ObjectiveTo observe the changes of plasma homocysteine (Hcy) and brachial ankle pulse wave velocity (baPWV) in patients with subclinical hypothyroidism, and discuss the relationship between subclinical hypothyroidism and arterial stiffness. MethodSeventy-three patients with subclinical hypothyroidism who were not treated before were divided into two groups according to thyroid stimulating hormone (TSH) level between January 2013 and June 2014. There were 35 patients in group A (4 mU/L < TSH < 10 mU/L) and 38 in group B (TSH ≥ 10 mU/L). Another 30 healthy individuals were selected as controls. Hcy and baPWV were determined in all subjects. ResultsCompared with the controls, patients had significantly higher level of TSH, Hcy and baPWV in group A, and had significantly higher TSH, triacylglycerol (TG), low density lipoprotein cholesterol (LDL)-C, Hcy, and baPWV in group B (P<0.05). Compared with group A, TSH, TG, LDL-C, Hcy, and baPWV in group B patiens were significantly higher (P<0.05). Pearson correlation analysis showed that Hcy was positively correlated with TSH (r=0.353, P<0.01) and baPWV was positively correlated with TSH (r=0.416, P<0.01). ConclusionsHcy level and peripheric arterial stiffness increase in patients with subclinical hypothyroidism. Both of them are correlated positively with TSH.
Objective To explore the effect of preoperative hypothyroidism on postoperative cognition dysfunction (POCD) in elderly patients after on-pump cardiac surgery. Methods Patients who were no younger than 50 years and scheduled to have on-pump cardiac surgeries were selected in West China Hospital from March 2016 to December 2017. Based on hormone levels, patients were divided into two groups: a hypo group (hypothyroidism group, thyroid stimulating hormone (TSH) >4.2 mU/L or free triiodothyronine 3 (FT3) <3.60 pmol/L or FT4 <12.0 pmol/L) and an eu group (euthyroidism group, normal TSH, FT3 and FT4). The mini-mental state examination (MMSE) test and a battery of neuropsychological tests were used by a fixed researcher to assess cognitive function on 1 day before operation and 7 days after operation. Primer outcome was the incidence of POCD. Secondary outcomes were the incidence of cognitive degradation, scores or time cost in every aspect of cognitive function. Results No matter cognitive function was assessed by MMSE or a battery of neuropsychological tests, the incidence of POCD in the hypo group was higher than that of the eu group. The statistical significance existed when using MMSE (55.56% vs. 26.67%, P=0.014) but was absent when using a battery of neuropsychological tests (55.56% vs. 44.44%, P=0.361). The incidence of cognitive deterioration in the hypo group was higher than that in the eu group in verbal fluency test (48.15% vs. 20.00%, P=0.012). The cognitive deterioration incidence between the hypo group and the eu group was not statistically different in the other aspects of cognitive function. There was no statistical difference about scores or time cost between the hypo group and the eu group in all the aspects of cognitive function before surgery. After surgery, the scores between the hypo group and the eu group was statistically different in verbal fluency test (26.26±6.55 vs. 30.23±8.00, P=0.023) while was not statistically significant in other aspects of cognitive function. Conclusion The incidence of POCD is high in the elderly patients complicated with hypothyroidism after on-pump cardiac surgery and words reserve, fluency, and classification of cognitive function are significantly impacted by hypothyroidism over than other domains, which indicates hypothyroidism may have close relationship with POCD in this kind of patients.
Objective To explore the potential causal relationship between thyroid dysfunction and osteoporosis (OP) through bidirectional two-sample Mendelian randomization (MR) analysis to provide genetic evidence for the risk association between thyroid dysfunction and OP, and provide reference for early prevention and treatment of OP. Methods Causal relationships were estimated based on data from genome-wide association studies for hypothyroidism (n=410141), hyperthyroidism (n=460499), Hashimoto thyroiditis (n=395640), and OP (n=212778). The inverse variance weighted method was used as the main analysis method, and the other four methods were used as the supplementary analysis methods to evaluate the causal effect of thyroid dysfunction and OP. Results The results of inverse variance weighted method showed that hypothyroidism [odds ratio (OR)=1.097, 95% confidence interval (CI) (1.017, 1.183), P=0.017], hyperthyroidism [OR=1.089, 95%CI (1.000, 1.186), P=0.049] and Hashimoto thyroiditis [OR=1.190, 95%CI (1.054, 1.343), P=0.005] were positively correlated with the causal effect of OP. The results of reverse MR analysis did not support that OP would increase the risk of hypothyroidism, hyperthyroidism or Hashimoto thyroiditis (P>0.05). In the bidirectional MR analyses, there was no heterogeneity in Cochran Q detection, MR-Egger intercept test results showed that there was no horizontal pleotropy, and the leave-one-out method analysis results showed that the MR analysis results were reliable. Conclusion Hypothyroidism, hyperthyroidism, and Hashimoto thyroiditis increase the risk of OP, while OP is not found to increase the risk of thyroid dysfunction in reverse studies.
The present study aimed to investigate the impact of hypothyroidism on left ventricular systolic function using real-time three-dimensional speckle tracking imaging (RT3D-STI). Thirty hypothyroidism patients and forty healthy volunteers were recruited and received RT3D-STI measurement of global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and global area strain (GAS). A comparison of differences between the hypothyroidism patients and those in the healthy group was carried out and we obtained the results as followings. The values of GLS were (-18.93°3.89) vs. (-21.44°1.99), with P<0.01, GRS were (51.13°11.95) vs. (56.10°5.76), with P<0.0; and GAS were (-31.63°5.38) vs. (-34.40°2.32), with P<0.01, i.e. they were lower in hypothyroidism group than those in the health group. While GCS were (-17.75°1.92) vs. (-17.03°3.45), with P>0.05, which were not significantly different between the two groups. In linear regression, GLS showed significant correlation with both TSH (b=-0.69, P<0.01) and FT3(b=0.71, P<0.01). Meanwhile, the GRS (b=2.98, P<0.05) and GAS (b=3.11, P<0.05) linearly correlated with FT3 level. In conclusion, the present study shows that the global longitudinal and radial moves of left ventricular are weaker in patients with hypothyroidism than healthy controls. And the impairment of left ventricular function would aggravate as FSH rises or FT3 declines.
ObjectivesTo systematically review the relationship between hypothyroidism and the risk of atrial fibrillation.MethodPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, CBM, VIP and WanFang Data databases were electronically searched to collect cohort and case-control studies on the association between hypothyroidism and atrial fibrillation from inception to November 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 5 cohort studies involving 574 268 subjects and 18 059 atrial fibrillation cases were included. The results of meta-analysis showed that hypothyroidism was not associated with atrial fibrillation (OR=1.10, 95%CI 0.75 to 1.61, P=0.62). From subgroup analysis, no relationship was identified in community population (OR=0.97, 95%CI 0.72 to 1.29, P=0.82) and cardiac surgery patients (OR=1.22, 95%CI 0.58 to 2.53, P=0.60).ConclusionsHypothyroidism does not increase the risk of atrial fibrillation. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
ObjectiveTo investigate the relationship between thyroid stimulating hormone (TSH) and the blood lipid level in patients with subclinical hypothyroidism (SCH). MethodsWe carried out a retrospective analysis on the clinical data of 264 patients with their first diagnosis of subclinical hypothyroidism without treatment from 2010 January to 2014 January. A total of 288 healthy controls were chosen from communities. The patients were groups based on TSH≥10.0 mU/L and 3.6 mU/L≤ TSH< 10.0 mU/L. We investigated the relationship between TSH and the level of blood lipids by analyzing liver and renal function, blood lipids, thyroid function, and thyroid peroxidase antibody (TPO-Ab) in the patients. ResultsTriglyceride (TG) and high density lipoprotein cholesterol levels were not significantly different among the three groups (P>0.05). Total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) levels of the group with TSH≥10 mU/L were respectively (5.93±1.12) and (3.82±1.11) mmol/L, which were significantly higher than those in the controls[(4.43±1.12) and (2.66±0.43) mmol/L] (P<0.05). TC, TG and LDL-C levels of the group with 3.6 mU/L≤ TSH< 10.0 mU/L were higher than the controls, but the differences were not significant (P>0.05). After thyroid hormone replacement therapy within 12 weeks, TG, LDL-C, and TC levels of TPO-Ab positive patients with subclinical hypothyroidism (n=112) were respectively (4.62±1.03), (2.97±0.52), and (1.17±0.62) mmol/L, which were significantly lower than those levels before treatment[(5.43±1.18), (3.62±0.58), and (2.03±0.71) mmol/L] (P<0.05). ConclusionThe disorder of lipid metabolism exists in patients with subclinical hypothyroidism. Especially, the level of TSH greater than or equal to 10 mU/L is a high risk factor for dyslipidemia. In TPO-Ab positive patients, therapy of thyroid hormone replacement can effectively improve the blood lipid abnormalities in patients with subclinical hypothyroidism, and it may be an effective measure to improve the disorder of lipid metabolism economically and effectively.
目的 提高临床医生对甲状腺功能减退症（甲减）并发急性呼吸衰竭的认识，减少误诊，提高救治率。方法 对2002年11月－2011年6月收治的6例甲减并发急性呼吸衰竭患者予以有创机械通气及早期使用左旋甲状腺素治疗，使病症得以控制和治愈。 结果 患者使用有创机械通气治疗平均7 d，住院治疗14～43 d，平均（28.6 ±14.4）d， 5例治愈，1例死亡。 结论 甲减并发呼吸衰竭早期使用机械通气及甲状腺激素替代治疗可提高抢救成功率。