Association of thyroid function with arterial pressure in normotensive and hypertensive euthyroid individuals: A cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Overt hypothyroidism has been associated with arterial hypertension and increased arterial stiffness. Results in euthyroid individuals have been conflicting. We investigated associations of thyroid function with systolic (SAP) and diastolic (DAP) arterial pressure in euthyroid subjects.</p> <p>Methods</p> <p>311 euthyroid individuals (185 women, mean age 43.9 ± 9) without a history of diabetes attending a preventive medicine program were examined. Subjects receiving thyroxine (10.6%) were excluded; 19.3% had hypertension, 43% had a family history for hypertension. TSH, fT4, thyroid autoantibodies, insulin, glucose were measured. The "fT4.TSH product", which has been suggested as a T4 resistance-index, was calculated.</p> <p>Results</p> <p>TSH range was 0.1–8, median 1.4 mU/L, fT4 range was 11.5–25.2 pmol/L, median 17.4. TSH and the "fT4.TSH product" were positively associated with DAP (p < 0.03, for both associations). In the subgroup of individuals with TSH levels 0.36–2.5 mU/L, both TSH and the "fT4.TSH product" were positively correlated with SAP (r = +0.133 p = 0.044, r = +0.152 p = 0.026) and DAP (r = +0.243 p < 0.001, r = +0.252 p < 0.001 respectively); in multivariate analysis the "fT4.TSH product" was a significant predictor of DAP independently of HOMA-IR and BMI (p < 0.001). Similar associations were found when only the non-hypertensive subjects were analysed (p = 0.004). Hypertensive patients had higher TSH levels (p = 0.02) and belonged more frequently to the subgroup with TSH > 2 mU/L (35.3% vs 21.3%, p = 0.045).</p> <p>Conclusion</p> <p>In euthyroid individuals the association of thyroid function with diastolic arterial pressure remains significant even when a stricter "normal range" for TSH levels is considered. The "freeT4.TSH" product appears to be an even stronger predictor of DAP, independently of HOMA insulin resistance index and obesity.</p

Effects of Recombinant Human Thyrotropin Administration on 24-Hour Arterial Pressure in Female Undergoing Evaluation for Differentiated Thyroid Cancer

Objective. Thyroid-stimulating-hormone (TSH) receptors are expressed in endothelial cells. We investigated whether elevated TSH levels after acute recombinant TSH (rhTSH) administration may result in alterations in blood pressure (BP) in premenopausal women with well-differentiated thyroid carcinoma (DTC). Designs. Thirty euthyroid DTC female patients were evaluated by rhTSH stimulation test (mean age 40.4 ± 8.6 years). A 24 h ambulatory systolic and diastolic blood pressure (SBP, DBP) monitoring (24 hr ABPM) was performed on days 2-3(D2-3). TSH was measured on day 1(D1), day 3(D3), and day 5(D5). Central blood pressure was evaluated on D3. Twenty-three patients were studied 1-4 weeks earlier (basal measurements). Results. TSH levels were D1: median 0.2 mU/L, D3: median 115.0 mU/L, and D5: median 14.6 mU/L. There were no significant associations between TSH on D1 and D3 and any BP measurements. Median D5 office-SBP and 24 h SBP, DBP, and central SBP were correlated with D5-TSH ( &lt; 0.04). In those where a basal 24 h ABPM had been performed median pulse pressure was higher after rhTSH-test ( = 0.02). Conclusions. TSH, when acutely elevated, may slightly increase SBP, DBP, and central SBP. This agrees with previous reports showing positive associations of BP with TSH

The effect of obesity and dietary habits on oxidative stress in Hashimoto’s thyroiditis

Objective: Increased oxidative stress has been described in patients with Hashimoto’s thyroiditis (HT). The aim of the present study was to investigate whether high oxidative stress is further influenced by obesity and dietary habits in euthyroid women with HT. Methods: Two hundred eighteen consecutive euthyroid women with HT were studied and separated in two groups; 102 with thyroxine replacement and 114 without. For the evaluation of oxidative stress, total lipid peroxide levels in serum (TOS) were measured and recoded as ‘high TOS’ vs ‘medium/low TOS’. The type of food and consumption frequency were recorded. Two binary variables were considered; normal vs low fruit consumption and daily vs sporadic vegetable consumption. Results: ‘High TOS’ was more frequent in women under thyroxine replacement (31.4% vs 14.7%, OR = 2.7, 95% CI: 1.4–5.2). The prevalence of ‘high TOS’ was higher among overweight/obese women compared to women with normal BMI (30.4% vs 12.5%, OR = 3.1, 95% CI: 1.5–6.4). Low fruit consumption was associated with increased ‘high TOS’ prevalence (30.6% vs 12.9%, OR = 3.0, 95% CI: 1.4–6.2). Sporadic vegetable consumption was associated with increased ‘high TOS’ prevalence compared to daily consumption (29.9% vs 13.5%, OR = 2.7, 95% CI: 1.3–5.7). The examined risk factors were independent and additive in their effect on TOS. At least three risk factors had to be concomitantly present for the likelihood of ‘high TOS’ to be significantly elevated. Conclusions: Oxidative stress is increased in women with HT under thyroxine replacement. Nevertheless, normal BMI, daily fruit and vegetable consumption, all contribute in maintaining oxidative stress at low levels

Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study

Background Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours.Methods In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186.Findings Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78 center dot 6%] female patients and 4922 [21 center dot 4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1 center dot 4 [IQR 0 center dot 6-3 center dot 4]) compared with the prepandemic phase (2 center dot 0 [0 center dot 9-3 center dot 7]; p&lt;0 center dot 0001) and pandemic decrease phase (2 center dot 3 [1 center dot 0-5 center dot 0]; p&lt;0 center dot 0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69 center dot 0%] of 3704 vs 1515 [71 center dot 5%] of 2119; OR 1 center dot 1 [95% CI 1 center dot 0-1 center dot 3]; p=0 center dot 042), lymph node metastases (343 [9 center dot 3%] vs 264 [12 center dot 5%]; OR 1 center dot 4 [1 center dot 2-1 center dot 7]; p=0 center dot 0001), and tumours at high risk of structural disease recurrence (203 [5 center dot 7%] of 3584 vs 155 [7 center dot 7%] of 2006; OR 1 center dot 4 [1 center dot 1-1 center dot 7]; p=0 center dot 0039).Interpretation Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation.Funding None.Copyright (c) 2023 Published by Elsevier Ltd. All rights reserved

Coronary artery disease in postmenopausal women - the role of endogenous sex hormones and their receptors

Objectives: Long term estrogen action appears to be protective, while androgen may be detrimental for vascular health in women. The sensitivity to sex hormones is influenced by variants in estrogen and androgen receptor genes (ERα, ERβ, AR). The aim of this study was to investigate the role of the sex hormones and of common ERα, ERβ and AR gene polymorphisms in the severity of CAD in postmenopausal women. Methods: We studied 174 postmenopausal women undergoing coronary angiography (age 45-88 yrs). The severity of CAD was assessed by the number of arteries with >50% stenosis, as well as with the presence of angina and myocardial infarctions (MI). ERα polymorphisms PvuII, XbaI and ERβ polymorphisms AluΙ and RsaΙ were investigated. The length of (CAG)n repeats of the AR was genotyped. Reproductive parameters, predisposing risk factors for CAD were recorded; biochemical and hormonal parameters were measured. Results: 75 women had 0, 39 had one, 37 had two and 23 had three vessels with severe stenosis. The time since menopause was significantly longer in women with angina and MIs compared to those without (20.3±8.7 vs 15.8±8.7yrs, 22.6±8.6, vs 18.1±8.9yrs respectively, p50% στένωση), το ιστορικό ΣΝ, το γυναικολογικό ιστορικό και ελέγχθηκαν ορμονικές και βιοχημικές παράμετροι. Μελετήθηκαν οι πολυμορφισμοί του ERα PvuII (c.454-397T>C) και XbaI (c.454-351A>G), του ERβ AluI (1730G>A) και RsaI (1082G>A) καθώς και οι πολυμορφισμοί του ΑR που προκύπτουν από το μήκος (CAG)n των επαναλαμβανόμενων αλληλουχιών (ΕΑ) του γονιδίου του AR. Αποτελέσματα: 75 γυναίκες είχαν 0, 39 είχαν 1, 37 είχαν 2 και 23 είχαν 3 αγγεία με σοβαρή στένωση στην αγγειογραφία. Η χρονική απόσταση από την εμμηνόπαυση ήταν σημαντικά μεγαλύτερη και ανεξάρτητη της χρονολογικής ηλικίας στις γυναίκες με ιστορικό στηθάγχης ή ΟΕΜ (p19 ΕΑ (18.2 και 1.45% αντίστοιχα, p=0.019). Τα επίπεδα ολικής χοληστερόλης και LDL παρουσίαζαν αρνητική συσχέτιση με τον αριθμό (CAG)n ΕΑ (p<0.04). Τα μέσα επίπεδα της SHBG ήταν χαμηλότερα στις γυναίκες που έφεραν βραχύτερα αλλήλια (p=0.03). Συμπεράσματα: Στην ομάδα των μετεμμηνοπαυσιακών γυναικών που μελετήσαμε, η βαρύτητα της ΣΝ, σχετίζεται με μειωμένη έκθεση σε ενδογενή οιστρογόνα κατά τη διάρκεια της ζωής τους. Συχνοί πολυμορφισμοί των οιστρογονικών υποδοχέων (ERα και ERβ) και του AR, οι οποίοι ενδεχομένως τροποποιούν δια βίου την ευαισθησία των ιστών στις ορμόνες του φύλου επηρεάζουν τη βαρύτητα της ΣΝ ή/και παράγοντες κινδύνου για ΣΝ και μπορεί ενδεχομένως να χρησιμοποιηθούν ως προγνωστικοί δείκτες για την εξέλιξη της ΣΝ