Hashimoto's Disease Research Articles

Bipolar limbic expression of auto-immune thyroid targets: thyroglobulin and thyroid-stimulating hormone receptor.

The associations between thyroid auto-immunity and neuro-psychiatric disorders are well-documented. However, there exists limited literature specifically linking auto-immune thyroid disease (AITD) to bipolar disorder (BD). Thus, we investigated the likely association between Hashimoto's disease and BD through the extra-thyroidal localisation of thyroid-stimulating hormone receptor (TSH-R) and thyroglobulin (TG) in limbic regions of normal and bipolar human adult brain. Further, we hypothesised that changes in thyroid expression in bipolar limbic cortex may contribute to mood dysregulation associated with BD. Immuno-chemistry and in-situ PCR were used to localise TSH-R/TG within the amygdala, cingulate gyrus and frontal cortex of normal (n = 5) and bipolar (n = 5) brains. Reverse-transcriptase qPCR provided fold-change differences in TSH-R gene expression. The results demonstrated reduced thyroid protein expression in bipolar limbic regions; these novel results correlate with other neuro-imaging reports that describe reduced cortico-limbic tissue volumes and neuro-physiological activity during BD. We also demonstrated TG-like proteins exclusive to bipolar amygdala neurons, and which relates to previous neuro-imaging studies of amygdala hyperactivity and enhanced emotional sensitivity in BD. Indeed, reduced TSH-R/TG in limbic regions may predispose to, or bear relevance in the pathophysiology of mood dysregulation and symptoms of BD. Further, we attribute mood dysregulation in BD to limbic-derived TSH-R, which probably provides potential targets for thyroid auto-immune factors during Hashimoto's disease. Consequently, this may lead to inactivated and/or damaged neurons. The neuro-pathology of diminished neuronal functioning or neuronal atrophy suggests a novel neuro-degeneration mechanism in BD.

Comparison of BD Barricor™ vs. BD Rapid Serum Tube (RST) for thyroid hormones

A 70-year-old man was referred to our emergency department for shortness of breath on exertion and systemic edema. He had been taking lithium carbonate for 2 years (500 mg/day over previous 3 months) for bipolar disorder diagnosed at age 60. He was diagnosed with hypothyroidism accompanied by Hashimoto's disease 2 weeks before hospitalization. Massive pericardial effusion and bilateral pleural effusions were demonstrated by transthoracic echocardiography and computed tomography. Cardiac tamponade occurred on the 3rd day. Pericardiocentesis and thoracentesis were performed once and three times, respectively, because of the acute deterioration of hemodynamic status due to pleural and pericardial effusion. Lithium carbonate is a widely used and effective treatment for bipolar disorder. However, lithium has a narrow therapeutic range and many side effects. An important aspect of this case was the rapid development of severe hypothyroidism, although serum lithium concentration was measured regularly and was maintained within the therapeutic range. It is important to note that lithium can cause serious complications, as in this patient, even if serum lithium concentration is measured regularly and maintained within the therapeutic range. We report the first case of cardiac tamponade caused by hypothyroidism associated with administration of lithium.<Learning objective: Lithium carbonate is a widely used and effective treatment for bipolar disorder. Goiter and hypothyroidism are common clinical side effects of lithium, but the complication of cardiac tamponade has not been reported. An important aspect of this case was the rapid development of severe hypothyroidism, although serum lithium concentration was measured regularly and was maintained within the therapeutic range. Therefore, timely diagnosis and treatment of hypothyroidism by routine assessment of thyroid function should be performed.>

HLA alleles, especially amino-acid signatures of HLA-DPB1, might contribute to the molecular pathogenesis of early-onset autoimmune thyroid disease.

The major histocompatibility complex region has been suggested to play an important role in the development of autoimmune thyroid disease (AITD). In this study, we investigated the associations of human leukocyte antigen (HLA) alleles and amino acid variants of HLA with early-onset AITD. HLA class I and class II genes were analyzed in 116 Korean children with AITDs (Graves’ disease [GD]: 71, Hashimoto’s disease [HD]: 45) and 142 healthy controls. HLA-B*46:01 (OR = 3.96, Pc = 0.008), -C*01:02 (OR = 2.51 Pc = 0.04), -DPB1*02:02 (OR = 3.99, Pc = 0.04), and -DPB1*05:01 (OR = 4.6, Pc = 0.003) were significantly associated with GD, and HLA-A*02:07 (OR = 4.68, Pc = 0.045) and -DPB1*02:02 (OR = 6.57, Pc = 0.0001) with HD. The frequency of HLA-DPB1*05:01 was significantly higher in GD patients than in HD patients (Pc = 0.0005). Furthermore, differences were found between patients with Thyroid associated ophthalmopathy (TAO) and those without TAO in the distribution of HLA-B*54:01 (8.6% vs. 30.6%, P = 0.04) and -C*03:03 (37.1% vs. 11.1%, P = 0.02). In the analysis of amino acid variants of HLA molecules, both Leu35 (OR = 23.38, P = 0.0002) and Glu55 (OR = 23.38, P = 0.0002) of HLA-DPB1 were strongly associated with GD and showed different distributions between GD and HD (P = 0.001). Our results suggest that HLA alleles, especially amino-acid signatures of the HLA-DP β chain, might contribute to the molecular pathogenesis of early-onset AITD.

IRAK2 and TLR10 confer risk of Hashimoto's disease: a genetic association study based on the Han Chinese population.

Hashimoto's disease (HD) is one of the major clinical subtypes of autoimmune thyroid disease. Both environmental and genetic factors contribute to the pathogenesis of HD. Previous evidence has shown that both IRAK2 and TLR10 are potential candidate susceptibility genes for HD. In this study, a total of 3654 Chinese women, including 973 HD cases and 2681 healthy controls, were recruited. Thirty-three tag single nucleotide polymorphisms (SNPs) in IRAK2 and TLR10 were genotyped. Genetic association analyses at both the single-marker and haplotype levels were performed. Gene-by-gene interaction analyses were also conducted in case-only samples, as well as eQTL analyses for significant SNPs based on data extracted from the GTEx database. We identified that two SNPs, rs165501 (OR = 1.20, P = 0.0008, IRAK2) and rs10004195 (OR = 1.23, P = 0.0001, TLR10), were identified to be significantly associated with HD. Rs10004195 was significantly associated with the gene expression of TLR10 in human pituitary tissues (P = 2.00 × 10-4), while rs165501 was significantly associated with the expression of IRAK2 in human thyroid tissues (P = 3.10 × 10-6). No significant results were obtained in the gene-by-gene interaction analyses. Our findings suggest that both IRAK2 and TLR10 play important roles in the onset and development of HD.

The Role of Surgery in Autoimmune Conditions of the Thyroid.

The two most common autoimmune conditions of the thyroid include chronic lymphocytic (Hashimoto's) thyroiditis and Graves' disease. Both conditions can be treated medically, but surgery plays an important role. Hashimoto's thyroiditis and Graves' disease are mediated by autoantibodies that interact directly with the thyroid, creating inflammation and impacting thyroid function. Patients may develop large goiters with compressive symptoms or malignancy requiring surgical intervention. In addition, there are several surgical indications specific to Hashimoto's and Graves' Disease.

A case of primary autoimmune hypophysitis associated with hashimoto's disease, alopecia areata and chronic hepatitis

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

Thyroidectomy Improves Quality of Life and Fatigue in Patients with Hashimoto's Disease and Persistent Symptoms Compared to Adequate Thyroid Hormone Replacement

Thyroidectomy Improves Quality of Life and Fatigue in Patients with Hashimoto's Disease and Persistent Symptoms Compared to Adequate Thyroid Hormone Replacement

SAT-579 A Rare Presentation of Ophthalmopathy in a Patient with Hashimoto's Hypothyroidism

Ophthalmopathy is a known disorder that consists of inflammation of the orbits and periorbital tissues that can be commonly seen in systemic autoimmune diseases such as Graves. On the other hand, ophthalmopathy associated with Hashimoto's thyroiditis is a rare presentation that is under-reported in the literature. A 58-year-old female was admitted to the hospital for sudden onset of double vision with subsequent progression of vision loss in her left eye. Prior to admission, she had a known history of hypothyroidism for several years with non-compliance to replacement therapy. On admission, patient's thyroid function tests (TFTs) showed a TSH of 37.95 and a Free T4 of 0.6 along with elevated thyroid peroxidase (TPO) antibodies at 58.3, thus confirming the diagnosis of Hashimoto's hypothyroidism. Upon Ophthalmology consultation, she was noted to have orbitopathy, namely left eye rectus lateralis paralysis, that was attributed to the TPO antibodies. The patient was started on appropriate thyroid hormone replacement with improvement of TFT values within a few days. However, the patient continued to have persistent diplopia despite therapy. At this time, the patient was started on prednisone 20 mg daily for a total of 2 weeks. At the end of the steroid therapy, complete resolution of the orbitopathy with vision improvement was noted. Hashimoto's ophthalmopathy is a rare form of orbitopathy especially when compared to the well-known version in Graves' Disease. In the literature, there has been some case studies that looked at the association of Hashimoto's thyroiditis with diplopia. In one study, the authors noted that both Graves' and Hashimoto's diseases accounted for 6% of thyroid associated eye disease while Graves' disease accounted for the majority of cases. The authors also noted that patients with Hashimoto's thyroid-associated eye disease were: older, had a longer duration of Hashimoto's diagnosis, were less likely to have co-existent other autoimmune disease, had a positive history of tobacco usage, and had elevated values of thyroid stimulating antibodies (TSAb). The authors also established a positive correlation between the occurrence and severity of thyroid associated eye disease in relation to increasing TSAb levels.1 Although Hashimoto's associated ophthalmopathy is a rare presentation of this autoimmune thyroid disorder, it is prudent to have a high index of suspicion in order to institute appropriate anti-inflammatory therapy such as steroid therapy for early resolution of eye symptoms. Early identification and treatment can stop the disease progression and prevent complications such as blindness due to optic nerve compression. 1. Kan E, Kan EK, Ecemis G, Colak R. Presence of thyroid-associated ophthalmopathy in Hashimoto's thyroiditis. International Journal of Ophthalmology. 2014;7(4):644-647. doi:10.3980/j.issn.2222-3959.2014.04.10.

SUN-593 Puzzling TFTs: A Case of a TSHoma and Underlying Hashimoto's Disease

Introduction: TSH-secreting adenomas (also known as TSHomas or thyrotropinomas) are rare pituitary tumors (0.5-3% of pituitary adenomas) and a rare cause of hyperthyroidism (<1%). Characteristic lab values include a non-suppressed TSH with elevated T4 and T3. Clinical Case: A 61 year old man with chronic exhaustion was found to have an elevated TSH in 2013. Family history was notable for hypothyroidism in his sister and mother. His PCP started the patient on levothyroxine (LT4) and escalated dose up to 175 mcg daily. However, the TSH remained persistently elevated despite good adherence. His levothyroxine was increased to 215 mcg and he developed palpitations. TSH decreased from 11.89 (0.35-5.5 uIU/L) to 4.7 with this dose change, but free T4 increased from 1.61 to 2.54 (0.8-1.9 ng/ml). A pituitary MRI in 7/2015 showed a hypoenhancing 8x8 mm pituitary microadenoma. He was then seen for a second opinion, taken off levothyroxine and monitored. Physical exam was notable for slight tachycardia with HR 105, no thyromegaly or nodules, and otherwise the patient was euthyroid appearing. Labs were otherwise notable for an anti-TPO antibody 261 (0-115 IU/ml), TSI <89 (<140%), alpha subunit 1.6 (0.1-0.5 ng/ml), SHBG 76.4 (17-66 nmol/L), TSH 14.37, and free T4 2.3. Repeat MRI in 4/2018 demonstrated an interval increase of pituitary adenoma (1.3x1.2x1.1 cm). Methimazole was started (partially as a diagnostic test) and TSH increased from 44 to 134. The patient underwent uncomplicated transphenoidal surgery (TSS). Immunohistochemistry of the tumor demonstrated positive TSH staining. At 6 weeks after surgery, TSH was 2.05 with free T4 0.6, consistent with operative cure. Clinical Lessons: There is a wide differential diagnosis for non-suppressed TSH with elevated T4 and T3, including assay interference, familial syndromes including resistance to thyroid hormone beta (RTHβ), abnormal binding proteins, and TSHoma. Diagnostic testing includes repeating TFTs, obtaining a pituitary MRI, and using labs including SHBG and alpha subunit to differentiate between RTHβ and TSHoma. The first line treatment for TSHoma is TSS. In this patient with underlying Hashimoto’s disease and a TSHoma, TSH was somewhat suppressible with high-dose LT4 and the free T4 and total T3 were not always frankly high (appearing similar to subclinical hypothyroidism), delaying the time to diagnosis.

Clinical analysis of risk factors for lateral cervical lymph node metastasis in stage cN0 papillary thyroid carcinoma and preventive dissection

Objective To discuss the clinical characteristics for lateral cervical lymph node metastasis in stage cN0 papillary thyroid microcarcinoma and significance and feasibility of preventive dissection, and provide reference for clinical treatment. Methods Reviewd the clinical data of 191 patients with stage cN0 papillary thyroid microcarcinoma patients from Jul. 2011 to Dec. 2016 underwent surgery in the Department of General Surgery of Lianyungang Oriental Hospital. Assessed the need for preventive cervical lymph node dissection.Chi-square test and logistic regression were used to analyze the relationship between cervical lymph node metastasis and gender, age, tumor number, tumor size, capsule infiltration, single and bilateral tumors, Hashimoto′s disease, and central lymph node metastasis. Results The positive rate of cervical lymph node metastasis in papillary thyroid microcarcinoma was 27.9% (50/191). Univariate analysis showed that the metastasis of the cervical lymph nodes was associated with infiltration of the capsule, Hashimoto disease, and CLN metastasis (all P<0.05). Multivariate logistic regression analysis showed that the capsule infiltration (OR=7.563, P=0.000), Hashimoto′s disease (OR=4.635, P=0.003), and central lymph node metastasis (OR=3.075, P<0.001) were able to be independent risk factors for cervical lymph node metastasis. When the positive number of lymph node metastasis in the central region was ≥ 2, the positive rate of cervical lymph nodes was significantly increased (P<0.001). Eleven patients (5.8%) had temporary recurrent laryngeal nerve palsy, 29 patients (15.1%) had transient hypoparathyroidism, and no patients with permanent recurrent laryngeal nerve palsy and hypoparathyroidism. Conclusions The removal of the cervical lymph nodes helps to accurately classify the tumor and assess the risk.It is important to choose the postoperative treatment follow-up plan for patients.For patients with capsule infiltration, Hashimoto′s disease, and central lymph node metastasis, cervical lymph node dissection should be routinely performed. Key words: Surgical procedures, operative; Parathyroid glands; Neck dissection; Papillary thyroid microcarcinoma; Prophylactic lateral cervical lymph node dissection

Annals for Educators - 2 April 2019.

Annals for Educators - 2 April 2019.

Prevalence of Autoimmune Gastritis in Individuals Undergoing Medical Checkups in Japan.

Objective Based on both endoscopic findings and serum auto-antibody levels, we determined the prevalence of autoimmune gastritis (AIG), which has not been previously reported, in individuals who underwent health checkup examinations in Japan. Methods At total of 6,739 subjects (4,288 males, 2,451 females; mean age 52.1 years) underwent an upper gastrointestinal endoscopic examination as part of an annual medical checkup. Those suspected to have AIG based on endoscopic evidence of proximal-predominant gastric mucosal atrophy were further examined for the presence of anti-parietal cells and anti-intrinsic factor antibodies, with a final diagnosis of AIG made in cases found to be positive for either or both of those factors. Results Of the 6,739 examined subjects, 46 were suspected to have AIG based on the endoscopic findings, of whom 33 were finally diagnosed with AIG, for an overall prevalence 0.49% (females 0.65%, males 0.40%). Seven with AIG also had thyroid disease, including Hashimoto's and Basedow disease, while none with AIG showed anemia in blood test findings. The prevalence of AIG was not different regardless of the H. pylori infection status (negative, positive, post-eradicated). Conclusion In individuals who underwent an upper gastrointestinal endoscopic examination as part of an annual checkup in Japan, the prevalence of AIG was 0.49%. We concluded that it is not uncommon for asymptomatic and healthy individuals to have AIG, and propose that additional studies are needed to clarify its prevalence as well as to establish the criteria used for diagnosis.

Expression of miRNA-146b-5p in patients with thyroid cancer in combination with Hashimoto's disease and its clinical significance.

The expression level of microRNA (miRNA)-146b in patients with thyroid carcinoma (TC) in combination with Hashimoto's thyroditis (HT) was evaluated to analyze the clinical significance. Eighty-seven patients who underwent thyroid surgery in The Third Affiliated Hospital of Southern Medical University from March 2010 to February 2013 were enrolled. Of the patients, 37 were diagnosed with TC (group A), and 50 were diagnosed with TC in combination with HT (group B). Forty patients were diagnosed with HT (group C). The expression levels of miRNA-146b-5p in cancer tissue and paracancerous tissue of patients in the two groups were measured by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Correlation between the miRNA-146b-5p levels and the clinicopathological characteristics of patients with combined TC and HT were evaluated. According to the expression of miRNA-146b-5p, patients in group B were separated into the high and low expression groups to observe the five-year cancer recurrence rate. There was no significant difference in miRNA-146b-5p expression between the papillary carcinoma group, the follicular carcinoma group and the medullary carcinoma group (P>0.05). The miRNA-146b-5p expression in the lesion tissue of group B was significantly higher than that of groups A and C, while the miRNA-146b-5p expression in the lesion tissue of group A was significantly higher than that of group C (P<0.05), and the lesion tissue of the three groups was higher than that of the corresponding parastatal tissue (P<0.05). The miRNA-146b-5p expression level was associated with tumor size, lymph node metastasis and TNM stage (P<0.05), while not associated with sex, age, lesion multiplicity, smoking history, diabetes history and pathological type in group B (P>0.05). The non-recurrence rate of group B high expression subgroup was lower than that of group B low expression subgroup (P=0.045). High expression of miRNA-146b-5p was found in the cancer tissues of patients with combined TC and HT. The expression level of miRNA-146b-5p was associated with tumor size, lymph node metastasis and TNM stage. It is a potential prognostic indicator for patients with combined TC and HT.

Thyroidectomy Versus Medical Management for Euthyroid Patients With Hashimoto Disease and Persisting Symptoms: A Randomized Trial.

Hashimoto disease is a chronic autoimmune thyroiditis. Despite adequate hormone substitution, some patients have persistent symptoms that may be the result of immunologic pathophysiology. To determine whether thyroidectomy improves symptoms in patients with Hashimoto thyroiditis who still have symptoms despite having normal thyroid gland function while receiving medical therapy. Randomized trial. (ClinicalTrials.gov: NCT02319538). Secondary care hospital in Norway. 150 patients aged 18 to 79 years with persistent Hashimoto-related symptoms despite euthyroid status while receiving hormone replacement therapy and with serum antithyroid peroxidase (anti-TPO) antibody titers greater than 1000 IU/mL. Total thyroidectomy or medical management with hormone substitution to secure euthyroid status in both groups. The primary outcome was general health score on the Short Form-36 Health Survey (SF-36) at 18 months. Secondary outcomes were adverse effects of surgery, the other 7 SF-36 subscores, fatigue questionnaire scores, and serum anti-TPO antibody titers at 6, 12, and 18 months. During follow-up, only the surgical group demonstrated improvement: Mean general health score increased from 38 to 64 points, for a between-group difference of 29 points (95% CI, 22 to 35 points) at 18 months. Fatigue score decreased from 23 to 14 points, for a between-group difference of 9.3 points (CI, 7.4 to 11.2 points). Chronic fatigue frequency decreased from 82% to 35%, for a between-group difference of 39 percentage points (CI, 23 to 53 percentage points). Median serum anti-TPO antibody titers decreased from 2232 to 152 IU/mL, for a between-group difference of 1148 IU/mL (CI, 1080 to 1304 IU/mL). In multivariable regression analyses, the adjusted treatment effects remained similar to the unadjusted effects. Results are applicable only to a subgroup of patients with Hashimoto disease, and follow-up was limited to 18 months. Total thyroidectomy improved health-related quality of life and fatigue, whereas medical therapy did not. This improvement, along with concomitant elimination of serum anti-TPO antibodies, may elucidate disease mechanisms. Telemark Hospital.

Differential diagnosis value of ultrasound elastography in Hashimoto's thyroiditis with benign and malignant nodules

Objective To investigate the differential diagnosis value of ultrasound elastography in Hashimoto's thyroiditis with benign and malignant nodules. Methods From January 2013 to December 2015, 21 patients(25 nodules) with Hashimoto's thyroiditis and malignant nodules and 52 patients(76 nodules) with benign nodules in Jiangshan Hospital of Traditional Chinese Medicine were studied.All nodules were detected by color Doppler ultrasound and ultrasound elastography. Results The proportion of boundaries clear, morphological rules, non-low-echo, no calcification or coarse calcifications, RI value <0.70, blood flow grade 0-Ⅰin patients with malignant nodules(32.0%, 24.0%, 12.0%, 40.0%, 32.0%, 24.0%) were lower than those of the benign group(80.3%, 51.3%, 47.4%, 97.4%, 60.5%, 51.3%)(χ2=20.245, 5.682, 9.928, 44.228, 6.153, 5.682, P=0.000, 0.017, 0.002, 0.000, 0.013, 0.017). The sensitivity, specificity and diagnostic accuracy of two-dimensional color Doppler ultrasound in diagnosing Hashimoto's thyroiditis with malignant and benign nodules were 68.0%, 75.0% and 73.2%, respectively.The ultrasound elastography ≥Ⅲ grade level was as the predictor of malignant nodules, the sensitivity, specificity and diagnostic accuracy of ultrasound elastography in diagnosing Hashimoto's thyroiditis with benign and malignant nodules were 88.0%, 69.7% and 74.3%, respectively.The ultrasound elastography strain rate ratio=5.13 was the cut-off point, the ultrasound elastography strain rate ratio in diagnosing Hashimoto's thyroiditis with benign and malignant nodules, the sensitivity was 76.0%, the specificity was 92.1%, the diagnostic accuracy was 88.1%. Conclusion Ultrasound elastography grading and ultrasound elastography strain rate have certain value in the differential diagnosis of Hashimoto's thyroiditis with malignant and benign nodule. Key words: Hashimoto disease; Thyroid neoplasms; Thyroid nodule; Ultrasounography; Sensitivity and Specificity

Thyroid Diagnosis from SPECT Images Using Convolutional Neural Network with Optimization

Thyroid disease has now become the second largest disease in the endocrine field; SPECT imaging is particularly important for the clinical diagnosis of thyroid diseases. However, there is little research on the application of SPECT images in the computer-aided diagnosis of thyroid diseases based on machine learning methods. A convolutional neural network with optimization-based computer-aided diagnosis of thyroid diseases using SPECT images is developed. Three categories of diseases are considered, and they are Graves' disease, Hashimoto disease, and subacute thyroiditis. A modified DenseNet architecture of convolutional neural network is employed, and the training method is improved. The architecture is modified by adding the trainable weight parameters to each skip connection in DenseNet. And the training method is improved by optimizing the learning rate with flower pollination algorithm for network training. Experimental results demonstrate that the proposed method of convolutional neural network is efficient for the diagnosis of thyroid diseases with SPECT images, and it has superior performance than other CNN methods.

The Presence of Thyroid Peroxidase Antibody Is Associated with Lower Placental Weight in Maternal Thyroid Dysfunction.

Thyroid dysfunction (TD) is caused by thyroid peroxidase (TPO) antibody, as seen in Hashimoto's disease. TD is a common problem of reproductive age and may impair fetal development. Here, we determined the effect of TPO antibody on perinatal outcomes in Japanese women with TD before conception. A retrospective study involving cases of maternal TD with term singleton birth was conducted. The subjects with TD were divided into two groups according to the presence (n = 22) or absence (n = 20) of TPO antibody. The control groups matched for age, parity, and gestational weeks were selected for TPO antibody-positive (n = 44) and -negative TD subjects (n = 40), respectively. Using the standard curve of Japanese placental weight, the frequency of placental weight less than the 50th percentile (small placenta) was examined. Placental weight was lower among TPO antibody-positive TD subjects, compared with TPO antibody-negative TD subjects (p < 0.01). However, other outcomes were similar between the groups. Importantly, compared with control mothers, placental weight was significantly lower (p < 0.01), birth weight tended to be lower (p = 0.07), and the incidence of gestational diabetes mellitus was higher (p = 0.02) among TPO antibody-positive subjects. There was no significant difference in placental weight between TPO antibody-negative subjects and controls. The frequency of small placenta was significantly higher in TPO antibody-positive subjects (odds ratio: 16.7) even when considering diabetes and pregnancy induced hypertension. Thus, the presence of TPO antibody is associated with lower placental weight among Japanese women having TD.

Management of hypothyroidism by Kshara Basti (therapeutic enema)– A case report

Hypothyroidism is emerging as a common health concern in India as well as worldwide. An autoimmune cause accounts for approximately 90% of adult hypothyroidism mostly due to Hashimoto’s disease. This autoimmunity goes parallel with the theory of Ama (intermediatory product) in Ayurveda. A case of a 27-year-old female patient, presenting with pain in multiple joints, deformity in the right little finger, morning stiffness lasting for more than 3 h, reduced appetite, constipation, and lethargy, diagnosed with Amavata (rheumatoid arthritis), was subclinically diagnosed with hypothyroidism and treated with Deepana (stimulates digestion), Pachana (promots digestion) and Koshtha Shuddhi (mild purgation) for 5 days followed by Kshara Basti (therapeutic enema) for 5 days. Reduction in serum- thyroid-stimulating hormone (S. TSH) (31.1 mIU/ml to 16.6 mIU/ml) along with relief in clinical manifestations of the disease was the outcome. Koshtha Shuddhi followed by Kshara Basti has its efficacy in hypothyroidism, as it not only improved signs and symptoms but S.TSH level was reduced significantly. This case report proposes an innovative treatment modality for the management of hypothyroidism, which needs to be validated through a well-planned study on a large sample size.

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.

Total circulating cell-free miRNA in plasma as a predictive biomarker of the thyroid diseases.

Thyroid cancer is a common endocrine cancer. Great progress has been made in resolving its molecular mechanisms in recent years. The molecular changes observed in thyroid cancer can be used as biomarkers for diagnostic, prognostic and therapeutic purposes. MicroRNAs (miRNAs) are important components in biological and metabolic pathways, such as developmental stages, signal transduction, cell maintenance, and differentiation. Hence, their malfunctioning can expose humans to malignancies. miRNA expressions have been shown to be dysregulated in different tumor types, like thyroid cancer, and may cause tumor initiation and progression. In previous studies, only cancer has been studied, and miRNA has been detected from the tissues in all the studies performed. In this study, we have focused on thyroid diseases such as bening nodules and Hashimoto's disease, which might be the cause of thyroid cancer, and have carried out miRNA tests in the blood samples taken from the arms thyroid patients. The present study was conducted on the blood samples of 100 thyroid patients. Of the 100 patients in our study, 33 consisted of patients with thyroiditis, while 37 patients were diagnosed with benign thyroid nodules and 30 patients had thyroid cancer. For the control group, 18 patients were included. The plasma samples were analyzed, and the total miRNA levels were determined. We found that the ccf-miRNA amount of benign patients is significantly lower than that of the controls. Similarly, the miRNA amount in the controls is significantly higher than that of the thyroiditis (P = 0.06) and the malign groups miRNA (P = 0.084). Although the present study has a low number of patients, the plasma samples could be used as a source of circulating miRNAs. In addition, the total miRNA of thyroid diseases could be used as a biomarker for different types of thyroid diseases. We could suggest, for future study, that specific miRNAs in bodily fluid might show specific properties to be used as biomarkers of thyroid diseases.