Cases Of Autoimmune Thyroiditis Research Articles

Autoimmune thyroiditis in adolescents: Two different presentations

Autoimmune thyroiditis is one of the most common causes of acquired hypothyroidism in children and adolescents. Both genetic susceptibility and environmental factors play a role in etiopathogenesis. We report two cases of autoimmune thyroiditis here with varied presentation. Both of them had different clinical features of hypothyroidism at presentation. On investigation, both of them had elevated thyroid-stimulating hormone (TSH), low T4 and elevated anti-Thyroid peroxidase (TPO) antibodies. Case 1 also had elevated anti-TG antibody level. Based on these findings, diagnosis of autoimmune thyroiditis was made and started on levothyroxine tablet, for which both of them showed both clinical and biochemical improvements.

Cytological evaluation of thyroid swellings Govt. Medical College, Kathua: Two year study

Fine needle aspiration cytology plays an important role in avoiding unnecessary surgeries as benign and malignant lesions virtually cannot be accurately diagnosed by any non-invasive method. FNA has become the first line diagnostic test in the preoperative evaluation of thyroid lesions because of the simplicity, diagnostic accuracy and cost effectiveness. The Bethesda system of thyroid cytology reporting makes the reports clinically relevant and helps the clinicians to take appropriate therapeutic interventions. The study was conducted both retrospectively and prospectively over a period of 2 year. All fine needle aspirates of thyroid done in the Cytology laboratory of Department of Pathology of GMC Kathua were included in the study. A total of 76 patients were included in this study, Out of 76 patients, 69 cases were reported as benign (90.7%) lesions. Only 03 (3.9%) cases were reported as malignant lesions. 04 cases were reported as unsatisfactory aspirate due to scant cellularity. Among the benign cases, the most common diagnosis was benign follicular nodule in 50 cases (65.8%) followed by autoimmune thyroiditis in 17 cases (22.6%). 01 case (1.31%) each was reported as granulomatous thyroiditis and thyroglossal cyst. Benign follicular nodule cases comprised of 47 (61.8%) colloid nodule and 03 cases (3.9%) of adenomatous nodule. Among cases of autoimmune thyroiditis, 10 cases (13.1%) were reported as Hashimoto’s thyroiditis and 7 cases (9.2%) were reported as lymphocytic thyroiditis. All the malignant cases were of papillary carcinoma, thyroid. Thyroid cytopathology can fairly distinguished between inflammatory, benign & malignant lesions. Therefore, thyroid fine needle aspirate is a cost effective, easy and time saving OPD procedure. It can reliably and effectively be used for preoperative diagnosis and accurate categorization of thyroid lesions.

Клінічний випадок діагностики автоімунного тиреоїдиту після проведення коронароангіографії

Актуальність. На сьогодні найбільш об’єктивним та інформативним методом діагностики стенозуючого ураження коронарних артерій є коронарна ангіографія, яка все ширше використовується в клінічній практиці. Мета: аналіз клінічного випадку діагностики автоімунного тиреоїдиту (АІТ) до та після проведення коронароангіографії для удосконалення тактики ведення хворих з патологією щитоподібної залози (ЩЗ). Матеріали та методи. Системний аналіз, бібліосемантика й аналіз випадку захворювання конкретного пацієнта. Пошук літератури по базах даних CyberLeninka, NCBI. Результати. Відомо, що використання великих доз йодовмісних рентгеноконтрастних речовин призводить до розвитку ускладнень у вигляді алергічних реакцій, токсичного впливу на нирки та дисфункції ЩЗ. Дослідники також відзначають, що розвиток дисфункції ЩЗ частіше виникає у хворих з наявністю в анамнезі тиреоїдної патології та у жителів йододефіцитних регіонів. На нашу думку, дану категорію пацієнтів потрібно відносити до групи високого ризику щодо можливого загострення і/або погіршення перебігу захворювання ЩЗ, тому перед коронароангіографічним обстеженням слід контролювати її морфофункціональний стан. Висновки. Використання високих доз йодовмісних рентгеноконтрастних речовин під час проведення коронарної ангіографії у пацієнтів навіть з компенсованою патологією ЩЗ має високий ризик розвитку її дисфункції у вигляді АІТ з тиреотоксикозом, тому даній групі пацієнтів рекомендовано проводити моніторинг морфологічного та функціонального стану залози до та після проведення коронарної ангіографії з метою їх раннього виявлення та адекватної і своєчасної корекції.

Meta-analysis of the risk of autoimmune thyroiditis, Guillain-Barré syndrome, and inflammatory bowel disease following vaccination with AS04-adjuvanted human papillomavirus 16/18 vaccine.

PurposeTo assess the risk of three autoimmune diseases ‐ autoimmune thyroiditis (AIT), Guillain‐Barré syndrome (GBS), and inflammatory bowel disease (IBD) ‐ in females following AS04‐HPV‐16/18 vaccination.MethodsThis meta‐analysis included data from 18 randomized controlled trials, one cluster‐randomized trial, two large observational retrospective cohort studies, and one case‐control study. Following vaccination, a risk window of 2 years was defined for AIT and IBD and 42 days for GBS. Odds ratios (ORs) were estimated using three methods: meta‐analysis inverse‐variance with continuity correction (primary analysis), pooled estimate, and beta‐binomial regression.ResultsIn all studies apart from the case‐control study, 154 398 exposed and 1 504 322 non‐exposed subjects were included, among whom there were 141 and 1972 cases of (autoimmune) thyroiditis; 2 and 2 cases of GBS; and 43 and 401 cases of IBD, respectively. In the case‐control study, there were 97 cases of AIT and 13 of GBS; matched with 802 and 130 controls, respectively. The primary analysis OR estimates were 1.46 (95% confidence interval [CI] 1.22‐1.76), 11.14 (2.00‐61.92), and 1.11 (0.75‐1.66) for (autoimmune) thyroiditis, GBS, and IBD, respectively.ConclusionsThis meta‐analysis did not show an increased risk of IBD following vaccination with AS04‐HPV‐16/18. The 1.5‐fold increased risk of (autoimmune) thyroiditis does not allow us to conclude about a causal association. For GBS, the very low number of cases and wide 95% CIs negate any firm conclusion.

Associations between Systemic Sclerosis and Thyroid Diseases.

We have reviewed scientific literature about the association of systemic sclerosis (SSc) and thyroid disorders. A high incidence, and prevalence, of new cases of autoimmune thyroiditis (AT) and/or hypothyroidism have been shown in sclerodermic patients (overall in the female gender). An association among a Th1 immune-predominance, low vitamin D levels, and AT have been also shown in SSc patients. Cases of Graves’ disease (GD) have been described in SSc patients, too, according with the higher prevalence of thyroid autoimmunity. It has been also shown a higher prevalence of papillary thyroid cancer (PTC), in association with AT, in SSc patients. However, in order to confirm results about GD and thyroid cancer, studies in larger number of patients with SSc are needed. During the follow-up of SSc patients it would be appropriate to monitor carefully their thyroid status. The abovementioned data strongly suggest a periodic thyroid function follow-up in female SSc patients [showing a borderline high (although in the normal range) thyroid-stimulating hormone level, antithyroid peroxidase antibody positivity, and a small thyroid with a hypoechoic pattern], and, when necessary, appropriate treatments. In conclusion, most of the studies show an association among SSc, AT, and hypothyroidism, such as an increased prevalence of TC overall in SSc patients with AT. Only few cases of GD have been also described in SSc.

Fine needle aspiration cytology of thyroid and its correlation with serological findings

Background: Thyroid autoimmunity can cause several forms of thyroid disorders i.e. Grave’s disease, Hashimoto’s thyroiditis, atrophic autoimmune thyroiditis, post-partum thyroidits etc. Cytological diagnosis may be sometimes difficult is some cases. In such conditions, cytology along with serological tests aid at reaching a correct diagnosis.Hence, this study was undertaken to evaluate the serum level of anti-TPO antibody with respect to serum concentrations of thyroid hormones and its importance in diagnosing autoimmune thyroiditis.Material and Methods: This study was carried out in the department of pathology from June 2013-May 2014. Patients coming to the department of pathology TUTH, Maharajgunj for FNA of thyroid were included. TFT level was noted and anti TPO antibody level was evaluated by CLIA.Results: Ninety-five thyroid FNAC was included in the study, which comprises of 16.8 % males and 83.2% females with a M: F 1: 4.9. Maximum number of cases was seen in the age range 21-30 years (25.3%), mean age being 40.4years. The cytological diagnosis comprised colloid goiter(43.2%), lymphocytic thyroiditis (25.3%), Hashimoto thyroiditis(18.9%). Out of 42 cases of autoimmune thyroiditis diagnosed cytologically, 16 (38%) were hypothyroid, 4 (9.5%) hyperthyroid, 8 (19%) sub-clinical hypothyroid and 14 (33.5%) were euthyroid. The sensitivity and specificity of positive anti TPO in correctly identifying autoimmune thyroiditis was 85.7% and 79.2% respectively. The positive and negative predictive value for the test was 76.5% and 87.5% respectively.Conclusion: Nodular goitre can harbour a certain per cent of autoimmune thyroiditis and in such cases anti TPO antibody level along with cytodiagnosis appears to be helpful.

Histologic pattern of thyroid disorders in Southern Kerala

Since the implementation of universal salt iodization in 1986, India is said to be in the transition phase from iodine deficiency to iodine sufficiency, and this is expected to change the spectrum of thyroid disorders in the country. Materials and Methods: A retrospective study of 246 biopsy specimens of subtotal/total/hemi thyroidectomy cases done during a period of 6 years from 2007 to 2012 at a tertiary hospital in Trivandrum, Kerala, is analyzed. Results: Thyroidectomy specimens accounted for 3.2% of the total surgical specimens received during the study period. Among the 246 thyroidectomy specimens, nodular colloid goiter (NCG) with or without other associated thyroid lesions outnumbered other disorders accounting for a total of 142 cases (58%) followed by 90 cases of autoimmune thyroiditis (AIT) with or without other thyroid lesions (37%). Dual lesions such as AIT with colloid goiter (7 cases, 3%), AIT with tumors (45 cases, 18%), and NCG with tumors (40 cases 16%) were also noted. The presence of tumors was found in 106 cases (43%). The overall incidence of malignancy was 36%. Forty-one cases of AIT and 36 cases of NCG were associated with papillary thyroid carcinoma (PTC) (46% and 25%, respectively); the difference was statistically significant ( P = 0.01). Conclusions: This study showed that the incidence of AIT and associated PTC is high, and the role of iodine or any other goitrogens in triggering or enhancing the onset and development of AIT in this area deserves further study.

Statistical Correlations of the Spontaneous Abortion with Trombophilia and Other Associated Pathologies.

15-20% of all known pregnancies progress with a miscarriage or an ectopic pregnancy. The recurrent miscarriage is a delicate clinical situation because with all the advances in genetic and immunologic research the incriminating factors haven't been discovered yet. The treatment is also subject to controversies, being perceived as either ineffective or aggressive. A number of 376 pregnant women with a gestational age smaller than 12 weeks have been selected, 226 of them with spontaneous abortion. In the study group of patients with previous spontaneous abortions we have found a series of associated pathology. From the cases with secondary non idiopathic recurrent miscarriage we have identified 4 cases of thrombophilia with antiphospholipid syndrome, 2 cases of thrombocytosis, one case of autoimmune thyroiditis, one case of uterine tumor, one case of MTHFR C homozygous thrombophilia and one case of FVL heterozygous thrombophilia. Knowing the correlations between the recurrent miscarriage and the hereditary thrombophilia as well as the options of treatment for increasing the chances of having a pregnancy with a normal evolution direct the doctors in testing the patients with recurrent miscarriage for hereditary thrombophilia.

Clinical study on immune neutropenia

Objective To explore the diagnosis and of immune neutopenia.Methods Clinical data of 150 patients with immune neutropenia were collected and analyzed.Results Of 150 patients with immune neutropenia,35 cases went male(23.3％),115 cases were female(76.7％),and male to female ratio was 1 ∶ 3.3.Based on the difference produced way of granulocytes associated antibody,all patients could be divided into alloimmune neonatal neutropenia 9 cases (6.0％),drug-induced immune neutropenia 28 cases (18.7 ％),primary autoimmune neutropenia 22 cases(14.6％),and secondary autoimmune neutropenia 91 cases (60.7％).Secondary autoimmune neutropenia included 39 cases of systemic lupus erythematous,21 cases of rheumatoid arthritis,2 cases of immune hemolytic anemia accompany with neutropenia,6 cases of immune thrombocytopenia accompany with neutropenia,3 cases of autoimmune hepatitis,16 cases of autoimmune thyroiditis,and 4 cases of Sjogren's syndrome.Conclusion The majority of primary immune neutropenia are female,which is usually secondary to autoimmune diseases.The diagnosis of primary immune neutropenia is very complicated,which requires a long period of clinical observation and follow-up.The majority of granulocytes associated antibody is IgG in the autoimmune neutropenia patients.Yet sometimes two or three kinds of antibodies were increased as well. Key words: Neutropenia; Antibodies ,antineutrophil cytoplasmic

Unusual pediatric co-morbility: autoimmune thyroiditis and cortico-resistant nephrotic syndrome in a 6-month-old Italian patient

We report on a case of autoimmune thyroiditis in a 6-month-old patient with cortico-resistant nephrotic syndrome. Normal serum levels of thyroid hormons and thyroid-stimulating hormone were detected with high titers of circulant antithyroid antibodies and a dysomogeneous ultrasound appearance of the gland, typical of autoimmune thyroiditis. The research of maternal thyroid antibodies was negative. This is the first case of autoimmune thyroiditis found in such a young patient with pre-existing nephrotic syndrome ever described in literature. This association is random because nephrotic syndrome does not have an autoimmune pathogenesis and the genes involved in autoimmune thyroiditis are not related to those of nephrotic syndrome.

Idiopathic nonspecific interstitial pneumonia: an interstitial lung disease associated with autoimmune disorders?

Recent evidence suggests that idiopathic nonspecific interstitial pneumonia (iNSIP) is a distinct clinical entity amongst other idiopathic interstitial pneumonias, and some data seem to suggest a possible pathogenetic role of autoimmunity. The aim of the present study was to assess if iNSIP might represent an early lung manifestation of an autoimmune disease. After initial review of cases found in the medical records database by searching for the term "NSIP" (n = 63), 37 iNSIP cases were identified, and were re-evaluated using a dynamic integrated multidisciplinary approach. 27 cases with iNSIP were selected for the study. Mean ± sd age at first respiratory symptom was 54.2 ± 8 yrs, 70% were females, and 59% were never-smokers. At follow-up (mean ± sd 59.7 ± 29 months, range 12-138 months), autoimmune diseases occurred in 14 (52%) patients, with seven (26%) cases of autoimmune thyroiditis, six (22%) of undifferentiated connective tissue disease and three (11%) of connective tissue disease. Patients developing autoimmune diseases were older and more frequently never-smoking females. In >50% of patients diagnosed with iNSIP, evidence of autoimmune diseases develops within 2 yrs, suggesting a probable link between the clinical entity of iNSIP and autoimmune disorders.

Substernal Thyroid Masses

Substernal Thyroid Masses

Lithium associated autoimmune thyroiditis.

A case of autoimmune thyroiditis after long term treatment with lithium is described in a 29 year old Japanese woman with manic depression. Positive serum antithyroglobulin and antimicrosomal antibodies, diffuse...

Goitre in southern Chinese children in Hong Kong

In a 9-year retrospective review of goitre in Chinese children in Hong Kong, 84 children and adolescents were identified. There was a female predominance with a male:female ratio of 1:5.5. The majority of patients (95%) were found to have diffuse enlargement of the thyroid gland. Forty-nine were found to have Graves' disease. The mean age of presentation of patients with Graves' disease was 11.34 years. Forty-three of them were found to have thyroid autoantibodies. Only two cases of autoimmune thyroiditis with thyroid autoantibodies were diagnosed. The other causes of goitre include simple colloid goitre, multinodular goitre and suppurative thyroiditis. The spectrum of disease causing goitre in Chinese children is thus quite different from that reported in Caucasian children in developed countries. Further studies are necessary to define the genetic or environmental factors resulting in the observed differences.

Affections autoimmunes et traitement par interféron. À propos d'une observation associant thyroïdite-lupus like syndrome et adiponécrose

We report a new case of autoimmune thyroiditis associated with lupus like syndrome and cutaneous aseptic necrosis in a 44-year-old women receiving long term interferon therapy for chronic myelogenous leukemia.

Myopathy: As an Initial Presentation of Hypothyroidism in Two cases of Autoimmune Thyroiditis

Although hypothyroidism may cause a wide range of muscle disturbances, an overt myopathy may rarely present as an isolated initial presentation of hypothyroidism. The frequency of myopathy in hypothyroidism ranges from 30 to 80%. The major muscular symptoms are weakness, muscular cramps and myalgia. Laboratorial investigation generally shows increased levels of muscle enzymes and low serum thyroid hormones, with high thyrotrophic-stimulating hormone (TSH) elevated. The electrophysiological study reveals myopathy, neuropathy or mixed pattern. The treatment consists in hormone replacement and the prognosis is good in most of the cases. We report two cases that developed cramps, myalgia, and weakness, one of them presented as a polymyositis-like syndrome. The muscle enzymes were increased with a raised level of TSH. The myopathy was the initial manifestation of hypothyroidism in these cases. Both the patient was treated by replacement of thyroxin with significant clinical and biochemical improvement. DOI = 10.3329/jom.v8i1.1379 J MEDICINE 2007; 8 : 32-36