Hypoglycemia in relation to thyroid diseases: A retrospective cohort study

There is the recognition of a pattern of elevations of serum enzymes in hyperthyroid and hypothyroid patients. The aims of this study were to determine the activities of serum creatine kinase (CK) and lactate deydrogenase (LDH) in thyroid disorders, and to evaluate the relationship between CK, LDH and FT4, and TSH levels. In this retrospective study, thyroid function tests, serum CK and LDH activities were obtained from the medical records of newly diagnosed hyperthyroid and hypothyroid patients attending the Endocrinology Clinic at the University Hospital of the West Indies from 2005- 2009. Elevation of CK activity was found in 5 patients (28%, 5/18) with overt hypothyroidism and in 12 patients (24.0%, 12/50) with subclinical hypothyroidism. The mean CK activity in subclinical hypothyroid patients was 179.80 ± 125.68 U/L compared with 389.901 ± 381.20 U/L in overt hypothyroid patients. The elevation of LDH activity was found in 6 patients (33.3%, 6/18) with overt hypothyroidism and in 37 patients (74.0%, 37/50) with subclinical hypothyroidism. In the hypothyroid patients, a positive correlation was found between CK activity and TSH (r = 0.292, P = 0.015), and a negative correlation between CK activity and FT4 (r = - 0.325, P = 0.007); and between FT4 and TSH (r = - 0.371, P = 0.002). The significant elevation in serum CK and LDH activities indicates that these can be used as parameters for screening hypothyroid patients but not hyperthyroid patients.

Background The deficiency of vitamin D3 (VD) is a universal health issue, its role in different kind of diseases is being studied recently. However, its role in thyroid diseases is not well established yet. This study aims to determine the impact of VD in the pathogenesis of hypothyroidism and hyperthyroidism. Method. Three hundred Iraqi females with age ranged between 30 and 55 years participate in this research, 100 of them were hypothyroid patients, 100 females were hyperthyroid patients and the other 100 females were healthy volunteers served as controls. Thyroid hormones, VD, liver function parameters, and kidney function parameters were determined using different analysis techniques. Results. The levels of VD were significantly decreased in both hypothyroid and hyperthyroid patients (19.644 ± 10.524 for hypothyroid patients and 22.712 ± 11.249 for hyperthyroid patients vs. 30.880 ± 2.587 for controls, p <0.0001). Liver function parameters were within the normal ranges in all the patients. Creatinine and uric acid were within the normal ranges, while urea was significantly increased and out of the normal clinical range in both hypothyroid and hyperthyroid patients (39.560 ± 9.912 for hypothyroidism patients and 42.460 ±7.171 for hyperthyroid patients vs. 26.920 ± 5.033 for controls, p <0.0001). Conclusion. Vitamin D3 and kidney function tests must be included in the differential detection of thyroid diseases. Still, further investigations are needed to understand the underlying mechanism by which VD affects thyroid hormone regulation.

Altered fibrinolytic parameters and serum lipid profile are strongly related to thyroid dysfunction. To investigate the patterns of the fibrinolytic abnormalities and serum lipid profile in the hypo- and hyperthyroid patients. We also took an aim at studying the relationships between free T4 levels (FT4) and these parameters. Hyperthyroid (n = 30), hypothyroid (n = 20) patients and euthyroid control subjects (n = 30) were evaluated for several fibrinolytic parameters including plasma plasminogen activator inhibitor-1 (PAI-1) and D-dimer (D-D). Serum lipid profile and lipoprotein(a) (Lp(a)) were also measured. We found different patterns of fibrinolytic abnormalities and lipid profile in hypo- and hyperthyroid patients. The hypothyroid patients had low plasma PAI-1 levels and high D-D values as compared to hyperthyroid patients (p < 0.001) and euthyroid control subjects (p < 0.05 and 0.001, respectively). In sharp contrast, the hyperthyroid patients had high plasma PAI-1 levels (p < 0.001) but without concomitant change in plasma D-D values, as compared to the euthyroid control subjects. Hypothyroidism was associated with high total cholesterol, triglycerides, LDL-C and Lp(a) levels and low HDL-C levels as compared to both hyperthyroid and euthyroid states (p < 0.001). FT4 levels were correlated positively with HDL-C but negatively with total cholesterol, triglycerides, LDL-C and Lp(a) levels in both hypo- and hyperthyroid patients. Also FT4 levels were correlated positively with PAI-1 but negatively with D-D in both hypo- and hyperthyroid patients (p < 0.02, 0.01, 0.001 and 0.03 respectively). We found hyperfibrinolytic, and hypofibrinolytic patterns in hypothyroid, hyperthyroid patients, respectively. The hypothyroid patients had atherogenic lipid profile. These variations indicate possible pathophysiologic roles for thyroid hormones in the regulation of the fibrinolytic system and lipid profile. Mechanisms of these variations are open for future investigations.

Although hypo- and hyperthyroid patients have different symptoms in the gastrointestinal tract, the mechanism of thyroid action on the gut remains poorly understood. Thus the aim of this study was to investigate the effect of hypo- and hyperthyroidism on gastric myoelectrical activity, gastric emptying, dyspeptic symptoms. Twenty-two hyperthyroid (median age 45, 15 females) and 11 hypothyroid (median age 42, 10 females) patients were included into the study. Dyspepsia score, hypo- and hyperthyroid symptom scale, abdominal ultrasonography and upper gastrointestinal endoscopy were performed. Gastric myoelectrical activity was measured by electrogastrograpy (EGG) before and after therapy both preprandially and postprandially and compared with age, gender, and body-matched controls (12 for hypothyroid, 15 for hyperthyroid patients). Radionuclide gastric emptying studies were performed with a solid meal. Hypothyroid patients revealed a significant increase in preprandial tachygastria as compared with controls (12.3% vs 4.8%). The percentage of preprandial normal slow waves (2.4-3.7 cpm) was below 70% (dysmotility) in 7 of 11 hypothyroid patients versus 2 of 12 controls (P < 0.05). Hyperthyroid patients revealed a significantly higher preprandial (3.1 vs 2.8) and postprandial (3.4 vs 3) DF when compared with the controls (P < 0.05). A higher percentage of postprandial taschygastria (7.9 vs 0) was present in hyperthyroid patients than in the controls (P < 0.05). The decrease on postprandial EGG power (power ratio < 1) was observed in 7 patients the in hyperthyroid group and 1 in controls (P < 0.05). The percentage of postprandial normal slow waves was below 70% in 10 of 20 hyperthyroid patients vs 1 of 15 controls (P < 0.05). After therapy these differences disappeared in the euthyroid state. The hypo- and hyperthyroid symptom scale correlated to dyspepsia score. Dyspepsia score in hyperthyroidism correlated to power ratios in hyperthyroid patients. We detected some correlations between serum levels of fT3 or fT4 and some EGG parameters in hypo- and hyperthyroidism. Dyspepsia score and hypo- and hyperthyroid symptom scale were improved significantly after therapy in the euthyroid state. In conclusions, we showed gastric dysrhythmia by EGG in both hypo- and hyperthyroid patients. Dyspeptic symptoms correlated to the activity of thyroid disease. After therapy, these findings and dyspeptic symptoms improved in the euthyroid state. Abnormalities of power ratios may be responsible of dyspeptic symptoms in hyperthyroid patients. EGG may be a useful and noninvasive tool for detecting gastric disturbances during hypo- and hyperthyroidism.

Objective To study the relationship between the thyroid dysfunction and coronary artery disease (CAD). Methods Two thousands and twelve patients,diagnosed as CAD by coronary angiography from January 2003 to February 2010 in Peking Union Hospital,were enrolled into this study and divided into normal thyroid function, hyperthyroidism, and hypothyroidism groups. The thyroid function data and the coronary angiography findings were compared among three groups. Results The incidence rates of hypertension (40%vs. 69. 4% vs. 78.6%, x2 = 12. 331, P = 0. 01) and hyperlipemia(20. 0% vs. 67.4% vs. 85.7%, x2 =12. 331 ,P=0. 002) in hyperthyroidism patients were significantly lower than normal thyroid function patients and hypothyroidism patients, but no significant differences were found in the comparison of diabetes incidence rates among three groups (20. 0% vs. 41.6% vs. 35.7%, x2 = 2. 114,P =0. 347). According to the coronary angiography findings, we found that the incidence rate of CAD of hypothyroidism patients was higher than hyperthyroidism patients(71.0% vs. 55. 2%, x2. = 1. 804, P = 0. 179), but the difference didn' t reach statistically significant level. Two hyperthyroidism patients had coronary artery spasm and acute myocardial infarction. Conclusion Hypothyroidism had more promotion effect on coronary artery disease than hyperthyroidism,but higher serum thyroxin level increased the risk of coronary spasm and the probability of acute myocardial infarction,which could be well adjusted by medication treatment. Key words: Thyroid function; Coronary artery disease; Coronary artery spasm

Antidepressant-Resistant Depression in Patients With Comorbid Subclinical Hypothyroidism or High-Normal TSH Levels.

Background: Thyroid dysfunction is a common endocrine disorder that may result from autoimmune, genetic, or infectious causes. Aim: This study aimed to explore the relationship between CMV infection and thyroid dysfunction in relation to anti-thyroid peroxidase (antibody positivity). Methods: A cross-sectional study was conducted in Kirkuk, Iraq, from October 2024 to April 2025. It included 100 patients with thyroid dysfunction (13 hyperthyroid, 87 hypothyroid) and 50 healthy controls. Serum samples were analyzed for TSH, T3, T4, anti-TPO antibodies, and CMV IgM/IgG. Results: CMV seropositivity was significantly associated with thyroid dysfunction (P = 0.038). Among hyperthyroid patients, 30.77% were CMV IgG positive and 7.69% had combined IgM and IgG positivity. In hypothyroid patients, 21.84% were CMV IgG positive and 10.34% showed co-positivity. Anti-TPO antibody positivity was found in 23% of patients. A strong and statistically significant association was observed between Anti-TPO positivity and CMV IgM/IgG co-positivity (34.78% vs. 2.60% in Anti-TPO negatives; P = 0.001). Gender-stratified analysis revealed that CMV IgM/IgG co-positivity was markedly more prevalent in Anti-TPO positive males. Conclusion: The findings indicate a significant relationship between CMV infection and thyroid dysfunction, especially hypothyroidism with autoimmune features. CMV may act as a triggering factor in thyroid autoimmunity.

Aim: To assess the prevalence of Thyroid Eye Disease among thyroid disorder patients. Introduction: Thyroid Eye Disease (TED) is a debilitating autoimmune disorder seen in hyperthyroid, hypothyroid and euthyroid patients. The global prevalence of TED is estimated to be 16 per 100,000 women and 2.9 per 100,000 men in the general population. Common symptoms include dry eyes, eyelid retraction, excessive watering, conjunctival redness and swelling, retro-orbital pain and blurred vision. This study aims to assess the prevalence of TED among dysthyroid patients attending Saveetha Medical College and Hospital, Chennai. Methodolody: The purpose of this study is to find the prevalence of TED among dysthyroid patients attending Saveetha Medical College and Hospital, Chennai during the months of July and August. A detailed history of each patient was taken after which a series of tests were conducted to identify and classify the severity of TED. This was done using NOSPECS (no signs, only signs, soft tissue involvement, proptosis, extraocular muscle involvement, corneal involvement, sight loss) classification. Schirmers test was performed to assess the prevalence of dry eyes among TED patients. Result: 122 patients consisting of 87 females and 35 males were included in this study. 43% (53 patients) were found to have Thyroid Eye Disease. There was no significant difference in prevalence between male and female subjects (43.6% and 42.8% respectively). The presence of TED was far greater in hyperthyroid than in hypothyroid patients. 44 out of 53 patients with TED were hyperthyroid (83%), 7 were hypothyroid (13.2%), and 2 patients were euthyroid (3.7%) . Schirmers test conducted on each patient revealed that 12% of the TED patients suffered from dry eyes. NCT test conducted to find the intraocular pressure in TED patients revealed no significant results. Conclusion: The high prevalence of TED seen in dysthyroid patients in this study calls for increased awareness regarding ocular manifestations in thyroid disorders. Patients should be encouraged to undergo regular checkups to ensure normal functioning of eyes and to prevent progression of the disease.

Serum levels of adhesion molecules ICAM-1 and VCAM-1 and tissue inhibitor of metalloproteinases, TIMP-1, are elevated in patients with autoimmune thyroid disorders: Relevance to vascular inflammation

Serial determinations of plasma and erythrocyte magnesium concentrations were made before and during therapy in 13 hyperthyroid and 12 hypothyroid patients. Plasma magnesium concentrations were initially subnormal in 7 hyperthyroid patients and returned to normal as a response to antithyroid therapy became manifest. In 6 normomagnesemic hyperthyroid patients, plasma magnesium concentrations also tended to increase with therapy. Six hypothyroid patients had supranormal plasma magnesium concentrations prior to therapy. These returned to normal with treatment in 5 patients, but one subject showed a persistent elevation of the plasma magnesium concentration despite a satisfactory response to therapy. A decrease in plasma magnesium concentrations also occurred in the 6 normomagnesemic hypothyroid patients. Pretreatment erythrocyte magnesium concentrations were subnormal in 6 hyperthyroid and one hypothyroid patient. The response of erythrocyte magnesium concentrations to therapy was unpredictable, and increase...

Changes in plasma lipid concentrations are well known metabolic consequences of thyroid dysfunction. The alterations are most prominent in hypothyroidism which is typically associated with pronounced hypercholesterolaemia and frequently with moderate hypertriglyceridaemia. In cases of hypothyroidism, how the serum Lp(a) levels are influenced by thyroid hormone remains unknown and contradictory results on the effect of thyroid hormone on serum Lp(a) levels have been reported. There is substantial evidence to suggest that elevated serum Lp(a) levels contribute significantly to the development of CHD. The present study was designed to determine the lipoprotein(a) [Lp(a)], lipid profile and thyroid hormone levels in newly diagnosed hypothyroid patients and to find any correlation that existed between Lp(a) and other parameters. Untreated hypothyroid (n=50) patients were included in the study. We also included 40 normal healthy subjects as controls. Lipid profile, Lp(a) and thyroid profile were estimated by using autoanalyzers. The results of this study showed that levels of HDL-cholesterol were significantly decreased (p<0.001), whereas those of other lipid parameters and Lp(a) levels were found to be significantly increased (p<0.001) in hypothyroid patients as compared to those in controls. Correlation study revealed a significant positive correlation between Lp(a) and TSH levels in hypothyroid patients. Our present findings indicated that hypothyroidism could be strongly associated with lipid abnormalities that enhanced the development of cardiovascular diseases. Also, Lp(a) and non-HDL-C should be estimated with other lipid parameters as a useful index for measuring the cardiac risk in hypothyroid patients. A recommended screening should be advised for any patient with thyroid dysfunction, especially hypothyroidism, to assess lipid abnormalities by using Lp(a) and non- HDL-C and he/she should treated at the earliest.

SUMMARY The urinary excretion of endogenous and exogenous oestrogens was studied in patients with disordered thyroid function, and in obese and non-obese patients without evident thyroid disease. Hypothyroid patients and obese patients converted a larger percentage of administered oestradiol-17β to urinary oestriol and a lower percentage to urinary oestrone than hyperthyroid patients and non-obese patients. The recovery of administered oestradiol as oestriol, oestrone and oestradiol in urine was the same in the hypothyroid, obese and non-obese patients but considerably lower in the hyperthyroid patients. Similar differences were found in the urinary excretion of endogenous oestrogens. The excretion of endogenous oestrogens varies with the weight of the patient; it was greater in the obese than in the non-obese. The findings indicate that the pathways of oestrogen metabolism are influenced by a number of the factors, including thyroid function, associated with the weight of the patient.

The c-erbAalpha gene encodes two thyroid hormone receptors, TRalpha1 and TRalpha2, that arise from alternative splicing of the TRalpha pre-mRNA. TRalpha2 is not able to bind triiodothyronine (T(3)) and acts as a weak antagonist of TRs. It has been suggested that the balance of TRalpha1 to TRalpha2 is important in maintaining homeostasis. Here, we study the effect of thyroid hormone on the splicing of TRalpha under various conditions in HepG2 cells. First, T(3) was added to HepG2 cells that endogenously express TRalpha. This resulted in a decrease in the TRalpha1:TRalpha2 mRNA ratio after the addition of 10(-)(8 )M or 10(-)(7 )M T(3). Then, HepG2 cells were incubated with sera from hypothyroid or hyperthyroid patients. Sera from hyperthyroid patients (n=6) decreased the TRalpha1:TRalpha2 ratio compared with HepG2 cells incubated with sera from euthyroid patients (n=8). Sera from hypothyroid patients (n=6) had no effect on the TRalpha1:TRalpha2 ratio but supplementation with T(3) caused a decrease in the ratio. Finally, we tested sera from patients with nonthyroidal illness (NTI; n=17) which showed no effect on TRalpha splicing when compared with controls. Free thyroxine levels in sera from hypo-, eu-, and hyperthyroid patients, but not that of NTI patients, were negatively correlated (P<0.01) to the TRalpha1:TRalpha2 ratio. We next studied the expression of the splicing factors hnRNP A1 and ASF/SF2 (SF2) in relation to the splicing of the TRalpha gene. In HepG2 cells incubated with NTI sera a negative relationship was found between the ratio of hnRNP A1:SF2 and the TRalpha1:TRalpha2 ratio. A high hnRNP A1:SF2 ratio is associated with the use of the distal 5'-splice site. The splicing direction should then change towards TRalpha2, which is indeed the case. Rev-ErbA, which is partly complementary to TRalpha2 and could therefore interfere in the splicing process, did not relate to the TRalpha1:TRalpha2 ratio. In conclusion, high T(3) levels induce a low TRalpha1:TRalpha2 ratio which could protect the cell from excessive T(3)-induced gene expression. In vivo, this might be a mechanism to keep tIssues relatively euthyroid during high serum T(3) levels.

Plasma total homocysteine levels in hyperthyroid and hypothyroid patients

Adipose tissue is a hormonally active system that produces and releases different bioactive substances. Leptin, adiponectin and resistin are some of the recently discovered adipocytokines that participate in the regulation of intermediate metabolism. The aim of this study was to evaluate the circulating levels of leptin, adiponectin and resistin in patients with thyroid dysfunction before and after normalization of thyroid function with appropriate therapy. We studied 20 patients with hyperthyroidism (16 women and 4 men; mean age 47.2 +/- 3.9 years) and 20 patients with hypothyroidism (17 women and 3 men; 51.5 +/- 4.1 years). A group of 20 euthyroid subjects served as control group. Patients were evaluated at the time of diagnosis and again after normalization of thyroid function with appropriate therapy. Serum concentrations of free T4 (FT4), total T3, TSH, insulin, leptin, adiponectin and resistin were measured in all subjects. Hyperthyroid patients showed significantly decreased leptin levels in comparison with controls (11.0 +/- 1.1 vs. 30.4 +/- 5.0 microg/l, P < 0.001). No significant differences in adiponectin levels between hyperthyroid and control groups were found (27.8 +/- 4.0 vs. 46.0 +/- 12.0 mg/l, NS). Patients with hyperthyroidism exhibited reduced resistin levels in comparison with euthyroid subjects (6.4 +/- 0.8 vs. 8.4 +/- 0.7 microg/l, P < 0.05). Normalization of circulating thyroid hormone was accompanied by a nonsignificant increase in leptin levels (12.9 +/- 1.7 microg/l, P < 0.01 vs. control) and no significant modification both in adiponectin (32.0 +/- 7.1 mg/l, NS) and resistin (5.4 +/- 0.7 microg/l, NS) levels. Adjustment of adipocytokine concentrations for body mass index (BMI) showed that treatment of hyperthyroidism induced a significant reduction in adjusted resistin concentrations (0.21 +/- 0.03 vs. 0.28 +/- 0.03 microg/l/BMI units, P < 0.05), with no changes in adjusted leptin and adiponectin. Hypothyroid patients showed significantly lower leptin levels compared with the controls (16.0 +/- 3.5 vs. 30.4 +/- 5.0 microg/l, P < 0.05). Adiponectin levels in patients with hypothyroidism (71.8 +/- 16.0 mg/l) were similar to those in the control group and were not modified with therapy. Resistin levels were significantly reduced among hypothyroid patients (5.8 +/- 1.0 microg/l, P < 0.05), and were not increased after levothyroxine therapy. A significant rise in BMI-corrected leptin levels was observed after replacement therapy, with no changes in adiponectin- and resistin-corrected values. The results suggest that (1) low serum leptin levels are present in both hyperthyroid and hypothyroid patients but are only increased after therapy in the latter; (2) resistin might be implicated in the insulin resistance state that accompanies thyrotoxicosis; and (3) inadequate secretion of adiponectin seems to have no role in metabolic changes associated with thyroid dysfunction.