Autoimmune Thyroid Disorders In Patients Research Articles

8534 Comorbid Autoimmune Thyroid Disease in a Parent-Child Pair with Resistance to Thyroid Hormone Beta

Abstract Disclosure: A.H. Smith: None. E. Grethen: None. Resistance to Thyroid Hormone Beta (RTHβ) is an inherited disorder caused by mutations in the gene encoding the thyroid hormone receptor beta protein, resulting in decreased binding affinity to triiodothyronine in certain tissues. An asymptomatic individual with RTHβ may demonstrate abnormalities in serologic evaluation of thyroid hormone markers. When other thyroid pathologies present with RTHβ, however, the diagnosis and management can quickly become complex. Below we discuss two cases, a parent-child pair, with different presentations of presumably the same RTHβ gene. Patient 1 is a 61-year-old male with a history of autoimmune thyroiditis several years ago, presenting for continuation of care; he has had levothyroxine doses gradually uptitrated to over 3 mcg/kg to normalize TSH despite persistently high free T4 levels. He also has a family history notable for six out of seven siblings with autoimmune thyroid disease. Patient 2 is a 44-year-old male who was evaluated for hypothyroidism and difficulty with levothyroxine titration. Prior to consultation, he underwent radioactive iodine ablation for presumed Grave’s disease, followed by total thyroidectomy due to persistent symptoms. Post-operatively, he required high doses of levothyroxine to maintain normal TSH levels; however T4 and T3 levels remained high. Both patients confirmed proper levothyroxine supplementation. Further analysis of both patients demonstrated mildly elevated TBG and normal alpha subunit. Patient 2 pursued genetic testing while patient 1 declined, revealing a heterozygous R320S mutation in the TR-beta protein. Further testing and genetic counseling were offered to other family members. Propranolol and levothyroxine supplementation were titrated accordingly; triiodothyronine administration was attempted but did not alleviate symptoms. These two cases demonstrate the increased risk of autoimmune thyroid disorders in patients with RTHβ and the unique challenges they pose in accurate diagnosis. Autoimmune thyroiditis in RTHβ, with goiter, elevated T4 and elevated T3 levels, can be easily confused with Grave’s disease, especially when TSH is suppressed during active thyroiditis. Timely diagnosis can aid in targeted management of sequelae, prevent ineffective treatments for comorbid conditions which may mimic other diseases, and provide anticipatory/preventive guidance for family members to help with screening. Presentation: 6/1/2024

The role of autoimmune thyroid disorders in patients with alopecia areata

Objective: The aim of this study was to investigate the association of thyroid autoimmunity with alopecia areata (AA) by examining thyroid stimulating hormone (TSH) and thyroid autoantibody levels. In addition, to compare the epidemiologic data obtained with the data of our country. Methods: Our study was organized as a cross-sectional, retrospective study. The study was performed on patients between the ages of 2-65 years who were admitted to our outpatient clinic between 01.01.2008 and 31.12.2011, who were clinically or histopathological diagnosed with AA, examined for etiology and thyroid autoantibodies were requested. Patients under two years of age and over 65 years of age, patients with no thyroid autoantibodies and pregnant patients were excluded. Results were expressed as mean±standard deviation and median values. Mann-Whitney U test was used to compare TSH, anti-TG antibody (Anti-TG) and anti-TPO (Anti-TPO) antibody values in the variables of nail involvement, psychiatry, comorbidity and family history. Spearman correlation analysis was used to examine the relationships between age and disease duration and TSH, Anti-TPO and Anti-TG variables. Results: In our study, 65 (42.8%) of 152 patients were female and 87 (57.2%) were male. The ages of the patients ranged between 2-65 years and the mean age was 26.5±14.6 years. The mean age of females was 27.5±14.4 and 25.7±14.9 in males. Elevated thyroid autoantibodies were found in a total of 29 patients, 21 of whom were female and 8 of whom were male. Of these 29 patients, 10 had hypothyroidism, 2 had chronic thyroiditis and 3 had toxic multinodular goiter. 14 patients did not return after the examination at the internal medicine outpatient clinic, so the diagnosis of thyroid disease could not be reached. The mean TSH, Anti-TG and Anti-TPO values were 2.27±1.57, 29.2±99 and 71.5±2.2, respectively. When these values were analyzed separately as men and women, they were found to be 2.6±2.02, 41.8±1.23 and 134±2.8 in women and 1.99±1.03, 19.8±75.6 and 24.5±1.32 in men. There was a significant difference between men and women in terms of Anti-TG and Anti-TPO values (p=0.011 and p=0.001, respectively). A significant correlation was found between disease duration and Anti-TPO positivity (p=0.045); however, a similar relationship was not found between disease duration and Anti-TG positivity (p=0.34). Conclusions: As a result of this study, although there was a significant correlation between anti-TPO and duration of AA, the association between thyroid autoimmunity and AA was not found to be statistically significant. This may be due to the fact that humoral autoimmunity plays a role in thyroid autoimmunity and primarily cellular autoimmunity plays a role in AA. In addition, the epidemiologic data of our study were similar to the data of studies conducted in our country.

Study on Autoimmune Thyroid Disorders in Chronic Spontaneous Urticaria at a Tertiary Care Central Rural Hospital in India.

Background Chronic spontaneous urticaria (CSU) is a medical condition characterized by the persistence of urticaria for more than six weeks, primarily caused by mast cell activation. Autoimmune thyroid diseases (AITDs) are the most common cause of dysfunction of the thyroid gland, and they are influenced by both genetic and environmental factors. Mast cell mediators have a significant role in the pathogenesis of CSU through two main pathways: the derangement of intracellular signaling pathways in mast cells and basophils and the production of autoantibodies against these cells. This study aimed to explore the association between AITDs and CSU by examining clinical features and measuring thyroid hormones and anti-thyroid peroxidase (anti-TPO) antibodies in patients. Aim and objectives The primary aims of this study are to investigate the prevalence and clinical characteristics of autoimmune thyroid disorders in patients with chronic spontaneous urticaria. The specific objectives are to evaluate the triiodothyronine (T3), tetraiodothyronine (T4), thyroid-stimulating hormone (TSH), and anti-thyroid peroxidase (anti-TPO) antibody levels in patients and controls and to explore the correlations between these parameters and the development and severity of chronic spontaneous urticaria. Material and method The present study was an observational investigation that enrolled 40 patients, consisting of 20 cases and 20 controls. The inclusion criteria involved patients of both sexes, aged above 18 years, who had chronic spontaneous urticaria and agreed to participate in the study with informed consent. Patients with other skin conditions lacking abnormal thyroid etiopathogenesis were also included. Exclusion criteria included patients with major systemic disease, uncontrolled medical or surgical illness, renal or hepatic disorders, and pregnant or lactating females. Patients with chronic spontaneous urticaria underwent a comprehensive clinical evaluation, and their urticaria severity was scored using an established scoring system. Blood samples were collected from both cases and controls for measuring T3, T4, TSH, and anti-TPO antibody levels. The anti-TPO antibody was processed using the enzyme-linked immunosorbent assay (ELISA) method. The autoimmune thyroid disease was screened by monitoring T3, T4, TSH, and anti-TPO antibody levels. Results There were significant variations observed in thyroid-stimulating hormone and anti-thyroperoxidase antibody levels. Among the cases analyzed, 40% demonstrated an urticaria severity score of one, while 25% reported a duration exceeding eight weeks. Additionally, 25% of patients experienced severe pruritus and intense wheals. Conclusions This research has discovered a robust association between serum anti-TPOantibodies and the occurrence of chronic spontaneous urticaria. To mitigate the potential for chronic spontaneous urticaria to lead to long-term morbidity, it is imperative to consider testing for serum anti-TPO antibodies in conjunction with primary thyroid markers, including T3, T4, and TSH.

Study of gut microbiome in Egyptian patients with autoimmune thyroid diseases.

Hashimoto's thyroiditis (HT) and Graves' disease (GD) are the most prevalent forms of autoimmune thyroid disorders (ATD). A pathogenic link with gut microbial dysbiosis has been described in different autoimmune disorders but not yet fully elucidated in patients with ATD. The present study aimed to elucidate changes in gut microbiome in Egyptian patients with ATD. The gut bacterial composition of 20 patients with ATD and 30 age, sex, and BMI-matched healthy subjects as controls was analysed using Quantitative SYBR Green Real-Time PCR technique targeting 16S rRNA of selected bacterial genera and/or species. Compared with controls; the Firmictus/Bacteroidetes ratio (known to be representative for healthy status) was significantly decreased in patients with ATD (P<.001), without a significant difference between GD and HT patients. Also, the relative abundance of beneficial bacteria associated with the gut barrier and anti-inflammatory state; A. mucinophilia, Bifidobacterium, Lactobacillus, and F. prausnitzii, were decreased in ATD patients. TRAb in GD patients and anti-TPO in HT patients showed a significant positive correlation with Bacteroidetes (P=.001) and (P=.018), respectively. Egyptian patients with ATD show dysbiosis of the gut microbiome that can be related to the pathogenesis of ATD. This hopefully points to the potential therapeutic benefits of manipulating the composition of the gut microbiome in the management or even protection from ATD.

Frequency of autoimmune thyroid disorders in patients with psoriatic arthritis and effect of anti-TNF alpha treatment

Amaç: Bu çalışmada psöriatik artrit (PsA) hastalarında tiroid hastalığı sıklığı ve anti-TNF tedavinin otoimmun tiroid hastalığına olan etkisi araştırılmıştır..Gereç ve Yöntem: Romatoloji polikliniğinde PsA tanısıyla takip edilen 95 hastanın tiroid stimülan hormonu (TSH), triiyodotironin (sT3), tiroksin (sT4), antitiroglobulin (Tg) ve anti-tiroid peroksidaz (TPO) retrospektif olarak incelendi. Çalışmaya, verileri eksiksiz olan ve tiroid hastalığına yol olan sekonder nedeni olmayan 66 adet PsA (F / M: 43/23) ve 35 sağlıklı kontrol (F / M: 25/10) alındı. Tüm olgulara endokrinoloji uzmanı tarafından tiroid ultrasonografisi yapıldı.Bulgular: PsA hastalarından 38 tanesi hastalık modifiye edici antiromatizmal ajan (DMARD) tedavisi (Grup 1; ortalama yaş: 43.94 ± 9.81) ve 28 hasta anti-TNF-α tedavisi (Grup 2; ortalama yaş: 42.25 ± 11.48) alıyordu. Grup 3 sağlıklı kontrollerden oluşuyordu (yaş ortalaması: 40,52 ± 8,34). Tüm grupların ortalama anti-TPO değerleri ve anti-Tg değerleri arasında anlamlı farklılıklar gözlendi.Sonuç: PsA hastalarında otoimmün tiroid bozuklukları kontrol grubundan daha sık gözlendi. DMARD alan PsA hastalarında anti-TNF-α tedavisi alan hastalardan daha sık otoimmün tiroid bozuklukları görüldü. Bu durum tiroid bozukluklarının patogenezinde TNF-α nın rolü olabileceğini gösterdi.

Effect of Vitamin D Supplementation on Thyroid Autoimmunity among Subjects of Autoimmune Thyroid Disease in a Coastal Province of India: A Randomized Open-label Trial.

Objective:Hashimoto's thyroiditis (HT) is a variant of autoimmune thyroid disorders (AITD) which has been associated with vitamin D (vit-D) deficiency. However, whether vit-D supplementation is linked to reduction of thyroid autoantibodies and improvement of thyroid function is not well characterized. The present study was planned to evaluate the effect of vit-D supplementation on possible improvement of thyroid autoantibody titer and thyroid hormone profile in patients with AITD subjects.Methods:Twenty-three patients of HT were given weekly supplementation of 60,000 IU vit-D for 8 weeks followed by once a month for another 4 months. After 6 months of vit-D supplementation, thyroid autoantibody titer (TPO antibody) and thyroid hormone profile was rechecked.Results:Mean serum vit-D was increased significantly from 15.33 ± 5.71 to 41.22 ± 12.24 ng/mL (normal levels) after supplementation. There was significant increase in thyroid autoantibody titre (from 746.8 ± 332.2 to 954.1 ±4 59.8 IU/ml; P = 0.006) and TSH level (7.23 ± 3.16 to 3.04 ± 2.62 (mIU/L); P = 0.01) following 6 months of vit-D supplementation.Conclusion:Vitamin-D levels were low in AITD patients in eastern India and, its supplementation in HT patients increased thyroid antibody titer and there was significant reduction in serum TSH and increased in free T4.

The frequency of autoimmune thyroid disorders in patients with thyroid dysfunction in Erbil city

Background and objective: Thyroid disorders are one of the most frequent pathologies found in the general population, but identifying thyroid disease can be clinically challenging because subclinical thyroid dysfunction and autoimmune thyroiditis are often asymptomatic and usually diagnosed biochemically. This study aimed to distinguish the autoimmune thyroid diseases from other forms of thyroid dysfunctions in patients admitted to PAR hospital in Erbil city. Methods: blood was withdrawn from healthy subjects, and unhealthy patients suffer from thyroid dysfunction, their age and gender were recorded, and their blood serum were subjected to test the thyroid function antibodies including triiodothyronine T3, thyroxin T4, and thyroid stimulating hormone TSH. Also, autoimmune antibodies were tested including anti-thyroglobulin antibody (anti-TGA) and thyroperoxidase antibody (TPO antibodies). Results: no significant differences were shown in T3 levels while contrary highly significant differences were shown in T4, TSH anti-TGA and anti-TPO levels between healthy subjects and unhealthy patients groups. The percentages of autoimmune thyroid diseases were (45.2%) as compared to the other forms of thyroid dysfunctions (54.8%). Most of the patients were females in the age group 30-39 years. Conclusion: In Erbil city population/PAR hospital the prevalence of autoimmune thyroid diseases were more frequent among other thyroid diseases collectively. It is mostly found in females rather than males within the age group 30-39 years.

Pathogenic Th17 and Th22 cells are increased in patients with autoimmune thyroid disorders

To study the levels of pathogenic and non-pathogenic Th17 and Th22 cells in autoimmune thyroid disorders patients. Although Th17 cells seem to play an important role in the pathogenesis of thyroid autoimmune disorders, the specific subsets of these lymphocytes have not been analyzed in this condition. We assessed the levels of Th17 (pathogenic and non-pathogenic) and Th22 cells in peripheral blood and thyroid glands of autoimmune thyroid disorders patients (n = 26, 16 with Graves' disease and 10 with Hashimoto's thyroiditis) and 15 healthy controls by multi-parametric flow cytometry and immunofluorescence microscopy. We found increased levels of pathogenic Th17 lymphocytes and Th22 cells in peripheral blood from autoimmune thyroid disorders patients. In addition, these cells were detected in thyroid glands from HT patients. Furthermore, we found significant correlations between the levels of these cells and disease activity, disease duration, and the presence of ophthalmopathy. The increased levels of pathogenic Th17 lymphocytes and Th22 cells in autoimmune thyroid disorders suggest their involvement in the pathogenesis of this condition.

Increased incidence of autoimmune thyroid disorders in patients with psoriatic arthritis: a longitudinal follow-up study.

Contrasting results have been reported about the prevalence of thyroid autoimmunity (AT) and dysfunction (TD) in patients with psoriatic arthritis (PsA). In this study, we pointed to evaluate the incidence of new cases of clinical and subclinical TD in a broad group of patients with PsA versus a control group, matched by age and gender belonging to the same geographic area. PsA patients with TD were excluded firstly, and new cases of thyroid disorders were evaluated in 97 PsA patients and 97 matched controls, who had comparable iodine intake (median follow-up of 74months in PsA versus 92 in controls). A raised rate of new cases of hypothyroidism, TD, positive antithyroid peroxidase (AbTPO) antibodies, and appearance of a small hypoechoic thyroid pattern in PsA, especially in female gender, compared to controls has been evidenced. Risk factors in female gender for the development of TD are thyroid-stimulating hormone (TSH) within the normal range but at the higher limit, positive AbTPO, and small thyroid volume. To sum up, thyroid function follow-up and suitable treatments should be performed regularly in female patients at high risk (TSH within the normal range but at the higher limit, positive AbTPO, hypoechoic and small thyroid).

CCR5-Δ32 gene polymorphism is related to celiac disease and autoimmune thyroiditis coincidence in patients with type 1 diabetes

AimThe aim of the study was to assess the relationship between CCR5-Δ32 polymorphism and the coincidence of celiac and autoimmune thyroid diseases with type 1 diabetes mellitus (T1D) in children. Methods420 children with T1D aged 15.5±3.0years and 350 healthy controls were studied. Characterization of CCR5-Δ32 genotypes (rs333) was analyzed by polymerase chain reaction (PCR). ResultsThe allele frequency was significantly different in diabetic children as compared to the healthy controls (p<0.0001). We found negative association between T1D and Δ32 allele (OR=0.383; 95% CI=0.268–0.549). Besides, we observed alterations in the frequencies of CCR5-Δ32 genotypes due to celiac and autoimmune thyroid diseases. The risk of celiac disease for patient carriers of the 32-bp deletion was more than threefold higher than for noncarriers (OR=3.490; 95% CI=1.357–8.859; p=0.009). Similar results were obtained in the case of autoimmune thyroiditis. The risk of autoimmune thyroiditis for patient carriers of the 32-bp deletion was also more than threefold higher than for noncarriers (OR=3.466; 95% CI=1.754–6.849; p=0.0004). ConclusionsThe findings of our studies suggest that the CCR5-Δ32 polymorphism is associated with type 1 diabetes mellitus and the Δ32 allele increases the risk of celiac disease and autoimmune thyroid disorders in patients with T1D.

Anti-C1q autoantibodies are linked to autoimmune thyroid disorders in pregnant women.

Anti-C1q antibodies (anti-C1q) have been implicated in the pathogenesis of autoimmune diseases, including autoimmune thyroid disorders (AITD). The aim of this study was to evaluate the association between anti-C1q and thyroid function in pregnancy-associated AITD. In 96 pregnant women screened positive for AITD (thyroid dysfunction and/or antibodies against thyroperoxidase - TPOAb), anti-C1q were measured during the 9-11th gestational week and after delivery (median 16 months after delivery), and compared to the corresponding serum levels of thyroid hormones. As controls, 80 healthy pregnant women, 72 non-pregnant AITD patients and 72 blood donors were included. In the non-pregnant AITD group, two serum samples ≥6 months apart were analysed. Compared to blood donors, anti-C1q levels were substantially higher in all pregnant women analysed. In pregnancy, anti-C1q levels were higher in the TPOAb-positive women than in controls (37 versus 17·5%, P<0·0001). Anti-C1q-positive pregnant women screened positive for AITD had higher thyroid-stimulating hormone (TSH) levels than anti-C1q-negative women (2·41 versus 1·94 mU/l, P=0·01), and TSH correlated positively with anti-C1q (r=0·226, P=0·045) in the TPOAb-positive women. After delivery, serum levels of anti-C1q decreased in the positively screened TPOAb-negative women (8·8 versus 5·9 U/l, P=0·002), but not in the TPOAb-positive ones, and they no longer correlated with TSH. Anti-C1q antibody levels increase during pregnancy in general and even more in the context of AITD, where they correlate with thyroid stimulating hormone levels.

Vitamin D supplementation reduces thyroid peroxidase antibody levels in patients with autoimmune thyroid disease: An open-labeled randomized controlled trial.

Background and Aims:Although Vitamin D deficiency has been linked to autoimmune thyroid disorders (AITD), the impact of Vitamin D supplementation on thyroid autoimmunity is not known. This study aimed to evaluate the impact of Vitamin D supplementation on thyroid autoimmunity (thyroid peroxidase antibody [TPO-Ab] titers) in patients with newly diagnosed AITD in a randomized controlled trial.Materials and Methods:One hundred two patients with newly diagnosed AITD (TPO-Ab > 34 kIU/L and/or sonographic evidence of thyroiditis) patients were randomized into Group-1 (intervention group) and Group-2 (control group). Group-1 received cholecalciferol 60,000 IU weekly and calcium 500 mg/day for 8 weeks; Group-2 received calcium 500 mg/day for 8 weeks. Responders were defined as ≥25% fall in TPO-Ab titers. Individuals with at least 3-month follow-up were analyzed. Trial is registered at ctri.nic.in (CTRI/2015/04/005713).Results:Data from 100 AITD patients (68 with thyroid stimulating hormone [TSH] ≤10 mIU/L, 32 with TSH > 10 mIU/L), 93% having Vitamin D insufficiency, were analyzed. TPO-Ab titers were highest among patients in the lowest 25-hydroxyvitamin D quartile (P = 0.084). At 3 months follow-up, there was significant fall in TPO-Ab in Group-1 (−46.73%) as compared to Group-2 (−16.6%) (P = 0.028). Sixty-eight percentage patients in Group-1 were responders compared to 44% in Group-2 (P = 0.015). Kaplan–Meier analysis revealed significantly higher response rate in Group-1 (P = 0.012). Significantly greater reduction in TPO-Ab titers was observed in AITD with TSH ≤ 10 mIU/L compared to TSH > 10 mIU/L. Cox regression revealed Group-1 followed by TPO-Ab and free tetraiodothyronine levels to be a good predictor of response to therapy (P = 0.042, 0.069, and 0.074, respectively).Conclusion:Vitamin D supplementation in AITD may have a beneficial effect on autoimmunity as evidence by significant reductions in TPO-Ab titers.

Levels of regulatory T cells CD69(+)NKG2D(+)IL-10(+) are increased in patients with autoimmune thyroid disorders.

Regulatory T (Treg) cells play an important role in the pathogenesis of autoimmune thyroid disorders (AITD). New subsets of CD4(+)CD69(+) and CD4(+)NKG2D(+) T lymphocytes that behave as regulatory cells have been recently reported. The role of these immunoregulatory lymphocytes has not been previously explored in AITD. We analyzed by multi-parametric flow cytometry different Treg cell subsets in peripheral blood from 32 patients with AITD and 19 controls, and in thyroid tissue from seven patients. The suppressive activity was measured by an assay of inhibition of lymphocyte activation. We found a significant increased percentage of CD4(+)CD69(+)IL-10(+), CD4(+)CD69(+)NKG2D(+), and CD4(+)CD69(+)IL-10(+)NKG2D(+) cells, in peripheral blood from GD patients compared to controls. The increase in CD4(+)CD69(+)IL-10(+) and CD4(+)CD69(+)IL-10(+)NKG2D(+) T cells was especially remarkable in patients with active Graves' ophthalmopathy (GO), and a significant positive correlation between GO activity and CD4(+)CD69(+)IL-10(+) or CD4(+)CD69(+)IL-10(+)NKG2D(+) cells was also found. In addition, these cells were increased in patients with a more severe and/or prolonged disease. Thyroid from AITD patients showed an increased proportion of CD69(+) regulatory T cells subpopulations compared to autologous peripheral blood. The presence of CD69(+), NKG2D(+), and IL-10(+) cells was confirmed by immunofluorescence microscopy. In vitro functional assays showed that CD69(+) Treg cells exerted an important suppressive effect on the activation of T effector cells in controls, but not in AITD patients. Our findings suggest that the levels of CD69(+) regulatory lymphocytes are increased in AITD patients, but they are apparently unable to down-modulate the autoimmune response and tissue damage.

The evaluation of thyroid carcinoma in childhood and concomitance of autoimmune thyroid disorders.

Autoimmune thyroiditis has been suggested as a precancerous condition in some adult studies, but there is still controversy. The importance of autoimmune thyroiditis in childhood thyroid cancer is not yet completely clear. We aimed to evaluate in this study the characteristics of childhood thyroid cancer in patients particularly in terms of coexisting factors including autoimmune thyroid disorders (ATD). Twenty patients diagnosed with primary thyroid cancer were evaluated retrospectively in a Pediatric Endocrinology clinic for 10 years. Patients were followed up for 57.22±11 months. Concomitant conditions (thyroidal and/or extra thyroidal) were determined. Most of the patients (80%) had a coexisting factor. ATDs are the most frequently encountered among them (40%). The ages at the time of diagnosis were older; and the tumor sizes were smaller in patients with concomitant ATDs than without autoimmune thyroid disorders. The follow-up characteristics were similar in both groups. In conclusion, ATDs are frequently encountered in association with thyroid cancer during childhood and adolescence. A thyroid autoimmunity may facilitate the development of a malignant thyroid tumor; on the other hand, increased attention to the thyroid gland may facilitate frequent diagnosis of thyroid cancer. A close follow-up of ATD patients should also include the evaluation of the development of thyroid malignancy.

AB0576 The frequency of autoimmune thyroid disorders in patients with psoriatic arthritis and the effect of anti tnf-alpha treatment on autoimmune thyroid disease.

BackgroundPsoriatic Arthritis (PsA)is an inflammatory rheumatic disease accompanied by psoriasis. Coexistence of autoimmune thyroid disorders and rheumatic diseases such as Sjögren’s syndrome, systemic lupus erythematosus and rheumatoid arthritis has been...

Thyroid autoimmunity associated with recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS) is an autoimmune disorder characterized by the periodic appearance of aphthous lesions on the oral mucosa. TH1 cytokines plays a key role in the aetiopathogenesis. Autoimmune thyroid disease (ATD) is the most common autoimmune disease and is frequently accompanied by various other autoimmune diseases. To investigate the frequency of ATD which has not been studied in the patients with RAS. Ninety patients and 30 healthy volunteers were included into the study. The serum samples were assayed for thyroid stimulant hormone (TSH), free and total triiodothyronine (fT3, TT3), free and total thyroxine (fT4, TT4), thyroglobuline, anti-thyroid peroxidase antibody (anti-TPO) and anti-thyroglobuline antibody (anti-TG) levels. Thyroid ultrasonography was performed as well. In RAS patients, the fT3, TT3 levels were higher; whereas the fT4 levels were lower that the control group (P < 0.05). The anti-thyroid antibody was positive in 31.11% of the patients with RAS, and in only 10% of the individuals in the control group (P < 0.05). The mean anti-TG level was also higher in the RAS group. Ultrasonography revealed nodules in 28.8% of the patients with RAS and in 16.7% of the individuals in the control group (P < 0.05). The sT4 levels were lower and the TSH, anti-TPO and anti-TG levels were significantly higher in the RAS patients with thyroid nodules than the RAS patients without nodules (P < 0.05). These results may be related to either the advance age of the patients or the increased duration of the autoimmune activation which may affect the thyroid. The frequency of thyroid autoimmune-related problems was higher in patients with RAS. It would be worthy of searching autoimmune thyroid disorders in patients with RAS.

Role of Renal Anemia in the Functional, Morphological and Autoimmune Thyroid Disorders in patients on Chronic Hemodialysis

Thyroid disorders are common in chronic kidney disease. The aim of this study was to examine the role of renal anemia on thyroid function, morphology and autoimmunity in clinically euthyroid patients on chronic hemodialysis (HD). Prospective study during 12 months period included 40 stable patients on chronic HD treatment. Patients were divided into two groups according to the serum hemoglobin level (group A Hgb > 125 g / L and group B Hgb < 125 g / L). Blood samples were taken for determination total and free thyroid hormones, thyroid antibodies and standard biochemical tests. Thyroid ultrasonography was performed with a 7.5 MHz transducer, 50 mm linear transducer. Thyroid volume was calculated, echostructure assessed and presence of nodular changes. In group A, was found significantly lower levels of total T3 (1.29 +/- 0469 vs. 1.55 +/- 0352, p < 0.1); higher prevalence of low T3 syndrome (17.24% (n = 5) vs. 0.00 (n = 0), p < 0.05); ultrasound findings suggestive for Hashimoto thyroiditis (13.79 (n = 4) vs. 0.00% (n = 0), p < 0.05) and multinodular goiter (13.79% (n = 4) vs. 0.00% (n = 0), p < 0.05). We found no statistically significant difference in the mean values of of thyroid antibodies levels, as well as in their percentage representation among groups. Morphological, functional and autoimmune disorders of thyroid gland are more common in patients on HD with Hgb level < 125 g/L. These findings suggest a role of renal anemia in the pathogenesis of these, and need for periodical screening of thyroid function, morphology, and titer of thyroid antibodies in patients HD, as well as more effective diagnosis and more aggressive treatment of renal anemia.

Thyroid dysfunction in patients with hepatitis C on IFN-α therapy

IFN-α therapy for hepatitis C is associated with a high prevalence of thyroid dysfunction, which is often irreversible. Two studies have recently investigated the role of HCV, PEG-IFN-α and ribavirin in the development of autoimmune thyroid disorders in patients with hepatitis C on antiviral treatment.

Increased risk of thyroid pathology in patients with thyroid hemiagenesis: results of a large cohort case–control study

Thyroid hemiagenesis (THA) is an anomaly resulting from the developmental failure of one thyroid lobe. Etiopathogenesis, clinical significance, and management of patients in whom THA is diagnosed are still a matter of debate. The aim of the study is to provide the first systematic analysis of a large cohort of subjects with THA. Forty patients with THA are described in comparison to a control group of 80 subjects with fully developed thyroid gland. Serum concentrations of thyrotropin (TSH), free thyroxine (FT(4)), free triiodothyronine (FT(3)), and thyroid autoantibodies were measured. In 37 patients, thyroid ultrasonography and Tc-99m thyroid scintiscan were performed, followed by fine-needle aspiration biopsy if indicated. The remaining archival three cases were diagnosed with the use of I-131 scintiscan under basal conditions and after TSH stimulation. Patients with THA, while usually clinically euthyroid, presented with significantly higher levels of TSH and FT(3) as well as with higher FT(3)/FT(4) concentration in comparison to the control group. Furthermore, a higher incidence of associated functional, morphological, and autoimmune thyroid disorders in patients with THA was observed when compared to subjects with bilobate thyroid (P<0.05). Our results revealed that individuals with THA are more likely to develop thyroid pathology. The observed high incidence of associated pathologies is presumably due to long-lasting TSH overstimulation. Therefore, THA diagnosis should be followed by systematic observation and adequate levothyroxine treatment in patients with elevated TSH level.

Autoimmune thyroid disorders in patients with psoriasis

A few studies have shown a high prevalence of thyroid autoimmunity in patients with psoriatic arthritis. However, thyroid autoimmunity has not been investigated in patients with psoriasis who do not have psoriatic arthritis. We aimed to investigate thyroid autoimmunity in patients with psoriasis. The study included 105 consecutive patients with psoriasis who did not have psoriatic arthritis and a sex and age matching control group consisting of 96 patients with tinea pedis. All of the patients with psoriasis were examined dermatologically and PASI scores were calculated for each patient. Free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), antithyroglobulin (AbTG), and antithyroidperoxidase antibody (AbTPO) levels were measured in all of the subjects. The levels of TSH, FT3, FT4, AbTG and AbTPO and ultrasonographic findings of thyroid gland were compared statistically between psoriasis and control groups. Also, the levels of TSH, FT3, FT4, AbTG and AbTPO of psoriasis patients were compared with PASI scores. Mann-Whitney U test was used as statistical method. The mean age of patients with psoriasis was 40.54 +/- 16.91 years. 56 patients were female, 49 were male. The levels FT4 were found to be significantly increased in the patient group. But levels of AbTPO and AbTG were not statistically different between the two groups. The patients who had thyroiditis plus nodules in thyroid ultrasonography had statistically longer disease periods. This is the first study that investigated autoimmune thyroid disorders in patients with psoriasis who did not have arthritis. We believed that thyroid autoimmunity in patients with psoriasis was no different from that found in healthy individuals.