الفهرس 
Introduction & Aim of the workOnly 14 pages are availabe for public view
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Abstract
In hypothyroidism patients, atherosclerosis risk aspects such as elevated blood pressure, elevated hsCRP levels. and changes in the coagulation system, dysfunction of endothelium and increase arterial stiffness and thermogenic lipid profile are also existing.
When studying the different clinical parameters and comparing it between the study groups, we found that BMI was higher in patients with OH group than those with SCH and control group .When comparing the change occurred in BMI after treatment with Levothyroxine therapy in both OH and SCH group, we found a significant difference before and after treatment. We also found a significant difference in the values of waist circumference and hip circumference before and after treatment in SCH group only. As regard as SBP, we found a significant difference in its values in OH group before and after treatment. Also, we found a significant difference in the level of hsCRP between control, SCH and OH groups. We found a significant difference between level of serum insulin in control group and SCH group. We found also a statistically significant difference between control group and SCH group as regard level of HOMA-IR.
Moreover, we compared MPI in three groups of OH, SCH and control group. The new in our study that we found improvement in parameters of MPI in both OH and SCH groups after 6 months of treatment with Levothyroxine therapy .Also there was improvement in EF% post treatment with Levothyroxine in both OH group and SCH .Also, we did not find any significant differences in values of IVS d, LAD, AOD and E/A in both hypothyroidism group and control group. LV systolic function is usually subnormal in hypothyroid patients as demonstrated by slightly reduced values of ejection fraction and stroke volume. Also, we noticed that values of E/A, e septal, e lateral, LV mass, IVRT, IVCT and ASI were high in OH groups than SCH and control group and this was statistically significant. Our study noticed statistically significant difference in diastolic dysfunction between OH, SCH and control group, we found DD grade 1 in 44.4% of patients with SCH group who improved all after treatment .We found increase in ASI in OH group in comparison to SCH and control group and this change was statistically significant with P value< 0.001 between three groups. ASI improved after treatment with levothyroxine therapy in OH and SCH group. ASI in SCH patients decreased and the change of ASI post treatment ,but the change of ASI after treatment in comparison to pre-treatment was not statistically significant.
When studying the relationship between hypothyroidism and atherosclerosis in our study as regard to values of CIMT and FMD on duplex study, we found that there was a statistically significant difference between values of CIMT in mm between OH , SCH and control group before treatment with L-thyroxine therapy .After six months therapy with L-thyroxine, there was a significant change in values of CIMT in both OH and SCH. We found a significant reduction in values of lipid profile after six months therapy with Lthyroxine in both OH groups and SCH groups .
When studying the level of ANGPTL8, we found significant differences between overt hypothyroidism patients, SCH patients and healthy control subjects. When studying the change occurred in level of ANGPTL8 after levothyroxine therapy in both OH and SCH groups, we found a statistically significant differences after treatment in both groups. When studying the effect of replacement therapy with L- thyroxine on serum level of TPO Ab in both OH group and SCH group we did not find any statistically significant difference before and after treatment in both groups. Also, we found a significant difference in levels of VWF being the lowest in OH groups than SCH groups and the highest in control group. Also, a significant improvement in the level of VWF was noticed in SCH groups after L-thyroxine treatment for 6 months .In our study after doing multiple linear regression for prediction of pre-treatment ANGPTL3 (dependent variable) , we found only significant negative association with age as in dependent variable associated with ANGPTL3 pre-treatment .Also after doing multiple stepwise linear regression for prediction of pretreatment ANGPTL3,we found pre-treatment free T4 as independent variables associated with pre-treatment ANGPTL3.
After doing multiple linear regression for prediction of pre-treatment ANGPTL8 and multiple stepwise linear regression, we found only pre-treatment free T3 as independent variables associated with pre-treatment ANGPTL8.When studying prediction of ANGPTL3 posttreatment using multiple regression , analysis , we found that posttreatment DBP , VWF post treatment and post treatment MPI as predictors of ANGPTL3 posttreatment. As regard as ANGPTL4 post treatment, by using multiple regression, analysis for predictors of ANGPTL4 , we found that VWF post treatment ,WHR post treatment and post treatment ASI as predictors of ANGPTL4 posttreatment. As regard ANGPTL8 post treatment, we found only post treatment MPI as predictors after doing multiple step wise linear regression by using multiple regression, analysis for predictors of ANGPTL4, we found that VWF post treatment .We did not find any studies for comparison as regard post treatment ANGPTL3,4,8 predictors.
When doing the ROC curve analysis for evaluation of diagnostic performance of ANGPTL3, 4, 8 in discriminating thyroid dysfunction. As regard ANGPTL3, The AUC of these markers was (0.993 at cut off value > 26 mmol / L, sensitivity was (100 % , specificity was 94.44 %).For ANGPTL4, The AUC was (1 at cut off value > 1.4, sensitivity was 100, specificity was 100 %).For ANGPTL8, The AUC was (1 at cut off value > 213, sensitivity was 100 % , specificity was 100 %).
We concluded that:
-Significant difference in the level of hsCRP was present between control, SCH and OH groups.
-Significant difference was present between level of serum insulin and HOMAIR in control group and SCH group.
-We found that the values of MPI were higher in OH, SCH patients compared to control group. Also, there was an improvement in parameters of
MPI in both OH and SCH groups after 6 months of treatment with Levothyroxine therapy. Also, we noticed that LVEF was higher in control group compared to OH group.
-Significant difference in LVDD was present between OH , SCH and control group.
-When studying the relationship between hypothyroidism and atherosclerosis in our study as regard to values of CIMT on duplex study, we found that there was a statistically significant difference between values of CIMT in mm between OH , SCH and control group before treatment with L-thyroxine therapy also, there was a significant improvement in values of CIMT in both OH and SCH group after six months with L-thyroxine therapy.
-When doing the ROC curve analysis for evaluation of diagnostic performance of ANGPTL3, 4, 8 in discriminating thyroid dysfunction. As regard ANGPTL3, The AUC was (0.993 at cut off value > 26 mmol / L, sensitivity was (100 %, specificity was 94.44 %). For ANGPTL4, The
AUC was (1 at cut off value > 1.4, sensitivity was 100, specificity was
100 % ). For ANGPTL8, The AUC was (1 at cut off value > 213, sensitivity was 100 % , specificity was 100%). That means the possibility of using ANGPTL3,4,8 in discriminating patients with hypothyroidism.
- Improvement in parameters of metabolic syndrome and hyperlipidemia after six months of levothyroxine therapy in hypothyroidism patients.