Cardiac Malformations in Congenital Hypothyroidism: A Case Report

Introduction: Congenital hypothyroidism is the most common causes of preventable mental retardation. It is associated with other births defects like cardiac malformations. Descriptions in Sub Saharan Africa are rare, justifying the present report. Case Report: We reported the cases of 3 female patients, diagnosed with hypothyroidism, presenting in addition pulmonary stenosis. The diagnosis was late in all the patients and we noticed clinical improvement under levothyroxine. Conclusion: Association congenital hypothyroidism and cardiac defect is not rare. Our patients are female with no history of consanguinity, presenting congenital hypothyroidism with a gland in situ associated with pulmonary stenosis. Systematic screening of other births defects is thus recommended in affected patients.

Influence of Prenatal Surveillance on Maternal and Perinatal Prognosis: A Prospective Study over 6 Months at the Maternity Ward of the Owendo University Hospital (Gabon)

Introduction: The occurrence of pregnancy in women is a risky situation. Prenatal care is necessary, which is not often the case in our context. Aim: To analyze the influence of antenatal surveillance on maternal and perinatal prognosis. Patients and Method: Preliminary longitudinal and analytical survey at the Owendo University Hospital (OHU) over 6 months. It focused on prenatal surveillance. The study population consisted of parturients who gave birth within 24 hours and we studied sociodemographic characteristics, variables related to antenatal contact, those of delivery as well as maternal and newborn outcomes. Results: 2485 deliveries were recorded and 1300 patients were retained according to the inclusion criteria. No prenatal contact (ANC0) was performed in 93 (7.15%), insufficient (ANCI) in 943 patients (72.5%), and sufficient (ANCS) in 264 patients (20.30%). Patients with low school level were significantly found when the NPC was not performed or insufficient and the same was true for the group of patients who were not employed and those who were single (p < 0.005). The caesarean section rate and perinatal mortality are high in this case. Conclusion: The quality of prenatal contact is insufficient in our context. The absence or inadequacy of the latter has a strong negative impact on maternal and perinatal morbidity and mortality.

Precocious Puberty in a 5-Year-Old Girl with a Giant Hypothalamic Hamartoma Discovered Perinatally: Case Report

Background: Hypothalamic hamartoma is a rare non-neoplastic lesion, typically identified in early childhood during investigations for precocious puberty and/or gelastic seizures. However, cases of diagnosis even earlier or during fetal development have been documented. Case Presentation: A newborn girl was diagnosed with hydrocephalus during pregnancy. An MRI revealed a large oval hypothalamic process, which suggested a hypothalamic hamartoma. At the age of 2, she experienced alternating crying and laughing seizures, followed by a decrease in visual acuity. Due to involvement of the optic pathways, surgery was not performed and she underwent antiepileptic medicines and gamma knife radiotherapy. At the age of 5 years and 3 months, she presented with breast development and laboratory tests confirmed central precocious puberty. Quarterly injections of GnRH agonists have since been administered with favorable results. Conclusion: Early-diagnosed hypothalamic hamartomas require close monitoring, by an experienced multidisciplinary, to promptly detect and treat potential complications, especially precocious puberty, and prevent any undesirable impact on final height.

Traditional Chinese medicine prescriptions and herbs for the treatment of hypothyroidism:a narrative review

The increasing prevalence of hypothyroidism,which can cause endocrine dysfunction,abnormal neurological function,and cardiovascular and cerebrovascular injuries,poses serious health problems.Thyroid hormone supplementation constitutes the current main therapeutic method for hypothyroidism,yet it has many limitations and risks and is not suitable for everyone.Therefore,it is necessary to seek alternative and complementary treatment methods.It has been proven in practice that traditional Chinese medicine(TCM)possesses multi-channel comprehensive characteristics for the treatment of hypothyroidism and has more advantages than single thyroid hormone supplementation.Through a comprehensive examination of existing literature about TCM efficacy in addressing hypothyroidism,we have meticulously consolidated the most recent research findings on prescriptions and herbal substances employed in the treatment of this condition.Furthermore,we have explicated their respective functions in the management of hypothyroidism,thereby offering valuable perspectives and recommendations for the prospective utilization of natural remedies in its treatment.

Mechanism of intervention of medicine combined with mild moxibustion on hypothyroidism rat model

Objective:To explore the intervention effect of medicine combined with mild moxibustion on immune factor and Na/I symporter(NIS)in hypothyroidism rat model.Methods:The model was successfully made by intragastric administration of propylthiouracil(PTU)solution medicine and medicine combined with mild moxibustion groups were given levothyroxine sodium suspension 60μg/kg body weight by gavage,once a day.In the medicine combined with mild moxibustion group,mild moxibustion was applied in“Dazhui”,“Mingmen”,“Pishu”,“Shenshu”,and 10 minutes per point,once a day,and one day off every six days;four weeks in a row.The model group and medicine was fixed in the same way as the medicine combined with mild moxibustion group.The blank group received no treatment.The contents of thyrotropin-releasing hormone(TSH),tatalthyroxine(TT4),thyroid peroxidase antibody(TPOAb),thyroglobulin antibodies(TGAb),Interleukin-4(IL-4)and Interleukin-23(IL-23)in serum were determined by Enzyme Linked Immunosorbent Assay(ELISA).The content of NIS and the expression level of NISmRNA in thyroid tissues of each group were detected by immunohistochemistry and real-time polymerase chain reaction(R-T PCR).Results:Compared with the blank group,the contents of TSH,TPOAb,TGAb and IL-23 in the serum of rats in the model group were increased,the contents of IL-4 and TT4 were decreased,and the contents of NIS and NISmRNA in thyroid tissue were decreased,with statistical significance(P<0.01).Compared with model group,the contents of TSH,TPOAb,TGAb and IL-23 in serum of medicine group and medicine combined with mild moxibustion group were decreased,while the contents of IL-4 and TT4 were increased;the NIS content and NISmRNA expression in thyroid tissues were increased,and the differences were statistically significant(P<0.01).Compared with the medicine group,NISmRNA expression in thyroid tissues of medicine combined with mild moxibustion groups was increased,and the difference was statistically significant(P<0.05).Conclusion:Medicine combined with mild moxibustion can decrease the contents of TPOAb,TGAb and IL-23,and increase the content of IL-4,increasing the content and expression of NIS to interfere with the hypothyroidism rat model.

Hypothyroidism in Childhood and Adolescence

Juvenile hypothyroidism is an unfrequent form of hypothyroidism that affects children. If not diagnosed and treated properly, it may cause severe neurological disorders during growth. The most frequent difficulties are found in school performance, difficulties in concentration, hyperactivity or fatigue and damage on the onset of puberty. Starting levothyroxine as a drug of choice is essential, and it should be made according to the age and weight of the child. Laboratory tests for control should be requested periodically, along with a strict control of the child’s development and growth. The family-doctor relationship, along with a clear guidance on the importance of treatment, is critical to achieve a successful treatment. This article is a review about the main clinical features of hypothyroidism in childhood, especially in developing countries, providing key aspects of adherence and characteristics of its follow-up.

Socio-Medical and Demographic Factors Associated with Perinatal Mortality in a Southern Benin Health Zone Hospital in 2020: A Case-Control Study

Background: Perinatal mortality remains a major public health concern in developing countries such as Benin. To better steer response interventions, this study was carried out in southern Benin with the aim of identifying the demographic and socio-medical factors linked to perinatal mortality. Methods: The case-control study, held from January 1 to December 31, 2020, covered 154 targets, including 77 cases of neonates deceased within the perinatal period and 77 live-born control neonates selected on a one-for-one basis. Univariate analysis using the McNemar test and logistic regression were used to identify risk factors for perinatal mortality, at a 5% threshold of significance. Results: Sahoué/mina ethnicities, only associated socio-demographic characteristic, increased the risk of perinatal death by 2.47 times (p = 0.008). Mother’s age, education, occupation, marital status, and household size were not associated (p > 0.05). Risk of death was increased 2.5 times when the mother was referred (p = 0.007), 3.3 times when she came from a hard-to-reach locality (p Conclusion: Although attention must also be paid to referral and access to care, this study identifies antenatal consultation as the main target of any intervention to reduce perinatal mortality.

Predictive Value of Amniotic Fluid Index in Term Small for Gestational Age with Normal Doppler Studies for Perinatal Outcomes

Background and Aim: Delivery of a fetus with SGA is associated with increased risk of perinatal morbidity and mortality. Evidence is limited for the accuracy of Oligohydramnios to predict substantive perinatal morbidity and mortality in non–anomalous SGA fetuses monitored with normal Doppler studies. The aim of this study is to determine the association between amniotic fluid index and adverse perinatal outcomes in term SGA fetuses with normal Doppler studies. Method: This is a prospective observational study carried out by 340 pregnant women who were admitted to obstetrics unit, Sri Jayewardenepura from January 2019 to January 2023. Singleton pregnancies at term who were diagnosed with SGA (EFW 10th centile or AC 10th centile) with normal umbilical artery and middle cerebral artery Doppler studies were included. AFI was assessed predelivery and data were collected according to demographic details, mode of delivery, time of delivery, intrapartum events, and neonatal outcomes. Results: A total of 340 term pregnant women were studied. Out of them, 44% were in AFI more than 10 groups and 37% and 19% were in AFI 5 - 10 and less than 5 groups respectively. More obstetrics interventions were reported in AFI 5 groupa in terms of induction of labor (P 0.04) and emergency caesarean sections (P 0.003). No significant deference in immediate neonatal outcome was detected between each group. (Meconium-stained liquor (P 0.634), 1 minute APGAR (P 0.575) and 5-minute APGAR P 0.165)). Neonatal unit admission (P 0.001) and long-term neonatal complications were

Banking of perinatal mesenchymal stem/stromal cells for stem cellbased personalized medicine over lifetime:Matters arising

Mesenchymal stromal/stem cells(MSCs)are currently applied in regenerative medicine and tissue engineering.Numerous clinical studies have indicated that MSCs from different tissue sources can provide therapeutic benefits for patients.MSCs derived from either human adult or perinatal tissues have their own unique advantages in their medical practices.Usually,clinical studies are conducted by using of cultured MSCs after thawing or short-term cryopreserved-then-thawed MSCs prior to administration for the treatment of a wide range of diseases and medical disorders.Currently,cryogenically banking perinatal MSCs for potential personalized medicine for later use in lifetime has raised growing interest in China as well as in many other countries.Meanwhile,this has led to questions regarding the availability,stability,consistency,multipotency,and therapeutic efficiency of the potential perinatal MSC-derived therapeutic products after longterm cryostorage.This opinion review does not minimize any therapeutic benefit of perinatal MSCs in many diseases after short-term cryopreservation.This article mainly describes what is known about banking perinatal MSCs in China and,importantly,it is to recognize the limitation and uncertainty of the perinatal MSCs stored in cryobanks for stem cell medical treatments in whole life.This article also provides several recommendations for banking of perinatal MSCs for potentially future personalized medicine,albeit it is impossible to anticipate whether the donor will benefit from banked MSCs during her/his lifetime.

Comparison of protective effects of electroacupuncture and moxibustion at Zusanli(ST 36)on perinatal nicotine exposure-induced lung phenotype in rat offspring

Objective:To compare the effects of electroacupuncture(EA)and moxibustion at Zusanli(ST 36)on the lung phenotype of rat offspring exposed to nicotine during the perinatal period.Methods:Pregnant Sprague-Dawley rats were randomly divided into 4 groups:the control group(saline only),the model group(nicotine only),the EA group(nicotine+EA at ST 36 acupoints bilaterally),and the moxibustion group(nicotine+moxibustion at ST 36 acupoints bilaterally).n=6 rats per group.On postnatal day 21,the body weight,lung weight,and pulmonary function were determined and lung morphometry was performed.Peroxisome proliferator-activated receptor gamma andβ-catenin levels in the lung tissue of offspring were also determined.Results:Perinatal nicotine exposure(PNE)results in decreased body and lung weights of offspring rats,abnormal lung tissue morphology,and significantly altered pulmonary function,showing an increase in total airway resistance and a decrease in tidal volume,minute ventilation,total airway compliance,and peak expiratory flow.Bilateral EA at ST 36 acupoints could block all of these perinatal nicotine-induced effects.Although moxibustion also had protective effects in nicotine-induced offspring lungs,some of these effects did not reach statistical significance,e.g.,protection against the upregulation ofβ-catenin,the downregulation of PPARγsignaling,and the increase in peak expiratory flow.Conclusion:Maternal EA at ST 36 blocked the PNE-induced changes in key developmental signaling pathways,prevented the PNE-induced changes in lung morphology,and protected pulmonary function.Moxibustion at ST 36 showed similar but weaker protective effects against the PNE-induced changes in the exposed offspring.It is important to note that the mechanism underlying the protective effects of moxibustion at ST 36 may be different from those of EA at ST 36,and further research is needed to understand these differences.

Very early onset perinatal constipation:Can it be cow’s milk protein allergy?

Delayed passage of meconium or constipation during the perinatal period is traditionally regarded as a signal to initiate further work up to evaluate for serious diagnoses such as Hirschsprung’s disease(HD),meconium ileus due to Cystic Fibrosis,etc.The diagnosis of HD particularly warrants invasive testing to confirm the diagnosis,such as anorectal manometry or rectal suction biopsy.What if there was another etiology of perinatal constipation,that is far lesser known?Cow’s milk protein allergy(CMPA)is often diagnosed in infants within the first few weeks of life,however,there are studies that show that the CMPA allergen can be passed from mother to an infant in-utero,therefore allowing symptoms to show as early as day one of life.The presentation is more atypical,with perinatal constipation rather than with bloody stools,diarrhea,and vomiting.The diagnosis and management would be avoidance of cow's milk protein within the diet,with results and symptom improvement in patients immediately.Therefore,we discuss whether an alternative pathway to address perinatal constipation should be further discussed and implemented to potentially avoid invasive techniques in patients.This entails first ruling out CMPA with safe,noninvasive techniques with diet modification,and if unsuccessful,then moving forward with further diagnostic modalities.

Reducing psychiatric illness in the perinatal period:A review and commentary

This brief overview highlights the global crisis of perinatal psychiatric illness(PPI).PPI is a major contributor to many adverse pregnancy,childbirth,and childhood development outcomes.It contributes to billions of dollars in spending worldwide each year and has a significant impact on the individual,their family,and their community.It is also highly preventable.Current recommendations for intervention and management of PPI are limited and vary considerably from country to country.Furthermore,there are several significant challenges associated with implementation of these recommendations.These challenges are magnified in number and consequence among women of color and/or minority populations,who experience persistent and negative health disparities during pregnancy and the postpartum period.This paper aims to provide a broad overview of the current state of recommendations and implementation challenges for PPI and layout a framework for overcoming these challenges.An equityinformed model of care that provides universal intervention for pregnant women may be one solution to address the preventable consequences of PPI on child and maternal health.Uniquely,this model emphasizes the importance of managing and eliminating known barriers to traditional health care models.Culturally and contextually specific challenges must be overcome to fully realize the impact of improved management of PPI.

Evaluation of Perinatal and Developmental Outcomes in Neonates with Abstinence Syndrome Admitted to NICU

Drug abuse by pregnant women is one of the significant problems for mothers and their neonates.This study aimed to investigate the effects of maternal substance use disorder during pregnancy on neonatal developmental criteria.In a case-control study,clinical records of 90 neonates diagnosed with neonatal abstinence syndrome who were admitted to NICU in one of four hospitals affiliated with Shahid-Beheshti University of Medical Sciences in Tehran,Iran between 2017 and 2020 were compared to 90 neonates without neonatal abstinence syndrome(control group).Demographic information and data for neonatal developmental characteristics and complications were extracted from the clinical records of this convenience sample.Data for the type and method of maternal substance use during pregnancy were collected through a telephone call with mothers.Our data showed that the prevalence of drug addiction was 1.8%among pregnant women,and the most common drugs used by mothers were opium(n=45%,50%),amphetamine(n=30%,33%),and methadone(n=14%,16%).Neonates with abstinence syndrome had a higher prevalence of transient tachypnea of the newborn(TTN)(P=0.004),and a prevalence of being admitted to NICU(P=0.05)and for a longer duration(P<0.001).Their mothers had a higher prevalence of having pre-eclampsia(P=0.010).Using morphine vs.amphetamine showed no difference based on their effects on mothers and neonates.Substance use during pregnancy increased the prevalence of pregnancy complications(pre-eclampsia)and neonatal complications(TTN and prevalence and duration of hospitalization).Therefore,planning for the development of health policies to raise awareness among women and more broadly,all members of the community,is important to prevent the tendency to engage in this potentially high-risk behavior.

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.

Consumptive Hypothyroidism: T3 or Not T3, That Is the Question

Consumptive hypothyroidism is often the clinical condition that results from neoplasms producing their own selenodionases that convert T4 needed to be converted to active T3 into an active form of thyroid hormone, rT3. This often requires treatment with high doses of IV T4, with or without doses of T3 as well, until the neoplasm is treated. This principle is demonstrated in the below case of a 65 y/o female with medical history significant for Ia Kappa multiple myeloma, complete heart block s/p AICD placement, and papillary thyroid cancer status post thyroidectomy in 2020, who had initially presented with persistent bone pain, progressive encephalopathy and failure to thrive with more than a 50 lb weight loss over a few months. Labs on presentation were not remarkable for progression of her underlying multiple myeloma, however, she was found to have a new significantly elevated TSH. She underwent imaging with a CT chest, abdomen, and pelvis, which showed new hepatic lesions, subcutaneous nodules, and new pulmonary nodules with associated lymphadenopathy and a left-sided pleural effusion. CT-guided liver biopsy evinced a metastatic neuroendocrine carcinoma, further supported by an elevated calcitonin and chromogranin. She was treated with high dose IV T4 at 1.38 mcg/kg however continued to worsening thyroid function labs. She was then started on Liothyronine at 20 mcg and subsequently improved. This patient’s case illustrates the importance of considering consumptive hypothyroidism when thyroid profile abnormalities and symptoms of severe hypothyroidism are seen in the context of malignant neoplasms, and further illustrates the important of considering T3 as part of the treatment regimen when IV T4 is not resulting in improvement.

Diabetes mellitus and hypothyroidism: Strange bedfellows or mutual companions?

Clinicians should be cognizant of the close relationship that exists between two of the most common endocrine disorders, primary hypothyroidism and diabetes mellitus. This applies to patients with both type 1 and type 2 diabetes mellitus(T1DM and T2 DM respectively). However, the association is greater in T1 DM, probably because of the shared autoimmune predisposition. In patients with T2 DM, the relationship is somewhat weaker and the explanation less clear-cut. Factors such as dietary iodine deficiency, metformin-induced thyroid stimulating hormone suppression and poor glycemic control may all be implicated. Further translational research is required for greater clarification. Biochemical screening for abnormal thyroid function in individuals who have diabetes is warranted, particularly in females with T1 DM, and therapy with L-thyroxine appropriately instituted if hypothyroidism is confirmed.

Spontaneous ovarian hyperstimulation syndrome and pituitary hyperplasia mimicking macroadenoma associated with primary hypothyroidism

We report an unusual case of spontaneous ovarian hyperstimulation syndrome and pituitary hyperplasia mimicking macroadenoma in an adult,non-pregnant woman.Her condition was triggered by unrecognized primary hypothyroidism,which regressed after thyroid hormone replacement therapy.This case highlights the need for clinicians and radiologists to familiarize themselves with the clinical and imaging features detected in case of these complications of primary hypothyroidism,which are not well known in the medical and radiological profession.Such improved knowledge will help avoid delays in diagnosis,progression to lifethreatening complications,and unnecessary surgery.

Subclinical Hypothyroidism and Isolated Hypothyroxinemia during Pregnancy and Their Association with Pregnancy Outcome: A 2-Year Study

INTRODUCTION: Overt hypothyroidism in pregnancy is associated with adverse outcomes, but the effects of subclinical hypothyroidism and isolated hypothyroxinemia on pregnancy outcomes are still controversial. Subclinical hypothyroidism might be associated with preterm delivery, low Apgar score, fetal death and miscarriages and isolated hypothyroxinemia with preterm labor, high birth weight and neurocognitive deficits in children. Other studies show no association with any complications at all. In the present study we tried to estimate whether maternal subclinical hypothyroidism and isolated hypothyroxinemia are associated with complications during pregnancy in our population which represents the pregnant population of Western Greece. METHODS: In a total of 469 pregnant women, third trimester serum was assayed for thyroid-stimulating hormone (TSH) and free thyroxine (free T4). Thyroid hypofunction was defined as 1) subclinical hypothyroidism with TSH levels above 3 mIU/L for the 3rd trimester and normal free T4 and 2) isolated hypothyroxinemia with TSH levels below 3 mIU/L for the 3rd trimester and free T4 below the 5th percentile. The results were associated with birth weight, week of labor, history of miscarriages and demographic characteristics. Patients with thyroid hypofunction were compared with euthyroid patients (TSH and free T4 between normal limits). The results were analyzed with one-way ANOVA and χ2 test. RESULTS: Subclinical hypothyroidism was documented in 10.9% and isolated hypothyroxinemia in 21.7% of pregnant women. Subclinical hypothyroidism was not associated with birth weight, week of labor, or history of miscarriages. On the contrary, hypothyroxinemia was associated with high birth weight (P < 0.05). CONCLUSION: In our study, we did not find a link between subclinical hypothyroidism and adverse pregnancy outcomes. Similarly, hypothyroxinemia was not associated with pregnancy complications. However, it was associated with higher birth weight. Our studies contribute to our understanding, whether or not subclinical hypothyroidism and isolated hypothyroxinemia are associated with pregnancy adverse outcomes and whether treatment and test for hypothyroidism should become routine during pregnancy.

Effect of treatment of overt hypothyroidism on insulin resistance

AIM: To investigate the impact of hypothyroidism and thyroxine therapy on insulin sensitivity in patients with overt hypothyroidism.METHODS: The study included twenty seven overtly hypothyroid and fifteen healthy euthyroid South Western Asian females.Both groups had matching age and body mass index.Physiological and pathological conditions as well as medications that may alter thyroid function,glucose homeostasis or serum lipids were ruled out.Serum thyrotropin(TSH),free tetraiodothyronine(FT4),free triiodothyronine(FT3),fasting insulin(FI),fasting plasma glucose(FPG),total cholesterol and triglycerides were measured before and six months after initiating thyroxine therapy for hypothyroid patients and once for the control group.Insulin resistance(IR) was estimated using homeostasis model assessment(HOMA-IR) and Body mass index(BMI) was calculated.RESULTS: Both study groups,hypothyroid patients and euthyroid control subjects,had matching age and body mass index(P-value 0.444,0.607 respectively).No significant difference was found between the hypothyroid patients and the euthyroid control group regarding fasting plasma glucose,fasting insulin,insulin resistance,total cholesterol and triglycerides(P-values 0.432,0.621,0.883,0.586,0.05 respectively).In the hypothyroid patients,triglycerides showed direct correlation to TSH and inverse correlation to FT3.Similarly total cholesterol inversely correlated to FT3 but its direct correlation to TSH did not reach statistical significance.After thyroxine replacement and reaching an euthyroid state as confirmed by clinical and laboratory data,there was no significant change in fasting plasma glucose,insulin resistance or triglyceride level(P-value 0.216,0.204,0.175 respectively) while total cholesterol significantly decreased(P-value 0.043) and fasting insulin significantly increased(P-value 0.047).CONCLUSION: Hypothyroidism has no impact on insulin sensitivity.Correction of hypothyroidism is not associated with a significant change of insulin sensitivity or triglycerides,but with a significant reduction of total cholesterol.

Hypothyroidism in patients with autoimmune pancreatitis

AIM To examine thyroid function and clinical features of hypothyroidism in autoimmune pancreatitis(AIP) patients.METHODS We examined thyroid function in 77 patients with type 1 AIP(50 males, 27 females; median age 68 years, range 33-85) diagnosed according to the Japanese diagnostic criteria for AIP 2011. We compared clinical and serological findings between patients with and without various categories of hypothyroidism. The change in hypothyroidism after steroid therapy was also examined. RESULTS Eight patients(10%) had hypothyroidism of 6 patients had subclinical hypothyroidism with a normal serum free thyroxine(FT4) and high thyroid stimulating hormone(TSH) level, and 2 patients had central hypothyroidism with low serum free triiodothyronine(FT3), FT4 and TSH levels. A significant goiter of the thyroid was not observed in any patient. There were no significant differences in age; male to female ratio; serum concentrations of IgG and IgG 4-related disease(IgG4-RD); presence of antithyroglobulin antibody, antinuclear antigen or rheumatoid factor; or presence of extrapancreatic lesions between the 6 patients with subclinical hypothyroidism and patients with euthyroidism. After steroid therapy, both subclinical and central hypothyroidism improved with improvement of the AIP.CONCLUSION Hypothyroidism was observed in 8(10%) of 77 AIP patients and was subclinical in 6 patients and central in 2 patients. Further studies are necessary to clarify whether this subclinical hypothyroidism is another manifestation of IgG4-RD.