High Normal Thyrotropin (TSH) is Associated with Higher Needed Dose of Erythropoietin in Hemodialysis Patients

Background: Recombinant human erythropoietin demonstrated an impressive ability to improve hematocrit, raising hematocrit of hemodialysis patients, eliminating the need for transfusions, and in patients with iron overload, decreased serum ferritin. Thyrotropin could affect hematopoiesis by binding to a functional thyrotropin receptor, which is found in both erythrocytes and some extrathyroidal tissues. The aim of this study was to evaluate the relationship of Thyrotropin level within normal reference range (in euthyroid state) on erythropoietin dose in end-stage renal disease patients on hemodialysis. Methods: Prospective cross-sectional study was carried out at the hemodialysis units. It included 60 patients who had end-stage renal disease on hemodialysis. The selected patients were classified into 2 groups: Group A: included 30 end-stage renal disease patients on hemodialysis with Thyrotropin level (0.4-<2.5 miu/L) and Group B: included 30 end-stage renal disease patients on hemodialysis with Thyrotropin level (2.5-4.2 miu/L). Results: the hemoglobin level and the hematocrit level showed a highly statistically significant difference between both groups. The needed Erythropiotin dosage was higher in group B than in group A with highly statistically significant difference. Weighted Erythropiotin dosage was calculated (weighted Erythropiotin=Erythropiotin dosage/weight) and the mean required dose was less than the required dose in group B and there was a highly statistically significant difference between the two groups. There was a significant negative correlation between the Thyrotropin level and hematocrit level and that leads us to conclude that the higher the Thyrotropin, the lower hematocrit will be and subsequently the higher Erythropiotin dose needed. Conclusions: There is a relationship between Thyrotropin level even within normal reference range (in euthyroid state) on erythropoietin dose in end-stage renal disease patients on hemodialysis. In other words, the higher Thyrotropin level is, the more Erythropiotin dose needed. The required erythropoietin stimulating agent dose can be predicted by measuring Thyrotropin level.

Suppressive effects of neonatal bisphenol A on the neuroendocrine system

The aim of this study was to assess the effects of neonatal bisphenol A (BPA) administration on neuroendocrine features (the thyroid–brain axis). BPA (20 or 40 µg/kg) was orally administered to juvenile male albino rats ( Rattus norvegicus) from postnatal days (PNDs) 15 to 30. Both doses resulted in lower serum thyroxine (T4), triiodothyronine (T3), and growth hormone levels and higher thyrotropin level than the control levels at PND 30. In the neonatal cerebellum and cerebrum, vacuolation, pyknosis, edema, degenerative changes, and reductions in the size and number of the cells were observed in both treated groups. Alternatively, elevations in oxidative markers (lipid peroxidation, nitric oxide, and hydrogen peroxide [H2O2]) at both dose levels were recorded at PND 30, along with decreased activities of antioxidant markers (ascorbic acid, total thiol [t-SH], glutathione, glutathione peroxidase, glutathione reductase, glutathione-S-transferase, and catalase) with respect to control levels. Thus, the BPA-induced hypothyroid state may disturb the neonatal thyroid–brain axis via production of free radicals, and this could damage the plasma membrane and cellular components, delaying cerebrum and cerebellum development.

Evaluation of Serum Thyrotropin and Urinary Protein level among Pre-eclamptic Pregnancies

<p><strong>Objective: </strong>This study was done to evaluate serum thyrotropin (thyroid stimulating hormone,TSH) and urinary protein level among preeclamptic pregnancies.</p><p><strong>Patients and methods: </strong>This study was conducted at the Institute of Nuclear medicine and Allied Sciences, Rajshahi along with Department of Gynecology &amp; Obstetrics, Rajshahi Medical College Hospital, Rajshahi during the period between 1^st July, 2011 and 31^st June, 2013.Total 66 preeclamptic pregnant patients who were referred for the assay of serum thyrotropin hormone level were included as sample under the basis of non-random purposive sampling technique. Their age, urinary protein level and level of serum thyrotropin hormone were recorded and analyzed.</p><p><strong>Results:</strong> Among the total enrolled preeclamptic pregnant patients (n=66), Mean (± SD) age was 27 ± 3.88 years (range=19 to 35 years). Regarding urinary protein level, 26 (39.39 %) patients had 1+ urinary protein level and 40 (60.61%) patients had ≥ 2+ urinary protein level. Serum thyrotropin level was 6.16 ± 0.85 (mean ± SD) among total 66 patients. Among the preeclamptic pregnant patients having 1+ urinary protein level, thyrotropin level was 5.38 ± 0.70 (mean ± SD) and 6.67 ± 0.49 (mean ± SD) among the patients having ≥ 2+ urinary protein level.</p><p><strong>Conclusion: </strong>Thyrotropin level is higher in preeclamptic pregnant patients and reflects severity of preeclampsia.</p><p>Bangladesh J. Nuclear Med. 19(2): 120-122, July 2016</p>

Sonographic Echo-pattern of the Thyroid Gland among the Non-nodular Goitrous Patients Having Abnormal thyrotropin Level at their First Diagnosis

Objective: This study was done to observe the high resolution sonographic echo-pattern of the thyroid gland among the non-nodular goitrous patients having abnormal thyrotropin (TSH) level at their first diagnosis.Method: This study was conducted at the Institute of Nuclear medicine and Allied Sciences, Rajshahi, Bangladesh during the period between 1st January, 2014 and 31st March, 2015. The goitrous patients are referred at this Institute by the clinicians for radionuclide thyroid scan, HRUS of thyroid gland and thyroid function tests. Under the basis of convenient sampling technique, 62 patients are included as sample. Their age, gender, HRUS echo-patterns of goiter and thyrotropin levels are recorded and analyzed with statistical software IBM SPSS v. 16.Results: Among the total enrolled patients (n=62), 57 (91.9 %) were female and five (8.1 %) were male. Mean (± SD) age was 28 ± 11.85 years (range=8 to 69 years). Regarding thyrotropin level among the sample patients (n=62), 53 (85.5 %) had above normal range and 9 (14.5 %) had below normal range. In relation to sonographic echo-pattern of the non-nodular goitrous patients (n=62), 43 (69.4 %) had hypoechoic feature, 15 (24.2 %) had non-homogenous feature and four (6.5 %) had both hypoechoic and non-homogenous feature. Among the 43 goitrous patients with hypoechoic feature, 38 had thyrotropin above normal range and five had below normal range; among the 15 goitrous patients with non-homogenous feature, 12 had thyrotropin above normal range and three had below normal range and among the four goitrous patients with both hypoechoic and non-homogenous feature, three had thyrotropin above normal range and one had below normal range.Conclusion: The results of this study will be helpful in the relevant prospective studies which will be concerned with developing non-nodular goiter management algorithm, in addition to the role of other parameters like thyroid function tests especially thyrotropin level, circulating thyroid autoantibodies detection and fine needle aspiration biopsy (FNAB) cytology findings.Bangladesh J. Nuclear Med. 18(2): 152-155, July 2015

Lateralized exanthem mimicking figurate inflammatory dermatosis of infancy after methimazole therapy

We reported a case of an 11-year-old girl admitted to our hospital for goiter, tachycardia, sweating, and visible and palpable thyroid. Thyroid function tests revealed a low thyrotropin level (<0.004 mIU/L) and elevated free thyroxine level (3.4 ng/ dL) diagnosed with Graves’ disease and treated with methimazole. This anti-thyroid drug is recommended as first-line treatment in children with Graves’ disease because it produces minor adverse effects with respect to propylthiouracil. She developed a lateralized exanthem mimicking figurate inflammatory dermatosis of infancy after methimazole therapy. The symptoms resolved after discontinuation of methimazole and treatment with an antihistamine and a corticosteroid. Furthermore, the treatment was changed to propylthiouracil without any adverse effects. According to current literature this is the first case of cutaneous figurate erythema related to methimazole, different from other well-known reactions such as skin eruption or urticaria.

Thyroid Disorders

Current assays measure thyrotropin (previously called thyroid-stimulating hormone) concentrations as low as 0.01 mIU/L, allowing differentiation between low-normal values and suppressed values. In patients with normal pituitary, thyrotropin levels are increased in primary hypothyroidism, during recovery from nonthyroid illness, and with thyroid hormone resistance. Thyrotropin levels are low in hyperthyroidism, in nonthyroidal illness, in the first trimester of pregnancy, and with the use of certain drugs (eg, somatostatin, dopamine, and glucocorticoids). Measurement of the thyrotropin level is the best single test of thyroid function in these patients.