Correlation Study of Aortic Velocity Propagation, Abdominal Aortic Intima-Media Thickness, and Epicardial Adipose Tissue Thickness in Subclinical Hypothyroidism Patients

Objective:To explore the correlation between epicardial fat thickness(EFT),aortic velocity propagation(AVP),and abdominal aortic intima-media thickness(AA-IMT)in patients with subclinical hypothyroidism(SH).Additionally,to compare these indicators between SH patients and healthy individuals,providing a new theoretical basis for the clinical prevention and treatment of cardiovascular diseases.Method:Clinical data from 50 SH patients(23 males and 27 females)and 50 healthy outpatient examinees(22 males and 28 females)were analyzed.The participants were selected from January 2022 to December 2023 at Loudi Central Hospital.EFT,AVP,and AA-IMT were measured,and their correlations were analyzed.Results:SH patients had significantly higher EFT and AA-IMT levels than the control group,while their AVP was significantly lower,with these differences being statistically significant(P<0.05).Correlation analysis revealed a significant negative correlation between EFT and AVP(P<0.001),a significant positive correlation between EFT and AAO-IMT(P<0.001),and a significant negative correlation between AVP and AAO-IMT(P<0.001).Multivariate binary logistic regression analysis identified increased EFT,decreased AVP,and increased AAO-IMT as independent risk factors for SH patients.Conclusion:In SH patients,EFT and AAO-IMT are elevated,whereas AVP is reduced.EFT and AVP are significantly correlated with AAO-IMT.EFT and AAO-IMT can serve as reliable indicators for evaluating subclinical atherosclerosis in SH patients,providing a diagnostic basis for clinical practice.

Subclinical hypothyroidism is associated with lipid-rich plaques in patients with coronary artery disease as assessed by optical coherence tomography

Background Subclinical hypothyroidism （SCH） has recently been acknowledged as an unconventional risk factor for coronary artery disease （CAD） and characterized by poor prognosis, which may be due to atherosclerotic plaque characteristics. We conducted this study to observe coronary plaque characteristics in coronary artery disease patients with concomitant SCH. Methods Patients with coronary artery disease were enrolled in the study and divided into an SCH group （patients, n = 26; plaques, n = 35） and a non-SCH group （patients, n = 52; plaques, n = 66）. They were divided 1：2 according to propensity-matched analysis including age, diabetes mellitus, gender, CAD severity and culprit vessel. Optical coherence tomography （OCT） imaging was performed on all patients, and images were analyzed by two inde- pendent investigators. Lipid-rich plaques （LRP）, the precursor of vulnerable plaques, were defined as having more than one quadrant occu- pied with lipid pool. Maximum lipid arcs were simultaneously recorded. Fibrotic plaques and calcific plaques were also identified. The pres- ence of coronary dissection, plaque erosion, thrombus, macrophage, calcific nodule, thin-cap fibroatheroma and micro channel were all noted. Results The ratio of LRP in SCH group was significantly higher than that in non-SCH group （54% vs. 30.3%, P = 0.037）. That was the case as well for the maximum lipid arcs value （181.5°± 61.6° vs. 142.1° 4± 35.9°, p = 0.046）. While thin-cap fibroatheroma （TCFA） was detected, no difference was identified between the two groups in either TCFA ratio （20% vs. 16.7%, P = 0.579） or fibrous cap thickness （57.5 4± 14.0 vs. 63.5 4±10.7 gin, P = 0.319）. Other OCT characteristics such as dissection, plaque erosion, thrombus, macrophage shadow and calcific nodule were also similar. ConcLusion Higher ratio of LRP with greater lipid arc in SCH patients may be related to the plaque instability and poor prognosis in CAD patients with SCH.

Analysis of the features of TCM and western medicine in the diagnosis and treatment of subclinical hypothyroidism characteristics

The diagnosis and treatment of subclinical hypothyroidism are summarized by reviewing the related English and Chinese literature, the comparative analysis of traditional Chinese medicine （TCM） and western medicine in the understanding of subclinical hypothyroidism, the epidemiology, etiology, pathogenesis, the patterns addition to the therapeutic hypothyroidism, with a pr and the clinical manifestation in principle and drugs of subclinical ospect of providing insight in the clinical treatment of the disease.

The risk of cardiovascular events in patients with subclinical hypothyroidism： An updated meta-analysis based on 53813 participants

Background Subclinical hypothyroidism is a metabolism disease with elevated thyroid stimulating hormone （TSH） and normal thyroid hormone levels. Patients with subclinical hypothyroidism can have abnormal lipid metabolism, hypertension, coagulation dysfunction, vascular endothelial dysfunction. However, the relationship between subclinical hypothyroidism and cardiovascular events is still uncertain. Methods Prospective studies on the association between subclinical hypothyroidism and coronary heart disease were searched in PubMed, Embase, Wanfang databases and the Cochrane Library. The incidences of coronary heart disease, cardiac death, heart failure and all-cause death were compared between subclinical hypothyroidism group and euthyroidism group. Odds ratios （ORs） with 95% confidence intervals （95% CIs） were used as summary statistics. Results Thirteen eligible studies incorporating 53813 participants were included in this recta-analysis. No significant dif- ferences were found in the comparison of the risk of CHD （9.67% vs. 7.74%, OR=1.09, P=0.19）, cardiac death （7.80% vs. 4.74%, OR=1.34, P=0.06）, all-cause death （13.26% vs. 13.63%, OR=l.05, P=0.77） and heart failure （7.12% vs. 4.29%, OR=1.24, P=0.22） between the subclinical hypothyroidism group and euthyroidism group. Conclusions Our results indicate that subclinical hypothyroidism might not increase the risk of cardio- vascular disease.

The incidence of adverse clinical outcome in acute coronary syndrome patients with subclinical hypothyroidism

Background Subclinical hypothyroidism is associated with adverse cardiovascular outcomes.But less is known about its prognostic role in patients with acute coronary syndrome(ACS).Methods 538 ACS patients with normal serum concentrations of T3 and T4 underwent coronary angiography in our hospital from January 2015 to January 2019 were retrospectively enrolled.They were divided into normal thyroid stimulating hormone(TSH)group(0.27-4.2 uIU/mL)(n=385)and high TSH group(>4.2 uIU/mL)(n=135).The study endpoints were the major adverse cardiovascular events(MACEs).The univariate and multivariate regression analysis including significant covariables were performed to test for the association between subclinical hypothyroidism and MACEs.Results The mean concentration of TSH were 8.72(6.37-11.02)uIU/mL in the high TSH group and 1.94(1.34-2.45)uIU/mL in the normal TSH group.Multivariate logistic regression analysis found that subclinical hypothyroidism[Odds ratio(OR):1.94,95%confidence interval(CI):1.23-2.65,P=0.030]was associated independently with MACE rate in ACS patients.The area under the receiver operating characteristic curve showed that the subclinical hypothyroidism had good predictable value for MACEs in patients with ACS(area under the curve:0.713,95%CI:0.668-0.802,P<0.001).Conclusions Subclinical hypothyroidism is associated with worse clinical prognosis in ACS patients.Clinicians need to pay more attention to subclinical hypothyroidism in ACS patients.[S Chin J Cardiol 2021;22(1):1-6]

MULTIVARIATE ANALYSIS OF RELATIONSHIPS BETWEEN IODINE BIOLOGICAL EXPOSURE AND SUBCLINICAL THYROID DYSFUNCTIONS

Objective To assess the relationships between iodine biological exposure and subclinical thyroid dysfunctions. Methods The cross-sectional survey was performed to obtain the epidemiologic data of population in three communities with different iodine biological exposure： mild iodine deficiency [median urinary iodine concentration （MUI） of 50-99 μg/L], more than adequate iodine intake （MUI of 200-299 μg/L）, and excessive iodine intake （MUI over 300 μg/L）. Univariate and multivariate analysis （logistic regression analysis） were used to analyze the risk factors of subclinical hypothyroidism and subclinical hyperthyroidism. Logistic regression analysis with sex and age controlled suggested that more than adequate iodine intake （OR = 3.172, P = 0.0004） and excessive iodine intake （OR = 6.391, P = 0.0001） increased the risk of subclinical hypothyroidism, while excessive iodine intake decreased the risk of subclinical hyperthyroidism （OR = 0.218, P= 0.0001）. Logistic regression analysis including interaction of iodine intake and antibodies [tryroid peroxidase antibody （TPOAb） and thyroglobulin antibody （TgAb）] suggested that excessive iodine intake was an independent risk factor of subclinical hypothyroidism （OR = 6.360, P= 0.0001）, but independent protect factor of subclinical hyperthyroidism （OR = 0.193, P= 0.0001）. More than adequate iodine intake and it＇s interaction with TgAb increased the risk of subclinical hypothyroidism independently, in addition, it decreased the risk of subclinical hyperthyroidism at the present of TPOAb. Conclusion Both excessive iodine intake and more than adequate iodine intake could increase risk of subclinical hypothyroidism, supplement of iodine should be controlled to ensure MUI within the safe range.

Fetomaternal Outcome in Maternal Hypothyroidism Complicating Pregnancies at Paropakar Maternity and Women’s Hospital

Background: Thyroid disorders are the most common endocrine disorders in pregnancy accounting for 10% of subclinical hypothyroidism in all pregnancies. Screening for hypothyroidism is essential in all pregnant women, especially in Nepal, a low-income region where women have an increased risk of developing iodine deficiency during pregnancy. Hence this study is to analyze fetomaternal outcomes in maternal hypothyroidism complicating pregnancies. Methods: This retrospective observational study was carried out at Paropakar Maternity and Women Hospital, a tertiary center located in Kathmandu, Nepal. The Subjects of this study were 330 antenatal women with a singleton pregnancy with hypothyroidism admitted for delivery in the obstetrics ward, and informed consent was obtained. Women were chosen irrespective of age, parity, residency, and socioeconomic status. Women with multiple pregnancies and any preexisting medical disorders including heart disease, diabetes, and hypertension were excluded. Routine hematological parameters and estimations of T3, T4, and thyroid stimulating hormone (TSH) were conducted. Patients with hypothyroidism were divided into overt and subclinical and were subsequently assessed for maternal and fetal complications. The occurrence of maternal outcomes and perinatal outcomes were recorded. Result: Out of 470 total hypothyroid cases, 330 were enrolled in the study and the remaining 140 were excluded. In our study, the incidence of hypothyroidism in pregnancy was 2.11% with 1.7% of subclinical hypothyroidism and 0.31% of overt hypothyroidism. The mean age of the patient was >30 years with 53.3% (n = 176) primigravida. Mostly 70.3% (n = 232) from rural areas. Pre-Eclampsia, gestational diabetes abruptio placenta, and postpartum hemorrhage were the adverse maternal outcome with a higher percentage of these in overt hypothyroidism which was statistically significant. Concerning fetal outcome APGAR score <6 in 5 min, Intrauterine growth restriction (IUGR), NICU admission, neonatal Respiratory distress syndrome (RDS), Intrauterine fetal death (IUFD), and congenital anomaly were found with a higher percentage in overt hypothyroidism. Conclusion: Since the impact of hypothyroidism on fetomaternal morbidities have been identified so screening for hypothyroidism to be included as a routine screening test and should be treated accordingly to improve maternal and fetal outcome.

Thyroid disease in pregnancy: A review of diagnosis, complications and management

Malfunction of the thyroid gland is the second most common endocrine disorder encountered during pregnancy. It is well known that overt disease of the thyroid gland, either hyper or hypo can adversely affect pregnancy outcome. There is also an ongoing debate surrounding the issue of subclinical hypothyroidism and its effect on the cognitive development of the unborn child. The goal of this paper is to present a systematic review of the literature and the current recommendations for diagnosis and treatment of thyroid disease in pregnancy and postpartum.

Association between Insulin Resistance and Metabolic Syndrome with Thyroid Status in Normal and Overweight/Obese Population: A Review

Background: Hypothyroidism has multiple etiologies and manifestation where accurate diagnosis and appropriate treatment is required and is in?uenced by coexisting medical conditions. This paper describes evidence-based clinical causes and indications. Objective: The objective is to review the clinical effect of hypothyroidism in different selected aspects and summarize the potential evidence about relationship between subclinical hypothyroidism with cardiovascular disease, diabetes mellitus, insulin resistance and mortality. Data Sources: A systematic review was conducted by searching English-language articles identified from 23 databases and search engines, yielding over 1000 documents. Study Selection: They are reports on the effects of hypothyroidism versus euthyroidism on obesity, insulin resistance, cardiovascular disease, coronary heart disease and mortality. Data Extraction: Data from research articles on hypothyroidism including subclinical hypothyroidism (SCH) and overt hypothyroidism, insulin resistance including diabetes mellitus and risk for coronary heart disease (CHD) including metabolic syndrome were independently assessed and summarized. Data Synthesis: Twelve of twenty-nine identified studies involved population-based cohorts, case controls and retrospective studies that included 4306 subjects. All 13 studies examined risks associated with subclinical hypothyroidism with type 2 diabetes mellitus (T2DM) and prevalence rates of SCH in T2DM patients ranged from 4.69% to 64.28% in the 12 included studies. Moreover, 4 studies out of the above 12 studies have revealed insulin resistance in the participants. Another population-based 12 studies have been carried out to assess hypothyroidism-related cardiac manifestation and according to the given data, average prevalence of CHD in hypothyroid participants is 25.20 (vary from 3.73 to 47.14) and it is 13.90 in euthyroid participants (vary from 1.17 to 38.49). Conclusions: Type 2 diabetes mellitus people are more likely to get subclinical hypothyroidism and subclinical hypothyroid population also shows several complications associated with type 2 diabetes mellitus. Besides, subclinical thyroid dysfunction might represent a risk factor for coronary artery disease and mortality.

Non-medicalization of medical science:Rationalization for future

As we delve into the intricacies of human disease,millions of people continue to be diagnosed as having what are labelled as pre-conditions or sub-clinical entities and may receive treatments designed to prevent further progression to clinical disease,but with debatable impact and consequences.Endocrinology is no different,with almost every organ system and associated diseases having subclinical entities.Although the expansion of these“grey”pre-conditions and their treatments come with a better understanding of pathophysiologic processes,they also entail financial costs and drug adverse-effects,and lack true prevention,thus refuting the very foundation of Medicine laid by Hippocrates“Primum non nocere”(Latin),i.e.,do no harm.Subclinical hypothyroidism,prediabetes,osteopenia,and minimal autonomous cortisol excess are some of the endocrine preclinical conditions which do not require active pharmacological management in the vast majority.In fact,progression to clinical disease is seen in only a small minority with reversal to normality in most.Giving drugs also does not lead to true prevention by changing the course of future disease.The goal of the medical fraternity thus as a whole should be to bring this large chunk of humanity out of the hospitals towards leading a healthy lifestyle and away from the label of a medical disease condition.

Effect of different iodine intake on the prevalence of hypothyroidism in 3 counties in China

Iodine is an important constituent for the synthesis of thyroid hormone. Deficient or excessive iodine intake may affect thyroid size and function. 1 The strategy of Universal Salt lodination （USI） has been implemented in China since 1996. The median urinary iodine （MUI） was 330 μg/L in 1997, and 306 μg/L in 1999. We conducted a cross-sectional epidemiological study in three counties （rural communities） in 1999 to investigate the effect of iodine intake on the prevalence of hypothyroidism.

Isolated Thyrotropin Elevation is Associated with Insufficient Night-sleep in Night-sleep Restricted Subjects

Mild thyroid stimulating hormone （TSH） elevations are highly prevalent whereas large proportion of individuals with TSH elevations is without chronic autoimmune thyroid diseases.TSH secretion exhibits a daily circadian rhythm,and we previously reported that individuals with sleep disorders have significantly higher TSH levels than controls.