Early Detection of Autoimmune Thyroid Heart Disease Via Urinary Exosomal Proteins
Early Detection of Autoimmune Thyroid Heart Disease Via Urinary Exosomal Proteins
Autoimmune thyroid disease revealed close relationship with heart failure, including the
 entities of subclinical hyperthyroidism and hypothyroidism. Heart failure is a principal
 complication of all forms of heart disease. The American College of Cardiology defines HF as
 a complex clinical syndrome that impairs the ability of the ventricle to fill with or inject
 blood. In fact, it may be caused by a defect in myocardial contraction, by an impairment in
 ventricular filling with preserved systolic function ('diastolic HF') or by a combination of
 both. Earlier detection of probable trend of heart failure in subclinical thyroid diseases is
 very important in not only Taiwan, Pan-Asia, but all over the aging world. However, it is not
 currently available.

 The investigators will enroll 20 patients with subclinical hyperthyroidism, subclinical
 hypothyroidism, and collect their urine specimens in outpatient clinic per year.

 Prognostic biological markers via this prospective study. The study was designed as
 prospective pattern, and the investigators will enroll clinical and subclinical thyroid
 disease with quarterly follow-up, then detect urine exosomal proteins NT-proBNP. The
 investigators try to find the correlation of outcome with unknown/fresh biomarkers in this
 study with time-dependent manner.

 The investigators hope to find earlier predicting biomarkers for heart dysfunction in
 autoimmune thyroid disease.
Clinical and subclinical thyroid disease is usually used to describe patients with mild
 symptoms correlated to hyperthyroid or hypothyroid state. Thyroid ultrasonography could
 differentiate benign or malignant nodular lesion, together with fine needle aspiration
 cytology and surgical pathology. Thyrotropin (TSH, thyroid stimulating hormone) is the
 pivotal investigation in laboratory diagnosis to define subclinical thyroid diseases. An
 elevated TSH with normal free thyroxine and triiodothyronine levels in serum is defined to be
 subclinical hypothyroidism, and a subnormal TSH with normal thyroid hormone concentrations to
 be subclinical hyperthyroidism. Generally, the prevalence of subclinical hypothyroidism and
 hyperthyroidism were reported as 4% -10% & 1%-2% in general population, respectively.
 Although subclinical thyroid disease is prevalent, there is still no consensus for screening
 clinical and subclinical thyroid disease, including hyperthyroidism, hypothyroidism, nodular
 goiter and thyroid cancer. Under consideration of age, gender or familial history of
 autoimmune thyroid disease. However, screening for thyroid dysfunction should be considered
 in some high risk patients, including 1) elderly; 2) history of atrial fibrillation; 3)
 previous thyroid disease history; 4) other confirmed autoimmune diseases; 5) neck exposure of
 radiation (for example, nasopharyngeal cancer, post-radiation); 6) family history of probable
 autoimmune thyroid disease, and 7) pregnant state with prior thyroid disease history.
 Therapeutic decision for clinical and subclinical thyroid dysfunction should be considered
 individually. Therapeutic options will be anti-thyroid medications and/or radioactive iodine,
 and thyroidectomy could be considered with larger goiters for hyperthyroidism. For clinical
 and subclinical hypothyroidism, the therapeutic consideration should be aimed on reduction of
 progression to overt hypothyroidism, improving heart function, correction of dyslipidemia,
 and relieving senescence depressive mood. Thyroid ultrasonography will help us to keep long
 term observation of thyroid structural change. But long term outcome for treatment of such
 functional and structural thyroid diseases had not been recorded delicately in Taiwan.
 Further investigations should be observed in the future. The investigators hope to check the
 relationship between various thyroid diseases and biochemical survey/ultrasonography. The
 purpose of this study is aiming for early prevention and detection the potential risk factors
 for thyroid diseases in Taiwan.
Inclusion Criteria:

 -  diagnosed patients with autoimmune thyroid disease (subclinical hyperthyroidism,
 subclinical hypothyroidism)

 Exclusion Criteria:

 -  Unclearly diagnosed patients with autoimmune thyroid disease (subclinical
 hyperthyroidism, subclinical hypothyroidism)