The management and metabolic characterization: hyperthyroidism and hypothyroidism

Serum Klotho protein level in patients with thyroid dysfunction

OBJECTIVES

This study focused on determining the new marker Klotho and its correlation with other parameters in thyroid dysfunction.

METHODS

Seventy-seven thyroid dysfunction patients were recruited during the period (from Aug 2024 to Dec 2024) with an age range (33-56) years. The patient group was subdivided into two groups: group I (21) Patients with Hyperthyroidism and group II (56) Patients with Hypothyroidism, for comparison, 30 healthy individuals were included as a control. The protein level Klotho was estimated using ELISA. Biochemical parameters; blood urea, creatinine, and lipid profile were measured spectrophotometrically. T3, T4 and TSH were determined using ELFA kit.

RESULTS

Serum levels of Klotho protein were significantly lower (p-value < 0.001) in group I compared to the control group. There was a significant difference (p < 0.001) in the Klotho protein levels in group II compared with the control group. Klotho protein was negatively correlated to TSH, creatinine concentrations, and age. The AUC was excellent with high diagnostic accuracy in differentiating newly diagnosed thyroid dysfunction from the healthy subject group.

CONCLUSIONS

Serum Klotho levels in patients with thyroid dysfunction significantly decreased, particularly in hypothyroidism patients. These levels are inversely correlated with thyroid-stimulating hormone levels and age.

Thyroid function and its association with vitamin deficiencies: a case-control study in Duhok

BACKGROUND

Hypothyroidism, characterized by insufficient thyroid hormone production, is a common endocrine disorder with significant health implications. Recent studies suggest that micronutrient deficiencies, particularly in vitamin D, vitamin B12, and ferritin, may contribute to thyroid dysfunction. This study aims to explore the relationship between hypothyroidism and these micronutrient deficiencies in a clinical setting.

RESEARCH DESIGN AND METHODS

A case-control study was conducted between September and December 2024 at Public Central Health Lab., Duhok Azadi teaching Hospital, Iraq. A total of 885 participants were included, with 170 hypothyroid patients and 715 healthy controls. Serum levels of TSH, T3, T4, vitamin D, vitamin B12, and ferritin were measured. Multivariable regression analysis was used to examine the associations between thyroid function and micronutrient status.

RESULTS

Hypothyroid patients had significantly higher TSH (9.4 ± 11.5 vs. 1.8 ± 0.8 mIU/L, p < 0.0001) and lower T4 (116.1 ± 28.6 vs. 129.2 ± 27.4 nmol/L, p < 0.0001) compared to controls. Vitamin B12 and ferritin levels were also lower in the hypothyroid group (p < 0.0001), while vitamin D showed no significant difference (p = 0.0524).

CONCLUSION

Hypothyroidism is associated with vitamin B12 and ferritin deficiencies, highlighting the importance of micronutrient in thyroid dysfunction management. Future studies should explore autoantibodies.

CLINICAL TRIAL REGISTRATION

http://duhokhealth.org/en/identifier/is/25092024-8-11.

Associations between indicators of lipid and glucose metabolism and hypothyroidism

BACKGROUND

Hypothyroidism, a prevalent thyroid hormone abnormality identified by biochemical indicators, is prone to serious consequences because of its insidious clinical manifestations and easy underdiagnosis. This research aimed to elucidate the relationships between indicators of lipid and glucose metabolism and hypothyroidism and to assess the value of metabolic indicators for hypothyroidism.

METHODS

Prevalence surveys were conducted utilizing information from 3254 NHANES individuals who passed screening between 2007 and 2012. Comparisons of baseline characteristics, assessment of logistic regression and subgroup analyses, visualization of restricted cubic splines curves, and validation of causal mediation analyses were performed to obtain a comprehensive view of the relationships between indicators of lipid and glucose metabolism and hypothyroidism.

RESULTS

Lipid and glucose metabolism indicators, especially the unconventional parameters triglyceride‒glucose index (TyG) and remnant cholesterol (RC) and the conventional parameter triglyceride (TG), exhibited robust positive relationships with hypothyroidism and served as crucial mediators in the pathways by which hypothyroidism affects health outcomes. Indicators were varying suggestive for hypothyroidism in distinct populations, with TyG being relatively more valuable.

CONCLUSIONS

Indicators of lipid and glucose metabolism (TyG, TG, and RC) were intimately associated with hypothyroidism, with potential applications in the assessment and management of hypothyroidism.

Association between atherosclerosis and the development of multi-organ pathologies

Atherosclerosis is a chronic inflammatory disease affecting the vascular system, characterised by the accumulation of modified lipoproteins, immune cell aggregation and the development of fibrous tissue within blood vessel walls. As atherosclerosis impacts blood vessels, its adverse effects may manifest across various tissues and organs. In this review, we examine the association of atherosclerosis with Alzheimer's disease, stroke, pancreatic and thyroid dysfunction, kidney stones and chronic kidney diseases. In several cases, the reciprocal causative effect of these diseases on the progression of atherosclerosis is also discussed. Particular attention is given to common risk factors, biomarkers and identified molecular mechanisms linking the pathophysiology of atherosclerosis to the dysfunction of multiple tissues and organs. Understanding the role of atherosclerosis and its associated microenvironmental conditions in the pathology of multi-organ disorders may unveil novel therapeutic avenues for the prevention and treatment of cardiovascular and associated diseases.

The Effect of Some Micronutrients Multi-Supplementation on Thyroid Function, Metabolic Features and Quality of Life in Patients Treating With Levothyroxine and Vitamin D: A Double-blind, Randomized Controlled Trial

Background

It has been reported that reducing inflammatory damage and providing essential nutrients can improve thyroid function. Although sufficient clinical evidence does not support the routine prescription of nutritional supplements except for vitamin D therapy, as part of hypothyroidism treatment. We aimed to investigate the effects of supplementation with certain micronutrients known as essential for normal thyroid function on thyroid function, metabolic manifestations, and quality of life in patients with hypothyroidism.

Methods

In the current randomized controlled trial, we randomly assigned 104 patients with hypothyroidism receiving levothyroxine and vitamin D to either supplementation with 200 µg selenium, 15 mg zinc, 250 mg magnesium, 2500 IU vitamin A, 120 mg vitamin C, and 100 IU vitamin E per day (LT4VDS group) or placebos (LT4VDP group) for 8 weeks. Serum thyroid-stimulating hormone (TSH), free thyroxine (fT4), anti-thyroid peroxidase antibody (TPO-Ab), triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL-c), high-density lipoprotein (HDL-c), fasting blood sugar (FBS), fasting insulin, homeostatic model assessment for insulin resistance (HOMA-IR), C-reactive protein (CRP), as well as blood pressure, and anthropometric values, were measured before and after intervention. The 36-item short-form survey, the International Physical Activity Questionnaire, and 2 food recalls were completed. Thyroid function test, metabolic factors, and quality of life indices were compared between the 2 groups after the intervention, using analysis of covariance tests, with robust standard errors and intention to treat analysis, "multiple imputation method," adjusted for covariates.

Results

In the LT4VDP group, higher postintervention values of FBS (98.5 [85.7, 106.5] in LT4VDP group vs 89 [82.5, 95.7] in LT4VDS group; P = 0.012; effect size, 0.083), and HOMA-IR (2.1 [1.3, 3.8] in LT4VDP group vs 1.6 [1.1, 2.4] in LT4VDS group; P = 0.031; effect size, 0.053) were observed. Intention to treat analysis (n = 95 participants) showed similar results regarding FBS. In the LT4VDP group, a marginal increase regarding CRP (Δ: 1 [-1, 1] in LT4VDP group vs -0.6 [-1, 1] in LT4VDS group; P = 0.051), and Insulin (Δ: 2.9 [0.4, 6.1] in LT4VDP group vs 1 [-0.5, 2.3] in LT4VDS group; P = 0.042) were observed, whereas in the LT4VDS group the physical quality of life partially improved (Δ: 0.2 [9.1] in LT4VDP group vs 3.6 [6.3] in LT4VDS group; P = 0.044, effect size, 0.012). Between-group comparison of difference values did not show significant results regarding other outcomes, including TSH, fT4, TPO-Ab, mental quality of life, TG, TC, LDL, HDL, and blood pressure.

Conclusion

An 8-week supplementation with the nutrients above may affect insulin resistance and quality of life in patients with hypothyroidism; additional clinical trials are recommended.

Impact of polyethylene microplastics exposure on kallikrein-3 levels, steroidal-thyroidal hormones, and antioxidant status in murine model: protective potentials of naringin

The widespread presence of microplastics in the environment has raised significant concerns regarding their potential impact on human and animal health. Among various microplastic types, polyethylene microplastics (PE-MPs) are particularly prevalent due to the extensive use in packaging and consumer products. Exploring the uncharted therapeutic potentials of naringin, this study delves into its mitigating effects on disruptions in kallikrein-3 levels, steroidal-thyroidal hormone balance, and antioxidant defense triggered by PE-MPs exposure, paving the way for novel interventions in environmental toxin-induced endocrine and oxidative stress disorders. Male Wistar rats (n = 24) were randomly grouped into four: Control, PE-MPs (1.5 mg/kg), PE-MPs + NAR (1.5 mg/kg PE-MPs + 100 mg/kg NAR), and NAR (100 mg/kg). Hormonal and antioxidant parameters were assessed after 28 days of exposure. PE-MPs exposure caused a significant increase(p < 0.005) in the level of kallikrein-3 (KLK-3) while it significantly reduces the levels of testosterone (TST), luteinizing hormone, thyroid stimulating hormone (TSH) and Free-triiodothyronine (fT3) and Total cholesterol (TChol) concentration. PE-MPs exposure also disrupted significantly (p < 0.005) antioxidant profile by down-regulating the activities of glutathione-S-transferase, catalase (CAT), superoxide dismutase (SOD) and reducing levels of glutathione (GSH) and ascorbic acid (AA) while concentration of malondialdehyde (MDA) levels were increased relative to control. However, the mitigating potentials of naringin on disruptions in hormonal and antioxidant profiles caused by PE-MPs exposure were demonstrated, as NAR normalized KLK-3, steroid, and thyroid hormone levels, cholesterol concentration, and enhanced antioxidant defense. This suggests that NAR is a promising protective agent against endocrine and oxidative damage induced by environmental contaminants such as microplastics.

Association between serum Klotho levels and hypothyroidism in older adults: NHANES 2007-2012

Whether Klotho plays any role in hypothyroidism is unknown. This study aimed to determine the relationship between serum Klotho levels and hypothyroidism in older adults. From the 2007 to 2012 National Health and Nutrition Examination Survey (NHANES), 1444 older adults aged 65-79 were included in this cross-sectional study. Hypothyroidism was diagnosed using participants' reports of current medications and TSH tests. Klotho was measured using an enzyme-linked immunosorbent assay. The relationship between serum Klotho levels and hypothyroidism in older people was analyzed by one-way analysis of variance, multiple linear regression models, subgroup analyses, interaction tests, smoothed curve fitting, and threshold effects. A total of 209 (14.47%) participants were identified as having hypothyroidism. Serum Klotho (ln transformation) is independently and significantly negatively associated with the risk of hypothyroidism after complete adjustment for confounders (OR = 0.49, 95% CI 0.31-0.80; P = 0.0039). The results remained stable based on subgroup analyses and interaction tests. However, we observed an inverted U-shaped curve between the two using a smoothed curve fitting in the subgroups of 70 < age ≤ 75 years and females, with inflection points of 6.26 and 6.17, respectively. The results of our study indicate that serum Klotho levels negatively correlate with hypothyroidism among older adults.

Association between urinary organophosphate ester metabolite exposure and thyroid disease risk among US adults: National Health and Nutrition Examination Survey 2011-2014

Background

Organophosphate esters (OPEs) may interfere with thyroid function, but the relationship between OPEs and thyroid disease remains unclear. This study aims to elucidate the relationship between OPEs exposure and thyroid disease risk in the general population in the United States.

Method

Data were obtained from the 2011-2014 National Health and Nutrition Examination Survey cycle. All participants were tested for seven OPE metabolites in their urine and answered questions about whether they had thyroid disease through questionnaires. Logistic regression was employed to analyze the association between exposure to individual OPE metabolites and thyroid disease. Weighted Quantile Sum (WQS) regression modeling was utilized to assess exposure to mixed OPE metabolites and risk of thyroid disease. Bayesian kernel machine regression(BKMR) models to analyze the overall mixed effect of OPE metabolites.

Result

A total of 2,449 participants were included in the study, 228 of whom had a history of thyroid disease. Bis(1,3-dichloro-2-propyl) phos (BDCPP), Diphenyl phosphate (DPHP) and Bis(2-chloroethyl) phosphate (BCEP) were the top three metabolites with the highest detection rates of 91.75%, 90.77% and 86.57%, respectively. In multivariate logistic regression models, after adjustment for confounding variables, individuals with the highest tertile level of BCEP were significantly and positively associated with increased risk of thyroid disease (OR=1.57, 95% CI=1.04-2.36), using the lowest tertile level as reference. In the positive WQS regression model, after correcting for confounding variables, mixed exposure to OPE metabolites was significantly positively associated with increased risk of thyroid disease (OR=1.03, 95% CI=1.01-1.06), with BCEP and DPHP having high weights. In the BKMR model, the overall effect of mixed exposure to OPE metabolites was not statistically significant, but univariate exposure response trends showed that the risk of thyroid disease decreased and then increased as BCEP exposure levels increased.

Conclusion

The study revealed a significant association between exposure to OPE metabolites and an increased risk of thyroid disease, with BCEP emerging as the primary contributor. The risk of thyroid disease exhibits a J-shaped pattern, whereby the risk initially decreases and subsequently increases with rising levels of BCEP exposure. Additional studies are required to validate the association between OPEs and thyroid diseases.

Insights on the Association between Thyroid Diseases and Colorectal Cancer

Benign and malignant thyroid diseases (TDs) have been associated with the occurrence of extrathyroidal malignancies (EMs), including colorectal cancers (CRCs). Such associations have generated a major interest, as their characterization may provide useful clues regarding diseases' etiology and/or progression, with the possible identification of shared congenital and environmental elements. On the other hand, elucidation of the underlying molecular mechanism(s) could lead to an improved and tailored clinical management of these patients and stimulate an increased surveillance of TD patients at higher threat of developing EMs. Here, we will examine the epidemiological, clinical, and molecular findings connecting TD and CRC, with the aim to identify possible molecular mechanism(s) responsible for such diseases' relationship.