Chronic Autoimmune Thyroiditis Research Articles

From Hypothyroidism to Stroke … Is it Such a Short Way?

A 72-year-old patient, known in her personal medical history with essential hypertension, chronic autoimmune thyroiditis and hypothyroidism, undergoing chronic treatment with Euthyrox, shows specific symptoms of hyperthyroidism (palpitations, profuse sweating). After the tests, it appears that the patient has a thyrotoxicosis related to Graves’ disease. Treatment with Thyrozol is initiated. 10 days after the initiation of Thyrozol treatment, a severe neutropenia is noted (0 neutrophils on the peripheral blood smear). It is decided to cease the treatment with Thyrozol and start the treatment with Filgastrim, granulocyte colony stimulating factor and Dexamethasone.

Understanding and approach of Ayurveda management towards a unique case of Hashimoto Thyroiditis - A Case Report

Hashimoto thyroiditis is also known as chronic autoimmune thyroiditis and chronic lymphocytic thyroiditis, is an autoimmune disease in which thyroid cells are destroyed via cell and antibody-mediated immune processes. It is the most common cause of hypothyroidism in developed countries. The Pathophysiology of Hashimoto Thyroiditis involves the formation of antithyroid antibodies that attack the thyroid tissue, causing progressive fibrosis. The condition is sometimes not diagnosed until late in the disease process. The most common laboratory findings demonstrate elevated Thyroid-Stimulating Hormone (TSH) and low Thyroxine (T4) levels, coupled with increased anti thyroid peroxidase (anti-TPO) antibodies. In Ayurveda, it can be correlated with Rasavaha Sroto Vikara, Dhatwagnimandya, Vataja Pandu, Pittavruta Vata based on symptoms. Case Report: In this present study a female patient aged 37 years, known case of Hashimoto Thyroiditis since 8 years was treated with Shiro Takradhara, Sarvanga Abhynaga, Virechana and specific Shamanaushadhi’s as per signs and symptoms. Results: After 2 months of treatment there was a significant reduction in the signs and symptoms of the disease with 70% improvement in the condition.

Prevalence of thyroid diffuse goiter and its association with body mass index and the presence of cysts and nodules in children and adolescents: the Fukushima Health Management Survey.

The main cause of diffuse thyroid goiter is autoimmune chronic thyroiditis, otherwise known as Hashimoto's thyroiditis. Thyroid hormones play pivotal roles in growth and development during childhood. However, the prevalence of diffuse goiter and the relationships between diffuse goiter, thyroid volume, cysts and nodules, and anthropometric measurements in children are not well known. Among 789,459 participants who participated in thyroid ultrasound examinations, 320,206 participants (male: 161,728; female: 158,478) aged 1-23 years were analyzed. Logistic regression analyses were conducted to calculate the odds ratios of the standard deviation score of body mass index (BMI-SDS), the SDS of bilateral width multiplied thickness area (BWTAR-SDS) as a provisional determination of thyroid volume, and the presence of nodules or cysts for positive diffuse goiter compared with negative diffuse goiter after correction for sex and age. The prevalence of diffuse goiter increased in a female-dominant manner with aging. Compared with the absence of diffuse goiter, the age- and sex-adjusted odds ratios (95% confidence intervals) for BMI-SDS (1 SD), BWTAR-SDS (1 SD), cysts, and nodules were 1.24 (1.21-1.27), 3.21 (3.13-3.29), 0.53 (0.50-0.58), and 1.38 (1.17-1.64), respectively. The odds ratios of nodules for positive diffuse goiter were 4.18 (1.08-16.08), 1.76 (1.01-3.07), 1.80 (1.32-2.45), and 1.34 (1.08-1.67) in the age groups 1-7, 8-11, 12-15, and 16-23 years, respectively. The age-dependent increase in the prevalence of diffuse goiter was independently associated with increased BMI and positive prevalence of nodules in young individuals.

Effects of Hormone Replacement Therapy on Autoimmune Markers and Clinical Outcomes in Pediatric Patients with Hashimoto's Thyroiditis

Objective: Hashimoto’s Thyroiditis (HT), a chronic autoimmune thyroiditis, is the predominant cause of hypothyroidism in regions without iodine deficiency. HT is characterized by the loss of immunological tolerance of the thyroid gland, leading to autoimmune attacks. This study aimed to compare the autoantibody profiles, along with clinical and laboratory findings, of patients diagnosed with Hashimoto’s disease who were either receiving treatment or followed without treatment. Material and Methods: Clinical manifestations, laboratory data, and thyroid ultrasonography (USG) findings of patients diagnosed with Hashimoto’s thyroiditis receiving hormone therapy and those followed without treatment were compared in our clinic. Results: Among a total of 249 patients, 116 received hormone replacement therapy, while 133 were followed without treatment. The mean age of all patients was 13.91±3.71 years, with a mean age at diagnosis of 11.51±3.79 years. After twelve months of follow-up, the untreated group showed an increase in serum fT4 and antiTPO levels (p=0.012 and p=0.001), with no significant difference found in serum TSH, fT3, and antiTG levels. Those receiving treatment exhibited a significant decrease in serum TSH levels and a significant increase in serum fT4 levels (p=0.002 and p<0.001, respectively). Although there was an increase in serum antiTPO and antiTG levels over time, no change was detected in serum fT3 levels. Clinical improvement was significantly greater in the treatment group (p=0.044). Conclusion: It has been concluded that early initiation of hormone replacement therapy in Hashimoto’s thyroiditis can mitigate negative clinical effects during follow-up, contributing to patient comfort and alleviating clinical complaints.

Thyroid Eye Disease: Epidemiology, Natural History, and Risk Factors.

Thyroid eye disease (TED) is an autoimmune disorder of the orbit and the most frequent extrathyroidal manifestation of Graves' disease but it may rarely occur in euthyroid/hypothyroid patients with chronic autoimmune thyroiditis. TED is a relatively infrequent disorder, particularly in its severe forms. Men tend to have more severe TED at an older age. The prevalence of TED is lower than in the past among patients with recent onset Graves' hyperthyroidism, and moderate-to-severe forms requiring aggressive treatments are no more than 5% to 6% of all cases. After an initial inflammatory (active) phase and a plateau phase, TED stabilizes and eventually inactivates (inactive or burnt-out phase) after an estimated period of 18-24 months. Minimal-to-mild TED often remits spontaneously, but complete restitutio ad integrum almost never occurs when TED is more than mild. Several risk factors contribute to its development on a yet undefined genetic background. Cigarette smoking is the most important of them, but thyroid dysfunction (both hyper- and hypothyroidism), radioactive iodine therapy (if not accompanied by low-dose steroid prophylaxis), elevated thyrotropin receptor antibodies, and, probably, hypercholesterolemia represent relevant modifiable risk factors. Early diagnosis, control and removal of modifiable risk factors, and early treatment of mild forms of GO (local treatment and selenium) may effectively limit the risk of progression to more severe forms.

SAT463 Hormonal Contraceptive Use and Hypothyroidism Risk

Abstract Disclosure: S. Gloe: None. T.B. Carroll: Consulting Fee; Self; Corcept Therapeutics. Research Investigator; Self; Corcept Therapeutics, Novartis Pharmaceuticals. Introduction: Thyroid dysfunction is one of the most common endocrine disorders, with an estimated 4.3% of the US affected by subclinical hypothyroidism and 0.3% affected by overt hypothyroidism. Chronic autoimmune thyroiditis is the most common cause of hypothyroidism in the US and is estimated to affect 5-10x more women than men. Given this higher incidence in women, it is possible that hormonal difference or hormonal medications may play a role in thyroid dysfunction. Nearly 15% of women aged 15-49 use oral contraceptive pills (OCP) and 10.4% use other long-acting reversible hormonal contraceptives. A recent study showed a 25% increased prevalence of hypothyroidism in women with prior OCP use and in women with more than 10 years of OCP use the risk of developing hypothyroidism was nearly 4 times as high. Methods: Using the TriNetX database, four distinct groups of women aged 18-45 were identified using data from 1/1/2010 -1/1/2020. The four groups were EPC (n=5849), POC (n=5052), IUD (n=1000), and controls without prior hormonal contraception use (n = 6677). Demographic data, date of diagnosis of hypothyroidism, alcohol use, tobacco use, and BMI was obtained for each subject. Exclusion criteria included thyroidectomy (partial or total), lack of sufficient medication data, and a hypothyroidism diagnosis prior to or within 90 days of the first contraceptive medication order. A logistic model was then created accounting for known risk factors for the development of hypothyroidism (race/ethnicity, alcohol use, smoking, and BMI).Results: Initial comparison of treatment groups to controls demonstrated an no difference in risk of developing hypothyroidism for the EPC group (OR=1.18, p=0.2), but the POC and IUD groups had decreased risk of hypothyroidism (OR=0.39, p=<0.001 and OR=0.45, p=0.029, respectively). Using the logistic model, all groups demonstrated a decreased risk of hypothyroidism as compared to the control group (EPC: OR=0.3, p=<0.001, POC: OR=0.14, p=<0.001, IUD: OR=0.12, p=<0.001). Additionally, individuals identifying as Black/African Americans were less likely to develop hypothyroidism when compared to white/Caucasian subjects (OR=0.25, p=<0.001). Finally, BMI showed a fairly weak but significant association with development of hypothyroidism (OR=1.04, p=< 0.0001). Conclusion: Contrary to prior research, our data suggests a potential protective effect against the development of hypothyroidism for EPC, POC, and IUD use. The data also confirms prior studies showing a lower incidence of hypothyroidism in individuals who identify as Black/African American and perhaps those with lower BMI. Presentation Date: Saturday, June 17, 2023

General overview of the Risk factors, Pathogenesis, and Combined treatments for Hashimoto's Thyroiditis (HT)

In regions of the world where iodine is abundant, Hashimoto's thyroiditis, also known as Hashimoto's disease or autoimmune thyroiditis, is the most prevalent cause of hypothyroidism. It is a chronic inflammation of the thyroid gland. It is characterized by autoimmune-mediated thyroid gland destruction, which results in progressive thyroid failure, either with or without goiter formation. In young to middle-aged women, Hashimoto's thyroiditis typically starts as a painless, diffuse, firm thyroid gland enlargement that progresses to hypothyroidism. Many people don't initially exhibit hypothyroidism, and some don't even have a goiter or may have an atrophic thyroid gland. Hashimoto's thyroiditis (HT), also known as chronic autoimmune thyroiditis, is an inflammatory condition that is characterized by parenchymal atrophy, fibrosis, and diffuse lymphocytic infiltration. being the main source of primary hypothyroidism in regions with adequate iodine. With the help of various criteria, such as physical examination, blood tests for thyroid hormone levels (TSH is low, T3 and T4 are tall, for example), serum cholesterol and triglycerides, blood glucose, and radioactive iodine uptake, it is possible to distinguish between infections and clutter. According to estimates from several thyroid disease studies, 42 million persons in India are estimated to have the ailment. The pathogenesis causes, risk factors and combination therapy linked to Hashimoto's thyroiditis are discussed in this review study.

Сhronic autoimmune thyroiditis is a «signal disease» in the multiorgan autoimmune syndrome

The current century has been declared by the WHO as the «century of autoimmune diseases», of which there are more than a hundred today. The natural course of any autoimmune disease is characterized by progression from a latent and subclinical to a clinical stage and is associated with the presence of specific circulating autoantibodies. During the life of a person with one verified autoimmune disease, there is a high probability of consecutive manifestation of other autoimmune pathologies. Every fourth patient with chronic autoimmune thyroiditis develops autoimmune non-thyroid pathologies during his life, and vice versa, chronic autoimmune thyroiditis is present among people with non-thyroid autoimmune diseases. Modern ideas about the pathogenetic mechanisms of the development and progression of autoimmune diseases make it possible to consider chronic autoimmune thyroiditis as a «signal pathology» in the multiorgan autoimmune syndrome.

Post-iodination trends in thyroid pathology; 14-year experience at a single center in a goitre endemic area

Introduction: Goitre is endemic in many parts of Sri Lanka. Universal iodination of salt was commenced in Sri Lanka in 1995 as a measure to reduce the prevalence. This study was designed to identify the pattern of thyroid pathology reported during a period of 14 years from 2002 to 2015 in a Pathology Unit serving the population in a goitre endemic area in Sri Lanka.Methods: This descriptive cross-sectional study included all thyroidectomy specimens histologically assessed at our unit from 2002 to 2015. Data on age, gender, clinical presentation, type of resection, and histopathological diagnosis were retrieved from the records. The trend of change in thyroid pathology over time was analysed by comparing 2002-2010 cohort (615specimens) with the 2011-2015 cohort (995 specimens).Results: This study included 1610 thyroidectomy specimens. Features of colloid goitre were present in 71.6% (1152/1610). Prevalence of chronic autoimmune thyroiditis and thyroid cancer was 41% (660/1610) and 15.3% (246/1610) respectively. There was no significant change in the gender and the age at presentation over the years. However, an upward trend in the prevalence of both focal and diffuse chronic autoimmune thyroiditis (p<0.001), hyperplastic nodules (p=0.008), papillary microcarcinoma (p<0.001), papillary carcinoma and colloid nodular goitre (p=0.004) was evident.Conclusions: Parallel increase in the prevalence of chronic autoimmune thyroiditis and papillary carcinoma together with the upward trend in the prevalence of colloid nodular goiter was evident.

Hashimoto's Thyroiditis among Patients with Thyroid Disorders Visiting a Tertiary Care Centre.

Hashimoto's thyroiditis is a chronic autoimmune lymphocytic thyroiditis characterised by thyroid autoantibodies. Early detection and treatment of this condition help in reducing the morbidity and mortality associated with it. The aim of the study was to find out the prevalence of Hashimoto's thyroiditis among patients with thyroid disorders visiting a tertiary care centre. A descriptive cross-sectional study was conducted among patients visiting the outpatient department of a tertiary care centre. Data from 14 April 2017 to 13 April 2019 was collected between 30 June 2022 to 15 September 2022 from medical records. Ethical approval was obtained from the Nepal Health Research Council. Hashimoto's thyroiditis was diagnosed based on clinical presentation and positive antibodies to thyroid antigens. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Among 813 patients with thyroid disorders, 393 (48.33%) (44.89-51.77, 95% Confidence Interval) had Hashimoto's thyroiditis. The manifestation of the spectrum of Hashimoto's thyroiditis were euthyroid in 215 (54.70%), subclinical hypothyroidism in 102 (25.95%), subclinical hyperthyroidism in 23 (5.85%), overt hyperthyroidism in 9 (2.30%) and overt hypothyroidism in 4 (1.02%). The prevalence of Hashimoto's thyroiditis among patients with thyroid disorders was higher than in other studies done in similar settings. anti-thyroid peroxidase antibodies; Hashimoto's thyroiditis; thyroid disorders.

Calcitonin levels in autoimmune atrophic gastritis-related hypergastrinemia.

Calcitonin (Ct) is currently the most sensitive biochemical marker of C-cell disease (medullary thyroid cancer [MTC] and C-cell hyperplasia), but its specificity is relatively low. Our aim was to examine whether autoimmune atrophic gastritis (AAG) and chronic hypergastrinemia, with or without chronic autoimmune thyroiditis (AT), are conditions associated with increased Ct levels. Three groups of patients were consecutively enrolled in this multicentric study: group A consisted of patients with histologically-proven AAG (n = 13; 2 males, 11 females); group B fulfilled the criteria for group A but also had AT (n = 92; 15 males, 77 females); and group C included patients with AT and without AAG (n = 37; 6 males, 31 females). Median Ct levels did not differ between the three groups. Ct levels were undetectable in: 8/13 cases (61.5%) in group A, 70/92 (76.1%) in group B, and 27/37 (73.0%) in group C. They were detectable but ≤ 10ng/L in 4/13 (30.8%), 20/92 (21.7%) and 7/37 (18.9%) cases, respectively; and they were > 10ng/L in 1/13 (7.7%), 2/92 (2.2%) and 3/37 (8.1%) cases, respectively (P = 0.5). Only three patients had high Ct levels (> 10ng/L) and high gastrin levels and had an MTC. There was no correlation between Ct and gastrin levels (P = 0.353, r = 0.0785). High gastrin levels in patients with AAG do not explain any hypercalcitoninemia, regardless of whether patients have AT or not. This makes it mandatory to complete the diagnostic process to rule out MTC in patients with high Ct levels and AAG.

A Comparative Analysis of Strain and 2D Shear Wave Elastography in the Diagnosis of Autoimmune Thyroiditis in Pediatric Patients.

This paper aims to assess the usefulness of shear-wave elastography (SWE) and strain elastography (SE) for identifying and monitoring thyroid gland changes in children diagnosed with chronic autoimmune thyroiditis (CAT). Our study included 77 children between the ages of six and eighteen. Of these, 45 were diagnosed with CAT, while 32 had no thyroid pathology. Following a clinical examination and laboratory tests, an ultrasound was carried out, and then a SE (using a Hitachi Preirus machine) and SWE (using an Aixplorer Mach 30, Supersonic imagine, France) were performed in the same session. The median thyroid elastic index (EI) in the CAT group was 13.8 (13.3-17) kPa compared to 10.1 (9.3-11.2) kPa in healthy children (p < 0.0001). We found a median strain ratio (SR) of 1.2 (1.2-1.3) for CAT compared to 0.7 (0.6-0.9) for healthy thyroid tissue (p < 0.0001). The optimal cut-off value for predicting the presence of CAT in children using SR was >1 (Se = 82.2%, Sp = 87.5%, PPV = 90.2%, and NPV = 77.8%, AUROC = 0.850), while using SWE, the optimal cut-off value for predicting the presence of CAT in children was >12 kPa (Se = 88.9%, Sp = 93.7%, PPV = 95.2%, and NPV = 85.5%, AUROC = 0.943). Both techniques are useful for measuring thyroid tissue elasticity, and their diagnostic accuracy and reliability are comparable.

Frequency of Coeliac Disease in Children with Chronic Autoimmune Thyroiditis

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Abstract #1402994: Unilateral Exophthalmos in A Patient with Hashitoxicosis: Case Report and Review of the Literature

Hashitoxicosis is a transient period of hyperthyroid state in a patient with Hashimoto thyroiditis. Ii is not common condition. Exophthalmos is usually bilateral disease commonly associated with Graves's hyperthyroidism. It rarely occurs in Hashimoto thyroiditis or hashitoxicosis. Unilateral exophthalmos is a less common presentation of Graves's ophthalmopathy. So, we present this case of a male with Hashimoto thyroiditis, who presented with unilateral exophthalmos and Hashitoxicosis. A 41-year-old male presented with protrusion of his right eye. He was diagnosed 9 months ago with Hashimoto thyroiditis based on clinical ground, laboratory tests and thyroid scan. His TSH was 18.5 (N 0.4- 4) and FT4 was 0.023 (N12-22). TPO was positive (Thyroid Peroxidase anti-bodies). Thyroid scan showed diffused homogeneous reduced uptake. He was started on Thyroxine 100ug/day. Six months later his thyroid function test on follows up showed features of subclinical hyperthyroidism. His Thyroxine was reduced gradually till it was stopped. Three months later, he developed palpitations, weight loss and noticed changes in his right eye. On examination he was toxic his pulse 100 bpm, right eye there is exophthalmos, lid retraction and lid lag. He has small goiter and no bruit. No pretibial myxedema or proximal myopathy. Laboratory tests showed suppressed THS 0,013 and high FT4 26.8. We diagnosed him as having Hashitoxicosis and started on Propranolol 20 mg three times daily. He did not improve and repeated TSH was 0.006 and FT4 was 46.3(12-22). Neomercazole was started at a dose of 30 mg/day, Over the next 6 months Neomercazole was tapered until the patient become hypothyroid and thyroxine was restarted. Currently he is on thyroxine 100ug and is doing well. However, the exophthalmos did not resolve completely. Hashimoto thyroiditis is the most common cause of hypothyroidism in Iodine sufficient areas. It is characterized by elevated levels of thyroid anti-bodies (Anti TPO antibodies are present in 90% of cases). Hashitoxicosis is the hyperthyroid phase in chronic autoimmune thyroiditis. it occurs due to the release of preformed thyroid hormones from the inflamed thyroid gland. The exact duration of the disease is not well described, in average it last less than 8 months. The term Hshitoxicosis sometimes used to describe an autoimmune thyroid disease overlap syndrome of Graves's disease and Hashimoto disease. The presentation of our patient was consistent with Hashitoxicosis. But due to his severe symptoms and development of exophthalmos we suspect overlap syndrome, so we started antithyroid medication. Wasniewska et al. investigated the outcome of Hashitoxicosis in 14 children. Due to more severe presentation, four patients required antithyroid medications as in our patient. A definitive resolution of hyperthyroidism was recorded 8.3- 6.3 months after the diagnosis, as in our patient who recovered over a period of 6 months. Graves's orbitopathy (GO) usually associated with Graves's hyperthyroidism, rarely occurs in hypo- or euthyroid state, unlike our patient who developed unilateral exophthalmos in hypothyroidism.

Abstract #1395500: Silent Thyroiditis as a Complication of Severe Acute Respiratory Syndrome Coronavirus 2 Vaccine

Silent autoimmune thyroiditis, a type of chronic autoimmune thyroiditis, as an adverse effect of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination is infrequently reported in the literature. We hereby describe a case of silent thyroiditis followed by Grave’s orbitopathy after vaccination against SARS-CoV2. An 84-year-old male presented to clinic with a 10-pound weight loss with no other symptoms of hyperthyroidism, no personal history of thyroid illnesses, or recent viral infections. He had normal thyroid function 3 months prior to presentation. He had received 3 doses of SARS-CoV2 Pfizer-BioNTech vaccine with the last dose 5 months prior to presentation. Thyroid exam was normal. Laboratory testing revealed thyroid stimulating hormone (TSH) level of 0.005 IU/ml (0.45-4.5 IU/ml), total T4 14.4 g/dl (4.5-12.1 g/dl), and total T3 1.22 nmol/l (0.6-1.81 nmol/l). Thyroid Ultrasound revealed a heterogeneous atrophic thyroid gland with no nodules or hypervascularity. He was started on Methimazole by primary care provider. Four months later, he was seen in the Endocrinology clinic and reported no hyperthyroidism symptoms. His TSH level at that time was 65.9 IU/ml, free T4 0.47 ng/dl (normal: 0.82-1.77 ng/dl), total T3 level 75 ng/dl (normal: 71-180 ng/dl), thyroid stimulating immunoglobulin 2.05 IU/l (0-0.55 IU/L), thyrotropin receptor antibody level 2.8 (0-1.75). Methimazole was discontinued. At 6 months after initial presentation laboratory testing showed TSH 5.010 IU/ml, free T4 1.2 ng/dl, thyroid peroxidase antibody of 148 IU/ml (normal 0-34 IU/ml), thyroglobulin antibody 131.6 IU/ml (normal 0.0-0.9 IU/ml). He was diagnosed with silent autoimmune thyroiditis. A few weeks later, the patient presented to an ophthalmologist with bilateral eye bulging and impaired vision. He was diagnosed with acute Graves’ orbitopathy and started on pulse-dose of intravenous Methylprednisolone 250 mg twice daily and urgently referred to a tertiary ophthalmology center for teprotumumab infusion. His thyroid function tests were normal at that time on no thyroid medications. The underlying mechanisms of thyroid impairment following SARS-CoV2 vaccination are not completely understood. There is a role of molecular mimicry between SARS-CoV2 antigens and thyroid antigens that may help to hasten the emergence of autoimmunity in vulnerable individuals. Our patient developed multiple thyroid-related antibodies following vaccination. Silent painless thyroiditis is a self-limiting condition, characterized by temporary thyrotoxicosis, followed by a brief period of hypothyroidism and then a complete return to normal thyroid function. A radioactive iodine uptake scan can help differentiate between the different causes of thyrotoxicosis in the acute thyrotoxic phase. Development of severe Graves orbitopathy following silent autoimmune thyroiditis after SARS COV2 vaccination has not been previously reported.

Unexplained Hyperthyrotropinemia: A Biochemical and Clinical Challenge.

A raised serum TSH in the absence of a clear etiology, or "unexplained hyperthyrotropinemia" (UH), can be challenging for clinicians. The aim of the present study was to evaluate potential strategies aimed at a clinical and biochemical characterization of UH patients. We compared 36 patients with UH with a control group of 14 patients with chronic autoimmune thyroiditis (CAT) and subclinical hypothyroidism. The two groups were compared in terms of the following: (i) the rate of normalization of TSH after repeating with another assay; (ii) the rate of normalization of TSH over time with the same assay; (iii) the reduction in TSH after precipitation with polyethilenglycole (PEG); and (iv) free thyroxine (FT4) levels. Similar TSH levels were observed in UH [5.65 (5.21-6.37)] and CAT [5.62 (5.17-8.50)] (p = 0.489). TSH measurement with another assay method showed a normal TSH value in 41.9% of UH vs. 46.1% of CAT patients (p = 0.797). After repeating the TSH measurement in time with the same assay method, an increased TSH value was confirmed in all cases, in both groups (0% in the UH group vs. 0% in the CAT group, p = 1.000). TSH recovery after PEG precipitation was similar in the two groups (% precipitable post-PEG: 68.75 ± 3.14 in UH vs. 68.67 ± 7.18 in CAT, p = 0.960). FT4 levels were similar in the two groups (FT4 1.02 ± 0.20 ng/dl in UH vs. 1.00 ± 0.20 ng/dl in CAT, p = 0.789). The results do not support the concept that laboratory interferences are more frequent in UH patients, suggesting that patients with UH should be managed in the same way as patients with CAT until proven otherwise.

The Dramatic Outcome of the Late Diagnosis of the Chronic Autoimmune Thyroiditis with the Severe Primary Hypothyroidism

The article is devoted to the analysis of a clinical case of the severe hypothyroidism. A review of the “clinical masks” of the hypothyroidism is presented. The examination of the polymorbid patients should include the level of thyroid-stimulating hormone and thyroid hormones. The untimely initiation of substitution therapy is associated with a poor prognosis, and the early start of the treatment is a guarantee of saving the life of a patient with severe hypothyroidism.

Acute adrenal crisis precipitated by thyroid storm in a patient with undiagnosed autoimmune polyglandular syndrome type 2.

Autoimmune polyglandular syndrome (APS) type 2 is characterized by the presence of Addison's disease (AD) along with autoimmune thyroid disease and/or type 1 diabetes. APS type 2 is known as Schmidt's syndrome when autoimmune adrenal insufficiency is associated with chronic lymphocytic thyroiditis. We report a very rare case of a 28-year-old female patient who had Schmidt's syndrome revealed by a thyroid storm (TS) concomitant with an acute adrenal crisis. The onset of AD resulted in a surgical emergency. The patient presented with cardiogenic shock and an acute abdomen. The precipitation factor was Hashitoxicosis presented as TS. This life-threatening condition was successfully reversed with aggressive medical therapy based on antithyroid drugs and intravenous glucocorticoids. This hyperthyroid phase lasted for a period of 8 months. The patient eventually developed hypothyroidism, suggesting that Hashimoto's thyroiditis was the most likely diagnosis. She was started on levothyroxine replacement therapy and remained euthyroid on levothyroxine. The case we describe had several diagnostic pitfalls that are discussed both at the start as well as during the evolution. Autoimmune diseases can appear concomitantly or succeed each other over time. The clinician must be vigilant to detect these diseases in time in order to avoid a misdiagnosis of a life-threatening emergency such as adrenal insufficiency or thyroid storm. Thyroid storm is an uncommon but life-threatening manifestation of hyperthyroidism. Diagnosis is dependent on clinical symptoms, and no specific laboratory tests are available. Glucocorticoids should be used in the treatment of thyroid storm because they have an inhibitory effect on peripheral conversion of T4 to T3. In patients who have severe thyrotoxicosis, especially in conjunction with hypotension, treatment with glucocorticoids has become standard practice because of the possibility of relative adrenal insufficiency or the possibility of undiagnosed Addison's disease. The differential diagnosis of hyperthyroidism can be challenging. Graves' disease can be discussed in view of the severity of the clinical presentation and the prolonged duration of the hyperthyroid phase. Hashitoxicosis is the initial hyperthyroid phase in chronic autoimmune thyroiditis. The hyperthyroid phase is always followed by definitive resolution, with persistent euthyroidism and no hyperthyroid relapses. Synthetic antithyroid drugs may be prescribed during the hyperthyroid phase of Hashimoto thyroiditis if the clinical presentation is severe and the duration of the hyperthyroid phase is prolonged.

A Successful Case Study on Ayurvedic Management of Hypothyroidism

Abstract: Hypothyroidism is mainly classified, resulting in failure of thyroid function and secondary (middle) due to failure of an adequate thyroid-stimulating hormone (TSH) from the pituitary gland or thyrotrophin-releasing hormone (TRH) from the hypothalamus. Secondary hypothyroidism can be distinguished from the pituitary and hypothalamic by using TRH tests. In some cases, failure of hormone action in peripheral muscles can be detected. Primary hypothyroidism may be clinical when free T4 (FT4) decreases and TSH increases or subclinical when FT4 is normal and TSH increases. In secondary hypothyroidism FT4 decreases and TSH normal or decreases. Major hypothyroidism is often caused by chronic autoimmune thyroiditis, causes that are rarely treated with radioiodine and thyroidectomy. Hypothyroidism is one of the most common endocrine disorders seen in daily OPD. As per Charak Samhita, we can categorize Hypothyroidism in Anukta vhadhies. Vata and Kapha are two main doshas involved in this vhadhies. Present case is one of my successful cases of hypothyroidism. 32 year’s female patient suffering from weakness, dry skin, poor memory, hair loss, constipation, acidity, breathlessness since the last 8 years, and from last one month all symptoms increase rapidly. Patient having history of piles and thyroid and under allopathic treatment since last 4 years. After 1.5 months Ayurvedic treatment patient got relief in most of symptoms of disease and TSH level before treatment 8.65 to reduce 3.40.

The impact of cholecalciferol on cognitive performance in patients with hypothyroidism and autoimmune thyroiditis

Hashimoto’s thyroiditis is a chronic autoimmune thyroiditis characterized by lymphocytic infiltration that may result in the gradual loss of thyroid tissue. According to a study, even with normal thyroid function, autoimmune thyroiditis can cause neuroinflammation, leading to emotional changes and mental disorders. Although the mechanism is unclear, some research indicates that vitamin D has a beneficial effect on autoimmune thyroid diseases. The relationship between serum vitamin D levels and cognitive impairment in patients with autoimmune thyroiditis has been established in clinical studies.&#x0D; Objective — to investigate the impact of cholecalciferol on cognitive function in patients with hypothyroidism and autoimmune thyroiditis in the Western Ukrainian population.&#x0D; Materials and methods. The study involved 56 patients diagnosed with hypothyroidism resulting from autoimmune thyroiditis. These patients were divided into two groups. Group 1 (n=28) received cholecalciferol at a dose of 4000 IU/day (28.000 IU/week) and L‑thyroxine (88.39±12.70 mg/day), while Group 2 (n=28) received only L‑thyroxine (87.50±12.73 mg/ day). Assessments were conducted at the start and end of a 12‑week treatment period, and cognitive function was measured using the Mini‑Mental State Examination. The results showed a decline in cognitive function.&#x0D; Results. Following the treatment course, patients demonstrated an improvement in cognitive function. In Group 1, where patients were treated with cholecalciferol and L‑thyroxine, the proportion of patients with moderate (pre‑dementia) cognitive impairment decreased from 50% to 21.4%. However, there were no significant changes observed in the group that received only L‑thyroxine. Normalization of cognitive function as determined by the MMCE test increased from 28.6% to 78.6% in Group 1, and from 21.4% to 50% in Group 2 patients.&#x0D; Conclusions. Based on our findings, vitamin D supplements should be given to patients diagnosed with autoimmune thyroiditis and hypothyroidism in order to enhance cognitive function.&#x0D;