Search Results (50)

The thyroid gland plays a crucial role in regulating metabolism and supporting development through the production of the hormones T4 and T3. These hormones are essential during childhood for nervous system myelination, physical growth, puberty, skeletal and dental maturation, and overall metabolic balance. In early infancy, when the hypothalamic–pituitary–thyroid axis is still immature, thyroid dysfunction can result in a range of long-term complications. The metabolism and action of thyroid hormones depend not only on iodine but also on other vital micronutrients, particularly selenium (Se). This narrative review aims to comprehensively examine the role of selenium in maintaining thyroid health from fetal life through adolescence. Selenium is a key micronutrient involved in thyroid development, hormone synthesis, antioxidant defense, and immune regulation, especially during pregnancy and childhood. Inadequate selenium levels may contribute to the onset, progression, and clinical management of various thyroid disorders, particularly hypothyroidism and autoimmune thyroid diseases. Although scientific evidence supports selenium’s critical functions in hormone metabolism and antioxidant protection, public awareness and monitoring of selenium intake remain insufficient. Beyond the need for further research, there is an urgent call for integrated public health strategies, ranging from sustainable, food-based approaches to targeted clinical screening and educational programs. Promoting awareness of selenium’s importance and incorporating selenium status into maternal and pediatric care protocols could play a significant role in preventing deficiencies and supporting long-term endocrine and neurodevelopmental health. Full article

Lipid hormone imbalances involving glucocorticoids, thyroid hormones (THs), and sex hormones have widespread metabolic consequences, contributing to the global increase in obesity and insulin resistance. This review examines the complex role of disrupted lipid hormone pathways in the development of metabolic disorders, particularly metabolic dysfunction-associated steatotic liver disease (MASLD). Endocrine disorders such as hypercortisolism, hypothyroidism, and polycystic ovary syndrome (PCOS) are closely linked to MASLD through shared metabolic pathways. Mechanisms include glucocorticoid-induced gluconeogenesis and lipolysis, impaired lipid clearance in hypothyroidism, and the hyperandrogenism-induced downregulation of hepatic low-density lipoprotein (LDL) receptors. PCOS-related factors—such as central obesity, adipocyte hypertrophy, low adiponectin levels, and genetic predisposition—further promote hepatic steatosis. Thyroid dysfunction may also impair the hepatic deiodination of T4, contributing to lipid accumulation and inflammation. Given the overlapping pathophysiology among endocrine, hepatic, and reproductive disorders, multidisciplinary collaboration is essential to optimize diagnosis, treatment, and long-term cardiometabolic outcomes. Full article

Background: Postpartum urinary retention (PPUR) typically resolves within the first three days following delivery. However, in rare instances, it may persist beyond 72 h and, in some cases, extend for several weeks. The current study aimed to evaluate long-term sequelae in women who endured PPUR following vaginal delivery. Methods: Between January 2013 and December 2019, 362 women who experienced PPUR following delivery at our institution were identified and subsequently invited to complete the UDI-6 questionnaire that serves to assess lower urinary tract symptoms. The questionnaires were filled out and returned by 242 women (66.8%). Results: Participants who had no urinary complaints (145/242; 60%) were assigned to Group 1. Of the 97 women allocated to Group 2 (97/242; 40%), 96 reported only mild urinary symptoms, while just 1 individual scored above the threshold of 33.3, suggesting elevated urinary distress. Risk factors known to be associated with PPUR were equally distributed among the two groups. A predominance of Caucasians was noted in Group 2 (p = 0.012). Voiding dysfunction (question 5 of UDI-6), taken separately, was proclaimed by 15 women from Group 2 (15/97 = 15.5%). When these were compared to the rest of the cohort (n = 227), an association with hypothyroidism was recognized (p = 0.036). Well-established risk factors for PPUR, such as nulliparity and epidural analgesia, were observed less frequently among women with persistent voiding dysfunction (p = 0.045 and p = 0.049, respectively), while postpartum uterine atony was more frequent (p = 0.047). Significant long-term effects after PPUR are uncommon. Conclusions: Hypothyroidism and postpartum uterine atony emerge as risk factors allied to long-term voiding dysfunction. Full article

Background: Multiple sclerosis (MS) and autoimmune diseases (AIDs) share immunological underpinnings, leading to frequent co-occurrence. This study investigated the prevalence of AIDs among Polish patients with MS (PwMSs) and its potential effects on disease characteristics. The aims were to compare clinical and demographic characteristics between PwMSs with and without coexisting AIDs. Methods: A retrospective analysis was conducted on data from 580 PwMSs who were treated at the Department of Neurology, University Clinical Center in Katowice, Poland, between February 2018 and August 2023. Variables analyzed included age, sex, MS type, disease duration, treatment, Expanded Disability Status Scale (EDSS) scores, thyroid-stimulating hormone (TSH), and vitamin D3 serum concentrations. Results: AID was identified in 16.9% of PwMSs (n = 98). Compared with PwMSs without AIDs, PwMSs with AIDs exhibited significantly higher mean age (44.61 ± 11.40 vs. 42.24 ± 12.27 years; p = 0.0151), longer disease duration (10.77 ± 6.72 vs. 9.56 ± 7.19 years; p = 0.0102), and higher EDSS scores (2.97 ± 1.43 vs. 2.89 ± 1.84; p = 0.0261). Among PwMSs, the prevalence of AIDs was significantly higher in females (20.24%) compared to males (8.13%; p = 0.0022), and strongly associated with the relapsing-remitting MS subtype (p = 0.0352). Autoimmune thyroid diseases were markedly the most prevalent in PwMSs (hypothyroidism 7.24%). Conclusions: PwMSs with AIDs exhibit distinct characteristics, including older age, increased disease duration, and greater disability. Thyroid disorders are notably the most prevalent AIDs among PwMSs. These findings underscore the intricate interplay between AIDs and MS and highlight the necessity for further research into their long-term impact. Full article

Subacute thyroiditis (SAT) represents an inflammatory disease of the thyroid gland, often resulting from viral infections or post-viral inflammatory responses. Long-term hypothyroidism is a possible evolution, requiring frequent follow-up and, if necessary, levothyroxine (LT4) replacement therapy. We retrospectively included 139 patients (out of 428) with SAT referring to the “Fondazione Policlinico Universitario A. Gemelli IRCCS” (Rome), between 2010 and 2022 to identify predictive parameters for long-term hypothyroidism. We evaluated TSH, FT4, and FT3 at four timepoints (diagnosis, 4–8 weeks, 10–20 weeks, and 28–54 weeks). We started LT4 therapy in patients with TSH > 10 μUI/mL or between 4–10 μUI/mL, with symptoms of hypothyroidism. “Long-term hypothyroidism” was defined as TSH > 4 μUI/mL after LT4 reduction and/or withdrawal. Univariate analysis showed correlations between long-term hypothyroidism and higher FT3 and FT4 and positive anti-Tg Abs at diagnosis and higher changes in TSH values (ΔTSH), decreased thyroid volume, and persistence of hypoechoic areas during follow-up. Furthermore, more severe thyrotoxicosis at presentation may be associated with a faster progression to hypothyroidism, likely due to greater thyroid damage. Multivariable analysis found ΔTSH (TP2-TP1) as an independent predictor of hypothyroidism. We propose specific biochemical and ultrasonographic parameters at diagnosis and during follow-up as possible predictors of long-term hypothyroidism after SAT, reducing treatment and healthcare costs for most patients who will never require replacement therapy. Full article

Expanded newborn screening (NBS) programs are essential for early detection and treatment. This study highlights the implementation of an expanded NBS program for inborn errors of metabolism (IEMs) and congenital hypothyroidism (CH) in rural Thailand, focusing on Health Regions 7 and 8 as a model for resource-limited settings. Using the KKU-IEM web-based platform, the program streamlined workflows, integrating logistics, real-time sample tracking, and electronic data management. Regular training sessions, continuous feedback, and systematic monitoring improved outcomes. Starting from October 2022, the program covered 98.6% of 123,692 live births, identifying 101 CH cases (1 in 1208 live births) and 20 IEM cases (1 in 6100 live births). The CH incidence was slightly higher than Thailand’s national average, while the IEM incidence was double that found in a previous Bangkok pilot study. Six cases highlighted maternal conditions affecting outcomes. Process improvements reduced the average reporting time from 9.13 days in 2023 to 8.4 days in 2024, with a 19% reduction in Bueng Kan Province. Efficiencies were driven by electronic ordering, real-time tracking, and stakeholder collaboration. This program demonstrates a scalable model for rural settings, emphasizing technology integration, collaboration, and quality control. Future efforts should refine diagnostics, expand disease coverage, and enhance long-term outcomes. Full article

Background and Objectives: Chronic obstructive pulmonary disease (COPD) is a notable cause of morbidity and mortality worldwide and can become complicated by Type 2 respiratory failure. This study aimed to analyze the cardiological and metabolic comorbidities of patients admitted to the intensive care unit (ICU) due to COPD-related Type 2 respiratory failure and evaluate their effects on clinical outcomes. Materials and Methods: A retrospective analysis was conducted on 258 patients admitted to the secondary-level pulmonary disease intensive care unit between January 2022 and January 2024. Patients’ demographic data, cardiological and metabolic comorbidities, laboratory parameters, and ICU-related variables were evaluated using statistical analysis methods. Results: The most common comorbidities were hypertension (57.0%), congestive heart failure (48.1%), diabetes mellitus (31.4%), and obesity (37.6%). Female patients had significantly higher rates of hypothyroidism, hypertension, obesity, and congestive heart failure compared to males. Patients diagnosed with chronic kidney disease (CKD) had markedly higher cardiothoracic ratios and proBNP levels. ICU length of stay was considerably longer in patients with acute kidney injury (AKI) and coronary artery disease (CAD). Cardiomegaly and obstructive sleep apnea syndrome (OSAS) were more frequently observed in obese patients. Additionally, in COPD patients, a body mass index (BMI) threshold of 25.5 was determined as a cutoff value for radiological cardiomegaly findings with a sensitivity of 69.9% and a specificity of 59.5%. Elevated pCO₂ and bicarbonate levels in patients receiving long-term oxygen therapy (LTOT) were associated with advanced-stage COPD. Conclusions: Metabolic and cardiological comorbidities notably impact the clinical prognosis and ICU management of patients diagnosed with COPD and Type 2 respiratory failure. This study, which aims to provide a snapshot of the comorbidities in patients requiring ICU admission due to COPD exacerbation-related Type 2 respiratory failure but without a fatal course, seeks to highlight the key areas where preventive and protective healthcare services should be focused in this patient group. Special attention should be given to monitoring female and obese patients. Future studies should explore how individualized and preventive follow-ups and treatment approaches can improve patient outcomes, with a particular emphasis on these identified areas. Full article

Background: Hypothyroidism is the most common thyroid dysfunction in childhood, resulting from the decreased biological activity of thyroid hormones in tissues. Pediatric patients with hypothyroidism, when left untreated or when thyroid hormone levels fail to normalize despite treatment, may exhibit various complications such as growth retardation, obesity, and hypercholesterolemia. Aim: We conducted a monocentric retrospective study to evaluate potential differences in obesity rates and auxological parameters between healthy patients and children with hypothyroidism undergoing levothyroxine replacement therapy. Additionally, we examined possible differences in lipid and glucose metabolism between the two groups. Materials and Methods: We collected and analyzed data from the electronic medical records of 108 patients who were regularly followed up for thyroid dysfunction at the Pediatric Endocrinology Unit of the Fondazione Policlinico Universitario A. Gemelli IRCCS from January 2016 to June 2024. We also included 104 healthy controls who underwent thyroid function testing during the same period, followed up in the same department for regular auxological check-ups. Results: Our findings revealed that patients with acquired hypothyroidism had a lower height z-score compared to healthy controls (t(210) = −2.6; p = 0.01). Additionally, they exhibited higher blood glucose and triglyceride levels, although these values remained within the normal range. Conclusions: We highlight the critical importance of the early diagnosis of hypothyroidism to initiate levothyroxine replacement therapy promptly and mitigate the long-term effects of hypothyroidism on children’s growth. Full article

Background: Polycystic ovary syndrome (PCOS) and autoimmune thyroid disease (AITD) have a high prevalence in women of reproductive age. PCOS can lead to long-term adverse health effects such as obesity, diabetes, and increased metabolic and cardiovascular risk. Although it is known that subclinical and clinical hypothyroidism may also worsen body mass index (BMI), lipid profile, and metabolic risk, there are few studies on the impact of elevated thyroid autoantibodies alone and associated chronic inflammation on metabolic complications in women with PCOS. The main aim of the study was to assess the prevalence of AITD among Polish women with PCOS and the metabolic impact of the co-occurrence of both diseases in euthyroid individuals. The additional aim was a review of the literature on the prevalence of co-occurrence of PCOS and AITD and the metabolic consequences of this condition. Methods: A total of 424 women aged 16–46 years were recruited into the study—230 women diagnosed with PCOS and 194 women diagnosed with PCOS and co-occurrence of euthyroid AITD. Before participating in the study, patients signed a written informed consent. The study was approved by the local ethics committee. Statistical analysis was performed using IBM SPSS Statistics (v.25). A mini-review of the literature was performed using the PubMed database. Results: Women with co-occurrence of PCOS and euthyroid AITD had statistically significantly higher serum levels of total cholesterol (189.57 mg/dL vs. 180.16 mg/dL; p = 0.005; d Cohen’s = −0.278), LDL-cholesterol (109.80 mg/dL vs. 102.01 mg/dL; p = 0.009; d Cohen’s = −0.256), and triglycerides (107.77 mg/dL vs. 96.82 mg/dL; p = 0.027; d Cohen’s = −0.219) compared to women with PCOS. The difference was observed regardless of body weight. BMI was also statistically significantly higher in the PCOS-AITD group (27.55 kg/m² vs. 25.46 kg/m²; p = 0.003; d Cohen’s = −0.319), as was the prevalence of obesity (32.5% vs. 20.7%; Chi-square = 7.956; p = 0.047). The mini-review of the literature did not find many studies evaluating the impact of thyroid autoantibodies on metabolic outcomes in PCOS euthyroid women, and the data are still inconclusive. Conclusions: The presence of elevated serum concentrations of thyroid autoantibodies in euthyroid women with PCOS increases the risk of obesity and metabolic consequences. It is observed even in euthyroid and non-obese individuals. Consequently, the cardiovascular risk in these women may be higher than in PCOS women without elevated thyroid autoantibodies. It is important to assess thyroid autoantibodies in all women with PCOS. In euthyroid PCOS women with co-occurrence of elevated serum levels of thyroid autoantibodies, it is crucial to pay more attention to maintaining an appropriate body mass index. There is an urgent need for further studies in large groups of women assessing the impact of elevated thyroid autoantibodies alone on metabolic outcomes in euthyroid women with PCOS to confirm and clarify the results. Full article

Objectives: This study aimed to investigate the relationship between excessive postpartum iodine intake and the incidence of thyroid disease in mothers, as well as child growth and development. Methods: Of 1054 participants in the 2019 nationwide survey that assessed maternal postpartum iodine intake, 684 mothers participated in a follow-up study. Data on maternal thyroid disease incidence and child growth and development from infant or toddler health checkups were collected. Iodine and nutrient intake were assessed using three-day dietary records, and serum thyroid hormones (triiodothyronine (T3), thyroid-stimulating hormone (TSH), and free thyroxine (free T4)) were measured. Relative risks (RRs) were estimated using Poisson regression analysis. Results: Among the 684 participants, 23 (3.4%) were diagnosed with thyroid disease by a physician during the follow-up period. The incidence of maternal thyroid disease was not significantly associated with excessive iodine intake, even after adjusting for confounding factors. Additionally, excessive maternal iodine intake was not related to subclinical hypothyroidism in mothers or child growth and development. Conclusions: After a three-year follow-up, no relationship was observed between high postpartum iodine intake and the risk of thyroid disease. Large-scale longitudinal studies are required to evaluate the long-term effects of excessive postpartum iodine intake on maternal health and child growth and development. Full article

Objective: This study investigated the impact of maternal subclinical hypothyroidism on fetal thymus size and development and explored how inadequate thyroid hormone production in pregnant women affects the fetal thymus. Methods: Conducted at the Giresun Obstetrics, Gynecology, and Pediatrics Training and Research Hospital, this case–control study involved 86 pregnant women, 43 with hypothyroidism and 43 without. Maternal thyroid function was assessed using TSH and free T4 levels, and fetal thymus size and thymus–thorax ratio were measured using ultrasound. Exclusion criteria were chronic hypertension, gestational hypertension or eclampsia, multiple pregnancies, infectious diseases, renovascular diseases, diagnosed with hypothyroidism prior to pregnancy and other endocrine disorders, fetal cardiac diseases, and morbid obesity. Data collected included maternal age, gestational week, number of pregnancies, parity, number of living children, thyroid-stimulating hormone (TSH) and Free thyroxine 4 (T4) levels, and fetal thymus measurements (transverse diameter and thymus/thorax ratio). Statistical analyses were performed using the Mann–Whitney U test and logistic regression analysis. The relationships between TSH, thymus diameters, thorax diameters, and the thymus–thorax ratio were evaluated using Spearman’s correlation coefficient. Results: The thymus–thorax ratio was significantly reduced in the hypothyroid group (p = 0.003). Logistic regression analysis identified TSH as an independent risk factor for a low thymus–thorax ratio, with each unit increase in TSH associated with a 1.345-fold higher likelihood of having a low thymus–thorax ratio. A significant negative correlation was found between TSH levels and the TTR ratio (Spearman’s correlation coefficient r = −0.338, p = 0.001). Conclusions: An association was identified between maternal TSH levels and the thymus–thorax ratio, with increasing TSH levels correlating with a decrease in the thymus–thorax ratio. Regular monitoring of thyroid hormone levels during pregnancy and appropriate replacement treatment in cases of deficiency are crucial for optimal fetal thymus development. Further multicenter studies are needed to confirm these findings and investigate the long-term implications of altered fetal thymus development. Full article

Background: Selenium (Se) is an essential trace element for maintaining human health, with significant antioxidant and immunoregulatory functions. Inadequate Se intake may be associated with Keshan disease, Kashin–Beck disease, and hypothyroidism. However, effective indicators for scientifically guiding Se supplementation in Se-deficient populations are still lacking. Objectives: This study aims to explore the dynamic distribution of Se across various nutritional biomarkers and major organs in rats through a Se supplementation experiment, as well as the pairwise correlations between them, in order to identify reliable nutritional indicators for evaluating Se levels in the body. Methods: Se levels in hair, blood, and major tissues and organs were determined by atomic fluorescence spectrometry, and glutathione peroxidase (GSH-Px) levels were measured using an ELISA. Results: Se supplementation significantly increased Se levels in rat blood, hair, and major organs, as well as GSH-Px levels in blood. Se primarily accumulated in the liver and kidneys, followed by myocardium, spleen, and muscles. Serum and plasma Se were found to be the best indicators of short-term Se intake, while erythrocyte Se levels showed a stronger correlation with Se levels in tissues and organs, making it a better marker for assessing long-term Se nutritional status compared to hair Se. Conclusions: This study demonstrates the potential of erythrocyte Se levels as an indicator for evaluating long-term Se nutritional status, providing scientific evidence for Se nutritional assessments. Full article

Background: Lithium is a cornerstone in the treatment of bipolar disorder (BD). However, lithium use requires careful monitoring of thyroid function due to associated dysfunctions. The aim of our real-world study is to retrospectively evaluate the impact of lithium on thyroid function and how these thyroid alterations can be measured and managed. Methods: A retrospective observational study was performed on 150 patients with BD who started lithium treatment at the University Hospital of Siena. Thyroid function was assessed at baseline and after the introduction of lithium by measuring TSH, T3, and T4 levels at baseline and after 3, 6, 9, and 12 months, during which changes in psychiatric symptoms were also evaluated using specific psychometric scales. Results: Significant increases in TSH levels were observed at 3 and 6 months, while T3 and T4 levels decreased significantly at 3 months. Transient thyroid dysfunction occurred in 36.7% of patients, but normalized without the discontinuation of lithium or need for thyroid replacement therapy in most cases; however, replacement therapy was initiated in 8.7% of patients. There were no significant differences in treatment response between patients with and without thyroid abnormalities, as the abnormalities were transient or resolved. Conclusions: In our sample, lithium induced some cases of hypothyroidism, which, being transient or corrected with replacement therapy, did not interfere with symptomatic improvement. These findings underscore the necessity for continuous thyroid function monitoring during lithium therapy. Clinicians should be prepared to initiate thyroid replacement therapy, when necessary, as timely management can prevent the interruption of lithium treatment and ensure ongoing symptomatic improvement in BD patients. Future studies could include larger and more diverse populations to validate these findings further, extending the follow-up period beyond 12 months to better observe long-term thyroid function trends and management outcomes. Full article

Background: Hypothyroidism is very common worldwide. It is known to be associated with frailty which, in turn, is associated with increased morbidity and mortality in the elderly. Low ALT blood activity is an established marker for sarcopenia and frailty. The incidence and outcomes of the association between low ALT values and hypothyroidism, as manifested in elevated blood TSH levels, is unknown. The objective of this study was to assess if low ALT values could improve the prediction of clinical outcome in hypothyroid patients. Methods: This was a retrospective analysis of hospitalized patients in a large, tertiary hospital. Results: Over a period of 21 years, an overall population of 16,827 patients were identified as eligible to participate in this study. Within the study population, 726 (4.3%) were classified as suffering from hypothyroidism (TSH values > 6 MIU/L) and 2184 (13%) were classified as patients with sarcopenia (ALT < 12 IU/L). Within our patient population, hypothyroidism was associated with sarcopenia in a statistically significant manner (p = 0.011). Patients classified as suffering from both hypothyroidism and sarcopenia had significantly shorter survival: A multivariate analysis showed that the frail and hypothyroid group of patients had a statistically significant risk of mortality in the next 5 years (HR = 3.6; CI 2.75–4.71; p < 0.001). Conclusions: Sarcopenia and frailty are common comorbidities, bearing negative long-term clinical outcomes. Low ALT values could serve as a useful biomarker for screening of patients already diagnosed with hypothyroidism. Full article

Background/Objectives: Levothyroxine (L-T4) is available for use in congenital hypothyroidism (CH) in three formulations: tablets, drops, and oral solution. This study aims to compare the efficacy and safety of all three L-T4 formulations. Methods: We enrolled 63 children born between January 2019 and April 2023 in the Emilia-Romagna Region (Italy) and diagnosed with CH by newborn screening. They were divided according to the L-T4 formulation used: drops (Group D), oral solution (Group S), and tablets (Group T). Clinical and laboratory data were collected up to 3 years after the start of replacement therapy. Results: Serum-free thyroxine (sFT4) and thyroid stimulating hormone (sTSH) normalization occurred within the first month of treatment in most patients of all groups. No negative effects on growth and cognitive development were observed. At 7–15 days we found higher median sTSH levels (p = 0.031) and a greater percentage of patients with sTSH > 5 µU/mL (p = 0.011) in Group S than in Group T, but comparable sFT4 levels. At 12 months, a greater percentage of patients of Group D showed sFT4 values below the normal range than Group S (p = 0.011) and Group T (p = 0.038); Conclusions: Overall, our study reported an equal efficacy of the L-T4 oral solution compared to drops and tablets in CH treatment. A larger series of patients and a long-term follow-up are needed. Full article