Basedow-Graves Disease Research Articles

HLA Class II Allele Groups Involved in Autoimmune Thyroid Diseases: Hashimoto's Thyroiditis and Basedow-Graves Disease.

Autoimmune thyroid diseases (AITD), particularly Hashimoto's thyroiditis (HT) and Basedow-Graves disease (BGD) are diseases of global public health concern, characterized by autoimmune attacks on the thyroid gland, leading to hypothyroidism in HT and hyperthyroidism in BGD. We conducted a study between 2019 and 2021 in northwestern Transylvania (Romania) on patients with HT and with BGD compared to the control group. The aim of the study was to investigate the correlations of HLA class II alleles with AITD by identifying potential genetic susceptibility factors such as HLA-DRB1 and HLA-DQB1 genes in patients diagnosed with HT and BGD. Various molecular biology methods, including SSP-PCR low-resolution and PCR-SSO were employed to analyze DNA samples from patients and control subjects. Our study revealed the influence of the HLA-DRB1*03/*16 genotype as a genetic susceptibility factor for HT, a similar influence regarding BGD being observed for the HLA-DRB1*03 allele group, DRB1*03/*16 genotype, and the DRB1*03/DQB1*06 haplotype. The only protective factor detected in our study was the HLA-DRB1*13 allele group, for both HT and BGD. By elucidating any specific allele or genotype associations that might contribute to the development of AITD, our study can contribute to the prevention and early detection of these diseases.

637-P: The Impact of the Lockdown on Romanian Patients with Type 1 Diabetes and Basedow-Graves’ Disease

Introduction: The lockdown imposed in Romania to limit the spread of COVID-infection has led to socio-psychological changes, especially stress affecting the endocrine system. Objectives: Monitoring the impact of the lockdown imposed in Romania on patients with type 1 diabetes (DM 1) and compensated Basedow-Graves’ disease (BGD) , in treatment with antithyroid drugs (AD) . Material and Method: This retrospective observational study included 151 patients with DM 1 and BGD and was based on an original questionnaire published online with questions about blood glucose, HbA1c, and TSH, diabetologist and endocrinologist contact, access to treatment, and factors influencing the glycemic control. Results: We observed that 71.52% reported that they were afraid to go to the hospital when their general condition was altered (p <0.001) , and 80.13% stated that the stress increased during the restrictions (p <0.001) . A percent of 68.87% felt overwhelmed by the multitude of information about their disease, which they had to manage on their own (p˂0.001) . However, 67.54% of patients stated that they were able to contact the diabetologist and endocrinologist more often, via telemedicine (p˂0.001) and only 37.74% agreed that they did not encounter difficulties in managing type 1 diabetes during the pandemic, compared to 25.16% who had difficulties. Also, 33.77% of patients had decompensations of BGD, although initially the TSH value was within normal limits under treatment with AD. Conclusions: Stress and anxiety were among the main causes that led to increased blood sugar levels and decompensation of BGD, suggesting that the psychological impact of the pandemic could bring long-term complications.

Clinical features of patients with Basedow Graves disease seen at a university hospital

Basedow Graves disease (BGD) is the leading cause of hyperthyroidism. The characteristics of patients seen at a university hospital may differ from those described in the general population. To describe the clinical features of patients with BGD seen at a university hospital. Review of medical records of all patients seen at our hospital between 2009 and 2014 with the diagnosis of thyrotoxicosis, hyperthyroidism or BGD. Clinical features, laboratory results and treatments were recorded. We reviewed clinical records of 272 patients; 15 had to be excluded due to incomplete data. BGD was present in 77.9% (n = 212). The mean age of the latter was 42 years (range 10-81) and 76% were women. Ninety six percent were hyperthyroid at diagnosis and thyroid stimulating hormone was below 0.1 mIU/L in all patients. Median free thyroxin and triiodothyronine levels were 3.26 ng/dl and 3.16 ng/ml, respectively. Thyrotropin-receptor antibodies were positive in 98.5% and 85.7% had positive thyroid peroxidase antibodies. Graves orbitopathy (GO) was clinically present in 55% of patients. Of this group, 47% had an active GO, 26% had a moderate to severe disease and 7.8% had sight-threatening GO. As treatment, 26% received radioiodine, 44% anti-thyroid drugs exclusively, 28% underwent thyroidectomy and 2% did not require therapy. In this group of patients, we observed a greater frequency of severe eye disease and a high rate of surgical management. This finding could be explained by referral to highly qualified surgical and ophthalmological teams.

Epidemiological, clinical, therapeutic and evolutive aspects of Basedow-Graves disease in the Depatment of Internal Medicine at CHU Aristide Le Dantec, Dakar (Senegal)

La maladie de Basedow est une affection auto immune associant une thyrotoxicose à des manifestations de fréquence variable comme le goitre, l'ophtalmopathie et le myxœdème prétibial. Son diagnostic est souvent facile, tandis que sa prise en charge demeure encore difficile. L'instauration d'un traitement médical simple expose à un risque de récidive. Au Sénégal et en Afrique Sub-saharienne peu d'études ont porté sur la maladie de Basedow. L'objectif de l'étude était de décrire les aspects épidémiologique, clinique, thérapeutique et évolutif de la maladie de Basedow en milieu hospitalier à Dakar. Il s'agissait d'une étude rétrospective menée du 1er janvier 2010 au 31 décembre 2013 dans le service de Médecine Interne du centre hospitalier universitaire Aristide Le Dantec. Durant la période, 108 patients suivis en consultation externe pour maladie de Basedow, ont été inclus sur un total de 834 patients suivis en consultation externe. le diagnostic a été retenu devant les signes cliniques, biologiques et immunologiques. Cent huit patients, atteints de maladie de Basedow ont été inclus sur un total de 834 consultations. Le sex ratio était de 7,3 et la moyenne d'âge de 34,6 ans. Les principaux motifs de consultation étaient : les palpitations et l'amaigrissement dans respectivement 46,3% et 39,8% des cas. Le syndrome de thyrotoxicose était présent chez 93,5% des patients, un goitre était noté chez 87% des patients et une exophtalmie chez 78,7% des patients. La principale complication était à type de cardiothyréose retrouvée chez 11,1% des patients. Tous les patients ont eu un traitement par antithyroïdiens de synthèse. L'évolution a été favorable dans 19,4% des cas. Une récidive à été notée dans 57% des cas et dans 23,1% des cas les patients ont été perdus de vue. La maladie de Basedow est la cause de la plus fréquente d'hyperthyroïdie. Le tableau est dominé par les manifestations cliniques liées à l'hyper métabolisme de l'organisme. Dans cette étude, il apparait que la thyroïdectomie n'est pas de première intention si l'on connait le nombre élevé de récidive après le traitement médical.

The Unusual Cause of Dangerous Arrhythmias at the Young

Objectives: The main objectives of this clinical case presentation was to found the real cause of dangerous arrhythmias (frequents polymorphic premature ventricular bates and repeated passes of none sustained ventricular tachycardia) at a young patient. Methods: I present the clinical case of a young woman patient 21 years old, who came at the consultation for irregular palpitations after increase physical effort–mountain climbing-her favorite sport activity. At the objective examination were found irregular heart bates HR=98 bates/min, without murmur heart or added sounds, BP=150/90 mmHg, normal vesicular breath sound on the lung. The EKG showed: sinus rhythm, HR=98 bates/minutes, many polymorphic premature ventricular bates and a short pass of a non sustained ventricular tachycardia (less than 30 seconds). The patient was monitored and followed antiarrhythmic therapy with xilin iv bolus 1 mg/kg body and after that double dose of xilin 1% i.v. in perfusion during the first 24 hours with disappears of the dangerous arrhythmias and after that remain on beta-blocker therapy- Carvedilol 6, 25 mg daily. In the first instance these dangerous arrhythmias were put in context of increase physical effort. The usual laboratory tests and the specific cardiac enzymes: Troponin I and CPKMB were in normal range and was excluded a heart attack. The levels of TSH, Free T3, FreeT4 were normal and the thyroid ultrasound-normal, excluding a possible thyroidal disease (hyperthyroidism- Basedow Graves disease or toxic thyroid adenoma and cardiothyreosis The level of electrolytes (potassium, magnesium, calcium, sodium, chloride) were normal so a dyselectrolytemia was excluded like a cause of these dangerous arrhythmias. Transthoracic echocardiography put in evidence unexpected a solid mass inside of the left ventricular cavity. The patient was referred to the Cardiovascular Surgery Department. The formation was removed from the left ventricular cavity and the result of the histopathological examination confirmed safe the diagnosis of ventricular myxoma. Results: The atrial myxoma is common in medical literature, but rare. Ventricular myxoma is very uncommon, rare and sometimes can develop so dangerous arrhythmias like repeated passes of ventricular tachycardia and also polymorphic premature ventricular bates and can put in danger patent’s life because of risk of degeneration in ventricular fibrillation and cardiac arrest. Conclusion: Sometimes, rare, an unknown ventricular myxoma could be the real cause of dangerous arrhythmias in the young and must to be removed.

Total thyroidectomy in Basedow-Graves� disease treatment: our experience

In the present study the authors, after a short historical description of the Basedow-Graves' disease, describe their case-study gathered over the last five years. They mention the most widely accepted hypothesis regarding disease's etiology, strongly linked to autoimmune disorders, and the role that some viral agents (Coksackie B and HTLV-II) may have in initiating autoantibody production and T cells activation in genetically predisposed individuals. Basic and clinical aspects of the diagnosis and disease treatment, highlighting the use of thyroidectomy, are addressed. They conclude that total thyroidectomy represents today the treatment of choice, which, after appropriate preparation to reach the euthyroidism condition, can ensure a successful cure.

Acute psychiatric presentation of steroid-responsive encephalopathy: the under recognized side of autoimmune thyroiditis.

Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), also known as Hashimoto encephalopathy, represents a rare disorder of presumed autoimmune origins that can be diagnosed when a protean variety of psychiatric symptoms are present in association with elevated titers of anti-thyroid antibodies. Symptoms can have a rapid and complete remission with corticosteroid treatment. A 19-year-old girl, with clinical history of Basedow-Graves disease, has been admitted to our department after presenting acute psychiatric symptomatology. Clinical and serological findings were used to formulate the diagnosis of SREAT, confirmed by subsequent positive response to corticosteroid treatment. SREAT can mimic an acute psychiatric symptomatology, thus it seems extremely relevant for psychiatrists to consider this syndrome in differential diagnosis algorithm, especially in those patients presenting a history of autoimmune thyroid disorder, in order to ensure adequate diagnosis and treatment.

Cracking Spaces in Hashimoto Thyroiditis Are Lymphatic and Prelymphatic Vessels

A century ago Hashimoto described the histologic hallmarks of struma lymphomatosa: (1) lymphoid follicles, (2) changes in the epithelial cells, (3) formation of connective tissue, and (4) diffuse round cell infiltration. He also showed some cracking spaces close to lymphoid follicles resembling vessels. The aim of this study was to investigate the possible lymphatic nature of these spaces and their prevalence in non-neoplastic thyroid tissue. Ten cases of Hashimoto thyroiditis (HT), 5 of Basedow-Graves disease (BG), and 5 of normal thyroid tissue (NT) were selected. Tissues were stained with hematoxylin and eosin, CD31 (Dako), and D2-40 (Dako) stains. Cracking spaces staining positive for CD31 and D2-40 stains were considered as lymphatic vessels. Site, distribution, intravascular valves and lymphocytes, perivascular lymphoid aggregates, and number and surface of lymphatic vessels were evaluated using a computer-assisted digital videocamera microscope (Nikon digital sigh, DS-2Mv). The number of lymphatic vessels increased from NT [3 (range, 2 to 13)] to BG [8 (range, 5 to 9)] to HT [12.5 (range, 10 to 16)]. A significant statistical difference was observed within the group (P=0.003): HT differed from NT (P=0.016) and BG (P=0.002). The area of lymphatic vessels increased from NT [0.01 mm (range, 0.01 to 0.12 mm2)] to BG [0.03 mm2 (range, 0.01 to 0.19 mm2)] to HT [0.03 mm (range, 0.01 to 0.6 mm2)]. A significant statistical difference was observed among the groups (P=0.001): NT differed from HT (P<0.001) and from BG (P<0.001). Lymphatic vessels showed valves, perivascular lymphoid aggregates, and intravascular lymphocytes. The cracking spaces shown by Hashimoto are mainly lymphatic vessels and represent a characteristic feature of autoimmune thyroid diseases.

Pseudomalabsorption of thyroid hormones: case report and review of the literature

Many causes of thyroxine malabsorption are described in the literature, but the most common cause of failure of thyroxine therapy is poor patient compliance, or pseudomalabsorption. We describe the case of a female patient who underwent total thyroidectomy for Basedow-Graves disease. Post-operatively, several treatment regimens were employed to achieve euthyroidism, but only injectable thyroxine was found to be effective. To exclude levothyroxine malabsorption, the patient was hospitalized in a hypothyroid state while a single oral test dose of levothyroxine (1000 μg) was administered. Within 4 hours a decrease of TSH level (from 59.7 to 55.6 μUI/ml) and a significant increase in free T4 levels (from 0.8 to 15.5 pg/ml) was observed, eliminating a malabsorption problem. The cause of resistance to thyroid hormone therapy was poor patient compliance, leading to the designation of this as a case of pseudomalabsorption.

1104 Ischemic stroke and Basedow Graves disease (1 case report)

1104 Ischemic stroke and Basedow Graves disease (1 case report)

Vasculite leucocitoclástica: uma rara manifestação associada ao metimazol

As tionamidas são drogas freqüentemente utilizadas no tratamento do hipertireoidismo da moléstia de Basedow Graves (MBG), tanto como terapia primária como para o preparo do paciente para cirurgia ou iodo radioativo. Reações adversas com o uso destas drogas ocorrem em cerca de 3 a 12 % dos pacientes, variando desde reações leves e freqüentes até quadros incomuns, graves e potencialmente fatais. Descrevemos o caso de uma paciente, com diagnóstico de hipertireoidismo por MBG, que após cerca de um mês de uso de metimazol, iniciou com poliartralgia acompanhada de lesões úlcero-necrotizantes em terço distal de membros inferiores que à avaliação laboratorial e histológica mostrou-se compatível com vasculite cutânea leucocitoclástica, padrão este encontrado nas vasculites por reação de hipersensibilidade. Após retirada da droga antitireoidiana e tratamento com prednisona a paciente evoluiu com regressão das lesões cutâneas sendo, então, encaminhada para terapia com iodo radioativo.

Genetic Determinants of Graves Disease

Basedow–Graves disease is an autoimmune thyroid syndrome. Genetic factors contribute to the pathogenesis of Graves disease, and current findings confirm that a number of genes may be involved in the development of autoimmune thyrotoxicosis. At present three loci, namely human leukocyte antigen (HLA, 6p21.3), cytotoxic T-lymphocyte-associated esterase-4 (CTLA4, 2q33), and thyroid-stimulating hormone receptor (TSHR, 14q31), are the only well-known genetic determinants for Graves disease. It is difficult to determine clearly the contribution of large multifunctional proteasome genes and transporter genes associated with antigen processing in the disorder, because of strong linkage disequilibrium between these genes and certain HLA alleles. Two recently discovered suspectibility loci, 20q11.2 and Xq21.33–q22, should be studied to find specific genes linked to Graves disease.

Síndrome de Down e hipertiroidismo.: Comunicación de 3 casos

We report three patients with Down syndrome that developed a hyperthyroidism. A 25 years old female and a 18 years old male had Basedow Graves disease and were treated with radioiodine. A 19 years old male had a Hashitoxicosis and is presently being treated with propylthiouracyl. Clinical and subclinical thyroid dysfunction is frequent in patients with Down syndrome and the risk increases with age. Therefore a surveillance with yearly TSH measurements should be done in these patients, since signs and symptoms of thyroid disease are barely detected in them. Hypothyroidism is the most frequent dysfunction but hyperthyroidism is also associated to Down syndrome.