History Of Autoimmune Thyroiditis Research Articles

A nomogram for predicting adverse pathologic features in low-risk papillary thyroid microcarcinoma

BackgroundIdentifying risk factors for adverse pathologic features in low-risk papillary thyroid microcarcinoma (PTMC) can provide valuable insights into the necessity of surgical or non-surgical treatment. This study aims to develop a nomogram for predicting the probability of adverse pathologic features in low-risk PTMC patients.MethodsA total of 662 patients with low-risk PTMC who underwent thyroid surgery were retrospectively analyzed in Qilu Hospital of Shandong University from May 2019 to December 2021. Logistic regression analysis was used to determine the risk factors for adverse pathologic features, and a nomogram was constructed based on these factors.ResultsMost PTMC patients with these adverse pathologic features had tumor diameters greater than 0.6 cm (p < 0.05). Other factors (age, gender, family history of thyroid cancer, history of autoimmune thyroiditis, and BRAFV600E mutation) had no significant correlation with adverse pathologic features (p > 0.05 each). The nomogram was drawn to provide a quantitative and convenient tool for predicting the risk of adverse pathologic features based on age, gender, family history of thyroid cancer, autoimmune thyroiditis, tumor size, and BRAFV600E mutation in low-risk PTMC patients. The areas under curves (AUC) were 0.645 (95% CI 0.580–0.702). Additionally, decision curve analysis (DCA) and calibration curves were used to evaluate the clinical benefits of this nomogram, presenting a high net benefit.ConclusionTumor size > 0.60 cm was identified as an independent risk factor for adverse pathologic features in low-risk PTMC patients. The nomogram had a high predictive value and consistency based on these factors.

RELATIONSHIP BETWEEN ULTRASOUND CHANGES IN THE LIVER AND HYPOTHYROIDISM IN PATIENTS WITH AUTOIMMUNE THYROIDITIS

Hashimoto's autoimmune thyroiditis (AIT) is one of the most frequent causes of hypothyroidism, which leads to the development of dysfunctions of various body systems. Since the hepatobiliary system is closely related to the thyroid gland, a decrease in thyroid function is considered one of the factors in the development of non-alcoholic fatty liver disease. Early detection of changes in the liver in patients with hypothyroidism makes it possible to start therapy in time and prevent the development of complications, such as fatty dystrophy, inflammation, damage to hepatocytes, fibrosis, cirrhosis.&#x0D; The aim. Determine the relationship between hypothyroidism and ultrasound changes in the liver in patients with AIT.&#x0D; Methods. 62 patients with AIT and hypothyroidism were examined. The first group included 32 patients with a history of AIT up to two years, the second group included 30 patients with a history of the disease for more than two years, and the control group included 30 patients without signs of thyroid pathology. Thyroid function was assessed based on the results of a hormone levels blood test. Multiparametric ultrasound examination of the liver and thyroid gland was performed on Siemens Acuson S2000 and S3000 devices in B-mode, color doppler mapping, pulse-wave doppler and shear-wave elastography (SWE) modes.&#x0D; Results. Ultrasound changes in the liver were more often observed in patients with subclinical hypothyroidism on the background of AIT. It was found that the number of patients with sonographic signs of liver damage is greater in the second group than in the first. Sonographic signs of the hepatobiliary system damage included an increase in the size of the liver, an increase in the echogenicity of its parenchyma, not homogeneous structure and dilatation of the portal vein.&#x0D; The analysis of the level of shear wave speed in the parenchyma of the thyroid gland showed that it was higher in second groups and its increase was also noted in patients with subclinical and clinical hypothyroidism.&#x0D; The results of SWE of the liver demonstrated a positive correlation between the stiffness of the liver parenchyma and the duration of AIT. Also, significantly higher values of SWE were observed in patients who, at the time of examination, had laboratory signs of thyroid dysfunction and the high level of shear wave velocity in the thyroid gland parenchyma. The analysis of the number of cases of liver fibrosis in two groups showed that it is more often detected during the long course of the disease. The percentage of patients with F1-F2 in the first group was 32% and in the second group - 53%.&#x0D; Conclusions. The established relationship between sonographic signs of diffuse changes in the liver parenchyma and hypothyroidism determines the expediency of using multiparametric ultrasound examination of the hepatobiliary system in patients with AIT to assess its condition, early diagnosis of fibrosis and determine the need for correction of treatment tactics.

Metastatic renal cell carcinoma, the possibility of targeted therapy. Case.

Malignant neoplasms of the kidney are quite an urgent problem. In the Russian Federation in 2019, 20758 patients with a newly diagnosed renal cell carcinoma were registered; it should be noted that at the end of 2019, 177 755 patients with this diagnosis were registered. Clear cell carcinoma of the kidney is the most common (75–80%) and most studied subtype of renal cell carcinoma. Because renal cell carcinoma is resistant to chemotherapy, interleukin-2 or interferon alpha has previously been widely used as the first line of treatment for metastatic disease. Sunitinib is an oral tyrosine kinase inhibitor that includes the vascular endothelial growth factor receptor (VEGFR) and the platelet growth factor receptor (PDGFR). Two phase II studies of sunitinib as an anti-angiogenic agent have shown clinical efficacy in patients who progressed on cytokine therapy. Currently, in connection with the development of immuno-oncological drugs, tyrosine kinase inhibitors are fading into the background. It should also be noted that immuno-oncological drugs have their own spectrum of contraindications and immune-mediated toxicity. A clinical case of treatment of a patient with metastatic renal cell carcinoma in the group with a favorable prognosis for IMDC and contraindications to immunotherapy is presented. A history of autoimmune thyroiditis, which was previously treated with levothyroxine sodium, contraindicated treatment with checkpoint inhibitors. The patient started therapy with the tyrosine kinase inhibitor sunitinib. Sunitinib therapy made it possible to achieve disease control for more than 4 years with satisfactory tolerance. The noted adverse events were stopped during therapy and did not lead to a reduction in doses of sunitinib and its cancellation.

Metastatic malignant struma ovarii with coexistence of Hashimoto's thyroiditis.

SummaryStruma ovarii is a rare ovarian teratoma characterized by the presence of thyroid tissue as the major component. Malignant transformation of the thyroidal component (malignant struma ovarii) has been reported in approximately 5% of struma ovarii. The management and follow-up of this unusual disease remain controversial. We report the case of a woman with a history of autoimmune thyroiditis and a previous resection of a benign struma ovarii that underwent hystero-annexiectomy for malignant struma ovarii with multiple papillary thyroid cancer foci and peritoneal involvement. Total thyroidectomy and subsequent radioiodine treatment lead to complete disease remission after 104 months of follow-up. The diagnosis and natural progression of malignant struma ovarii are difficult to discern, and relapses can occur several years after diagnosis. A multidisciplinary approach is mandatory; after surgical excision of malignant struma, thyroidectomy in combination with 131I therapy should be considered after risk stratification in accordance with a standard approach in differentiated thyroid cancer patients.Learning pointsMalignant struma ovarii is a rare disease; diagnosis is difficult and management is not well defined.Predominant sites of metastasis are adjacent pelvic structures.Thyroidectomy and 131I therapy should be considered after risk stratification in accordance with standard approaches in DTC patients.

Hashimoto’s encephalopathy in a child treated with immunoglobulin therapy

This case report presents a 14-month follow-up of a case of Hashimoto's encephalopathy (HE) treated with im- munoglobulins for the first time in an 11-year-old adolescent. The diagnostic criteria were: (a) a drop in school performance and psychological withdrawal for several weeks, (b) an euthyroid state with a past medical history of autoimmune thyroiditis treated with thyroxin, (c) a first episode of tonic-clonic seizure with clinical and electroencephalographic (EEG) findings of encephalopathy, (d) a high serum concentration of antithyroglobulin and antithyroid peroxidase antibodies, (e) negative results of cerebrospinal fluid and blood studies for viral and bacterial infections. Her acute epileptic symptoms resolved with clonazepam. Immunoglobulin therapy (400 mg/kg/day for 5 days every 6 weeks) was given for 14 months. Her cognitive function was greatly improved but a light-to-mild cognitive deficit remained. An EEG performed at her 14-month follow-up showed a correlation with her cognitive improvement. We suggest that immunoglobulin can be used as a first-line therapy in HE to avoid side effects or relapses as has been described with long-term steroid therapy.

Hashimoto Encephalopathy Presenting as Schizophrenia-like Disorder

Hashimoto encephalopathy (HE) is associated with numerous neuropsychiatric symptoms and responds well to steroid therapy. In the past, only a few cases were reported to present with pure psychiatric syndromes. We describe a case of HE with presenting symptoms like that of schizophrenic patients. We describe a 73-year-old woman with a history of autoimmune thyroiditis. She had psychotic symptoms for 3 years that responded poorly to antipsychotic agents, and she was thus admitted in 2007. The diagnosis of HE was made, although the patient presented neurologic symptoms and signs including abnormal electroencephalography, recent memory impairment, and executive function declination. The psychotic symptoms subsided completely in a few days after high-dose intravenous steroid therapy. The neuropsychiatric manifestation of HE can be similar to typical schizophrenia. Considering the effectiveness of steroid therapy for HE, we suggested HE as an important differential diagnosis for psychotic disorders, particularly for those patients of late onset, with abnormal electroencephalography, history of autoimmune thyroiditis, or poor response to conventional psychiatric treatment, so as to provide prompt and effective treatment for these patients.

P312 - Prevalence of antibodies against thyroglobulin (anti-Tg) and thyroid peroxidase (anti-TPO) in patients with inflammatory bowel disease on scheduled infliximab or conventional treatment: a two years follow up study

P312 - Prevalence of antibodies against thyroglobulin (anti-Tg) and thyroid peroxidase (anti-TPO) in patients with inflammatory bowel disease on scheduled infliximab or conventional treatment: a two years follow up study

Treatment and Survival of Patients with Thyroid Lymphoma: A Population-Based Study with Clinical and Pathologic Reviews

PurposeThe purpose of this study was to determine the incidence, clinical and histologic features, and patterns of outcome of thyroid lymphomas. Patients and MethodsA retrospective population-based survey of 38 patients with thyroid lymphoma was taken. Median age was 69 years (range, 33–87 years), with a 1:4 female predominance. Fifty percent of cases had a history of autoimmune thyroiditis, and coexistent thyroiditis was found in 67% of cases in which preexistent thyroid tissue was present. The most common subtype was diffuse large B-cell lymphoma (DLBCL; 63%) followed by extranodal marginal zone lymphoma (ENMZL; 29%). Ten of the patients with DLBCL showed a concomitant low-grade mucosa-associated lymphatic tissue component, and 4 cases of aggressive ENMZL were diagnosed. At diagnosis, 22 patients (58%) had localized disease, and 41% had low-risk international prognostic index scores. ResultsTherapy was diverse and included all possible treatment modalities, none of which showed superiority. A complete clinical response was exhibited in 64% of patients, 14% exhibited a partial response, and 22% developed progressive disease. At a median followup of 43 months (range, 0-240 months), 15 patients had relapsed or developed progressive disease. Two-year overall survival rate was 59% for all patients, 68% for patients with localized disease, and 47% for patients with disseminated lymphoma. ConclusionMany thyroid lymphomas have clinical and histologic features characteristic of ENMZL and belong to this specific clinicopathologic entity.

Hashimoto Encephalopathy with Pegylated Interferon Alfa-2b and Ribavirin

To report an instance of Hashimoto encephalopathy probably resulting from pegylated interferon alfa-2b and ribavirin. A 36-year-old woman with a 10-year history of autoimmune thyroiditis presented with symptoms and signs consistent with Hashimoto encephalopathy during therapy with pegylated interferon alfa-2b and ribavirin for chronic hepatitis C. Hashimoto encephalopathy is a rare autoimmune condition that occurs in patients with Hashimoto thyroiditis and high titers of antithyroid antibodies. It is characterized by a variety of nonspecific neuropsychiatric symptoms, increased cerebrospinal fluid protein level, and abnormal brain imaging and electroencephalogram. Prompt response to corticosteroids is observed in most cases. As of August 29, 2005, this is the first report of such an association. An objective causality assessment revealed that the Hashimoto encephalopathy was probably caused by the patient's medications. Hashimoto encephalopathy may rarely be triggered by interferon alfa therapy in susceptible patients.