Should Female Patients Undergoing Parathyroid-Sparing Total Thyroidectomy Receive Routine Prophylaxis for Transient Hypocalcemia?

Objective: The objective of the study was to correlate prolactin (PRL) levels with different levels of thyroid-stimulating hormone (TSH).
 Methods: The study included 221 non-pregnant females of the age group of 16–43 years. TSH and PRL were assayed. Subjects were divided into three groups based on TSH levels, namely, low, normal, and high TSH levels and results compared.
 Statistical analysis: The comparison between different groups was done using test ANOVA. Correlation between TSH and PRL was established using Pearson’s correlation test.
 Results: Five subjects in Group-1 with low TSH values (mean 0.096±0.08 μIU/ml) had PRL 9.8±6.25 ng/dl, 186 subjects in Group-2 with normal TSH values (mean 1.98±0.94 μIU/ml) had PRL 16.58±8.78 ng/dl, and in Group-3 with high TSH values (mean 6.45±3.91 μIU/ml) had PRL 26.53±15.98 ng/dl. p value for TSH is <0.001 (significant) and for PRL also is <0.001 (significant). Positive correlation has been found in overall 221 subjects between TSH and PRL with correlation coefficient r=0.239 and p=0.01 (significant).
 Conclusion: PRL levels were higher in group with high TSH values. In most previous studies (subjects with established subclinical or overt hypothyroid), PRL was found higher with higher TSH levels. This study showed strong positive association between TSH and PRL irrespective of the thyroid status.

Objective: To evaluate the incidence of post-hemithyroidectomy hypothyroidism and identify possible risk factors that indicates which patients require thyroid function monitoring after surgery.
 Methods: A prospective study of patients with benign, non-toxic thyroid disease undergoing hemithyroidectomy between January 2017 and July 2019 in the Department of Otolaryngology and Head-Neck Surgery, Sir Salimullah Medical College Mitford Hospital, Dhaka. All patients were in euthyroid state preoperatively.Thyroid specimens were examined for pathological diagnosis and thyroid function was evaluated again six weeks after surgery.
 Results: All had normal preoperative thyroid function. Six weeks after surgery, 10 (22.22%) of the cases developed hypothyroidism (6.66% overt or symptomatic hypothyroidism and 15.56% subclinical hypothyroidism). The mean preoperative TSH level was significantly higher in the hypothyroid group than in the euthyroid group (2.1±1.1 vs 1.3±0.7mIU/L, p<0.01).Seven of patients with preoperative thyroid stimulating hormone (TSH) level more than or equal to 2 mIU/L developed hypothyroidism in comparison to only 3 of those with preoperative TSH <2 mIU/L (odds ratio 11.3).
 Conclusion: Ten (22.22%) patients in the present study developed hypothyroidism after hemithyroidectomy. Preoperative TSH more than or equal 2 mIU/L, elevation of thyroid antibodies and thyroiditiswarrant post-operative close TSH monitoring. Awareness of such risk factors for post-operative hypothyroidism would improve patients care and reduce complications.
 Bangladesh J Otorhinolaryngol; October 2020; 26(2): 95-101

To explore the potential role of serum calcium levels at admission in the expansion of acute traumatic intracerebral hematoma (tICH) and to construct a novel nomogram to predict tICH expansion. In this multicenter retrospective study, 640 and 237 patients were included in the training and validation datasets, respectively. Risk factors for acute tICH expansion were selected by logistic regression analysis. Causal mediation and interaction analysis were used to explore the relationship between serum calcium promotion of tICH expansion and inflammatory response. Receiver operating characteristic, calibration and clinical decision curves were applied to estimate the performance of multivariate models. Low serum calcium level was strongly associated with acute tICH expansion in patients with brain contusion. There was no significant interaction of hypocalcemia across multiple subgroups including sex, age, and coagulation dysfunction. 24.5% of the mechanisms by which hypocalcemia promotes acute tICH expansion can be explained by an inflammatory response. The addition of serum calcium made the modified model (serum calcium plus basic model) more accurate than basic model with subdural hematoma, multihematoma fuzzy sign, time to baseline CT, level on Glasgow Coma Scale score, platelet count, baseline tICH volume ≥ 5 mL, and monocyte-to-lymphocyte ratio. Low serum calcium level is a novel risk factor for acute tICH expansion, the mechanism of which may be mediated in part through the response of immune cell. The online dynamic nomogram provides a user-friendly tool for the prediction of acute tICH expansion.

Traditionally subtotal thyroidectomy has been the preferred operation for benign thyroid diseases such as Grave's disease and multinodular goitre. Towards the end of the 21st century total thyroidectomy has been the operation of choice. However there have been concerns that there is likely to be a larger percentage of patients to suffer from temporary and permanent hypocalcaemia. At the Launceston General Hospital total thyroidectomy has been preferred operation. There has not been an audit previously however anecdotally we do not perceive a high rate of complication. This study was a retrospective analysis of patient data from January 1996 to June 2008. The records for all patients that had undergone a total thyroidectomy for either malignant or benign disease at Launceston General Hospital was collected and reviewed. A total of 159 patients had undergone a total thyroidectomy from January 1996 to June 2008. The operations were performed by 12 different surgeons, however 4 surgeons performed the bulk of the operations (80%). The median age of patients was 54. 82% (130) of the study group were female. 89% (141) of the cases were performed for benign disease of the thyroid. 18% (29) patients had a post‐op calcium level less than 2.0. 7 (4.4%) of patients required long term supplements, however 4 out of the 7 had total thyroidectomies for malignant disease. Total thyroidectomy for benign disease of the thyroid is an operation associated with low mortality and morbidity. Hypocalcaemia is a problem that is encountered with this type of operation. Our results show that we have an acceptable rate of hypocalcaemia post total thyroidectomy, hence an appropriate operation for benign disease of the thyroid.

Prevalence of hypothyroidism in patients with chronic kidney disease: a cross-sectional study from North India

The association of preoperative thyroid-stimulating hormone level and the risk of differentiated thyroid cancer in patients with thyroid nodules: A systematic review and meta-analysis

In September 1979 screening for Congenital Hypothyroidism (C.H.) was started in Greece. As the screening method Thyroid-Stimulating Hormone (TSH) determination in dried blood spots collected on the 5th day of life was chosen. To date 137,207 newborns (65% of all live births in Greece) have been screened. The distribution of TSH levels in a single estimation was as follows: < 12.5μIU/ml 87.7%, 12.5-30μIU/ml 11.4% and > 30μIU/ml 0.9%.Values > 30μIU/ml were confirmed by a second estimation from the initial card in 171 cases, which were recalled for a new blood specimen (recall rate 0.12%). Among them 97 had TSH values between 30 and 50μIU/ml and TSH estimation from a blood spot on a new card 1-3 months later showed TSH values < 12.5μIU/ml. In 41 cases with TSH values 50-80μIU/ml, serum TSH and T4 revealed 4 cases of C.H. (9.7%), while 37 cases had serum TSH and T4 values within normal limits and were considered as Transient Hyperthyrotropinemias (T.H.). Finally among 33 cases with initial TSH values > 80μIU/ml, in 29 (88%) the diagnosis of C.H. was confirmed on biochemical and clinical grounds, while 4 were considered as T.H. The overall incidence of primary C.H. in our population was 1:4,157.

Cardiac arrest is a common cause of death among patients undergoing maintenance hemodialysis; however, the prevalence and risk factors for cardiac arrest in the setting of acute kidney injury (AKI) are not studied in detail. Patients who received hemodialysis for AKI between 2014 and 2024 were classified as those who experienced cardiac arrest during hemodialysis (group A) and patients who had cardiac arrest during hospitalization outside the hemodialysis session (group B). Logistic regression analysis was performed to determine the odds of cardiac arrest during the hemodialysis session versus outside the session. Among the 1702 patients who received hemodialysis for AKI, 33 (0.02%) experienced cardiac arrest at the time of hemodialysis (group A), and 100 (0.06%) had cardiac arrest outside the session (group B). Previous history of atrial fibrillation was more common in group A (39% vs. 19%, p = 0.017). Groups were comparable in terms of oxygen or vasopressor requirement and baseline mean serum creatinine. Metabolic acidosis was more severe, and serum blood urea nitrogen and calcium levels were higher in group B (p < 0.05). Ultrafiltration rates were higher in group A than in group B (mean 10.6 mL/h/kg vs. 6.2 mL/h/kg, p < 0.001). There were more deaths in group A within the first 24 h following cardiac arrest (79% vs. 48%, p < 0.05); however, spontaneous recirculation and overall in-hospital mortality were comparable. In the multivariate regression model, atrial fibrillation (OR = 4.91, 95% CI 1.35-17.8, p = 0.016), lower pre-dialysis serum calcium levels (OR = 2.66, 95% CI 1.25-5.65, p = 0.011), and higher ultrafiltration volume (OR = 10.9, 95% CI 3.90-30.5, p < 0.001) were independently associated with an increased risk of cardiac arrest during hemodialysis sessions. History of atrial fibrillation, lower pre-dialysis serum calcium levels, and higher ultrafiltration volumes are associated with an increased risk of cardiac arrest during hemodialysis than cardiac arrest outside the hemodialysis session in the AKI setting.

BackgroundHypocalcaemia, defined by serum calcium level less than 8.5 mg/dl, could be caused by human immunodeficiency virus (HIV) and diarrheal diseases. In Ethiopia, while morbidities from diarrheal diseases and HIV are serious health problems, studies assessing the interactions amongst of the three do not exist. Therefore, the present study was undertaken to investigate the level of calcium among diarrheic patients with and without HIV co-infection.MethodsConsecutive diarrheic patients attending Gondar University Hospital in Ethiopia were enrolled and screened for HIV, intestinal parasites, Shigella and Salmonella. Concentration of calcium in serum was determined using an inductively coupled plasma mass spectrometer.ResultsA total of 206 diarrheic patients were included in the study (109 = HIV positive, 97 = HIV negative). Intestinal parasites and Shigella species were detected in 32.2% and 8.5% of the patients, respectively. The serum calcium levels in the patients who were found positive for Shigella species or intestinal parasites was not significantly different by the presence or absence of HIV co-infection. HIV infected diarrheic patients had significantly lower mean serum calcium levels (7.82 ± 1.23 mg/dl) than those negative for HIV (8.38 ± 1.97) (P = 0.015). The age groups 25–35 and greater than 45 years showed significantly lower mean serum calcium levels (7.77 ± 1.55 mg/dl) in comparison to the other age groups (7.84 ± 1.41 mg/dl, P = 0.009). On the other hand, females presented with significantly lower mean serum calcium levels (7.79 ± 1.60 mg/dl, P = 0.044) than males (8.26 ± 1.65 mg/dl).ConclusionThere is high prevalence of hypocalcaemia among diarrheic patients in northwest Ethiopia. And HIV stood out to be a major risk factor for development of hypocalcaemia among the diarrheic patients in northwest Ethiopia. Further studies are required to substantiate and characterize the mechanisms and consequences of calcium metabolism disorders among HIV infected individuals in the study area.

Objective To observe the value of thyroid stimulating hormone (TSH) combined with β-human chorionic gonadotropin (β-hCG) in the prediction of preeclampsia (PE) in the first trimester of pregnancy. Methods A retrospectively cohort analysis was performed on 368 pregnant women who had undergone early clinical examination and delivery. The patients were divided into PE group (52 cases) and control group (316 cases) according to whether PE occurred. The general data, thyroid function, β-hCG and pregnancy-associated plasma protein A (PAPP-A) were comparatively analyzed. Using the clinical diagnosis as the golden standard , the receiver operating characteristic (ROC) curves were used to compare the diagnostic value and diagnostic efficacy of those indicators for predicting adverse pregnancy outcomes. Results Univariate analysis showed that pre-pregnancy body mass index [BMI, (24.41±2.11) kg/m2], TSH [(2.79±0.83) mIU/L] and PAPP-A [(1.27±0.28) mIU/L)] levels in PE group were significantly higher than those in control group [(23.72±1.96) kg/m2, (1.99±0.53) mIU/L, (0.98±0.39) mIU/L](P=0.021, 0.000, 0.000), while β-hCG level [(3.06±1.72)×104 IU/L] was significantly lower than that in control group [(5.48±2.29)×104 IU/L](P=0.000). Multivariate logistic regression analysis showed that TSH (OR=15.423, 95% CI=12.963~59.162, P=0.000) and PAPP-A (OR=9.794, 95% CI=4.195~22.867, P=0.000) were independent risk factors for PE, while β-hCG (OR=0.889, 95% CI=0.853~0.927, P=0.000) was a protective factor of PE. ROC curves showed that the area under the curve of TSH and β-hCG (AUC=0.780, 0.788) was higher than that of PAPP-A (AUC=0.705) and pre-pregnancy BMI (AUC=0.575), the Youden index showed that the best cut-off of TSH and β-hCG were TSH≥2.21 mIU/L and β-hCG≤ 3.96×104 IU/L. The diagnostic value of TSH combined with β-hCG (AUC=0.927) was significantly higher than that of TSH or β-hCG alone. The sensitivity of TSH combined with β-hCG in predicting PE was 96.15%, which was significantly higher than that of TSH and β-hCG (χ2=3.983, 4.981; P=0.046, 0.026), while no statistical differences were found in the diagnostic accuracy (χ2=0.363, 3.160; P=0.547, 0.075). Conclusion TSH combined with β-hCG have a high value in the prediction of PE in the first trimester of pregnancy, of which the best cut-off of TSH and β-hCG are TSH≥2.21 mIU/L and β-hCG≤3.96×104 IU/L, respectively. Key words: Thyroid stimulating hormone (TSH); Human chorionic gonadotropin (hCG); Preeclampsia (PE); Eclampsia; Sensitivity; Specificity

Background: Thyroid Stimulating Hormone (TSH) and Free Thyroxin (FT4) concentration are currently highlighted in their relation to thyroid carcinoma development in thyroid nodule patients. This study aimed to identify the difference in the pre-operative mean serum concentration of TSH and FT4 in patients with benign thyroid nodules and thyroid carcinoma at Sanglah General Hospital Denpasar.Methods: : This study was a case-control study that involved 110 patients with thyroid nodules who underwent thyroidectomy at Sanglah General Hospital from January until December 2019, whose specimens were examined histopathologically at the Anatomical Pathology Laboratory of Sanglah General Hospital. Cases were patients with thyroid carcinoma. Controls were patients with benign thyroid nodules. The data were collected from medical records. Results: Most subjects in the thyroid carcinoma group were female (72.7%). The thyroid carcinoma group had a higher mean age at the time of thyroidectomy (47.33 ± 13.4) compared to the benign thyroid nodule group (46.07 ± 12.5) (p = 0.61). Significant difference was found regarding the nodule size between the two groups (p &lt; 0.001). There were no significant differences in terms of nodule lateralization (p = 0.56) and the number of nodules (p = 0.58). Papillary thyroid carcinoma was the most common type of thyroid carcinoma (89.1%). A significantly higher pre-operative mean serum TSH concentration was found in cases (1.0 ± 0.23 IU/mL) compared to controls (0.8 ± 0.23 IU/mL) (p &lt; 0.001). The pre-operative mean serum FT4 concentration was significantly lower in cases (1.1 ± 0.25 IU/mL) compared to controls (1.2 ± 0.22 IU/mL) (p = 0.006). The optimal TSH and FT4 cut-off values for thyroid carcinoma were &gt; 1.0 IU/mL (61% sensitivity, 71% specificity) and &lt; 1.1 IU/mL (61% sensitivity, 51% specificity), respectively Conclusions: : Higher pre-operative mean TSH concentration and lower mean FT4 concentration were found in patients with thyroid carcinoma. There were statistically significant differences between patients with thyroid carcinoma and benign thyroid nodules in terms of these two laboratory parameters.

Levothyroxine Dosage Is Associated with Stability of Thyroid-stimulating Hormone Values

Total thyroidectomy in therapy-resistant Graves' disease.

Although levothyroxine (LT4) replacement therapy for hypothyroidism has been established as safe, inexpensive and effective, many studies from different countries reported out-of-reference range thyroid-stimulating hormone (TSH) values for the hypothyroid patients under LT4 treatment. The aim of this study was to determine TSH levels of primary hypothyroid patients under LT4 treatment and to assess self-reported compliance with daily LT4 intake in tertiary care centers in Turkey. In this cross-sectional, observational study, adult patients with primary hypothyroidism, receiving LT4 treatment for at least 6 months, were included. The patients were from 12 tertiary care centers in 9 cities of Turkey. TSH and free T4 levels were recorded from patient files and self-reported compliance with daily LT4 intake was assessed by interviewing the subjects at the last visit. A total of 1,755 subjects (46 ± 13 years; F/M: 89.9/10.1%) with primary hypothyroidism were enrolled. Of the hypothyroid subjects, 44.8% had out-of-reference range serum TSH levels. TSH values were over the reference range (TSH > 4 mIU/L) in 26.2% and were under the reference range (TSH < 0.5 mIU/L) in 18.6% of the patients. Total duration of LT4 treatment was 5.9 ± 4.7 years and mean dose was 1.2 ± 0.6 μg/kg/day. Non-compliant patients (31.1%) had higher TSH levels (6.9 ± 16 vs 3.8 ± 0.9 mIU/L, P = 0.01) compared to compliant patients. The results of this study revealed that nearly half of the hypothyroid patients had out-of-reference range serum TSH values, despite under LT4 treatment. Compliance with LT4 treatment seems to be one of the major determinants to reach the target TSH levels in hypothyroid patients.

Objective: To critically analyze the frequency and factors leading to hypocalcemia in Total/ Near Total thyroidectomy Methods: This descriptive case series study was conducted over period of one year by taking sample of 138 patients of simple multinodular goiter or carcinoma of thyroid who underwent total/near total thyroidectomy and patients who had serum calcium &lt;8mg/dl postoperatively. Recurrent thyroid surgery or patients undergoing lobectomy were excluded from the study. SPSS version 21 was used for data analysis. Mean ± SD represent the continuous variables &amp; frequencies/ percentages represent the quantitiave results. Chi-square test was applied to analyze effect modification. P value &lt;0.05 was taken as significant. Study was approved by the ethical review committee of the SMBBMU - Larkana. Results: The mean ± SD age of patients was 39.86 ± 11.5 years with a range from 22 to 60 years. The mean ± SD serum Pre-operative calcium was 9.64 ± 0.44 mg/dL. Post thyroidectomy) values of serum calcium were noted as mean ± SD 7.68 ± 2.11 mg/dL. Sixty five percent (n =90) of all patients were females. NTT- were 67.4% (n = 93) while TT- 32.6% (n = 45). Frequency of hypocalcemia was 28.3% (n = 39). More patients after TT developed hypocalcemia (44.4%) than NTT (20.4%) P value = 0.004). Old age, female gender, surgery for thyroid cancer and patient with lower preoperative serum calcium had a higher frequency of hypocalcemia after thyroidectomy. Practical implication Conclusion:The frequency of post thyroidectomy hypocalcemia in this study is 28.3%. Post thyroidectomy hypocalcemia is associated with both NTT and TT, however the frequency is more common (more than twice) after TT. Factors like old age, female gender, patients having thyroid cancer and having lower serum calcium preoperatively are strong effect-modifiers. Keywords: Total thyroidectomy. Near total thyroidectomy,Calcium, Hypocalcemia, .Parathyroid hormone.