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Medicine Apr 2021Whether hypothyroidism is related to non-alcoholic fatty liver disease (NAFLD) is controversial. Our aim was to investigate the relationship between NAFLD and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Whether hypothyroidism is related to non-alcoholic fatty liver disease (NAFLD) is controversial. Our aim was to investigate the relationship between NAFLD and hypothyroidism that may predict the NAFLD potential of these lesions and new prevention strategies in hypothyroidism patients.
METHODS
Totally 51,407 hypothyroidism patients with average 28.23% NAFLD were analyzed by Revman 5.3 and Stata 15.1 softwares in the present study. The PubMed and Embase databases were systematically searched for works published through May 9, 2020.
RESULTS
The blow variables were associated with an increased risk of NAFLD in hypothyroidism patients as following: increased of thyroid stimulating hormone (TSH) levels (odds ratio [OR] = 1.23, 1.07-1.39, P = .0001); old age (mean difference [MD] = 3.18, 1.57-4.78, P = .0001); increased of body mass index (BMI) (MD = 3.39, 2.79-3.99, P < .000001); decreased of free thyroxine 4 (FT4) levels (MD = -0.28, -0.53 to -0.03, P = .03). In addition, FT3 (MD = 0.11, -0.09-0.3, P = .29) had no association with the risk of NAFLD in hypothyroidism patients.
CONCLUSION
Our systematic review identified results are as following: hypothyroidism was positively associated with the risk of NAFLD. The increased concentration of TSH levels maybe a risk factor that increased incidence of NAFLD. The BMI of NAFLD patients was significantly higher than that of non-NAFLD patients. Old age was significantly associated with the incidence of NAFLD. FT4 was significantly associated with the risk of NAFLD due to its negatively effect while FT3 was not significantly related to the risk of NAFLD. Taken together, the present meta-analysis provides strong evidence that hypothyroidism may play a vital role in the progression and the development of NAFLD.
Topics: Disease Progression; Humans; Hypothyroidism; Non-alcoholic Fatty Liver Disease; Prognosis; Risk Factors; Thyroid Function Tests; Thyrotropin
PubMed: 33907168
DOI: 10.1097/MD.0000000000025738 -
Diabetes & Metabolic Syndrome 2021Coronavirus disease (COVID-19) still becomes a global burden that affected people in different groups. The aim of this study was to evaluate the association between... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIMS
Coronavirus disease (COVID-19) still becomes a global burden that affected people in different groups. The aim of this study was to evaluate the association between thyroid disease and the outcome of COVID-19 patients.
METHOD
This was a meta-analysis study from articles obtained through a systematic literature search to investigate the relationship between thyroid disease and COVID-19 outcomes. Composite poor outcomes comprised of severity, mortality, intensive care unit (ICU) admission, and hospitalization.
RESULTS
A total of 31339 patients from 21 studies included in this study. Thyroid disorder was associated with increased composite poor outcome (risk ratio (RR) 1.87 [95% confidence interval (CI) 1.53, 2.27], p < 0.001; I2 = 84%, p < 0.01), this included higher disease severity (RR 1.92 [1.40, 2.63], p < 0.05; I2 = 86%, p < 0.01), ICU admission (RR 1.61 [1.12, 2.32], p > 0.05; I2 = 32%, p < 0.05), mortality (RR 2.43 [1.44, 4.13], p < 0.05; I2 = 83%, p < 0.01), and hospitalization (RR 1.28 [1.17, 1.39], p < 0.05; I2 = 0%, p < 0.96). Meta-regression analysis indicated that age (p = 0.002) was a significant influence that affects the association. Also, the presence of unspecified thyroid disease (RR 1.91 [1.38, 2.65], p < 0.05; I2 = 81%, p < 0.01) and hypothyroidism (RR 1.90 [1.45, 2.55], p < 0.05; I2 = 85%, p < 0.01) during admission were associated with poor outcomes.
CONCLUSION
Thyroid abnormalities increased the risk of COVID-19 composite poor outcomes and were influenced by the patient's age. Abnormal thyroid and hypothyroidism, but not hyperthyroidism, were associated with poor COVID-19 outcomes.
Topics: COVID-19; Humans; Hypothyroidism; Regression Analysis
PubMed: 34731819
DOI: 10.1016/j.dsx.2021.102312 -
Endocrine Practice : Official Journal... Mar 2023This study aims to determine whether elevated endogenous thyrotropin levels contribute to an increased risk of adverse outcomes, such as all-cause mortality in older... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This study aims to determine whether elevated endogenous thyrotropin levels contribute to an increased risk of adverse outcomes, such as all-cause mortality in older adults with subclinical hypothyroidism.
METHODS
Eight electronic databases were searched for relevant articles from inception until March 23, 2022. Cohort studies assessing the association between thyrotropin levels and the risk of mortality among older adults aged ≥60 years with subclinical hypothyroidism were eligible. The outcomes of interest were either all-cause or cardiovascular-related mortality. Two independent researchers assessed the eligibility of the studies and collected data through a previously defined data extraction form. The Newcastle-Ottawa Scale was used to evaluate the quality of evidence, and multivariate-adjusted hazard ratios (HRs) (95% Cl) were collected as the necessary risk estimate for synthesis. Random-effects models were applied for meta-analysis.
RESULTS
Overall, 13 studies involving 44 514 participants were included in this meta-analysis. There were no significant differences in the risk of all-cause mortality (pooled HR: 1.18 [95% Cl: 0.95, 1.45], I = 94%) and cardiovascular-related mortality (pooled HR: 1.08 [95% Cl: 0.94, 1.23], I = 0%) between euthyroid older adults and older adults with subclinical hypothyroidism. The results remained the same when only older adults with thyrotropin ≥10 mIU/L were assessed (pooled HR for all-cause mortality and cardiovascular-related mortality, respectively: 1.53 [95% Cl: 0.81, 2.88], I = 22%, 1.35 [95% Cl: 0.63, 2.86], I = 43%).
CONCLUSION
High thyrotropin levels are not associated with increased risk for all-cause mortality as well as cardiovascular-related mortality in older adults aged ≥60 years with subclinical hypothyroidism, suggesting an unnecessity in initialing treatment.
Topics: Aged; Humans; Thyrotropin; Risk Factors; Hypothyroidism; Cohort Studies; Proportional Hazards Models
PubMed: 36464133
DOI: 10.1016/j.eprac.2022.11.011 -
Systematic Reviews Sep 2020Thyroid eye disease is an autoimmune disorder of the orbital retrobulbar tissue commonly associated with dysthyroid status. The most frequent condition is...
BACKGROUND
Thyroid eye disease is an autoimmune disorder of the orbital retrobulbar tissue commonly associated with dysthyroid status. The most frequent condition is hyperthyroidism, although it is also present in hypothyroid and euthyroid patients. The prevalence of thyroid conditions in patients with thyroid eye disease had been previously evaluated; however, there is no consensus on a global prevalence. The study aims to estimate the prevalence of hyperthyroidism, hypothyroidism, and euthyroidism in patients with TED, through a systematic review of literature.
METHODS
We conducted a systematic review of the literature following the PRISMA guidelines, in MEDLINE, COCHRANE, EMBASE, Science Direct, and LILACS databases. Inclusion criteria were primary studies of patients with a diagnosis of thyroid eye disease made by an ophthalmologist or with diagnosis criteria, with measurement of thyroid function (TSH, T3, and free T4), and diagnosis of the primary thyroid condition. A quality assessment was made through the Joanna Briggs Institute Quality tools. Finally, we extracted relevant details about the design, the results, and the prevalence of thyroid disorders in thyroid eye disease.
RESULTS
The initial search revealed 916 studies, of which finally thirteen met inclusion criteria. Six studies were performed in Europe (Germany, Wales, and Spain), five in Asia (Iran, South Korea, Japan, and Singapore), one in North America (USA), and one in Africa (Ghana). The global prevalence, in patients of thyroid eye disease, was 10.36% for hypothyroidism, 7.9% for euthyroidism, and 86.2% for hyperthyroidism.
CONCLUSIONS
Professionals should be aware that thyroid eye disease can be present in patients with a normal thyroid function. The assessment for these patients is based on orbital images; serum TSH, T3, and free T4; antibody levels as thyrotropin receptor antibodies; and thyroperoxidase levels. Additionally, we want to encourage research in this field in other regions of the world such as Latin America.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO ID CRD42020107167.
Topics: Africa; Asia; Europe; Humans; Hyperthyroidism; Hypothyroidism; North America; Prevalence; Thyrotropin
PubMed: 32873324
DOI: 10.1186/s13643-020-01459-7 -
Frontiers in Endocrinology 2022The correlation between benign thyroid disease (BTD) and breast cancer (BC) has long been discussed. However, the definite relationship and potential mechanism between... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The correlation between benign thyroid disease (BTD) and breast cancer (BC) has long been discussed. However, the definite relationship and potential mechanism between them are still disputed. The current meta-analysis aimed at performing a comprehensive assessment of the relationship between different types of benign thyroid disease and the risk of breast cancer, furthermore, assessing whether benign thyroid disease exerts an influence on the aggressiveness of breast cancer.
METHOD
A systematic literature search (PubMed, Web of Science, MEDLINE, and Embase databases) identified studies to evaluate the correlation between BTD and BC risk. Data were analyzed using version 16.0 STATA software, including the odds ratio (OR) and its corresponding 95% confidence intervals (CIs). Publication bias and quality assessment were conducted for the included studies.
RESULT
Overall, 18 studies involving 422,384 patients with BTD were incorporated. The outcome showed that autoimmune thyroiditis (OR: 2.56, 95%CI: 1.95-3.37, I 0.0%, p=0.460), goiter (OR: 2.13, 95%CI: 1.19-3.79, I 80.6%, p=0.000), and Graves' disease (OR: 5.01, 95%CI: 1.49-16.82, I 0.0%, p=0.358) was connected with a higher risk of BC. Both hypothyroidism (OR: 0.82, 95%CI: 0.64-1.04, I 85.0%, p=0.000) and hyperthyroidism (OR: 1.07, 95%CI: 0.93-1.24, I 24.9%, p=0.206) had no significant association with the risk of BC. Additionally, the pooled analysis showed no apparent correlation between BTD and aggressiveness of BC. However, subgroup analysis indicated a positive relationship between BTD and aggressiveness of BC in the Europe subgroup (HR: 2.05, 95%CI: 1.32-3.17, I 86.4%, p=0.000).
CONCLUSION
Autoimmune thyroiditis, goiter, and Graves' disease are connected with an increased risk of BC. Furthermore, subgroup analysis suggested that BTD increases the aggressiveness of BC in the European population geographically. Nevertheless, further research is needed to prove these discoveries.
Topics: Humans; Female; Thyroiditis, Autoimmune; Breast Neoplasms; Thyroid Diseases; Goiter; Graves Disease
PubMed: 36313770
DOI: 10.3389/fendo.2022.984593 -
Frontiers in Endocrinology 2022Rheumatoid arthritis (RA) is an autoimmune disorder. Multiple studies have investigated the risk of thyroid dysfunction in patients with RA but have reached conflicting... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Rheumatoid arthritis (RA) is an autoimmune disorder. Multiple studies have investigated the risk of thyroid dysfunction in patients with RA but have reached conflicting conclusions. This systematic review aimed to determine whether patients with RA are at higher risk of thyroid dysfunction.
METHODS
We comprehensively reviewed online literature databases, including PubMed, Scopus, Embase, and the Cochrane Library, from their respective inception dates to March 25, 2022. Studies that provided data on at least one case of thyroid dysfunction in RA patients and their controls were included. Based on these data, we calculated pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) for thyroid dysfunction in RA and non-RA patients.
RESULTS
Twenty-nine studies met the inclusion criteria, involving a total of 35,708 patients with RA. The meta-analysis showed that, compared with non-RA patients, RA patients had an increased risk of developing thyroid dysfunction, particularly hypothyroidism (OR 2.25, 95% CI 1.78-2.84). Subgroup analysis suggested that study type and sample source of control group were the source of heterogeneity.
CONCLUSIONS
Patients with RA are at increased risk of developing thyroid dysfunction, especially hypothyroidism. Routine biochemical examination of thyroid function in RA patients should be strengthened. Larger prospective studies are needed to explore the causal relationship between RA and thyroid dysfunction, and to investigate the impact of thyroid dysfunction on RA disease activity, drug efficacy, and medication safety.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42022331142.
Topics: Humans; Thyroid Diseases; Hypothyroidism; Arthritis, Rheumatoid; Prospective Studies
PubMed: 36313752
DOI: 10.3389/fendo.2022.1015516 -
Systematic Reviews Apr 2024Thyroid dysfunction (TD) and type 2 diabetes mellitus (T2DM) frequently co-occur and have overlapping pathologies, and their risk increases with age. Thyroid dysfunction... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Thyroid dysfunction (TD) and type 2 diabetes mellitus (T2DM) frequently co-occur and have overlapping pathologies, and their risk increases with age. Thyroid dysfunction along with T2DM will worsen macro- and microvascular complications, morbidity, and mortality.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guideline was followed. The databases used were Embase, ScienceDirect, PubMed, and Google Scholar. The Joana Briggs Institute (JBI) scale was used to assess the quality of the included studies. The data was extracted by Microsoft Excel and analyzed through STATA version 14 software. The overall pooled prevalence of TD and its main components were estimated using the random-effects model. The consistency of studies was assessed by I test statistics. Pooled meta-logistic regression was used to present the pooled prevalence with a 95% confidence interval (CI). Besides, subgroup and sensitivity analyses were employed.
RESULT
Thirty-eight studies were included. The pooled prevalence of TD was 20.24% (95% CI: 17.85, 22.64). The pooled prevalence of subclinical hypothyroidism, hypothyroidism, subclinical hyperthyroidism, and hyperthyroidism was found to be 11.87% (95% CI: 6.90, 16.84), 7.75% (95% CI: 5.71, 9.79), 2.49% (95% CI: 0.73, 4.25), and 2.51% (95% CI: 1.89, 3.13), respectively. Subgroup analysis based on continent revealed a higher prevalence of TD in Asia and Africa. Factors like being female, HbA1c ≥ 7%, DM duration > 5 years, family history of TD, central obesity, smoking, the presence of retinopathy, and neuropathy were found associated with TD.
CONCLUSION
The current systematic review and meta-analysis showed that the TD's pooled prevalence was relatively higher than the general population. Therefore, regular screening of TD should be done for T2DM patients.
Topics: Humans; Diabetes Mellitus, Type 2; Prevalence; Thyroid Diseases; Hyperthyroidism; Hypothyroidism; Risk Factors; Adult
PubMed: 38689302
DOI: 10.1186/s13643-024-02527-y -
The Journal of Clinical Endocrinology... Jan 2021Weight gain is a major driver of dissatisfaction and decreased quality of life in patients with hypothyroidism. Data on the changes in body weight following... (Meta-Analysis)
Meta-Analysis
CONTEXT
Weight gain is a major driver of dissatisfaction and decreased quality of life in patients with hypothyroidism. Data on the changes in body weight following thyroidectomy are conflicting.
OBJECTIVE
To perform a systematic review of the literature and a meta-analysis of weight changes following total thyroidectomy.
DATA SOURCES
Literature search on PubMed.
STUDY SELECTION
Studies in English published between September 1998 and May 2018 reporting post-thyroidectomy weight changes.
DATA EXTRACTION
Data were reviewed and compared by 3 investigators; discrepancies were resolved by consensus. Meta-analyses were performed using fixed and random effect models. Univariable and multivariable meta-regression models for weight change were implemented against study follow-up, gender, and age. Exploratory subgroup analyses were performed for indication for surgery.
DATA SYNTHESIS
Seventeen studies (3164 patients) with 23.8 ± 23.6 months follow-up were included. Severe heterogeneity across studies was observed. Using a random effect model, the estimated overall weight change was a gain of 2.13 kg, 95% confidence interval (CI; 0.95, 3.30). Age was negatively associated with weight change (β = -0.238, P < 0.001). In subgroup analyses, weight gain was more evident in patients undergoing thyroidectomy for hyperthyroidism: 5.19 kg, 95% CI (3.21, 7.17) vs goiter or malignancy 1.55 kg, 95% CI (0.82, 2.27) and 1.30 kg, 95% CI (0.45, 2.15), respectively.
CONCLUSIONS
Patients undergoing thyroidectomy experience possible mild weight gain, particularly younger individuals and those with hyperthyroidism as the indication for surgery. Prospective studies directed to assess the pathophysiology of weight gain post-thyroidectomy, and to test novel treatment modalities, are needed to better characterize post-thyroidectomy weight changes.
Topics: Adult; Body Weight; Female; Follow-Up Studies; Humans; Male; Middle Aged; Postoperative Complications; Risk Factors; Thyroidectomy; United States; Weight Gain
PubMed: 33106852
DOI: 10.1210/clinem/dgaa754 -
Frontiers in Endocrinology 2019The standard of care in management of hypothyroidism is treatment with levothyroxine (L-T4). Sometimes patients are dissatisfied with L-T4 and the combination of...
The standard of care in management of hypothyroidism is treatment with levothyroxine (L-T4). Sometimes patients are dissatisfied with L-T4 and the combination of levo-triiodothyronine (L-T3) with L-T4 is considered. We performed a systematic review and meta-analysis of blinded randomized controlled trials (RCTs), reporting how often hypothyroid patients prefer combination L-T3/L-T4 treatment to L-T4 alone. We also explored for explanatory factors for combination therapy preference in sensitivity analyses examining trial, patient, and disease characteristics. Potential dose-response relationships were explored using meta-regression analyses. We searched 9 electronic databases (from inception until February, 2019), supplemented with a hand-search. Two reviewers independently screened abstracts and citations and reviewed full-text papers, with consensus achieved on the included studies. Two reviewers independently critically appraised the quality of included studies and abstracted the data. Random effects meta-analyses were reported for the percentage of patients preferring combination L-T3/T-T4 therapy over L-T4 alone. A binomial distribution of choices (i.e., preference of combination therapy or no preference for combination therapy) was assumed. We included 7 blinded RCTs including 348 hypothyroid individuals in the primary meta-analysis. The pooled prevalence rate for preference of combination therapy over L-T4 was 46.2% (95% confidence interval 40.2%, 52.4%) ( = 0.231 for the difference from chance). There was no significant statistical heterogeneity among study results (Q = 7.32, degrees of freedom = 6, = 0.293, = 18.0%). In sensitivity analyses, combination treatment preference was explained in part by treatment effects on TSH concentration, mood and symptoms, but not quality of life nor body weight. In a secondary dose-response meta-regression analyses, a statistically significant association of treatment preference was identified for total daily L-T3 dose, but not L-T3:L-T4 dose ratio. In conclusion, in RCTs in which patients and investigators were blinded to treatment allocation, approximately half of participants reported preferring combination L-T3 and L-T4 therapy compared to L-T4 alone; this finding was not distinguishable from chance. An observed potential positive L-T3 dose effect on treatment preference deserves further study, with careful consideration of thyroid biochemical indices and patient reported outcomes.
PubMed: 31396154
DOI: 10.3389/fendo.2019.00477 -
Indian Journal of Endocrinology and... 2023The data on the characteristics of patients with idiopathic intracranial hypertension (IIH) following levothyroxine (LT4) replacement are limited. Here, we report a case... (Review)
Review
The data on the characteristics of patients with idiopathic intracranial hypertension (IIH) following levothyroxine (LT4) replacement are limited. Here, we report a case and systematically review published cases of idiopathic intracranial hypertension (IIH) following levothyroxine (LT4) replacement. The systematic review was performed as per the PRISMA guidelines. Our patient is a 46-year-old lady with hypothyroidism (thyrotropin: 319 mIU/L, free thyroxine: 0.04 ng/dl), treated with 100 μg.d of LT4 and presented a month later with headache, visual diminution, bilateral lateral rectus palsies, and papilledema. Cerebrospinal fluid (CSF) pressure was 32 cmH2O. Drainage of CSF, oral acetazolamide, and modification of LT4 dose resulted in prompt symptomatic improvement and complete reversal of IIH. In the systematic review (n = 21), the median age of patients (7 males) was 13 (IQR: 8.8- 26.5) years. The median duration of hypothyroid symptoms was 4 (n = 10, IQR: 0.44-6.25) years whereas that from initiation of LT4 replacement to the diagnosis of IIH was 2 (n = 20, IQR: 1.17-4) months. Initial median serum thyrotropin and thyroxine were 100 (n = 14, IQR: 72.5-421.6) mIU/L, and 1.13 (n = 12, IQR: 1.0-2.45) μg/dl which changed to 2.2 (n = 7; IQR: 0.23-3.40) mIU/L and 8.90 μg/dl (n = 8, IQR: 6.43-14.85 μg/dl), respectively at diagnosis of IIH after LT4 treatment with median daily LT4 doses of 0.89 (n = 8, IQR: 0.60 - 1.17) times the maximum recommended dose for age. To conclude, we report an adult woman with IIH following LT4 replacement for primary hypothyroidism, a rare entity. Pediatric age, prolonged symptom duration, and use of higher LT4 replacement dose may be associated with IIH following LT4 replacement.
PubMed: 37215264
DOI: 10.4103/ijem.ijem_439_22