Hashimoto's Disease Research Articles

Epigenome-wide Association Study Shows Differential DNA Methylation of MDC1, KLF9, and CUTA in Autoimmune Thyroid Disease.

Autoimmune thyroid disease (AITD) includes Graves disease (GD) and Hashimoto disease (HD), which often run in the same family. AITD etiology is incompletely understood: Genetic factors may account for up to 75% of phenotypic variance, whereas epigenetic effects (including DNA methylation [DNAm]) may contribute to the remaining variance (eg, why some individuals develop GD and others HD). This work aimed to identify differentially methylated positions (DMPs) and differentially methylated regions (DMRs) comparing GD to HD. Whole-blood DNAm was measured across the genome using the Infinium MethylationEPIC array in 32 Australian patients with GD and 30 with HD (discovery cohort) and 32 Danish patients with GD and 32 with HD (replication cohort). Linear mixed models were used to test for differences in quantile-normalized β values of DNAm between GD and HD and data were later meta-analyzed. Comb-p software was used to identify DMRs. We identified epigenome-wide significant differences (P < 9E-8) and replicated (P < .05) 2 DMPs between GD and HD (cg06315208 within MDC1 and cg00049440 within KLF9). We identified and replicated a DMR within CUTA (5 CpGs at 6p21.32). We also identified 64 DMPs and 137 DMRs in the meta-analysis. Our study reveals differences in DNAm between GD and HD, which may help explain why some people develop GD and others HD and provide a link to environmental risk factors. Additional research is needed to advance understanding of the role of DNAm in AITD and investigate its prognostic and therapeutic potential.

Clinical course and cytokine analysis of a systemic juvenile idiopathic arthritis patient with trisomy 21.

Trisomy 21 is sometimes complicated by congenital heart disease; however, comorbid type I diabetes mellitus and diseases involving autoantibodies such as Hashimoto's disease and Graves' disease are not uncommon. In contrast, autoinflammatory diseases such as Kawasaki disease and systemic juvenile idiopathic arthritis are rarely observed. We report a rare case of trisomy 21 with systemic juvenile idiopathic arthritis that responded well to the first course of methylprednisolone pulse therapy, but flared up and was complicated by macrophage activation syndrome (MAS). Subsequent methylprednisolone pulse therapy and cyclosporine resolved this condition. Cytokine analyses at several time points during the clinical course revealed that interleukin-18, interleukin-6, and chemokine ligand 9 levels were elevated even MAS onset in the patient with trisomy 21 once the clinical symptoms seemed to have settled down. Thus, in the future, early analysis of cytokine profiles should be performed for risk assessments of MAS and for determining the treatment intensity, even T21 patients.

Hashimoto’s thyroidits and other causes of hypothyrodisim – systematic review

Introduction and objective: The aim of the study is to summarize the knowledge about hypothyroidism, with particular emphasis on Hashimoto's disease, as its most common cause.&#x0D; Review metods: Literature review of PubMed database using key words contained in ‘Medical Subject Headings’ MeSH. State of Knowledge: Hashimoto's disease is the most common form of thyroiditis, as well as main cause of hypothyroidism. It is an autoimmune disease that leads to gradual fibrosis and atrophy of the thyroid gland. It occurs several times more frequently in women than in men. Treatment mainly involves supplementation of thyroid hormones due to the progressive hypothyroidism. Levothyroxine (L-T4) therapy has a long history of clinical use, a defined pharmacological profile, and is considered as safe treatment of hypothyroidism of the thyroid gland. There are also other, less common causes of hypothyroidism, such as postoperative hypothyroidism, de Quervain's disease, post-radioactive iodine treatment status, drug-induced and central hypothyroidism, which are equally important and should not be forgotten during the diagnostic process.&#x0D; Summary: Hypothyroidism can be caused by various factors, the main being Hashimoto’s thyroiditis. Regardless of the etiology, treatment in most cases involves levothyroxine (LT-4) supplementation, which leads to euthyroidism and resolution of symptoms. Surgery may need to be performed in pateitns who meet the surgical criteria and show unresponsiveness to conservative treatment.

SAT532 A Rare Case of Thyroid Carcinoma Noted in a Patient with Thyroid Nodule Showing Prior Benign Biopsy and Prior Negative Molecular Testing

Abstract Disclosure: M.M. Hillhouse: None. P. Madhavan: None. F.M. Woron: None. Background: Molecular studies have a high sensitivity for ruling out malignancy (1). This patient was diagnosed with the follicular variant of papillary thyroid carcinoma despite negative molecular testing and benign cytology in multiple prior biopsies. Clinical Case: 31 y.o. female with a past medical history of Hashimoto's disease on levothyroxine presented for follow up of thyroid nodules. She does not have a family history of thyroid cancer or personal history of neck radiation. The patient was noted to have a right thyroid nodule around 14 years of age and this was monitored during her childhood. The nodule measured 2.3 x 0.6 cm on ultrasound in 2015. The nodule measured 2.0 x 1.6 x 1.5 cm in 2017. FNA in 2017 revealed benign cytology (Bethesda II). On ultrasound in 03/2019, the nodule measured 2.2 x 1.5 x 1.8 cm. The nodule demonstrated a greater than 20% increase in all dimensions on ultrasound images in 12/2020 to 2.9 x 2.0 x 2.6 cm. A repeat ultrasound in 04/2021 demonstrated no significant change in size. Repeat FNA performed in 07/2021 demonstrated clusters of follicular cells in flat and microfollicular groups and was interpreted as atypia of undetermined significance (Bethesda III). AFIRMA testing was benign (∼4% of malignancy. The nodule increased in size to 3.5 x 2.6 x 3.1 cm on ultrasound in 07/2022. It appeared solid and hyperechoic and was classified as TI-RADS 3. A new 0.8 cm nodule on the left lobe was also identified. Repeat FNA of the right nodule in 09/2022 demonstrated macrophages, colloid and groups of follicular cells and was classified as non-diagnostic (Bethesda I). She reported difficulty breathing in the supine position and she underwent a right hemithyroidectomy and isthmusectomy in 11/2022. Pathology results were remarkable for invasive encapsulated follicular variant of papillary thyroid carcinoma with focal angioinvasion and tumor capsular invasion. The margins were negative for tumor. The parenchyma was consistent with lymphocytic thyroiditis. Ultrasound after interval right hemithyroidectomy in 12/2022 in an outside facility demonstrated an unchanged subcentimeter left thyroid nodule and multiple bilateral anterior cervical/level 6 lymph nodes suspicious for metastatic disease given the absence of hilum. Patient is currently undergoing repeat imaging and work up for the lymphadenopathy. Conclusion: This case study highlights the importance of maintaining high clinical suspicion for thyroid malignancy in cases of increasing thyroid nodule size and compressive symptoms despite negative cytological and molecular testing.

THU240 A Study Of 21 Cases Of Graves Disease In Childhood Presenting At Our Hospital For The First Time

Abstract Disclosure: T. Kashima: None. N. Ujita: None. H. Konno: None. A. Fujioka: None. H. Miyagi: None. M. Igarashi: None. H. Doi: None. K. Yoshii: None. Y. Naiki: None. R. Horikawa: None. M. Noordin: None. Although Graves disease is most common among women in their 20s and childhood-onset cases account for less than 5% of all cases of Graves disease, they account for the majority of hyperthyroidism in children. We report here a retrospective review of data on pediatric patients with Graves' disease who visited our hospital for the first time at the time of their initial examination. Methods We analyzed 21 pediatric patients with Graves disease who visited our hospital between November 2004 and January 2022. The electronic medical records of 21 patients were retrospectively reviewed for sex, age, height SD score, weight SD score, underlying disease, blood test results, and treatment initiation. Results There were 17 girls and 4 boys. The median age was 11 years and 5 months. Symptoms such as fever, feverishness, palpitations, weight loss, hyperactivity, and irritability were observed in 5 of the patients. Four patients had symptoms related to academic performance, such as low grades and poor concentration. Median physical findings were height SD score 0.62 (N=21), weight SD score 0.06 (N=21), and body mass index -4.4%. Two patients had bronchial asthma and atopic dermatitis, and one had myasthenia gravis and trisomy21 as underlying diseases. One patient was considered to have attention deficit hyperactivity disorder and was receiving antipsychotic medication. The median blood test values at the first visit were ALP 857 U/L (N=19), total cholesterol level 122 mg/dL (N=19), fT3 14.31 pg/mL (N=21), fT4 4.60 ng/dL (N=21), thyroid stimulating antibody 668 % (N=7), TSH receptor antibody 16.6 IU/L (N=20 TSH was less than sensitive in all cases. Nineteen patients received thiamazole. Fourteen patients received propranolol. Five patients received inorganic iodine. Five patients received inorganic iodine, starting at a median of 0.926 mg/kg/day of body weight. Discussion As with adults, females were more common. The symptoms were similar to those of attention deficit hyperactivity disorder, and thus warranted attention. Symptoms related to poor academic performance were also considered important. Anti-thyroglobulin antibodies and anti-TPO antibodies were also detected, suggesting that we should be careful about the possibility of the disease progressing to Hashimoto's disease. Presentation: Thursday, June 15, 2023

HYPOTHYROÏDIES AU SERVICE DE MEDECINE INTERNE/ENDOCRINOLOGIE-DIABETOLOGIE NUTRITION DU CENTRE HOSPITALIER NATIONAL DE PIKINE-SENEGAL : ETUDE RETROSPECTIVE DU 01JANVIER 2011 AU 30 JUIN 2019

SummaryIntroduction: Hypothyroidism is the most common thyroid dysfunction. It is important to determine the cause because some forms are reversible. The objective of our study was to establish the profile of hypothyroidism in our practice. Methods: this was a retrospective study during the period from January 1, 2011 to June 30, 2019 including all patients with hypothyroidism confirmed by hormonal assays and followed at the Internal Medicine, Endocrinology, Diabetology and Nutrition department of the National Hospital Center of Pikine. Results: we retained 292 files of patients monitored for hypothyroidism. The average age of the patients was 49.7 years. There were 276 women and 16 men. Hypothyroidism was peripheral in 289patients (98.97%) and central in 3 patients (1.03%). Concerning the aetiologies of peripheral hypothyroidism, it was a thyroidectomy in 70 patients (23.97%), radio-iodine therapy in 7 patients (2.39%), Hashimoto’s disease in 58 patients (19.86%), atrophic thyroiditis in 10 patients (3.42%) and a thyroid hormone synthesis disorder in 2 patients (0.68%). In 140 patients suffering from peripheral hypothyroidism (47.94%), no aetiology could be retained. Hashimoto’s disease was associated with other autoimmune diseases in 3 patients including myasthenia gravis, Addison’s disease and Goujerot syndrome. For the three patients presenting thyrotropic insufficiency, Sheehan syndrome was suggested in the face of a notion of haemorrhagic delivery, followed by an absence of milk flow. Pituitary magnetic resonance imaging showed an empty Sella turcica appearance. Conclusion: we can conclude that the aetiologies of hypothyroidism in our practice are dominated by thyroidectomy and Hashimoto’s disease. The aetiology was undetermined in 48% of patients due to insufficient exploration Keywords: Hypothyroidism, Hashimoto disease, Sheehan, Dakar, Senegal

FRI469 Natural History Of de Quervain’s Thyroiditis In The Era Of COVID -19: The Greek Experience Of 226 Cases

Abstract Disclosure: N. Angelopoulos: None. D.P. Askitis: None. I. Androulakis: None. N. Valvis: None. R. Paparodis: None. V. Petkova: None. A. Boniakos: None. D. Zianni: None. I. Perogamvros: None. K.A. Toulis: None. S. Livadas: None. Background: Subacute thyroiditis (SAT) is a usually self-limiting disease however,patients with pronounced tenderness normally receive nonsteroidal anti-inflammatorydrugs (NSAIDs) or systemic steroids. Disease recurrence is unfortunately common, while approximately 0.5-15% of patients require permanent thyroxine substitution. Among the thyroid SARS-CoV-2 complications, SAT was reported early and the question whether SAT might be underestimated was raised. Aims and Scope: The aims of this retrospective study were: (1) to determine predictive factors for SAT recurrence and the development of hypothyroidism and (2) to identify potential clinical and laboratory characteristics in patients with SAT due to SARS-CoV-2 infection. Methods: We retrospectively reviewed the records of 226 patients with confirmed subacute thyroiditis between January 2020 and November 2022 in eleven outpatient endocrine clinics with geographical representativeness of Greek territory. Results: Mean age was 48.01 years and F/M 158/68. Baseline hypothyroidism was present in 11 patients (4.86%), 36 had Hashimoto, 30 had nodular disease, 4 had both Hashimoto and nodules, 1 was hyperthyroid and the remaining 144 patients had no thyroid disease. At the end of follow up (16.77±0.8 months) 68 patients (34.5%) had hypothyroidism (P &amp;lt;0.001, 15 of them with nodules), 17 Hashimoto, 4 Hashimoto and nodular disease, 1 developed hyperthyroidism and 1 was thyroidectomized due to multiple recurrences. Regarding treatment protocols, significant differences were detected for treatment duration (shorter with ibuprofen, p&amp;lt;0.001), time-to-symptoms relief (shorter with methylprednisolone, p&amp;lt;0.05) and the initial equivalent dose of cortisone (lower in combined treatment with cortisone and ibuprofen, p&amp;lt;0.001). Demographical (age, gender, BMI), serological (ESR,CRP) and treatment parameters (type of therapy, duration of therapy, initial dose of treatment, time to treat, time to symptoms relief) were not related with the development of hypothyroidism. Recurrence was observed in 28 patients (14.1%) all treated with glucocotricoids. 34 patients had covid-19 related SAT with no specific clinical manifestation of the disease. Compared to the non-covid group, BMI was higher (27.58±4.05 vs 25.69±5.44, respectively, p=0.026) and a shorter time-to-symptoms relief was observed (3.56±1.94 vs 5.46±6.93 days, respectively, p=0.044). Conclusion: In a large cohort of patients, corticosteroid therapy was found to promptly alleviate the acute symptoms during the onset of SAT, duration of treatment was longer and the incidence of recurrence greater than that observed with nonsteroidal anti-inflammatory drugs. Both regimens could not prevent the development of delayed hypothyroidism. Clinical characteristics of SAT after COVID-19 were similar to those of typical SAT. Presentation: Friday, June 16, 2023

Do Dietary Supplements Affect Inflammation, Oxidative Stress, and Antioxidant Status in Adults with Hypothyroidism or Hashimoto's Disease?-A Systematic Review of Controlled Trials.

This systematic review aims to summarise the results of controlled trials on dietary supplements (DS) usage and inflammation, oxidative stress, antioxidant status, and thyroid parameter improvement in hypothyroidism (HT)/Hashimoto's thyroiditis (AIT) patients. The study protocol was registered with PROSPERO (no. CRD42022365149). A comprehensive search of the PubMed, Scopus, and Web of Science databases resulted in the identification of nineteen randomised controlled trials and three non-randomised studies for the review; three studies examined the effect of supplementation with vitamin D, twelve studies-with selenium, and seven studies-with other DS. Based on very limited evidence, the lack of influence of vitamin D supplementation on inflammatory parameters was found, while no studies have examined oxidative stress and antioxidant status parameters, and only one provided results for a single thyroid parameter after an intervention. Some evidence was found proving that selenium supplementation may decrease inflammation and improve thyroid parameters, but reaching a conclusion about its influence on oxidative stress and antioxidant status is not possible because of the insufficient number of studies. Additionally, due to examining other DS (e.g., multicomponent, Nigella sativa, and genistein) only in single studies, conclusions cannot be drawn. Further long-term, high-quality randomised controlled trials are necessary to better understand the influence of DS on inflammation, oxidative stress, and antioxidant status, as well as their potential to improve thyroid gland function in HT/AIT patients.

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

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

Hashimoto's disease - the role of factors and diet in the course of the disease

Introduction: Hashimoto's disease is an autoimmune disorder that develops as a result of a pathological reaction of the patient's immune system, which consequently destroys the body's own healthy cells and tissues. Genetic, environmental and immunological factors influence its development. The disease may initially be asymptomatic. The exact aetiology of the disease is unknown. The worldwide incidence is approximately 10-12%.&#x0D; Purpose: This paper aims to present the influence of genetic factors, environmental factors, trace elements, and diet on the development and course of Hashimoto's disease based on the current state of knowledge.&#x0D; Conclusions: Hashimoto's disease is a multifactorial disease, but the relevance of all factors presented in the development and progression has not yet been confirmed. To date, a special diet for patients has not been created. Further research is needed to better understand the pathogenesis of the disease in order to help patients control HT.&#x0D; Methods: Data for the article were retrieved using PubMed setting the time descriptors to 2013-2023.

Analysis of Chosen Polymorphisms rs1982073 T/C, rs1800471 C/G TGFβ1 in Pathogenesis of Hashimoto's Diseases

Analysis of Chosen Polymorphisms rs1982073 T/C, rs1800471 C/G TGFβ1 in Pathogenesis of Hashimoto's Diseases

Autoimmune polyendocrine syndromes associated with autoimmune rheumatic diseases.

Autoimmune polyendocrine syndromes (APSs), also called autoimmune polyglandular syndromes, are a group of autoimmune diseases characterized by the co-occurrence of dysfunctions of several (at least two) endocrine glands. They develop under the influence of environmental factors in genetically predisposed people. Autoimmune polyendocrine syndromes may accompany autoimmune rheumatic diseases and worsen their course - APS-2 and APS-3 are the most common. The APS-2 includes the coexistence of, e.g. Hashimoto's disease, celiac disease and rheumatoid arthritis (RA). In APS-3, rheumatic diseases such as RA, systemic lupus erythematosus, and Sjögren's syndrome may coexist with Hashimoto's disease, type 1 diabetes and hypogonadism or other endocrinopathies. Undiagnosed endocrine diseases may be the reason for the intensification of metabolic disorders observed in the course of rheumatic diseases, cause the ineffectiveness of rheumatological treatment and also increase the frequency of bone fractures due to osteoporosis, cardiovascular complications and even miscarriages when coexistent, e.g. Hashimoto's disease with hypothyroiditis, which increases the risk of pregnancy loss. It is important to be able to conduct an extensive interview, paying attention to the symptoms of possible endocrinopathy as well as the features of other autoimmune disorders in the physical examination (e.g. vitiligo or darkening of the skin in Addison's disease). Depending on the history and physical examination, screening for various APSs is advised.

Coexistence of Autoimmune Thyroiditis and Juvenile Idiopathic Arthritis.

Autoimmune thyroid disease seems to occur more often in children with juvenile idiopathic arthritis (JIA) than in the general pediatric population. We investigated the prevalence of autoimmune thyroiditis (Hashimoto's thyroiditis) in young patients with JIA in Greece, which has not been evaluated previously. This descriptive study included patients with JIA followed up at the Pediatric Rheumatology Unit of the Second Department of Pediatrics of a tertiary general hospital in Thessaloniki, Greece. All patients were diagnosed and sorted according to the classification criteria of the International League of Associations for Rheumatology. The presence of thyroid autoantibodies was considered for determining autoimmune thyroiditis. Basic demographic, clinical, and laboratory data were collected from patients' records. Results: The analyzed sample comprised 130 patients with JIA (mean age 12.22years; 69.2% female). Most patients (70%) had a family history of at least one autoimmune disease and 30.8% of Hashimoto's thyroiditis. More than half (53.8%) had enthesitis-related arthritis (ERA), 22.3% had oligoarthritis, and 15.4% had psoriatic arthritis. Thyroid autoantibodies were detected in 22/130 patients (16.9%) suggesting autoimmune thyroiditis; most of these patients were euthyroid, whereas 3/22 (13.6%) had overt hypothyroidism determined by elevated levels of thyroid-stimulating hormone, decreased levels of free thyroxine, and typical ultrasound findings for Hashimoto's thyroiditis. The prevalence of clinical cases of Hashimoto's disease was 2.3%. The prevalence of autoimmune thyroiditis in our JIA cohort is higher compared to the general population and consistent with the previously reported range. Hence, investigation for thyroid autoimmunity should be included in the workup of patients with JIA.

Association of HLA-DRB1*04 gene with Hashimoto’s thyroiditis among Iraqi-Kurdish population in Erbil province

Background and objective: Hashimoto’s thyroiditis is one of the common autoimmune thyroid diseases with increasing incidence in the general population. It has been suggested that a combination of genetic and environmental factors increase the risk of developing the disease. The current study aimed to find the association between HLA-DRB1*04 gene with Hashimoto's Thyroiditis among the Iraqi-Kurdish population in Erbil Province. Methods: The case-control study was conducted on 45 untreated patients with Hashimoto’s thyroiditis who have already been diagnosed and 45 control subjects. Blood specimens were taken from the subjects for gene detection purposes via conventional polymerase chain reaction. Sera specimens were used to run enzyme linked immunosorbent assay to measure the level of IFNγ. Results: The age of subjects ranged from 32 to 63 years with no significant difference between mean ±SE of cases (46.822±1.087 years) with the mean ±SE (47.044 ±1.162 years) of the control subjects (P = 0.999). The mean ±SE of free T3 and T4 levels was lower in cases in comparison to those of controls, while the mean ±SE of TSH level in cases was significantly higher compared to those of controls. Statistically there was a highly significant difference in the mean ±SE of free T3, free T4 and TSH levels between cases and controls (P &lt;0.001). Furthermore, the mean ±SE of anti-TPO, anti-Tg and IFNγ levels was higher in cases compared to those of control subjects. Statistical analysis shows a highly significant difference between mean ±SE of anti-TPO and anti-Tg antibody levels of cases compared to those of controls (P &lt;0.001). As for IFNγ level, there was a significant difference between mean±SE of IFNγ levels in cases and controls (P = 0.021). The conventional polymerase chain reaction results showed that 39/45 (86.7%) of cases were tested positive for HLA-DRB1*04, while only 20/45 (44.04 %) of the control subjects tested positive for the gene, statistical analysis revealed a highly significant association between the existence of the gene with HT disease (P &lt;0.001). Conclusion: The study revealed a highly significant association between the existence of HLA-DRB1*04 gene and Hashimoto's thyroiditis disease among the Iraqi-Kurdish population in Erbil Province.

Association of Helicobacter pylori Infection with Autoimmune Thyroid Disease in the Female Sex.

Helicobacter pylori infection has been associated with an increased risk of thyroid diseases (TDs), although scientific evidence is conflicting. In the present study the relationship between TDs, including both autoimmune (AI) and non-autoimmune TD, and H. pylori infection was investigated. Data from records of patients undergoing upper endoscopy and histologically evaluated for H. pylori infection were retrieved. In addition to demographic information, the features of gastritis based on non-targeted biopsies collected from the antrum, angulus, and corpus were analyzed. The presence of H. pylori infection and atrophy and/or metaplasia and/or dysplasia in at least one gastric specimen was defined as a long-lasting H. pylori infection and the presence of a chronic-active gastritis as a current infection. Hashimoto's and Graves' diseases were included in the AITD group, and thyroid nodules, goiter, iatrogenic thyroid hypo/hyper function, and thyroidectomy in the non-autoimmune TD group. A total of 8322 records from adult patients from Northern Sardinia, characterized by a similar genetic background, was analyzed. Participants were aged 18-93 years (females 5339, 64.1%), and more specifically, 562 (6.7%) had a diagnosis of AITD and 448 (5.4%) of non-autoimmune TD. A significant association between long-lasting H. pylori and AITD (OR 1.34; 95%CI 1.13-1.60) was found, irrespective of age, sex, body mass index, and smoking status, while it was not associated with non-autoimmune TD. Current H. pylori infection did not show significant ORs for AITD (OR 0.99; 95%CI 0.64-1.57) and non-autoimmune TD (OR 0.86; 95%CI 0.66-1.15). The association with long-lasting H. pylori infection was confirmed to be significant for both Hashimoto's thyroiditis and Graves' disease by multivariable regression analysis. Stratification according to sex revealed a significant association only for females (OR 1.39; 95%CI 1.12-1.72). Our results indicate that long-lasting H. pylori infection is associated with AITD in the female adult population of Northern Sardinia.

A Brief Look at Hashimoto's Disease, Adrenal Incidentalomas, Obesity and Insulin Resistance-Could Endocrine Disruptors Be the Other Side of the Same Coin?

Hashimoto's disease (HD) is the most common cause of hypothyroidism in developed countries. The exact pathomechanism behind it has not been clearly established; however, an interplay of genetic susceptibility, environmental triggers (including diet) and epigenetic factors seems to be involved. Among the latter, increasingly more attention has been paid to some hormonally active substances, known as endocrine disruptors, which are commonly used worldwide. HD has become a condition widely reported in the media, acting as a culprit for inexplicable weight gain, chronic fatigue or weakness. Nevertheless, the recognition of HD is undeniably increasing and represents a major public health burden. At the same time, improving access to imaging tests has increased the number of incidentally diagnosed adrenal tumors. Above all, the widespread use of chest computed tomography (CT) due to the COVID-19 pandemic has contributed to frequent incidental detection of adrenal lesions. Fortunately, a vast majority of these findings are asymptomatic benign tumors with no excessive hormonal activity, and therefore, they are defined as adrenal incidentalomas (AIs). Interestingly, recent studies have indicated that patients with AIs are more prone to obesity and insulin resistance. Although mutual relationships between the thyroid and the adrenal glands have been studied widely, still, little is known about the possible pathophysiological associations between thyroid autoimmunity and the occurrence of adrenal incidentalomas. This article presents a brief review of the common endocrine disorders with a special focus on the frequently coexisting insulin resistance and/or obesity. Furthermore, in response to the recent growing interest in endocrine disruptors, with their transgenerational epigenetic effects that influence hormonal system function, a concise overview of the topic has also been included.

Effects of Autoimmune Protocol (AIP) diet on changes in thyroid parameters in Hashimoto's disease.

In the scientific world, the nutritional needs of persons with Hashimoto's autoimmune thyroid disease are discussed, and there is a lot of interest in the autoimmune protocol (AIP). The aim of the study was to check the effects of AIP on thyroid parameters in euthyroid patients with Hashimoto's disease. Among 28 people with Hashimoto's (including 1 male) the consumption of nutrients, anthropometrics, symptoms of the disease, values of thyroid parameters: FT3, FT4, TSH, thyroid ultrasound and autoimmune aTPO, aTG were analyzed before and after 12 weeks of using the AIP diet. The impact of changes in the consumption of selected nutrients on changes in thyroid biochemical parameters were analyzed using multiple regression models, where the dependent variables of the created models were changes in thyroid biochemical parameters. After applying the AIP diet, the number of people reporting symptoms of malaise decreased, the levels of FT3 and FT4 as well as TSH decreased, remaining within the reference concentration range. aTG decreased slightly, but aTPO increased significantly. Ultrasound examination also showed a decrease in the volume of the thyroid gland. The body weight of the subjects decreased, which indicates a caloric deficit. Given the numerous advantages of the AIP diet, extending the observation time of the diet, along with its personalization in terms of food selection, energy and nutritional value, could show changes in both well-being and biochemical test results to a greater extent. The use of a personalized AIP protocol can improve the quality of life, a positive change in mental state, reduction of stress, and above all, the improvement of adverse ailments associated with Hashimoto's disease.

A case of severe hypothyroidism in an elderly patient with Hashimoto's Disease

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

The role of oxidative stress in Hashimoto's disease

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

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

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