Epidemiology of Hypothyroidism, Hyperthyroidism and Positive Thyroid Antibodies in the Croatian Population

A Scoping Review on the Prevalence of Hashimoto's Thyroiditis and the Possible Associated Factors

BACKGROUND

Hashimoto's thyroiditis (HT) is the most common autoimmune thyroid disease (AITD) and is characterized by the presence of thyroid autoantibodies against thyroid peroxidase and/or thyroglobulin. Several studies have found that the global prevalence of HT has increased in recent decades, while others show the opposite.

METHODS AND RESULTS

The objective of this scoping review was to synthesize and analyze the different studies that have evaluated the prevalence of HT (in adults) and the possible associated factors. The following databases were consulted, as follows: MEDLINE, Web of Science, PubMed, and Scopus. The search terms "epidemiology", "prevalence", and "Hashimoto disease" and "Hashimoto thyroiditis" were used. The search was limited to articles published between January 1965 and October 2024, and only articles in English were considered. In order to reduce selection bias, each article was scrutinized using the JBI Critical Appraisal Checklist independently by two authors. Studies were included if the number of participants (study population and/or cases and controls, depending on the study design) was clearly described and duplicate studies were excluded. A total of 59 studies were identified, the vast majority of them used a cross-sectional design, using different methods of disease assessment.

CONCLUSIONS

Globally, the prevalence of HT is estimated to be between 5-10%; some areas with prevalences > 20% and others < 0.5% were identified. Prevalence is also higher in women than in men. Multiple underlying factors (genetic, epigenetic, environmental, and lifestyle), together with socioeconomic, nutritional, overdiagnosis, inter alia, may explain (at least in part) the wide variability in the prevalence of HT.

Long-term forecasting and evaluation of medicine consumption for the ATC class H with a focus on thyroid hormones in OECD countries using ARIMA models

Thyroid hormones are among the most prescribed medicines. In many countries, there are shortages combined with evidence of overuse and irrational prescribing. An analysis was conducted for ATC class H with a focus on thyroid hormones for OECD countries. This study aims to evaluate prescribing behaviours, forecast long-term developments and promote rational prescribing behaviour. The ARIMA(2,1,2) (autoregressive integrated moving average) model successfully predicted the future for 30 OECD countries and the non-OECD country Croatia until 2040. An upward trend is forecast for 18 countries, including Austria (+ 5.7%), Chile (+ 220.0%), Czechia (+ 52.8%), Denmark (+ 15.6%), Estonia (+ 87.8%), Greece (+ 238.7%), Hungary (+ 5.7%), Iceland (+ 18.6%), Italy (+ 42.9%), Latvia (+ 83.7%), Lithuania (+ 131.2%), Portugal (+ 106.7%), Slovakia (+ 182.1%), Slovenia (+ 57.4%), Spain (+ 162.8%), Turkey (+ 168.7%), the United Kingdom (+ 138.1%) and Croatia (+ 190.6%). A downward trend is forecast for 13 countries, including Australia (-3.4%), Belgium (-38.8%), Canada (-95.1%), Costa Rica (-79.5%), Finland (-14.7%), France (-100.0%), Germany (-16.4%), Israel (-21.6%), Korea (-100.0%), Luxembourg (-100.0%), the Netherlands (-35.9%), Norway (-23.6%) and Sweden (-43.6%). The reliability and accuracy of the forecasts varies, being influenced by data quality. While a downward trend is favoured, an upward trend is seen as problematic. Increasing trends predominate in Southern and Eastern Europe and Latin America, while decreasing trends predominate in Northern and Western Europe and the Asia-Pacific Region. Some external factors affect all countries, like an increasing prevalence of thyroid disease. There is evidence of cultural influences on prescribing behaviour. While there is evidence of inappropriate use in countries where prescriptions are predicted to increase, measures to restrict the use of thyroid hormones are more common in countries with a recently reported and predicted declining trend.

Thyroid Dysfunction Prevalence and Risk Factors in the Southeastern Part of Bangladesh: A Cross-Sectional Study

Background and Aims

Globally thyroid disorders (TDs) are common health issues including in the Southeast Asian region. The purpose of this study was to ascertain the prevalence of thyroid disorders in the Bangladeshi population, with a particular focus on the frequency, etiology, and comorbidity of various thyroid diseases.

Methods

A cross-sectional research design was conducted in the southeastern part of Bangladesh. Information regarding prior diagnosis and current management of TDs was obtained through a questionnaire.

Results

Of the 300 respondents, 209 were female, and 91 were male. Females were found to be more predominant across all categories of TDs (χ 2 = 17.738, p < 0.05). Furthermore, the older age group (31-45 years) demonstrated a higher frequency of thyroid problems (OR: 1.320). Specifically, hyperthyroidism was identified as the most common thyroid disorder, followed by hypothyroidism, and euthyroidism. Hyperthyroidism was found to be less common in males (18.69%) compared to females (43.06%), while hypothyroidism was more prevalent in males (46.15%) compared to females (27.75%). Multiple logistic regression analysis demonstrates that participants with a family history of TDs have a significantly higher chance (OR: 2.991, CI: 1.480-6.044, p < 0.05) of having hyperthyroidism than those without such a history. Interestingly, the studied population also exhibited higher rates of comorbidities including gastritis, diabetes, and cardiovascular diseases.

Conclusion

According to the study's findings, it is advised to concentrate on educating Bangladeshis about thyroid problems, particularly female population. Moreover, healthcare professionals should check elderly patient's thyroid conditions and consider the possibility that thyroid dysfunction can coexist with other conditions.

Associations of Urinary Perchlorate, Nitrate, and Thiocyanate with Female Infertility and Mediation of Obesity: Insights from NHANES 2013-2018

Classified as endocrine disrupting chemicals (EDCs), perchlorate, nitrate, and thiocyanate have been implicated with obesity and reproductive disorders. This study used three cycles of the National Health and Nutrition Examination Survey (NHANES 2013-2018); 813 women of reproductive age were finally included. We used multivariable logistic regression to analyze the associations between the three anions and obesity and infertility. Subsequently, we performed mediation analysis to explore the potential mediating effect of obesity on infertility in association with anion exposure. Increased concentrations of perchlorate and nitrate showed inverse correlations with the risk of obesity (OR = 0.73, 95% CI: 0.55-0.96; OR = 0.59, 95% CI: 0.40-0.87). Perchlorate was negatively associated with infertility (OR = 0.68, 95% CI: 0.51-0.91), and obesity was a mediator in association between perchlorate and infertility. These findings suggest that women of reproductive age may be protected from obesity and infertility by exposure to perchlorate and nitrate, with obesity acting as a moderating factor in the observed association. This study provides a valuable understanding of the complex links between environmental contaminants, obesity, and reproductive health, and identifies potential strategies to reduce the risk of infertility and improve women's health.

Public Awareness of the Symptoms and Risk Factors of Thyroid Disease in Saudi Arabia

INTRODUCTION

Thyroid disorders are a common manifestation of hormonal disorders that result from either excessive or insufficient production of thyroid hormones and the swelling of the thyroid gland. A lack of information and awareness of the signs and risk factors of thyroid problems can lead to untreated patients, thereby harming public health.

METHODS

Observational cross-sectional research was conducted in the Al-Baha region of Saudi Arabia, with 531 residents selected from the general population. The data were analyzed using SPSS to derive significant insights, and questionnaires were used to collect the data.

RESULTS

The results revealed that 79 (14.9%) of the participants had been diagnosed with thyroid disease. The risk factors for thyroid diseases reported were as follows: female gender (386, 72.7%); exposure to radiation (329, 62.0%); smoking (312, 58.8%); family history (300, 56.5%); and insufficient or excess intake of iodine (277, 52.2%). Only 110 (20.7%) of the participants knew that the use of amiodarone medication is a risk factor for thyroid diseases. The symptoms reported included fatigue (430, 81.0%), feeling cold, and weight gain (409, 77.0%); neck lump (379, 71.4%); depression (367, 69.1%); and hair loss (336, 63.3%). Early diagnosis (426, 80.2%), a well-exercised program (394, 74.2%), and a well-balanced diet (392, 73.8%) were the prevention methods reported by a majority of the participants. The study results revealed an average score of 13.57±2.11, with a minimum knowledge score of 0 and a maximum of 25. A statistically significant difference was observed in knowledge scores based on the participant's gender, age, education level, previous diagnosis with thyroid diseases, family history of thyroid diseases, and having performed thyroid gland investigation with p-values <0.05 (<0.001, 0.019, 0.027, <0.001, 0.023, and 0.031), respectively.

CONCLUSION

Nearly half of the participants had low knowledge scores regarding the risk factors and clinical manifestations of thyroid diseases. Although a sizable proportion of participants demonstrated awareness of some clinical presentations and prevention methods, there are serious knowledge gaps regarding the risk factors and symptoms of thyroid disease among the general population in the Al-Baha region. There is a need for targeted health education programs to improve public awareness of risk factors and early detection and prevention measures of thyroid diseases to improve the quality of life among community members.

Husband smoking is associated with Wife's thyrotropin abnormality: A population-based cohort study among Chinese reproductive-aged women

OBJECTIVES

To comprehensively assess the association of husband smoking with wives' thyrotropin abnormality.

METHODS

This population-based retrospective cohort study included 2 406 090 Chinese reproductive-aged women who had participated twice in the National Free Pre-pregnancy Checkups Project between 2010 and 2020. Multivariate-adjusted odds ratios and 95% confidence intervals for subnormal and supranormal thyrotropin were estimated according to the husband's smoking status.

RESULTS

Husband smoking at the first visit was associated with a 17% (15%-20%) and 26% (24%-28%) increased odds of subnormal thyrotropin and supranormal thyrotropin respectively compared to participants in neither-smoker group. In non-smoking participants with normal thyrotropin levels at the first visit, the corresponding increased risk of subnormal thyrotropin and supranormal thyrotropin at the second visit were 15% (12%-18%) and 19% (16%-21%) in contrast to participants without husband-smoking exposure. In non-smoking participants with abnormal thyrotropin levels at their first visit, husband smoking cessation was associated with 27% (17%-35%) and 36% (31%-40%) reduced odds of subnormal thyrotropin and supranormal thyrotropin at the second visit compared with the participants whose husband still smoking at the second visit.

CONCLUSION

Husband smoking was associated with wives' subnormal thyrotropin and supranormal thyrotropin, and cessation of husband smoking could reduce the odds of thyrotropin abnormality. Couple-focused smoking intervention should be developed to reduce the burden of asymptomatic thyroid disease in females.

Impact of mildly evaluated thyroid-stimulating hormone levels on in vitro fertilization or intracytoplasmic sperm injection outcomes in women with the first fresh embryo transfer: a large study from China

PURPOSE

This study aimed to investigate the association between mild elevation of thyroid-stimulating hormone (TSH) levels and pregnancy outcomes of in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatments in women with the first fresh embryo transfer.

METHODS

Large single-center retrospective cohort study of 15,728 patients from January 2018 to December 2022 were enrolled in the analyses. Clinical pregnancy rates, live birth rates, miscarriage rates, and ectopic pregnancy rates were compared between the TSH levels < 2.5 mIU/L group (N = 10,932) and TSH levels ≥ 2.5 mIU/L group (N = 4796). Subgroup analysis was performed for patients with TSH levels ≥ 2.5 mIU/L, dividing them into the thyroid peroxidase antibody (TPO)-negative group (N = 4524) and the TPO-positive group (N = 272).

RESULTS

There were no significant differences in the aforementioned pregnancy outcomes between the TSH levels < 2.5 mIU/L group and TSH levels ≥ 2.5 mIU/L group. Similarly, no significant differences were observed in the pregnancy outcomes between the TPO-negative group and the TPO-positive group.

CONCLUSION

Mildly elevated pre-conception TSH levels in thyroid-normal infertile patients did not have an impact on pregnancy outcomes of IVF/ICSI treatments.

Innate Immunity in Autoimmune Thyroid Disease during Pregnancy

Autoimmune thyroid disease (AITD) is the most common organ-specific autoimmune disorder clinically presented as Hashimoto thyroiditis (HT) and Graves' disease (GD). The pathogenesis of AITD is caused by an inappropriate immune response related to genetic, non-genetic, and environmental factors. Pregnancy is one of the factors that have a great influence on the function of the thyroid gland because of the increased metabolic demand and the effects of hormones related to pregnancy. During pregnancy, an adaptation of the maternal immune system occurs, especially of the innate immune system engaged in maintaining adaptive immunity in the tolerant state, preventing the rejection of the fetus. Pregnancy-related hormonal changes (estrogen, progesterone, hCG) may modulate the activity of innate immune cells, potentially worsening the course of AITD during pregnancy. This especially applies to NK cells, which are associated with exacerbation of HD and GD. On the other hand, previous thyroid disorders can affect fertility and cause adverse outcomes of pregnancy, such as placental abruption, spontaneous abortion, and premature delivery. Additionally, it can cause fetal growth retardation and may contribute to impaired neuropsychological development of the fetus. Therefore, maintaining the thyroid equilibrium in women of reproductive age and in pregnant women is of the highest importance.

Thyroxine biosensors: a review on progress and challenges

Hypothyroidism is a global concern that needs to be monitored, controlled and treated. Thyroxine is the most common biomarker for the diagnosis of hypothyroidism and a therapeutic hormonal replacement for hypothyroid patients. People suffering from hypothyroidism need to monitor their levels of thyroxine to avoid health complications. Diagnostic labs are not always easily accessible and, hence, point-of-care biosensors can become a useful alternative. Several studies have shown high sensitivity, selectivity and stability but there is no commercial point-of-care biosensing device available. This paper presents the critical aspects, including the need for thyroxine biosensors, the physicochemical properties of the thyroxine molecule, nanomaterials and bioreceptors used for sensing. The challenges and prospects of thyroxine biosensors are also discussed.

The Thyroid Hormone Axis and Female Reproduction

Thyroid function affects multiple sites of the female hypothalamic-pituitary gonadal (HPG) axis. Disruption of thyroid function has been linked to reproductive dysfunction in women and is associated with menstrual irregularity, infertility, poor pregnancy outcomes, and gynecological conditions such as premature ovarian insufficiency and polycystic ovarian syndrome. Thus, the complex molecular interplay between hormones involved in thyroid and reproductive functions is further compounded by the association of certain common autoimmune states with disorders of the thyroid and the HPG axes. Furthermore, in prepartum and intrapartum states, even relatively minor disruptions have been shown to adversely impact maternal and fetal outcomes, with some differences of opinion in the management of these conditions. In this review, we provide readers with a foundational understanding of the physiology and pathophysiology of thyroid hormone interactions with the female HPG axis. We also share clinical insights into the management of thyroid dysfunction in reproductive-aged women.

The Role of Toll-like Receptor 2 (TLR2) in the Development and Progression of Hashimoto’s Disease (HD): A Case Study on Female Patients in Poland

Chronic lymphocytic thyroiditis, commonly known as HD, is one of the most common thyroid disorders. Due to the diverse factors affecting the etiopathogenesis of this disease (hormonal disorders and genetic and environmental factors), as well as the direct involvement of the immune system, scientists are increasingly willing to undertake research aimed at explaining the impact of the loss of immune tolerance and reactivity of autoantigens on the development of the disease. One of the directions of research in recent years is the role of the innate immune response, particularly Toll-like receptors (TLRs), in the pathogenesis of HD. The purpose of this study was to determine the importance of Toll-like receptor 2 (TLR2) expression on selected populations of immune cells, namely, monocytes (MONs) and dendritic cells (DCs), in the course of HD. Particular attention was paid to the analysis of TLR2’s correlation with clinical parameters and the possibility its use as a potential biomarker molecule in the diagnostic process. Based on the obtained results, we found a statistically significant increase in the percentage of all analyzed populations of immune cells, i.e., mDC BDCA-1+CD19−, pDC BDCA-1+CD123, classical MONs CD14+CD16−, and non-classical MONs CD14+CD16+ showing on their surface TLR2 expression in patients diagnosed with HD compared to the healthy volunteers. Moreover, in the study group, we noted a more than 6-fold increase in the concentration of the soluble form of TLR2 in plasma compared to healthy patients. In addition, the correlation analysis showed significant positive correlations between the level of TLR2 expression on selected subpopulations of immune cells and biochemical indicators of thyroid function. Based on the obtained results, we can assume that TLR2 may be involved in the immunopathogenesis of HD.

Assessment of Saudi Society's Knowledge Regarding Hypothyroidism and Its Neuropsychiatric Clinical Manifestations

Background: This study was conducted to assess the level of knowledge and awareness of hypothyroidism and its neuropsychiatric clinical manifestations among the Saudi population. Methods: This was a cross-sectional study employing a convenient sampling technique, conducted between February and May 2022. A questionnaire was distributed online to all participants in all five regions. Results: In this survey, a total of 2016 Saudi citizens participated. When asked about depression, more than half of the participants (59.6%) correctly identified depression as one of the neuropsychiatric clinical symptoms of hypothyroidism. Nearly half of the participants (47.5%) were unaware that anxiety was not a neuropsychiatric manifestation of hypothyroidism. With a percentage of 91.0%, the majority of participants exhibited poor knowledge. The regression analysis showed that males have significantly reduced knowledge about hypothyroidism than females (coefficient −3.686, p-value < 0.0001). Similarly, those who have “enough income and can save” were more knowledgeable than others (coefficient 0.731, p-value < 0.02). Regarding the source of information, journals provide three times more information (p-value 0.0001), and healthcare practitioners provides four times more information as compared to family and friends (p-value 0.0001). Conclusion: Due to a lack of knowledge about hypothyroidism and its complications, symptoms, risk factors, and treatment, the most viable solution to these misconceptions would be to implement a variety of educational programs to increase public awareness of this issue.

Thyrotoxicosis in Africa: a systematic review and meta-analysis of the clinical presentation

Background

Thyrotoxicosis is a common endocrine disorder. The clinical presentation is variable, and it is often misdiagnosed or diagnosed late in Africa. This study was aimed at collating and analyzing the clinical characteristics of the disease across the continent so as to enhance correct and timely diagnosis.

Methods

The study is a systematic review with a meta-analysis. Studies, done in Africa, which documented the clinical features of thyrotoxicosis were selected. African Journal Online (AJOL), PubMed, SCOPUS and Google Scholar, Research Square, SciELO, and medRxiv were systematically searched using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study quality was assessed using the Newcastle-Ottawa scale. Heterogeneity was determined using I2 statistic and Cochran’s Q test. LFK index and the symmetry of the Doi plot were used to assess publication bias.

Results

The eligible studies were 59 and the total sample size was 9592. The most common symptoms of thyrotoxicosis on the continent included palpitations (69%), weight loss (65%), heat intolerance (64%), tiredness (49%), increased appetite (49%), hyperhidrosis (48%), and insomnia (47%). The most common signs were thyromegaly (88%), tachycardia (67%), sweaty palms (54%), hand tremor (49%), and exophthalmos (49%). Atrial fibrillation, heart failure, and thyrotoxic heart disease were found in 9, 12, and 22% respectively. Other findings were hypertension (25%) and diabetes (9%).

Conclusion

Clinical presentation of thyrotoxicosis varies, and understanding these peculiarities would mitigate misdiagnosis and delayed diagnosis in Africa.