bluuebunny/crossref_metadata_2025_split huggingface dataset:
FRI535 Quality Of Life And Symptomatology In Patients With Autoimmune Thyroiditis
Authors: Miguel Pereira Luis , Neves Celestino , Sérgio Neves João , Delgado Luís , Carvalho Davide 
Published: October 2023

Abstract
Disclosure: L.M. Pereira: None. C. Neves: None. J. Neves: None. L. Delgado: None. D. Carvalho: None.
Introduction: Autoimmune thyroiditis (AIT) may be associated with physical, psychological and behavioral symptoms even in patients achieving normal TSH and free T4 levels with levothyroxine treatment. Objective: Our aim was to evaluate the associations the resistance to thyroid hormone, assessed by the Parametric Thyroid Feedback Quantile-Based Index (PTFQI), and laboratorial parameters with Quality of life (QoL) in AIT. Methods: We evaluated 145 patients with AIT treated with levothyroxine followed in outpatient clinic. We assessed lipid profile, high-sensitivity C-reactive protein, B12 vitamin, folic acid, thyroid antibodies, thyroid function tests and calculated the index PTFQI of resistance to thyroid hormones. The following questionnaires were applied to participants: the Thyroid Dependent Quality of Life questionnaire (ThyDQoL), the Thyroid Symptom Rating Questionnaire (ThyTSQ), the Thyroid Treatment Satisfaction Questionnaire (ThyTSQ) and the Brief Symptom Inventory (BSI). Statistical analysis was performed with the One-way ANOVA test and Pearson’s correlation test. P values ≤ 0.05 were considered as statistically significant. Results: In this sample, the age was 54.4 ± 15.3 years, 89.7 % were female, BMI was 28.4 ± 5.2 Kg/m2, TSH was 2.69 ± 8.48 µUl/mL and FT4 was 1.15 ± 0.40 ng/dL. Patients reported a mean QoL value of -2.11 points (range from -9 to 1). In regard to the ThySRQ, 46.2 % of patients reported at least moderately memory problems, 50.4% of patients reported at least being moderately tired and 62.7 % showed some type of depressive feelings. Regarding ThyTSQ, 83.5 % demonstrated being satisfied with treatment and 82 % believe that treatment is working well. We found that PTFQI correlates positively with thyroid peroxidase antibodies (r = 0.19; p = 0.03) and negatively with triglycerides (r = -0.26; p = 0.002) and BMI (r = -0.21; p = 0.01). In relation with symptomatology, we observed negative correlations among PTFQI and constipation (r = -0.18; p = 0.02), skin problems (r = -0.27; p = 0.01), nail problems (r = -0.19; p = 0.01) and dizziness symptoms (r = -0.18; p = 0.03). Conclusions: In this study, we observed a high prevalence of memory problems, tiredness and depressive feelings in patients with AIT treated with levothyroxine. We also found that PTFQI is associated with physical and psychological symptoms. Further studies are needed to analyze the role of autoimmunity and PTFQI for the worsening of the QoL in patients with AIT.
Presentation: Friday, June 16, 2023
FRI541 The Epidemiology Of Thyroid Eye Disease In Olmsted County, Minnesota
Authors: Rachmasari Kharisa N , Thapa Prabin , Sighoko Dominique , Abdul Jabbar Layla , Stan Marius N 
Published: October 2023

Abstract
Disclosure: K.N. Rachmasari: None. P. Thapa: None. D. Sighoko: Employee; Self; Horizon Therapeutics. L. Abdul Jabbar: None. M.N. Stan: None.
Objective: To describe the epidemiology of Thyroid Eye Disease (TED). Methods: A population-based cohort of all Olmsted County, Minnesota, residents who had newly diagnosed TED between April 3, 2002, and December 31, 2021, was identified through the medical diagnostic index of the Rochester Epidemiology Project. Individuals aged 18 years and older were included. Incidence rates and point prevalence were calculated. Results: We identified 137 incident patients, of whom 124 (90.5%) were female (p &lt; 0.0001). The overall incidence was 6.24 cases/100,000 person-years in Olmsted County, corresponding to 6.25 cases/100,000 person-years for the US population (age and sex adjusted incidence). Women had higher incidence (10.94 cases/ 100,000 person-years) compared to men (1.22 cases/100,000 person-years). The distribution of incidence rates by ten-year age groups demonstrated peak incidence rates in the age groups 70 to 79 years (17.94 cases/100,000 person-years for women compared with 4.04 cases for men). The majority of cases (77/137) occurred between 50-79 years of age. No clear trend was identified for the yearly incidence between 2002 and 2021. The overall estimated point prevalence per 100,000 was 65.6 (95% CI, 57.8 – 72.9). Prevalence was 117.6 (95% CI, 96.5 – 141.4) for females and 11.2 (95% CI, 5.1 – 21.2) for males (p &lt; 0.0001). Conclusions: Incidence rates for TED remained stable and significant over the last 2 decades. Majority of disease burden is present after the age of 50 with the peak between 70-79 years, a decade later than in the previous study from our population (1). Based on reported incidence and prevalence of Graves’ disease (2), our data indicates that TED continues to affect about 20-30% of that population and appropriate resources should be devoted to furthering education, management, and research into this condition.
References:
1. Bartley GB, Fatourechi V, Kadrmas EF, et al. The incidence of Graves' ophthalmopathy in Olmsted County, Minnesota. Am J Ophthalmol 1995;120(4):511-7, doi:10.1016/s0002-9394(14)72666-2
2. Hussain YS, Hookham JC, Allahabadia A, et al. Epidemiology, management and outcomes of Graves' disease-real life data. Endocrine 2017;56(3):568-578, doi:10.1007/s12020-017-1306-5
Presentation: Friday, June 16, 2023
FRI543 Effect Of Vitamin D Replacement On Thyroid Autoimmunity And thyroid Functions In Subclinical Hypothyroid And Vitamin D Deficient Patients: A Randomized Controlled Trial
Authors: Aljohani Naji J 
Published: October 2023

Abstract
Disclosure: N.J. Aljohani: None.
Background: Vitamin D status has been implicated to influence several non-skeletal diseases including diabetes, cardiovascular diseases, and auto-immunity. Several observations have also associated vitamin D deficiency with thyroid disorders, but prospective data is lacking. In this randomized clinical trial, we aimed to determine whether vitamin D correction improves subclinical hypothyroid status of Arab adult patients. Subjects and Methods: A total of 84 subjects with subclinical hypothyroidism were recruited and allocated (1:1) to receive either vitamin D 50,000 IU weekly in first four months (cases) or placebo (Vitamin D 5000 IU weekly). Thyroid function and thyroid autoantibodies was repeated after 3 and 6 months with vitamin D level to see sufficient vitamin D replacement status. Results: Post-intervention, 31 cases and 37 controls completed the intervention. Cases had a significant increase in 25(OH)D levels after 3 and 6 months of intervention. In both cases, and controls, there was a significant decrease in TSH over time (p&lt;0.05), with no significant changes in both circulating FT4 and FT3 levels. A significant decrease in TPO ab and anti-TG ab levels after 6 months (p&lt;0.05) were observed only in cases. In conclusion, vitamin D correction modestly improves thyroid status of Arab patients with known subclinical hypothyroidism. Further investigations are needed as to whether vitamin D supplementation is more beneficial among subclinical hypothyroid patients who were deficient at baseline.
Presentation: Friday, June 16, 2023
FRI544 Serological Profile In Rheumatoid Arthritis And Its Interplay With Autoimmune Thyroid Diseases
Authors: Kolitz Tamara , Kivity Shaye , Tessler Idit , Marcus-Perlman Yonit , Izkhakov Elena , Yaish Iris , Greenman Yona 
Published: October 2023

Abstract
Disclosure: T. Kolitz: None. S. Kivity: None. I. Tessler: None. Y. Marcus-Perlman: None. E. Izkhakov: None. I. Yaish: None. Y. Greenman: None.
Objective: Autoimmune thyroid diseases (AITD) are the most common organ-specific autoimmune disorders, with an estimated prevalence of 5%. AITD encompass the clinical scope of Hashimoto’s thyroiditis (HT) and Graves’s disease (GD). Rheumatoid arthritis (RA) is a relatively common non-organ-specific autoimmune disease with an estimated global prevalence of 0.5-1%. Numerous studies have investigated the association of thyroid disorders and RA in various populations, but results were inconsistent. This study is aimed to assess the rate of AITD in RA patients and to further investigate these rates in subgroups of patients with seronegative RA, seropositive RA and dual-positive RA antibodies [i.e., positive anti-cyclic citrullinated peptide (CCP) and rheumatoid factor (RF)]. Methods: We used a big-data platform (MDClone Ltd., Israel) to create a cohort of RA patients with and without coexistent AITD. The cohort included 1316 patients who were treated in the Tel Aviv Sourasky Medical Center for any diagnosis between January 2008 and December 2022. Results: There were 340 men (25.8%) and 976 (74.2%) women in the cohort. The mean age at time of initial coding of RA diagnosis in our referral center was 62.5±15 years. AITD was found in 15.5% of the entire RA cohort. Hypothyroidism was the most common thyroid-associated diagnosis (in 95.8% of patients with RA and AITD). When RA patients were further sub-classified to seronegative, seropositive, and dual-positive RA, the rates of AITD were 11.8%, 17.6% and 25%, respectively (p=0.007). AITD rates in seropositive women and men were 20.6% and 8%, respectively (p&lt;0.001). In the RA-seronegative subgroup, the rate of AITD was 15.6% in women and 2.7% in men (p&lt;0.001). The mortality rates in RA-seronegative patients, RA-seronegative patients with AITD, RA-seropositive patients and RA-seropositive patients with AITD were 5.5%, 8.3%, 21.6% and 29.5%, respectively (p=0.05). Conclusion: Our findings suggest that the prevalence of AITD in patients with RA is associated with the specific serological profile, with highest rates in RA patients who are positive for both anti-CCP and RF. Randomized prospective studies are required to explore any cause-and-effect correlation and to delineate the impact of AITD on RA outcome and mortality rates.
Presentation: Friday, June 16, 2023
SAT462 TSI Versus TRAb In The Diagnosis Of Grave’s Disease
Authors: Ibrahim Katherine , Raju Karishma , Morkos Michael 
Published: October 2023

Abstract
Disclosure: K. Ibrahim: None. K. Raju: None. M. Morkos: None.
Objective: Improvement in the thyroid antibody titers can help in predicting the remission of Graves’ disease. We aimed to assess the level of elevation of the antibody titers, thyroid stimulating immunoglobulin (TSI) and thyroid receptor antibody (TRAb) in patients with Grave’s disease. Research and Design Methods: This is a retrospective cross-sectional study of patients diagnosed with Graves’ disease at an academic outpatient endocrinology clinic from August 2019 to November 2022. TSI and TRAb were measured synchronously during the initial assessment of the patients, titers were compared against the upper limit of normal to assess their level of elevation. TSI was measured using Semi-Quantitative Chemiluminescent Immunoassay and TRAb using Quantitative Electrochemiluminescent Immunoassay. SPSS® (version 28) was used for statistical analysis, descriptive statistics were utilized and paired-sample t-test was used to compare TSI And TRAb ratios. Results: We identified 41 patients who presented for initial assessment of Graves’ disease, 31 (75.6%) were female, 23 (56.1%) Caucasian, and 16 (39.0%) African American. Mean age (± standard deviation) 46.3 ± 14.2 years. Mean TSI 8.3 ± 15.9 IU/L (ref &lt;0.55), TSI ratio of elevation above the upper limit of normal was 11.1 ± 15.3, Mean TRAb 8.9 ± 9.4 (ref ≤1.75), TRAb ratio of elevation above the upper limit of normal was 5.1 ± 5.4. The correlation coefficient for both TSI and TRAb ratios was 0.92 (p &lt;0.001). One patient had a normal TSI but elevated TRAb level and two patients had a normal TRAb level but elevated TSI levels. Conclusion: TSI was more highly elevated above its normal range than TRAb. TSI can be a reasonable initial antibody test for patients with Graves’ disease to establish a baseline.
Presentation: Saturday, June 17, 2023
SAT464 Hyperthyroidism Does Not Negatively Impact Outcomes of Adult Hospitalizations for Pulmonary Embolism: A Nationwide Analysis
Authors: Gbenga Olafimihan Ayobami , Deenadayalan Vaishali , Ehiremen Ojemolon Pius , Litvin Rafaella , Annabel Ogar Ufeh , Krishnaraju Ellil , Sami Faria , Hilda Olojakpoke Eloho 
Published: October 2023

Abstract
Disclosure: A.G. Olafimihan: None. V. Deenadayalan: None. P.E. Ojemolon: None. R. Litvin: None. U.A. Ogar: None. E. Krishnaraju: None. F. Sami: None. E.H. Olojakpoke: None.
Introduction: Acute pulmonary embolism (PE) is a medical emergency associated with high mortality rates. Hyperthyroidism has been associated with an increased risk of venous thromboembolism and PE. However, there are limited studies on its impact on the outcomes of patients with PE. We aimed to assess hyperthyroidism’s effect on in-hospital PE outcomes using the National Inpatient Sample (NIS). Methods: Data were extracted from the US Nationwide Inpatient Sample (NIS) from 2016 to 2019. The NIS contains hospital discharge information estimating yearly US hospitalizations. We included hospitalizations with a principal discharge diagnostic code for PE using the ICD-10-CM code (E22.2). Hospitalizations of patients less than 18 years of age were excluded from the study. This cohort was divided based on the secondary diagnosis of hyperthyroidism.The primary outcome was inpatient mortality, and secondary outcomes were hospital length of stay (LOS), total hospital charge, odds of acute respiratory failure (ARF), acute renal failure (AKI), undergoing embolectomy, tissue plasminogen activator (tPA) use and Inferior vena cave (IVC) filter placement. Multivariate linear regression analysis was used to adjust for confounders. Statistical significance was set at a p-value &lt; 0.05. Results: There were 745,360 hospitalizations involving PE as the reason for admission, and 20.1% had comorbidity with hyperthyroidism. Admissions for PE with comorbid hyperthyroidism had similar in-hospital mortality (adjusted OR:1.17, P=0.41), mean LOS (4.9 vs 4.3 days, P=0.11) and mean THC ($53,127 vs $48,236, P=0.43) compared to those without hyperthyroidism. The odds of developing ARF (aOR: 0.93, P=0.466) or AKI (aOR: 0.95, P=0.71) were similar. Odds of undergoing embolectomy (aOR: 1.07, p=0.83), receiving tPA (aOR=1.03, P=0.87) and placing IVC filter (aOR=0.80, P=0.19) were similar between both groups. Conclusion: Hospitalizations for pulmonary embolism with hyperthyroidism had similar inpatient mortality compared to those without hyperthyroidism. Also, mean LOS, total hospital charge, ARF and AKI complications, and odds of embolectomy, tPA administration and IVC filter placement were alike for both categories.
Presentation Date: Saturday, June 17, 2023
SAT467 Monitoring TSH Over Time May Not Be Necessary in Patients With Thyroid Nodules
Authors: Kaul Sabrina , Gupta Ankur 
Published: October 2023

Abstract
Disclosure: S. Kaul: None. A. Gupta: None.
Introduction: A substantial number of patients with thyroid nodules receive monitoring of blood thyroid stimulating hormone (TSH) levels after the initial diagnosis. There is not enough literature supporting long-term monitoring of blood TSH levels in these patients with thyroid nodules. The objective of this study was to evaluate the change in blood TSH level in patients with known thyroid nodules over time and to determine if repeat blood TSH testing is required in these patients. We hypothesized that monitoring of blood TSH level is not warranted in patients with thyroid nodules in the absence of a history of medical conditions or medications that are known to affect thyroid hormone levels. Methods: We studied 100 patients aged 18 to 99 years at the Dayton VA Medical Center with at least one thyroid nodule on imaging studies from January 2010 to December 2016 with normal blood TSH level at time of the diagnosis of the thyroid nodule. Subjects with abnormal thyroid hormone level, history of hot thyroid nodule, autoimmune thyroid disease (on imaging or blood work), thyroid or pituitary surgery, radioactive iodine treatment, neck irradiation, or usage of thyroxine or any other medications known to affect thyroid hormone levels were excluded. Blood TSH level at the time of diagnosis of thyroid nodule and after were retrospectively studied and analyzed for 100 subjects. Normal blood TSH level range at time of diagnosis was noted to be 0.35-5.50 uIU/mL or 0.35-4.00 uIU/mL depending on the assay method used. Normal repeat blood TSH level range was noted to be 0.35-5.50 uIU/mL, 0.35-4.00 uIU/mL, or 0.55-4.78 uIU/mL depending on the assay method used. Results: 100 subjects with normal blood TSH at the time of diagnosis of their thyroid nodule had blood TSH level monitoring for an average time period of 5.74 years. Out of the 100, six subjects (6%, 95% CI [2.52%, 12.73%]) developed an abnormal blood TSH level in a mean time period of 6.94 years. One subject’s initial blood TSH level increased from 3.38 uIU/mL to 7.76 uIU/mL after 8.52 years. This subject did not receive treatment with thyroxine. In the other five subjects, blood TSH level decreased to below normal range in a mean time period of 6.63 years and ranged from 0.25-0.52 uIU/mL. Blood TSH level remained within normal range for 94 subjects in a mean time period of 5.67 years. Conclusion: Monitoring of blood TSH level over time may not be required in most patients with thyroid nodules in the absence of symptoms, medical conditions, or medications that are known to affect thyroid hormone levels.
Presentation Date: Saturday, June 17, 2023
SAT483 Role of Cholestyramine in Refractory Amiodarone-induced Thyrotoxicosis
Authors: Zhao Huaying , Leung Joseph 
Published: October 2023

Abstract
Disclosure: H. Zhao: None. J. Leung: None.
Role of Cholestyramine in Refractory Amiodarone-Induced Thyrotoxicosis. Background: Amiodarone-induced thyrotoxicosis (AIT) is divided into type 1 (AIT1; treated with thioamides) and type 2 (AIT2; treated with glucocorticoids). Combined therapy is utilized in mixed or indefinite forms. When medical treatment is unsuccessful, radioiodine ablation or thyroidectomy are considered. Clinical Case: A 76-year-old gentleman, with a history of atrial fibrillation treated with amiodarone, presented with recurrent atrial fibrillation refractory to cardioversion. Investigations revealed TSH &lt;0.01, FT4 58.1 (ref 10.0-20.0 pmol/L), FT3 16.0 (ref 3.5-6.5 pmol/L), TPO negative and TRAB negative. As thyroid ultrasound revealed absence of focal nodules or hypervascularity and technetium pertechnetate scan demonstrated no thyroid activity, AIT2 was suspected. Prednisone was initiated and amiodarone discontinued. Due to minimal response after a month, a mixed type was suggested and methimazole added. Despite intensification of the antithyroid regimen, FT4 increased to 59.5. Methimazole was discontinued for radioiodine ablation assessment. Given low thyroid uptake (&lt;3%), ablation was deemed unlikely beneficial. After patient refused thyroidectomy, cholestyramine was initiated, resulting in significant improvement, with FT4 declining from 46.0 to 29.0 in 2 weeks. Euthyroidism was achieved after 2 months of cholestyramine treatment and medications were stopped. At 6 months post presentation, he developed amiodarone-related hypothyroidism and began levothyroxine. Conclusion: Previous reports propose that cholestyramine, an ion exchange resin, interrupts enterohepatic circulation of thyroid hormone and demonstrated the use of cholestyramine in refractory Grave’s hyperthyroidism. This is one of the first few reports demonstrating the possible role of cholestyramine in AIT refractory to first line medical therapy.
Presentation Date: Saturday, June 17, 2023
SAT491 Development of Thyroidal Nodule in Congenital Hypothyroid Girl With Thyroid Peroxidase Gene Mutation
Authors: Lee Jisu , Oh Arum , Han Heon-Seok 
Published: October 2023

Abstract
Disclosure: J. Lee: None. A. Oh: None. H. Han: None.
Background: Reduced thyroxine synthesis in dyshormonogenesis induces increased thyrotropin (TSH) secretion through reduced negative feedback of thyroxine. Consequently, the affected patients are born with goiter or develop postnatal goiter, when L-thyroxine (LT4) supplementation is delayed. Cases of thyroid cancer have been reported in congenital hypothyroidism (CH) due to dyshormonogenesis, usually of follicular histology. Clinical Case: A 22-year lady has been taking LT4 since 8-years, under the diagnosis of goitrous CH. Her mother recalled neck swelling at newborn period. However, normal newborn screening test prevented neonatal goiter from further investigation. Initial test at 8-year of age revealed normal thyroid function without thyroid auto-antibodies, diffuse enlarged thyroid gland with increased uptake on 99mTc scan, and diffuse thyroid enlargement with heterogeneous echogenicity on ultrasonography (US). The goiter size waxed and waned according to the drug compliance. The highest TSH level (normal 0.17-4.05 μIU/mL) was 8.68 μIU/mL even without medication for 8 months by her own judgement. At 11.5-years, US found isoechoic solid nodule of 1.8 x 1.7 x 1.6 cm with peripheral halo in the inferior aspect of right thyroid, which was demonstrated to be benign follicular lesion favoring nodular hyperplasia on fine needle aspiration biopsy. With good drug compliance, the nodule size decreased to 1.1 x 0.9 cm at 18-years, and peripheral calcification appeared around the isoechoic solid nodule previously reported without change in size at 22-years. NGS panel for CH reported compound heterozygous variants in TPO gene. One pathogenic variant from asymptomatic father is c.2757del;p.(Met921Trpfs*53), the other likely pathogenic variant from asymptomatic mother is c.1580G&gt;T;p.(Trp527Leu). Conclusion: This case is demonstrating development of thyroid nodule even with mild increased TSH level during LT4 medication in dyshormonogenic CH caused by TPO mutation. Regular follow-up and compliance to LT4 might be important to avoid thyroid tissue stimulation and possibly nodule formation by elevated TSH.
Presentation Date: Saturday, June 17, 2023