bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Tale of Two Therapies- A Comparison of Armour Thyroid and Levothyroxine
Authors: Shah Meghna , Proumen Rachael , Sunkara Akhila , Acharya Runa , Patel Amy 
Published: May 2021

Abstract
Treatment of hypothyroidism is predominantly with levothyroxine due to its ability to generate stable T3 levels and its long half-life. Many patients report continued hypothyroid symptoms despite normal TSH values on levothyroxine and request to switch to desiccated animal thyroid extract. Desiccated thyroid extract is less used for fear of side effects and risks. There are only a handful of studies available comparing desiccated animal thyroid extract to levothyroxine. We conducted a retrospective study on 250 hypothyroid patients over the age of 18 who presented to our clinic from 2008-2018. We excluded patients who had a history of thyroid cancer and documented non-adherence. We analyzed 125 patients on levothyroxine (males=43, females=82) and 125 patients who were on levothyroxine but chose to switch to Armour Thyroid (males=7, females=118). We examined the following variables; when comparisons of proportions were made between the two groups, N-1 chi square test was used to determine significance.
1. Reason for change to Armour Thyroid from levothyroxine: Top reasons were fatigue (n=51/125, 40.8%), inability to lose weight (n=32/125, 25.6%), mental fog (n=8/125, 6.4%), hair loss (n=8/125, 6.4%) and desire for a natural product (n=7/125, 5.6%)
2. Percentage of patients complaining of fatigue/weight gain in euthyroid state: 16/125 (12.8%) of patients on Armour Thyroid and 29/125 (23.2%) of patients on levothyroxine had complaints of fatigue and weight gain with a normal TSH. This 10.4% difference was significant (p value=0.033, 95% CI 0.84% to 19.8%).
3. Presence of side effects: 24/125 (19.2%) patients on Armour Thyroid discontinued it before 6 months. The top reasons were no improvement of symptoms (n=9/24, 37.5%), palpitations (n=5/24, 20.8%), worsening anxiety (n=3/24, 12.5%), cost (n=2/24, 8.33%), and loss of appetite (n=2/24, 8.33%). 5/125 (4.00%) patients on levothyroxine chose to discontinue it before 6 months. The reasons included presence of palpitations (n=3/5, 60.0%), hair loss (n=1/5, 20.0%), and gluten intolerance (n=1/5, 20.0%). A total of 11/125 (8.8%) had adverse effects from Armour Thyroid while 4/125 (3.2%) of patients on levothyroxine had adverse effects to the medication. The difference of 5.6% leaned toward clinical significance and trended toward being statistically significant (p value=0.06, CI -0.4842% to 12.1677%).
Our research shows that patients generally feel better on Armour Thyroid compared to levothyroxine. Armour Thyroid is an effective medication to use for patients who remain symptomatic on levothyroxine and should be considered as a viable option in clinical practice. However, our study also indicated that patients may have more adverse effects on Armour Thyroid when compared to levothyroxine and further studies are needed comparing the two medications. Limitations of our study include the retrospective nature of the study and the sample size.
Clinical Implication of TSH Screening in Venous Thromboembolism Patients
Authors: Dejhansathit Siroj , Mejia Ana Marcella Rivas , Nugent Kenneth 
Published: May 2021

Abstract
Background: Venous thromboembolism (VTE) that have significant morbidity and mortality for patients in the community and hospital. A recent meta-analysis found a significantly increased risk of incidence VTE among patients with hyperthyroidism compared to patients without hyperthyroidism. To our knowledge, no study has attempted to explore whether screening for TSH levels in VTE patients leads to a diagnosis of undiagnosed thyroid dysfunction as VTE could be the first presenting symptom. Method: We conducted a retrospective cohort study and analyzed data of all patients treated at University Medical Center, Lubbock, Texas in 18-85 years of age with a diagnosis of DVT and/or PE in 2019. Qualitative chart review to identify cases of clinically significant TSH screening in VTE patients that leads to thyroid dysfunction diagnosis. Associations between variables tested using Student’s t-test, chi-square, and Fisher’s exact test. Results: Of total of 533 participants with diagnosis of VTE in 2019, 85 participants were included in the study. Seven participants (8.24%) were found to have high TSH level (&gt;4.2 mIU/mL). None of them was found to have low level of TSH. Participants in high TSH group were more likely to be female (71.43%) and Caucasian (71.43%). In high TSH group patients tended to have both PE and DVT diagnosis at the same admission (71.43%). Weight and BMI were significance higher than those with normal TSH level. Segna et al conducted a prospective multicenter cohort study on association between thyroid dysfunction and venous thromboembolism. The study measure thyroid hormones and thrombophilic biomarkers at 1 year after the acute VTE and follow for the recurrent VTE (rVTE). They found that after 20.8 months of follow-up, 9% developed rVTE. However, none of them was found in subclinical hyperthyroidism group. Furthermore, in their multi-variate analyses, the hazard ratio for rVTE was 0.80 (95%CI 0.23-2.81) subclinical hyperthyroidism compared with euthyroid participants. They concluded that subclinical hyperthyroidism may be associated with lower rVTE risks. Similarly, with Liviu study found hyperthyroidism was not associated with an increased risk of VTE. Qualitative chart review in our patients with high TSH resulted that none of them had history of tobacco use. One participant was on birth control pills with the history of cervical carcinoma. Conclusion:The association of thyroid dysfunction and the development of VTE is debated on the literature review. In our study we found multiple patients with high TSH level (8.24%) in VTE patients with no prior history of thyroid dysfunction. TSH could play an important role in hypercoagulable state. Subclinical hypothyroidism and/or hypothyroidism may induce a prothrombotic event. However, larger cohort studies with higher prevalence of high TSH participants are needed to prove a relationship between TSH level and VTE events.
Evaluation of the Optimal Thyroxine Levels for Thyroxine Hormone Replacement in Patients With Central Hypothyroidism
Authors: Lee Ka Fai , So Hay Man , Mak Wai Han 
Published: May 2021

Abstract
Introduction: Central hypothyroidism results from pituitary or hypothalamic dysfunction. The evaluation of the adequacy of thyroxine replacement is difficult, due to the loss of thyrotropin (TSH) as an accurate feedback marker. This study aim to explore the potential metabolic and clinical effects of different free T4 (fT4) replacement targets in patients with central hypothyroidism. Method: This was a single center, prospective open-label crossover-like trial of 51 patients (mean age 56±12.9 years, 27 male) with hypopituitarism with multiple hormonal deficiencies including central hypothyroidism after excluding those with primary thyroid diseases, high risk for cardiovascular diseases (CVD) and known CVD. Dosage of levothyroxine (L-T4) was titrated to a targeted lower, middle and upper fT4 tertile and maintained for 24 weeks before assessment. Anthropometric and physiological measurements, metabolic and peripheral tissue markers, cognitive and quality of life assessments (SF-36 and Hong Kong Montreal Cognitive Assessment-5 [HK-MoCA-5]) were compared before and after each fT4 tertile change. This was followed by another 24-week cycle of L-T4 dosage adjustment to achieve fT4 in another tertile, with the same assessment as above. Results: We demonstrated that raising fT4 target from lower to upper tertile within the normal reference range resulted in significant decrease in body mass index (27.1±6.0 vs 25.7±5.6 kg/m2, P&lt;0.01), waist circumference (89.5±12.7 vs 86.4±12.1 cm, p&lt;0.01), diastolic blood pressure (79.1±12.9 vs 74.5±12.9 mmHg, p&lt;0.05) and low density lipoprotein cholesterol (3.94±0.88 vs 2.90±0.71 mmol/L, p&lt;0.01), apart from expected significant effect on tissue markers such as increased sex-hormone binding globulin (SHBG), increased ferritin and reduced creatinine kinase (CPK). The occurrence of metabolic syndrome (48.2% vs 29.0%, p &lt;0.05) was significantly reduced with increasing fT4 from middle to upper tertile, without significant effect on glycemic indexes, heart rate, SF-36 and HK-MoCA-5. Conclusion: In this study, we demonstrated that raising fT4 target to the upper tertile of normal resulted in a favourable improvement in various metabolic indexes without a significant increase in adverse effects over a period of 48 weeks.
High Prevalence of Anti Thyroid Antibodies in an Albanian Cohort of Patients
Authors: Minxuri Dorina , Mitre Anila , Bino Silva , Toska Ina , Mulla Ina 
Published: May 2021

Abstract
Introduction: Albania is classified as iodine deficient region and endemic goiter in this country has been a concern for public health. A salt iodization program has been implemented in Albania since 2008. Most of regions still remain with a mild or moderate iodine deficiency there are no studies on prevalence of thyroid autoimmune disorders. The purpose of this study was to assess thyroid function and the presence of thyroid antibodies in subjects that were not previously diagnosed or treated for thyroid disorders. Methods: This is a cross-sectional study performed in a cohort of patients in Albania during a 2 year period (january 2018-january 2020). We assessed the prevalence of thyroid function disorders and presence of thyroid antibodies in 5047 subjects (81% females and 19% males). Individuals previously diagnosed or treated for thyroid disease were excluded from the study. TSH, Free T4, total T3, Anti TPO(thyroid peroxidase) and anti TG (thyroglobulin) were measured with electrochemiluminescence method with Cobas 6000 Roche Diagnostics. We calculated the frequency of thyroid antibodies and the abnormal thyroid function. Statistical analysis was performed to see if there was a difference between individuals with positive antibodies and those negative for antibodies. Results: 91 % (4596) of subjects resulted euthyroid. We found a low prevalence of overt thyroid dysfunction (hyperthyroidism 0.48% and hypothyroidism 1.69%). The rates of subclinical hypothyroidism and hyperthyroidism were 5.5% and 1.4% respectively. The prevalence of positive thyroid antibodies, at least one of them was 28% in females and 14% in males (2:1 ratio). 97.3 % of subjects who testet negative for antibodies had normal thyroid function compared to 73.5% in antibodies positive group. There was a significant difference for subclinical hypothyroidism and other thyroid disorders between antibodies positive group and antibodies negative group (p value &lt;0.0000119% of individuals(from 5047 examined) had normal thyroid function and resulted positive for anti TPO or anti TG. Conclusions: Undiagnosed biochemical thyroid dysfunctions were common in subjects living in a mild to moderate iodine-deficient area especially subclinical hypothyroidism. TSH level correlated well with the presence of antibodies resulting in significant difference in thyroid function between 2 groups. We found a high prevalence (19%) of thyroid antibodies in euthyroid subjects. TPO antibodies in euthyroid subjects can be used to identify subjects with increased risk for hypothyroidism such as women who are pregnant (to predict first trimester or postpartum thyroid dysfunction), patients with other autoimmune diseases, subjects on drugs like amiodarone or relatives of patients with autoimmune thyroid diseases.
Patterns of Body Weight Changes in Patients With Hypothyroidism, a Retrospective Study From Basrah, Southern Iraq
Authors: Alidrisi Haider A , Odhaib Samih Abed , Altemimi Mahmood Thamer , Alibrahim Nassar Taha , Alhamza Ali Hussain , Almomin Ammar , Zaboon Ibrahim , Nwayyir Hussein Ali , Hussein Ibrahim Hani , Imran Husam Jihad , Alzajaji Qusay Baqer , Budair Ahmed Sabah , Hamza Muqdam Ali , Mansour Abbas Ali 
Published: May 2021

Abstract
Background: Weight gain is one of the most important hypothyroidism-related concerns among patients with hypothyroidism. However, not as expected, thyroxine replacement does not necessarily result in body weight (BWT) reduction among those patients. The study aimed to assess the patterns of BWT changes through time in patients with hypothyroidism. Method: A retrospective database study from Faiha Specialized Diabetes, Endocrine, and Metabolism Center. A total of 346 adult patients with hypothyroidism, 192 newly diagnosed and 154 known, who had 1 visit every 3 months, 5 visits per one year. From those patients, 116 new and 69 known had completd 9 visits per two years. Each visit involved thyroid-stimulating hormone (TSH) and BWT measurements. Patients with chronic liver or renal disease, diabetes mellitus, thyroid cancer, or other malignancies, pregnancy, and on steroid or hormonal therapies were excluded. The patients were further subdivided based on average TSH levels into controlled (TSH≤4.2 μIU/mL) and uncontrolled TSH&gt;4.2 μIU/mL. Repeated measures ANOVA with a Greenhouse-Geisser correction and Post hoc tests using the Bonferroni correction were used to evaluate BWT changes through the study. Results: Both newly diagnosed and known hypothyroidism, over one and two years, in patients with average TSH&gt;4.2 μIU/mL, BWT increased significantly through visits. For newly diagnosed over one year, (F(2.41, 321.60) = 3.28, p = 0.03), and mean BWT increase = 1.4 ± 0.38 kg from 3rd to 12th month visits, (p = 0.004). For newly diagnosed over two years, (F(3.10, 263.89) = 9.08, P &lt; 0.0005), mean BWT increase = 3.02 ± 0.77 kg from 3rd to 24th month visits, (p = 0.007). And for known hypothyroidism over one year, (F(2.56, 187.47) = 7.11, p = 0.0003), mean BWT increase = 1.97 ± 0.64 kg at 12th month visit, and over two years, (F(2.35, 77.56) = 4.67, P = 0.009), mean BWT increase = 3.78 ± 1.26 kg at 24th month visit. While in all other patients with average TSH≤4.2 μIU/mL, the BWT changed non-significantly through visits. For newly diagnosed patients over one year and two years (p = 0.10, 0.34 respectively), and known patients over one year and two years (p = 0.47, 0.34 respectively). Conclusion: In contrary to what is believed, adequate treatment with thyroxine does not associate with weight reduction. Instead, either the patient kept on the same weight or continued to gain more weight.
A Higher Cutoff for TSI Would Better Predict Recurrence in Patients With Graves’ Disease?
Authors: Fontes Rosita , Negri Maurício Massucati , Marui Suemi , Gomes Dalva Margareth Valente , Schrank Yolanda , Castelar Pinheiro Maria Fernanda Miguens , Fragoso Perozo Andrea Faria Dutra , Araujo Paula Bruna Mattos Coelho 
Published: May 2021

Abstract
Introduction: GD is an autoimmune disease mediated by immunoglobulins (Igs) that activate TSH receptor (rTSH). Relapse after withdrawal of antithyroid drugs (ATD) can reach 60%. Measurement of TSH receptor antibodies (TRAb) and thyroid stimulating immunoglobulin (TSI) could be an indirect indicator of GD activity. TRAb assays measures thyroid-stimulating, thyroid-blocking and neutral Igs; TSI assays measures only stimulating Igs. Objetive: Evaluate, prospectively, autoimmunity before and after ATD therapy for thyrotoxicosis through TSI measurement. Methods: Patients were evaluated at the first visit and at the time of ATD withdrawal. TSH, thyroid hormones, TPO antibody, thyroglobulin antibody, and TRAb were measured using eletrochemiluminescent assays Roche Diagnostics; TSI was determined by chemiluminescent assay Siemens Diagnostics. According to manufacturers, TRAb &lt; 1.75 IU/L and TSI &lt; 0.55 IU/L were negative. Results: Sixty-seven patients mean age 45,7±2,45 years, 65 women, were evaluated: 50 at the first visit, 40 (80%) with GD, and 10 (20%) with toxic multinodular goiter (TMNG). TSI diagnostic sensitivity (Sen%) and specificity (Spe%) to diagnose GD were 90% and 100% respectively, similar to that of TRAb, of 89% and 100%. Thirty-six patients were evaluated for recurrence after suspension of ATD (19 of them also had the initial assessment): 21 (58.3%) did not present recurrence in an mean period of 9.5±2.1 months (3-18); and 15 (41.7%) relapsed in 4.4±2.6 months (2-12). In 10/21 patients who did not relapse, and whose TRAb was negative, TSI was positive at low levels, which was responsible for the low Spe% of this test. Assessing possible other cutoff points for the TSI in the recurrence assessment, an adjustment to 1.4 (TSI &lt;1.4 IU/L = negative) raised the Spe% to 86%. Conclusions: In this group, TSI and TRAb were equivalent for GD diagnosis. Many clinical factors have been suggested and TRAb measurement is known to be useful for predicting GD relapse because of the active pathogenic role of TRAb. For predicting recurrence, with the proposed cutoff point proposed by the kit manufacturer for TSI, a better sensitivity was obtained when compared with TRAb (93% versus 67%), despite very low specificity (38%); by raising the cutting point to 1.4 specificity could be increased to 86% without reduced sensitivity. A larger sample in needed to support a higher TSI cutoff point in the clinical routine for the assessment of GD recurrence after ATD.
Abnormal Thyroid Function Is Associated With Lymphopenia in Bacterial Sepsis and COVID-19
Authors: Grondman Inge , de Nooijer Aline H , Antonakos Nikolaos , Janssen Nico A F , Mouktaroudi Maria , Leventogiannis Konstantinos , Medici Marco , Smit Johannes W A , Van Herwaarden Antonius E , Jaeger Martin , Netea Mihai G , Giamarellos-Bourboulis Evangelos J , Netea-Maier Romana T 
Published: May 2021

Abstract
Background: Lymphopenia is a key feature of immune dysfunction in bacterial sepsis and COVID-19 patients and is associated with poor clinical outcomes, but the cause is largely unknown. These severely ill patients may also present with thyroid function abnormalities, so-called non-thyroidal illness syndrome (NTIS), and several studies have suggested that TSH, thyroxin (T4) and triiodothyronine (T3) play a crucial role in the homeostatic regulation and function of lymphocyte populations.
Aim: The purpose of this study was to test the hypothesis that abnormal thyroid function correlates with lymphopenia in severly ill patients with bacterial sepsis or COVID-19.
Methods: Retrospective analysis of absolute lymphocyte counts and circulating TSH, T4, FT4, T3, albumin and inflammatory biomarkers was performed in two independent cohorts of bacterial sepsis (n=224) and hospitalized COVID-19 patients (n=35).
Results: Only T3 correlated (rho=0.252, p-value: &lt;0.001) with lymphocyte counts in the bacterial sepsis population and lower concentrations were found in severe lymphopenic compared to non-lympopenic patients (p-value: &lt;0.001; n=56 per group). Severe lymphopenic COVID-19 patients (n=17) showed significantly lower plasma concentrations of TSH, T4, FT4 and T3 (p-value: 0.026, &lt;0.001, 0.001, &lt;0.001, respectively) compared to patients withouth lymphopenia (n=18), and demonstrated significantly increased values of the inflammatory parameters IL-6, C-reactive protein and ferritin (p-value: &lt;0.001, 0.023, and 0.008, respectively). Remarkable, after one week follow-up, the majority of (12/15) COVID-19 patients showed quantitative recovery of their lymphocyte numbers, while TSH and thyroid hormones remained mainly disturbed.
Conclusions: Abnormal thyroid function correlates with low lymphocyte counts in severe sepsis and COVID-19 patients, but future studies need to establish whether a causal relationship is involved.
Characterization of Thyroid Disease Prevalence Among Transgender and Gender-Diverse Patients
Authors: Christensen John David , Davidge-Pitts Caroline , Castro M Regina , Caraballo Pedro 
Published: May 2021

Abstract
Objective: Transgender and gender-diverse individuals are at risk of insufficient treatment of endocrine diseases due to a number of barriers to care. There are currently no data evaluating the prevalence of thyroid disease in this population, and it is unknown if gender-affirming hormone therapy affects treatment of thyroid disease in these individuals. Methods: Utilizing a registry of 676 patients over 18 years of age who were seen in our Transgender and Intersex Specialty Care Clinic from 2015-2019, we identified 554 individuals seeking medical therapy for gender dysphoria/incongruence. Of these, 56 patients were taking thyroid hormone or antithyroid medications or had a coded diagnosis of thyroid disease; 2 were excluded as they were receiving thyroid hormone as adjunctive therapy for refractory depression. 54 patients were therefore analyzed with respect to thyroid disease (TD+), and compared to those 498 patients without thyroid disease (TD-) with regard to average vital signs, demographics, and presence of common comorbidities. Results: Fifty percent of our TD+ patients were recorded female sex at birth, and 98% were Caucasian. TD+ patients were much more likely to have essential hypertension (OR 5.99), to use tobacco (OR 2.23), and to be overweight or obese (OR 2.16) than TD- patients. Due to the evolving natural history of disease, some TD+ patients belonged to multiple categories: 48 patients, 26 trans feminine and 21 trans masculine, had hypothyroidism, of whom 41 had overt hypothyroidism and 2 patients had subacute thyroiditis that progressed to the hypothyroid phase of illness. 5 patients (3 trans masculine and 2 trans feminine) demonstrated hyperthyroidism, 4 of whom had Graves’ Disease. 2 patients had multinodular goiter, both trans masculine. 2 patients had thyroid malignancies, both trans feminine, of whom one had proven follicular thyroid carcinoma and the other had unspecified thyroid malignancy. Among hypothyroid patients, there was a slight non-significant trend toward increased thyroid hormone requirements while receiving treatment with estradiol or testosterone. Conclusion: To our knowledge, this represents the first attempt to characterize the prevalence of various thyroid disease states in the gender diverse population. Our data corresponded to a prevalence of hypothyroidism of approximately 8.7%, which is higher than previously published estimates of 3-5% in the general population. Whether this represents actual increased prevalence or assessment bias is uncertain. It is important for all health professionals who care for gender diverse people to identify and appropriately treat thyroid disease, and to monitor thyroid function closely if gender-affirming hormone therapy is initiated.