Vitamin D deficiency is associated with thyroid diseases

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

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.

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.

Thyroid dysfunction encompassing both hypothyroidism and hyperthyroidism, represents a significant global health burden affecting millions of individuals worldwide. Thyroid hormones play a pivotal role in regulating metabolism including glucose homeostasis making their dysregulation a potential contributor to metabolic complications such as hypoglycemia. Despite the well-documented effects of thyroid hormones on glucose metabolism the interplay between thyroid dysfunction and hypoglycemia remains underexplored, particularly in specific populations. This retrospective cohort study investigates the correlation between thyroid dysfunction and hypoglycemia, focusing on differences between hypothyroid and hyperthyroid patients. A total of 200 patients (100 with hypothyroidism and 100 with hyperthyroidism) were analyzed using clinical records, laboratory tests and symptom assessments. Key findings revealed that hypothyroid patients exhibited a higher prevalence of hypoglycemia (45%)compared to hyperthyroid patients(30%).Severe symptoms such as dizziness and sweating were more common in hypothyroid patients, while tremors and palpitations were more frequent in hyperthyroid patients. These findings align with the physiological roles of thyroid hormones in glucose metabolism: hypothyroidism impairs hepatic gluconeogenesis and glycogenolysis, leading to reduced glucose production during fasting, whereas hyperthyroidism accelerates glucose metabolism but may cause reactive hypoglycemia due to rapid glucose utilization or hyperinsulinemia. Logistic regression analysis identified several predictors of hypoglycemia, including age ≥50 years, suboptimal treatment, and hypothyroidism itself. Older patients and those with suboptimal levothyroxine dosing were at heightened risk, underscoring the importance of individualized treatment strategies. This study highlights the critical link between thyroid dysfunction and hypoglycemia, emphasizing the need for early diagnosis, tailored treatment approaches, and regular glucose monitoring in high-risk groups. By integrating clinical evaluation, laboratory tests, and symptom monitoring, healthcare providers can optimize diagnostic accuracy and management strategies for patients with thyroid dysfunction. These findings advocate for multidisciplinary interventions to mitigate the risk of hypoglycemia and improve patient outcomes, particularly in vulnerable populations such as older adults and those with suboptimal treatment adherence.

AimsVitamin D measurement is a composite of vitamin D2 (25(OH)D2) and D3 (25(OH)D3) levels, and its deficiency is associated with the development of type 2 diabetes (T2DM) and diabetic complications; vitamin D deficiency may be treated with vitamin D2 supplements. This study was undertaken to determine if vitamin D2 and D3 levels differed between those with and without T2DM in this Middle Eastern population, and the relationship between diabetic microvascular complications and vitamin D2 and vitamin D3 levels in subjects with T2DM.MethodsFour hundred ninety-six Qatari subjects, 274 with and 222 without T2DM participated in the study. Plasma levels of total vitamin D2 and D3 were measured by LC-MS/MS analysis.ResultsAll subjects were taking vitamin D2 and none were taking D3 supplements. Vitamin D2 levels were higher in diabetics, particularly in females, and higher levels were associated with hypertension and dyslipidemia in the diabetic subjects (p < 0.001), but were not related to diabetic retinopathy or nephropathy. Vitamin D3 levels measured in the same subjects were lower in diabetics, particularly in females (p < 0.001), were unrelated to dyslipidemia or hypertension, but were associated with retinopathy (p < 0.014). Neither vitamin D2 nor vitamin D3 were associated with neuropathy. For those subjects with hypertension, dyslipidemia, retinopathy or neuropathy, comparison of highest with lowest tertiles for vitamin D2 and vitamin D3 showed no difference.ConclusionsIn this Qatari cohort, vitamin D2 was associated with hypertension and dyslipidemia, whilst vitamin D3 levels were associated with diabetic retinopathy. Vitamin D2 levels were higher, whilst vitamin D3 were lower in diabetics and females, likely due to ingestion of vitamin D2 supplements.

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

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.

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.

It is known that NT-proBNP levels increase in cardiac failure. However, NT-proBNP levels in different thyroid states are still unclear. We aimed to evaluate serum NT-proBNP levels in both hyperthyroid and hypothyroid patients without cardiac insufficiency. Thirty-six patients with hyperthyroidism (42.9 +/- 16.7 years), 25 patients with hypothyroidism (35.4 +/- 13.9 years) and 34 age-matched euthyroid subjects (41.4 +/- 13.8 years) were included in the study. After anthropometric evaluations, body fat analyses were determined by bioelectrical impedance. Electrocardiography and echocardiography were used in cardiac evaluations. Serum NT-proBNP was measured by immunoassay. Mean serum NT-proBNP levels in hyperthyroid patients were higher than in both control subjects (13.65 +/- 13.02 vs. 6.50 +/- 4.83 pmol/l, P = 0.002) and hypothyroid patients (13.65 +/- 13.02 vs. 5.98 +/- 5.08 pmol/l, P = 0.003). However, mean serum NT-proBNP levels in hypothyroid patients were not different from those in control subjects. There was a positive correlation between serum NT-proBNP and thyroid hormones (NT-proBNP and FT3: r = 0.324, P = 0.001; NT-proBNP and FT4: r = 0.269, P = 0.009, respectively). Serum NT-proBNP levels were positively correlated with left ventricle end-diastolic diameters (r = 0.232, P = 0.04), interventricular septum thickness (r = 0.315, P = 0.006), and negatively correlated with left ventricular ejection fraction (r = -0.238, P = 0.04). Serum NT-proBNP levels may increase in hyperthyroidism independently of cardiac insufficiency. Therefore, hyperthyroidism may lead to cardiac ultrastructural changes undetermined by conventional echocardiography and these changes may be responsible for elevation of NT-proBNP levels. In contrast to decreased thyroid hormones, excess thyroid hormones may have a more pronounced effect on serum NT-proBNP levels.

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.

Impact Of Vitamin D Level Pre and Post Allogeneic Hematopoietic Stem Cell Transplant

To evaluate the relationship between pterygium and serum thyroid hormone, vitamin B12, vitamin D3, folic acid, and ferritin levels between pterygium patients and control and to assess its correlation with clinical findings. 18–65-year-old 100 pterygium patients and age and sex matched 60 healthy control subjects were included. The peripheric blood sampling results were investigated. Free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), vitamin B12, vitamin D3, folic acid, and ferritin levels of pterygium and control groups were compared. FT3 level was higher in the patient group compared to the control group, while vitamin B12, vitamin D3, folic acid and ferritin levels were significantly lower in the patient group compared to the control group (p < 0.05) No significant difference was found between the patient and control groups in terms of age, gender and body mass index (BMI) (p = 0.295, p = 0.625, p = 0.547, respectively). This study reports that pterygium patients have lower serum vitamin B12, folic acid, ferritin and vitamin D3 levels than healthy individuals.

Hepatic conversion of amino nitrogen to urea nitrogen in hypothyroid patients and upon l-thyroxine therapy

To investigate the thyroid hormone metabolism in altered states of thyroid function, serum concentrations of 3, 3'-diiodothyronine (3, 3'-T2), 3', 5'-T2 and 3, 5-T2 as well as T4, T3 and rT3 were determined by specific radioimmunoassays in 17 hyperthyroid and 10 hypothyroid patients, before and during the treatment. Serum T4, T3, rT3, 3, 3'-T2 and 3', 5'-T2 concentrations were all higher in the hyperthyroid patients than in age-matched controls and decreased to the normal ranges within 3 to 4 months following treatment with antithyroid drugs. In the hypothyroid patients, these iodothyronine concentrations were lower than in age-matched controls and returned to the normal ranges after 2 to 3 months treatment with T4. In contrast, serum 3, 5-T2 concentrations in hyperthyroid patients (mean +/- SE : 4.0 +/- 0.5 ng/dl) were not significantly different from those in controls (3.9 +/ 0.4 ng/dl), although they tended to decrease in 3 of 6 patients after the antithyroid drug therapy. Serum 3, 5-T2 levels in the hypothyroid patients (3.8 +/- 0.6 ng/dl) were also within the normal range and showed no significant change following the T4 replacement therapy. However, serum 3, 5-T2 as well as 3, 3'T2 concentrations rose significantly with a marked rise in serum T3 following T3 administration, 75 micrograms/day for 7 days, in Graves' patients in euthyroid state.(ABSTRACT TRUNCATED AT 250 WORDS)

Celiac disease an autoimmune disease; it occurs in Europe at 1%, and in the world people (0.3–1.3%). It causes histopathological changes in the mucosa of the intestine (villi atrophy). The findings showed that it occurs due to the reduction of the absorbed nutrients.&#x0D; Helicobacter pylori are colonized in human gastric mucosa, which mainly causes stomach injury. The rate of H. pylori is as high as almost 50%, and it also occurs in childhood. Vitamin/mineral deficiencies, weight loss, and Malabsorption characterize classical celiac disease. The study aimed to detect the effect of H. pylori in celiac patients and determine vitamin B12, D3, and Ferritin in celiac patients infected with H. pylori. The study includes 41 celiac patients with H. pylori and 31 celiac cases without H. pylori of both genders and 52 apparently healthy individuals of comparable age and gender to save as a control group. The vitamin D3, B12, and ferritin levels were measured for each participant. The study found a positive correlation between celiac and H. pylori, with decreased ferritin levels in patients with celiac disease. Also, the patient group showed a significant decrease in Vitamin D3. Also, the B12 level in the patient group decreased. There was no significant gender-related variation between males and females regarding the patient and control groups' Ferritin, vitamin D3, and Vitamin B12 levels. There was no significant age-related variation between individuals under 35 years of age and those over 35 years of age regarding the ferritin and vitamin B12 levels in the patient and control groups. However, vitamin D3 level was lower in patients less than 35 years of age than in cases with more than 35 years of age. Minerals and vitamin deficiencies are observed in untreated CD cases irrespective of age and gender and irrespective of H. pylori. All CD patients had one or more nutritional deficiencies. Serum nutritional parameters like iron, Vitamin B12, and D3 should be included in the clinical workup of CD patients in addition to the serological markers. It was found that H.pylori does affect the levels of ferritin ,vitamin B12 and vitamin D3 in celiac patients .This study confirmed that there is a positive correlation between H. pylori and celiac disease. In addition, H. pylori infection may aggravate some symptoms of CD.