Lower Serum Dipeptidyl peptidase-Ⅳ Level is Associated With 3 Types of Autoimmune Thyroid Diseases

Backgroud: Autoimmune thyroid diseases (AITD) are the most common organ specific autoimmune disorders. The reduction of serum dipeptidyl peptidase-IV (sDPPIV) levels have been reported in patients with autoimmune diseases. Few studies have analyzed the association between sDPPIV levels and AITD, especially in Graves’ disease (GD), Graves’ ophthalmopathy (GO) patients. So the aim of this study was to evaluate the association between sDPP-IV levels and 3 types of AITD, that is Graves’ disease (GD), Graves’ ophthalmopathy (GO), Hashimoto’s thyroiditis (HT). Methods 65 newly diagnosed GD ,22 GO, 27 HT patients and 30 healthy individuals were recruited for this study. Clinical characteristics and thyroid function data were collected for all participants. sDPP-IV was measured by enzyme-linked immunosorbent assay. Results Compared with the controls, GD patients and GO patients had significantly lower sDPP-IV levels(662.2 ± 38.81 and 438.4 ± 31.78 vs.786.3 ± 46.95, P = 0.01 or P < 0.001). It was also found that in GO individuals, sDPP-IV was lower than in GD subjects(P = 0.002). The lower the sDPP-IV level is, the higher the risk for developing GD or GD will be. In addition, sDPP-IV levels have negative association with the antithyroid peroxidase antibody(TGab)(r =-0.20, p = 0.02) and antithyroglobulin antibody(TPOab)(r =-0.19, p = 0.03). But there was no significant relationship between thyroid hormone and sDPP-IV levels.GO parients were groups by proptosis with and without muscle thicken,the sDPP-IV levels in proptosis with muscle thicken were lower than proptosis without muscle thicken(P < 0.05).Logistic regression analysis showed that sDPP4 were negatively correlated with GO and GD. Conclusions Take together, the present study showed for the first time that sDPP-IV concentrations are aberrant in GD and GO patients and that the reduced sDPP-IV expression may be involved in the progression of GO and GD diseases.

Hyponatraemia due to hypothyroidism: a rare side effect from pomalidomide

Pomalidomide is an immunomodulatory drug used for relapsed and refractory multiple myeloma (RRMM). Hypothyroidism is an uncommon side effect of pomalidomide. We present a 70-year-old male patient with RRMM on daratumumab, pomalidomide and dexamethasone, who presented with 2 weeks of fatigue. Laboratory values showed sodium of 120 mEq/L, plasma osmolarity of 256 mOsm/kg, urine osmolarity of 648 mOsm/kg and urine sodium of 93 mEq/L. Adrenocorticotropic hormone (ACTH) stimulation test was within normal limits. Thyroid-stimulating hormone (TSH) was 88.6 IU/mL (0.380–4.700 IU/mL), total triiodothyronine (TT3) <21 ng/mL (0.8–2 ng/mL), free thyroxine (fT4) 0.10 ng/dL (0.93–1.70 ng/dL) and free triiodothyronine (fT3) <0.5 pg/mL (2.3–4.2 pg/mL). Antithyroid peroxidase antibody was 726 IU/mL (<9 IU/mL). TSH 1 year ago was 2.88 IU/mL and TT3 was 1.06 ng/mL. He was started on levothyroxine with improvement in his symptoms, sodium level and thyroid functions. The most likely culprit was pomalidomide. Checking thyroid functions before and periodically while on pomalidomide is important in screening for this possible side effect.

Screening of Thyroid Disorder among Pregnant Ladies in a Tertiary Hospital of Nepal

Thyroid disorders (TD) are the second most common endocrine disorders seen in pregnancy. Many physiological changes in pregnancy lead to hypothyroidism in pregnancy. Hypothyroid in pregnancy is associated with many adverse maternal and fetal outcomes. Objective of this study was to find the prevalence of TD in pregnancy in Nepal Medical College Teaching Hospital (NMCTH), Antithyroid Peroxidase Antibody (TPO-Ab) positive cases with hypothyroidism and to evaluate maternal fetal outcome in hypothyroid pregnancies. This was a prospective hospital based observational study. The study was done in Department of Obstetrics and Gynecology, NMCTH from August 2018 to July 2019. Among 420 pregnant ladies 71.0% were euthyroid, 25.7% were hypothyroid (25.2%of subclinical and 0.5% overt), 3.3% were hyperthyroid (0.7% of overt) and 6.4% were TPO-Abpositive with hypothyroidism. Inspite of treatment, Gestational hypertention, Pre-eclampsea and LSCS is significantly high in hypothyroid pregnancy than euthyroid pregnancy. High prevalence of hypothyroidism in this study necessitates universal screening of TD at first trimester of pregnancy.

Factors Associated with the Prevalence of Thyroid Nodules and Goiter in Middle-Aged Euthyroid Subjects

The aim of the present study was to determine associations of thyroid hormone levels and different metabolic parameters and anthropometric measurements with volume of nodular and nonnodular thyroid as well as with prevalence of goiter and thyroid nodules in middle-aged euthyroid subjects. Methods. The study consisted of 317 euthyroid subjects aged 48-49 from the Kaunas Cardiovascular Risk Cohort study. Thyroid-stimulating hormone (TSH), free thyroxine (FT4), and antithyroid peroxidase antibody (ATPO) levels, as well as anthropometric and metabolic parameters and smoking information, were evaluated. Results. In subjects with and without thyroid nodules, thyroid volume correlated with components of metabolic syndrome, body mass index (BMI), smoking, and TSH levels. In the nonnodular thyroid group, thyroid volume was also positively related to serum insulin and HOMA-IR, whereas a negative correlation between thyroid volume and leptin was identified in the nodular thyroid group. The goiter was identified in 12.3% of subjects. Female gender, thyroid nodules, smoking, BMI, and levels of TSH were independent predictors for goiter. Thyroid nodules were found in 31.2% of participants. Female gender, higher TSH levels, and thyroid volume were independent risk factors for thyroid nodules. Conclusions. Female gender, thyroid nodules, smoking, BMI, and TSH levels were identified as potential predictors of goiter. Female gender, TSH levels, and thyroid volume predicted the presence of thyroid nodules.

Atorvastatin-Diltiazem Combination Induced Rhabdomyolysis Leading to Diagnosis of Hypothyroidism

Statins and hypothyroidism, independently, can rarely cause rhabdomyolysis. The combination of them especially with concurrent intake of drugs such as diltiazem increases the risk of rhabdomyolysis. Hashimoto’s encephalopathy is a rare condition associated with Hashimoto’s thyroiditis and some patients with that can present with a stroke like picture. An elderly male who has been on atorvastatin for three years and on diltiazem for a week presented with sudden onset inability to walk and confusion. On examination muscle tenderness was noticed and creatine kinase levels indicated rhabdomyolysis which we attributed to atorvastatin. Patient developed a seizure and myoclonus of masseters. Considering this, his confusion and his neutrophilia and high C-reactive protein levels, empirical antibiotics with dexamethasone were started and the patient responded to that. His cerebrospinal fluid and blood culture reports that arrived later did not show sepsis. After going home also his CK (creatine kinase) levels remained high; TSH (thyroid-stimulating hormone) level test was done and hypothyroidism was diagnosed. His antithyroid peroxidase antibody levels were also very high. We retrospectively think he had Hashimoto’s encephalopathy as well. His lipid profile and TSH and CK values returned to normal in that order after a few months of levothyroxine therapy.

Tyrosine Kinase Inhibitors Induced Thyroid Dysfunction: A Review of Its Incidence, Pathophysiology, Clinical Relevance, and Treatment

Tyrosine kinase inhibitors (TKI) belong to a new class of molecular multitargeted anticancer therapy which targets different growth factor receptors and hence attenuates cancer cell survival and growth. Since their introduction as adjunct treatment for renal cell carcinoma and gastrointestinal stromal tumors (GIST), a number of reports have demonstrated that TKI can induce thyroid dysfunction which was especially more common with sunitinib maleate. Many mechanisms with respect to this adverse effect of tyrosine kinase inhibitors have been proposed including their induction of thyroiditis, capillary regression in the thyroid gland, antithyroid peroxidase antibody production, and their ability to decrease iodine uptake by the thyroid gland. Of interest is the observation that TKI-induced thyroid dysfunction may actually be protective as it was shown to improve overall survival, and it was suggested that it may have a prognostic value. Followup on thyroid function tests while patients are maintained on tyrosine kinase inhibitor is strongly recommended. When thyroid dysfunction occurs, appropriate treatment should be individualized depending on patients symptoms and thyroid stimulating hormone level.

Graves’ Hyperthyroidism-Induced Psychosis Treated With Aripiprazole—A Case Report

Graves’ disease is an autoimmune syndrome with symptoms such as tachycardia, atrial fibrillation, and psychiatric symptoms. Limited evidence exists for the treatment of Graves’ hyperthyroidism-induced psychosis with atypical antipsychotics. A 47-year-old female with a psychiatric history of bipolar disorder presented for the first time to the psychiatric hospital. She was agitated and grossly psychotic with delusions. Electrocardiogram showed atrial fibrillation and tachycardia. Drug screen urinalysis was negative. Endocrine workup resulted in a diagnosis of Graves’ disease (thyroid-stimulating hormone [TSH]: 0.005 μIU/mL, triiodothyronine [T3]: 537 ng/dL, thyroxine [T4]: 24 mcg/dL, free T4: 4.5 ng/dL, positive antithyroid peroxidase antibody, and antinuclear antibody). Aripiprazole 10 mg daily was initiated and titrated to 15 mg daily on day 4. On day 16, her suspicious behavior, judgment, and insight improved. Other medications given included aspirin 325 mg daily, metoprolol 25 mg twice daily, titrated to 12.5 mg twice daily, and methimazole 30 mg daily, titrated to 20 mg twice daily, and discontinued on day 29. The patient received radioiodine I-131 treatment 1 week later. We report the first known case on the use of aripriprazole to treat Graves’ hyperthyroidism-induced psychosis. Further studies examining the long-term effects and appropriate dose and duration of aripiprazole in this patient population are needed.