International Journal of Endocrinology and Metabolism最新文献

Objectives: This systematic review sought to address three key questions: (1) what differences in abnormal thyroid function test results are observed between COVID-19 patients and healthy individuals? (2) How does the severity of COVID-19 infection influence the development of thyroid dysfunction? (3) What impact do COVID-19 vaccines have on thyroid function and autoimmune processes?

Methods: A literature search was conducted in PubMed, Web of Science, and Scopus from December 2019 to April 2023 to identify studies on thyroid dysfunction in COVID-19 patients without pre-existing thyroid conditions. The search focused on observational and case-control studies.

Results: The literature search yielded 329 reports, from which duplicates and unrelated publications were excluded. Ultimately, 21 studies met the inclusion criteria and were selected for review. A second literature search yielded 605 reports, from which 5 studies were selected for inclusion in the systematic review.

Conclusions: The findings suggest that SARS-CoV-2 infection can induce transient and reversible thyroid dysfunction, possibly through direct viral effects on the thyroid gland or via indirect immune-mediated mechanisms. Clinicians should be mindful of the potential, albeit rare, thyroid-related adverse effects of COVID-19 vaccines and monitor thyroid function, particularly in high-risk individuals.

Context: Metabolic disorders are a growing global concern, especially in developed countries, due to their increasing prevalence. Serum lipid profiles, including triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), and low-density lipoprotein (LDL), are commonly used clinical biomarkers for monitoring the progression of these metabolic abnormalities. In recent decades, hydrogen-rich water (HRW) has gained attention as a safe and effective treatment, with regulatory effects on lipid peroxidation and inflammatory responses in clinical trials.

Objectives: This systematic review and meta-analysis aim to evaluate the effectiveness of HRW therapy on blood lipid profiles in randomized controlled trials (RCTs) for metabolic disorders.

Methods: Following the PRISMA guidelines, a search for RCT studies was conducted in the PubMed, Web of Science, Embase, and Google Scholar databases up to January 2024. Eight studies that met all eligibility criteria, including RCTs involving metabolic dysfunctions and evaluations of lipid profiles, were included for further analysis. Data extraction was followed by quality evaluation using the Jadad scoring system. Meta-analysis was conducted using STATA software.

Results: The eight selected RCTs included a total of 357 patients with various metabolic disorders. All studies showed either no or low risk of bias. The overall levels of TG [95% CI: -0.27 (-0.47, -0.07)], TC [95% CI: -0.07 (-0.32, -0.18)], and LDL [95% CI: -0.06 (-0.28, 0.15)] demonstrated slight decreases across the studies. However, there was some heterogeneity in HDL levels [95% CI: -0.11 (-0.37, 0.14)] among the studies (I² = 37.32%). Meta-regression analysis further indicated a positive association between the outcomes and the duration of the intervention as a moderating factor.

Conclusions: Hydrogen-rich water demonstrated modest lipid-lowering effects in patients with metabolic disorders. However, due to the observed heterogeneity in HDL variations, further long-term trials involving larger populations are needed to clarify these inconsistencies.

Background: Due to autoimmune mechanisms, celiac disease (CD) may affect patients with type 1 diabetes mellitus (T1DM) more than the general population.

Objectives: We evaluated the effect of a gluten-free diet (GFD) on HbA1c levels in patients with both type 1 diabetes and CD.

Methods: In this cross-sectional study, biochemical and clinical information was gathered from 174 children with T1DM from January 2013 to January 2019.

Results: We assessed 174 children with T1DM (93 girls and 81 boys). Celiac disease was diagnosed in 18 out of 174 cases (10.34%). Height and weight percentiles showed significant differences between children with CD and those without CD (P = 0.015 and P = 0.026, respectively). The average HbA1c in the celiac group was 8.61 ± 2.20 (95% CI: 5.1 - 12.1) prior to GFD therapy. HbA1c was assessed six and twelve months following the initiation of the GFD and was found to be 8.32 ± 1.46 (95% CI: 6 - 9.8) and 8.37 ± 1.67 (95% CI: 6.1 - 10.2), respectively. No significant change in HbA1c was observed before and after therapy (P = 0.501).

Conclusions: Diabetic children with CD exhibit lower weight and height compared to those without CD. Gluten-free diet therapy in patients with CD did not affect HbA1c levels.

Background: Congenital hypothyroidism is the most common preventable and treatable cause of intellectual disability in children. A key component of the surveillance system for congenital hypothyroidism is ensuring a regular treatment program for affected children. Despite nearly 20 years since the successful implementation of the newborn screening program for hypothyroidism in Iran, a comprehensive evaluation of patients' adherence to treatment has not been conducted.

Objectives: The aim of this study was to investigate the adherence to treatment among patients with congenital hypothyroidism in Iran.

Methods: In this national cross-sectional study conducted in 2024, the adherence to treatment of 400 children with congenital hypothyroidism born between 2019 and 2023 in Iran was examined using the Morisky Medication Adherence Scale. The patients were randomly selected from national registry data. Data were analyzed using chi-squared tests, Fisher's exact test, and logistic regression in Stata software version 16.

Results: The mean and standard deviation of medication adherence was 6.35 ± 1.41. Overall, adherence was good (≥ 6) in 284 (71.0%) of the study participants. In the univariate analysis, the most significant factors influencing adherence were place of residence, higher maternal education, lower paternal education, and type of congenital hypothyroidism (CH). In the multivariate analysis, children with permanent CH had good adherence, and parental education was not statistically significant (P > 0.05).

Conclusions: The results of this study showed that medication compliance in more than two-thirds of hypothyroid children diagnosed by national newborn screening is good. Given the importance of treatment in these patients, it is recommended that intervention plans be implemented, including educational programs and active follow-up of patients to increase compliance.

Background: The involvement of essential trace elements in the pathogenesis of Hashimoto's thyroiditis (HT) has been suggested, although the available evidence is limited.

Objectives: The aim of this study was to investigate the interplay between serum selenium (Se), iron (Fe), zinc (Zn), and copper (Cu) status with thyroid auto-antibodies and thyroid echogenicity in women with newly diagnosed HT.

Methods: A cohort of newly diagnosed female HTs (n = 56) and matched controls (n = 64) were recruited. Serum Se, Fe, Zn, and Cu were measured by furnace graphite atomic absorption spectrometry (FGAAS). Thyroid hormone profiles and thyroid autoantibodies were assessed via ELISA.

Results: In HTs, mean serum Se, Fe, and Zn were significantly lower, while serum Cu was higher in HTs compared to controls (64.11 ± 20.75 vs. 92.3 ± 29.36 μg/L, 53.67 ± 14.09 vs. 70.38 ± 18.44 μg/dL, 64.38 ± 18.88 vs. 90.89 ± 29.99 μg/dL, and 101.18 ± 33.40 vs. 82.2 ± 26.82 μg/dL; all P < 0.001). Pearson correlation analysis revealed a significant inverse correlation between serum Se, Zn, and Cu with thyroid peroxidase antibody (TPO-Ab) and thyroglobulin antibody (Tg-Ab) levels (P < 0.001). While no significant correlation was observed between thyroid antibodies and serum Fe levels, logistic regression revealed associations between thyroid antibodies and serum Fe. Upon dividing serum Se and Zn into quartiles, there was a significant alteration in the levels of TPO-Ab and Tg-Ab, with a reduction in the levels of antibodies observed from the first quartile to the fourth quartile.

Conclusions: We conclude that Se, Fe, and Zn deficiency, coupled with increased Cu levels, are associated with elevated thyroid antibodies in the setting of Hashimoto Thyroiditis.

Background: Zinc and vitamin E affect the metabolism of testosterone and inflammatory factors. We aimed to evaluate the effect of zinc and vitamin E supplementation on plasma testosterone levels and inflammatory markers in patients undergoing coronary artery bypass graft (CABG) surgery.

Methods: This study was a secondary analysis of a previously published randomized controlled trial in a subsample of male patients undergoing CABG surgery. Patients in the zinc-vitamin E group (n = 27) received oral zinc (120 mg) and vitamin E (1200 international units) one day prior to surgery, followed by 30 mg of zinc and 200 units of vitamin E per day for three weeks after surgery. Patients in the control group (n = 25) received a placebo. Plasma levels of total testosterone, cortisol, interleukin-6 (IL-6), and white blood cell toll-like receptor-4 (TLR-4) gene expression were determined at three-day and three-week intervals following surgery. Changes in these markers were analyzed using a repeated-measures analysis of variance.

Results: A comparison of the groups revealed no significant difference in the concentration of plasma total testosterone levels (P = 0.059) or cortisol. Three weeks following the surgical procedure, a positive correlation was observed between the change in plasma zinc concentrations and the change in plasma testosterone levels (r = 0.32; P = 0.025). The administration of zinc and vitamin E supplements resulted in a reduction in plasma IL-6 levels on postoperative day 3 (P = 0.025), while no significant effect was observed in week 3 (P = 0.091). The expression of the TLR-4 gene in WBCs was found to be lower in the zinc-vitamin E group compared to the placebo group on day 3 (P = 0.051) and week 3 (P = 0.025).

Conclusions: The administration of zinc and vitamin E to patients undergoing CABG was associated with a relative improvement in postoperative inflammatory markers. Plasma zinc levels demonstrated a correlation with testosterone levels, suggesting a potential avenue for further research in these patients.

Background: Insulin resistance is a critical first step in the development of many chronic diseases such as diabetes, hypertension, and coronary artery disease (CAD). Early recognition of changes in insulin sensitivity and subsequent glycolipid dysregulation is paramount in reversing the progression of these diseases. Since the prevalence of insulin resistance is relatively high, there is a demand for a simple, easy, and inexpensive method for its detection.

Objectives: To assess the association of metabolic score for insulin resistance (METS-IR) with prehypertension (preHTN) in normoglycemic individuals.

Methods: A cross-sectional study included two groups with normal blood glucose levels (age and sex matched, 179 adults each) with and without preHTN. Those with a history of hypertension, diabetes, CAD, or on chronic drug treatment were excluded from the study. Metabolic score for insulin resistance was calculated as Ln [(2 × FPG (mg/dL) + fasting TG (mg/dL)] × BMI (kg/m²)/Ln [HDL-c (mg/dL)].

Results: The METS-IR score was significantly higher in those with preHTN (P < 0.001). One-way ANOVA showed significant differences in BMI, TG, and HDL-c according to METS-IR quartiles. Cox regression analysis showed that METS-IR is a single independent predictor of preHTN (OR = 1.3, 95% CI 1.20, 1.34).

Conclusions: Metabolic score for insulin resistance is significantly associated with and an independent predictor of prehypertension in euglycemic people.

Context: In recent decades, adverse reactions to gluten have increased, collectively known as gluten-related disorders (GRDs). The most prominent GRD is celiac disease (CD), a T-cell-mediated autoimmune-like disorder of the small intestine triggered by the ingestion of gluten proteins in genetically predisposed individuals. Celiac disease is often associated with various autoimmune and idiopathic conditions, including autoimmune thyroid disorders (AITDs). Autoimmune thyroid disorders result from immune system dysregulation and lead to an assault on the thyroid gland. This study aims to examine the potential effect of gluten consumption on the development of AITDs.

Evidence acquisition: A narrative literature review was conducted using the Google Scholar, Scopus, and PubMed electronic databases to identify studies investigating the role of gluten in the development of AITDs. Keywords such as "Gluten," "Autoimmune thyroid disease," and "Gluten-free diet" were used.

Results: The involvement of gluten in the pathogenesis of autoimmune diseases is mediated through various mechanisms. Gluten may contribute to the expansion and progression of AITDs through mechanisms such as dysbiosis, leaky gut, and cross-reactivity. There is evidence that adherence to a gluten-free diet (GFD) may positively impact patients with AITDs, supporting the importance of personalized dietary strategies to mitigate risks associated with gluten intake.

Conclusions: The findings suggest that dietary management, particularly strict adherence to a GFD, may be beneficial for individuals with both CD and AITDs. Emerging evidence highlights the importance of personalized dietary strategies to mitigate the risks associated with gluten intake. A deeper understanding of the gut-thyroid axis could lead to the development of innovative approaches in the management of autoimmune disorders.

Background: Considering the high prevalence of benign thyroid disorders, the availability of an instrument measuring health-related quality of life (HRQoL) in this population is very important.

Objectives: The current study aims to translate and validate the Persian version of the ThyPRO-39.

Methods: In accordance with standard methodology, a double forward, reconciliation, and backward translation of the questionnaire was conducted. A field consultant identified discrepancies between the original questionnaire and the back translation. Discrepancies were addressed, revised, and retested before submitting it for developer review. Finally, five cognitive interviews were conducted among patients with benign thyroid problems to ensure alignment between their understanding of the Persian items and their original English counterparts.

Results: Translation and linguistic validations of the Persian version of the ThyPRO-39 Questionnaire were developed according to the established rules. Two translators did the forward translation with no significant disagreement. Considering backward translation, the field consultant changed eight items, and the developer provided seven additional comments. After interviewing five patients, nine revisions were performed by the field consultant. Finally, an external consultant reviewed all changes and approved the questionnaire.

Conclusions: We translated and linguistically validated the Persian version of the ThyPRO-39. Now, the ThyPRO-IR is ready for assessment of thyroid-specific QoL in Iranian patients with benign thyroid disorders.

Background: Hypocalcemia is the most frequent complication of thyroid surgeries. Hypocalcemia is the most common complication following thyroid surgeries and is crucial in managing patients with thyroid cancer.

Objectives: This study aimed to describe hypocalcemia after thyroidectomy and evaluate the factors associated with postoperative hypocalcemia.

Methods: A cross-sectional study was conducted on 91 patients with thyroid cancer at Hanoi Medical University Hospital. Hypocalcemia was defined as serum calcium levels lower than 2.1 mmol/L, measured 24 hours after surgery.

Results: In the postoperative period, 27.5% of the patients exhibited hypocalcemia, with distinct prevalence rates observed between the total thyroidectomy group (47.6%) and the thyroid lobectomy group (10.2%). Concurrently, hypoparathyroidism manifested in 15.4% of the cases. Various factors were identified as contributors to postoperative hypocalcemia, including lymph node metastasis (odds ratio [OR] = 2.6; P < 0.05), total thyroidectomy (OR = 8.0; P < 0.01), diminished parathyroid hormone (PTH) levels (OR = 12.6; P < 0.001), and reduced 25-hydroxyvitamin D3 (25[OH]D3) levels (P < 0.01). Furthermore, multivariate analyses revealed that free thyroxine (FT4) (P = 0.04), 25(OH)D3 (P = 0.037), surgical procedure (P < 0.001), and cancer stage (P < 0.001) independently predicted postoperative hypocalcemia. Notably, our findings underscored a substantial correlation between total thyroidectomy (OR = 21.5, P < 0.001), diminished PTH levels (P < 0.001), and the occurrence of postoperative hypoparathyroidism.

Conclusions: The identification of lymph node metastasis, total thyroid surgery, decreased PTH and 25(OH)D3 levels, and albumin concentration are crucial factors in guiding the surgical team to prevent the onset of hypocalcemia.