Dysregulation of Thyroid Hormone Equilibrium in Hyperthyroidism: A Prospective Case Control Study of T3, T4 and TSH Dynamics
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Hyperthyroidism is a neuroendocrine disorder with dysfunction of the hypothalamic–pituitary–thyroid axis and systemic metabolic acceleration. Although clinically relevant, regional biochemical profiling of thyroid hormone changes has not been well characterized. Objective: To characterize changes in serum concentrations of triiodothyronine (T3), thyroxin (T4), and thyroid-stimulating hormone (TSH) in hyperthyroid patients, and to assess its distribution according to age and sex. In a prospective case–control study from February 2022 to March 2023, a total of 100 subjects (50 hyperthyroid patients (15 men and 35 women) and 50 control sexactly matched forage and within therangeo f25–65years) were comprised. Serum T3, T4 and TSH levels were determined respectively by fluorescence immunoassay (iCHROMA™system). Statistical comparisons were made by one-way ANOVA (P < 0.05; P < 0.01). The hyperthyroid patients had high endocrine dysfunction with T3 and T4 levels significantly increased and TSH level significantly decreased in the hyperthyroid patients compared to controls (P ≤ 0.01). Peak prevalence was found in the 40–60-year age group, prompting stratified analysis and indicating age-related susceptibility. In addition, there was also a strong female predominance (64%) underscoring the contribution of biological sex in disease presentation. Such a massive hormonal disturbance indicates a strong inverse relation between an excess of thyroid hormone and the negative modulation of the pituitary by TSH. Here, we describe an identifiable biochemical pattern of hyperthyroidism characterized by increased peripheral thyroid hormone action and feedback suppression of TSH. The results offer regional specific support for demographic determinants of disease distribution and demonstrate the clinical benefit of combined hormone profiling for detection of the disease at an early stage and the possibility of ongoing disease monitoring. These findings help improve diagnostic practices and may also guide endocrine evaluation in specific at-risk groups.
[1] N. M. Z. Yousif, “Estimation of Normal Thyroid Volume in Adults Using Ultrasonography,” Sudan University of Science and Technology, 2018.
[2] S. M. T. Gharibzahedi and S. M. Jafari, “The importance of minerals in human nutrition: Bioavailability, food fortification, processing effects and nanoencapsulation,” Trends Food Sci. Technol., vol. 62, pp. 119–132, 2017.
[3] V. Triggiani et al., “Role of iodine, selenium and other micronutrients in thyroid function and disorders,” Endocrine, Metabolic & Immune Disorders-Drug Targets, vol. 9, no. 3, pp. 277–294, 2009.
[4] S. M. Kansagra, C. R. McCudden, and M. S. Willis, “The challenges and complexities of thyroid hormone replacement,” Lab. Med., vol. 41, no. 6, pp. 338–348, 2010.
[5] T. F. Davies et al., “Graves’ disease,” Nat. Rev. Dis. Primers, vol. 6, no. 1, pp. 1–23, 2020.
[6] H. Thomsen, X. Li, K. Sundquist, J. Sundquist, A. Försti, and K. Hemminki, “Familial risks between Graves disease and Hashimoto thyroiditis and other autoimmune diseases in the population of Sweden,” J. Transl. Autoimmun., vol. 3, p. 100058, 2020.
[7] A. Kawicka and B. Regulska-Ilow, “Metabolic disorders and nutritional status in autoimmune thyroid diseases,” Advances in Hygiene and Experimental Medicine, vol. 69, pp. 80–90, 2015.
[8] A. Ogbera, O. Fasanmade, and O. Adediran, “Pattern of thyroid disorders in the southwestern region of Nigeria,” Ethn. Dis., vol. 17, no. 2, pp. 327–330, 2007.
[9] M. Barczyński, “Graves’ Disease and Toxic Nodular Goiter (Plummer’s Disease),” in Endocrine Surgery Comprehensive Board Exam Guide, Cham: Springer International Publishing, 2022, pp. 53–82.
[10] C. D. Norris and Y. Anzai, “Anatomy of Neck Muscles, Spaces, and Lymph Nodes,” Neuroimaging Clinics, vol. 32, no. 4, pp. 831–849, 2022.
[11] N. Aggarwal, A. K. Pankaj, R. K. V GarimaSehgal, A. Parihar, P. Manik, and P. Chhaya, “Morphological Evaluation of the Thyroid Lobes and Isthmus in Asymptomatic Indian Young Adults using Ultrasonography: A Cross-sectional Study,” 2022.
[12] G. Bereda, “Hyperthyroidism: Definition, Causes, Pathophysiology and Management,” Journal of Biomedical and Biological Sciences, vol. 1, no. 2, pp. 1–11, 2022.
[13] A. Atkinson and V. E. Esenabhalu, “Hashimoto’s Disease: Associated Thyroid Gland Disorders, Pharmacological, and Nutritional Interventions,” Open J. Endocr. Metab. Dis., vol. 12, no. 10, pp. 211–224, 2022.
[14] D. S. R. BHAT, “A study of clinical profile of types of anemia in primary hypothyroidism,” Shri Dharmasthala Manjunatheshwara University, Dharwad, 2022.
[15] S. Verma, L. Warrier, B. Bolia, and S. Mehta, “Past, present, and future of virtual tourism-a literature review,” International Journal of Information Management Data Insights, vol. 2, no. 2, p. 100085, 2022.
[16] L. Bartalena, E. Piantanida, D. Gallo, S. Ippolito, and M. L. Tanda, “Management of Graves’ hyperthyroidism: present and future,” Expert Rev. Endocrinol. Metab., vol. 17, no. 2, pp. 153–166, 2022.
[17] E. Yorke, “Hyperthyroidism and liver dysfunction: a review of a common comorbidity,” Clin. Med. Insights Endocrinol. Diabetes, vol. 15, p. 11795514221074672, 2022.
[18] J. F. Close, Gastrointestinal Disorders and Therapeutic Management. 2022.
[19] M. Dentice and D. Salvatore, “THEMATIC REVIEW Deiodinases: the balance of thyroid hormone Local impact of thyroid hormone inactivation,” Journal of Endocrinology, vol. 209, pp. 273–282, 2011.
[20] H. Y. Kim and S. Mohan, “Role and mechanisms of actions of thyroid hormone on the skeletal development,” Bone Res., vol. 1, no. 1, pp. 146–161, 2013.
[21] L. Zhuravlyova and M. Filonenko, Diseases of the thyroid gland: tutorial for students and interns. 2020.
[22] J. P. Walsh, “Thyroid function across the lifespan: do age-related changes matter?,” Endocrinology and Metabolism, vol. 37, no. 2, pp. 208–219, 2022.
[23] N. Guo, M. Xue, and Z. Liang, “Advances in the differential diagnosis of transient hyperthyroidism in pregnancy and Graves’ disease,” Arch. Gynecol. Obstet., pp. 1–9, 2022.
[24] Y. Liu et al., “Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury,” Sci. China Life Sci., vol. 63, pp. 364–374, 2020.
[25] P. Lewis et al., “Psychological well‐being of mothers of youth with fragile X syndrome: Syndrome specificity and within‐syndrome variability,” Journal of Intellectual Disability Research, vol. 50, no. 12, pp. 894–904, 2006.
[26] M. Banach et al., “PoLA/CFPiP/PCS guidelines for the management of dyslipidaemias for family physicians 2016,” Archives of Medical Science, vol. 13, no. 1, pp. 1–45, 2017.
[27] E. Daniel, “Provision of electronic banking in the UK and the Republic of Ireland,” International Journal of bank marketing, vol. 17, no. 2, pp. 72–83, 1999.
[28] A. Alemu, B. Terefe, M. Abebe, and B. Biadgo, “Thyroid hormone dysfunction during pregnancy: A review,” Int. J. Reprod. Biomed., vol. 14, no. 11, p. 677, 2016.
[29] B. Barrett and A. J. Bauer, “The effects of amiodarone on thyroid function in pediatric and adolescent patients,” Curr. Opin. Pediatr., vol. 33, no. 4, pp. 436–441, 2021.
[30] N. Ochs et al., “Meta-analysis: subclinical thyroid dysfunction and the risk for coronary heart disease and mortality,” Ann. Intern. Med., vol. 148, no. 11, pp. 832–845, 2008.
[31] A. C. Bianco et al., “Paradigms of dynamic control of thyroid hormone signaling,” Endocr. Rev., vol. 40, no. 4, pp. 1000–1047, 2019.
[32] P. Laurberg et al., “Iodine intake as a determinant of thyroid disorders in populations,” Best Pract. Res. Clin. Endocrinol. Metab., vol. 24, no. 1, pp. 13–27, 2010.
[33] J. H. Lazarus, “Thyroid Disorders Associated with Pregnancy: Etiology Diagnosis and Management,” Treat. Endocrinol., vol. 4, pp. 31–41, 2005.
[34] M. LaBrunda, D. Brown, F. E. Bell III, and A. D. Vaughan, “Ultrasound of the Gastrointestinal Tract,” in Understanding Physiology with Ultrasound, New York, NY: Springer US, 2023, pp. 135–173.
[35] J. Köhrle et al., “3, 5-T2—a Janus-faced thyroid hormone metabolite exerts both canonical T3-mimetic endocrine and intracrine hepatic action,” Front. Endocrinol. (Lausanne)., vol. 10, p. 787, 2020.
[36] S. S. Salih, “Evaluation of Thyroid Hormones Levels in Patients with Chronic Kidney Diseases,” 2020.
[37] G. Mintziori, M. Kita, L. Duntas, and D. G. Goulis, “Consequences of hyperthyroidism in male and female fertility: pathophysiology and current management,” J. Endocrinol. Invest., vol. 39, pp. 849–853, 2016.
[38] G. Mintziori, M. Kita, L. Duntas, and D. G. Goulis, “Consequences of hyperthyroidism in male and female fertility: pathophysiology and current management,” J. Endocrinol. Invest., vol. 39, pp. 849–853, 2016.
[39] M. P. Vanderpump, “The epidemiology of thyroid disease,” Br. Med. Bull., vol. 99, no. 1, 2011.
[40] C. D. Norris and Y. Anzai, “Anatomy of Neck Muscles, Spaces, and Lymph Nodes,” Neuroimaging Clinics, vol. 32, no. 4, pp. 831–849, 2022.
[41] J. P. Walsh, “Thyroid function across the lifespan: do age-related changes matter?,” Endocrinology and Metabolism, vol. 37, no. 2, pp. 208–219, 2022.
[42] V. Brusseau et al., “Heart rate variability in hyperthyroidism: A systematic review and meta-Analysis,” Int. J. Environ. Res. Public Health, vol. 19, no. 6, p. 3606, 2022.
[43] A. Ogbera, O. Fasanmade, and O. Adediran, “Pattern of thyroid disorders in the southwestern region of Nigeria,” Ethn. Dis., vol. 17, no. 2, pp. 327–330, 2007.
