Diagnosis Of Hashimoto's Thyroiditis Research Articles

8229 Prevalence of Thyroid Cancer in Patients with Hashimotos Thyroiditis Presenting Concomitant Thyroid Nodular Disease

Abstract Disclosure: M.A. Alvarez Castillo: None. L. Sanchez Arriaga: None. A. Segovia Palomo: None. Introduction: Hashimoto's thyroiditis (HT) is the most frequent autoimmune thyroid disease and the main cause of goiter and hypothyroidism; it induces a process of aseptic autoimmune inflammation. Fibroinflammatory changes lead to the development of thyroid nodules (TN), additionally chronic inflammation is an important player in the development of cancer, although this association is controversial. The prevalence of thyroid cancer (TC) in patients with HT ranges from 0.61-58.4% (25.01%), being higher than in patients with TN without concomitant HT. Objective: To know the prevalence of malignancy in patients with HT who present thyroid nodular disease. Methodology: An observational, descriptive, retrospective, and longitudinal study was carried out. Patients with HT diagnosis were selected by measuring Ab TPO and/or Ab TG who presented an ultrasound diagnosis of TN and FNAB of the thyroid lesion had been performed. Descriptive statistics and linear regression were used. Results: 87 patients: 6 (6.9%) men and 81 (93.1%) women aged 47.9 (12.7) years. 4 (4.5%) required FNAB in 2 TN, for a total of 91 TN studied. 64% had a diagnosis of hypothyroidism and were taking LT4, TSH 4.40 (4.44) mUI/mL, FT4 1.00 (0.27) ng/dL. Mean Ab TPO was 794.7 ± 1354.6. Diagnosis time 19.5 (29.1) months. 39.6% the detection was made by the patient and 35.2% by the doctor. Major axis was 18.8 (12.1) mm. Ultrasound pattern of single TN 58.2% and multinodular 41.8%. Median TIRADS was 4, with a mode of 5. 81.3% reported Bethesda II and 18.7% malignant or suspected, were sent for surgery, malignancy was confirmed in 16/ 17 lesions. 14 (15.3%) were TPC and 2 lymphomas, the main subtypes were classic papillary and NHL, respectively. Mode of ATA risk was intermediate. Multivariate analysis only TIRADS represented risk factor (OR 2.08) Conclusions: The frequency of TC in our population was 15.3%, which reflects a higher prevalence of malignancy in thyroid nodules in patients with chronic thyroiditis, in accordance with what has been reported in other series. Presentation: 6/3/2024

The impact of Hashimoto's thyroiditis on the clinical outcome of papillary thyroid cancer after radioactive iodine therapy: a propensity score matching study.

The potential association between Hashimoto's thyroiditis (HT) and papillary thyroid carcinoma (PTC) has been studied from different perspectives for many years. This study was aimed to evaluate the impact of HT on the clinical outcomes of PTC patients after radioactive iodine (RAI) therapy. We conducted a retrospective study on consecutive patients with PTC who underwent RAI therapy from April 2017 to May 2020. The diagnosis of HT was based on pathological examination, and patients were divided into the HT and non-HT group. Distributions of age, gender, ultrasound features, papillary variants, extrathyroidal extension, and other histopathological characteristics were observed. Propensity score matching (PSM) was used to compare the clinical features and outcomes between the two groups at 1 and 3-year follow-up. In total, 782 patients with PTC were enrolled (570 women, 212 men). HT was presented in 130 (16.6%) patients, and was associated with younger age, smaller primary tumors, less extrathyroidal extension, and less lymph node metastasis at presentation. On review of the images, only calcification and blood flow distribution were significantly different among the US features (P < 0.05). At the end of follow-up (three years), the responses to RAI therapy were significantly different between the two groups (ER: 76.9% vs 64.9%; IDR:11.5% vs 17.2%; BIR: 4.6% vs 10.7%; SIR: 6.9% vs 7.2%, P = 0.03). Patients with HT had less frequently evidence of disease (11.6% vs 17.9%). When compared with the matched groups, 123 pairs of patients were successfully matched, PTC patients with HT were found to have a better response to RAI therapy. PTC patients with HT had less aggressive characteristics at presentation. Importantly, the presence of HT not only had a significant association with the outcome, but was also protective from the risk of recurrence.

Demonstration of Epstein-Barr Virus by In Situ Hybridization in Papillary Thyroid Carcinomas Developing on Background of Hashimoto's Thyroiditis.

This study aimed to demonstrate the role of Epstein-Barr Virus (EBV) in papillary thyroid carcinomas (PTC) developing on the background of Hashimoto's thyroiditis (HT). The presence of EBV in tumoral tissue, lymphocytes, and peritumoral normal thyroid tissue was investigated using the in situ hybridization method in paraffin blocks. The subtypes of PTC, tumor diameter, TNM stage, multifocality, invasion of thyroid capsule, perineural invasion, and muscular tissue invasion were identified and compared according to EBV involvement. Eighty-one patients with HT diagnosis, with 93.8% (n=76) female and 6.2% (n=5) male, were included in the study. Papillary microcarcinoma was the pathological diagnosis in 24.2% (n=15) of the cases. EBV was identified in 58.06% (n=36) of the tumor cells nuclei, 58.06% (n=36) in the tumor cell cytoplasm, 16.12% (n=10) in tumor infiltrative lymphocytes, and 53.2% (n=33) in normal parenchymal follicle epithelial cells (NPFEC). In the T2 stage, the rate of EBV nuclear positivity in patients was significantly higher (p=0.034). The classic variant of papillary carcinoma was accompanied by a significantly higher rate of EBV-negative NPFEC (67.6%, p=0.049). In multifocal tumors, EBV positivity was found to be significantly higher in lymphocytes in the surrounding tissues (58.3%, p=0.034). A significant increase in EBV positivity in the surrounding tissue lymphocytes was observed in multifocal PTC developing on a background of HT. This suggests a possible association between HT and EBV.

Coexistence of Endometriosis and Thyroid Autoimmunity in Infertile Women: Impact on in vitro Fertilization and Reproductive Outcomes

Objectives: The objective of the study was to evaluate the prevalence and impact of impaired thyroid-stimulating hormone (TSH) levels on the reproductive outcomes of in vitro fertilization patients diagnosed with endometriosis and compared to controls without endometriosis. Design: This is a retrospective cohort study on prospectively collected data. Setting: The study was conducted at tertiary care university hospital. Participants: Participants were infertile women with histopathological diagnosis of endometriosis. Methods: For 12 months (January 2018 to January 2019), women were deemed suitable and subsequently divided according to serum TSH levels above or below 2.5 mIU/L and compared to patients without endometriosis. Needed sample size was at least 41 patients for each cohort of women. Co-primary outcomes were the live birth rate (LBR), clinical pregnancy rate (CPR), and pregnancy loss rate (PLR). Results: Overall, 226 women (45 with endometriosis and 181 controls without endometriosis) were included. Diagnoses of Hashimoto thyroiditis were significantly more frequent in women with rather than without endometriosis (14/45 [31.1%] vs. 27/181 [14.9%]; p = 0.012). Similarly, in women with endometriosis, Hashimoto diagnosis rates were higher with TSH ≥2.5 mIU/L compared to TSH <2.5 mIU/L (9/15 [60%] vs.5/30 [16.6%]; p = 0.001) so were the Hashimoto diagnosis rates in control group (women without endometriosis) with TSH ≥2.5 mIU/L compared to TSH <2.5 mIU/L (17/48 [35.4%] vs. 10/133 [7.5%], respectively; p = 0.001). Effect size analysis confirmed an increased risk of Hashimoto thyroiditis in women with endometriosis and TSH ≥2.5 mIU/L compared to women with endometriosis and TSH <2.5 mIU/L (risk ratio [RR] 3.60 [95% CI 1.46–8.86]) and in women with endometriosis and TSH ≥2.5 mIU/L compared to non-endometriotic euthyroid patients (RR 7.98 [95% CI 3.86–16.48]). Dysmenorrhea risk was higher in endometriotic euthyroid women compared to euthyroid patients with no endometriosis (RR 1.87 [95% CI 1.21–2.87]). The risk was still increased in euthyroid women with endometriosis relative to dysthyroid women with no endometriosis (RR 1.97 [95% CI 1.11–3.50]). There were no significant differences between the four groups for CPR, LBR, PLR and retrieved oocytes, immature oocytes, degenerated and unfertilized oocytes, cultured blastocysts, embryos and transferred embryos. Limitations: Limitations of the study were retrospective design, limited sample size, and use of different ovarian stimulation protocol. Conclusions: Thyroid autoimmunity seems more common in women with endometriosis and TSH over 2.5 mIU/L. However, there was no significant impact on in vitro fertilization and reproductive outcomes related to the coexistence of endometriosis, Hashimoto disease, and higher TSH levels. Due to limitations of the study, additional evidence is required to validate the abovementioned findings.

Investigation of neopterin levels in children with hashimoto thyroiditis

ABSTRACT Objective: Hashimoto Thyroiditis is an autoimmune disease caused by genetic and environmental factors and is known as the most common cause of hypothyroidism in childhood. Neopterin has been measured in many autoimmune disorders and has been identified as a marker of cellular immune activation. The aim of this study was to investigate the autoimmune association of neopterin in patients with Hashimoto's Thyroiditis aged 5-18 years. Material and Method: Neopterin levels were measured in 80 individuals, 40 of whom were followed up with the diagnosis of Hashimoto Thyroiditis and 40 of whom were not diagnosed with Hashimoto Thyroiditis. Results: While the mean value of neopterin levels in the control group participating in this study was 86.4170 ± 3.59284, the mean value in the patient group was 101.32 ± 9.75378. When we look at the participant age data, it is seen that the patients and controls are compatible with each other (p&gt;0.05). In addition, it is seen that there is a significant positive correlation p

The Evaluation of the Efficacy of C-reactive Protein-to-Albumin Ratio as a Marker for Hashimoto’s Thyroiditis

Aim: Hashimoto's thyroiditis (HT), the leading cause of hypothyroidism in developed nations, is an autoimmune condition characterized by the progressive destruction of the thyroid gland through various cell- and antibody-mediated immune mechanisms. C-reactive protein-to-albumin ratio (CAR) is a known inflammatory marker easily obtained from a routine blood test. In this context, this study aims to investigate the efficacy of CAR instead of conventionally used thyroid antibodies in predicting the diagnosis and prognosis of HT. Materials and Methods: The participants in this prospective cross-sectional study were adults aged 18 years and above diagnosed with Hashimoto's thyroiditis (HT), seeking medical care at the Internal Medicine and Family Medicine Departments of Recep Tayyip Erdoğan University Training and Research Hospital in Rize, Turkey, during the period from April to July 2022. An age- and gender-matched control group was created from healthy individuals who applied to the outpatient clinics for routine check-ups. The patient and control groups were compared based on C-reactive protein (CRP), hemoglobin, and albumin serum levels of free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH). Results: The patient and control groups comprised 142 HT patients and 62 healthy individuals. CRP level and CAR value were significantly higher. However, albumin and hemoglobin levels were significantly lower in the patient group than in the control group. [1.5 (0.4-5.6) mg/dL vs. 0.98 (0.3-2.6) mg/dL, p&lt;0.001; 58 (11.5-193.1) vs. 29.5 (8.1-72.2) p&lt;0.001; 2.9 (2.1-4.1) g/dL vs. 3.3 (2.3-4.2) g/dL, p&lt;0.001; and 12±1.1 g/L vs. 12.7±1.760 g/L, p=.005; respectively]. The multivariate analysis revealed CRP, CAR, albumin, FT3, and hemoglobin as significant predictors of HT, with CAR being the most promising one among them [Odds Ratio (OR): 1.11, 95% confidence interval (CI): 1.38-1.19, p=0.003]. Conclusions: This study’s findings indicated that CAR is an easily measurable, reliable, and cost-effective marker of HT that can be used as an alternative to conventional thyroid antibodies in primary care centers.

Identification and Preliminary Clinical Validation of Key Extracellular Proteins as the Potential Biomarkers in Hashimoto's Thyroiditis by Comprehensive Analysis.

Hashimoto's thyroiditis (HT) is an autoimmune disruption manifested by immune cell infiltration in thyroid tissue and the production of antibodies against thyroid-specific antigens, such as the thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb). TPOAb and TGAb are commonly used in clinical tests; however, handy indicators of the diagnosis and progression of HT are still scarce. Extracellular proteins are glycosylated and are likely to enter body fluids and become readily available and detectable biomarkers. Our research aimed to discover extracellular biomarkers and potential treatment targets associated with HT through integrated bioinformatics analysis and clinical sample validations. A total of 19 extracellular protein-differentially expressed genes (EP-DEGs) were screened by the GSE138198 dataset from the Gene Expression Omnibus (GEO) database and protein annotation databases. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were used to analyze the function and pathway of EP-DEGs. STRING, Cytoscape, MCODE, and Cytohubba were used to construct a protein-protein interaction (PPI) network and screen key EP-DEGs. Six key EP-DEGs (CCL5, GZMK, CXCL9, CXCL10, CXCL11, and CXCL13) were further validated in the GSE29315 dataset and the diagnostic curves were evaluated, which all showed high diagnostic accuracy (AUC > 0.95) for HT. Immune profiling revealed the correlation of the six key EP-DEGs and the pivotal immune cells in HT, such as CD8+ T cells, dendritic cells, and Th2 cells. Further, we also confirmed the key EP-DEGs in clinical thyroid samples. Our study may provide bioinformatics and clinical evidence for revealing the pathogenesis of HT and improving the potential diagnosis biomarkers and therapeutic strategies for HT.

Mapping the path towards novel treatment strategies: a bibliometric analysis of Hashimoto's thyroiditis research from 1990 to 2023.

Hashimoto's thyroiditis (HT), a common form of thyroid autoimmunity, is strongly associated with deteriorating clinical status and impaired quality of life. The escalating global prevalence, coupled with the complexity of disease mechanisms, necessitates a comprehensive, bibliometric analysis to elucidate the trajectory, hotspots, and future trends in HT research. This study aims to illuminate the development, hotspots, and future directions in HT research through systematic analysis of publications, institutions, authors, journals, references, and keywords. Particular emphasis is placed on novel treatment strategies for HT and its complications, highlighting the potential role of genetic profiling and immunomodulatory therapies. We retrieved 8,726 relevant documents from the Web of Science Core Collection database spanning from 1 January 1990 to 7 March 2023. Following the selection of document type, 7,624 articles were included for bibliometric analysis using CiteSpace, VOSviewer, and R software. The temporal evolution of HT research is categorized into three distinct phases: exploration (1990-1999), rapid development (1999-2000), and steady growth (2000-present). Notably, the United States, China, Italy, and Japan collectively contributed over half (54.77%) of global publications. Among the top 10 research institutions, four were from Italy (4/10), followed by China (2/10) and the United States (2/10). Recent hotspots, such as the roles of gut microbiota, genetic profiling, and nutritional factors in HT management, the diagnostic dilemmas between HT and Grave's disease, as well as the challenges in managing HT complicated by papillary thyroid carcinoma and type 1 diabetes mellitus, are discussed. Although North America and Europe have a considerable academic impact, institutions from emerging countries like China are demonstrating promising potential in HT research. Future studies are anticipated to delve deeper into the differential diagnosis of HT and Grave's disease, the intricate relationship between gut microbiota and HT pathogenesis, clinical management of HT with papillary thyroid carcinoma or type 1 diabetes, and the beneficial effects of dietary modifications and micronutrients supplementation in HT. Furthermore, the advent of genetic profiling and advanced immunotherapies for managing HT offers promising avenues for future research.

Ultrasound characteristics of Hashimoto’s thyroiditis in the subclinical stages of the disease

ObjectiveTo investigate the prognostic value of indicators from b-mode ultrasound, color Doppler ultrasound, and strain elastography of the thyroid gland in the diagnosis of Hashimoto's thyroiditis (HT). MethodsIn 70 euthyroidal patients with HT, demographic characteristics, serum thyroid profile and ultrasound parameters, including thyroid gland size, vascularity and stiffness (elastography strain index) of the parenchyma, and flow indices of the superior and inferior thyroid artery were recorded. The control group consisted of 70 age and weight matched euthyroid individuals with negative anti-thyroid antibodies (anti-TPO and anti-Tg). ResultsA significant difference was observed between the two groups in total thyroid size (ml, median ± standard deviation, SD) 7.86 ± 2.9 in HT vs. 6.35 ± 2.7 ml in controls, p = 0.003) and parenchymal vascularity which was increased in patients with HT (p < 0.001). Tissue strain index was higher in the HT group but without reaching statistical significance In logistic regression, thyroid size (odds ratio 1.20, 95% confidence interval: 1.02–1.41, p = 0.022) demonstrated significant prognostic value for the presence of HT. No differences were found between the two groups, regarding the peak systolic velocity (PSV), end-diastolic volume (EDV), pulsatility index (PI) and resistive index (RI) values of the thyroid arteries. In the ROC analysis (AUC 0.653, p = 0.002), a thyroid size >7.3 ml exhibited sensitivity of 61.43% and specificity of 72.6% for the diagnosis of HT. ConclusionPatients with HT exhibit larger thyroid size and increased intrathyroidal vascularity on ultrasound prior to the manifestation of hypothyroidism compared to the healthy population. Flow indices of the superior thyroid artery do not have prognostic value in the diagnosis of HT.

Hashimoto's Thyroiditis and Papillary Thyroid Carcinoma: A Follow-Up Study in Patients with Absence of Aggressive Risk Factors at the Surgery of the Primary Tumor.

Hashimoto's thyroiditis (HT) is often associated with papillary thyroid carcinoma (PC); it is still a matter of controversy whether the behavior of carcinoma is more aggressive or not. During the follow-up, we retrospectively enrolled 97 patients with PC/HT after thyroidectomy without risk factors at the surgery of the primary tumor, such as multifocality/multicentricity, extrathyroid tumor extension, vascular invasion, neck and distant metastases, and aggressive histological variants. HT diagnosis was confirmed by histology and serum thyroid antibodies. Tumor size was ≤10 mm in 64 cases (microcarcinomas); 206 matched PC patients after thyroidectomy without HT and risk factors were enrolled as controls, totaling 122 microcarcinomas. During follow-up, metastases occurred in 15/97 (15.5%) PC/HT cases, eight microcarcinomas, and in 16/206 (7.8%) without HT, eight microcarcinomas (p = 0.04). Considering both PC/HT and PC patients without HT who developed metastases, univariate analysis showed an increased risk of metastases in patients with HT coexistence, OR: 2.17 (95% CI 1.03-4.60) p = 0.043. Disease-free survival (DFS) was significantly (p = 0.0253) shorter in PC/HT than in the controls. The present study seems to demonstrate that HT is not a cancer protective factor in PC patients given the less favorable outcomes and significantly shorter DFS. HT may also represent an independent recurrence predictor without other risk factors.

Hashimoto Thyroiditis - A Comprehensive Review

Hashimoto thyroiditis (HT) is an inflammatory disorder that often results in hypothyroidism. It has several global implications affecting different regions worldwide. Risk factors for acquiring HT include diet, inheritance, sex, epigenetics, and comorbidities. HT is a complex autoimmune illness characterized by an attack on the thyroid gland by the immune system. At the cellular level, genetic predisposition, environmental triggers, and the loss of immunological tolerance to thyroid antigens all play significant roles in the disease's genesis and progression. There are several mechanisms by which HT may develop, but the typical progression is autoimmune in origin. Many patients do not initially present with symptoms, but later develop symptoms of hypothyroidism. These symptoms include constipation, fatigue, dry skin, weight gain, cold intolerance, decreased energy, memory loss, muscle cramps, hair loss, and irregular menses. Patients with HT usually present with a firm, nontender neck goiter on a physical exam. To distinguish HT from other thyroid pathologies, patient serum should be collected to check for thyroid-specific auto-antibodies against thyroglobulin, thyroid peroxidase, thyroid stimulating hormone. Imaging studies such as ultrasonography with computer-aided techniques using gray-scale features are also diagnostic tools in differentiating between a healthy thyroid and HT. While the most common intervention of HT is synthetic hormone administration with levothyroxine sodium (L-T4), other alternatives or additional treatments include glucocorticoid use, diet alterations, selenium supplementation, vitamin D supplementation, and in more extreme cases, thyroidectomy. While research continues discovering new interventions, each treatment plan is highly variable based on underlying causes and presentations. This comprehensive review hopes to provide an up-to-date compact analysis of literature pertinent to the epidemiology, etiology, risk factors, genetics, pathophysiology, classifications, clinical presentation, diagnosis, and treatments of HT.

Effect of gluten-free diet on autoimmune thyroiditis progression in patients with no symptoms or histology of celiac disease: a meta-analysis.

Hashimoto's thyroiditis (HT) is the most common autoimmune disease. HT may be associated with nonthyroidal autoimmune diseases, including celiac disease (CD) or other gluten-related conditions (GRC). In the last years, interest about gluten-free diet (GFD) has increased for its supposed extraintestinal anti-inflammatory effect; thus, many patients with HT initiate GFD on their own. The aim of this meta-analysis is to examine all available data in literature about the effect of a GFD on TgAb, TPOAb, TSH, FT4, and FT3 levels in patients with HT and no symptoms or histology of CD. The study was conducted according to MOOSE (Meta-analysis Of Observational Studies in Epidemiology). The search was performed on databases PubMed and Scopus. The last search was performed on 7 February 2023. Quality assessment was performed. Meta-analyses were performed using the random-effect model. Hedges' g was used to measure the effect size (ES). Statistical analyses were performed using StataSE 17. The online search retrieved 409 articles, and 4 studies with a total of 87 patients were finally included for quantitative analysis. The risk of bias was generally low. The mean period of GFD was almost 6 months. The meta-analyses showed reduction in antibody levels with ES: -0.39 for TgAb (95% CI: -0.81 to +0.02; p = 0.06; I² = 46.98%) and -0.40 for TPOAb (95% CI: -0.82 to +0.03; p = 0.07; I² = 47.58%). TSH showed a reduction with ES: -0.35 (95% CI: -0.64 to -0.05; p = 0.02; I² = 0%) and FT4 showed an increase with ES: +0.35% (95% CI: 0.06 to 0.64; p = 0.02; I² = 0%). FT3 did not display variations (ES: 0.05; 95% CI: -0.38 to +0.48; p = 0.82; I² = 51%). The heterogeneity of TgAb, TPOAb, and FT3 data was solved performing sub-analyses between patients with or without GRC (TgAb p = 0.02; TPOAb p = 0.02; FT3 p = 0.04) and only for FT3, performing a sub-analysis between patients taking and not taking LT4 (p = 0.03). This is the first meta-analysis investigating the effect of GFD on HT. Our results seem to indicate a positive effect of the gluten deprivation on thyroid function and its inflammation, particularly in patients with HT and GRC. However, current lines of evidence are not yet sufficient to recommend this dietary approach to all patients with a diagnosis of HT.

De Ritis score as an inflammatory marker in Hashimoto's thyroiditis

AbstractBackgroundThe aim of the study was assessing the De Ritis score, an inflammatory marker, in Hashimoto's thyroiditis (HT) patients which is characterized with autoimmunity and chronic inflammation.MethodsBetween October 2021 and October 2022, the subjects in our outpatient clinics diagnosed with thyroiditis and healthy controls enrolled to the study. Age, gender, and laboratory parameters including C‐reactive protein (CRP), alanine (ALT), and aspartate (AST) transaminases, thyroid stimulating hormone (TSH), free T4 (FT4), were obtained and recorded for all participants, retrospectively. Division of AST by ALT was the formula to calculate the De Ritis score. Characteristics and laboratory data of the study and healthy controls were compared.ResultsMedian de Ritis ratio of the HT group (1.11 (0.56)%) was significantly higher than that of the control group (0.91 (0.41)%), (p &lt; .001). A positive and significant correlation between De Ritis score and CRP (r = 0.46, p &lt; .001) values. ROC analysis revealed the sensitivity and the specificity of CRP in predicting HT were higher than those of the De Ritis score. A De Ritis score higher than 0.9% has 67% sensitivity and 50% specificity in selecting patients with thyroiditis (AUC: 0.69, p &lt; .001, 95% CI: 0.63–0.76).ConclusionsWe think that elevated De Ritis score can be used as an adjunctive tool in the diagnosis of HT.

A Review of Testing for Distinguishing Hashimoto's Thyroiditis in the Hyperthyroid Stage and Grave's Disease.

Hashimoto's thyroiditis (HT) and Graves' disease (GD) are two very common autoimmune thyroid diseases (AITD). In this review, we use "HT in the hyperthyroidism stage" to refer to early HT with clinical manifestations of hyperthyroidism. In clinical practice, it is not easy to distinguish between HT in the hyperthyroidism stage and GD as they exhibit very similar clinical symptoms. The current literature lacks so far studies that systematically compare and summarize hyperthyroidism due to HT and GD from varied aspects. It is necessary to focus on all the clinical indices of HT in the hyperthyroidism stage and GD, for accurate diagnosis. Multiple databases such as PubMed, CNKI, WF Data, and CQVIP Data were used to search the literature concerning HT in the hyperthyroidism stage and GD. The information extracted from the relevant literature was summarized and further analyzed. To differentially diagnose hyperthyroidism as HT or GD, it is recommended to first focus on serological tests, followed by imaging tests, as well as the thyroid I131 uptake index. In pathology, fine needle aspiration cytology (FNAC) is the gold standard for the differential diagnosis of HT and GD. Test results from cellular immunology and genetics could also be used to accurately diagnose between the two diseases, which may be further developed and studied in the future. In this paper, we reviewed and summarized the difference between HT in the hyperthyroidism stage and GD from the following six aspects: blood tests, imaging, thyroid I131 uptake, pathology, cellular immunology, and genetics.

Does the Association of Hashimoto's Thyroiditis with Differentiated Thyroid Cancer Really Have a Protective Role?

The study is an investigation of aggressive tumor features, prognosis, and disease-specific mortality rates of differentiated thyroid cancer (DTC) in the presence of concomitant Hashimoto's Thyroiditis (HT). The data of patients with DTC followed in our tertiary care center between 2000-2022 were analyzed. Variables such as patient age, gender, preoperative serum autoantibody levels, tumor characteristics, and treatment modalities were obtained from medical records. The diagnosis of HT was based either on the presence of a positive result in the pathological examination and/or on antibody positivity. A total of 637 patients [mean±SD age, 44.9±13.5 years; 485 women [76.1%)] were included in the analysis. The overall prevalence of coexistent HT was 22.9% (n=146). The disease-specific mortality associated with DTC was 2.9%. DTC patients with HT compared to those without; have more positive lymphovascular invasion (p<0.001), and lymph node metastases (p<0.001). According to the Kaplan-Meier curves, disease-specific survival rates among DTC patients without HT were significantly higher than patients with HT (log-rank p=0.002). The disease-specific mortality rate was 4.79% in DTC patients with HT, it was 1.43% in those without HT. Hashimoto thyroiditis was not associated with a 10-year recurrence-free survival (p=0.059). Differentiated thyroid cancers with concomitant HT are associated with some aggressive tumor features (such as lymphovascular invasion and nodal metastasis) and lower survival. In staging systems based on tumor risk factors, it may be useful to evaluate the presence of concomitant HT as a prognostic factor.

Hashimoto's thyroiditis and renal transplant rejection.

Hashimoto's thyroiditis (HT) is a common autoimmune thyroid disorder that can disrupt thyroid function and homeostasis. As HT results from a dysregulated immune system, we hypothesized that these patients might be more susceptible to transplant failure; however, literature on this association is limited. The purpose of this study is to examine the association of HT with the risk of renal transplant failure. We utilized the United States Renal Database System dataset collected from 2005 to 2014 and compared the time from first renal transplant to transplant failure in end-stage renal disease (ESRD) patients with a HT diagnosis to ESRD patients without a HT diagnosis that underwent renal transplant. A total of 144 ESRD patients had International Classification of Disease-9 claim codes for HT prior to renal transplant, amongst a total cohort of 90,301 renal transplant patients aged 18-100 and meeting criteria. Patients with HT were significantly more likely to be female, white, and to have a diagnosis of cytomegalovirus compared to patients without. ESRD patients with a HT diagnosis that underwent renal transplant had a significantly increased risk of renal transplant failure compared to those ESRD renal transplant patients without an HT diagnosis. There was a significantly increased adjusted hazard ratio for graft failure in patients with a HT diagnosis compared to those without. Thyroid health and HT may play a significant role in the development of the increased risk of renal transplant failure observed in this study. Additional studies are needed to investigate the underlying mechanisms for this association.

High Cathelicidin Levels Are Associated With Hashimoto Thyroiditis

Introduction: Hashimoto thyroiditis (HT) is a common chronic autoimmune thyroid disease. Many studies on autoimmune diseases have investigated human cathelicidin from the anti-microbial peptide family. This article aims to determine the level of cathelicidin in Hashimoto's thyroiditis and evaluate its relationship with thyroid functions. Material and Method: Eighty-eight subjects were included in the study. Gender, age, and BMI were similar between 48 HT patients and 40 healthy controls. Cathelicidin levels were studied in serum samples with an ELISA kit. Results: There were euthyroid and subclinical hypothyroid HTs in the study. There was a significant difference between the controls and patients in terms of TSH (p&lt;0.001), fT4 (p=0.001), anti-TPO (p=0.001), and anti-Tg (p=0.001). Median cathelicidin level was significantly higher in the HT group (853.53 pg/ml) than in the control group (577.08 pg/ml) (p&lt;0.001). Cathelicidin levels were similar (p=0.555) in HT with euthyroid and subclinical hypothyroidism. There were no correlations between cathelicidin level and age, year of disease, BMI, TSH, fT4, fT3, anti-TG, and anti-TPO. Diagnosis of HT was approximately 5.6 times higher in patients with high cathelicidin values (p&lt;0.001). The possible effect of cathelicidin on the development of HT was evaluated by univariate binary logistic regression analysis, and the diagnostic threshold for cathelicidin was found to be 714 pg/ml (sensitivity 71%, specificity 70%). Conclusion: Our study is the first to examine the relationship between HT and serum cathelicidin. High cathelicidin was associated with HT independent of thyroid hormone levels, a possible role in the pathogenesis of HT.

Revisiting femoral cartilage thickness in cases with Hashimoto's thyroiditis in thyroidology: a single institute experience.

Hashimoto's thyroiditis, also known as chronic lymphocytic thyroiditis or autoimmune thyroiditis, is a considerable part of the spectrum of chronic autoimmune thyroid gland disorders which is pathologically associated with various degrees of lymphocytic infiltration. The purpose of the present study was to evaluate whether cartilage thickness is affected in patients with Hashimoto's thyroiditis or not in thyroidology. A total of 61 individuals had been evaluated in this case-control study, including 32 euthyroid Hashimoto's thyroiditis patients and 29 healthy subjects comparable in age, sex, and body mass index. The patients with a history of knee trauma or knee surgery, an additional systemic disease such as diabetes mellitus, or an inflammatory disease like rheumatoid arthritis, systemic lupus erythematosus, and scleroderma had not been included in the study. The thickness of the femoral articular cartilage was measured using B-mode ultrasonography, and the right lateral condyle, right intercondylar area, right medial condyle, left medial condyle, left intercondylar area, and left lateral condyle were also measured. No statistically significant difference between patients with Hashimoto's thyroiditis diagnosis and healthy controls in terms of age, age groups, gender, and body mass index (p>0.05). As a consequence, no obvious connection between autoimmune markers and cartilage thickness in patients with Hashimoto's thyroiditis was recognized. Although the diverse manifestation of Hashimoto's thyroiditis could be observed, it seems to be no liaison between thyroid autoimmunity and cartilage thickness.

Evaluation of IL-10, MCP-1, IFN gamma, and protectin D1 levels in patients with Hashimoto's thyroiditis.

Hashimoto's thyroiditis (HT) is one of the most prevalent autoimmune endocrine diseases and caused by the loss of immune tolerance for the thyroid gland. Many pathophysiological mechanisms were speculated about the development of HT. In our study, we aimed to reveal the relationship between HT and IL-10, MCP-1, IFNɤ, and PD1 levels and compare them with control subjects. We collected 37 patients with HT and 25 controls referred to our outpatient clinic. The diagnosis of HT was based on the detection of circulating antibodies to thyroid antigens and decreasing echogenicity on thyroid USG in patients with appropriate clinical characteristics. Serum IL-10, MCP-1, IFNɤ, and PD1 levels were detected using an ELISA KIT (96T) method according to the manufacturer's instructions. All subjects were euthyroid (median TSH level was 1.68mU/L in HT vs 1.83mU/L in the controls, p = 0.672). Twenty-three of 37 patients with HT were taking L-thyroxin replacement. Levels of serum IL-10, IFNɤ, and PD1 in patients with HT were higher than the controls, but the differences were not statistically significant (p = 0.393, p = 0.495, and p = 0.052 respectively). The serum levels of MCP-1 in HT patients were statistically different and higher than the controls (p = 0.018). Correlation analysis displayed significant associations between IL-10, MCP-1, IFNɤ, and PD1 levels. Our study demonstrated that serum MCP-1 levels in HT patients were significantly increased; on the other hand, significant difference was not found between HT patients and the controls in terms of serum IL-10, IFNɤ, and PD1 levels.

Increased Incidence of Hashimoto Thyroiditis in Selenium Deficiency: A Prospective 6-Year Cohort Study.

In 2015, we reported an increased prevalence of thyroid disease in a county of low habitual selenium (Se) intake in comparison to a neighboring county with higher intake in a cross-sectional survey in Shaanxi Province, China. To explore longitudinal effects of low Se status, a prospective cohort study was conducted in the same area from 2013 to 2019, and thyroid peroxidase autoantibodies (TPO-Abs) and disease incidence were compared. A total 1254 individuals from 1500 reinvited participants were successfully enrolled. Venous blood, fingernails, and urine samples were collected and analyzed to evaluate thyroid status, TPO-Abs, serum Se, and urinary iodine. Diagnosis of Hashimoto thyroiditis (HT) was based on elevated thyrotropin, presence of TPO-Abs, and ultrasound characteristics. Se deficiency was categorized using a serum concentration of 80 µg/L as a threshold, and tested by logistic regression for a relationship to TPO-Abs and HT. Se deficiency was observed in 46.2% of participants from the adequate-Se county (Ziyang) and in 89.7% from the low-Se county (Ningshan). Se concentrations in fingernails differed strongly by residency (Ziyang vs Ningshan; 678.7 vs 364.3 μg/kg; Z = -9.552; P < .001). Newly diagnosed HT in Ziyang was less frequent than in Ningshan (0.09% vs 0.31%; χ 2 = 4.350; P = .037). The conversion rate to seropositive TPO-Abs was 10.2% in Ningshan vs 5.6% in Ziyang. Excluding iodine as confounding factor, low-Se was confirmed as a risk factor for HT (relative risk [95% CI]; 3.65 [1.03-12.90]; P < .05). The data indicate an increased incidence of TPO-Ab seroconversion with low Se supply and support the hypothesis that Se deficiency contributes to HT as a modifiable risk factor.