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Obesity Pillars Sep 2024The obesity paradox in patients with coronary artery disease is well established, but the role of the metabolic syndrome associated with obesity is not well studied. Our...
In-hospital outcomes in metabolically healthy and unhealthy individuals over 65 years of age with obesity undergoing percutaneous intervention for acute coronary syndrome: A nationwide propensity-matched analysis (2016-2020).
BACKGROUND
The obesity paradox in patients with coronary artery disease is well established, but the role of the metabolic syndrome associated with obesity is not well studied. Our study aims to evaluate the in-hospital outcomes of percutaneous coronary intervention (PCI) in metabolically healthy individuals with obesity (MHO) and metabolically unhealthy (MUHO) individuals with obesity over 65 years of age with acute coronary syndrome (ACS) between 2016 and 2020.
METHODS
This was a retrospective and observational study. Patients were identified through utilizing the National Inpatient Sample (NIS) Database (2016-2020) and ICD-10 codes. By employing a -test and Pearson's Chi-square test, we assessed and contrasted the initial attributes, concurrent conditions, and results pertaining to all-cause mortality (ACM), cardiogenic shock (CS), length of stay (LOS), and hospitalization expense. Moreover, propensity score matching was conducted in a 1:1 ratio with respect to age, gender, and race. We also utilized multivariable logistic regression to compare MHO and MUHO in terms of the impact on all-cause mortality.
RESULTS
Out of a total of 135,395 patients identified, 2995 patients with MUHO were matched with 2995 MHO patients. Patients in the MUHO group had a higher prevalence of chronic pulmonary disease (24.9 % vs. 19.5 %), peripheral vascular disease (9.3 % vs. 6.7 %), hypothyroidism (16 % vs. 11.5 %), prior myocardial infarction (15.9 % vs. 6.2 %), and prior stroke (7.5 % vs. 2.8 %). Patients in the MHO group had a higher ACM (12.4 % vs. 2.8 %, p < 0.001), CS (18.55 % vs. 7 %, p < 0.001), stroke (2.2 % vs. 1 %, p < 0.001), ventricular assist device insertions (5.2 % vs. 2.7 %, p < 0.001), and IABP insertions (8.8 % vs. 3.8 %) compared to the MUHO cohort.
CONCLUSION
Our study revealed an obesity paradox in individuals over 65 years of age undergoing PCI demonstrating worse outcomes, including higher in-hospital mortality, CS, stroke, Ventricular assist device and IABP insertion in MHO patients compared to the MUHO cohort.
PubMed: 38846675
DOI: 10.1016/j.obpill.2024.100114 -
Cureus May 2024The leading cause of isolated thrombocytopenia in asymptomatic individuals is immune thrombocytopenia (ITP). It is an autoimmune disease characterized by decreased...
The leading cause of isolated thrombocytopenia in asymptomatic individuals is immune thrombocytopenia (ITP). It is an autoimmune disease characterized by decreased platelet counts caused by the immune system's destruction of platelets. Sometimes, autoimmune thyroid diseases and ITP can coexist, which could cause an aggravated immune system response. When thyroid autoimmune diseases are present, treating ITP may become challenging. Treatment of the underlying thyroid disease in such individuals results in a significant improvement in platelet count, along with remission of the disease. It enhances the response to traditional ITP therapy. In this case report, we present a case of a 40-year-old female who was treated for ITP along with hypothyroidism, resulting in a considerable improvement in platelet count and a remission of the condition.
PubMed: 38846217
DOI: 10.7759/cureus.59813 -
Therapeutic Advances in Medical Oncology 2024Perioperative use of immune checkpoint blockade (ICB) improves survival in patients with early-stage cancer. Treatment-related adverse events (AEs), frequently involve...
BACKGROUND
Perioperative use of immune checkpoint blockade (ICB) improves survival in patients with early-stage cancer. Treatment-related adverse events (AEs), frequently involve the endocrine system which may increase perioperative complications and affect quality of life.
OBJECTIVE
We conducted a meta-analysis to elucidate the impact of adding ICB to conventional neoadjuvant/adjuvant therapy on the incidence of endocrine AEs.
DESIGN
A systematic review and meta-analysis of randomize-controlled trials (RCTs).
DATA SOURCES AND METHODS
A systematic search of PubMed, Embase, Web of Science, and Cochrane library was performed for RCTs comparing groups with and without the addition of ICB to conventional perioperative therapy in patients with cancer. Outcomes included all-grade and grade 3-5 thyroiditis, hyperthyroidism, hypothyroidism, adrenal insufficiency, hypophysitis, type 1 diabetes mellitus, and hyperglycemia. The odds ratios (ORs) of all-grade and grade 3-5 endocrine were pooled using the random-effect model meta-analysis.
RESULTS
Twenty-four RCTs comprising 12,199 patients were identified for meta-analysis. The addition of ICB was associated with higher incidence of thyroiditis [all grade: OR = 3.53 (95% confidence interval (CI): 1.88-6.64)], hyperthyroidism [all-grade: 7.18 (4.30-12.01); grade 3-5: 3.93 (1.21-12.82)], hypothyroidism [all-grade: 5.39 (3.68-7.90); grade 3-5: 3.63 (1.18-11.11)], adrenal insufficiency [all-grade: 3.82 (1.88-7.79); grade 3-5: 5.91 (2.36-14.82)], hypophysitis [all-grade: 10.29 (4.97-21.3); grade 3-5: 5.80 (1.99-16.92)], and type 1 diabetes mellitus [all-grade: 2.24 (1.06-4.74); grade 3-5: 3.49 (1.21-10.08)]. The cumulative incidence of each grade 3-5 endocrine AE was low (<1.3%). No grade 5 AEs leading to death were observed.
CONCLUSION
The addition of neoadjuvant/adjuvant ICB to conventional therapy was associated with an increased incidence of several endocrine AEs. Clinicians should be aware of the risk of endocrinopathy from the perioperative ICB use to facilitate risk-benefit discussion with patients with early-stage cancer.
TRIAL REGISTRATION
The protocol of this research was registered in PROSPERO (CRD42022332624).
PubMed: 38845790
DOI: 10.1177/17588359241257874 -
Brain and Behavior Jun 2024This study aimed to investigate sex differences in risk factors for suicide attempts in first-episode and drug naive (FEDN) major depressive disorder (MDD) with comorbid...
Sex differences in correlates of suicide attempts in Chinese Han first-episode and drug-naïve major depressive disorder with comorbid subclinical hypothyroidism: A cross-sectional study.
BACKGROUND
This study aimed to investigate sex differences in risk factors for suicide attempts in first-episode and drug naive (FEDN) major depressive disorder (MDD) with comorbid subclinical hypothyroidism (SCH).
METHODS
A total of 1034 FEDN MDD patients with comorbid SCH were enrolled. The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and Positive and Negative Syndrome Scale (PANSS) positive subscale were used to assess patients' symptoms. Thyroid hormone levels and metabolic parameters were measured.
RESULTS
MDD patients with SCH had a significantly higher risk of suicide attempts than those without SCH (25.4% vs. 12.2%). Logistic regression showed that HAMA score, thyroid stimulating hormone (TSH) levels, and thyroid peroxidase antibody (TPOAb) levels were significantly associated with an increased risk for suicide attempts in both male and female MDD patients comorbid SCH, while low-density lipoprotein cholesterol (LDL-C) was significantly associated with an increased risk for suicide attempts only in male patients, HAMD score and systolic blood pressure were significantly associated with an increased risk for suicide attempts only in female patients.
CONCLUSION
SCH comorbidities may increase suicide attempts in MDD patients. Our results showed significant sex differences in clinical and metabolic factors associated with suicide attempts among FEDN MDD patients with comorbid SCH, highlighting appropriate sex-based preventive interventions are needed.
Topics: Humans; Male; Female; Depressive Disorder, Major; Adult; Cross-Sectional Studies; Hypothyroidism; Suicide, Attempted; Comorbidity; China; Middle Aged; Risk Factors; Sex Characteristics; Sex Factors; Young Adult; Thyrotropin; East Asian People
PubMed: 38844426
DOI: 10.1002/brb3.3578 -
Cureus May 2024We report the case of a 64-year-old female with a history of hypothyroidism and isolated parotid sarcoidosis who presented with acute-onset chest pain and dyspnea....
We report the case of a 64-year-old female with a history of hypothyroidism and isolated parotid sarcoidosis who presented with acute-onset chest pain and dyspnea. Echocardiogram demonstrated transiently reduced ejection fraction with apical hypokinesis, without evidence of obstructive coronary lesions on angiography, compatible with stress-induced cardiomyopathy. She received a ketamine infusion as a mental health treatment shortly before the development of symptoms, suggesting that this medication may have precipitated her cardiomyopathy. In recent years, ketamine has become a popular option for treating mental health disorders, including major depressive disorder and substance use disorders. It should be used with caution in patients with known cardiovascular disease, and its cardiac effects warrant further study.
PubMed: 38840998
DOI: 10.7759/cureus.59709 -
Frontiers in Pediatrics 2024Congenital hypothyroidism (CH) is the most common cause of endocrinopathy in the newborn Its incidence lies between 1 in 3,000 and 1 in 2,000, However, congenital goiter...
Congenital hypothyroidism (CH) is the most common cause of endocrinopathy in the newborn Its incidence lies between 1 in 3,000 and 1 in 2,000, However, congenital goiter is a rare form of presentation. Hypothyroidism secondary to autoimmune etiology is extremely rare, with an incidence of 1:84.700-1:31.000 newborns. Anti-thyroid peroxidase antibodies (TPOAb) are able to cross the placenta but rarely induce hypothyroidism in the newborn, much less goiter. A case of congenital goiter in a male newborn secondary to maternal high TPOAb levels is reported. The mother was diagnosed of Hashimoto thyroiditis prior to the pregnancy. At birth, a grade 3 goiter was detected in the newborn. Laboratory testings revealed hypothyroidism with free thyroxine of 7.6 pmol/L, thyroid-stimulating hormone of 108 mUI/L and high TPOAb levels. Treatment with Levothyroxine was started the second day of life with progressive thyroid function normalization. Neurological development has been normal until the date.
PubMed: 38840805
DOI: 10.3389/fped.2024.1348431 -
Frontiers in Nutrition 2024Specific nutrients found in food, such as minerals, antioxidants, and macronutrients, have a significant impact on immune function and human health. However, there is...
PURPOSE
Specific nutrients found in food, such as minerals, antioxidants, and macronutrients, have a significant impact on immune function and human health. However, there is currently limited research exploring the relationship between specific nutrients, immune system function, and thyroid dysfunction commonly observed in autoimmune thyroid diseases, which manifest predominantly as hyperthyroidism or hypothyroidism. Therefore, the objective of this study was to investigate the connections between dietary traits and thyroid dysfunction, as well as the potential mediating role of immune cells, using Mendelian randomization (MR) analysis.
METHODS
The two-step MR analysis used single-nucleotide polymorphisms as instruments, with a threshold of < 5e-08 for nutrients and thyroid dysfunction, and < 5e-06 for immune cells. Data from different GWAS databases and UK Biobank were combined to analyze 8 antioxidants and 7 minerals, while the data for 4 macronutrients came from a cohort of 235,000 individuals of European. The outcome data (hypothyroidism, = 3340; hyperthyroidism, = 1840; free thyroxin [FT4], = 49,269; thyroid-stimulating hormone [TSH], = 54,288) were source from the ThyroidOmics consortium. Immune trait data, including 731 immune phenotypes, were collected from the GWAS catalog.
RESULTS
The results revealed that nutrient changes, such as lycopene, toenail and blood selenium, and α-tocopherol, impacted the immune system. Immune cells also affected thyroid function, with cDC cells promoting hypothyroidism and median fluorescence intensity (MFI) phenotypes correlating strongly with FT4 levels. Toenail and blood selenium reduce the relative cell counts (RCC) phenotypes of immune cells (CD62L- plasmacytoid DC %DC and transitional B cells %Lymphocyte), thereby diminishing its promoting effect on hypothyroidis. Furthermore, toenail and blood selenium mainly impacted phenotypes in three types of T cells (CD25 + + CD8br, CD3 on CD45RA- CD4+, and CD45RA on Terminally Differentiated CD8br), reinforcing the negative regulation of FT4 levels.
CONCLUSION
The role of immune cells as mediators in the relationship between nutrients and thyroid dysfunction highlights their potential as diagnostic or therapeutic markers. Toenail and blood selenium levels can indirectly impact hypothyroidism by influencing the RCC levels of two types of immune cells, and can indirectly affect FT4 levels by influencing three types of T cells.
PubMed: 38840695
DOI: 10.3389/fnut.2024.1378969 -
Translational Pediatrics May 2024Alport syndrome (AS) is a rare progressive hereditary kidney disease that is clinically principally associated with hematuria, proteinuria, and progressive renal...
BACKGROUND
Alport syndrome (AS) is a rare progressive hereditary kidney disease that is clinically principally associated with hematuria, proteinuria, and progressive renal dysfunction. This condition not only impairs renal function but also potentially affects auditory and ocular health, significantly impacting the patient's quality of life.
CASE DESCRIPTION
This article reports a young girl with AS, combined with dwarfism attributable to growth hormone (GH) deficiency, diagnosed at Wenzhou People's Hospital in 2019. The clinical data and diagnostic steps were retrospectively analyzed. Genetic testing showed that she carried a new mutation in the gene, c.2317_2318delAG (p.R773Gfs*14), classified as "pathogenic" under the criteria of the American College of Medical Genetics and Genomics (ACMG), confirming her AS diagnosis. Significantly, the patient's height was more than two standard deviations (SDs) below the average for children of her race, sex, and age. The peak GH level post-stimulation was below 5 ng/mL, coupled with a growth rate of less than 5 cm/year, leading to the diagnosis of GH deficiency. Consequently, recombinant human GH (rhGH) therapy was initiated.
CONCLUSIONS
After a year of rhGH treatment, we observed a notable increase in her height, without any adverse effects like elevated intracranial pressure, hypothyroidism, or worsening kidney function.
PubMed: 38840691
DOI: 10.21037/tp-23-569 -
BMC Endocrine Disorders Jun 2024Thyroid disorders have been reported in hypercortisolism patients. Endogenous Cushing's syndrome (CS) potentially complicates its metabolic sequelae. We investigated... (Meta-Analysis)
Meta-Analysis
PURPOSE
Thyroid disorders have been reported in hypercortisolism patients. Endogenous Cushing's syndrome (CS) potentially complicates its metabolic sequelae. We investigated thyroid function in CS patients to determine this relationship.
METHODS
In this cross-sectional study, we screened CS patients from 2016 to 2019 at our hospital. Patient demographic, medical history, and laboratory data were collected. Additionally, we performed a meta-analysis to demonstrate the prevalence of thyroid dysfunction in patients with CS.
RESULTS
Among 129 CS patients, 48.6% had triiodothyronine (TT3), 27.9% had thyroxine (TT4), 24.6% had free T3 (FT3), 27.7% had free T4 (FT4), and 6.2% had thyroid-stimulating hormone (TSH) levels below the reference values. Those with clinical CS showed more pronounced thyroid suppression than did those with subclinical CS. Cortisol levels were markedly greater in patients with pituitary hypothyroidism (P < 0.001). Serum cortisol levels throughout the day and post low-dose dexamethasone-suppression test (LDDST) results correlated with thyroid hormone levels, particularly in ACTH-independent CS. Correlations varied by thyroid status; FT3 and TSH were linked to cortisol in euthyroid individuals but not in those with low T3 or central hypothyroidism. TSH levels notably halved from the lowest to highest cortisol tertile post-LDDST. Finally, meta-analysis showed 22.7% (95% CI 12.6%-32.9%) central hypothyroidism in 528 CS patients of nine studies.
CONCLUSION
Thyroid hormone levels are significantly correlated with cortisol levels and are impaired in patients with CS. However, the physiological adaptation and pathological conditions need further study.
Topics: Humans; Cushing Syndrome; Cross-Sectional Studies; Male; Female; Thyroid Function Tests; Adult; Middle Aged; Thyroid Gland; Thyroid Diseases; Thyrotropin; Hydrocortisone; Thyroid Hormones; Thyroxine; Prognosis
PubMed: 38840128
DOI: 10.1186/s12902-024-01614-4