Hashimoto's Patients Research Articles

Prevalence of Thyroiditis Following Either COVID-19 Infection or Vaccination in a Group of Egyptian Hashimoto Cases

Abstract Background Hashimoto's thyroiditis (HT), the most frequent autoimmune thyroid disorders (AITDs), is the leading cause of hypothyroidism in the iodine-sufficient areas of the world. COVID-19 is a highly transmissible infectious disease caused by the Severe Acute Respiratory Syndrome Virus 2 (SARS-CoV- 2), belong to the family of beta-coronaviruses. The disease rapidly spread, leading to COVID-19 pandemic on March 11, 2020. Aim of the Work The aim of this study was to evaluate the thyroid function consequences following either (COVID-19) infection or vaccination, in relation to their clinical features, biochemical, immunological, and inflammatory markers. Patients and Methods This study was a pilot study, conducted on 80 subjects attending COVID vaccination center and Emergency isolation in Ain Shams university hospital during the period from August to October 2022 14 males, 66 females, age>18 years old and <70 years’ old to evaluate the thyroid function consequences following either (COVID-19) infection or vaccination, in relation to their clinical features, biochemical, immunological, and inflammatory markers. Results Our study showed significant increase in the level of TSH and decrease in the level of free T3, Free T4 in Hashimoto’s patients who exposed to COVID19 infection. Also it showed significant increase in the level of free T3, Free T4 and decrease level of TSH in normal subjects after exposure to COVID19 infection. Additionally, our study showed increase level of free T3, Free T4 in normal subjects after being exposed to COVID19 vaccine (AstraZeneca) in contrast to TSH being decreased in them. Furthermore, we found significant increase in the level of free T3, Free T4 in Hashimoto’s subjects after their exposure to AstraZeneca vaccine, with non significant difference regarding –anti- TPO, Antithyroglobulin. Conclusion COVID19 infection and vaccination against COVID might be followed by an attack of thyroiditis (disturbed thyroid function test) in Hashimoto patient and even in normal person.

Total Antioxidant Capacity, Salivary Catalase, and Superoxide Dismutase in Hashimoto's Thyroiditis Patients

Hashimoto's thyroiditis (HT) is one of the common causes of hypothyroidism. Although various factors are involved in its development, recently the role of oxidative stress in its pathogenesis has been known. The present study aimed to investigate the level of total antioxidant capacity (TAC), catalase (CAT), and salivary superoxide dismutase (SOD) in patients with HT compared with the control group. The present case-control design included patients aged 18-80 years suffering from HT referred to the endocrine clinic. Eligible patients were selected by the available sampling method. Complete unstimulated saliva was collected under a rest state in a comfortable room between 10:00 AM and 12:00 AM and a checklist was used to collect data. The chi-square, t-test, and Mann-Whitney U tests were used for data analysis using SPSS 22 software. The mean age of the participants was 36.55±9.37 years (range: 20-56). The two groups were the same in terms of age and gender (P>0.05). The findings indicated that the difference in the means CAT between the two groups was 22.63 which was strongly and statistically significant (P<0.001). In this study, the level of TAC and SOD in Hashimoto's thyroid patients was decreased and the level of CAT was increased. These initial findings show that oxidative stress can be associated with Hashimoto's thyroid disease or the possibility of developing this disease increase.

Outcomes of thyroidectomy in symptomatic, euthyroid Hashimoto's patients: a case control study.

Hashimoto's thyroiditis (HT) is managed with thyroid hormone replacement to maintain a euthyroid state. A subset of patients have refractory symptoms, which improve with thyroidectomy (TT). There remains a reluctance to proceed with surgery due to perceptions of complications, and limited data availability regarding improvements in quality of life (QoL). This retrospective case control study aims to analyse the outcomes and QoL scores for symptomatic euthyroid HT patients who underwent TT. Thirty euthyroid patients who underwent TT for the management of HT between 2017 and 2022 were identified. An age-matched control group of patients who underwent TT for symptomatic multinodular goitre (MNG) were randomly selected. Demographics, biochemistry, histology, outcomes, and pre- and post-operative SF-36 and ThyPRO-39 scores were compared between groups. There were no surgical complications in the HT group, whilst two MNG patients had complications. There was a similar rate of parathyroid auto-transplantation in both groups, more glands were transplanted in the HT group. There was a significant difference in pre- and post-operative QoL scores for both groups. Comparison revealed a significant improvement in hyperthyroid symptoms, social life and daily life scores in the HT group. There was a significant difference in pre- and post-operative anti-TPO, anti-TG and TSH levels in the HT group. Patients with symptomatic Hashimoto's thyroiditis, despite being euthyroid, may benefit from total thyroidectomy however this remains under-utilized. This study demonstrated that thyroidectomy was associated with an improvement in validated post-operative quality of life scores and was not associated with increased complication rates for appropriately selected patients.

Lipoprotein-Associated Phospholipase A2 and hs-CRP are Correlated with Anti-TPO Antibodies in Jordanian Non-Pregnant Women with Hashimoto’s Thyroiditis

Hashimoto’s thyroiditis (HT) is an autoimmune disorder characterized by elevated thyroid-stimulating hormone (TSH) levels. This research investigates the complex interaction between HT and cardiovascular risk in adult Jordanian non-pregnant women aged 20-50. Through a study involving 50 HT subjects and 40 healthy subjects, the levels of lipoprotein-associated phospholipase A2 (PLA2), high sensitivity C-reactive protein (hs-CRP), and anti-thyroid peroxidase (anti-TPO) antibodies were compared using ELISA methods and enzymatic colorimetric assays for lipid profiles. The results revealed significantly higher serum levels of hs-CRP, PLA2, and Anti-TPO in Hashimoto's patients, coupled with elevated cholesterol, triglyceride, and low-density lipoprotein (LDL) levels. Conversely, reduced levels of high-density lipoprotein (HDL) were observed in Hashimoto’s patients compared to healthy subjects. The study establishes a noteworthy correlation between thyroid autoimmunity, thyroid disease, PLA2, hs-CRP, and lipid profile, underscoring an increased cardiovascular risk in individuals with Hashimoto’s thyroiditis. The findings emphasize the prevalence of Anti-TPO antibodies in adult Jordanian non-pregnant women with Hashimoto’s thyroiditis.

The role of IL-4 −590 (C>T) Gene as diagnostic biomarker of Hashimoto thyroiditis disease patients in AL-Najaf provenance /Iraq

The study of IL-4 genotyping in Hashimoto patients is considered one of the challenges of sustainable development .Hashimoto disease is an autoimmune disease that causes the immune system to attack the cells of the thyroid gland, causing the death of the cells that produce thyroid hormones, and thus leads to chronic hypothyroidism. The aim of current study is to determine the genotyping of IL-4 -590C>T in the DNA of Hashimoto patients and compared with healthy subjects .A 54 blood samples were collected from people with Hashimoto's disease and 25 samples from healthy people during period from March to September of the year 2022 , DNA was extracted from blood using Favorprep Kit, then, using a specific primers for the C and T alleles of interleukin 4-590 C/T, then doubled using Arms PCR. Then, they were transported in agarose gel with the ethidium bromide dye and detected by the gel documentation system , ultraviolet rays use to determine the type of alleles present in each sample and compared with control group. The current study, which includes 50/54 female and 4/54 male with Hashimoto thyroiditis with ages ranged from 20-59 years old, the results show up that the age group 40-49 years were the most affected, Also the body mass index was had increases among patients. CT genotype present in 74% of Hashimoto patients while 16% of control. C allele was found as high rate in both patients and control with percentage 100% and 96% respectively. in conclusion: The Hashimoto patients have more frequency of CT genotyping of IL-4 -590 C>T than control ,while C Allele was high in both Hashimoto patients and controls. The -590 CC genotype in the IL4 gene may consider to be a strong predictive factor for the development of hypothyroidism in HD.

Hashimoto's Thyroiditis among Patients with Thyroid Diseases in Sulaimani City: A Cross-Sectional Study

This study aimed to measure the prevalence of Hashimoto's Thyroiditis among patients with thyroid diseases in Sulaimani city and to observe some features of this autoimmune disorder. Hashimoto's Thyroiditis, also known as Hashimoto's disease, is an essential cause of Hypothyroidism. Blood samples ‎were collected from 203 patients suffering from thyroid disease in Sulaimani endocrine center and Bakshin Private Hospital in Sulaimani city from December 2018 to March 2019. Serum levels of thyroid hormones, anti-thyroid peroxidase antibodies, anti-thyroglobulin antibodies, and anti-‎thyroid-stimulating hormone ‎receptor antibodies were determined using Cobas e411 Immuno‎analyzer; moreover, data about ‎gender, age, and family history of thyroid disease were recorded. The prevalence of Hashimoto's Thyroiditis among all thyroid patients was 62% (n=126/203), while Graves' disease was 15.3% (n=31/203); thus, autoimmune diseases represent 77.3% (157/203) of thyroid diseases. Hypothyroidism is diagnosed in 155/203 (76.4%) thyroid diseases, while the remaining 23.6% were patients with hyperthyroidism. The demographic data revealed that 88.9% (n=112/126) of Hashimoto's Thyroiditis are females, while 11.1 % (n=14/126) are males. The peak incidence of Hashimoto's Thyroiditis is in the age group 36-45 years; a family history of thyroid diseases was recorded in 64.3% of Hashimoto's patients. The correlation coefficient between anti-thyroid peroxidase antibodies and the ages of Hashimoto's Thyroiditis patients is 0.21938. Hashimoto's Thyroiditis is the main thyroid disorder in Sulaimani city among patients with thyroid diseases, Hypothyroidism, and autoimmune thyroid disorders; both seropositive and seronegative anti-thyroid peroxidase antibodies are recorded among Hashimoto's Thyroiditis patients. Family history of thyroid disorders and females of childbearing age are possible risk factors for developing Hashimoto's Thyroiditis. There is no significant correlation between anti-thyroid peroxidase antibodies concentrations and ages of Hashimoto's Thyroiditis patients, but these antibodies are much higher in Hashimoto's females than in Hashimoto's Thyroiditis males

Alterations in the amino acid profile in patients with papillary thyroid carcinoma with and without Hashimoto's thyroiditis.

Amino acids (AAs) play important physiological roles in living cells. Some amino acid changes in blood are specific for autoimmune disorders, and some are specific for thyroid cancer. The aims of this study were to profile AA metabolites in the serum of patients with papillary thyroid carcinoma (PTC0) without Hashimoto's thyroiditis (HT) and patients with PTC with HT (PTC1) and predict whether AA metabolites are associated with thyroid disease, thyroid hormone and thyroid autoantibodies. A total of 95 serum samples were collected, including 28 healthy controls (HCs), 28 PTC0 patients and 39 PTC1 patients. Serum samples were analyzed by high-performance liquid chromatography-triple stage quadrupole-mass spectrometry (HPLC-TSQ-MS), and twenty-one amino acids (AAs) were detected. The serum concentration of glutamic acid was significantly elevated in PTC1 patients compared with PTC0 patients. Lysine was the second amino acid that differentiated these two groups of PTC patients. In addition, the serum concentrations of glycine, alanine and tyrosine were significantly reduced in both PTC patient groups compared to the HC group. These AAs were also correlated with thyroid hormones and antibodies. Five amino acid markers, namely, glycine, tyrosine, glutamic acid, glutamine and arginine, separated/distinguished PTC0 patients from healthy subjects, and eight AA markers, the same AAs as above without arginine but with alanine, leucine, valine and histidine, separated/distinguished PTC1 patients from healthy subjects based on ROC analysis. Compared with the HCs, changes in AAs in PTC0 and PTC1 patients showed similar patterns, suggesting the possibility of a common pathophysiological basis, which confirms preliminary research that PTC is significantly associated with pathologically confirmed HT. We found two AAs, lysine and alanine, that can perform diagnostic functions in distinguishing PTC1 from PTC0.

Association between Hashimoto's thyroiditis and melanoma: a retrospective matched cohort study.

An inflammatory microenvironment has been shown to increase risk for malignant melanoma, suggesting that melanoma may be related to a pro-inflammatory state. Though Hashimoto's thyroiditis is one of the most common autoimmune diseases, there are no investigations of its relationship with melanoma. We aim to determine if Hashimoto's increases risk of developing melanoma. A retrospective, validated cohort of patients with a diagnosis of Hashimoto's between 2005 and 2020 were identified using the Olmsted County database. Patients were age and sex matched to controls without a Hashimoto's diagnosis. The primary outcomes were development of melanoma and time to first melanoma diagnosis. 4805 patients were included in the study, with 1726 (36%) having a diagnosis of Hashimoto's. Hashimoto's patients had no significant difference in risk of melanoma (relative risk 0.96, 95% CI 0.78-1.17) or nonmelanoma skin cancer (relative risk 0.95, 95% CI 0.86-1.06) compared with matched controls. This suggests that the local proinflammatory environment present in Hashimoto's does not contribute significantly to melanoma risk. Larger studies may be needed to further characterize the relationship between these diseases.

Adaptation and validation of the Hungarian version of Thyroid-Related Patient-Reported Outcome-39 (ThyPro-39) questionnaire: testing factor structure, known-group validity with the comparison of quality of life in Hashimoto’s thyroiditis and Graves’ disease

BackgroundLiving with autoimmune thyroid disease is a longstanding challenge and can seriously affect the quality of life. We aimed to adapt and validate the Hungarian version of the Thyroid-Related Patient-Reported Outcome-39 (ThyPro-39) questionnaire, test its factor structure, and compare two frequent autoimmune thyroid diseases, Hashimoto’s thyroiditis, and Graves’ disease. We tested the factor structure of ThyPro-39 with a series of confirmatory factor analyses (CFAs). To examine the validity of ThyPro-39 and to compare the quality of life of the two groups — Hashimoto’s thyroiditis (N = 240), Graves’ disease (N = 51) — CFA with covariates were used.ResultsOur results supported a bifactor model with psychosocial and somatic symptoms as general factors, and 12 symptom-specific factors. Based on the analysis of omega hierarchical indices ranging between 0.22 and 0.66, the specific scales also carry information besides the composite scores and should be used when a more detailed analysis is required. In the multivariate analysis, perceived stress was significantly associated with the general psychosocial factor (β = 0.80), symptom factors (β = 0.34), anxiety (β = 0.43), depressivity (β = 0.37), and emotional susceptibility (β = 0.38) specific factors. Graves’ patients reported more eye symptoms (d = 0.45) and cosmetic complaints (d = 0.40), while Hashimoto patients had more cognitive problems (d = 0.36) and more severe hypothyroid symptoms (d = 0.35). These group differences confirm the known-group validity of the questionnaire.ConclusionsThe validity of the Hungarian version of ThyPRO-39 is supported. We recommend using two composite scores of psychosocial and somatic symptoms and the specific symptoms scores to measure the quality of life in clinical practice and research.

INFERIOR THYROID ARTERY DOPPLER: A NEW TOOL IN DIFFERENTIATION OF GRAVE'S DISEASE AND HASHIMOTO'S THYROIDITIS. A NOVEL RADIOLOGICAL-PATHOLOGICAL CORRELATION STUDY

Background: Autoimmune thyroid diseases are characterized by diffuse involvement of thyroid gland with hypoechogenicity and altered echotexture at gray scale ultrasound being a characteristic feature. An overlap of this pattern in patients affected by Graves' disease or Hashimoto's thyroiditis. Differentiation between causes of thyrotoxicosis at time of diagnosis, either hyperthyroidism due to Graves' disease or destructive thyrotoxicosis due to thyroiditis, is very important as management of each is completely different. Comparison of Doppler indices Aims and Objectives: in patients of Diffuse thyroid disease ( Graves' and Hashimoto's) on ultrasound with normal study population. Participants w Material & Methods ere recruited in the ultrasound unit at the Victoria hospital, Bangalore medical college and research institute. We conducted a prospective study on a group of 20 Normal individuals and 40 patients with Diffuse thyroid disease on Ultrasonography (20 cases of Hashimoto's thyroiditis and 20 cases of Graves disease). The thyroid glands of all patients were evaluated by gray scale ultrasonography for size, shape and echotexture. Color-ow Doppler ultrasonography of the thyroid tissue was performed and spectral ow analysis of both inferior thyroid arteries was assessed. Inferior thyroid artery Doppler parameters were calculated in all patients. Mean PSV of normal indivi Results duals was 16.4. Hashimoto's patients who had their mean PSV was 36.2 and Graves patients who had their mean PSV 86.4. On applying unpaired t test, the two tailed p value was less than 0.05 (0.001 and 0.0001 respectively), which found statistically highly signicant. The comparison of Doppler indices of Hashimotos disease and Graves diseases - On applying unpaired t test, the two tailed p value was less than 0.05 (0.0001) which was found statistically highly signicant. Blood Conclusion ow is a useful marker in initial diagnosis of diffuse thyroid. The high correlation between Doppler indices with pathological diagnosis establishes this modality as an acceptable alternative to Nuclear imaging. Its role in pregnancy and lactation where nuclear imaging is contraindicated needs to be emphasised.

Evaluation of the association between human herpes virus 6 (HHV-6) and Hashimoto's thyroiditis.

Hashimoto's thyroiditis is a chronic inflammation and an autoimmune disease of the thyroid gland that causes hypothyroidism. Genetic, internal, and environmental factors are the causes of this disease. Because human herpes viruses such as herpesvirus type 6 (HHV-6) are involved in some autoimmune disorders, they may also play a role in causing this disease. This study aimed to evaluate the association between human herpes virus 6 (HHV-6) with Hashimoto's thyroiditis. In the present study, 64 samples of thyroid paraffin tissue including 32 samples of thyroid paraffin tissue of healthy individuals as control, and 32 samples of thyroid paraffin tissue of Hashimoto's thyroiditis patients were taken from the pathology department of Loghman Hakim Hospital in Tehran. A questionnaire collected demographic information of patients. After DNA extraction from the samples, the nested-PCR technique was performed using specific primers for HHV-6. Totally, the HHV6-DNA was found in 34.4% of thyroid tissues of healthy individuals (81.8% female and 18.2% male) and 46.9% of patients with Hashimoto's thyroiditis (73.3% female and 26.7% male). It was found that this difference in virus frequency between the two groups was not statistically significant (P value=0.309). There was also no statistically significant relationship between the prevalence of human herpesvirus type 6 and age or sex. Based on the present study, the number of HHV-6-infected individuals in Hashimoto's patients and controls did not differ significantly; therefore, HHV-6 appears not to be associated with Hashimoto's thyroiditis.

Doubtful Justification of the Gluten-Free Diet in the Course of Hashimoto's Disease.

The popularization of the gluten-free diet brings with it a fashion for its use, which can harm the treatment of Hashimoto’s disease. The few studies in this regard do not confirm positive changes resulting from a gluten-free diet. At the same time, the presence of other comorbid autoimmune diseases in this group of patients is increasing. This may have important implications for the interpretation of test results and the need for a gluten-free diet in some patients. In this review, the PubMed database was searched for links between a gluten-free diet, Hashimoto’s disease, and autoimmune diseases. When analyzing the available literature, we found no basis for introducing a gluten-free diet for the standard management of Hashimoto patients. The recommended diet is instead an anti-inflammatory diet that levels the supply (to compensate for deficiencies) of vitamin D, iodine, and selenium, which are found in plant products rich in polyphenols, antioxidants, and omega-3 fatty acids, as illustrated in this article.

The frequency and related factors of primary headaches in patients with Hashimoto thyroiditis.

The purpose of this study was to evaluate the incidence of primary headache and potential biomarkers in patients diagnosed with Hashimoto thyroiditis. Patients with Hashimoto thyroiditis referred to the outpatient endocrinology clinic were included in the study. The demographic data, thyroid function test results, and autoantibody titers were recorded. The headache's clinical characteristics were also determined. The same researcher used the visual analog scale for headache severity rating in all patients. 155 patients with Hashimoto thyroiditis were included the study. There were 95 (61.3%) cases diagnosed with headache consisting of 20 (21.1%) migraine cases, 17 (17.9%) tension type headaches (TTHs), and 20 (21.1%) new daily persistent headaches (NDPHs). 38 of 155 (24.5%) had hypothyroidism related headaches (HRHs). There was no statistically significant relationship between the headache type and a high blood antibody level anti thyroid peroxidase antibody (p=0.135), while a positive correlation was found with thyroid stimulating hormone (TSH) (p<0.001). Hashimoto patients with migraine (n=14, 70.0%) were found to have higher blood antibody levels, while these ratios were found as 86.8% (n=33) in HRH-patients, 76.5% (n=13) in TTH-patients, and 60.0% (n=12) in NDPH-patients. 86 of 155 (55.5%) patients reported new onset headaches after a Hashimoto's thyroiditis diagnosis, and the headaches persisted without hormone therapy in 48 (84.2%) of these patients. These patients diagnosed with primary headache and this was interpreted as demonstrating comorbidity between Hashimoto's disease and primary headaches. Detection of only the relationship between TSH level and headache suggested that different mechanisms play a role in the pathophysiology. In the diagnosis of primary headache, it is important to look into secondary reasons.

Integrative Analyses of Genes Associated with Hashimoto's Thyroiditis.

Objective Hashimoto's thyroiditis, also known as chronic lymphocytic thyroiditis, is a common autoimmune thyroiditis, which mostly occurs in young and middle-aged women. It can be manifested as hyperthyroidism in the early stage; hypothyroidism may appear with the progression of the disease. Studies have shown that multiple factors such as heredity, environment, and autoimmunity are involved in the pathogenesis, but the specific mechanism is not clear. In our study, we tried to find key genes and potential molecular mechanisms of Hashimoto's thyroiditis to provide new ideas for the therapeutic targets of Hashimoto's thyroiditis. Method GSE138198 and GSE54958 were downloaded from the GEO database, and two datasets were combined for analysis. The combined data were normalized to identify the differentially expressed genes (DEGs), and GO and KEGG enrichment analyses were performed. Protein-protein interaction (PPI) networks and hub genes between DEGs were identified. We also used the miRWalk database to identify regulatory miRNAs associated with expressions of DEGs. Result We identified 182 DEGs (160 upregulated and 22 downregulated) between Hashimoto's disease patients and the healthy control group. GO analysis showed that DEGs were mostly concentrated in detection of chemical stimulus involved in sensory perception, intermediate filament cytoskeleton, and olfactory receptor activity. KEGG pathway analysis showed that DEGs were mainly related to olfactory transduction. Some members of the KRTAP family and HTR5A, KNG1, DRD3, HTR1D, TAS2R16, INSL5, TAS2R42, and GRM7 are the most important hub genes in the PPI network. In addition, we recognized that OTUD4, LLPH, and ECHDC1 were the most important hub genes in the miRNA-target gene network. Conclusion In this study, a series of bioinformatics analyses of DEGs were performed to identify the key genes and pathways associated with Hashimoto's thyroiditis. These genes and pathways provide a more detailed understanding of the pathogenesis of Hashimoto's disease and provide new ideas for the therapeutic targets of Hashimoto's thyroiditis.

The effect of Thyroid Autoimmunity on Dyslipidemia in patients with Euthyroid Hashimoto Thyroiditis.

Background & Objective:The relationship between thyroid disorders and dyslipidemia has now been clearly demonstrated, but the relationship between thyroid autoimmunity and dyslipidemia in euthyroid patients is still controversial. Our aim in this study was to determine whether there is a risk of dyslipidemia in our patients with euthyroid hashimoto thyroiditis.Methods:Fifty-five autoantibody positive hashimoto patients and 55 antibody negative control groups who came to Sakarya University Medicine Faculty Endocrinology Outpatient Clinics between January 2018 and November 2019 were included in our case control study. The groups were similar in terms of age, cardiovascular risk factors and BMI. Both groups were compared according to the lipid profile results.Results:All type of lipids; including LDL (p = 0.008), HDL (p = 0.041), triglyceride (p = 0.045) and total cholesterol (p = 0.002), were higher in the patient group, and these differences were statistically significant. Anti-TPO and Anti-TG antibody titers and lipid levels were evaluated by separate correlation analysis. There was a significant positive correlation between Anti-TPO and LDL (r = 0.331, p <0.001), triglyceride (r = 0.267, p = 0.005) and total cholesterol (r = 0.316, p = 0.001), however no significant correlation was observed between Anti-TPO and HDL. Similarly, there was a significant positive correlation between Anti-TG and LDL (r = 0.318, p = 0.001), triglyceride (r = 0.218, p = 0.022), and total cholesterol (r = 0.301, p = 0.001), but HDL correlation relationship was not detected.Conclusion:The relationship between thyroid autoimmunity and dyslipidemia has been demonstrated in our study even in the euthyroid phase. Whether antibody positive patients should be followed more closely for dyslipidemia and cardiovascular events is still controversial. This question will be answered with larger randomized controlled trials.

Evaluation of Parenchymal Thyroid Diseases Using Ultrasonography

Background: Thyroid diseases are among the most common endocrine disorders seen in all age groups. The present study was conducted to determine parenchymal thyroid diseases using Ultrasonography (USG) in adult patients. Subjects and Methods: This study was conducted on 140 adult patients. Patients were divided into five groups such as Group I (normal); Group II had first detected, early untreated Hashimoto disease (EH); Group III comprised of chronic Hashimoto patients that are under treatment and/or follow up (H); Group IV had multinodular parenchymal hyperplasia (M); and Group V had nodular hyperplasia with Hashimoto (HM). They underwent spectral Doppler ultrasound and acoustic radiation force impulse using Siemens ACUSON S2000 machine. Results: The mean RI in group I was 0.54, in group II was 0.56, in group III was 0.42, in group IV was 0.48 and in group V was 0.49, mean AT in group I was 26.2, in group II was 25.3, in group III was 71.3, in group IV was 46.2 and in group V was 45.1, mean SWV in group I was 1.54, in group II was 1.72, in group III was 1.20, in group IV was 1.46 and in group V was 1.65. The difference was significant (P&lt; 0.05). Conclusion: Authors found that resistivity index, acceleration time and shear wave velocity together are reliable for differential diagnosis of parenchymal thyroid diseases.

The importance of nutritional factors and dietary management of Hashimoto's thyroiditis.

Hashimoto (HT) is an autoimmune disease in which destruction of the thyroid occurs as a result of lymphocyte infiltration. It is caused by an increased level of titers of antibody against thyroid peroxidase (TPO) and thyroglobulin (TG). Because of that,in HT patients, changes are observed in the level and metabolism of thyroid hormones, which leads to unspecified physical and psychological symptoms. A high level of antibodies attacking thyroid antigens has been positively correlated with the symptoms. From the etiological point of view, the most important are genetic factors; however, environmental factors are necessary to provoke the immune system to attack until the process is over. Scientists indicate specified stress, toxification, microbiota dysbiosis and under- or over-nutrition, to name only a few. Dietotherapy of Hashimoto's is based on the proper nourishment of the body and regulation of the immune system by an anti-inflammatory diet. Observational and controlled trials have shown frequent nutrition deficiencies in HT patients. In literature, there is evidence for selenium, potassium, iodine, copper, magnesium, zinc, iron, vitamin A, C, D and B. The role of the proper level of protein intake, dietary fibre and unsaturated fatty acids, especially the n-3 family, has been indicated. HT patients should often eliminate lactose because of intolerance and interactions with levothyroxine and gluten because of possible interactions of gliadin with thyroid antigens. The article describes the nutrition factors of HT patients, and share nutrition recommendations for diet therapy.

The Association between Burning Mouth Syndrome and Level of Thyroid Hormones in Hashimotos Thyroiditis in Public Hospitals in Shiraz, 2016

Statement of the Problem: Burning sensation in Hashimoto patient’s oral cavity is an unknown prevalent problem. Purpose: This study aimed to evaluate the prevalence and intensity of burning mouth syndrome (BMS) in patients suffering from Hashimoto’s thyroiditis in all public hospitals in Shiraz, 2016. Materials and Method: A total of 153 patients with Hashimoto’s thyroiditis were selected based on simple random sampling. The initial level of thyroid stimulating hormone (TSH), Anti-TPO (thyroperoxidase), Anti-TG (thyroglobulin), Free T3 (triiodothyronine) and Free T4 (thyroxine) serum as the indices of Hashimoto’s thyroiditis was assessed. The BMS intensity was measured according to each patient's verbal or nonverbal expression about the pain experience based on visual analog scale (VAS). Results: Based on the clinical evaluation and interview, only 19out of 153 cases (12%) reported BMS. The mean BMS was 3 based on VAS. Statistically significant association was detected between the level of TSH (p= 0.0001), Anti-TPO (p= 0.035), Anti-TG (p= 0.0001), Free T3 (p= 0.0001), Free T4 (p= 0.0001) indices in patients with BMS. Significant association was also observed between the level of Anti-TPO (p= 0.0001), Anti-TG (p= 0.0001), Free T3 (p= 0.0001) and TSH (p= 0.0001) indices and BMS intensity. However, no significant association was found between the BMS severity and Free T4 (p= 0.056). Conclusion: The level of TSH, Anti-TPO, and Anti-TG, Free T3, and TSH indices of Hashimoto’s patients were associated with the presence and severity of BSM. However, Free T4 level was only associated with the presence of BMS and not the intensity.

Thyroid Autoimmunity and Thyroid Cancer - The Pathogenic Connection: A 2018 Update.

The association between thyroid cancer and thyroid autoimmunity has long been suggested, but remains to be elucidated for several decades. Here the data on this issue are updated by summarizing relevant papers published between 2012 and early 2018. Although numerous papers demonstrated the significant increase in the prevalence of thyroid autoimmunity (positive intrathyroidal lymphocyte infiltration and/or anti-thyroglobulin/thyroid peroxidase antibodies) in patients with thyroid cancers as compared to those with benign nodules, and also the significant increase in the prevalence of papillary thyroid cancer (PTC) in patients with thyroid autoimmunity as compared to those without, there are some crucial biases that should be taken into account for their interpretation. However, a difference in the incidence of thyroid autoimmunity in patients with PTCs and those with other types of thyroid cancers appears to support the significant association of two conditions. Thyroid autoimmunity is, at least partly, likely to be elicited against antigens shared by normal and cancerous thyroid tissues, thereby inducing autoimmunity. At the same time, elevated TSH levels (even within the normal reference ranges), which often accompany Hashimoto's patients are a risk factor for thyroid cancer. However, it is still unclear whether or not the co-existence of thyroid autoimmunity impacts on cancer characteristics and prognosis. This issue needs to be further investigated with large-scale prospective studies.

Association between CTLA-4 + 49A > G and - 318C > T single-nucleotide polymorphisms and susceptibility to thyroid neoplasm.

Cytotoxic T-Lymphocyte Antigen 4 (CTLA-4 or CD152) is among the immune checkpoint molecules and its abnormal expression in cancer predisposed individuals might make the person more susceptible to tumor initiation and progression. Considering the implication of single-nucleotide polymorphisms (SNPs) in CTLA-4 gene expression and probably protein function, one can assume the involvement of these SNPs in neoplastic diseases. rs5742909 ( - 318C > T) and rs231775 ( + 49 A > G) are among the most commonly studied SNPs and have been considered as genetic factors related to thyroid diseases. In this cross-sectional study, we aimed to elucidate the association between these SNPs and susceptibility to various types of thyroid cancers. We investigated the genetic polymorphisms of - 318C > T and + 49 A > G in the CTLA-4 gene by means of ARMS-PCR and RFLP-PCR, respectively, in 167 patients with thyroid carcinomas (papillary, follicular, and anaplastic). The results were then compared with a group of 100 age-sex matched healthy individuals. A statistically significant association was observed between the presence of G allele in + 49 A > G locus and thyroid carcinoma, when comparing cases and controls (OR = 2.10; 95% CI = 1.35-3.28; P = 0.001) and the frequency of heterozygotes (AG) was higher than homozygotes for allele A (AA), in patients with and papillary thyroid carcinoma (PTC). Regarding Hashimoto's thyroiditis, the frequencies of A allele and AA genotype in PTC patients were higher than Hashimoto patients with no history of cancer (OR = 4.67, 95% CI = 2.70-8.08, P < 0.0001; and, OR = 4.68, 95% CI = 1.84-11.91, P = 0.0012; respectively). However; we observed no difference among allele/genotype frequencies in regards to locus - 318C > T. In this study, we observed that G allele in + 49 A > G and possibly lower expression of mutated CTLA-4 molecule, is associated with higher susceptibility to thyroid carcinoma. Although the G allele frequency was higher in thyroid cancer patients, when justified for the presence of lymphocytic thyroiditis, the presence of A allele seemed to increase the odds for PTC in patients with Hashimoto's disease.