Hypothyroidism in Bangladesh: Is Autoimmunity the Next Big Threat?

In many low and middle-income countries, iodine-deficient hypothyroidism leads to complex public health consequences. However, increasing evidence from population-based studies has linked thyroid autoimmunity with excess iodine intake. The iodine supplementation program in Bangladesh was a success story. This cross-sectional study aims to assess the pattern and predictors of autoimmunity among Bangladeshi hypothyroid patients. In this study, 154 consecutive, newly detected, biochemically-confirmed patients with primary hypothyroidism were recruited from the Endocrinology outpatient department of Bangabandhu Sheikh Mujib Medical University and tested for anti-thyroid peroxidase and anti-thyroglobulin antibody levels from October 2015 and November 2016. Patterns of thyroid autoimmunity were assessed via descriptive statistics. Predictors of autoimmunity were assessed with multivariable mixed-effect logistic regression. The mean age of participants was 36.1±11.0 years, and 70.1% were female. The frequency of thyroid autoimmunity in the study subjects was very high, 89.0% were positive for either anti-TPO or anti-Tg antibodies and 48.7% were positive for both. More participants were positive for anti-TPO antibodies (82.5%) than anti-Tg antibodies (55.2%). The risk of autoimmunity was associated with the thyroid's structural abnormalities but not with functional status. Weight gain and hypertension were associated with autoimmunity, whereas diabetes was protective against autoimmunity.

Antithyroid Antibody Status in Non-Pregnant Adult Bangladeshi Patients with Subclinical Hypothyroidism

Sub clinical hypothyroidism (SCH) is common in clinical practice. Autoimmunity is thought to be the most important cause of SCH. In this cross-sectional study, we investigated 120 SCH patients and 100 healthy controls attending the Endocrinology Outpatient Department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from June 2014 to April 2015 for anti-thyroid antibodies (anti-TPO and anti-Tg). Measurement of serum TSH, FT4, anti-TPO, and anti-Tg antibodies were done by using the chemiluminescent sequential immunometric assay. SCH patients had a higher mean age; the frequencies of female subjects, those having family history of thyroid disease or other autoimmune diseases, and goiter were higher in SCH group than in the control group. Forty-five percent (45%) of SCH patients were positive for anti-thyroid antibodies (23.3% for both anti-TPO and anti-Tg, 16.7% for only anti-TPO, and 5% positive for only anti-Tg) in comparison to only 10% anti-thyroid antibody positive controls (none for both antibodies, 8% for only anti-TPO, and 2% positive for only anti-Tg). The SCH subjects in the lower age group, females and with a TSH >10μIU/mL had the higher frequency of thyroid autoimmunity. Female gender, high socioeconomic condition, the presence of other autoimmune diseases, the presence of goiter and TSH >10μIU/mL were associated with higher odds of anti-thyroid antibody positivity in the SCH group, though none were statistically significant. The frequency of anti-thyroid antibody was higher in SCH and was more prevalent among the females, younger patients and those having a goiter, other autoimmune diseases, and TSH >10μIU/mL.

Effects of neonatally induced strabismus on binocular responses in cat area 18

Responses to binocular visual stimulation were compared in cortical area 18 of normal cats and in cats in which one eye was exodeviated by surgery early in postnatal life. In contrast to normal cats where most units (58%) were binocularly activated, relatively few units (10%) in strabismic cats were activated well by stimulation of either eye. Rather individual units were driven mainly via one eye or the other but not both. In addition, there was a tendency for more units to be driven well via the unoperated eye than via the exodeviated eye. Fewer cells preferring vertically oriented than horizontally oriented stimuli were found in area 18 of strabismic cats. This trend was observed for cells driven by either the normal or deviated eye and was especially marked among the small number of binocularly activated cells. Generally binocular responses and binocular interactions were found with stimulation at corresponding retinal points. In a few striking instances, however, the receptive fields of binocular neurons were located on noncorresponding retinal points at loci which would enable the cat to correlate the two images of an external object despite the large divergent strabismus. Quantitative responses to binocular stimuli presented at varied disparities and to stimuli with varied directions of motion in depth were compared in normal and strabismic cats. Despite the large strabismus, a reduced fraction of cortical neurons displayed substantial binocular interactions. In fact, binocular facilitation was as marked in the population of cells studied in strabismic cats as it was in normal animals. The major effect of strabismus was a reduction in the strength of binocular inhibition when units were tested with sideways motion. Disparity-specific responses to motion toward or away from the organism were little affected by strabismus. The degree of binocular facilitation and binocular inhibition among the cell population was similar in normal and strabismic cats. A subpopulation of units encountered in strabismic cats showed strong disparity-specific interactions for motion toward or away from the animal without equivalent modulation for sideways moving stimuli. Units with these properties were not found in normal animals and may, therefore, represent a special adaptation of the strabismic animals.

Prior strabismus protects kitten cortical neurons from the effects of monocular deprivation

The effects of 8 days of monocular eyelid suture beginning at 45 days of age were compared in normal kittens and in kittens which had been made strabismic by surgery early in life. In both groups of animals, monocular deprivation increased the relative strength of inputs from the non-deprived eye at the cortical level, but this effect was clearly less pronounced in the strabismic animals. The reduced effect of monocular deprivation in strabismic animals was observed mainly in the cortical hemisphere contralateral to the deprived eye.