Iodine Nutrition, Thyroid-stimulating Hormone, and Related Factors of Postpartum Women from three Different Areas in China: A Cross-sectional Survey

Objective Studies on the relationship between iodine,vitamin A(VA),and vitamin D(VD)and thyroid function are limited.This study aimed to analyze iodine and thyroid-stimulating hormone(TSH)status and their possible relationships with VA,VD,and other factors in postpartum women.Methods A total of 1,311 mothers(896 lactating and 415 non-lactating)from Hebei,Zhejiang,and Guangxi provinces were included in this study.The urinary iodine concentration(UIC),TSH,VA,and VD were measured.Results The median UIC of total and lactating participants were 142.00µg/L and 139.95µg/L,respectively.The median TSH,VA,and VD levels in all the participants were 1.89 mIU/L,0.44μg/mL,and 24.04 ng/mL,respectively.No differences in the UIC were found between lactating and non-lactating mothers.UIC and TSH levels were significantly different among the three provinces.The rural UIC was higher than the urban UIC.Obese mothers had a higher UIC and a higher prevalence of excessive TSH.Higher UICs and TSHs levels were observed in both the VD deficiency and insufficiency groups than in the VD-sufficient group.After adjustment,no linear correlation was observed between UIC and VA/VD.No interaction was found between vitamins A/D and UIC on TSH levels.Conclusion The mothers in the present study had no iodine deficiency.Region,area type,BMI,and VD may be related to the iodine status or TSH levels.

Analysis of the value and safety of thyroid-stimulating hormone in the clinical efficacy of patients with thyroid cancer

BACKGROUND Thyroid cancer(TC)is a common malignant tumor in the endocrine system.In recent years,the incidence and recurrence rates of TC have been raising due to increasing work pressure and irregular lifestyles.Thyroid-stimulating hormone(TSH)is a specific parameter for thyroid function screening.This study aims to explore the clinical value of TSH in regulating the progression of TC,so as to find a breakthrough for the early diagnosis and treatment of TC.AIM To explore the value and safety of TSH in the clinical efficacy of patients with TC.METHODS 75 patients with TC admitted to the Department of Thyroid and Breast Surgery of our hospital from September 2019 to September 2021 were selected as the observation group,and 50 healthy subjects were selected as the control group during the same period.The control group was treated with conventional thyroid replacement therapy,and the observation group was treated with TSH suppression therapy.The soluble interleukin(IL)-2 receptor(sIL-2R),IL-17,IL-35levels,free triiodothyronine(FT3),free tetraiodothyronine(FT4),CD3+,CD4+,CD8+,CD44V6,and tumor supplied group of factor(TSGF)levels were observed in the two groups.The occurrence of adverse reactions was compared between the two groups.RESULTS After treatment with different therapies,the levels of FT3,FT4,CD3+,and CD4+in the observation group and the control group were higher than those before treatment,while the levels of CD8+,CD44V6,and TSGF were lower than those before treatment,and the differences were statistically significant(P<0.05).More importantly,the levels of sIL-2R and IL-17 in the observation group were lower than those in the control group after 4 wk of treatment,while the levels of IL-35 were higher than those in the control group,and the differences were statistically significant(P<0.05).The levels of FT3,FT4,CD3+,and CD4+in the observation group were higher than those in the control group,and the levels of CD8+,CD44V6,and TSGF were lower than those in the control group.There was no significant difference in the overall incidence rate of adverse reactions between the two groups(P>0.05).CONCLUSION TSH suppression therapy can improve the immune function of patients with TC,lower the CD44V6 and TSGF levels,and improve serum FT3 and FT4 levels.It demonstrated excellent clinical efficacy and a good safety profile.

Correlation analysis of serum thyroglobulin,thyroid-stimulating hormone levels,and thyroid-cancer risk in thyroid nodule surgery

BACKGROUND Thyroglobulin(Tg)is one of the markers of thyroid cancer,and its concentration may be elevated in patients with malignant thyroid tumors.Thyroid-stimulating hormone(TSH)is secreted by the pituitary gland,which has a significant impact on thyroid gland function.Excessively high or low TSH levels may be associated with an increased risk of thyroid cancer.Thus,in-depth studies on the association of serum Tg and TSH levels with thyroid cancer risk in patients with thyroid nodules are warranted.This can help determine whether Tg and TSH levels can predict the degree of malignancy of thyroid nodules,which can in turn guide doctors in making accurate diagnoses and treatment decisions.Furthermore,such studies can provide more accurate diagnostic methods for thyroid nodules and help patients become aware of the presence of thyroid cancer as early as possible,thereby improving the success rate of treatment and prognosis.AIM To investigate the association of serum Tg and TSH levels with the risk of thyroid cancer in patients undergoing thyroid nodule surgery.METHODS The clinical data and laboratory examination results of 130 patients who underwent thyroid nodule surgery were retrospectively analyzed.Furthermore,their preoperative serum Tg and TSH levels were recorded.Histopathological examination conducted during follow-up revealed the presence of thyroid cancer.Correlation analysis were used to analyze the association of Tg and TSH levels with the risk of thyroid cancer.RESULTS Of the 130 patients,60 were diagnosed with thyroid cancer.Statistical analysis revealed a significant positive correlation between serum Tg levels and the risk of thyroid cancer(P<0.05).This suggests that high serum Tg levels are associated with an increased risk of thyroid cancer.However,no significant correlation was observed between serum TSH levels and the risk of thyroid cancer(P>0.05).CONCLUSION In patients who underwent thyroid nodule surgery,serum Tg levels exhibited a significant correlation with the risk of thyroid cancer but serum TSH levels did not.These findings suggest that serum Tg can serve as an important biomarker for assessing the risk of thyroid cancer in these patients.

Comprehensive treatment of thyroid-stimulating hormone(TSH)-secreting pituitary adenoma:one case report

Thyroid-stimulating hormone(TSH)-secreting pituitary adenoma is a rare type in all pituitary tumors.Recently we treated a TSH-secreting pituitary tumor in our hospital.The patient had been treated for hyperthyroidism,in which methimazole had been prescribed for 10 years,but the symptoms had not been alleviated.MRI imaging demonstrated the typical features of a sellar tumor,and the diameter was approximately 2.7 cm.Based on the laboratory studies:T3 at 6.27 nmol/L,T4 at 260.10 nmol/L,FT3 at 17.22 pmol/L,FT4 at 76.06 pmol/L,TSH at 9.93 Mu/L,the patient was diagnosed with a TSH-secreting pituitary tumor and central hyperthyroidism.After the patient was given octreotide for one week,he received resection of tumor via single-nostril transsphenoidal approach.After discharge,the patient received the radiation therapy two courses about 20 days.Through the comprehensive treatment of surgery,radiotherapy and drugs,the patient received a satisfactory result.

Thyroid-stimulating hormone-thyroid hormone signaling contributes to circadian regulation through repressing clock2/npas2 in zebrafish

Thyroid-stimulating hormone(TSH)is important for the thyroid gland,development,growth,and metabolism.Defects in TSH production or the thyrotrope cells within the pituitary gland cause congenital hypothyroidism(CH),resulting in growth retardation and neurocognitive impairment.While human TSH is known to display rhythmicity,the molecular mechanisms underlying the circadian regulation of TSH and the effects of TSH-thyroid hormone(TH)signaling on the circadian clock remain elusive.Here we show that TSH,thyroxine(T4),triiodothyronine(T3),and tshba display rhythmicity in both larval and adult zebrafish and tshba is regulated directly by the circadian clock via both E′-box and D-box.Zebrafish tshba^(−/−)mutants manifest congenital hypothyroidism,with the characteristics of low levels of T_(4)and T_(3)and growth retardation.Loss or overexpression of tshba alters the rhythmicity of locomotor activities and expression of core circadian clock genes and hypothalamic-pituitary-thyroid(HPT)axis-related genes.Furthermore,TSH-TH signaling regulates clock2/npas2 via the thyroid response element(TRE)in its promoter,and transcriptome analysis reveals extensive functions of Tshba in zebrafish.Together,our results demonstrate that zebrafish tshba is a direct target of the circadian clock and in turn plays critical roles in circadian regulation along with other functions.

Efficacy of the long-acting octreotide formulation in patients with thyroid-stimulating hormone-secreting pituitary adenomas after incomplete surgery and octreotide treatment failure

Background Little information about the current management of patients with thyroid-stimulating hormone （TSH）-secreting pituitary adenomas or about the usefulness of the somatostatin analogue octreotide was contained in the literature. This study aimed to report the efficacy and safety of the long-acting octreotide formulation in patients with TSH-secreting pituitary adenomas after incomplete surgery and octreotide treatment failure. Methods Fifteen patients with TSH-secreting pituitary adenomas （8 men and 7 women）, who previously underwent incomplete surgical resection and/or adjuvant radiotherapy （n=12） and failure of octreotide treatment （n=15）, followed between 2007 and 2010 in Beijing Tiantan Hospital were included in this study. All patients received 1- to 2-months of the long-acting octreotide formulation treatment after the above combination of treatment. Paired samples t-test was used to analysis the variables. Results After two-month duration of the long-acting octreotide formulation treatment, the mean serum free or unbound thyroxine （FT4） （（16.02±1.72） pmol/L） and free triiodothyronine （FT3） （（2.87±0.43） pmol/L） levels of 15 patients significantly decreased compared with those after octreotide-treatment （FT4, （35.36±7.42） pmol/L, P 〈0.001; FT3, （17.85±7.22） pmol/L, P 〈0.001）. Mean TSH levels stayed in the normal range after the long-acting octreotide formulation treatment （（0.72±0.21） mUlL） and were significantly lower than the pretreatment value （（5.27±1.04） mUlL, P 〈0.001）, post-surgery value （（3.37±0.31） mU/L, P 〈0.001） and post-octreotide-treatment value （（4.52±0.41） mU/L, P 〈0.001）. In these patients with TSH-secreting pituitary adenomas there was no evidence of tachyphylaxis. Conclusion The long-acting octreotide formulation may be a useful and safe therapeutic tool to facilitate the medical treatment of TSH-secreting pituitary adenomas in patients who underwent incomplete surgery or need long-term somatostatin analog therapy.

Enzyme-loaded liposome with biocatalytic precipitation for potentiometric immunoassay of thyroid-stimulating hormone in thyroid carcinoma

A simple and feasible potentiometric immunosensing platform based on enzymatic biocatalytic precipitation technique was designed for the sensitive detection of thyroid-stimulating hormone(TSH;a typical kind of biomarkers for thyroid carcinoma),using horseradish peroxidase(HRP)-loaded liposome for the signal amplification.To construct such an assay system,a sandwich-type immunoreaction was readily carried out on monoclonal anti-TSH capture antibody-coated electrode by using polyclonal antiTSH secondary antibody-conjugated HRP-loaded liposome.Accompanying the formation of sandwichtype immunocomplex,the carried liposome was lysed through the added Triton X-100 to release the entrapped HRP molecules,which catalyzed the oxidation of 4-chloro-1-naphthol to produce an insoluble and uncharged organic precipitation on the electrode surface,thereby causing the change of the local electrical potential.Two labeling protocols with and without the liposome were investigated for detection of target TSH,improved analytical features were achieved with HRP-entrapped liposome.Under optimal conditions,the potentiometric immunosensor had good responses for TSH detection within the linear range of 0.01-30 p IU/mL at a detection limit of 0.0067 p IU/mL.Good reproducibility,high specificity and long-time stability were acquired during the assay procedure.Importantly,a wellmatched accuracy between the potentiometric immunosensor and commercial human TSH ELISA kit was gave for the analysis of human serum samples.

The effects of thyroid-stimulating hormone,estradiol and prolactin on sodium/iodide symporter mRNA expression in mouse lactating mammary gland cells under different iodine levels

Objective The present study investigated the sodium/iodide symporter mRNA expression in mouse lactating mammary gland cells under different iodine levels and the effects of thyroid-stimulating hormone(TSH),estradiol(E2)and prolactin(PRL)on NIS mRNA expression in mouse lactating mammary gland cells.

Drug-Induced Hypothyroidism during Anti-Tuberculosis Treatment of Multidrug-Resistant Tuberculosis: Notes from the Field

We followed 188 euthyroidic persons undergoing treatment for multidrug resistant tuberculosis (MDR-TB) in the state of Karnataka, India to determine the incidence of hypothyroidism during anti-tuberculosis treatment. Overall, among MDR-TB patients with valid thyroid stimulating hormone (TSH) values, about 23% developed hypothyroidism (TSH value ≥10 mIU/ml) during anti-tuberculosis treatment;the majority (74%) occurring after 3 months of treatment. Among 133 patients who received a regimen that contained ethionamide, 42 (32%) developed hypothyroidism. Among 17 patients that received a regimen that contained para-aminosalicylate sodium, 6 (35%) developed hypothyroidism. Among 9 HIV positive patients on antiretroviral treatment, 4 (44%) developed hypothyroidism. These results differ from previously reported 4% incidence of hypothyroidism amongst patients who passively reported thyroidal symptoms during treatment, suggesting routine serologic monitoring of TSH throughout the course of treatment for MDR-TB is warranted.

Optimal Threshold of Stimulated Serum Thyroglobulin Level for ^(18)F-FDG PET/CT imaging in Patients with Thyroid Cancer

This study was to explore the optimal threshold of thyroid-stimulating hormone(TSH)-stimulated serum thyroglobulin(s-Tg) for patients who were to receive18F-fluorodeoxyglucose(18F-FDG) PET/CT scan owing to clinical suspicion of differentiated thyroid cancer(DTC) recurrence but negative post-therapeutic 131I whole-body scan(131I-WBS). A total of 60 qualified patients underwent PET/CT scanning from October 2010 to July 2014. The receiver operating characteristic(ROC) curve analyses showed that s-Tg levels over 49 μg/L led to the highest diagnostic accuracy of PET/CT to detect recurrence, with a sensitivity of 89.5% and a specificity of 90.9%. Besides, bivariate correlation analysis showed positive correlation between s-Tg levels and the maximum standardized uptake values(SUVmax) of18F-FDG in patients with positive PET/CT scanning, suggesting a significant influence of TSH both on Tg release and uptake of18F-FDG. So, positive PET/CT imaging is expected when patients have negative 131I-WBS but s-Tg levels over 49 μg/L.

Nerve cell apoptosis in patients with post-stroke depression

Objective:To study the relationship of serum thyroid-stimulating hormone (TSH) levels with neurotransmitters, neurotrophic state and nerve cell apoptosis in patients with post-stroke depression (PSD).Methods: Patients with ischemic stroke who were treated in our hospital between June 2014 and October 2016 were selected, and according to the HAMD-17 score at 14 days after onset, the enrolled patients were divided into into the post-stroke depression group (PSD group) and stroke group (PS group). Serum levels of TSH, neurotransmitters, neurotrophic cytokines and apoptotic molecules were detected.Results: Serum TSH, 5-HT, NE, DA, BDNF and NGF levels of PSD group were significantly lower than those of PS group while Bax, FasL, Fas and Caspase-3 levels were significantly higher than those of PS group;5-HT, NE, DA, BDNF and NGF levels of PSD group of patients with low TSH were significantly lower than those of PSD group of patients with normal TSH while Bax, FasL, Fas and Caspase-3 levels were significantly higher than those of PSD group of patients with normal TSH.Conclusion:The decrease of serum TSH level in patients with PSD can affect neurotransmitters, neurotrophic state and nerve cell apoptosis.

Atypical pituitary hormone–target tissue axis

A long-held belief is that pituitary hormones bind to their cognate receptors in classical target glands to actuate their manifold functions.However,a number of studies have shown that multiple types of pituitary hormone receptors are widely expressed in non-classical target organs.Each pituitary gland-derived hormone exhibits a wide range of nonconventional biological effects in these non-classical target organs.Herein,the extra biological functions of pituitary hormones,thyroid-stimulating hormone,follicle-stimulating hormone,luteinizing hormone,adrenocorticotrophic hormone,and prolactin when they act on non-classical organs were summarized,defined by the novel concept of an“atypical pituitary hormone–target tissue axis.”This novel proposal explains the pathomechanisms of abnormal glucose and lipid metabolism,obesity,hypertension,fatty liver,and atherosclerosis while offering a more comprehensive and systematic insights into the coordinated regulation of environmental factors,genetic factors,and neuroendocrine hormones on human biological functions.The continued exploration of the physiology of the“atypical pituitary hormone–target tissue axis”could enable the identification of novel therapeutic targets for metabolic diseases.

Thyroid function of twin-pregnant women in early pregnancy

Background: Serum human chorionic gonadotrophin (hCG) is higher in twin than that in singleton pregnancies. As hCG stimulates the thyroid to produce more free thyroxine (FT4), which may lead to decreased thyroid-stimulating hormone (TSH) levels, the reference ranges of thyroid-related indicators may differ between singleton and twin pregnancies in the first trimester. This study aimed to establish reference ranges for thyroid-related indicators in early twin pregnancies and to compare them with singleton pregnancies. Methods: Data of 820 twin-pregnant women were extracted from the established database of all pregnant women who delivered at Peking University First Hospital from October 2013 to May 2018;160 who met National Academy of Clinical Biochemistry criteria were included to establish TSH and FT4 reference ranges. We screened 480 (3:1 paired) women with singleton pregnancies from the same database as controls. The Mann-Whitney test for TSH and FT4 levels was applied for comparisons between singleton and twin pregnancies. Results: First-trimester reference ranges (4–12 gestational weeks) for twin pregnancies were: TSH 0.69 (0.01–3.35) mIU/L and FT4 16.38 (12.45–23.34) pmol/L. Median TSH was significantly lower at 7 to 12 gestational weeks than that at 4 to 6 gestational weeks (0.62 vs. 0.96 mIU/L, Z =-1.964, P = 0.049);FT4 was not significantly different between the two groups. Compared to singleton pregnancies, median TSH was significantly lower (0.69 vs. 1.27 mIU/L, Z =-6.538, P = 0.000), and FT4 was significantly higher (16.38 vs. 14.85 pmol/L, Z =-7.399, P = 0.000) in twin pregnancies in the first trimester. Conclusions: Specific reference ranges for thyroid-related indicators for twin pregnancies are needed to avoid a misdiagnosis of thyroid dysfunction. Moreover, establishment of separate reference ranges for 4 to 6 and 7 to 12 gestational weeks in twin pregnancies may be considered.

Ningbo thyroid dysfunction prevalence study： a cross-sectional survey in an employees-cohort

Background The prevalence and the spectrum of thyroid dysfunction in the mainland of China are not adequately understood. We performed a population-based study to determine the prevalence of major thyroid dysfunctions including overt and subclinical hyper- and hypothyroidism in a stable cohort. Methods All active and retired employees aged 20 years and older （11 067） of Sinopec Zhenhai Refining ＆ Chemical Company in Ningbo participated in the cross-sectional survey with a questionnaire and blood samples. Results A total of 10 405 individuals attended for screening. Using biochemical definitions 95.5% were euthyroid. The prevalence of former diagnosed hyperthyroidism was 1.1% in females and 0.4% in males, hypothyroidism 1.7% and 0.3%, and thyroid surgery 1.2% and 0.3%, respectively. In both sex the prevalence increased with age. Twenty-four percent of individuals with thyroid surgery or medications had abnormal thyroid-stimulating hormone （TSH） levels. In individuals without a history of thyroid disease, the prevalence of pathological TSH values in females and males were TSH 〉10 mU/L 0.60% and 0.29%; TSH 4.8-9.9 mU/L 5.71% and 2.25%; TSH 〈0.3 mU/L 0.87% and 0.41%, respectively. Overt hyper- and hypothyroidism were uncommon （0.2%, 0.3%, respectively）. The prevalence of subclinical hyper- and hypothyroidism was 0.4% and 3.4%, respectively. Subclinical hypothyroidism was more common in females （male 2.4% vs. female 5.8%, P 〈0.001） and with increasing age （P 〈0.001）. Conclusions The prevalence of thyroid dysfunction is 4.5% in the cohort. Among individuals with thyroid medications or surgery, only 75.7% were within the normal range of TSH. These results indicate that thyroid dysfunction is common in Chinese adults.

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.