Graves-Basedow Disease Research Articles

Graves-Basedow ophthalmopathy surgical approaches: Open vs Endoscopic

Graves-Basedow's disease (GBD) is an autoimmune pathology that affects the thyroid and is characterized by the presence of goiter, hyperthyroidism, ophthalmopathy, and dermopathy. Graves-Basedow ophthalmopathy (GBO) is a set of inflammatory and infiltrative alterations of the orbital tissue that affects 40–90% of subjects suffering from GBD. Our study aims to investigate the differences in the clinical outcomes of patients treated with two different techniques: the classic open and the more modern endoscopic. A retrospective clinical study was carried out from the year 2011 until the year 2020 to evaluate the clinical outcomes of two different surgical techniques for the treatment of GBO. Eighteen patients were given surgical indications, 12 males and 6 females aged between 37 and 69 years (average age 48.5 years), for a total of 36 orbits. From the year 2011 to the year 2014, all patients were treated with the open orbital decompression technique; from 2015 onwards, patients were subjected to orbital decompression with the endoscopic transnasal approach. Pre- and postoperative ophthalmometry, reduction of proptosis, and reduction of oculo-orbital index were compared for the two techniques. As evidenced by the statistical analysis carried out on the sample before and after surgical treatment, there is a statistically significant difference between ophthalmometry and the Oculo-Orbital Index (IOO) values; this indicates that surgical orbital decompression with two walls (floor and medial wall) is effective in reducing exophthalmos. The positive result is also confirmed by the reduction of proptosis, measured in millimeters, averaging 1.7 mm. In the analysis of data relating to the two different patient groups, treated respectively with endoscopic orbital decompression (Technique 1) and classical open orbital decompression (Technique 2), the results obtained show that there is no statistically significant difference between the results of the two techniques. Therefore, the choice of surgical approach is at the discretion of the surgeon. It is our opinion that orbital decompression with the endoscopic transnasal technique should be an absolute indication in all patients who have clinical and radiographic signs of involvement of the optic nerve at the orbital apex (crowded apex syndrome) thanks to the ability of this technique to add and decompress the optical channel at the apex. For all other patients with GBO, the endoscopic technique of orbital decompression can be indicated as a first-line surgical approach considering the absence of skin scars and the best aesthetic results.

Protocolo diagnóstico y terapéutico de las tiroiditis

Thyroiditis refers to an inflammation of the thyroid gland, with a variable impact on its functionality. In this protocol, thyroiditis is classified according to its progression as chronic, subacute, acute, or variable course. The epidemiology, etiology (autoimmune, infectious, traumatic, environmental, pharmacological, etc.), pathophysiology, and clinical course differ among the different types of thyroiditis. Some progress with characteristic pain and others are painless. The diagnosis is generally easy and clinical. A medical record and physical examination are essential as well as a good differential diagnosis between the types of thyroiditis and with other thyroid diseases such as Graves-Basedow disease and toxic multinodular goiter. In most cases, the treatment is simple if a proper diagnostic orientation is performed.

Tirotoxicosis e hipertiroidismo

Thyrotoxicosis is a clinical condition secondary to excess thyroid hormones (TH). It can be caused by increased synthesis and release of TH by the thyroid gland (hyperthyroidism, the most common cause) as well as by thyroid inflammation and destruction, ectopic production, or exogenous administration of TH. The diagnosis is biochemical and based on the determination of thyroid stimulating hormone (TSH) and thyroid hormones (thyroxine and triiodothyronine). To plan effective treatment, it is crucial to identify the underlying cause. Graves-Basedow disease is the most common cause, followed by toxic multinodular goiter and toxic thyroid adenoma. Less frequent, although relevant, are thyroiditis, extrathyroidal TH production, and factitious thyrotoxicosis. Some imaging tests, such as a Doppler ultrasound and thyroid scintigraphy, are helpful in the etiological diagnosis. The goal of treatment is to achieve symptoms control and reduce TH synthesis and secretion through the use of drugs or radical treatments (radioiodine or surgery).

WPŁYW INFEKCJI SARS-CoV-2 NA FUNKCJĘ TARCZYCY – PATOMECHANIZM I IMPLIKACJE KLINICZNE

The SARS-CoV-2 virus is the pathogenic agent of the COVID-19 disease, which pandemic had caused 6.8 million deaths worldwide by February 2023. In the course of the disease, involvement of the thyroid gland is observed. The pathomechanism of damage to the thyroid gland is bidirectional – direct cytotoxicity of the virus and the indirect effect of a cytokine storm. Circulating pro-inflammatory cytokines lead to deiodinase activity dysregulation, resulting in changes in plasma concentrations of TSH, fT3, and fT4. These hormone abnormalities are observed in about 16% of patients during COVID-19 and may also result from the treatment itself – systemic corticosteroids. Dysregulation of the immune system also leads to autoinflammatory thyroid diseases. It seems crucial to monitor thyroid hormones to detect subclinical forms of thyroiditis early. This paper presents the prevalence and potential pathomechanism of thyroid disorders observed during SARS-CoV-2 infection – subacute thyroiditis, low T3 syndrome, Graves-Basedow disease, and Hashimoto’s disease.

The Usefulness of Thyroid Antibodies in the Diagnostic Approach to Autoimmune Thyroid Disease.

Autoimmune thyroid disease (AITD) refers to a spectrum of various diseases, with two extremes of clinical presentation, hypothyroidism (Hashimoto's thyroiditis (HT) and hyperthyroidism (Graves-Basedow disease (GBD)). Both conditions are characterized by presenting a cellular and humoral autoimmune reaction, with an increase in the synthesis and secretion of antibodies directed toward various thyroid antigens, together with a phenomenon of thyrocyte necrosis and apoptosis (in HT) and a persistent thyrotropin-receptor stimulation (in GBD). The diagnosis of both entities is based on clinical, laboratory, and imaging findings. Three major anti-thyroid antibodies have been described, those directed against the TSH receptor (TRAb), against thyroid peroxidase (TPOAb), and against thyroglobulin (TgAb). Each of these autoantibodies plays a fundamental role in the diagnostic approach of autoimmune thyroid disease. TRAbs are the hallmark of GBD, and additionally, they are predictors of response to disease treatment, among other utilities. Likewise, TPOAb and TgAb allow for identifying individuals with a higher risk of progression to hypothyroidism; the positivity of one or both autoantibodies defines the presence of thyroid autoimmunity. In this review, the usefulness of anti-thyroid antibodies in the diagnostic approach to autoimmune thyroid disease is described.

Abstract #1397146: Recurrent Thyrotoxicosis in a Woman with a History of Graves - Basedow Disease

Although the most common cause of thyrotoxicosis is Graves - Basedow disease (GBD), the determination of the cause of thyrotoxicosis is important for establishing appropriate management. We present the case of a woman with suspected surreptitious ingestion of thyroid hormones or factitious thyrotoxicosis. A 42-year-old female patient she was diagnosed with hyperthyroidism due to GBD at the age of 14. At age 17 she received RAI (10 mCi), developed hypothyroidism and started levothyroxine (L-T4). At age 38 she presented again with hyperthyroidism: TSH: < 0.004 uIU/mL (VN: 0.4-4) and FT4: 3.19 ng/dl (0.8-1.9). She was suspended L-T4 and started antithyroid drugs (thiamazole). Due to persistence of hyperthyroidism despite 40 mg/d of thiamazole. She was hospitalized for study; thyroid ultrasound showed an atrophic thyroid and thyroid scintigraphy with technetium-99m reported absence of uptake in the thyroid bed, Ab-TPO and Ab-Tg were negative, Thyroglobulin: <0.2 ng/ml (1.6-59.9). After discontinuation of thiamazole and without any other medication, thyroid hormones (FT4 and FT3) normalized within two weeks, factitious thyrotoxicosis was suspected, and she was discharged without medication. At 42 years of age, she returned due to hyperthyroidism with TSH: 0.004uIU/mL, FT4: 2.59 ng/dl, and FT3: 5.05 pg/ml despite having restarted thiamazole in her place of origin; she denied taking thyroid hormone or nutritional supplements. On examination: HR: 105 bpm, mild distal tremor and non-palpable thyroid. The results of the thyroid, thyroid scintigraphy, Ab-TPO, Ab-Tg and levels of Thyroglobulin were similar to the previous ones. Transvaginal ultrasonography and a whole-body scan with RAI ruled out ectopic hyperthyroidism; the FT3/FT4 ratio was always less than 4.4, suggesting factitious thyrotoxicosis. Antithyroid and beta-blockers were suspended, control at 48 hours showed: FT4: 1.77ng/dl (0.8-1.9), FT3: 3.4pg/ml (1.8-4.2) and 25 days post-discharge: TSH: 7.72 ng/dl, FT4: 1.48 ng/dl and FT3: 2.09 pg/ml. The psychiatric evaluation did not show any alteration. The patient was asymptomatic and returned to her place of origin. Cholestyramine was not accepted by the patient. Factitious thyrotoxicosis is difficult to identify, especially when dealing with a patient with a history of GBD. The diagnosis of factitious thyrotoxicosis is based upon the absence of goiter, suppressed serum Tg level, decreased radioactive iodine (RAI) uptake, and excellent response after cholestyramine treatment in cases in which this entity is suspected.

Molecular Mechanisms in Autoimmune Thyroid Disease.

The most common cause of acquired thyroid dysfunction is autoimmune thyroid disease, which is an organ-specific autoimmune disease with two presentation phenotypes: hyperthyroidism (Graves-Basedow disease) and hypothyroidism (Hashimoto's thyroiditis). Hashimoto's thyroiditis is distinguished by the presence of autoantibodies against thyroid peroxidase and thyroglobulin. Meanwhile, autoantibodies against the TSH receptor have been found in Graves-Basedow disease. Numerous susceptibility genes, as well as epigenetic and environmental factors, contribute to the pathogenesis of both diseases. This review summarizes the most common genetic, epigenetic, and environmental mechanisms involved in autoimmune thyroid disease.

About a case: affective psychosis and hyperthyroidism

IntroductionHyperthyroidism due to Graves-Basedow disease is a common cause of neuropsychiatric manifestations, such as anxiety, psychomotor restlessness, mood disturbances, insomnia and psychosis. Hashimoto’s encephalopathy rarely occurs in so-called autoimmune thyroiditis, which can present with hyperthyroidism and neuropsychiatric symptoms similar to Graves’ disease. We add that the mystical-religious beliefs, present in all human cultures, and decisive in the case at hand, make us propose an evolutionary origin of them.ObjectivesClinical case descriptionMethodsA clinical case based on medical reports is describedResultsWe present the case of a 72-year-old woman, a member of the Seventh-day Adventist Church, well adapted to the Community. Known history of elevated antithyroid antibodies since 2019, brought to the emergency room involuntarily due to a mystical-religious delusional condition associated with behavioral disturbance. On examination, cachectic appearance, distal tremor, emotional exaltation and megalomanic speech were highlighted. Laboratory tests revealed primary hyperthyroidism with elevated antibodies. During admission, the differential diagnosis between Graves-Basedow disease and Hashimoto’s encephalopathy was considered. Thyroid scintigraphy oriented the diagnosis to Graves-Basedow disease, not requiring lumbar puncture or corticosteroid treatment. Treatment was based on high-dose antithyroid and antipsychotic drugs, with clinical and analytical remission at 3 weeks. The patient was referred to a Social Health Center for functional recovery. The family refers to a similar episode in 2014, of less intensity and self-limited, which is proposed to be a hashitoxicosis.ConclusionsDifferential diagnosis between Graves-Basedow and Hashimoto disease is essential as they differ in treatment and prognosis. The continuity that the delusion presents with the previous beliefs of the patient, differing mainly in the affective-behavioral implication, makes us consider a predisposition to psychosis in our patient. Religiosity can be adaptive in certain environments, since mystical beliefs have existed throughout the history of the human species and seem to be part of our nature.Disclosure of InterestNone Declared

Influence of selenium deficiency on the development of thyroid disorders - a literature review

Introduction and purpose: Selenium is essential for the proper course of many physiological and biochemical processes in the human body. It plays a large role in ensuring proper immunoendocrine function. The organ with the greatest amount of selenium per gram of tissue is the thyroid gland. This element builds enzymes involved in antioxidant processes - peroxidase, as well as deiodinases involved in the metabolism of thyroid hormones. There are scientific reports showing a beneficial effect of selenium supplementation in autoimmune diseases of the thyroid gland. The aim of this study is to summarize the current knowledge on the relationship between selenium deficiency and the development of thyroid dysfunction. Description of the state of knowledge: There is a correlation between selenium deficiency and the functioning of the thyroid gland. It has been shown that selenium levels are often lowered in patients with autoimmune thyroiditis. Research shows that selenium supplementation may lower TPOAb and TgAb antibody levels in patients with Hashimoto's disease. In patients with Graves' orbitopathy, administration of selenium resulted in delayed progression of orbitopathy and less disease severity. There are reports that supplementation with this element may also increase the effectiveness of antithyroid drugs in patients with Graves-Basedow disease. There was also an association between selenium deficiency and the development of goiter and thyroid nodules. Conclusions: Selenium plays an important role in the proper functioning of the thyroid gland. Although the specific role of selenium in the pathogenesis of thyroid disease is still under investigation, there are numerous reports saying that its deficiency may affect it. More research is needed on the relationship between selenium concentration and the regulation of thyroid function, because introducing it into the treatment regimen of thyroid disorders may give hope for better therapeutic effects.

Graves-Basedow disease treated by complementary medicine leading to severe thyrotoxicosis – a case report

Graves' disease is a common cause of hyperthyroidism. Inadequate treatment or non-compliance can lead to serious complications, including thyroid storm. &#x0D; We present the case of a 22-year-old woman who had been treated with antithyroid drugs (ATD) for almost 7 years, however decided to suspend conventional treatment and turned towards complementary and alternative medicine methods. Following the bioenergotherapist's advice, she began taking Lugol’s solution (LS) at a dose of 30 drops per day. After about one month of such therapy, the patient was urgently admitted to the Emergency Department with thyrotoxicosis with a high risk of thyroid storm development. With the implementation of intensive thyrostatic treatment and steroid therapy, euthyroidism was successfully restored.

Use of immune checkpoint inhibitors in patients with solid tumors and pre-existing autoimmune or inflammatory disease: real-world data.

Aim:Immune checkpoint inhibitors (ICIs) are a cornerstone in cancer treatment but they can induce immune-related adverse events (irAEs). Furthermore, patients with pre-existing autoimmune and/or inflammatory disease (AID) have been excluded from clinical trials. The objective of this study is to evaluate the efficacy and safety of ICIs in patients with cancer and AID.Materials & methods:This is an observational, retrospective study carried out at the Medical Oncology Department of Hospital Universitario Puerta de Hierro, Majadahonda, Madrid between January 2016 and December 2018.Results:A total of 202 cancer patients treated with ICIs were included, 15 (7, 4%) of them had pre-existing autoimmune diseases. The most frequent pre-existing AID were thyroid diseases (33.3%): autoimmune hypothyroidism, Graves–Basedow disease and Hashimoto’s thyroiditis. Three patients had psoriasis, two antinuclear antiboides + polyarthritis, one rheumatoid arthritis, another latent autoimmune diabetes in adults, another systemic lupus erythematosus and the last one, a polymyalgia rheumatica. In this series, the majority of patients (73.33%) did not experience any flare up of their autoimmune disease. In patients who had AID flare up, this was treated with corticosteroids. The most frequent cause of immunotherapy discontinuation was tumor progression (40%). A total of 20% of patients had to discontinue immunotherapy due to toxicity.Conclusion:In our series, AID flare ups or irAEs in patients with pre-existing AID who receive immunotherapy are not very common and can often be controlled without interrupting treatment. Prospective studies are needed to establish the incidence of irAEs in patients with pre-existing autoimmune conditions, evaluate risk–benefit and elaborate management clinical guidelines in this population.

Improvement Of Graves' Ophthalmopathy After Administration Of The Cyclooxygenase-2 Selective Inhibitor Celecoxib: A Case-Report

Graves' ophthalmopathy (GO) is a disabling complication of GravesBasedow disease, which in severe cases can progress toward blindness. Its treatment consists of the administration of corticosteroids, radiotherapy, as well as surgical treatment. The present report brings to your attention a case of moderate GO found in a patient recently diagnosed with Graves' disease that was resistant to the administration of Prednisone, stabilized under treatment with Celecoxib. A 45-year-old Caucasian woman presented in an outpatient facility with the following complaints: gritty feeling in both eyes, tachycardia, insomnia, anxiety, sweating, and weight loss. After the clinical European Scientific Journal, ESJ ISSN: 1857-7881 (Print) e - ISSN 1857-7431 January 2021 edition Vol.17, No.3 www.eujournal.org 2 examination and laboratory investigations, the patient has been diagnosed with Graves-Basedow disease and Graves' ophthalmopathy. Consecutively, treatment with Methimazole for Graves' disease and corticotherapy for Graves' ophthalmopathy were initiated. Due to the lack of response to Prednisone, other treatment methods were used, namely, Celecoxib 100 mg treatment, twice per day for 8 weeks. Under treatment with Celecoxib, GO was stabilized and remained stable even after discontinuation, respectively at six months and one year after discontinuation. Celecoxib can be an alternative treatment for mild and moderate ophthalmopathy in newly diagnosed Graves’ disease.

In sickness and in health: when myasthenia gravis is a conjugal matter.

Genes and environment contribute to the multifactorial etiology of autoimmune diseases. Familial clusters of autoimmune diseases are often observed among first-degree relatives sharing the same genetic background and environmental exposure. Rarer is the occurrence of the same autoimmune diseases in non-consanguineous spouses. We hereinafter report two non-consanguineous spouses who developed one after the other AChR-positive myasthenia gravis. This study has been approved by Catholic University Ethic Committee. The wife, previously affected by Graves-Basedow disease, was the first to be diagnosed with myasthenia gravis, basing on a generalized weakness and an anti-AChR-positive assay. The husband, who suffered from ulcerative colitis, 16years after his wife diagnosis complained of a mild generalized weakness. Repetitive nerve stimulation test and anti-AChR assay were confirmed myasthenia gravis. In these spouses, myasthenia gravis was not associated with thymoma. Human leukocyte antigen (HLA) class II genotyping showed distinct associations, with the wife carrying the DRB1*03:01 DQB1*02:01 and the husband the DRB1*07 DQB102 alleles. The wife's haplotype is strongly associated with myasthenia gravis and thyroiditis whereas HLA DRB1*07 allele was found to be related both to late-onset myasthenia gravis and ulcerative colitis. Compared with other autoimmune disorders, myasthenia gravis has a lower prevalence. The surveillance environmental exposure may greatly improve our knowledge of non-genetic drivers of autoimmunity.

Tirotoxicosis e hipertiroidismo

Thyrotoxicosis is a clinical disorder caused by an caused by the effect of excess of thyroid hormone in tissues, whereas hyperthyroidism refers to an increased thyroid hormone synthesis and secretion. Diagnosis is achieved by the measurement of the serum TSH and thyroid hormones (thyroxine and triiodothyronine). Etiology has to be identified in order to set up a proper treatment. Graves-Basedow disease (an autoimmune thyroid disorder) is the commonest cause of hyperthyroidism, followed by toxic nodular goiter or toxic thyroid adenoma (autonomous secreting thyroid nodules). In the thyroiditis, the thyroid gland is inflamed and the thyroid hormones are released. In the estruma ovarii the thyroid hormones have an extrathyroidal origen whereas in thyrotoxicosis facticia the origin of such an excess is exogenous. Etiological diagnosis of thyrotoxicosis and hyperthyroidism is based on clinical examination, laboratory and imaging (ultrasonography and scintigraphy) tests. The treatment of hyperthyroidism depends on the etiology and is focused in treating the symptoms as well as in reduce the synthesis and secretion of thyroid hormones (pharmacological treatment, radioiodine therapy and surgery).

Tiroiditis

Thyroiditis is a group of thyroid disorders characterized by the inflammation and destruction of the gland, and whose etiology and symptomatology are very diverse. Etiology can be autoimmune, infectious, traumatic, environmental or pharmacological. Pain appears in some types of thyroiditis. Depending on disorder stage, functionally its presentation either with thyrotoxicosis, hypothyroidism or both. Although diagnosis is easy, a proper differential diagnosis, as well among them as with non-inflammatory thyroid conditions (Graves-Basedow disease [GBS] or toxic nodular thyroid disease [TNTD], for example) is required. Proper diagnosis and treatment (relatively easy in most cases) involve a good prognosis. Presentation either be latent or almost silent or have a greater impact in the short, medium or long term.

Shear wave elastography in diffuse thyroid disease.

Our aim was to examine the contribution of shear wave elastography to ultrasonographic assessment in diffuse thyroid disease, specifically to evaluate the stiffness of the thyroid gland in diffuse thyroid disease and compare it with healthy controls. A total of 46 patients with diffuse thyroid disease were examined clinically, by conventional ultrasound, and shear wave elastography. The conventional ultrasound parameters followed were: volume, margin quality, presence of nodules, and vascularisation. We measured the mean, minimum, and maximum stiffnesses by shear wave elastography. Results were correlated with values in 128 healthy subjects. Patients with diffuse thyroid disease had significantly higher mean and maximal stiffnesses of the thyroid gland: 12.5 ± 5 kPa and 35.3 ± 12.8 kPa, respectively, and lower minimal stiffness: 0.5 ± 0.6 kPa than the healthy control group with mean, maximal, and minimal values of 9.5 ± 3.6 kPa, 22.5 ± 7.3 kPa, and 2.2 ± 2.1 kPa (P<0.001). Stiffness values were positively correlated with BMI and volume of the thyroid; they did not correlate with margin quality, presence of nodules nor vascularisation. Compared with healthy volunteers, thyroid glands of patients with diffuse thyroid disease had a blurred margin more frequently and the amount of nodules and vascularisation were higher. Patients with Graves-Basedow disease did not have significantly different mean, maximal, nor minimal stiffnesses than those with thyroiditis. Both mean and maximal stiffness of the thyroid gland are significantly higher in diffuse thyroid disease than in the healthy population, while minimal stiffness is lower.

Thyroid Pathology in End-Stage Renal Disease Patients on Hemodialysis.

Objectives: Chronic kidney disease is a rising cause of morbidity and mortality in developed countries, including end-stage renal disease (ESRD). The prevalence of thyroid comorbidities in persons with chronic kidney disease is documented higher than in normal population. The study aims to investigate the prevalence of morphological and functional thyroid disorders in patients with chronic kidney disease, with renal replacement therapy (hemodialysis). Methods: A cross-sectional study was performed on 123 consecutive patients with chronic kidney disease stage 5, on hemodialysis during a period of one month (May 2019–June 2020). All patients were enrolled for maintenance hemodialysis in B Braun Hemodialysis Center Timisoara and were examined on conventional 2B ultrasound. Thyroid blood tests were done, including serum free thyroxin (FT4), free triiodothyronine (FT3) and thyroid-stimulating hormone (TSH) at the time of starting hemodialysis. Results: We evaluated 123 patients (male to female ratio 70/53) mean age 62.2 ± 11.01, mostly above 65 years old, enrolled in the end-stage renal disease program, on renal replacement therapy. From the cohort, 76/123 presented thyroid disease, including autoimmune hypothyroidism, nodular goiter or thyroid cancer. Among them, 63 patients presented nodular goiter, including 3 thyroid cancers, confirmed by surgery and histopathological result, 22 patients had thyroid autoimmune disease. The serum thyroid-stimulating hormone levels found in the cohort was 3.36 ± 2.313 mUI/mL, which was in the normal laboratory reference range. The thyroid volume was 13 ± 7.18 mL. A single patient in the cohort presented Graves Basedow disease, under treatment and three patients present subclinical hyperthyroidism. We have found that thyroid disease risk is increased by 3.4-fold for the female gender and also the increase of body mass index (BMI) with one unit raises the risk of developing thyroid disease with 1.083 times (p = 0.018). Conclusion: To conclude, this study aimed to quantify the prevalence of thyroid disease in end-stage kidney disease population, especially nodular goiter, important for differential diagnosis in cases with secondary hyperparathyroidism. Thyroid autoimmune disease can be prevalent among these patients, as symptoms can overlap those of chronic disease and decrease the quality of life. We have found that thyroid disease has a high prevalence among patients with end-stage renal disease on hemodialysis. Thyroid goiter and nodules in ESRD patients were more prevalent than in the general population. Clinical surveillance and routine screening for thyroid disorders can improve the quality of life in these patients.

Thyroid diseases - ally or enemy of type 1 diabetes in children and adolescents?

Autoimmune thyroid diseases (AIT) are one of the most common disorders associated with type 1 diabetes (T1D) and they are capable of influencing its course. For Hashimoto's lymphocytic thyroiditis, the incidence is 14-28%, while for Graves-Basedow hyperthyroidism it is 0.5-7%. Aim of the study: Assessment of type 1 diabetes in the pediatric population with coexisting autoimmune thyroid diseases: Hashimoto's lymphocytic thyroiditis and Graves-Basedow's disease. Analyzing publications from the PubMed scientific database from 1990 to May 2020. Among pediatric patients with T1D and coexisting thyroid autoimmunity insufficient glycemic control is usually observed. Reported average increase in glycated hemoglobin concentration ranges from 7.9 to 9.2%. In children with T1D and subclinical hypothyroidism, an increased number of episodes of hypoglycemia was noted - 5 vs. 2 episodes per year among children with euthyroidism. In hyperthyroidism patients the number of episodes of hypoglycemia was 34.4 vs. 17.2 per 100 incidents in euthyroidism patients. An increased occurrence of diabetic ketoacidosis events may also be observed - 18.1 vs. 7.7 per 100 patients with euthyroidism per year. The risk of developing chronic complications in the form of cardiovascular diseases is also higher. However, basing on the available literature, this subject is still debatable. Autoimmune thyroid diseases often accompany and interfere with type 1 diabetes in children and adolescents. Paying special attention to the different course of diabetes in the presence of thyroid disorders is an important and essential element of diabetes care.

Preoperative Preparation With Lugol Solution in Patients With Graves-Basedow Disease.

Preoperative Preparation With Lugol Solution in Patients With Graves-Basedow Disease.

Thyroid Disease at the University Hospital of Conakry, Guinea

Objectives: To describe the epidemiological, clinical and therapeutic characteristics of thyroid disease at the University Hospital of Conakry, Guinea. Methods: This was a descriptive study with prospective data collection, carried out over the period of December 2016 to April 2019 at the endocrinology outpatient consultation at the University Hospital of Conakry. All the epidemiological, clinical and therapeutic data of the patients followed-up for thyroid disease were collected, analyzed and classified according to the epidemiological, clinical and therapeutic profile. The functional, morphological and autoimmune aspects of the thyroid gland were studied. Results: Out of a total of 3.517 endocrinology consultations during the study period, 204 patients were diagnosed with thyroid disease (180 women and 24 men, F/H ratio: 7.5). The average age was 47 ± 16 years. A total of 90 patients (44.33%) had hyperthyroidism, including 52 cases of Graves-Basedow disease (57.6%) and 24 cases of toxic multi-nodular goiter (32.6%). Hypothyroidism was confirmed in 25 patients (11%); about half (48%) of them had a complete thyroid surgery. The treatment of hyperthyroidism was exclusively done by synthetic antithyroid drugs, except 5 cases of Hashimoto disease with transient initial hyperthyroidism phase. Hypothyroidism was treated by hormone replacement therapy. Thyroidectomy, partial (n = 5) or total (n = 12), was performed for aesthetic discomfort (n = 6), cervical compression (n = 8) and suspicion of thyroid cancer (n = 3). Follow-up was considered regular in 40 cases (44%). Conclusion: Thyroid disease was frequent in this study conducted in Conakry and its clinical features were very diverse, dominated by hyperthyroidism mainly due to Grave disease. However, diagnostic and therapeutic strategies were hindered by the limitation in availability of biological and morphological explorations.