Search Results (620)

Background/Objectives: Postoperative hypothyroidism is a common complication following hemithyroidectomy and may necessitate lifelong levothyroxine replacement therapy. Although several clinical predictors have been identified, clinically applicable risk models integrating both clinical and ultrasonographic parameters remain limited. This study aimed to identify independent predictors of postoperative hypothyroidism and to develop practical risk scoring systems with and without ultrasonographic parameters based on these predictors. Methods: This observational cohort study included 95 patients who underwent hemithyroidectomy and were followed for at least 6 months. Clinical characteristics, thyroid autoantibodies, and ultrasonographic features of the remnant thyroid lobe were evaluated. Independent predictors of postoperative hypothyroidism were identified using multivariable logistic regression analysis, and two simplified risk scoring systems were developed based on the regression coefficients. Results: Postoperative hypothyroidism developed in 39 of the 95 patients (41.1%). In the model incorporating ultrasonographic parameters, preoperative TSH, a low remnant thyroid volume-to-body surface area ratio, and heterogeneous remnant thyroid parenchyma were independent predictors of postoperative hypothyroidism. The corresponding score stratified patients into low-, intermediate-, and high-risk categories with observed hypothyroidism rates of 9.1%, 44.7%, and 100.0%, respectively, and showed an AUC of 0.858. In the model without ultrasonographic parameters, preoperative TSH and thyroid autoantibody positivity were independent predictors; the corresponding score showed an AUC of 0.745. Conclusions: The proposed risk scoring systems may serve as practical tools for identifying patients at increased risk of postoperative hypothyroidism following hemithyroidectomy according to the availability of ultrasonographic assessment. External validation in independent cohorts is warranted before routine clinical implementation. Full article

Background: Fibromyalgia (FM) is a complex chronic pain disorder characterized by interactions among psychological, biological, and clinical factors. Although psychiatric symptoms and sleep disturbance are recognized contributors to disease burden, their multidimensional relationships with selected biological variables and fibromyalgia severity remain incompletely understood. Objective: This study aimed to investigate multidimensional associations among psychiatric symptoms, sleep disturbance, selected biological variables, and fibromyalgia severity using complementary analytical approaches, including multiple linear regression, Classification and Regression Tree (CART) analysis, and path analysis. Methods: In this cross-sectional study, 102 women with FM and 53 healthy female controls underwent standardized clinical and laboratory assessment. Fibromyalgia severity was assessed using the Fibromyalgia Impact Questionnaire (FIQ), depressive symptoms with the Beck Depression Inventory (BDI), anxiety symptoms with the Beck Anxiety Inventory (BAI), and sleep disturbance with the Jenkins Sleep Scale (JSS). Serum thyroid-stimulating hormone (TSH) and 25-hydroxyvitamin D concentrations were measured as selected biological variables. Multiple linear regression identified independent associations with disease severity, CART analysis evaluated hierarchical classification patterns, and path analysis examined direct and indirect associations within a predefined conceptual framework. Results: Depressive symptoms, sleep disturbance, and anxiety symptoms were independently associated with greater fibromyalgia severity, whereas TSH and vitamin D showed no consistent independent associations. CART identified sleep disturbance as the primary hierarchical classifier, followed by depressive and anxiety symptoms, achieving an overall classification accuracy of 93.5% (AUC = 0.951). Within the proposed conceptual framework, path analysis demonstrated direct associations between psychological symptoms and fibromyalgia severity, whereas TSH and vitamin D exhibited distinct indirect relationships through depressive and anxiety symptoms, respectively. Conclusions: Psychological symptoms were more consistently associated with fibromyalgia severity than the selected biological variables across complementary analytical approaches. The integrated use of multiple linear regression, CART analysis, and path analysis provided a multidimensional perspective on fibromyalgia and highlighted the importance of comprehensive biopsychosocial assessment while emphasizing that the observed findings represent statistical associations rather than causal relationships. Full article

Graves’ disease is an autoimmune hyperthyroid disorder in which thyroid peroxidase (TPO) plays a central role in excessive thyroid hormone production. However, current TPO-targeting drugs, such as propylthiouracil, have limited selectivity and can cause serious adverse effects. In this study, we established an integrated discovery pipeline to identify and optimize novel small-molecule TPO inhibitors. The pipeline began with high-throughput screening of approximately 7000 compounds from the KRICT chemical library for peroxidase inhibition, followed by cytotoxicity filtering and iterative medicinal chemistry to generate NE-2 derivatives. Lead compounds (NE-2-6, NE-2-7, and NE-2-8) were evaluated using enzymatic assays, selectivity profiling against myeloperoxidase (MPO) and lactoperoxidase (LPO), molecular docking, plasma pharmacokinetic profiling, and in vivo antithyroid pharmacodynamic testing in an Ad-TSHR289-induced thyroid hyperfunction model. NE-2-6 exhibited potent TPO inhibitory activity and relative selectivity within the tested peroxidase panel. UV–visible spectral scanning and H₂O₂-dependent inhibition assays suggested that NE-2-6 perturbs the heme-associated catalytic environment of TPO; however, these data do not establish a definitive binding mode or kinetic inhibition mechanism. In the Ad-TSHR289-induced thyroid hyperfunction model, NE-2-6 reduced serum T4 levels, supporting antithyroid pharmacodynamic activity. Because autoimmune endpoints and dose-matched PK–PD relationships were not fully assessed, the findings should be interpreted as preliminary preclinical evidence supporting further evaluation of NE-2-6 as a TPO-targeting antithyroid candidate. Full article

Congenital hypothyroidism (CH) is a common endocrine disorder characterized by thyroid hormone deficiency and has dramatic consequences if diagnosis and treatment are delayed. Although neonatal screening (NNS) and early levothyroxine (L-T4) treatment have markedly improved neurodevelopmental outcomes, evidence suggests that cardiovascular alterations may persist into later life. Thyroid hormones regulate lipid metabolism, endothelial nitric oxide (NO) availability, myocardial relaxation, vascular tone and arterial wall homeostasis. Early clinical studies in patients with CH reported variable lipid and lipoprotein abnormalities, whereas more recent studies have demonstrated endothelial dysfunction, increased arterial stiffness, and elevated carotid intima–media thickness (IMT), even in the absence of classical cardiovascular risk factors. These alterations appear to be associated with cumulative exposure to thyroid-stimulating hormone (TSH) abnormalities rather than isolated biochemical measurements. These findings suggest that CH may affect cardiovascular biology through multiple pathways, including dyslipidemia, endothelial dysfunction, vascular remodeling, and cumulative exposure to thyroid-stimulating hormone abnormalities. This review summarizes the available evidence linking congenital hypothyroidism to early vascular and atherosclerotic changes and discusses its conceptual relationship to familial hypercholesterolemia as another model of early-life cumulative cardiovascular risk. Full article

Background/Objectives: Preoperative differentiation between benign thyroid nodules and papillary thyroid carcinoma (PTC) remains clinically challenging, particularly after indeterminate cytology. This study evaluated routinely available complete blood count (CBC)-derived indices, erythrocyte parameters, thyroid function tests, and arithmetic thyroid hormone ratios. Methods: This retrospective, single-center case–control study reviewed thyroidectomy records from July 2020 to November 2024. Histopathology was re-adjudicated from the source reports; 158 adults with clearly benign nodules (n = 93) or PTC (n = 65) formed the final analytic cohort. Missing laboratory values were handled by variable-specific complete-case analysis. Benjamini–Hochberg false-discovery-rate (FDR) correction and an exploratory multivariable logistic model were applied. Results: Preoperative TSH and the conventional platelet-to-lymphocyte ratio (PLR) were higher in PTC (p = 0.002, q = 0.013; and p = 0.004, q = 0.023), whereas the fT4/TSH and fT3/TSH ratios were lower (both q = 0.013). The fT3 difference was nominal (p = 0.018, q = 0.076), and MCV was not significant (p = 0.076). In 126 complete cases, each doubling of TSH was associated with higher odds of PTC (adjusted odds ratio [aOR] 1.51, 95% CI 1.08–2.13), whereas higher fT3 was associated with lower odds (aOR 0.41, 95% CI 0.19–0.87). Conclusions: TSH and fT3 were independently associated with PTC in the exploratory model, while the PLR and TSH-normalized hormone ratios differed between groups but lacked validated diagnostic performance. These measures should not be used in isolation; prospective multicenter studies are needed to determine whether they add clinically meaningful information to ultrasonographic, cytological, and molecular assessments. Full article

Background/Objectives: Gestational diabetes mellitus (GDM) is a common metabolic complication of pregnancy associated with adverse maternal and neonatal outcomes. Data on GDM in Central Asian populations remain limited. This study aimed to identify factors associated with GDM and evaluate selected obstetric outcomes among pregnant women in Kazakhstan. Methods: A retrospective case–control study based on medical record data was conducted among 256 pregnant women, including 106 women with GDM and 150 women with normal glucose tolerance. GDM was diagnosed using a 75 g oral glucose tolerance test according to the International Association of Diabetes and Pregnancy Study Groups criteria. Demographic, clinical, anthropometric, laboratory, and obstetric data were obtained from medical records. Multivariable logistic regression was used to identify factors statistically associated with GDM. Obstetric outcomes were compared using unadjusted analyses. Results: Women with GDM were older than controls (31.6 ± 5.8 vs. 28.6 ± 5.3 years, p < 0.001) and had a higher pre-pregnancy body mass index (BMI) (29 [25–33] vs. 26 [23–29] kg/m², p < 0.001). Thyroid-stimulating hormone levels were also higher in the GDM group (p = 0.026). In multivariable analysis, pre-pregnancy obesity (adjusted OR 4.54, 95% CI 2.08–9.91; p < 0.001) and educational level (overall p = 0.001) remained associated with GDM, whereas maternal age was not independently associated after adjustment. Hypertension (24.5% vs. 2.0%; p < 0.001), eclampsia (3.8% vs. 0%; p = 0.028), cesarean delivery (52.8% vs. 28.0%; p < 0.001), and fetal macrosomia (21.7% vs. 12.0%; p = 0.037) were more frequent among women with GDM. No significant difference was observed in neonatal birth weight. Conclusions: Pre-pregnancy obesity and educational level were independently associated with GDM. Women with GDM more frequently experienced hypertensive complications, cesarean delivery, and fetal macrosomia; however, these findings were based on unadjusted analyses and should be interpreted cautiously. Further multicenter prospective studies are needed to confirm these findings in Central Asian populations. Full article

Background: Thyroid function tests are frequently requested, but manufacturer reference intervals often lack age- or sex-based stratification. This study established indirect reference intervals for thyroid stimulating hormone (TSH), free thyroxine (fT4) and free triiodothyronine (fT3) in a large adult population. We evaluated unsupervised algorithms and conventional partitioning to identify subgroups, compared multiple limit estimation methods, and assessed the diagnostic performance of the derived intervals against an independent, clinically defined external validation cohort. Methods: Data from 37,255 adults (age ≥ 18) collected between 2022 and 2024 were analyzed; a reference population of 5870 individuals was established following standardized exclusion criteria. Age-based subgroups were identified through hierarchical clustering with the Elbow method, and variable importance was assessed using Random Forest analysis. Reference intervals were calculated using non-parametric, Bhattacharya, refineR, and reflimR algorithms, applied to three population frameworks: (1) the total population without stratification, (2) subgroups derived from hierarchical clustering and (3) subgroups defined by the conventional Harris–Boyd partitioning method. Diagnostic performance was subsequently evaluated in an independent external cohort (National Health and Nutrition Examination Survey [NHANES]; N = 2297) for all estimated reference intervals. Three classification scenarios were assessed: TSH-only, fT4-only, and combined TSH + fT4, with sensitivity, specificity, Youden index, and decision curve analysis performed for each. Results: Random Forest analysis identified age as the dominant variable influencing TSH, fT4 and fT3 distributions (mean decrease in accuracy: TSH 41.62, fT4 44.18, fT3 43.7), while sex showed the lowest impact. Clustering yielded six age-based subgroups for analytes. Harris–Boyd partitioning yielded six age-based subgroups for TSH, two sex-based subgroups for fT4, and six combined age-and-sex subgroups for fT3. TSH limits were broadly concordant across all three approaches (six-subgroup partitioning: 0.36–0.68 to 4.75–5.67 mIU/L). For fT4, conventional (sex-based) and clustering (age-based) partitioning produced similar ranges (11.33–20.08 pmol/L), except reflimR’s notably lower limit (10.90 pmol/L). For fT3, conventional (age + sex) and clustering (age-only) partitioning showed comparable ranges (3.36–7.03 pmol/L), with clustering revealing a clearer age-related decline in the oldest group. Diagnostic performance varied markedly by analyte. TSH-only classification achieved positive discrimination across all 13 methods (Youden index: 0.173–0.239). In contrast, fT4-only and combined TSH + fT4 classifications performed at or below chance for most methods, with 75% of the cohort falling outside fT4 reference intervals, indicating an inter-platform harmonization issue rather than a partitioning failure. Decision curve analysis confirmed TSH-only classification’s superiority, exceeding universal testing from pt ≈ 0.20 onward across all methods. Conclusions: Age-stratified reference intervals combined with limit estimation showed potential diagnostic advantages over manufacturer and non-stratified intervals; however, an independent external validation using a clinically defined outcome indicated that this advantage was not consistently reproduced and was dependent on the clinical decision threshold considered. These results suggest that age stratification and algorithm choice merit further clinically adjudicated validation before broad clinical adoption, and that unsupervised clustering offers a practical, objective alternative to manual subgrouping for laboratories pursuing this approach. Full article

Background: The aim of this study was to investigate the impact of intraovarian platelet-rich plasma (PRP) treatment on ovarian reserve markers, hormonal profiles, oocyte yield, fertilization potential, and pregnancy outcomes in infertile women with diminished ovarian reserve. Methods: This retrospective single-center study was conducted at a tertiary referral center between January 2021 and December 2024 in the Department of Obstetrics and Gynecology, IVF Clinic, Private Diyarlife Hospital, Diyarbakır, Turkey. A total of 78 infertile women with diminished ovarian reserve (DOR) were included. DOR was defined in the present study as an AMH level < 1.1 ng/mL and/or an antral follicle count (AFC) < 5 follicles. Pre-PRP and post-PRP measurements were compared in the same patients. Hormonal and clinical parameters, including prolactin, thyroid-stimulating hormone (TSH), follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), estradiol, endometrial thickness, gonadotropin dosage, antral follicle count (AFC), mature metaphase II (MII) oocyte count, and two-pronuclear (2PN) zygote count, were evaluated before and after PRP treatment. Results: Significant increases were observed in AMH and prolactin levels, whereas FSH levels significantly decreased following PRP treatment (all p < 0.001). Post-PRP AFC, MII oocyte count, and 2PN zygote count were significantly higher than pre-PRP values (all p < 0.001). A total of 21 pregnancies (26.9%) were achieved, including 17 clinical pregnancies (81.0% of pregnancies; 21.8% of all patients), 4 biochemical pregnancies (19.0% of pregnancies; 5.1% of all patients), 11 miscarriages (52.4% of pregnancies; 14.1% of all patients), and 6 live births (28.6% of pregnancies; 7.7% of all patients). Significant positive correlations were identified between post-PRP AFC and MII oocyte count (r = 0.803, p < 0.001), post-PRP AFC and 2PN zygote count (r = 0.624, p < 0.001), and MII oocyte count and 2PN zygote count (r = 0.728, p < 0.001). Conclusions: Intraovarian PRP administration was associated with improvements in ovarian reserve markers, oocyte maturation, and fertilization-related outcomes in women with DOR. Significant increases in AFC, MII oocyte count, and 2PN zygote count were observed after PRP treatment. However, these improvements in ovarian reserve markers were not associated with significant differences between women who achieved pregnancy and those who did not. Because of the retrospective design and the absence of a control group, these findings should be interpreted as associations rather than evidence of a causal treatment effect. Although clinical pregnancies and live births were observed during follow-up, larger, multicenter randomized controlled trials are required to confirm these findings and to further evaluate the effect of PRP on reproductive outcomes. Full article

Chronic urticaria (CU) is a condition characterized by recurrent wheals/angioedema lasting longer than 6 weeks. It is treated in a stepwise manner, starting with antihistamines and escalating to more advanced therapies, if needed. It is frequently associated with autoimmune thyroiditis (AT), and thyroid autoantibodies and thyroid-stimulating hormone (TSH) may contribute to the severity of symptoms, though the exact pathogenesis remains unclear. We performed a systematic search on Scopus and Pubmed databases, finding nine studies published between 1989 and 2018. Five studies were therefore included in our meta-analysis, and we found that the treatment with L-thyroxine (LT4) is associated with a significant improvement in CU symptoms (sMD −2.31, 95% CI −2.98 to −1.64; p < 0.00001). However, when compared with placebo or standard care, LT4 did not demonstrate superiority in terms of symptom scores. It is unclear whether it provides greater benefit in individuals with normal thyroid function or hypothyroidism, or whether it is more effective when used as suppressive or replacement therapy. Therefore, evidence for LT4 treatment improving urticaria is conflicting, with uncertain benefit prompting further evaluation and in-depth study of the molecular mechanisms and markers linking CU and AT. Full article

This study aimed to investigate the effects of salinity changes on serum biochemistry, hormonal profiles, splenic immune function, hepatic lipid metabolism and intestinal microbiota of the F₂ generation of Chinese sturgeon (Acipenser sinensis) under freshwater and seawater acclimation (15–23.2 psu) conditions. A 30-day indoor culture experiment showed that seawater acclimation only induced a declining trend in juvenile growth without statistical significance compared to the freshwater group (p > 0.05). The levels of triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), alkaline phosphatase (ALP) and albumin II (ALBII) in the freshwater group were markedly lower than those in the seawater group (p < 0.05), while alanine aminotransferase (ALT), aspartate aminotransferase (AST), high-density lipoprotein cholesterol (HDL-C) and total protein (TPII) showed no significant differences (p > 0.05). The serum triiodothyronine (T3) concentration was significantly higher, and chloride ion (Cl⁻) was lower in freshwater individuals (p < 0.05). Cortisol, testosterone, K⁺, Na⁺, Ca²⁺, thyroid-stimulating hormone and T4 remained unchanged between the two salinity environments (p > 0.05). In gill tissues, lipase (LPS) and fatty acid synthase (FAS) activities were lower, whereas lipoprotein lipase (LPL) activity was higher in the freshwater group (p < 0.05), and no obvious difference was observed in hepatic metabolic enzymes. The splenic complement C4 content was significantly decreased in freshwater sturgeon (p < 0.05), while splenic C3, IgM and serum immune indices showed no statistical differences. All alpha-diversity indices of intestinal microbiota were significantly higher in the seawater group (p < 0.05). At the phylum level, the intestinal flora in the seawater group was dominated by Proteobacteria (69.6%) and Fusobacteriota (14.9%), whereas Fusobacteriota accounted for 81.5% in the freshwater group. At the genus level, seawater samples exhibited richer microbial composition including Sphingomonas, Cupriavidus and Cetobacterium, while the freshwater microbiota was overwhelmingly dominated by Cetobacterium (81.5%). In conclusion, salinity significantly regulates serum biochemistry, hormone secretion, lipid metabolism, splenic immunity and intestinal microbiota of the F₂ generation of Chinese sturgeon. The freshwater environment benefits lipid metabolism, thyroid hormone levels, and growth performance, with a simplified intestinal microbial structure. Seawater acclimation maintains higher gut microbial diversity and immune homeostasis, but induces osmotic stress, restricts thyroid hormone secretion and redistributes energy supply, thereby inhibiting fish growth. This study provides a theoretical basis for salinity domestication and scientific culture management of Chinese sturgeon. Full article

The Immulite 2000xpi, a chemiluminescent immunoassay (CLIA)-based analyzer, is currently recommended for measuring thyroid hormones (TH) concentrations in equids. However, scarce data are available on TH measurements in donkeys using this technique. Similarly, the effects of factors such as age and gender on TH concentrations have not been assessed with this analyzer. Serum free and total T4 and T3 concentrations were measured in 40 healthy donkeys (6.1 ± 0.8 years old; 8 intact jacks and 32 jennies) and 41 horses (10.7 ± 0.5 years old; 15 stallions and 26 geldings) using the Immulite 2000xpi. A Mann–Whitney test was used to compare two groups, and a Kruskal–Wallis test followed by Dunn’s post hoc test was used for comparisons among more than two groups. This analyzer had lower intra-assay variability and fewer measurements under the detection limit for tT4 and fT4 than for tT3 and fT3 determinations. The canine TSH kit for thyroid-stimulating hormone (TSH) showed high imprecision. Donkeys had higher serum TH concentrations than horses. No differences were observed among gender or age groups. This is the first study to report TH concentrations in donkeys using a CLIA-based analyzer and to evaluate the effects of several factors on TH concentrations. The canine TSH kit is not valid for measuring TSH in equids. Full article

Background and Objectives: Thyroid dysfunction has been increasingly reported during and after SARS-CoV-2 infection, yet prospective longitudinal studies integrating biochemical and imaging assessments remain limited. The aim of this study was to evaluate the evolution of thyroid function and structural changes during a 12-month follow-up after COVID-19 hospitalization. Materials and Methods: This prospective single-center cohort study included adult patients hospitalized with laboratory-confirmed COVID-19 between December 2022 and December 2024. Thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), anti-thyroid peroxidase (anti-TPO), and anti-thyroglobulin antibodies (anti-TG) were assessed during hospitalization and at 1, 3, 6, and 12 months. Color Doppler thyroid ultrasound was performed at baseline and 6 and 12 months. Acute disease severity, vaccination status, and corticosteroid exposure were recorded. Results: Of the 71 enrolled patients, 67 completed the 12-month follow-up. Subacute thyroiditis occurred in 4/67 patients (6.0%; 95% CI: 1.7–12.6%). After excluding individuals with pre-existing disease, newly detected autoimmune thyroiditis was identified in 8/61 patients (13.1%; 95% CI: 5.8–24.2%). Most cases were mild and self-limited. Ultrasound patterns suggestive of autoimmune thyroiditis increased over time, even in patients with minimal biochemical abnormalities. Thyroid hormone trajectories showed interindividual variability, with most values remaining within reference ranges. Associations with inflammatory markers, disease severity, and vaccination status were weak. Conclusions: A subset of patients developed biochemical and structural thyroid changes during the 12 months following COVID-19 hospitalization. These findings highlight the value of targeted thyroid follow-up after COVID-19, particularly in patients with persistent symptoms, borderline TSH values, or ultrasound changes suggestive of autoimmune thyroiditis. Full article

Background/Objectives: Celiac disease (CD) is an immune-mediated enteropathy with gastrointestinal and extraintestinal manifestations. In primary care, recognition can be delayed when psychiatric symptoms, arthralgia, thyroid dysfunction, alcohol exposure, and liver-test abnormalities coexist. This case report describes a confounder-aware diagnostic approach to histologically confirmed CD in a patient with a multifactorial primary-care presentation. Methods: We report a single-patient, de-identified reflective case from routine family medicine practice, organized according to CARE case-report principles. Results: A woman in her early sixties with hypothyroidism and glaucoma presented with new low mood, anhedonia, somnolence, generalized anxiety, increased alcohol intake, poor appetite, weight loss, abdominal bloating, diarrhea, flatulence, and polyarthralgia. Initial investigations, including celiac serology obtained before gluten-free diet advice, showed mild anemia, marked hyperferritinemia, severe cholestatic and hepatocellular liver-test abnormalities, uncontrolled hypothyroidism, and strongly positive tissue transglutaminase IgA (>250 kIU/L; reference 0.0–14.9). Radiographs showed mild osteoarthritis and osteopenia without erosive arthropathy. Computed tomography excluded malignancy but showed severe diffuse hepatic steatosis and mild pancreatic atrophy. Mirtazapine was started at the index visit; after the initial laboratory results, gluten-free diet advice, alcohol-reduction counseling, and levothyroxine adjustment were undertaken. During the diagnostic episode, small-bowel biopsy demonstrated moderate-to-severe crypt hyperplastic villous atrophy with increased intraepithelial lymphocytes, and gastric biopsies showed no significant pathology; the histology was consistent with CD. Symptoms improved substantially. Longer-term objective follow-up showed persistent but improved celiac serology (tTG-IgA 49.4 kIU/L), normalization of thyroid-stimulating hormone, partial improvement in gamma-glutamyl transferase, which remained elevated, and a later iron-deficiency pattern with persistent anemia. Conclusions: This case supports targeted CD testing when anxiety or depressive symptoms occur alongside gastrointestinal symptoms, weight loss, arthralgia, hypothyroidism or documented thyroid autoimmunity, anemia, osteopenia, or liver-test abnormalities. Histology and repeat serology confirmed the diagnosis, but the psychiatric and hepatic manifestations still require cautious interpretation because hypothyroidism, alcohol exposure, steatotic liver disease, and simultaneous treatments also shaped the clinical course. Full article

Background: Hypothyroidism is a globally prevalent disorder with variations in its occurrence. However, few studies have reported its prevalence in Saudi Arabia. This study aimed to establish the prevalence, characteristics, and predictors of subclinical and overt hypothyroidism in a clinical cohort from the Hail region of Saudi Arabia. Methods: A retrospective cross-sectional design was used. Electronic medical records of adults (aged ≥18 years) who underwent thyroid function testing (TSH, FT4, and FT3) at the study institution were reviewed. Participants with missing laboratory or demographic data and those with hyperthyroidism (TSH < 0.4 mIU/L) were excluded. Hypothyroidism was classified biochemically using internationally accepted TSH and FT4 thresholds. The final analysis cohort comprised 724 participants. Results: Of 724 participants, 471 (65.1%) were euthyroid, 234 (32.3%) had subclinical hypothyroidism, and 19 (2.6%) had overt hypothyroidism, yielding a total biochemical hypothyroidism prevalence of 34.9% (n = 253). Women were over-represented (89.6%), and obesity was prevalent (69%). The biochemical results confirmed that overt hypothyroidism showed significantly elevated TSH and decreased FT4 compared to subclinical hypothyroidism. There were non-significant associations between gender, BMI, and hypertension with thyroid status. Age was an independent predictor of hypothyroid status (OR = 0.983, 95% CI: 0.970–0.995, p = 0.008), and systolic blood pressure was also independently associated (OR = 1.011, 95% CI: 1.002–1.019, p = 0.016). Multiple regression showed age, hypertension, gonarthrosis, and chest pain were independently associated with TSH levels. Hierarchical clustering suggested potential regional patterns in hypothyroidism prevalence. Conclusions: Hypothyroidism, mostly subclinical, was prevalent in this clinical cohort. Age and systolic blood pressure were independent predictors, while BMI and gender were not. Biochemical assessment is essential for detection, and larger prospective studies are recommended. Full article

Purpose: This study introduces a robust approach for establishing reference intervals (RIs) for thyroid biomarkers in the Jordanian population by incorporating symptoms-based criteria into the control group selection. This method enhances the traditional inclusion–exclusion criteria by adding a symptom layer. Five thyroid biomarkers were analyzed: thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), thyroid receptor antibodies (TRAbs), and antithyroid peroxidase antibodies (TPOAb). The study also investigated the prevalence of thyroid disorders using the established population-specific RIs. Patients and Methods: Samples from 6782 participants across different regions were collected between June 2016 and May 2017. The Kruskal–Wallis and the Mann–Whitney tests identified the best partitioning based on age–gender significant differences, and 2.5th–97.5th percentiles were used to establish the RIs. Results: The TSH, FT4, and FT3 differed significantly among males and females, while no significant differences were found among different age groups. The RIs for males were as follows: TSH, 0.50–4.18 mIU/L; FT4, 12.00–21.16 pmol/L; and FT3, 2.28–4.17 pmol/L, while the corresponding RIs for females were as follows: TSH, 0.57–4.61 mIU/L; FT4, 12.02–24.69 pmol/L; and FT3, 2.53–3.71 pmol/L. TRAbs and TPOAb RIs were 0.3–1.89 IU/L and 0.83–23.87 IU/mL, respectively. The prevalence of overt hypothyroidism was 10.63%, subclinical hypothyroidism was 3.53%, overt hyperthyroidism was 0.66%, and subclinical hyperthyroidism was 1.52%. Conclusions: This study emphasizes the role of population-specific RIs in minimizing diagnostic errors. The addition of symptom criteria improved control group identification and RI accuracy. These findings improve the diagnosis of thyroid disorders in Jordan and suggest a reproducible framework for worldwide application. Full article