1
|
Zhao L, Selvaratnam I, Cunningham J, Filion KB, Grandi SM. Maternal hypothyroidism and subsequent metabolic outcomes in children: a systematic review and meta-analysis. BMC Pediatr 2024; 24:490. [PMID: 39090558 PMCID: PMC11293156 DOI: 10.1186/s12887-024-04963-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 07/23/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION As the fetus relies on maternal thyroid hormones in early pregnancy, maternal hypothyroidism plays an important role in fetal development. However, the association between maternal hypothyroidism and metabolic disease in offspring is unclear. OBJECTIVE To examine the association between maternal hypothyroidism in pregnancy and metabolic outcomes (obesity, hypertension, type 2 diabetes mellitus, and dyslipidemia) in children < 18 years. METHODS We systematically searched 5 databases from inception to May 2023. Eligible studies included cohort, case-control, and randomized controlled trials involving children born to mothers with or without hypothyroidism in pregnancy. Data were pooled across studies using random-effects models for outcomes reported in at least three studies. Quality assessment was performed using the ROBINS-E tool for observational studies and the Cochrane Risk of Bias tool for trials. RESULTS The search identified 3221 articles, of which 7 studies were included (1 trial, 6 observational). All studies were conducted outside of North America and ranged in size from 250 to > 1 million children. The follow-up time ranged from 6 to 20 years. Included studies support an increased risk of hypertension and glucose dysregulation in offspring exposed to maternal hypothyroidism (hypertension: OR 1.08, 95% CI 0.75, 1.57 and HR 1.81, 95% CI 1.21, 2.69; diabetes: RR 2.7, 95% CI 0.7, 10). In the pooled analysis, maternal hypothyroidism was not associated with obesity in offspring (OR 1.04, 95% CI 0.64, 1.70). CONCLUSION This study found inconsistent evidence on the association between maternal hypothyroidism in pregnancy and metabolic outcomes in offspring, though associations with hypertension and glucose dysregulation are possible.
Collapse
Affiliation(s)
- Lucy Zhao
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada
| | - Inthuja Selvaratnam
- Department of Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada
| | - Jessie Cunningham
- Department of Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada
| | - Kristian B Filion
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Sonia M Grandi
- Department of Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada.
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
2
|
Adelson RP, Garikipati A, Zhou Y, Ciobanu M, Tawara K, Barnes G, Singh NP, Mao Q, Das R. Machine Learning Approach with Harmonized Multinational Datasets for Enhanced Prediction of Hypothyroidism in Patients with Type 2 Diabetes. Diagnostics (Basel) 2024; 14:1152. [PMID: 38893680 PMCID: PMC11172278 DOI: 10.3390/diagnostics14111152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Type 2 diabetes (T2D) is a global health concern with increasing prevalence. Comorbid hypothyroidism (HT) exacerbates kidney, cardiac, neurological and other complications of T2D; these risks can be mitigated pharmacologically upon detecting HT. The current HT standard of care (SOC) screening in T2D is infrequent, delaying HT diagnosis and treatment. We present a first-to-date machine learning algorithm (MLA) clinical decision tool to classify patients as low vs. high risk for developing HT comorbid with T2D; the MLA was developed using readily available patient data from harmonized multinational datasets. The MLA was trained on data from NIH All of US (AoU) and UK Biobank (UKBB) (Combined dataset) and achieved a high negative predictive value (NPV) of 0.989 and an AUROC of 0.762 in the Combined dataset, exceeding AUROCs for the models trained on AoU or UKBB alone (0.666 and 0.622, respectively), indicating that increasing dataset diversity for MLA training improves performance. This high-NPV automated tool can supplement SOC screening and rule out T2D patients with low HT risk, allowing for the prioritization of lab-based testing for at-risk patients. Conversely, an MLA output that designates a patient to be at risk of developing HT allows for tailored clinical management and thereby promotes improved patient outcomes.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Qingqing Mao
- Montera, Inc. dba Forta, 548 Market St, PMB 89605, San Francisco, CA 94104-5401, USA; (R.P.A.); (A.G.); (Y.Z.); (M.C.); (K.T.); (G.B.); (N.P.S.); (R.D.)
| | | |
Collapse
|
3
|
Alshahrani RS, Mirghani H, Alharbi RT, Alenazi LM, Albalawi DL, Alomrani EMD, Alanazi LFN, Aljayzani AAA, Alamri RD. Knowledge of Thyroid Disease Manifestation and Risk Factors Among the General Population in the Tabuk Region of Saudi Arabia. Cureus 2024; 16:e56020. [PMID: 38606254 PMCID: PMC11007481 DOI: 10.7759/cureus.56020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
Background Thyroid disorders are caused either by excessive or inadequate thyroid hormone production or by the enlargement of the thyroid gland. Various types of thyroid disorders exist, including primary (related directly to the gland itself), secondary (related to thyroid function), and other types. This study aimed to assess the knowledge of thyroid disease manifestation and its risk factors among individuals living in Tabuk, Saudi Arabia. Methodology An observational cross-sectional study was conducted among 400 adults living in Tabuk city of Saudi Arabia aged 18 years or above. Data was collected using an electronic questionnaire through a simple random sampling method. Data was then coded, entered, and analyzed using both descriptive and inferential statistical methods using IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States). Results A total of 403 participants were enrolled in this study. More than half (n=265, 65.8%) were females, and 188 (46.7%) were in the age group of 18-35 years. The educational level of the majority of them was a bachelor's degree (n=296, 73.4%). Hypothyroidism was the most common thyroid disorder among family members (n=51, 62.4%). Inadequate iodine intake was thought to be a risk factor for thyroid disorders, as mentioned by 276 (68.5%) participants. Exact 284 (70.5%) participants believed that females are more at risk of having thyroid disease. The mean total knowledge score was found to be 25.1±4.48 out of a total of 34. Exact 216 (53.6%) participants had good knowledge about thyroid disorders. The female gender had significantly higher levels of knowledge as compared to males (p-value=0.002) regarding the manifestation and risk factors of thyroid disorders. In terms of educational level, a bachelor's or above was found to be significantly associated with a higher level of knowledge (p-value=0.003). Conclusion A good level of knowledge and awareness about thyroid disorders was observed among more than half of the participants. Few knowledge gaps were identified regarding knowledge about symptoms of hypothyroidism and certain medications which might cause thyroid disorders.
Collapse
|
4
|
Valli E, Dalotto-Moreno T, Sterle HA, Méndez-Huergo SP, Paulazo MA, García SI, Pirola CJ, Klecha AJ, Rabinovich GA, Cremaschi GA. Hypothyroidism-associated immunosuppression involves induction of galectin-1-producing regulatory T cells. FASEB J 2023; 37:e22865. [PMID: 36934391 DOI: 10.1096/fj.202200884r] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 01/31/2023] [Accepted: 02/27/2023] [Indexed: 03/20/2023]
Abstract
Hypothyroidism exerts deleterious effects on immunity, but the precise role of the hypothalamic-pituitary-thyroid (HPT) axis in immunoregulatory and tolerogenic programs is barely understood. Here, we investigated the mechanisms underlying hypothyroid-related immunosuppression by examining the regulatory role of components of the HPT axis. We first analyzed lymphocyte activity in mice overexpressing the TRH gene (Tg-Trh). T cells from Tg-Trh showed increased proliferation than wild-type (WT) euthyroid mice in response to polyclonal activation. The release of Th1 pro-inflammatory cytokines was also increased in Tg-Trh and TSH levels correlated with T-cell proliferation. To gain further mechanistic insights into hypothyroidism-related immunosuppression, we evaluated T-cell subpopulations in lymphoid tissues of hypothyroid and control mice. No differences were observed in CD3/CD19 or CD4/CD8 ratios between these strains. However, the frequency of regulatory T cells (Tregs) was significantly increased in hypothyroid mice, and not in Tg-Trh mice. Accordingly, in vitro Tregs differentiation was more pronounced in naïve T cells isolated from hypothyroid mice. Since Tregs overexpress galectin-1 (Gal-1) and mice lacking this lectin (Lgals1-/- ) show reduced Treg function, we investigated the involvement of this immunoregulatory lectin in the control of Tregs in settings of hypothyroidism. Increased T lymphocyte reactivity and reduced frequency of Tregs were found in hypothyroid Lgals1-/- mice when compared to hypothyroid WT animals. This effect was rescued by the addition of recombinant Gal-1. Finally, increased expression of Gal-1 was found in Tregs purified from hypothyroid WT mice compared with their euthyroid counterpart. Thus, a substantial increase in the frequency and activity of Gal-1-expressing Tregs underlies immunosuppression associated with hypothyroid conditions, with critical implications in immunopathology, metabolic disorders, and cancer.
Collapse
Affiliation(s)
- Eduardo Valli
- Laboratorio de Neuroinmunomodulación y Oncología Molecular, Instituto de Investigaciones Biomédicas (BIOMED), Pontificia Universidad Católica Argentina (UCA), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Tomás Dalotto-Moreno
- Laboratorio de Glicomedicina, Instituto de Biología y Medicina Experimental (IBYME), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Helena A Sterle
- Laboratorio de Neuroinmunomodulación y Oncología Molecular, Instituto de Investigaciones Biomédicas (BIOMED), Pontificia Universidad Católica Argentina (UCA), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Santiago P Méndez-Huergo
- Laboratorio de Glicomedicina, Instituto de Biología y Medicina Experimental (IBYME), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - María A Paulazo
- Laboratorio de Neuroinmunomodulación y Oncología Molecular, Instituto de Investigaciones Biomédicas (BIOMED), Pontificia Universidad Católica Argentina (UCA), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Silvia I García
- Facultad de Medicina, Instituto de investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires (UBA), Ciudad Autónoma de Buenos Aires, Argentina
- Departamento de Cardiología Molecular., Instituto de Investigaciones Médicas (IDIM), Universidad de Buenos Aires (UBA), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Carlos J Pirola
- Biología de Sistemas de Enfermedades Complejas, Centro de Altos Estudios en Ciencias Humanas y de la Salud (CAECIHS), Universidad Abierta Interamericana, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Alicia J Klecha
- Laboratorio de Neuroinmunomodulación y Oncología Molecular, Instituto de Investigaciones Biomédicas (BIOMED), Pontificia Universidad Católica Argentina (UCA), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Gabriel A Rabinovich
- Laboratorio de Glicomedicina, Instituto de Biología y Medicina Experimental (IBYME), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Graciela A Cremaschi
- Laboratorio de Neuroinmunomodulación y Oncología Molecular, Instituto de Investigaciones Biomédicas (BIOMED), Pontificia Universidad Católica Argentina (UCA), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| |
Collapse
|
5
|
Liao B, Liang J, Guo B, Jia X, Lu J, Zhang T, Sun R. ILSHIP: An interpretable and predictive model for hypothyroidism. Comput Biol Med 2023; 154:106578. [PMID: 36738707 DOI: 10.1016/j.compbiomed.2023.106578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 01/08/2023] [Accepted: 01/22/2023] [Indexed: 02/01/2023]
Abstract
Hypothyroidism is one of the common endocrine diseases, and its incidence is increasing year by year. Due to the insidious nature of this disease, it often leads to delayed treatment and even misdiagnosis. This paper proposes ILSHIP, an interpretable predictive model for hypothyroidism, to reduce its diagnostic complexity as well as improve the predictive performance and interpretability of existing models. First, the ILSHIP prediction model was built based on label encoding, missing value processing, feature selection, and data enhancement of the dataset. Second, the comprehensive performance of ILSHIP was compared with twelve existing related study models and eleven mainstream models, such as XGBoost and MLP. The experimental results showed that, based on the optimal hyperparameters the ILSHIP model can achieve 99.392%, 99.437%, 99.348%, 99.381%, and 99.960% in accuracy, recall, specificity, F1, and AUC, respectively. The accuracy of the ILSHIP model was about 0.7%-15.4% higher than the existing models. By introducing the SHAP framework into the ILSHIP model, important features affecting hypothyroidism such as thyroid stimulating hormone (TSH) and free thyroxine index (FTI) were also identified, and the influencing factors for different individuals were finally analyzed to provide a basis for medical personnel to monitor the condition.
Collapse
Affiliation(s)
- Bin Liao
- College of Big Data Statistics, Guizhou University of Finance and Economics, Guiyang, 550025, PR China
| | - Jinming Liang
- College of Statistics and Data Science, Xinjiang University of Finance and Economics, Urumqi, 830012, PR China.
| | - Binglei Guo
- School of Computer Engineering, Hubei University of Arts and Science, Xiangyang, 441053, PR China
| | - Xiaoyao Jia
- College of Statistics and Data Science, Xinjiang University of Finance and Economics, Urumqi, 830012, PR China
| | - Jiarong Lu
- College of Statistics and Data Science, Xinjiang University of Finance and Economics, Urumqi, 830012, PR China
| | - Tao Zhang
- Department of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, 830011, PR China
| | - Ruina Sun
- College of Statistics and Data Science, Xinjiang University of Finance and Economics, Urumqi, 830012, PR China; Institute of Information Engineering, Chinese Academy of Sciences, Beijing, 100093, PR China; School of Networks Security, University of Chinese Academy of Sciences, Beijing, 100049, PR China
| |
Collapse
|
6
|
Attenuation of Hypothyroidism-Induced Cognitive Impairment by Modulating Serotonin Mediation. Vet Sci 2023; 10:vetsci10020122. [PMID: 36851426 PMCID: PMC9966518 DOI: 10.3390/vetsci10020122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/29/2022] [Accepted: 02/04/2023] [Indexed: 02/08/2023] Open
Abstract
Thyroid hormones play an important role in the modeling of neural networks in the brain. Besides its metabolic effects, thyroid dysfunction, and hypothyroidism in particular, is frequently associated with cognitive decline and depressive-like behavior. The current study aimed to examine the changes in behavior, cognition, and memory in rats with propylthiouracil-induced overt hypothyroidism. The behavior and cognition were assessed using the open field test, T-maze, and novel object recognition test. We found significant differences in the behavioral patterns of the hypothyroid animals showing a reduction in locomotor activity, frequency of rearing, and impaired memory function compared to the euthyroid controls. As serotonin is an essential biomarker regulating cognition and mood, we tried to modulate the serotonin mediation in hypothyroid animals through tryptophan administration. Treatment with 5-hydroxy-tryptophan (5-OH-TRP) intraperitoneally for 10 days or directly into the hippocampus as a single injection led to attenuation of the hypothyroidism-induced cognitive and memory decline. A staggering amount of research is suggesting that the common denominators in the pathophysiology of depression and the behavior changes in hypothyroidism are the hippocampal complex and the distorted serotonin metabolism. In our study, it was observed a significant alleviation of cognitive impairment and an improvement of memory performance in hypothyroid rats after 5-OH-TRP administration. Current results are promising and may serve as groundwork for further investigation of functional and structural changes in the hippocampus during a hypothyroid state, and in particular, the effects of serotonin mediation in hypothyroid-associated depressive-like behavior.
Collapse
|
7
|
Kahaly GJ, Lotz J, Walder S, Hammad C, Krämer R, Frommer L, König J, Wolf J, Gottwald-Hostalek U, Urgatz B, Lackner KJ. A novel point-of-care device accurately measures thyrotropin in whole blood, capillary blood and serum. Clin Chem Lab Med 2022; 60:1607-1616. [PMID: 35951769 DOI: 10.1515/cclm-2022-0525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/22/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Point-of-care (POC) measurement of thyrotropin (TSH) may facilitate prompt diagnosis of thyroid dysfunction. We evaluated the analytical performance of a new POC TSH assay (Wondfo). METHODS TSH measurements were made from 730 consecutive, unselected subjects in an outpatient setting, using Wondfo in whole blood, capillary blood and serum or automated reference equipment (serum only). RESULTS TSH measurements were user-independent. Total intra-and inter-assay variation (CV%) was 12.1 and 16.2%, respectively. Total CV% was 10.6-22.6% and 14.5-21.6% in serum and whole blood, respectively. Linearity was very good. Recovery rate was 97-127%. Prolongation of incubation time increased TSH results of 12% (13%) and 33% (35%) after 2 and 5 additional minutes in serum (blood), respectively. When measured simultaneously in two Wondfo devices, the slope of the regression line was 1.03 (serum) and 1.02 (blood), with Spearman's correlation of 0.99 for both. TSH measurements between Wondfo and reference correlated strongly (r=0.93-0.96), though TSH measurements were lower with Wondfo (slopes of plots of measurements made using the two devices were 0.94 [serum vs. serum]; 0.83 [whole blood vs. serum] and 0.64 [capillary blood vs. serum]). Depending on sample material, TSH in capillary blood was lower vs. whole blood (slope: 0.82) and for whole blood vs. serum (Wondfo and reference method; slope: 0.69 and 0.83). Total haemolysis, but not elevated bilirubin or lipemia, disrupted TSH measurement. CONCLUSIONS The Wondfo system was straightforward to use without need for specialist technicians and demonstrated analytic performance suitable for clinical use for the diagnosis of thyroid dysfunction.
Collapse
Affiliation(s)
- George J Kahaly
- Molecular Thyroid Research Laboratory, Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
| | - Johannes Lotz
- Institute for Clinical Chemistry and Laboratory Medicine, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
| | - Sara Walder
- Molecular Thyroid Research Laboratory, Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
| | - Cara Hammad
- Molecular Thyroid Research Laboratory, Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
| | - Rebecca Krämer
- Molecular Thyroid Research Laboratory, Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
| | - Lara Frommer
- Molecular Thyroid Research Laboratory, Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
| | - Jochem König
- Institute of Medical Biostatistics, Epidemiology and Informatics, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
| | - Jan Wolf
- Molecular Thyroid Research Laboratory, Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
| | | | | | - Karl J Lackner
- Institute for Clinical Chemistry and Laboratory Medicine, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
| |
Collapse
|
8
|
Abstract
The mechanisms by which estrogens modulate physical activity remain unclear. A recent article published in Nature by Krause et al. (2021) demonstrates that estradiol increases the expression of melanocortin receptor 4 in a particular subset of neurons in the ventromedial nucleus of the hypothalamus, leading to increased physical activity.
Collapse
Affiliation(s)
- Miguel López
- NeurObesity Group, Department of Physiology, CIMUS, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela 15782, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Madrid 15706, Spain.
| |
Collapse
|