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Till Ittermann Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany

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Rehman Mehmood Khattak Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
Department of Zoology, Islamia College Peshawar (CU), Peshawar, Pakistan

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Marcello R P Markus Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany

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Jens-Peter Kühn Institute of Radiology, University Hospital, Carl-Gustav-Carus University, Dresden, Germany

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Marie-Luise Kromrey Department of Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany

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Giovanni Targher Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy

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Antje Steveling Department of Internal Medicine A, University Medicine Greifswald, Greifswald, Germany

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Matthias Nauck Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine, Greifswald, Germany

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Henry Völzke Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany

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inconsistent findings regarding the association between subclinical or overt primary hypothyroidism and NAFLD ( 2 , 3 ). While a significant positive association was reported between variably defined hypothyroidism and NAFLD in one meta-analysis ( 3 ), no

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Natércia Neves Marques de Queiroz University Hospital João de Barros Barreto, Federal University of Pará, Endocrinology Division, Belem, Pará, Brazil

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Franciane Trindade Cunha de Melo University Hospital João de Barros Barreto, Federal University of Pará, Endocrinology Division, Belem, Pará, Brazil

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Fabrício de Souza Resende University Hospital João de Barros Barreto, Federal University of Pará, Endocrinology Division, Belem, Pará, Brazil

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Luísa Corrêa Janaú University Hospital João de Barros Barreto, Federal University of Pará, Endocrinology Division, Belem, Pará, Brazil

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Norberto Jorge Kzan de Souza Neto University Hospital João de Barros Barreto, Federal University of Pará, Endocrinology Division, Belem, Pará, Brazil

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Manuela Nascimento de Lemos University Hospital João de Barros Barreto, Federal University of Pará, Endocrinology Division, Belem, Pará, Brazil

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Ana Carolina Lobato Virgolino University Hospital João de Barros Barreto, Federal University of Pará, Endocrinology Division, Belem, Pará, Brazil

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Maria Clara Neres Iunes de Oliveira University Hospital João de Barros Barreto, Federal University of Pará, Endocrinology Division, Belem, Pará, Brazil

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Angélica Leite de Alcântara University Hospital João de Barros Barreto, Federal University of Pará, Endocrinology Division, Belem, Pará, Brazil

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Lorena Vilhena de Moraes University Hospital João de Barros Barreto, Federal University of Pará, Endocrinology Division, Belem, Pará, Brazil

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Tiago Franco David University Hospital João de Barros Barreto, Federal University of Pará, Endocrinology Division, Belem, Pará, Brazil

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Wanderson Maia da Silva University Hospital João de Barros Barreto, Federal University of Pará, Endocrinology Division, Belem, Pará, Brazil

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Scarlatt Souza Reis University Hospital João de Barros Barreto, Federal University of Pará, Endocrinology Division, Belem, Pará, Brazil

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Márcia Costa dos Santos University Hospital João de Barros Barreto, Federal University of Pará, Endocrinology Division, Belem, Pará, Brazil

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Ana Carolina Contente Braga de Souza University Hospital João de Barros Barreto, Federal University of Pará, Endocrinology Division, Belem, Pará, Brazil

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Pedro Paulo Freire Piani University Hospital João de Barros Barreto, Federal University of Pará, Endocrinology Division, Belem, Pará, Brazil

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Neyla Arroyo Lara Mourão University Hospital João de Barros Barreto, Federal University of Pará, Endocrinology Division, Belem, Pará, Brazil

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Karem Mileo Felício University Hospital João de Barros Barreto, Federal University of Pará, Endocrinology Division, Belem, Pará, Brazil

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João Felício Abrahão Neto University Hospital João de Barros Barreto, Federal University of Pará, Endocrinology Division, Belem, Pará, Brazil

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João Soares Felício University Hospital João de Barros Barreto, Federal University of Pará, Endocrinology Division, Belem, Pará, Brazil

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to determine the most accurate vitamin D level to predict subclinical hyperparathyroidism (SHT). The cut-off point with maximum sensitivity and specificity in the ROC curve was defined as the minimum value in the equation ((1 − sensitivity) 2  + (1

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Signe Frøssing Department of Internal Medicine, Center of Endocrinology and Metabolism, Herlev Gentofte Hospital, Copenhagen, Denmark
Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark

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Malin Nylander Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
Department of Obstetrics & Gynecology, Herlev Gentofte Hospital, Copenhagen, Denmark

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Caroline Kistorp Department of Internal Medicine, Center of Endocrinology and Metabolism, Herlev Gentofte Hospital, Copenhagen, Denmark
Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark

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Sven O Skouby Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
Department of Obstetrics & Gynecology, Herlev Gentofte Hospital, Copenhagen, Denmark

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Jens Faber Department of Internal Medicine, Center of Endocrinology and Metabolism, Herlev Gentofte Hospital, Copenhagen, Denmark
Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark

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that target the metabolic aspect of PCOS are available. As most PCOS patients are in the reproductive age and thus rather young, they rarely present with overt CVD; as a result, biomarkers of subclinical and early dysfunction of the heart and vascular

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Ayse Nurcan Cebeci Paediatric Endocrinology, Department of Friedrich-Alexander University Hospital, Erlangen, Germany

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Vera Schempp Paediatric Endocrinology, University Hospital, Bonn, Germany

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Katharina Förtsch Paediatric Endocrinology, University Hospital, Düsseldorf, Germany

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Bettina Gohlke Paediatric Endocrinology, University Hospital, Bonn, Germany

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Michaela Marx Paediatric Endocrinology, Department of Friedrich-Alexander University Hospital, Erlangen, Germany

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Helmuth-Guenther Dörr Paediatric Endocrinology, Department of Friedrich-Alexander University Hospital, Erlangen, Germany

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Joachim Woelfle Paediatric Endocrinology, Department of Friedrich-Alexander University Hospital, Erlangen, Germany

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of 700 births in the USA ( 2 ). Patients with DS are at an increased risk of thyroid dysfunction, with overt or subclinical hypothyroidism being the most common, with an estimated frequency of 400 to 1950 in 10,000 ( 3 ). Although the incidence of GD

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Hershel Raff Division of Endocrinology, Division of Nephrology, Endocrine Research Laboratory, Department of Medicine
Division of Endocrinology, Division of Nephrology, Endocrine Research Laboratory, Department of Medicine
Division of Endocrinology, Division of Nephrology, Endocrine Research Laboratory, Department of Medicine
Division of Endocrinology, Division of Nephrology, Endocrine Research Laboratory, Department of Medicine

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Hariprasad Trivedi Division of Endocrinology, Division of Nephrology, Endocrine Research Laboratory, Department of Medicine

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Objective

Patients with end-stage renal disease (ESRD) can display the features of endogenous hypercortisolism but are difficult to evaluate for Cushing's syndrome. We evaluated the circadian rhythm of plasma compared with salivary cortisol in subjects with ESRD.

Design

Plasma and salivary cortisol and plasma ACTH samples were drawn frequently over 24 h in an inpatient research unit in stable ESRD subjects on daytime chronic hemodialysis (n=16) vs controls (n=8).

Methods

Plasma cortisol was measured every 2 h from 0800 to 0600 h the following day. Salivary cortisol was measured every 2 h, except between 2400 and 0400 h (sleep time). Plasma ACTH measured in a subset of samples and C-reactive protein (CRP) was measured as a marker of a subclinical inflammatory state in all subjects.

Results

ESRD subjects had a discernable circadian rhythm in plasma and salivary cortisol, but with a significantly higher nadir (1800–2400 h) compared with the controls (P=0.016–<0.001). After excluding four ESRD subjects without a normal circadian rhythm, the ESRD subjects still had higher nadir plasma and salivary cortisol and plasma ACTH compared with controls. There was no difference in the correlation of salivary and plasma cortisol in control vs ESRD subjects. ESRD subjects had higher CRP levels compared with controls.

Conclusions

ESRD subjects had increased late-night plasma and salivary cortisol and plasma ACTH levels. Late-night salivary cortisol is a reliable index of plasma cortisol in ESRD patients.

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Tal Almagor T Almagor, Pediatric Endocrine Unit, Haemek Medical Center, Afula, Israel

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Shlomo Almashanu S Almashanu, The national Newborn Screening program, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel

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Ghadir Elias Assad G Assad, Pediatric Endocrinology, Clalit Health Services, Nazareth, Israel

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Osnat Admoni O Admoni, Pediatric Endocrinology, Clalit Health Services, Afula, Israel

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Hanna Ludar H Ludar, Pediatric Health Center, Clalit Health Services, Haifa, Israel

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Shira London S London, Pediatric Health Center, Clalit Health Services, Haifa, Israel

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Shoshana Rath S Rath, Pediatric Health Center, Clalit Health Services, Tiberias, Israel

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Alina German A German, Pediatric Endocrine Institute, Haemek Medical Center, Afula, Israel

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Naama Schwartz N Schwartz, School of Public Health, Carmel Medical Center, Haifa, Israel

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Yardena Tenenbauim Rakover Y Rakover, Pediatric Endocrinology, Clalit Health Services, Afula, Israel

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Objectives: The incidence of congenital hypothyroidism (CH) has increased worldwide over the last decades mainly due to the lowering of screening thresholds, resulting in an increased identification of newborns with transient CH. Several studies reported the prevalence and the predictive parameters of transient CH but reports on the long-term outcome are rare. This study aimed to assess the long-term course of neonates with transient CH.

Design: Neonates diagnosed with transient and permanent CH between the years 1998 to 2018 at the Pediatric Endocrine Institute of Ha'Emek Medical Center were enrolled in the study. Data were retrieved retrospectively from medical files.

Results: Included in the study were 76 newborns (45M,59%) with transient CH and 53 (25M,47%) with permanent CH. The major cause of transient CH was prematurity (29%) and subclinical hypothyroidism (30%). During retrospective follow-ups of up to 23 years, reinitiation of LT4 therapy was not required apart from four patients with underlying syndromic etiologies. Neurodevelopmental impairment occurred in 16% of children with transient CH compared with 29.4% in the permanent CH group.

Conclusions: Transient CH is frequent among preterm infants but is limited to infancy. SCH frequently presents as overt hypothyroidism at birth but in most cases the requirement for LT4 supplemental therapy is limited to the first years of life, suggesting that long-term follow-up of thyroid function tests may be unnecessary for non-syndromic children. The high rate of neurodevelopmental impairment in newborns with transient CH emphasizes the need for neurodevelopmental monitoring in these patients.

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Giorgio Radetti Pediatrics, Regional Hospital, Bolzano, Italy

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Mariacarolina Salerno Pediatrics, University Federico II, Naples, Italy

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Chiara Guzzetti Pediatric Endocrinology, Ospedale Pedatrico Microcitemico ‘A. Cao’ – AOB Cagliari, Cagliari, Italy

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Marco Cappa Pediatric Endocrinology, Bambino Gesù Children Hospital, Roma, Italy

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Andrea Corrias Divisione di Endocrinologia Pediatrica, Ospedale Infantile Regina Margherita, Torino, Italy

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Alessandra Cassio Department of Pediatrics, University of Bologna, Bologna, Italy

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Graziano Cesaretti Department of Pediatrics, University of Pisa, Pisa, Italy

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Roberto Gastaldi Paediatric Department, Gaslini Hospital, Genova, Italy

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Mario Rotondi Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri I.R.C.C.S., ISPESL Laboratory for Endocrine Disruptors, University of Pavia, Pavia, Italy

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Fiorenzo Lupi Pediatrics, Regional Hospital, Bolzano, Italy

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Antonio Fanolla Department of Biostatistics, Regional Hospital, Bolzano, Italy

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Giovanna Weber Department of Pediatrics, Vita-Salute San Raffaele University, Milan, Italy

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Sandro Loche Pediatric Endocrinology, Ospedale Pedatrico Microcitemico ‘A. Cao’ – AOB Cagliari, Cagliari, Italy

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started in patients with either subclinical (high TSH with normal fT4) or overt hypothyroidism (subnormal fT4 and increased TSH). There is no consensus on the timing to start or discontinue therapy based on TSH concentrations in children and adolescents

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Elena Izkhakov Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel

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Joseph Meyerovitch Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Community Division, Clalit Health Services, Tel Aviv, Israel
The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel

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Micha Barchana School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel

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Yacov Shacham Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

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Naftali Stern Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

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Lital Keinan-Boker School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
National Cancer Registry, Israel Center for Disease Control, Ministry of Health, Israel, Ramat Gan, Israel

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benign disease ( 23 ). TSH suppression therapy caused a state of subclinical hyperthyroidism and is a part of TC treatment. The current study does not have any data on the exact dosages of levothyroxine or the TSH-suppressive levels that were achieved

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Dimitra Argyro Vassiliadi Department of Endocrinology Diabetes and Metabolism, National Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece

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Ioannis Ilias Department of Endocrinology Diabetes and Metabolism, Elena Venizelou Hospital, Elena Venizelou Square, Athens, Greece

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Maria Pratikaki 1st Department of Critical Care & Pulmonary Services, Medical School National & Kapodistrian, Evangelismos Hospital, University of Athens, Athens, Greece

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Edison Jahaj 1st Department of Critical Care & Pulmonary Services, Medical School National & Kapodistrian, Evangelismos Hospital, University of Athens, Athens, Greece

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Alice G Vassiliou 1st Department of Critical Care, GP Livanos & M Simou Laboratories, Medical School National & Kapodistrian, Evangelismos Hospital, University of Athens, Athens, Greece

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Maria Detsika 1st Department of Critical Care, GP Livanos & M Simou Laboratories, Medical School National & Kapodistrian, Evangelismos Hospital, University of Athens, Athens, Greece

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Kleio Ampelakiotou Department of Immunology and Histocompatibility Evangelismos Hospital, Athens, Greece

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Marina Koulenti Department of Endocrinology Diabetes and Metabolism, National Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece

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Konstantinos N Manolopoulos Department of Endocrinology Diabetes and Metabolism, National Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece

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Stamatis Tsipilis 1st Department of Critical Care & Pulmonary Services, Medical School National & Kapodistrian, Evangelismos Hospital, University of Athens, Athens, Greece

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Evdokia Gavrielatou 1st Department of Critical Care & Pulmonary Services, Medical School National & Kapodistrian, Evangelismos Hospital, University of Athens, Athens, Greece

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Aristidis Diamantopoulos Department of Endocrinology Diabetes and Metabolism, National Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece

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Alexandros Zacharis 1st Department of Critical Care & Pulmonary Services, Medical School National & Kapodistrian, Evangelismos Hospital, University of Athens, Athens, Greece

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Nicolaos Athanasiou 1st Department of Critical Care & Pulmonary Services, Medical School National & Kapodistrian, Evangelismos Hospital, University of Athens, Athens, Greece

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Stylianos Orfanos 2nd Department of Critical Care Medical School National & Kapodistrian University of Athens Attikon University Hospital, Athens-Haidari, Greece

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Anastasia Kotanidou 1st Department of Critical Care & Pulmonary Services, Medical School National & Kapodistrian, Evangelismos Hospital, University of Athens, Athens, Greece

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Stylianos Tsagarakis Department of Endocrinology Diabetes and Metabolism, National Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece

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Ioanna Dimopoulou 1st Department of Critical Care & Pulmonary Services, Medical School National & Kapodistrian, Evangelismos Hospital, University of Athens, Athens, Greece

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Groups n Low/suppressed TSH NTIS Overt and subclinical thyrotoxicosis Overt and subclinical hypothyroidism Other findings July Sun et al. Retrospective 336 Unselected COVID-19 + 336 NR NR NR NR Lower TSH levels

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Grethe Å Ueland Department of Clinical Science, University of Bergen, Bergen, Norway
Department of Medicine, Haukeland University Hospital, Bergen, Norway

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Thea Grinde Department of Clinical Science, University of Bergen, Bergen, Norway

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Paal Methlie Department of Clinical Science, University of Bergen, Bergen, Norway
Department of Medicine, Haukeland University Hospital, Bergen, Norway
K. G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway

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Oskar Kelp Department of Medicine, Akershus University Hospital, Nordbyhagen, Norway

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Kristian Løvås Department of Medicine, Haukeland University Hospital, Bergen, Norway
K. G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway

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Eystein S Husebye Department of Clinical Science, University of Bergen, Bergen, Norway
Department of Medicine, Haukeland University Hospital, Bergen, Norway
K. G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway

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subclinical CS, ACS has a much higher prevalence than overt CS, affecting up to 2% of the adult population ( 3 ). Despite the suspected link between subclinical and overt CS, evidence suggests that progression to overt CS is rare ( 1 ). Even though typical

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