE THYROIDITIS – A COMPARATIVE CROSS-SECTIONAL STUDY

BACKGROUND In many parts of the world, polymorphous light eruption (PLE) is the commonest cause of photosensitivity. Previous studies have suggested the association of PLE with multiple autoimmune diseases. Few studies are available suggesting the association of PLE with autoimmune thyroiditis. We have undertaken this study to conrm such an association and to predict which cases of PLE are likely to have hypothyroidism and autoimmune thyroiditis. METHODS This was a cross-sectional study with comparative group with 75 PLE cases and 75 controls. Thyroid function test (TFT) was done for all subjects and, if found abnormal, anti-thyroid peroxidase (TPO) antibodies were tested. The studied parameters were compared using Pearson's chi-squared test for signicance. RESULTS The male to female ratio was 1:2.1. Hypothyroidism and autoimmune thyroiditis were signicantly present in PLE cases. PLE lesions with papular morphology, persistent and recurrent PLE, positive family history and associated other autoimmune diseases were signicantly associated with autoimmune thyroiditis. CONCLUSION PLE is signicantly associated with hypothyroidism and autoimmune thyroiditis. Hence we suggest screening of PLE patients for hypothyroidism and, if required, for autoimmune thyroiditis for early diagnosis and treatment.

Absent Bell’s phenomenon in patients with thyroid eye disease

Background To investigate the incidence of absent Bell’s phenomenon (BP) and the relationship between absent BP and inferior rectus muscle hypertrophy and other clinical features in patients with thyroid eye disease (TED). Methods A total of 104 patients who were first diagnosed with TED between January and December 2014 were included. Inferior rectus muscle area and associations with clinical features of TED and thyroid function test including thyroid specific antibodies were compared between patients with TED with and without BP. The volume of the inferior rectus muscle was calculated by adding up all the cross-sectional areas measured on sagittal CT images. Results Among the 104 patients, 14 had absent BP (13.5%), 12 with bilateral and two with unilateral. There was no significant difference in thyroid function test, presence of TSIs, exophthalmos, or volume of inferior rectus muscle measured in CT scans (P > 0.05). Incidence of diplopia, elevation limitation, and upper eyelid retraction were risk factors of absent BP in TED patients (by logistic regression analysis, P < 0.05). Conclusions Inferior rectus muscle hypertrophy was not the cause of absent BP in TED patients. Fibrosis and tightening of the inferior rectus muscle, lower eyelid, and surrounding orbital tissues, rather than inferior rectus muscle hypertrophy, might be related to absent BP in TED patients.

Study of Fasting Lipid Profile in Patients with Subclinical Hypothyroidism in a Tertiary Care Hospital in Bangladesh

Subclinical hypothyroidism (SCH) is a metabolic disorder with prevalence about 4-10% in general population. This study was conducted to observe the pattern of fasting lipid profile in SCH and to correlate the components of it with thyroid stimulating hormone and free thyroxin level. This cross sectional observational study included 31 newly diagnosed cases of SCH and 17 age and BMI matched healthy control subjects with normal thyroid function test. Fasting lipid profile was recorded and compared. TSH was significantly higher in SCH compared to controls (9.09±2.79 vs 2.31±0.92 μIU/ml; p=0.001). FT4 was comparable between the groups (1.17±0.18 vs 1.28±0.20 ng/dl; p=0.938). Significantly higher level of Total cholesterol and LDL-C were observed in SCH compared to controls (TC 194.77±29.70 vs 156.59±20.45 mg/dl; p=0.042 and LDL-C 124.81±27.85 mg/dl vs 88.59±18.41mg/dl; p=0.045 respectively). Triglycerides and HDL-C were comparable between the groups (TG 134.90±80.97 vs 118.12±49.14 mg/dl; p=0.171 and HDL-C 42.87±4.83 vs 44.47±5.66; p=0.633 respectively). TSH showed significant positive correlation with TC and LDL-C (r=0.591, p<0.001 and r=0.644, p<0.001 respectively), but not with TG or HDL-C (r=0.011, p=0.943 and r=0.115, p=0.435 respectively). FT4 only showed significant negative correlation with LDL-C (r=0.302; P=0.037) but not with TC, TG or HDL-C (TC: r=0.245, P=0.093; TG: r=0.121, p=0.411 and HDL-C: r=0.108, p=0.466 respectively). SCH is associated with raised TC and LDL-C. So patients with SCH are more vulnerable to develop future adverse cardio-metabolic complications. Faridpur Med. Coll. J. 2021;16(1):17-20

Comparison of the sonography index of thyroid gland with serum level of Anti-thyroid peroxidase, Anti-thyroglobulin and thyroid function test in patients with Hashimoto thyroiditis

Background The purpose of this study was to determine the association of sonographic parameters with the serum levels of anti-thyroid peroxidase (TPO), anti-thyroglobulin (Tg), and thyroid hormones in patients with Hashimoto's thyroiditis. Methods 149 patients (118 females, 31 males; aged 18–60 years; mean age: 38.60 ± 8.03 years) who were diagnosed with Hashimoto's thyroiditis were enrolled in the study. Blood sample was taken to measure the serum levels of free T3 and T4, thyroid stimulating hormone (TSH), anti-TPO antibody titers, and anti-Tg antibody titers. The thyroid sonography of each patient was classified into one of the five grades by real-time ultrasonography (US) based on echogenicity, thyroid size, and thyroid pattern. We evaluated whether a correlation existed between thyroid characteristics on US and serum levels of thyroid hormones, anti-TPO and anti-Tg. Results Nodular structures were detected in 54 (36.2%) patients (38 micronodular and 16 macros nodular). Echogenicity was recorded as isoechoic in 15 (10.07%) and hypoechoic in 119 (79.87%) subjects. Euthyroid ‎subjects had significantly thicker isthmus than overt and subclinical hypothyroid patients (p = 0.018). Mean serum TSH, anti-Tg and anti-TPO titers was significantly higher in patients with micronodules than those with micronodules and subjects without nodules (P < 0.05). Isthmus thickness had a significant negative correlation with FT4 and FT3 (P = 0.046; r = 0.11& P = 0.017; r = 0.15, respectively). Thyroid autoantibodies had positive significant correlations with different parameters of the thyroid volume (P < 0.05). Conclusions Thyroid’s US findings in addition to serum levels of anti-Tg and anti-TPO titers would be useful in diagnosis and evaluation of the severity and extent of Hashimoto's thyroiditis, but further evaluations are needed. Trial registration: Trial registry identifier IR.SUMS.REC.1395.S161 (2015/11/30).