Early Detection of Autoimmune Thyroid Heart Disease Via Urinary Exosomal Proteins
Condition: Thyroid Diseases; Heart Failure
MeSH terms: Heart Diseases; Thyroid Diseases
Study type: Observational

Summary: 
      Autoimmune thyroid disease revealed close relationship with heart failure, including the
      entities of subclinical hyperthyroidism and hypothyroidism. Heart failure is a principal
      complication of all forms of heart disease. The American College of Cardiology defines HF as
      a complex clinical syndrome that impairs the ability of the ventricle to fill with or inject
      blood. In fact, it may be caused by a defect in myocardial contraction, by an impairment in
      ventricular filling with preserved systolic function ('diastolic HF') or by a combination of
      both. Earlier detection of probable trend of heart failure in subclinical thyroid diseases is
      very important in not only Taiwan, Pan-Asia, but all over the aging world. However, it is not
      currently available.

      The investigators will enroll 20 patients with subclinical hyperthyroidism, subclinical
      hypothyroidism, and collect their urine specimens in outpatient clinic per year.

      Prognostic biological markers via this prospective study. The study was designed as
      prospective pattern, and the investigators will enroll clinical and subclinical thyroid
      disease with quarterly follow-up, then detect urine exosomal proteins NT-proBNP. The
      investigators try to find the correlation of outcome with unknown/fresh biomarkers in this
      study with time-dependent manner.

      The investigators hope to find earlier predicting biomarkers for heart dysfunction in
      autoimmune thyroid disease.
    

Detailed description: 
      Clinical and subclinical thyroid disease is usually used to describe patients with mild
      symptoms correlated to hyperthyroid or hypothyroid state. Thyroid ultrasonography could
      differentiate benign or malignant nodular lesion, together with fine needle aspiration
      cytology and surgical pathology. Thyrotropin (TSH, thyroid stimulating hormone) is the
      pivotal investigation in laboratory diagnosis to define subclinical thyroid diseases. An
      elevated TSH with normal free thyroxine and triiodothyronine levels in serum is defined to be
      subclinical hypothyroidism, and a subnormal TSH with normal thyroid hormone concentrations to
      be subclinical hyperthyroidism. Generally, the prevalence of subclinical hypothyroidism and
      hyperthyroidism were reported as 4% -10% & 1%-2% in general population, respectively.
      Although subclinical thyroid disease is prevalent, there is still no consensus for screening
      clinical and subclinical thyroid disease, including hyperthyroidism, hypothyroidism, nodular
      goiter and thyroid cancer. Under consideration of age, gender or familial history of
      autoimmune thyroid disease. However, screening for thyroid dysfunction should be considered
      in some high risk patients, including 1) elderly; 2) history of atrial fibrillation; 3)
      previous thyroid disease history; 4) other confirmed autoimmune diseases; 5) neck exposure of
      radiation (for example, nasopharyngeal cancer, post-radiation); 6) family history of probable
      autoimmune thyroid disease, and 7) pregnant state with prior thyroid disease history.
      Therapeutic decision for clinical and subclinical thyroid dysfunction should be considered
      individually. Therapeutic options will be anti-thyroid medications and/or radioactive iodine,
      and thyroidectomy could be considered with larger goiters for hyperthyroidism. For clinical
      and subclinical hypothyroidism, the therapeutic consideration should be aimed on reduction of
      progression to overt hypothyroidism, improving heart function, correction of dyslipidemia,
      and relieving senescence depressive mood. Thyroid ultrasonography will help us to keep long
      term observation of thyroid structural change. But long term outcome for treatment of such
      functional and structural thyroid diseases had not been recorded delicately in Taiwan.
      Further investigations should be observed in the future. The investigators hope to check the
      relationship between various thyroid diseases and biochemical survey/ultrasonography. The
      purpose of this study is aiming for early prevention and detection the potential risk factors
      for thyroid diseases in Taiwan.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        The investigators will enroll 20 patients with subclinical hyperthyroidism, subclinical
        hypothyroidism, and collect their urine specimens in outpatient clinic per year.

        The investigators will analyze the urine exosomal proteins and probable biological markers,
        including NT-proBNP and other proteins.

        The investigators hope to find the prognostic biological markers via this prospective
        study. The investigators further hope to find newly therapeutic and follow-up pathway for
        such patients with autoimmune thyroid disease (subclinical hyperthyroidism, subclinical
        hypothyroidism).
      
Keywords: Exosome; Urine; Biological marker