Lipoprotein Ratios: Correlation With Glycated Hemoglobin (HbA1c) Among Thyroid Disorders' Patients

INTRODUCTION

Thyroid disorders and diabetes mellitus are prevalent conditions in the modern era. Moreover, glycated hemoglobin (HbA1c) is the established (prognostic as well as diagnostic) marker for long-term glycemic control, whereas the lipid profile is the marker for cardiovascular risks. The association of hypothyroidism with dyslipidemia is also a well-established fact. The current study explores a correlation between thyroid profile, glycemic status, and various lipoprotein indices.

OBJECTIVE

To look for an association between thyroid profile, glycemic status, and various lipoprotein indices.

METHODOLOGY

The cross-sectional study conducted at AIIMS Gorakhpur included a total of 108 subjects, with 37 normal subjects (Group I) and 71 patients) with T2DM (Type-2 diabetes mellitus) (Group II). Baseline characteristics of the two groups were compared for age, sex, presence of hypertension, fasting blood glucose, and body mass index (BMI). Blood samples were collected from the patients. The sera were analyzed for HbA1c and lipid profile, which included total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). Serum samples were also used to estimate the thyroid stimulating hormone (TSH) and triiodothyronine (fT3). The association between thyroid profile, glycemic status, and various lipoprotein indices was calculated.

STATISTICAL ANALYSIS

 Kolmogorov-Smirnov test for normality of the data. Spearmann correlation was used for nonparametric data.

RESULTS

There were significantly higher levels of total cholesterol, triglycerides, and LDL-C levels in T2DM subjects than in non-diabetic subjects. There was also a significant positive correlation observed between TSH and TC among the normal control group (ρ =0.348, P=0.04). Similarly, significant positive correlations were found for TG (ρ =0.354, P=0.04) and LDL-C (ρ =0.431, P=0.03) among non-diabetic subjects. Among patients with T2DM, TSH was significantly correlated positively with TG (ρ =0.530, P=0.006) and LDL-C (ρ =0.443, P=0.03). Similarly, in the same group, among lipid ratios, TG/HDL-C (ρ =0.311, P=0.04) and LDL-C/HDL-C (ρ =0.227, P=0.05) were significantly correlated to TSH. Furthermore, there were significant positive correlations between TSH and HbA1c (ρ =0.301, P=0.04). fT3 was found to have a strong negative correlation with HbA1c among patients with T2DM (ρ =-0.454, P=0.02).

CONCLUSION

Thyroid disorders exert significant effects on glycemic control and lipid metabolism, which may impact HbA1c levels and lipid profile parameters.

Hypothyroidism: A Peculiar Presentation

Hypothyroidism constitutes a prevalent pathology, with up to 80% of afflicted individuals displaying associated muscular symptoms. However, these symptoms rarely appear as the first or only manifestation of hypothyroidism. We report the case of a previously healthy 21-year-old man, diagnosed with hypothyroid myopathy after experiencing intense myalgias and cramps, which were relieved by oral administration of levothyroxine. This case demonstrates the significance of considering thyroid-related conditions when patients present muscular symptoms as these can represent the only or initial indicator of hypothyroidism. Timely thyroxine supplementation leads to the gradual resolution of most neuromuscular symptoms.

Evaluation of Thyroid Function Tests in Patients With COVID-19

Background SARS-CoV-2 infects cells via angiotensin-converting enzyme 2 (ACE2). ACE2 levels are high in the thyroid gland. Although the thyroid gland can be directly infected in COVID-19 patients, the hypothalamic-pituitary-thyroid axis is also affected. Therefore, changes in thyroid function occur in COVID-19 patients. This study aimed to examine the effect of thyroid function tests on the prognosis of COVID-19. Methodology A total of 146 patients who were diagnosed with COVID-19 and treated in the intensive care unit between August and November 2021 and who had no previous history of thyroid disease were included in the study. Demographic information, laboratory tests, and thyroid hormone levels during hospitalization and discharge patterns were evaluated. The patients were divided into two groups: group I included those who were discharged after recovery, and group II included those who did not respond to treatment and died. Results When the fT3 and fT4 levels of the patients were compared, the hormone levels decreased as the clinical severity of the disease increased. The amount of decrease in hormone levels was mostly seen in group II. In the recovered patient group, the amount of hormone decreased was less. The difference between fT3 and ft4 values between the groups was found to be statistically significant (P = 0.015 and P = 0.004). In addition, the difference between the groups' C-reactive protein (CRP), D-dimer, and ferritin values was statistically significant (P = 0.036, P = 0.022, and P < 0.000, respectively). There was no statistically significant difference between the groups in terms of demographic characteristics (P > 0.05). Conclusions Thyroid hormone changes were found to be an important prognostic parameter affecting disease severity and mortality in COVID-19 patients and can be used to predict mortality.

Rhabdomyolysis Secondary to Severe Hypothyroidism Due to Hashimoto's Thyroiditis: A Case Report

Hashimoto's thyroiditis, a chronic autoimmune inflammation of the thyroid glands, is the most common cause of hypothyroidism in iodine-sufficient areas, which can have varied clinical manifestations. It is more common in females and usually has an insidious course. Most patients present with mild clinical symptoms, such as constipation, fatigue, and weakness. Symptoms are associated with a slight increase in thyroid-stimulating hormone (TSH) levels and the presence of thyroid antibodies. However, overt hypothyroidism is uncommon. We hereby present an interesting case of rhabdomyolysis secondary to severe hypothyroidism due to Hashimoto's thyroiditis.

The Impact of Hypothyroidism on the Quality of Life of Adults in Riyadh, Saudi Arabia

Background and objective Hypothyroidism is extremely common and associated with far-reaching health consequences. The negative effects of hypothyroidism on patients' quality of life (QoL) are well-documented. It is said to be common in the countries of the Arabian Gulf, although it is often misdiagnosed and treated in an inconsistent manner. Hence, understanding how an illness like this affects a patient's life might help us enhance their QoL and get us closer to the healthcare transformation goals of Saudi Arabia's Vision 2030. Methodology This cross-sectional study was conducted in Riyadh, Saudi Arabia, between June 2022 and February 2023. A convenience non-probability sampling method was used. The WHO Quality of Life (WHOQOL)-BREF questionnaire in Arabic was used to compile the data. Data were collected using a standardized form, refined using Google Forms, and then documented in an Excel spreadsheet. The descriptive statistics were shown as means and standard deviations (SD). To assess the numerical data, a t-test was used, while the chi-square test was employed to examine the relationship between the qualitative factors. Results A total of 394 adults from the general population with hypothyroidism were surveyed, including 105 men and 289 women. Of them, 151 (38.3%) patients had not sought therapy for their hypothyroidism, while 243 (61.7%) patients had. When asked about the QoL, a significant segment (37.6%) of patients reported that it was high, and 29.7% reported being totally satisfied with their health. The WHOQOL-BREF domain scores revealed that environmental health had the highest value (24.04 ±4.62), followed by physical health (22.24 ±3.23), and then psychological health (18.08 ±2.82), and the lowest scores were reported for the rate of QoL and satisfaction with health (2.64 ±1.36 and 2.80 ±1.68), respectively. Each domain of the WHOQOL-BREF had its own set of variables that differed from one another in a statistically significant manner (p<0.001). Conclusions  Based on our findings, we recommend expert physician monitoring and implementing educational programs as well as placing a greater emphasis on patients' QoL in the management of hypothyroidism.

Can Thyrotropin, Tri-Iodothyronine, and Thyroxine Hormones be Predictors of Cancer in Thyroid Lesions?

Background Thyroid nodules are a common medical problem worldwide. This study aims to investigate and elucidate the relationship between thyroid-stimulating hormone (TSH), thyroxine (T4), and triiodothyronine (T3), and malignant thyroid nodules. Methods This prospective cross-sectional study was conducted at a public specialist hospital in Saudi Arabia from February 2020 to February 2021. All thyroid nodules were scanned using ultrasound imaging, and the largest diameter was measured for each and classified according to the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TIRADS) classification system. Thyroid function tests TSH, T3, and T4 were measured. Definitive diagnoses of thyroid nodules were given based on cytology. A one-way analysis of variance (ANOVA) test was used to compare means, and cross-tabulation was used to correlate the variables in the study. Results A total of 222 patients participated in this study; 23.42% were male and 76.57% were females. The mean age was 44.73 ± 13.31 years (range: 18 to 85 years). The percentage of malignancy was 20.6%, 36.3%, and 91.2% in TIRADS 3, TIRADS 4, and TIRADS 5, respectively. A weak positive linear relationship was noted between nodule size and TSH (R²= 0.012). The study demonstrates that TSH increases in malignant nodules more than in benign nodules, while T4 and T3 are decreased in malignant nodules. Conclusion The level of TSH increases in patients with malignant thyroid nodules more than in benign nodules, which can be used as a predictor of malignancy, while T4 and T3 reduced in malignant nodules with an ambiguous relationship.

Hiccups as a Rare Presentation of Thyrotoxicosis Triaged by an Epidural Steroid Injection

Thyrotoxicosis manifests when excess levels of thyroid hormone act on different tissues throughout the body. Excess hormone levels can be related to endogenous production or exogenous ingestion and can present differently in patients. It has been theorized that high levels of thyroxine can irritate the neuroanatomical hiccup center leading to persistent hiccups. Although extremely rare, physicians should be aware of this entity to allow for proper diagnosis and management. Here, we discuss a rare case of thyrotoxicosis after an epidural steroid injection presenting with intractable hiccups.

Myxedema Coma: Case Report and Literature Review

Myxedema coma is a life-threatening manifestation of hypothyroidism associated with altered mental status, hypothermia, and symptoms related to the slowing of other organ systems. It can occur as a culmination of severe, longstanding hypothyroidism or be precipitated by acute stressors such as infection, myocardial infarction, cold exposure, and surgery in patients with poorly controlled hypothyroidism. Given the high mortality rate and acuity with which the disease presents, treatment with thyroid hormone replacement should be initiated upon suspicion of the disease even prior to obtaining laboratory confirmation. Stress doses of hydrocortisone should also be given until coexisting adrenal insufficiency is excluded. We present a case of a 58-year-old male who presented to the emergency department after being found on the floor of his house. Physical examinations and laboratory results were significant for myxedema coma and the patient was given levothyroxine with improvement of symptoms and mild change in thyroid hormone levels during hospitalization. 

Unraveling the Role of Hypothyroidism in Non-alcoholic Fatty Liver Disease Pathogenesis: Correlations, Conflicts, and the Current Stand

Non-alcoholic fatty liver disease (NAFLD) has become one of the most common causes of chronic liver diseases globally. Because thyroid hormones play a crucial role in lipid metabolism, thyroid dysfunction has been implicated in NAFLD pathogenesis in the past decade, with hypothyroidism-induced NAFLD being regarded as a distinct disease entity. However, there has been no common consensus yet, and several studies have found contradictory results. Hence, we conducted this systematic review to represent the current view on the role of hypothyroidism (HT) and individual thyroid function parameters such as thyroid-stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TGAb) in NAFLD pathogenesis. We searched PubMed, PubMed Central, and Semantic Scholar databases from inception until January 2021 to identify relevant observational (case-control, cross-sectional, and longitudinal) studies. A total of 699 articles were recognized through our database search. After applying the eligibility criteria and performing quality assessment, 10 studies involving 42,227 participants were included in the final systematic review. Each of these studies assessed different thyroid function parameters, and NAFLD was found to be associated with HT in two studies, elevated TSH in three studies, suppressed T4 in three studies, elevated T3 in one study, and elevated TPOAb in one study. There was also a wide heterogeneity in HT definition, study population characteristics, and study design among these studies, making a direct comparison difficult. Because the recognition of HT-induced NAFLD has possible diagnostic, therapeutic, and prognostic implications, we recommend that comprehensive, long-term prospective studies be carried out to determine if HT or thyroid function parameters are causally associated with NAFLD.