This article reports the clinica diagnosis and treatment of a 66-year-old male patient with elevated free thyroxine(FT 4) following coronavirus disease 2019(COVID-19) infection. The thyroid function tests showed a significant increase in FT 4, while thyroid stimulating hormone(TSH) was not suppressed. Re-testing on different platforms revealed inconsistent FT 4 elevations, indicating potential interference in FT 4 measurement. Radioimmunoprecipitation assays confirmed the presence of anti-thyroxine autoantibodies(T 4Ab) in the patient′s body, specifically the IgM subtype. This article reviews relevant literature, focusing on the identification and differential diagnosis of thyroid hormone autoantibodies interference.

The syndrome of resistance to thyroid hormone(RTH) is a rare syndrome caused by the mutation of thyroid hormone receptor (TR) gene, which reduces the sensitivity of target organs to thyroid hormone (TH) and leads to the dysfunction of TH. Thyroid hormone resistance syndrome β (RTHβ) is caused by the mutations in the THRB gene. The main characteristics of RTHβ are increased thyroxine (T₄) in the circulating blood, normal or elevated levels of triiodothyronine(T₃), paired with normal or high thyroid-stimulating hormone (TSH) concentration. Clinically, it is easy to misdiagnose RTHβ as hyperthyroidism, and give anti-thyroid drugs, radioactive ¹³¹I therapy or surgery, which then leads to the aggravation of TH resistance, so the correct diagnosis of the disease is critical. In this paper, the molecular mechanism, clinical characteristics, diagnosis and treatment of RTHβ are summarized.

Background: Developmental hypothyroidism impairs learning and memory in offspring, which depend on extensive neuronal circuits in the entorhinal cortex, together with the hippocampus and neocortex. The entorhinal-dentate gyrus pathway is the main entrance of memory circuits. We investigated whether developmental hypothyroidism impaired the morphological development of the entorhinal-dentate gyrus pathway. Methods: We examined the structure and function of the entorhinal-dentate gyrus pathway in response to developmental hypothyroidism induced using 2-mercapto-1-methylimidazole. Results: 1,1´-Dioctadecyl-3,3,3´,3´-tetramethylindocarbocyanine perchlorate tract tracing indicated that entorhinal axons showed delayed growth in reaching the outer molecular layer of the dentate gyrus at postnatal days 2 and 4 in hypothyroid conditions. The proportion of fibers in the outer molecular layer was significantly smaller in the hypothyroid group than in the euthyroid group at postnatal day 4. At postnatal day 10, the pathway showed a layer-specific distribution in the outer molecular layer, similar to the euthyroid group. However, the projected area of entorhinal axons was smaller in the hypothyroid group than in the euthyroid group. An electrophysiological examination showed that hypothyroidism impaired the long-term potentiation of the perforant and the cornu ammonis 3–cornu ammonis 1 pathways. Many repulsive axon guidance molecules were involved in the formation of the entorhinaldentate gyrus pathway. The hypothyroid group had higher levels of erythropoietin-producing hepatocyte ligand A3 and semaphorin 3A than the euthyroid group. Conclusion We demonstrated that developmental hypothyroidism might influence the development of the entorhinal-dentate gyrus pathway, contributing to impaired long-term potentiation. These findings improve our understanding of neural mechanisms for memory function.

Thyroid diseases are common diseases in endocrinology. Thyroid function tests have become the most commonly used indicators to diagnose thyroid diseases. This review summarizes several abnormal thyroid function test results that may be encountered in clinical practice and analyzes the causes, which may provide ideas for the clinicians in the diagnosis of thyroid diseases.

Objective:To search for the clinical indicators in differentiating Graves′ disease from subacute thyroiditis (SAT).Methods:Retrospective analysis was performed on thyroid function measurement of 265 cases of newly diagnosed Graves′ disease, 76 cases of SAT with thyrotoxicosis, 100 cases of non-toxic thyroid nodules, 105 cases of autoimmune thyroid diseases with normal thyroid function, and 151 cases of outpatients with normal thyroid function and without thyroid diseases.Results:Free triiodothyronine(FT 3)/free thyroxine(FT 4) ratio of Graves′ disease patients was significantly higher than that of SAT patients with thyrotoxicosis (0.65±0.29 vs 0.32±0.75, P<0.05). Receiver operating characteristic curve(ROC curve) analysis of FT 3/FT 4 ratio between Graves′ disease group and SAT group showed that FT 3/FT 4 ratio greater than 0.4 with a sensitivity of 98.11% and a specificity of 83.81% for diagnosis of Graves′ disease. Conclusion:FT 3/FT 4 ratio greater than 0.4 is helpful for differentiating Graves′ disease from subacute thyroiditis with thyrotoxicosis.

Objective:To investigate the effect of entecavir combined with transcatheter arterial chemoembolization (TACE) on the quality of life, liver function and immune function of patients with primary liver cancer.Methods:From January 2017 to December 2018, 120 patients with primary liver cancer admitted to the Second Hospital of Jiaxing were randomly divided into observation group(60 cases) and control group(60 cases). The patients in the control group were treated with TACE, while those in the observation group were treated with entecavir on the basis of the control group.Both two groups were treated for 3 consecutive courses, and 4 weeks as a course of treatment.The short-term effect, KPS score, liver function and immune function of the two groups were compared before and after treatment.Results:The total effective rate of the observation group(71.67%) was higher than that of the control group(50.00%)(χ 2=5.911, P<0.05). The KPS score of the observation group was (84.25±3.67)points, which was higher than that of the control group[(75.58±3.29)points]( t=13.626, P<0.05). After treatment, the levels of ALT [(35.42±6.24)U/L], TBIL [(23.37±2.89)μmol/L] and AST [(37.29±4.23)U/L] in the observation group were lower than those in the control group [(52.29±4.56)U/L, (30.73±3.78)μmol/L and (54.35±3.89)U/L]( t=16.908, 11.982, 22.995, all P<0.05). The CD 3+ [(58.71±2.93)%], CD 4+ /CD 3+ [(39.74±3.45)%] and CD 4+ /CD 8+ (1.65±0.39) in the observation group were higher than those in the control group [(49.63±3.10)%, (31.12±2.13)% and (0.93±0.17)] ( t=16.489, 16.468, 13.109, all P<0.05). Conclusion:Entecavir combined with TACE is effective in the treatment of primary liver cancer, and it can improve the quality of life, liver function and immune function.

[Summary] We investigated a 12-year-old girl with elevated serum FT3 , FT4 , and TSH levels. The sequence of thyroid hormone receptorβ( TRβ) exons revealed a CCT→ACT transition mutation at nucleotide 453 site within exon10,whichresultedinthesubstitutionofcytosinetoadenosinein(P453T). Pituitarymagneticresonanceimage showed a pituitary micoradenoma. The patient underwent transsphenoidal pituitary adenomectomy. Pathological results exhibited positive TSH-β, GH, prolactin, ACTH, and α-HCG staining for the tumor. This is the first case report with thyroid hormone resistance syndrome and thyrotropin-secreting adenoma.

Data were collected through questionnaire from 505 women enrolled during early pregnancy.Based on soy intake frequency,the subjects were divided into three groups:frequent (three or more times per week),conventional ( more than twice per month but less than three times per week),and occasional ( two or fewer times per month).Serum TSH and FT4 were measured by chemiluminescence immunoassay.The urinary concentrations of two primary isoflavones (daidzein and genistein) and creatinine were further assessed in 95 subjects from the three groups.The percentages of frequent,conventional,and occasional consumers were 18.6％,62.6％,and 18.8％,respectively.No difference was found in age,medical records,family history of thyroid diseases,serum FT4,TSH,and prevalence of thyroid dysfunctions among three groups. Both urinary daidzein and genistein levels were significantly higher in the frequent consumers compared with the other two groups.No correlations were found between urinary isoflavone levels and serum FT4 or TSH.These findings suggest that dietary soy consumption during early pregnancy seems not to be associated with the development of thyroid dysfunction.

This study investigated the relationship between serum thyrotrophin levels and dyslipidemia in subclinical hypothyroid and euthyroid subjects. A total of 110 subjects with subclinical hypothyroidism and 1,240 euthyroid subjects enrolled in this study. Patients with subclinical hypothyroidism had significantly lower high density lipoprotein cholesterol (HDL-C) levels than those who were euthyroid. The lipid profiles were each categorized and mean thyrotrophin levels were higher in subjects in the dyslipidemia subclasses than subjects in the normal subclasses. Thyrotrophin was positively associated with serum triglyceride and negatively associated with serum HDL-C in women. Thyrotrophin was also positively associated with total cholesterol (TC) in the overweight population along with TC and LDL-C in overweight women. In the euthyroid population, thyrotrophin was positively associated with TC in the overweight population. In conclusion, serum thyrotrophin was correlated with dyslipidemia in subclinical hypothyroid and euthyroid subjects; the correlation was independent of insulin sensitivity.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cholesterol/blood ; Cholesterol, HDL/blood ; Dyslipidemias/*blood ; Female ; Humans ; Insulin Resistance ; Lipids/blood ; Male ; Middle Aged ; Thyrotropin/*blood ; Triglycerides/blood ; Young Adult

To explore the dose- and time- dependent relationship between the chronic iodine excess and thyroid structure, ultrastructure, and thyroid function in autoimmune-prone NOD. H-2h4 mice. Chronic iodine excess leads to iodine-induced goiter with an ultrastructure of follicle epithelial cells injury in a dose and time dependent way.