Our results suggest that OCD is characterized by more gray matter in brain regions comprising cortical-striatal-thalamic-cortical circuits. These findings are consistent with functional neuroimaging studies reporting hypermetabolism and increased regional cerebral blood flow in striatal, anterior cingulate, and orbital frontal regions among OCD patients while in a resting state.

Objective: The association between established hypothyroidism and high cholesterol levels is well known. The aim of the present study was to investigate the effect of thyroxine (T 4 ) administration on cholesterol levels in hypercholesterolemic subjects with TSH levels within the normal range ('highnormal' TSH compared with 'low-normal' TSH). Design and Methods: We determined TSH levels in 110 consecutive patients referred for hypercholesterolemia (serum cholesterol >7.5 mmol/l). Those with 'high-normal' TSH (2.0-4.0 mU/ml) as well as those with 'low-normal' TSH (0.40-1.99 mU/ml) were randomly assigned to receive either 25 or 50 mg T 4 daily for two months. Thus, groups A and B (low-normal TSH) received 25 and 50 mg T 4 respectively and groups C and D (high-normal TSH) received 25 and 50 mg T 4 respectively. Serum T 4 , tri-iodothyronine (T 3 ), TSH, free thyroxine index, resin T 3 uptake and thyroid autoantibodies (ThAab) as well as total cholesterol, high and low density lipoprotein cholesterol (HDL, LDL), and triglycerides were determined before and at the end of the two-month treatment period. Results: TSH levels were reduced in all groups. The most striking effect was observed in group D (TSH levels before: 2.77 Ϯ 0.55, after: 1.41 Ϯ 0.85 mU/ml, P < 0:01). Subjects in groups C and D had a higher probability of having positive ThAabs. A significant reduction in total cholesterol (P < 0:01) and LDL (P < 0:01) was observed after treatment only in group D. In those subjects in group D who were ThAab negative, there was no significant effect of thyroxine on cholesterol levels. Conclusions: Subjects with high-normal TSH levels combined with ThAabs may, in fact, have subclinical hypothyroidism presenting with elevated cholesterol levels. It is possible that these patients might benefit from thyroxine administration.

This newly proposed measure addresses prior limitations in cultural competency measurement and may enhance future research by providing a standardized tool for use in multiple clinical and cultural contexts.

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