Online ISSN: 2515-8260

Keywords : Subclinical Hypothyroidism


Study of Thyroid Functions in Chronic Kidney Disease Patients

Anvesh Kumar A, Kunche Sruthi, Megha Reddy

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1164-1174

Background: Abnormal thyroid function tests are frequently observed in patients of
chronic kidney disease. Kidneys plays a significant role in thyroid hormone metabolism
by conversion of T4 to T3 (the active metabolite). Low plasma free T3 in ESRD is a
marker of the inflammation and endothelial activation; and is known to predict all
cause mortality. The present study was done look for the biochemical abnormalities of
thyroid function tests in chronic kidney disease and to correlate the severity of CKD
and alterations of thyroid indices.
Materials and Methods: In a cross sectional study, thyroid function test [TT3, TT4,
FT4, TSH] were estimated by CLIA in 50 patients of chronic kidney disease who were
in various stages. Symptoms of hypothyroidism, thyroid hormone abnormalities and
CKD stage were analyzed using Chi square test and ANOVA tests.
Results: Among the mean age was 48.8 ± 12.2 years of which 33 were male and 17
females. The mean value of TT3 in CKD stage 3, 4, 5 were 1.01±0.39; 1.05± 0.6;
0.95±1.09 μg/mL respectively. (p= 0.02 Significant). The mean value of TT4 in CKD
stage 3, 4, 5 were 6.3± 2.4; 5.5± 1.5; 5.11 ± 1.01 μIU/ml respectively. (p=0.71 Not
significant).
Conclusion: Total T3 and total T4 were found to be progressively decreased as stage of
CKD increased. There was no significant correlation between TT4 and CKD stage.
There was a significant correlation between the prevalence of thyroid dysfunction and
the stage of chronic kidney disease.Higher the degree of renal insufficiency, the higher
was the prevalence of thyroid hormone abnormalities, the levels of thyroid profile i.e
T3, T4 decreases and TSH increases as severity of renal failure increases. Thyroid
hormone abnormalities could represent a risk factor for cardiovascular disease and
might also be implicated in kidney disease progression.

Correlation of Mean Platelet Volume with Subclinical Hypothyroidism at Tertiary Care Hospital

M M Basavaraju, Sumaiya Anjum, Thejashwini A, Anoop Cheriyan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 139-145

Background:Subclinical hypothyroidism (SH) is defined as elevated serum levels ofTSH
with normal levels of free T4 (fT4) and free T3 (fT3). The prevalence of SH has been
reported to be 4–10% in general population. Since it is generally asymptomatic, these
patients are mostly identified through routine screening or evaluation of non specific
symptoms. About 2–5% of patients progress to overt hypothyroidism annually.
Objectives: To study the mean platelet volume in patients with subclinical
hypothyroidism and to study the association between MPV and CAD in patients with
subclinical hypothyroidism.
Material &Methods:We studied 89 subclinical hypothyroid subjects and estimated
theirMean platelet volume and their cardiovascular function by ECG and 2D ECHO
and then analyzed the data.
Results:MPVwas high (>11fl) in 75.3% of subclinical hypothyroid and MPV has
significant positive correlation with TSH Values. 70.8% subclinical hypothyroid
subjects had LVDD. ECG changes suggestive of IHD and RWMA in 2D ECHO was
present in 48.3% and 37.1% of the subjects respectively.
Conclusion:In our study we found that subclinical hypothyroidsubjects have significant
elevation in MPV. It is also associated with left ventricular diastolic dysfunction. Hence
it is necessary to screen and treat high risk group for subclinical hypothyroidism and its
adverseoutcomes to minimize serious complications.

To Study Serum HDL Level in Subclinical Hypothyroidism and Its Association with TSH: A Case Control Study

Nehal Patel,Nitish Thakur, Sahil Chhabra, Sevy Puri,Luqman Hafeez, Kiran Kumar Singal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 218-222

Objectives:1)To study level of serum highdensity lipoprotein (HDL) level in subclinical
hypothyroidism andeuthyroid patients 2) To study association between serum HDL and
serum TSH in subclinical hypothyroidism.
Materials and Methods:The study was hospital based observational study which
included15 patients of subclinical hypothyroidism and 15 patient’s euthyroid after
diagnosis based on theirserum thyroid stimulating hormone (TSH), freeT3 and freeT4
level done during their regular visit to outpatient medicine department.Bloodsample
was collected of all the participants after an overnight (12hours) fasting and serum high
density lipoprotein levels was estimated. Statisticalanalysis was done on collected data.
Results: Participants with euthyroidism and subclinical hypothyroidism showed no
significant difference in serum high density lipoprotein levels and a negative correlation
was found between serum TSH and serum HDL level in subclinical hypothyroidism
group.
Conclusions:Thyroid hormones have various effects on lipid metabolism.The
effects of subclinical hypothyroidism on serum HDL level were not statistically
significantand a negative correlation between serum TSH and serum HDL which was
suggestive of linear decrease in serum HDL with increase in serum TSH levels.

STUDY OF CAROTID INTIMA MEDIA THICKNESS(CIMT) IN PATIENTS OF SUBCLINICAL HYPOTHYROIDISM(SCH)

Monika Sharma, Randhir Singh , Harharpreet Kaur , Kawalinder Girgla, Jasdeep Sandhu, Savita Kapila

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 572-577

BACKGROUND:Subclinical hypothyroidism (SCH) is defined as an elevated serum thyroidstimulating
hormone (TSH) level with a normal serum free tri-iodothyronine (FT3) & free
thyroxine (FT4) concentration. Hypothyroidism is associated with an increased risk of
atherosclerosis. SCH can progress to overt hypothyroidism. Carotid intima-media thickness
(CIMT) is a close marker of early atherosclerotic changes and is a widely accepted surrogate
end point for cardiovascular events.
AIMS AND OBJECTIVES: To study the CIMT in patients with SCH.
MATERIAL &METHODS:
35 individuals with newly diagnosed / untreated SCHwere studied. 35 age and sex matched
adults with normal thyroid profile were taken as controls. Serum TSH, FT3, FT4, and CIMT
were measured in all study subjects.
RESULTS:There was a statistically significant increase in CIMT on both sides.
CONCLUSION:SCH is associated with an increase in CIMT, which is a marker of
atherosclerosis, with a resultant risk of cardiovascular disease and stroke. Thus, it is
important to detect this condition early so that appropriate steps may be taken to prevent its
deadly complications.

Higher anti-TPO antibody titers are associated with greater thyroid-related symptomatology

Dr.TousiefIrshadAhmed, Dr.Summaiya Irshad

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 663-670

The thyroid peroxidase (TPO) is a 105 kDa glycoprotein enzyme and the main antigen of the
thyroid microsomal fraction. It catalyses iodine oxidation and thyroglobulin tyrosyl iodination
reactions in the thyroid gland. Anti-TPO antibodies activate complement and are thought to be
significantly involved in thyroid dysfunction and the pathogenesis of hypothyroidism. These
antibodies are significantly present in patientsof Hashimoto's thyroiditis,Gravesdisease and
even in non-thyroidal conditions such as diabetes. In sub-clinical hypothyroidism (SCH),
presence of these antibodies is associated with increased risk of developing overt
hypothyroidism (OH). In the present study, anti-TPO antibodies were tested on 33 individuals,
all of whom reported thyroid stimulating hormone (TSH) levels > 6μIU/mL. These included
18 with SCH and 15 with OH.Anti-TPO ab positivity (levels > 28.4 IU/ml) was observed in 17
patients (51.5%) which included 5 with SCH and 12 with OH. There was greater prevalence of
positivity in OH compared to SCH (80% vs 27.8%). 8 of 33 subjects (24%) had significantly
raised anti-TPO ab (>200 IU/ml). The Billewicz scoring system was used for assessment of
clinical features of hypothyroidism with value ≥25 strongly suggestive of OH. 9 of 33 subjects
had scores ≥25 and out of these, 7 had positive anti-TPO ab.Pearson correlation revealed the
serum TSH and anti-TPO levels to be strongly positively correlated, r(32) =
.7902, p <0.0001.The Billewicz diagnostic score was also correlated with anti-TPO levels, r(32)
= .4107 which was significant at p<0.05.Our results show that higher anti-TPO ab and
TSHlevels are associated with higher symptom scores, indicating underlying
pathophysiological and immunological processes and we suggest that antibodies against TPO
should be routinely assessed in patients presenting with either elevated TSH levels or with
symptoms suggestive of thyroid dysfunction.

LIPID PROFILE IN PATIENTS WITH SUBCLINICAL HYPOTHYROIDISM

Randhir Singh, HarharpreetKaur,Jasdeep Singh Sandhu, Savita Kapila

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 781-788

BACKGROUND:Subclinical hypothyroidism (SCH) is defined as an elevated serum thyroidstimulating
hormone (TSH) level with a normal serum free tri-iodothyronine (FT3) & free
thyroxine(FT4) concentration. Hypothyroidism is associated with dyslipidemia and increased
risk of atherosclerosis. SCH can progress to overt hypothyroidism. Lipid profile changes in
SCH, however, are controversial.
AIMS AND OBJECTIVES: To study the lipid profile in patients with SCH.
MATERIAL & METHODS:The present study was a case-control study involving 35 individuals
with newly diagnosed / untreated SCH were studied. 35 age and sex matched adults with
normal thyroid profile were taken as controls. Serum TSH, FT3, FT4, Total cholesterol,
Triglyceride, Low density lipoprotein cholesterol (LDL-C), High density lipoprotein
cholesterol (HDL-C)and Very low density lipoprotein cholesterol(VLDL-C) levels were
measured in all study subjects.
RESULTS: The average total cholesterol and LDL-C in the patients with SCH in our research
were statistically significantly higher than the control group. The mean serum triglyceride,
HDL-C and VLDL-C levels were not statistically different in patients as compared to controls.
CONCLUSION: SCH is associated with dyslipidemia which is a risk factor for atherosclerosis,
with a resultant risk of cardiovascular disease and stroke. Thus, it is important to detect this
condition early so that appropriate steps may be taken to prevent its deadly complications

Subclinical Hypothyroidism in Pregnancy: A Review

Dr. Ritimukta Panda; Dr. Kavya Sudha; Dr. K.Jaya Sri; Dr. Rachita Sarangi; Dr. Bhagirathi Kar; Dr. Gangadhar Sahoo

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 6, Pages 1443-1446

Pregnancy-reference levels of Subclinic hypothyroidism (SCH), along with normal level of serum thyroxine, are called high thyroid stimulation hormone level (TSH).
Autoimmune Thyroiditis is also common in patients of subclinical hypothyroidism. Subclinical Hypothyroidism in pregnancy is the cause of some adverse obstetric consequences. Changes in the metabolism of thyroid hormones during pregnancy needs to be kept in mind, while diagnosing thyroid abnormalities. There is a jump in the obstetric and neonatal results, like preterm delivery, miscarriage, fetal growth restriction, preeclampsia, gestational diabetes mellitus, low birth weight, abruptio placentae and poor Apgar scores at birth. Treatment with Cevothyroxine therapy may help reduce some of these adverse effects, however there is restricted evidence to provision it. The behavior of subclinical hypothyroidism should target maternal TSH concentrations of less than 2.5mIU/L. However there is a lack of recommendation for the official starting dose of levothyroxine. So, individualised low doses of levothyroxine can be started and thereafter titred to the maintain the TSH in the target level

Assessment of glycated haemoglobin level in non-diabetic overt hypothyroid patient

VidyaSagar Ram,Amit Varshney

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 5, Pages 1960-1964

Background: Dysfunction and anatomic abnormalities of the thyroid are among the most
common diseases of the endocrine glands. Almost one-third of the world’s population lives
in areas of iodine deficiency and present study determines the association ofglycated
haemoglobin level in non-diabetic overt hypothyroid patient.
Materials & Methods:130 subjects of both genders were divided into 2 groups. Group I
comprised of 70 patients with overt hypothyroidism and group II were 60 subjects (control
group) with no thyroid dysfunction. HbA1c was measured by immunoturbidimetry method
by clinical chemistry analyzer and serum TSH and FT4 were measured by radio immune
assay.
Results: Common clinical features were hoarseness of voice in 65%, fatigue in 53%,
weight gain in 70%, depression in 42%, puffy face in 35%, non- pitting edema in 39%, cold
intolerance in 31% and constipation in 22%. The mean TSH level in group I was 18.2
mIU/l and in group II was 3.4 mIU/l, FT4 level was 5.0 pmol/l in group I and 12.4 pmol/l
in group II, HbA1c level was 5.9% in group I and 5.2% in group II and FBS level was 5.2
mmol/l in group I and 4.7 mmol/l in group II. The difference was significant (P< 0.05).
There was correlation between TSH and HbA1c levels (r- 0.412, p< 0.05).
Conclusion: Hypothyroid patients had high level of glycatedhemoglobin level as compared
to control subjects