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At the end of a two-year follow-up elevated TSH levels normalize or remain unchanged in most the children with subclinical hypothyroidism
Filippo De Luca, Malgorzata Wasniewska, Giuseppina Zirilli, Tommaso Aversa, Teresa Arrigo
Italian Journal of Pediatrics , 2010, DOI: 10.1186/1824-7288-36-11
Abstract: Study design of this study is very accurate and the results are robust, thus supporting the Authors' conclusions.Aim of the present Commentary article is to discuss a paper concerning the natural course of idiopathic subclinical hypothyroidism (SH) in childhood and adolescence, that has been very recently published [1] and was included in the 2009 Pediatric Endocrinology Year Book [2]. Soon after its publication that paper was analyzed and commented by another Author on another journal [3].SH is a condition of moderate thyroid failure characterized by normal circulating levels of thyroid hormones with mildly elevated TSH serum concentrations. SH is a common clinical problem in adulthood and elderly, with an average worldwide prevalence that has been reported to be in the range of 4-10% in large general population screening surveys [4] and 7-26% in studies of elderly [5]. In pediatric age SH prevalence seems to be distinctly lower than in old people, although there are only few epidemiological studies concerning childhood and adolescence [6-8]. According to one of them, SH frequency in adolescents is slightly lower than 2% [8-15].Data from the literature regarding the natural course of SH are very controversial, probably due to the fact that most the available longterm studies are retrospective. Moreover all the available reports on the spontaneous evolution of SH in both aged and young patients have been based, to now, on unselected study populations including also patients with either thyroid disorders or other pathological causes that are well known to be able to affect SH development and evolution. The risk of progression to overt hypothyroidism, in fact, is known to be greater in those patients with underlying thyroid diseases [9] and the unfavourable prognostic value of goiter and thyroid autoantibodies was confirmed even in children and adolescents [10]. However, according to one of the few available follow-up studies on juvenile SH, this may be a benign and r
Dyslipidemia in subclinical hypothyroidism  [PDF]
?aparevi? Zorica,Bojkovi? Gradimir,Stojanovi? Drago? Lj.,Ili? Vesna
Medicinski Pregled , 2003, DOI: 10.2298/mpns0306276c
Abstract: Introduction Subclinical hypothyroidism is defined as an increased serum TSH and normal serum FT4 concentration. In subclinical hypothyroidism, thyroid peroxidase and thyroglobulin antibodies are frequently present. Subclinical hypothyroidism may have endogenous or exogenous causes. The prevalence of subclinical hypothyroidism is rather high. The number of patients progressing to overt hypothyroidism may be higher. These patients may be asymptomatic, or have only mild symptoms or a single symptom. Material and methods We investigated 35 patients with subclinical hypothyroidism in order to establish the type and degree of dyslipidemia and effects of therapy with L-thyroxine (50 micrograms/d) during three months. Results Serum cholesterol LDL-cholesterol and apo B were increased. A significant reduction of serum cholesterol, LDL-cholesterol and apo B concentrations was established during thyroid hormone replacement. Discussion and conclusion Only a few studies reported higher LDL and lower HDL-cholesterol values in subclinical hypothyroidism. Much interest was thus aroused to evaluate whether or not subclinical hypothyroidism is associated with hypercholesterolaemia. Only patients with serum thyrotropin (TSH) concentration above 10 mU/L had a significant reduction of serum cholesterol concentration during thyroid hormone replacement. Most patients with subclinical hypothyroidism should be treated with thyroxine to prevent progression to overt hypothyroidism Thyroid hormone replacement therapy may slow the progression of coronary heart disease, because of its beneficial effects on lipids. These findings and especially high rate of progression towards overt hypothyroidism suggest early thyroxine treatment.
Subclinical hypothyroidism: psychiatric disorders and symptoms
Almeida, Cloyra;Brasil, Marco Ant?nio;Costa, Ant?nio José Leal;Reis, Fabiola A A;Reuters, Vaneska;Teixeira, Patrícia;Ferreira, Márcia;Marques, Amanda M;Melo, Bianca A;Teixeira, Letícia B B de M;Buescu, Alexandre;Vaisman, Mário;
Revista Brasileira de Psiquiatria , 2007, DOI: 10.1590/S1516-44462007000200013
Abstract: objective: to evaluate the prevalence of psychiatric disorders and symptoms in patients with subclinical hypothyroidism. method: ninety-four outpatients with at least two elevated serum thyrotrophin levels (> 4 μu/ml) and normal ft4, and 43 euthyroid outpatients, both groups from hucff-ufrj, were evaluated. psychiatric diagnosis was based on the structured clinical interview diagnostic for the dsm-iv axis i (scid-i/dsm-iv), the psychopathological symptoms on hamilton anxiety and depression scales, and the beck inventory. results: our data showed an increased prevalence of psychiatric disorders in the subclinical hypothyroidism patients when compared to the euthyroid group (45.7% vs 25.6%; p = 0.025), mood disorders being the most frequent. the prevalence of depressive symptoms based on beck's scale among subclinical hypothyroidism patients was about 2.3 times higher than among euthyroid ones (45.6% vs 20.9%, p = 0.006). anxiety symptoms were also more frequent among subclinical hypothyroidism patients (87.0% vs 60.5%, p < 0.001), mainly clinical anxiety (44.6% vs 23.3%; p = 0.001). conclusion: our results showed a significant association of subclinical hypothyroidism with psychiatric disorders and an increased frequency of subsyndromic depression and anxiety symptoms in subclinical hypothyroidism in relation to the euthyroid group.
Subclinical hypothyroidism in eastern Nepal: A hospital based study  [PDF]
V Rohil,AK Mishra,MK Shrewastwa,KD Mehta,M Lamsal,N Baral,S Majhi
Kathmandu University Medical Journal , 2010, DOI: 10.3126/kumj.v8i2.3565
Abstract: Background: Subclinical hypothyroidism itself is associated with serious complications and also there is a known risk of subclinical hypothyroidism patients getting converted into overt disease.
Are neuropsychological changes relevant in subclinical hypothyroidism?
Almeida, Cloyra;Vaisman, Mario;Costa, Antonio José Leal;Reis, Fabiola A.A.;Reuters, Vaneska;Teixeira, Patricia;Ferreira, Marcia;Teixeira, Letícia B.B. de M.;Araújo, Glória R.B. de;Brasil, Marco Antonio;
Arquivos Brasileiros de Endocrinologia & Metabologia , 2007, DOI: 10.1590/S0004-27302007000400016
Abstract: introduction: neuropsychological changes are still controversial in patients with subclinical hypothyroidism (sh). the objective of this study is to assess these changes. method: cross-sectional study comparing the results of the neurocognitive evaluation of 65 sh patients and 31 individuals without thyroid disease. subclinical hypothyroidism was defined as at least two elevated serum tsh levels (> 4 μui/ml) with normal serum free t4 levels (0.9-1.8 ng/dl). the participants underwent the following neuropsychological assessment: buschke?s selective reminding procedure, rey-osterrieth complex figure test, warrington?s recognition memory test for words and faces, and the vocabulary subtest of the wais-r. results: the groups were similar in regard to mean age, sex and educational level. no neuropsychological change was found in patients with sh when compared with euthyroid individuals. conclusion: no difference was observed in the performance of the neuropsychological tests between both groups in regard to the functions studied.
Subclinical hypothyroidism in obese children  [PDF]
Emel Torun,Ergül Cindemir,?lker Tolga ?zgen,Faruk ?ktem
Dicle Medical Journal , 2013,
Abstract: Objective: Thyroid functions in obese children and adolescentswere evaluated in order to determine subclinicaland clinical hypothyroidism.Materials and methods: In this study, 85 obese (Bodymass index >97th percentile) children, aged 2-14 years, aswell as 47 healthy controls were enrolled. Levels of serumfree triiodothyronine (fT3), free thyroxine (fT4) and thyroidstimulatinghormone (TSH) of the two groups were compared.Obese children with TSH level above 5.4 IU/mlwere also analyzed for thyroid autoantibodies and thyroidultrasounds were performed.Results: Obese children showed higher serum concentrationsof TSH and fT3 than the controls but no significantdifference in serum fT4 levels was found between the twogroups (P=0.001). One child had high auto antibodiesand 32 had high TSH levels. Of 28 children with TSH >5,4IU/ml, 25 children had normal thyroid ultrasound findingsand three had nodules or thyroiditis but no enlargementof the thyroid gland.Conclusion: TSH and fT3 levels were found to be higherin obese children compared with non-obese children withno difference of fT4 levels between two groups.Key words: Body mass index, obesity, thyroid functions
Subclinical Hypothyroidism Effects on Cardiac Function  [PDF]
M. Niafar,M. Toufan,S. Ghafoori,N. Aghamohammadzadeh
Pakistan Journal of Biological Sciences , 2009,
Abstract: To evaluate heart function in subclinical hypothyroid women in comparison with healthy subjects, a prospective study was performed on newly detected subclinical hypothyroid women presenting to endocrinology clinic of Tabriz Sina Hospital from October 2007 to February 2008. Thirty five women with Subclinical Hypothyroidism (SH) in case group were matched with 35 healthy euthyroid women in control group. All patients in both groups were studied by two dimensional echocardiography and Tissue Doppler Imaging (TDI) in Tabriz Shahid Madani Hospital. The FT4 and TSH levels were measured. Comparison of TDI results in Right Ventricle (RV) showed the significantly lower mean Tv excursion in case group with no significant difference in other parameters. In Left Ventricle (LV), the mean Am, Av and Ev/Em were significantly higher and E/A was lower in the case group, but there was no significant difference in other parameters. No RV diastolic dysfunction was documented in both groups. There was no case with LV systolic dysfunction in both groups. There were 21 (60%) patients with LV diastolic dysfunction in the case group comparing with 11 (31.4%) cases in the control group (p = 0.016, OR = 0.306). Frequency of LV diastolic dysfunction was significantly higher in the case group in patients aged ≥40 years (94.1% vs. 53.3%; p = 0.013). There was no case of pericardial effusion in the studied population. According to our results, SH may cause LV diastolic dysfunction. Likewise, minor RV systolic dysfunction might be seen in these patients
Subclinical hypothyroidism and risk to carotid atherosclerosis
Valentina, Velkoska Nakova;Marijan, Bosevski;Chedo, Dimitrovski;Branka, Krstevska;
Arquivos Brasileiros de Endocrinologia & Metabologia , 2011, DOI: 10.1590/S0004-27302011000700007
Abstract: objective: the aim of this study was to assess whether subclinical hypothyroidism (sch) is associated with carotid atherosclerosis, as well as dyslipidemia, and arterial hypertension. subjects and methods: the study included 69 consecutive patients with newly diagnosed sch, and 30 matched healthy controls. body mass index (bmi), tsh, ft4, antibodies to thyroid peroxidase (tpoabs), lipids, blood pressure, mean and maximum carotid intima-media thickness (cimt) were determined in all participants. results: mean values of cimt, triglycerides, and total cholesterol/hdl-c ratio were significantly different in sch patients versus matched controls. linear multiple regression analysis demonstrated that tsh, diastolic blood pressure and triglycerides were independent predictors of mean cimt, ft4 for maximum cimt; and that tsh, ft4, age, and total cholesterol/hdl-c ratio were independent predictors of the presence of carotid plaques. conclusion: our data revealed that sch is associated with increase in cimt and presence of carotid plaques, independent of classical risk factors for atherosclerosis.
Association of Lipids with Oxidative Stress Biomarkers in Subclinical Hypothyroidism  [PDF]
Adriana Santi,Marta M. M. F. Duarte,Charlene C. de Menezes,Vania Lucia Loro
International Journal of Endocrinology , 2012, DOI: 10.1155/2012/856359
Abstract: Objective. The aim of the present study was to evaluate the oxidative stress biomarkers in patients with subclinical hypothyroidism ( ) and health controls ( ). Subjects and Methods. Total cholesterol (TC), triglycerides (TGs), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), thiobarbituric acid reactive substances (TBARSs), catalase (CAT), superoxide dismutase (SOD), and arylesterase (ARE) were analyzed. Results. TC, LDL-C, TBARS, and CAT were higher in subclinical hypothyroidism patients, whereas SOD did not change. Arylesterase activity was significantly lower in the SH group, compared with the control group. Correlation analyses revealed the association of lipids (TC and LDL-C) with both oxidative stress biomarkers and thyrotropin (TSH). Thyroid hormones were correlated only with triglyceride levels. In addition, TSH was significantly correlated with TBARS, CAT, and SOD. However, no significant correlations were observed after controlling TC levels. Conclusions. We found that SH patients are under increased oxidative stress manifested by reduced ARE activity and elevated lipoperoxidation and CAT activity. Secondary hypercholesterolemia to thyroid dysfunction and not hypothyroidism per se appears to be associated with oxidative stress in subclinical hypothyroidism. 1. Introduction Subclinical hypothyroidism (SH), defined as an elevated serum thyroid stimulating hormone (TSH) level associated with serum thyroid hormone concentrations within the reference range, is found in 4–10% of individuals from Western populations [1, 2]. Patients with hypothyroidism have an increased risk of developing atherosclerosis, and the subclinical stage is also considered a risk factor for this disease [3, 4]. Some investigators have found this connection to be attributed to increased levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and apolipoprotein (apo) B [5, 6], whereas others did not observe any significant differences [7, 8]. Thyroid hormones are associated with the oxidative and antioxidative status of the organism. Depression of metabolism due to hypothyroidism has been reported to decrease oxidant production and thus protects tissues against oxidant damage [9, 10]. However, data on the oxidative status of hypothyroidism are limited and controversial [11–13]. Lipid peroxidation (LPO) is a free radical chain reaction, which is triggered by hydroxyl radical and leads to membrane break. It facilitates the alteration in the protein structure and function and promotes generation of free radicals
Cardiovascular risk factors in patients with subclinical hypothyroidism  [PDF]
Pe?i? Milica,Anti? Slobodan,Koci? Radivoj,Radojkovi? Danijela
Vojnosanitetski Pregled , 2007, DOI: 10.2298/vsp0711749p
Abstract: Background/Aims. Overt hypothyroidism is disease associated with accelerated arteriosclerosis and coronary heart disease. Whether subclinical hypothyroidism (SH) is associated with increased cardiovascular risk is contraversial. As SH is a high prevalence thyroid dysfunction, specially in older women, it is important to evaluate cardiovascular risk factors in these patients and that was the aim of this study. Methods. We examined 30 patients with SH and 20 healthy controls. Subclinical hypothireoidism was defined as an elevated thyrotropin (TSH) (> 4.5 mU/L) and normal free thyroxine (FT4) level. In all the participants we determined body mass index (BMI), blood pressure, TSH, FT4, antibodies to thyroid peroxidase, antibodies to thyroglobulin, total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, triglicerides, total cholesterol/HDL cholesterol ratio and LDL/HDL cholesterol ratio. Results. Mean BMI in patients with SH was significantly higher (p < 0.05), as well as diastolic blood pressure (p < 0.01) compared with the controls. Average levels of total cholesterol (5.40±0.62 vs 5.06±0.19 mmol/l, p < 0.01) and triglycerides (2.16±0.56 vs 1.89±0.24 mmol/l, p < 0.05) were also significantly higher in the group with SH. Individual analysis revealed that the percentage of patients with SH having borderline elevated total cholesterol (63.33%), hypertrigliceridemia (43.33%) and elevated total cholesterol/HDL cholesterol ratio (26.67%) were significantly higher than the percentage in the controls. No significant correlation between TSH and lipid parameters was detected. Conclusion. Subclinical hypothyroidism was associated with higher BMI, diastolic hypertension, higher total cholesterol and triglicerides levels and higher total cholesterol/HDL cholesterols ratio. This might increase the risk of accelerated arteriosclerosis in patients with SH.
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