Antithyroid Drugs Effective as Initial Treatment for Graves ... Endocrinology Advisor
Read more here:
Antithyroid Drugs Effective as Initial Treatment for Graves ... - Endocrinology Advisor
Category Archives: Endocrinology
Save Your Heart, Save Your Life – University of New Mexico
The most important reason that I appreciate this award is that it gives me an opportunity to talk to many people that I normally never talk to and tell them that theres no reason to die of a heart attack, Schade said. I can theoretically save a few lives by getting people to understand that they can do something about it.
Schade, who serves as chief of the Division of Endocrinology & Metabolism, has been at UNM since the 1970s and has been the principal investigator on multiple large multicenter clinical studies involving diabetes and cardiovascular research. He has nearly 700 peer-reviewed publications.
In recent years, he has focused on the direct connection between diabetes and heart disease.
The problem with diabetes is not everybody is in good glucose control, Schade says. In those cases, elevated blood sugar damages the nerves, kidneys and lining of the blood vessels including those supplying the heart. The talk will really be about preventing heart disease in everybody, and particularly in diabetic patients, he says.
Schade cited four major risk factors for heart disease: diabetes, smoking, hypertension and high cholesterol. Some diabetic patients have all four, and of course they die at an early age, he says. Meanwhile, the societal costs of heart disease are staggering, claiming nearly 600,000 lives in the U.S. every year.
If you have a heart attack and you pay for all the nurses and all the doctors and all the medications and then you follow the patient, its $100,000, he says. In New Mexico, there are 6,000 calls to the emergency med service every month for chest pain.
With emeritus professor R. Philip Eaton, MD, Schade helped persuade the New Mexico Legislature in 2021 to mandate that health insurance plans cover the cost of coronary artery calcium scans, which cost about $150.
The non-invasive CT scan accurately predicts a persons risk of suffering a heart attack by identifying the presence of calcium-containing plaques in the inner lining of the blood vessels.
Weve sent a letter to Washington to try to get Medicare to cover the cost of a calcium scan, Schade says. Medicare doesnt cover it, even though Medicaid does.
Should a coronary artery calcium scan detect evidence of silent heart disease, lifestyle changes coupled with medication therapy can actually reverse the damage in the arteries, he says. Im trying to get the message out that you can do something to prevent it.
Schade is hoping for a big audience with whom to share his message of health empowerment.
This is a talk for everybody and everybody will enjoy it, Schade says. It will mean something to everybody, because everybody has a heart.
Continued here:
Working to fill the gaps in transgender health care – The Boston Globe
CONCORD, N.H. Health care for transgender people has become a hot button political issue, and providers in New England say the political debate around gender-affirming care makes their jobs harder.
Dr. Frances Lim-Liberty, a pediatric endocrinologist, and Jessica Smith, an endocrinology nurse practitioner and program coordinator for the states only pediatric and adolescent trans health program at Dartmouth Health, spoke with the Globe about the care they provide. The program has grown steadily since it began in 2014, and now serves about 500 young people from New Hampshire, Vermont, and Northern Massachusetts.
Lim-Liberty and Smith addressed the most-common myths surrounding trans health care, how this care helps young people, and how terrified patients are of losing access to it.
Q: You say theres no lower age limit about when youll start seeing patients at the clinics. When it comes to families with younger children, why are they seeking care?
Get N.H. Morning Report
A weekday newsletter delivering the N.H. news you need to know right to your inbox.
Lim-Liberty: Many have questions. They want to know how to support their kids. They are seeking therapists and mental health specialists who understand childhood and gender identity development.
We spend a lot of time counseling. The biggest gender affirming medical care we provide is guiding the family to resources, answering questions about puberty, where to find gender neutral clothing, where to find an understanding hairdresser. We have support groups, and a library with books and educational guides. Were trying to fill the gaps.
Q: What kinds of medical care do you offer?
Smith: If someone is thinking about medical affirmation, they first meet with a social worker, a psychologist, an endocrine provider, and therapists. Theres a team ready before we start.
Lim-Liberty: We are really careful in our approach. By the time were ready to start a puberty blocker or estradiol or testosterone, weve had many conversations and discussions.
Q: How do you talk to parents who might not understand gender affirming health care?
Smith: Usually those kids are really hurting by the time they see us. We try to engage parents by bringing in the mental health team and talking about the importance of treatment and what thats going to look like. When we have a young person struggling with distress related to gender dysphoria, we have to treat that in the same way we treat any other medical diagnosis. Outcomes are good.
Lim-Liberty: The most important part is sorting out the myths theyve heard, and the biases that they hold.
Q: What are some of the most common myths you encounter?
Lim-Liberty: That gender is a binary. Were all raised in a binary world. We have them start to think about gender as a spectrum and talk about what its like to have aspects of both masculinity and femininity.
Smith: We spend a lot of time talking about the fact that gender identity isnt easily influenced. Its normal that their teenager is hanging out with other trans kids. They find each other naturally, in the way athletes find each other and become friends.
Q: Theres a lot of talk about puberty blockers. What are they and when are they used?
Smith: Theres a big spread of disinformation about puberty blockers. Folks who have an anti-trans agenda are trying to use this as a scare tactic to say we are harming young people and thats absolutely false.
Puberty blockers have been used in pediatric endocrinology for decades to treat precocious puberty so there is a very good amount of data demonstrating safety and efficacy. We use puberty blockers to pause puberty for young people who are exploring their gender identity.
These are completely reversible medications. If a young person wants to stop the blocker and go through their natal puberty, we can do that safely with no bad outcomes. If somebody decides to transition from a puberty blocker to gender affirming hormone therapy, we can also do that.
Lim-Liberty: Theres lots of studies showing positive impacts on mental health: dropping depression rates, dropping suicidality and suicidal ideation. Jess and I experience that every day when were in the transgender clinic. We see these kids change, we see them blossom, we see them become the people that they talk about wanting to become at that first visit. We see them go from being reserved and quiet to being interested in activities or opening up about something they really like.
Q: The New Hampshire legislature considered a bill this session that would restrict the kind of care you can provide. Whats it like to be doing this work now given the political climate?
Lim-Liberty: Its very hard to be told that your work is wrong. Its very hard to be told that the trans kids you take care of every day shouldnt exist. Never have I, in any of the other endocrine conditions or diseases, had to defend someone for being who they are.
I dont like fighting legislation. Thats not not my training. Thats not something that I learned in medical school. While Im honored to do that, its also robbing me of the clinical work I need to be doing here. Its not fair to our kids.
We want our program to grow, and when we dont have the time and the resources to do that because were in Concord explaining that what were doing is best practice medicine, its I dont even have the right word: maddening, frustrating, unfair.
Smith: Gender affirming care is life saving work, And to have folks without an ounce of medical training saying we are harming children certainly that impacts us, but it has an incredible impact on our patients who are already marginalized and at risk. Theyre terrified they are going to lose care: What happens if New Hampshire bans gender affirming care? Where do we go? What do we do? We have to realize the impact this has on the trans community.
Read the original post:
Working to fill the gaps in transgender health care - The Boston Globe
Obesity is gateway to fatal diseases: Chandigarh hosts discussion on diabetes, endocrinology – The Indian Express
Obesity is not just a cosmetic disorder; it has its roots in the bodys endocrinological system. If ignored, it becomes the reason for many other irreversible health problems.
You have exhausted your monthly limit of free stories.
To continue reading,simply register or sign in
You need a subscription to read on. Start today at special Founders Day pricing.
This premium article is free for now.
Register to continue reading this story.
This content is exclusive for our subscribers.
Subscribe to get unlimited access to The Indian Express exclusive and premium stories.
This content is exclusive for our subscribers.
Subscribe now to get unlimited access to The Indian Express exclusive and premium stories.
This was one of the main issues discussed in a two-day continuing medical education (CME) that began in Chandigarh Saturday (April 15) on various aspects of diabetes and endocrinology. Sweet Diabetes Foundation is organising the CME to empower doctors by keeping them aware of international trends in treating advanced diabetes. More than 400 experts are participating in the CME and 25 doctors and health experts took part in the keynote session.
Dr Sachin Mittal, one of the leading endocrinologists of India and founder of Sweet Diabetes Foundation, spoke in detail about the lethal combination of diabetes and obesity, which he terms diabesity.
Diabetes, obesity, and heart disease have become common problems, even among the young. As per International Diabetes Federation, in India, 7.7 lakh people above 18 have diabetes, and the numbers are rising rapidly. Obesity is also increasing alarmingly across all age groups, including children and young adults. Chandigarh is fast emerging as the obesity capital of India, and its high time we focus on diet and healthy lifestyle to address the issue of childhood obesity, said Dr Mittal.
As per the Indian Council for Medical Research, Chandigarh (13.6 per cent) has the highest prevalence of obesity (among adults) compared to the rest of the country (11.8 per cent). Besides Indians being a high-risk group, a sedentary lifestyle and bad dietary habits are the major factors behind this rise.
Noted speakers also included Dr Saptarishi Bhattacharya, who talked about new-age treatments for obesity while talking about healthy diet parameters. Olympic gold medallist Abhinav Bindra will join the CME as the chief guest on the concluding day, April 16.
First published on: 16-04-2023 at 13:08 IST
See the original post:
G-CSF Priming Improves Pregnancy Rate in Assisted Reproductive … – Endocrinology Advisor
Dapagliflozin, Exenatide Combination Reduces Albuminuria in Type … – Endocrinology Advisor
Do You Have an Under-active Thyroid? This 90-Second Quiz Helps … – The Healthy
If youve ever suspected that your metabolism is a little sluggish, you might also wonder whether you have an under-active thyroid. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), around 5% of Americans aged 12 years or older have an underactive thyroid, or hypothyroidism. Thyroid experts like Dr. David S. Cooper, MD, MACP, with the division of endocrinology, diabetes, and metabolism at the Johns Hopkins University School of Medicine, suggest that the number of American adults experiencing mild hypothyroidism may be even higherpossibly closer to 10%.
Symptoms of an underactive thyroidcan be vague, and many hypothyroid symptoms can be confused with other medical conditions. So while the most reliable method of diagnosing an under-active thyroid is to see a licensed healthcare provider who runs lab workmaybe repeatedlysigns of hypothyroidism can start with a few main clues.
And note how important this can be. An under-active thyroid doesnt just cause frustrating questions about whether your body is utilizing calories as efficiently as it could. More severe cases of hypothyroidism can cause frustrating symptoms and pose health risks, in particular for cardiovascular health. Depending on how low your thyroid hormone levels are, medical treatment might be called for.
The Healthy @Readers Digest partnered with endocrinologists to develop a quiz that will help you determine whether its time to talk to your doctor about getting tested for hypothyroidism.
GetThe Healthy @Readers Digestnewsletterfor wellness insights delivered to you daily
Dr. Cooper says that in general, if you experience several of the symptoms we asked about that can be linked with hypothyroidism, speak with your licensed doctor. In most cases, your doctor can determine whether you have hypothyroidism using a routine blood test that measures levels of thyroid stimulating hormone (TSH).
That said, Dr. Cooper says its important to remember that many of the symptoms that can be associated with hypothyroidism can be caused by other conditions. Many of these symptoms are also experienced by people who are perfectly healthy, he adds. Dry skin is one example. Also according to Dr. Cooper, severe hypothyroidism tends to be fairly rare in the United States.
Dr. Cooper says that if your TSH levels are only a little higher than normal, and youre not experiencing any troublesome or severe symptoms, you may not need to start taking thyroid hormone replacement medications. But medically speaking, he says healthy levels of TSH tend to sit between 0.5 and 4, and people that have TSH levels of 10 or higher typically require treatment.
According to the experts, most health risks associated with hypothyroidism are related to severe or prolonged hypothyroidism, not mild cases. But Dr. Desai explains, untreated hypothyroidism can have long-term effects, ranging from mild conditions to life-threatening conditions.Hypothyroidism has been linked to infertility [and an] increased risk of miscarriages, she says. It has been associated with birth defects, including impaired mental development.
Dr. Desai adds that hypothyroidism can also cause elevated cholesterol levels, which can increase your risk of heart disease. She further explains that hypothyroidism can impact mental health, as it can lead to depression and can cause cognitive slowing. Hypothyroidism can also cause your thyroid gland to grow in size, which leads to the formation of a goiter, or enlarged thyroid gland.
Dr. Desai concludes by saying that in very severe cases of long untreated hypothyroidism, you can experience myxedema coma, which is a life-threatening condition that requires hospitalization.
Sources
See the original post:
Do You Have an Under-active Thyroid? This 90-Second Quiz Helps ... - The Healthy
Science Update: Children born to women with COVID-19 could be at … – National Institute of Child Health and Human Development
Infants born in 2020 through mid-2021 to women with COVID-19 weighed less at birth, but grew at a faster rate than a comparable group born to women who did not have COVID-19, according to a study funded by the National Institutes of Health. Previous studies have found that preterm infants and other infants who are small or underweight at birth and who undergo catch-up growth in the first year are at higher risk for later life obesity, heart disease, high blood pressure and diabetes, compared to infants born at normal weight. The authors called for additional studies of infants whose mothers had COVID-19 during pregnancy to learn if they have increased health risks later in life.
The study was conducted by Andrea Edlow, M.D., and Lindsay Fourman, M.D., of Massachusetts General Hospital, and colleagues. It appears in The Journal of Clinical Endocrinology and Metabolism. NIH funding was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development with additional support from the National Heart, Lung, and Blood Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, and the National Institute of Allergy and Infectious Diseases.
According to the U.S. Centers for Disease Control and Prevention, in 2020, pregnant women comprised 9% of reproductive aged women with COVID-19. Compared to nonpregnant females of similar age, pregnant people with COVID-19 are more likely to experience severe disease, more likely to be admitted to an intensive care unit, and more likely to need mechanical ventilation to help them breathe. Mothers with COVID-19 are more likely than those without the infection to give birth preterm and to have hypertensive disorders of pregnancy. Moreover, placentas from pregnancies complicated by COVID-19 are often inflamed at the junction between the maternal and fetal parts of the placenta and contain higher amounts of immune cells from mother and fetus.
Despite these ill effects, pregnant people with COVID-19 are unlikely to pass the virus on to their babies. However, few studies have been conducted on the potential long-term effects that may be experienced by children born to mothers with COVID-19 during pregnancy.
For the current study, researchers compared weight, length, and body mass index (BMI) at birth, 2 months, 6 months, and 12 months of 149 babies born to mothers with COVID-19 during pregnancy to those of 127 babies born to mothers without any symptoms of COVID-19. For each infant, researchers calculated a z-score for each of the three measures. Z-scores are a comparison measure of an individual to a formal standardin this case, average weight, length, and body measurements compiled as growth charts by the World Health Organization.
At birth, infants born to mothers with COVID-19 and those born to mothers without COVID-19 did not differ in average z-scores for length. However, those exposed to COVID-19 during pregnancy had an average birth weight z-score that was 30% lower than those not exposed and a BMI z-score that was 35% lower than that of the unexposed infants. By 12 months, infants exposed to COVID-19 in the uterus had a 53% greater gain in BMI z-score than the infants not exposed to COVID-19.
Although preterm infants often have a similar pattern of accelerated growth in comparison to term infants, the authors did not find preterm birth to be the cause of the rapid growth they saw in their study, as the z-scores considered gestational age at birth, and the study did not include enough preterm infants to account for the difference.
In fact, the difference between the two groups persisted, even after researchers statistically compensated for factors known to influence infant size, such as the mothers age and BMI.
The pattern of catch-up growth seen in infants exposed to COVID-19 during pregnancy may place them at risk for heart disease and other obesity-related illnesses later in life. The findings underscore the need to prevent COVID-19 in pregnant people using such protective measures as vaccination and wearing masks indoors, before and during pregnancy.
Ockene, MW, et al. Accelerated longitudinal weight gain among infants with in utero COVID-19 exposure. The Journal of Clinical Endocrinology & Metabolism. 2023.
See more here:
expert reaction to study looking at disturbed sleep and … – Science Media Centre
April 15, 2023
A study published in the Lancet Respiratory Medicine and presented at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) looks at sleep disturbance, dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK.
Dr Ivana Rosenzweig, Clinical Reader in the Neuroscience of Sleep, Kings College London, said:
Does the press release accurately reflect the science?
The study is a well-designed prospective multicentre cohort substudy that investigated the effects of sleep disturbance on recovery after COVID-19 in a cohort of adult participants, who were recruited from the Post-hospitalisation COVID-19 study (PHOSP-COVID). Based on their findings, the authors of the study (justifiably) speculate, that sleep disruption may be a major drive of breathlessness in these patients. However, it remains unclear to which extent this is further affected/moderated by the associated reduced muscle function and increased anxiety, both also recognised causes of breathlessness.
Is this good quality research? Are the conclusions backed up by solid data?
I agree that major strengths of the study include its size, multicentre nature, and the use of different complementary assessment measures to evaluate sleep disturbance. The findings and the authors conclusions are also further supported by the replicated and consistent clinical associations across each evaluation method.
Have the authors accounted for confounders? Are there important limitations to be aware of?
This is a substudy of a larger study, and thus, it is impossible to exclude that there are other potentially unaccounted for confounders. However, the authors were frank that only associations and learned conclusions can be done in clinical research, this is sometimes as good, and as close as we can get in uncovering the underlying mechanisms, and the authors have done their best to declare all possible limitations and to exclude or account for all known confounders.
What are the implications in the real world? Is there any overspeculation?
It will be now really interesting to see if interventions targeting sleep disturbance can improve daytime breathlessness too.
Dr Richard Russell, Clinical Reader in Respiratory Medicine at King College London, said:
This is an important study in that it sheds light into the nature of Long-Covid, its impact on those living with it and also a new focus for treatment. This nation-wide study was performed by an expert group who have looked at Long-Covid in a robust manner. This study has generated new evidence on this condition and also confirmed the importance of sleep to human well-being.
Sleep quality is not just about quantity; too little is not good for health as is too much. Quality is important. The finding that sleep disturbance occurs in people living with Long-Covid and that this is linked to symptoms is important as there are effective strategies to improve sleep quality that will hopefully impact the burden of this disease and improve the lives of those living with it.
Prof David Ray, Professor of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Diabetes; and Sir Jules Thorn Sleep and Circadian Neuroscience Institute, University of Oxford, said:
This is an observational cohort study. People hospitalised with Covid, after discharge were invited to take part, and about 50% of those approached did so. Observational data can identify associations, and here breathlessness was associated with poor sleep. It could be that breathlessness leads to poor sleep, the other way around, or something else e.g. anxiety could lead to both. The authors acknowledge the limitations of the study design, and attempt to control for them. However, it is clear that poor sleep and poor quality of life are closely linked, and so attention to improving sleep may be a low risk, and high gain approach to help people suffering with long covid. That would require a proper interventional trial, and that may be hard to do as the covid waves are now subsiding.
Prof Nicholas Hart, Professor of Respiratory and Critical Care Medicine, Kings College London, said:
This important study provides further insights into physical and mental health impact following hospitalisation as a consequence of COVID-19 infection. This study has shown that sleep disturbance, anxiety and dyspnoea (breathlessness) were more prevalent in hospitalised COVID-19 survivors following discharge. Of particular interest, these patients showed greater rest time and less efficient sleep during recovery. The next step is to confirm or exclude sleep disordered breathing or other sleep disorders, such as periodic limb movement disorder, so that we can apply interventions to improve sleep quality and assess the impact on breathlessness and anxiety.
Dr Julie Darbyshire, Senior Researcher, University of Oxford, said:
Patients rarely sleep well in hospital and poor sleep following hospital admission is common. Feeling breathless, especially overnight, is distressing and this study demonstrates how this is associated with disturbed sleep.
This study assessed sleep using validated methods which ensures quality of recording and comparison with other similar sleep assessment studies.
It is important to note that this study asked people to recall their sleep before they were hospitalised which is an unreliable measure. Comparisons between sleep before and after hospitalisation are therefore less reliable than comparisons between measures reported in real-time. This should not detract from the wider message that sleep quality after hospitalisation with COVID-19 is poor and is also associated with lower measures of health.
The statistical analysis in the article provides compelling evidence for the association between sleep and breathlessness, muscle weakness, and anxiety after hospitalisation for COVID-19. The press release suggests that sleep disruption might cause breathlessness (dyspnoea) whereas the article itself reports an association between the two without attributing a causal pathway. The press release does not mention the other primary associations with greatest sleep irregularity which include a lower deprivation index, smoking, existing depression or anxiety, diabetes, high blood pressure, and kidney disease.
Although we cant be sure from this study, it is plausible that targeting sleep disruption following admission to hospital for Covid may improve general health and recovery in some people, including muscle strength, anxiety, and breathlessness. In general I would say that for any patient struggling to sleep, regardless of why they were admitted to hospital, addressing this is likely to have an effect on their recovery.
Prof Amitava Banerjee, Professor of Clinical Data Science and Honorary Consultant Cardiologist, Institute of Health Informatics, UCL, said:
This is a detailed and very interesting analysis using novel methods, showing that sleep disturbance is common in patients hospitalised with COVID, even 5-8 months following hospital admission, and the sleep quality seems to be worse, even when compared with control groups in UK Biobank, both hospitalised and non-hospitalised. The authors found associations with multiple symptoms, especially shortness of breath, anxiety and muscle weakness.
However, there are some limitations. First, as the accompanying editorial notes, there may be biases in the patients who had sleep monitoring, compared to the overall population of people hospitalised with Covid. Second, this study only concerns hospitalised post- Covid individuals. The majority of people with Long Covid were not hospitalised for Covid so the results may not be generalisable to this larger group. Third, this study only shows correlation and does not show that sleep disturbance causes the symptoms of long Covid. For example, the sleep disturbances could well be an effect rather than a cause of symptoms like breathlessness and anxiety.
Good quality sleep is important for health and reduces risk of chronic diseases, such that it is included in the American Heart Associations Lifes Essential 8 health behaviour recommendations (https://www.heart.org/en/healthy-living/healthy-lifestyle/lifes-essential-8). Quality of sleep is therefore likely to be important for those with Long Covid in reducing their risk of chronic disease, but the role of sleep in the mechanism of Long Covid needs further research.
Effects of sleep disturbance on dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK: a prospective multicentre cohort study by Callum Jackson et al. was published in the Lancet Respiratory Medicine at 23:30 UK time on Saturday 15 April 2023.
DOI: 10.1016/S2213-2600(23)00124-8
Declared interests
Dr Ivana Rosenzweig: No COIs.
Prof David Ray: No conflicts.
Prof Nicholas Hart: I am part of PHOSP but not part of this study. No other conflicts relating to this work.
Dr Julie Darbyshire: I have no conflicts of interest to declare. I was the Chief Investigator for the NIHR funded SILENCE study which investigated the relationship between sound levels, sleep, and delirium in the intensive care unit, and Im currently working alongside patients with long covid to understand how long covid clinics can best support their recovery.
Prof Amitava Banerjeeis the chief investigator of STIMULATE-ICP, an NIHR-funded study in non-hospitalised individuals with Long Covid. He has also received research funding from Astra Zeneca unrelated to Covid or Long Covid.
For all other experts, no reply to our request for DOIs was received.
See the article here:
expert reaction to study looking at disturbed sleep and ... - Science Media Centre
Systemic Immune Inflammation Index Predictor for Thyroiditis | IJGM – Dove Medical Press
Introduction
Subacute thyroiditis (SAT) is a self-limiting inflammatory thyroid gland disease and is characterized by a sudden onset of neck pain, fever, and thyrotoxicosis caused by follicular epithelial destruction.1,2 Females between the ages of 30 and 50 are particularly vulnerable. In recent years, significant progress has been demonstrated in SAT pathogenesis, epidemiology, and clinical courses. It is a known fact that, inflammation plays a significant role in the development of SAT. Pathogenesis of SAT depends on genetic background and triggering factors, such as several viral infections, vaccines, and some drugs.3 The disease severity may reach its peak within three to four days and continues with fluctuating intensity for three to six weeks. Pain lasts for a week to a few months. The American Thyroid Association guidelines recommend corticosteroids in moderate/severe SAT. In our clinical practice, either non-steroidal anti-inflammatory agents (NSAIDs) or 1632 mg methylprednisolone (MPS) treatment has been administered depending on the clinicians preference. Clinical diagnosis can be made based on history, physical examination, biochemical evidence of transient thyrotoxicosis, and reduced radio-iodine uptake on radioactive iodine uptake scan.4 A very high (>50 mm/h) erythrocyte sedimentation rate (ESR) is an additional distinctive diagnostic feature in subacute thyroiditis. C-reactive protein (CRP) may also be elevated in many cases. Thyroid ultrasonography demonstrates heterogeneously hypoechoic and suppressed vascular patterns.5
A complete blood cell count provides information on the number and morphology of various cells. Neutrophils, a part of the innate immune system, have been shown to increase and release inflammation mediators in inflammatory conditions such as SAT. However, the mechanism of lymphocytopenia in patients with SAT remains unclear. Virus infection of T cells6 and elevated cortisol levels7 may be potential factors leading to lymphopenia. Platelets are known to have regulatory effects on both the innate and adaptive immune systems and that the various cytokines they secrete in collaboration with neutrophils cause tissue destruction as a result of the activation of more and more neutrophils and platelets. It is involved in the pathogenesis of numerous acute and chronic inflammatory and autoimmune diseases.8,9
There is a growing interest in the discovery of new biomarkers as indicators of inflammation. Several new leukocyte-based inflammatory indicators, including the Systemic Immune Inflammation Index (SII), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and neutrophil-to-lymphocyte ratio (NLR), have recently been used as diagnostic and prognostic predictors of certain diseases. These indicators have also been investigated as biomarkers for inflammatory and rheumatic diseases. SII, which was first developed in 2014, is considered to be more predictive compared to NLR and PLR.10 Besides, it has been shown to be associated with oncological outcomes in several types of cancer.11,12 It is also believed that SII may reflect the balance between host immune and inflammatory conditions.
Considering the research on this matter, our study may be the first one demonstrating the role of SII in the diagnosis and estimating the recovery time of SAT considering treatment.
The primary purpose of the present study is to evaluate the clinical significance of SII regarding recovery time, hypothyroidism, and recurrence rate in patients with SAT and to compare it to other inflammatory markers. Therefore, clinicians may have an idea about the most effective therapeutic choice and its duration by estimating recovery time.
Sixty-nine SAT patients (52 females and 17 males) with no comorbidities and 59 healthy volunteers (43 females and 16 males) admitted to the Outpatient Department of Endocrinology and Metabolism Diseases, Erzurum Training and Research Hospital between November 2021 and June 2022 were involved in this study. SAT was confirmed by typical symptoms, physical examination, increased ESR, elevated free T4 (fT4), decreased TSH, decreased radioactive iodine uptake and presence of hypoechoic areas with blurred margins and decreased vascularization on thyroid ultrasound in all the patients. Considering age and gender factors, there was almost no difference between the patient and control groups. The patients were followed up on 612 months. Anti-inflammatory medication (indomethacin or 1632 mg MPS, depending on their clinical condition) was started for all patients. The dose titration and duration of treatment could be changed according to the patients clinical symptoms. The number of the patients administered indomethacin and MPS was 31 and 38, respectively. Patients below 18 years, pregnant women, patients with chronic diseases such as heart disease, renal failure, hematological diseases, cancer, or rheumatic diseases, and patients receiving medical treatment that may influence the blood system during the preceding three months were excluded from the study.
Biochemical and hematologic tests were studied. Complete blood count parameters white blood cells, platelet count, neutrophil, lymphocyte, and monocyte count were performed with a Sysmex XN 9000 brand autoanalyzer. Other biochemistry parameters were studied with a Cobas C 701 brand biochemistry autoanalyzer (Roche, Germany). TSH and fT4 were measured by the chemiluminescent immunoassay method (Beckman Coulter, DXI 800, Brea, CA, USA). Reference ranges were defined as fT4: 0.891.76 ng/dl, TSH: 0.554.78 mIU/L, ESR: 020 mm/h, and CRP: 05 mg/L.
Novel inflammation parameters were calculated using the formulas NLR = neutrophils / lymphocytes, PLR = platelets / lymphocytes, SII (neuthrophils platelets) / lymphocytes, SLR (ESR lymphocyte rate) = ESR / lymphocytes and CLR (CRP lymphocyte rate) = CRP / lymphocytes.
Theoretically, CRP level increases more rapidly than ESR in early-stage inflammatory diseases and begins to decrease more quickly than ESR. Therefore, we defined the time when the CRP level decreased to normal and the clinical symptoms of patients resolved as the recovery time.
SPSS 22.0 (SPSS Inc., Chicago, IL, USA) statistical software was used for all analyses. The variables were investigated through visual and analytic methods (KolmogorovSmirnov/ShapiroWilk test) to determine whether they were normally distributed or not. Students T-Test and the MannWhitney U-Test were used to compare normally and non-normally distributed variables, respectively. Descriptive analyses were presented using means and standard deviations for normally distributed variables, whereas medians and minimum-maximum were used for non-normally distributed variables. The chi-square test was used to compare categorical variables. On the other hand, the Spearman correlation coefficient was used. P value less than 0.05 was deemed statistically significant.
Table 1 displays the age and gender distributions of the patient and control groups. There was no significant difference in genders or mean ages between the two groups (p>0.05). Neutrophils, monocytes, ESR, CRP, SII, PLR, SLR, CLR, and NLR were found to be significantly higher at the time of diagnosis in the patient group compared to the control group, while LMR was found to be lower. The median recovery period in the study group was thirty-five days (Table 2).
Table 1 The Distribution of Gender and the Means and Standard Deviations of the ParticipantsAge
Table 2 The Medians, Minimum, and Maximum Ranges of Parameters of the SAT Patients at the Time of Diagnosis and Healthy Controls
According to the results of Spearman correlation analysis, a statistically significant positive correlation was detected in SII levels, compared to other inflammation markers like SLR. On the other hand, as expected, there was a statistically significant negative correlation between SII and LMR. Furthermore, our statistical analysis revealed a strong positive correlation between SII and SAT recovery time and a weak-moderate positive correlation between PLR and recovery time (Table 3). According to the correlation analysis between the recovery time and SII based upon the medication administered in the treatment of SAT, a strong positive correlation was detected only in the group given MPS, not in the group given NSAIDs (Table 4). Also, SII levels at the time of diagnosis were already higher in patients receiving MPS (Table 5).
Table 3 Recovery Time Correlations with Other Inflammatory Markers in Patients with Subacute Thyroiditis Using Spearman Correlation Analysis
Table 4 Correlation Analyses Between Systemic Immune Inflammation Index and Recovery Time in Terms of Medical Treatment in Patient Group
Table 5 Comparisons of Some Parameters According to the Type of SAT Treatment
There was no correlation between SII level and ESR, CRP, fT4, or age factor. Hypothyroidism developed in 12 out of 69 patients (17%) during 612 months follow-up period. No significant correlation was detected between the development of hypothyroidism and other parameters such as SII, NLR, LMR, PLR, fT4, CRP/lymphocyte, ESR/lymphocyte, recovery time, and gender factor. Over the course of the follow-up period, only eight (11%) patients in the MPS group had recurrence. No recurrence was observed in the NSAID group (Table 5).
SII levels did not differ between patients developing and not developing recurrence. TSH and ESR levels at the time of diagnosis were higher in patients with recurrence, compared to those without recurrence (Table 6). Considering gender factor, the recurrence rate was 11.8% for males and 11.5% for females.
Table 6 Comparisons of Laboratory Test Results and Recovery Time of the Patients with and Without Recurrence
Subacute thyroiditis is an inflammatory disease with a high inflammatory load that can progress to long-term severe clinical symptoms and significant comorbidity. As can be seen in our study, females between the ages of 30 and 40 are exposed to subacute thyroiditis more frequently, compared to males (a ratio of 3 to 5:1). This inflammatory disease may be diagnosed with medical history and clinical, laboratory, and imaging findings. In the early phase of SAT, almost all patients may have hyperthyroidism and elevated acute-phase reactants. ESR is one of the most widely used laboratory tools for detecting inflammatory syndromes like SAT. However, it is important to take into account all factors that may influence ESR values such as age and gender factors, the lifestyles of patients, and common metabolic abnormalities.13 Occasionally, value discrepancies may be observed between CRP and ESR due to their kinetic differences. To illustrate, CRP level increases faster than ESR level and begins to decrease more quickly. However, whether one over the other or one over two tests combined has a higher predictive value remains debatable.14 Therefore, studies investigating additional parameters to guide diagnosis and prognosis of subacute thyroiditis are ongoing. Although the diagnostic role of ESR and CRP was determined in patients with SAT pursuant to other studies, we found in our study that these parameters were not clinically effective for estimating the healing process.
Some blood cell-derived indexes, including SII, NLR, PLR, and LMR, have been proposed as biomarkers for various inflammatory and non-inflammatory diseases. As a result, we felt compelled to investigate the blood cell-derived indexes, considering the severity of inflammation, duration of the disease, and treatment in patients with SAT. Although there are many studies on various hemogram-related ratios of subacute thyroiditis in the literature, the number of the studies on subacute thyroiditis and SII is limited.15,16 In these studies, as in our study, SII level has elevated significantly in the patient group with SAT when compared to the control group. However, the current study differs from the other studies in question owing to being a prospective observational study. Apart from this, whether blood cell-based inflammatory markers, particularly SII, are associated with recovery time is one of the most significant research subjects, considering the scope of our study. We found that SII may have prognostic value in predicting the healing process as well as its diagnostic role.
ESR, CRP, SII, PLR, and NLR levels in this study were found to be higher in the patient group, whereas the LMR level was found to be lower. SII and other inflammation markers such as CLR and SLR showed a statistically significant positive correlation. All these parameters might be used to assist acute-phase reactants in detecting inflammatory burden at the time of diagnosis. In the study of Takaldiran et al, NLR and PLR levels were found to be higher in patients with SAT than in the control group, similar to our study.17 We also revealed that patients with higher SII levels had a significantly longer recovery period. We know that the types of treatment have a strong confounding effect on the correlation between SII and recovery time. For this reason, we also studied on the correlation between the recovery time and SII based on the treatment modalities performed. We determined that SII levels affected the recovery time with a strong positive correlation in the patients receiving MPS, not NSAID. Not surprisingly, SII levels were found to be higher in patients receiving MPS due to the presence of milder clinical conditions in patients treated with NSAIDs.
In clinical practice, it is important to decide the most effective and appropriate treatment in the acute phase of the disease through the combination of all parameters such as medical history, clinical, laboratory, and imaging findings, and the severity of the disease, which accurately assess the inflammatory burden of the disease in patients with SAT suffering from severe pain and hyperthyroidism symptoms in order not to cause loss of time.
Thyroid inflammation and hyperthyroidism are usually transient, lasting two to eight weeks. Euthyroidism, hypothyroidism, and finally restoration of normal thyroid functions are experienced following hyperthyroidism. Some patients may skip the hyperthyroid phase entirely and proceed directly from the hypothyroid phase to the recovery phase, which is diagnosed clinically in general. However, 5% to 15% of patients progress to persistent thypothyroidism, which requires levothyroxine treatment.18,19 As mentioned above, hypothyroidism is generally transient, but it may nevertheless be permanent. In our study, hypothyroidism developed in 17% of the patients, pursuant to the study results in the literature. However, no correlation was found between the development of hypothyroidism and hematological parameters. The relatively short follow-up period of only 612 months, which is critical for progression to relapse or hypothyroidism in our study, may have affected this correlation.
In our study, patients receiving MPS had a higher SAT recurrence rate (21%), and the total recurrence rate was 11% consistent with the literature.20 In addition, TSH levels at the time of diagnosis were higher in the recurrence group, while TSH levels were lower in the non-recurrence group in accordance with the literature.21,22 Since the recurrence rate of patients with clinically severe hyperthyroidism is lower, the duration of the treatment administered may be shorter, which reduces the possibility of side effects when compared to a longer treatment period.
SII is a widely available, low-cost, universal, non-invasive, and easy-to-reproduce method for detecting inflammation on SAT. As a result, predicting the prognosis and the duration of the disease in the SAT acute phase could provide benefits in the follow-up process, as well as in the selection of aggressive anti-inflammatory treatment. Although SAT is a benign, self-limiting disease, the severe inflammatory burden of the disease in the acute phase may be exhausting for both patients and physicians. According to the results of our study, estimating the duration of the recovery period by considering the level of SII at the time of the diagnosis has importance. As a high SII level indicates a longer recovery period, deciding whether an aggressive treatment with a higher anti-inflammatory effect as the initial treatment would prevent loss of time. On the other hand, a low SII level indicates a shorter recovery period, which means patients may complete the treatment process without suffering any complications and side effects of a more aggressive treatment. Additionally, we found that higher pre-treatment TSH and ESR values may be a risk factor for recurrence. In clinical practice, this result may help the clinician choose an appropriate treatment without increasing recurrence risk, which is already high in the case of high TSH and ESR levels. In addition, shortening the duration of treatment may be considered in patients at low risk of recurrence.
With all these clinical data, multicenter studies involving a large number of patients and years of follow-up are required for SAT.
ESR and CRP levels play a crucial role in the diagnosis of SAT; however, SII level may also be a parameter in order to give clinicians an idea not only on the diagnosis of the disease but also on its prognosis. As a practical biomarker, SII level may be a new diagnostic and prognostic tool for SAT. According to our point of view, more comprehensive studies with a long follow-up period and a large number of patients need to be conducted to contribute to the research on SAT in the literature.
SAT, Subacute thyroiditis; SII, Systemic Immune-Inflammation Index; TSH, thyroid stimulating hormone; NSAIDs, non-steroidal anti-inflammatory agents; MPS, methylprednisolone; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; PLR, platelet-to-lymphocyte ratio; LMR, lymphocyte-to-monocyte ratio; NLR, neutrophil-to-lymphocyte ratio; SLR, sedimentation-to-lymphocyte ratio; CLR, CRP-to-lymphocyte ratio.
The datasets analysed during the current study are available from the corresponding author on reasonable request.
The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the Erzurum Training and Research Hospital Ethics Committee (Decision KAEK 2022/07-72 Date: 06.06.2022). Written informed consent was obtained from all participants.
We would like to thank the Society of Endocrinology and Metabolism of Trkiye for their valuable contributions to the research process by providing data and to the translation process.
There is no specific funding related to this research.
The authors report no conflicts of interest.
1. Zhao N, Wang S, Cui XJ, et al. Two-years prospective follow-up study of subacute thyroiditis. Front Endocrinol. 2020;11:47. doi:10.3389/fendo.2020.00047
2. Grges J, Ulrich J, Keck C, Mller-Wieland D, Diederich S, Janssen OE. Long-term outcome of subacute thyroiditis. Exp Clin Endocrinol Diabetes. 2020;128:703708. doi:10.1055/a-0998-8035
3. Stasiak M, Lewiski A. New aspects in the pathogenesis and management of subacute thyroiditis. Rev Endocr Metab Disord. 2021;22:10271039. doi:10.1007/s11154-021-09648-y
4. Intenzo CM, Park CH, Kim SM, Capuzzi DM, Cohen SN, Green P. Clinical, laboratory, and scintigraphic manifestations of subacute and chronic thyroiditis. Clin Nucl Med. 1993;18(4):302306. doi:10.1097/00003072-199304000-00007
5. Vural , Paksoy N, Gk ND, Yazal K. Subacute granulomatous (De Quervains) thyroiditis: fine-needle aspiration cytology and ultrasonographic characteristics of 21 cases. Cytojournal. 2015;12:9. doi:10.4103/1742-6413.157479
6. Fois AG, Paliogiannis P, Scano V, et al. The Systemic Inflammation Index on admission predicts in-hospital mortality in COVID-19 patients. Molecules. 2020;25:5725. doi:10.3390/molecules25235725
7. Calapkulu M, Sencar ME, Sakiz D, et al. The prognostic and diagnostic use of hematological parameters in subacute thyroiditis patients. Endocrine. 2020;68:138143. doi:10.1007/s12020-019-02163-w
8. Wang J, Arase H. Regulation of immune responses by neutrophils. Ann N Y Acad Sci. 2014;1319:6681. doi:10.1111/nyas.12445
9. Hu B, Yang XR, Xu Y, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20(23):62126222. doi:10.1158/1078-0432.CCR-14-0442
10. Fest J, Ruiter R, Ikram MA, Voortman T, Van Eijck CHJ, Stricker BH. Reference values for white blood-cell-based inflammatory markers in the Rotterdam Study: a population-based prospective cohort study. Sci Rep. 2018;8(1):10566. doi:10.1038/s41598-018-28646-w
11. Yang R, Chang Q, Meng X, Gao N, Wang W. Prognostic value of Systemic immune-inflammation index in cancer: a meta-analysis. J Cancer. 2018;9(18):32953302. doi:10.7150/jca.25691
12. Zhong JH, Huang DH, Chen ZY. Prognostic role of systemic immune-inflammation index in solid tumors: a systematic review and meta-analysis. Oncotarget. 2017;8(43):7538175388. doi:10.18632/oncotarget.18856
13. Alende-Castro V, Alonso-Sampedro M, Vazquez-Temprano N, et al. Factors influencing erythrocyte sedimentation rate in adults: new evidence for an old test. Medicine. 2019;98(34):e16816. doi:10.1097/MD.0000000000016816
14. Feldman M, Aziz B, Kang GN, Opondo MA, Belz RK, Sellers C. C-reactive protein and erythrocyte sedimentation rate discordance: frequency and causes in adults. Transl Res. 2013;161(1):3743. doi:10.1016/j.trsl.2012.07.006
15. Keskin , Dileki EN, ZA, Cengiz D, Duran C. Can the systemic immune-inflammation index be used as a novel diagnostic tool in the diagnosis of subacute thyroiditis? Biomark Med. 2022;16(10):791797. doi:10.2217/bmm-2022-0095
16. He P, Yang H, Lai Q, et al. The diagnostic value of blood cell-derived indexes in subacute thyroiditis patients with thyrotoxicosis: a retrospective study. Ann Transl Med. 2022;10(6):322. doi:10.21037/atm-22-719
17. Takaldiran I, Omma T, nder E, et al. Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and platelet-to-lymphocyte ratio in different etiological causes of thyrotoxicosis. Turk J Med Sci. 2019;49(6):16871692. doi:10.3906/sag-1901-116
18. Pearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med. 2003;348(26):26462655. doi:10.1056/NEJMra021194
19. Ross DS, Burch HB, Cooper DS, et al. American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26(10):13431421. doi:10.1089/thy.2016.0229
20. Sencar ME, Calapkulu M, Sakiz D, et al. An evaluation of the results of the steroid and non-steroidal anti-inflammatory drug treatments in subacute thyroiditis in relation to persistent hypothyroidism and recurrence. Sci Rep. 2019;9(1):16899. doi:10.1038/s41598-019-53475-w
21. Stasiak M, Tymoniuk B, Stasiak B, Lewiski A. The risk of recurrence of subacute thyroiditis is HLA-dependent. Int J Mol Sci. 2019;20(5):1089. doi:10.3390/ijms20051089
22. Bahadir T, Yilmaz M, Kilikan E. Factors affecting recurrence in subacute granulomatous thyroiditis. Arch Endocrinol Metab. 2022;66(3):286294. doi:10.20945/2359-3997000000473
See original here:
Systemic Immune Inflammation Index Predictor for Thyroiditis | IJGM - Dove Medical Press