Incidence Of Hashimoto's Thyroiditis Research Articles

Association of Hashimoto thyroiditis with papillary thyroid carcinoma and its clinical features – A retrospective study in a tertiary care hospital

Background: Papillary thyroid carcinoma (PTC) is the most widespread endocrine malignancy. Among the several risk factors, Hashimoto thyroiditis (HT) is one of the factors associated with increased incidence of PTC. Both HT and PTC share several epidemiologic features including high prevalence, female predominance, and increased incidence in iodine-sufficient areas. Aims and Objectives: The aim of the study was to assess the incidence of HT and PTC coexistent in endemic population. The study also aimed to determine the association of various prognostic parameters of PTC in patients with coexistent HT. Materials and Methods: This was a retrospective study done from May 2019 to May 2024 over a period of 5 years in a tertiary care hospital of West Bengal. A total of 54 patients with primary PTC who underwent total thyroidectomy with cervical lymph node dissection (LND) were studied. Patients with primary PTC with neck LND and complete medical history were included in this study. Patients with previous thyroidectomy surgery or patients with incidental PTC diagnosed in thyroidectomy specimens done for a benign neoplasm (without LND) were excluded from the study. Results: A total of 54 cases of PTC were studied out of which 23 cases were PTC associated with HT and 31 cases were PTC without HT constituting 42.59% and 57.4%, respectively. PTC associated with HT had a greater incidence in females. In this study, our results showed that PTC with HT had a greater tendency of tumor multifocality, greater mean lymph node size, and increase rate of extranodal tumor extension. At the same time, patients of PTC associated with HT had smaller tumor size and low clinical stage. Conclusion: PTC associated with HT had a female preponderance, larger metastatic lymph node, a tendency for multifocality, and extranodal extension. At the same, they also had smaller tumor size and low clinical stage indicating a complex and controversial effect of HT on PTC.

Evaluation of thyroid dysfunction in childhood-onset systemic lupus erythematosus: Risk factors for Hashimoto's thyroiditis.

Increased frequency of autoimmune thyroid disease, particularly Hashimoto's thyroiditis (HT) was reported several studies in the literature, in individuals with childhood-onset systemic lupus erythematosus (cSLE). Our study aimed to investigate the prevalence and contributing factors of thyroid dysfunction and HT among cSLE patients. Thyroid function tests were obtained cross-sectionally from cSLE patients. Demographic, clinical, and laboratory characteristics and activity scores were collected from medical records. Patients diagnosed with cSLE were compared to the healthy control group for the frequency of thyroid dysfunction. The Mann-Whitney U, independent samples t test, and the Chi-square or Fisher's exact test were used to compare study groups. A p-value below 0.05 was considered statistically significant. Out of 73 cSLE patients, 14 (19.1%) had subclinical hypothyroidism, 9 (12.3%) had clinical hypothyroidism, 12 (16.4%) were diagnosed with HT, and 12 (16.4%) had a family history of HT. Thyroid USG was performed in 5 euthyroid patients and 1 borderline subclinical hypothyroid patient with positive thyroid autoantibody and reported as diffuse heterogeneous echogenicity enlargement in the thyroid gland. There were no significant differences in clinical and laboratory data or medication used between the groups with and without HT; however, patients with HT had a higher frequency of clinical hypothyroidism and family history of HT. Cumulative prednisolone dose was significantly lower in patients diagnosed with HT. The frequency of HT was considerably higher in patients with cSLE compared to the healthy control group. The results demonstrate an increased incidence of HT in cSLE patients, even if they are euthyroid, and recommend that cSLE patients be screened more frequently.

Gender-Specific Impact of Metabolic Obesity Phenotypes on the Risk of Hashimoto's Thyroiditis: A Retrospective Data Analysis Using a Health Check-Up Database.

BackgroundHashimoto’s thyroiditis (HT) is recognized as the most common autoimmune thyroid disease, often accompanied by the diffuse enlargement of thyroid with abundant blood flow and elevated level of thyroid autoantibodies. As obesity had a positive association with the risk of HT. Thus, this retrospective study was established to further explore the gender relationship between metabolic obesity phenotypes and the risk of Hashimoto’s thyroiditis (HT).Materials and MethodsData for 3697 subjects aged ≥18 years were randomly collected from a Health check-up database from April to December 2019. Obesity was defined by general obesity (GO; body mass index [BMI] ≥28 kg/m2) and abdominal obesity (AO; waist circumstance, male ≥90 cm, female ≥85 cm). Metabolic unhealthy was defined as having at least one metabolic syndrome component and a homeostasis model assessment of insulin resistance ≥2.5. Obesity phenotypes were divided into three groups: GO, AO, compound obesity (GO+AO). After adjustment for potential confounding factors, multivariate logistic regression was used to assess the association between metabolic obesity phenotypes and risk of HT by sex and explore the correlation between different obesity patterns and HT risk by metabolic health status.ResultsThe incidence of HT was 23.5% and significantly higher among females than males with different metabolic phenotypes (26.2% vs 20.5%, p<0.05), except metabolically healthy AO. Compared with non-obese subjects, different metabolic obesity phenotypes were independent risk factors among males (p<0.05). Among females, unhealthy metabolic status with GO (adjusted odds ratio [OR]=2.62) or AO (adjusted OR=2.87) and metabolically healthy non-GO (adjusted OR=2.05) were risk factors of HT (p<0.05). Increasing BMI categories and waist circumstance quartiles were positively correlated with HT risk (p for trend <0.05). Subgroup analyses indicated that GO+AO (adjusted OR=2.52) or only AO (adjusted OR=2.41) were risk factors for HT for those with unhealthy metabolic status. Moreover, GO+AO (adjusted OR=2.37) was an independent risk factor for HT under healthy metabolic status.ConclusionGO+AO was associated with an increased risk of HT, identifying higher BMI/WC as a significant risk factor for HT. Males with unhealthy metabolic state or obesity and metabolically unhealthy females with obesity are high-risk group for HT. Additionally, only AO and GO+AO conferred increased risk of HT for individuals with metabolic abnormalities.

Familial Risk of Hashimoto's Thyroiditis Among First-Degree Relatives: A Population-Based Study in Korea.

Background: Few small-scale studies have reported a genetic and familial predisposition in Hashimoto's thyroiditis (HT), however, quantified familial risk estimates from population-level data are unavailable. We aimed to estimate the incidence and familial risk of HT among first-degree relatives (FDR) according to age, sex, and family relationships. Methods: We conducted a population-based study in the general population of Korea from 2002 to 2017. Using the nationwide health insurance database, which has full population coverage and family relationship information, a cohort of 22 million individuals with blood-related FDR comprising 12 million families were followed up for a familial occurrence of HT. Age- and sex-adjusted incidence risk ratios (IRRs) were calculated in individuals with an affected FDR compared with those without an affected FDR. Results: Among 21,940,795 individuals, 234,912 had an HT-affected FDR, of whom 2425 familial cases developed HT with an incidence of 7.12/10,000 person-years. The familial risk for HT was 6.5-fold (95% confidence interval [CI]: 6.24-6.78) higher in individuals with versus without affected FDR. According to relationship, familial risks were IRR 102.71, IRR 7.80, IRR 5.54, and IRR 5.52 with an affected twin, sibling, mother, and father, respectively, and the corresponding incidence (/10,000 person-years) was 115.57, 10.66, 5.73, and 5.91. Same-sex twins had three times higher risk of developing HT than opposite-sex twins (IRR 121.01 vs. 21.46). The sex-specific familial risk was higher in males than females. The risks demonstrated age dependence, being higher in younger age groups. Conclusions: This study represents the largest population-based study of familial HT risk in Asia. We demonstrated elevated familial risk of incident HT among FDR, but with lower magnitude as those observed in previous studies. Familial risk increased with the degree of genetic relatedness among FDR indicating a prominent role of genetic factors in the familial aggregation of HT. Elevated risks in the younger age groups should motivate clinicians to screen people with a family history, especially those <30 years.

Research on the Mechanism of T Cell Subsets and Cytokines in Hashimoto&amp;apos;s Thyroiditis

As being one of the most common diseases in autoimmune thyroid disease (AITD), Hashimoto's thyroiditis (HT) is an organ-specific autoimmune disease. It is mostly related to genetics, infection, and excessive iodine, but the exact pathogenesis has not yet clear. As one of the most important immune cells, T cells play an important role in the human immune. Helper T cells (Th) and regulatory T cells (Treg) are two important subgroups of T cells. The former include Th1, Th2, Th17 and other cells. HT patients is mainly characterized by expressing Th1 cytokines. The imbalance of Th1/Th2 ratio can induce abnormal immune response, which is closely related to the incidence of HT. Th17/Treg cells are mutually restricted in differentiation and mutually antagonistic in function. IL-17 secreted by Th17 cells directly promotes the inflammatory response of thyroid tissue and accelerates the damage of thyroid tissue. Abnormal Treg cell function cannot effectively inhibit the occurrence of autoimmune reactions and promote immune tolerance. Th17/Treg constitute a relatively independent group of cell networks except Th1/Th2. Under normal circumstances, Th1/Th2 and Th17/Treg cells maintain a dynamic balance. However, once unbalanced, they will lead to immune dysfunction and participate in the development of HT. This article reviews the mechanisms of Th1/Th2 and Th17/Treg cells and their cytokines in the pathogenesis of HT.

Excessive Iodine Promotes Pyroptosis of Thyroid Follicular Epithelial Cells in Hashimoto's Thyroiditis Through the ROS-NF-κB-NLRP3 Pathway.

Hashimoto's thyroiditis (HT) is a common autoimmune thyroid disease. In recent years, increasing evidence has proven that the incidence of HT is associated with the excessive iodine intake of the body. In the present study, we measured the status of pyroptosis in thyroid tissues from patients with HT and the effects of excessive iodine on the pyroptosis in thyroid follicular cells (TFCs), in an attempt to illuminate the effects of iodine excess on the development of HT disease. Our results showed that increased pyroptosis occurred in the thyroid tissues of HT patients and that an increase in pyroptosis activity in TFCs was primed by excessive iodine in vitro. This process was mediated by reactive oxygen species (ROS) and activation of the NF-κB signaling pathway. In addition, excessive iodine caused NLRP3 inflammasome activation in TFCs, which promoted TFC pyroptosis. Moreover, the release of interleukin-1β (IL-1β) was closely linked to pyroptosis activation. Taken together, our results suggested that excessive iodine contributed to aberrant activation of pyroptosis in TFCs, which could be a pivotal predisposing factor for HT development.

Significance of Crushed Fragments and Eosinophils in Cytological Diagnosis of Hashimoto's Thyroiditis.

IntroductionHashimoto's thyroiditis (HT) is a chronic autoimmune inflammatory disorder of the thyroid gland with a prevalence of 1%-4%. The incidence of HT seems to be increasing in recent times. If serological parameters are used as sole criteria for diagnosis, cases of HT get missed or over-diagnosed. There are established cytological features of HT but that could, at times, be seen in other thyroid disorders, making cytological diagnosis difficult. The present study was undertaken to find out the significance of crushed fragments and eosinophils along with the well-known cytological features in the diagnosis of HT.MethodsThis study was carried out over a period of two years and a total of 114 patients were registered for the study; 48 patients were HT cases. The control group comprised of 66 non-thyroiditis patients. Fine-needle aspiration cytology (FNAC) was performed on all patients with palpable thyroid swelling to compare cytological features of thyroiditis (study group) with aspirates of non-thyroiditis lesions (controls).ResultsThe background lymphocytes were found to be present in all cases of the study group but in variable numbers. The lymphocytes infiltrating the follicular epithelial cells were seen in most (93.75%) of the study cases. The presence of Hurthle cells was significantly higher (83%) in the study group as compared to the control group (4.5%). The presence of crushed cells morphology (crushed fragments) were seen in 40 (83.33%) of these 48 HT cases while none in the control group showed this feature. The presence of eosinophilic infiltration shows a statistically significant association with FNA diagnosis of HT patients (P<0.05).ConclusionThe crushed fragments, if visible at low power, gives a diagnostic clue for looking up for other features of HT. Also, the crushed fragments and eosinophils could avoid the false negative and misdiagnosis of neoplasm in paucicellular and highly cellular smear respectively.

&lt;p&gt;Upregulation Of Protein Tyrosine Phosphatase Receptor Type C Associates To The Combination Of Hashimoto’s Thyroiditis And Papillary Thyroid Carcinoma And Is Predictive Of A Poor Prognosis&lt;/p&gt;

IntroductionPTC is not generally considered a lethal disease, but prone to recurrence as the prognosis. Hashimoto’s thyroiditis (HT) is an important factor that affects the prognosis of papillary thyroid carcinoma (PTC). It is crucial to find biomarkers to identify the combination of HT with PTC and to predict the prognosis.MethodsRNASeq data from the Cancer Genome Atlas (TCGA) database was used to screen differentially expressed genes (DEGs) of PTC with HT via the edgeR package of R software version 3.3.0. Also, the DEGs were applied to the DAVID web-based tool to determine the enrichment of gene functions via Gene Ontology (GO) analysis and to identify associated pathways in the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. By constructing protein interaction networks within Cytoscape software, we screened candidate genes and explored possible relationships with the clinical phenotype of PTC. Finally, additional thyroid tissue samples were collected to verify the results above.ResultsAfter analyzing the RNA-Seq data of PTC patients from the Cancer Genomic Atlas, 497 differentially expressed PTC genes were found to be associated with HT, of which protein tyrosine phosphatase receptor type C (PTPRC), KIT, and COL1A1 were associated with tumor size and lymph node metastasis (p < 0.05). Verification of these results with another 30 thyroid tissues of clinical PTC patients revealed that the expression level of PTPRC in the PTC with HT group was higher than that in the PTC without HT group (p < 0.05) and the ROC curve showed a good discrimination (area under the curve = 0.846). However, the correlation with the clinical phenotype was not statistically significant (p > 0.05).DiscussionThese data suggest that upregulation of PTPRC enhances the incidence of HT associated with PTC and is also predictive of a poor prognosis.

SUN-622 Graves Disease Triggered by Lobectomy for Thyroid Cancer

Background: The incidence of Hashimoto thyroiditis as well as Graves disease in patients with thyroid cancer has been observed however molecular and pathophysiological basis of this association has only been hypothesized. Cases of new onset severe thyrotoxicosis and Graves ophthalmopathy shortly after lobectomy for thyroid cancer have not been described to our knowledge. Case: The patient is a 46-year-old woman who had a 2.5cm thyroid nodule. Fine needle aspiration showed atypia of undetermined significance and subsequent thyroid genomic classifier test Thyroseq confirmed positive for fusions involving THADA and IGF2BP3. Since THADA positive nodules are usually associated with low risk thyroid carcinoma and non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), thyroid lobectomy was advised. Prior to surgery the patient had positive thyroid peroxidase antibodies and was treated with low dose levothyroxine only during two pregnancies. Surgical pathology confirmed 2.5 cm NIFTP and 2 foci of papillary thyroid microcarcinoma of 0.5mm and 1mm with the background of chronic lymphocytic thyroiditis (Hashimoto). No further therapy was advised. At 6 weeks after left thyroid lobectomy the patient presented for a follow up clinically euthyroid with thyroid stimulating hormone (TSH) of 3 mcIU/mL. Two weeks after this regular follow up visit she started having severe periorbital swelling, double vision and bulging of her eyes that was followed by shortness of breath, palpitations, anxiety, sweating and weight loss. She presented to emergency room and was found to have suppressed TSH and positive TSI and TBII antibodies with high titer. After stabilization of hyperthyroidism with methimazole completion thyroidectomy was performed on patient request. Surgical pathology of the right thyroid lobe showed scattered papillary hyperplasia, chronic inflammation, focal atrophy and lymphoid follicles. Six weeks after completion thyroidectomy the patient is clinically euthyroid on levothyroxine and with significantly improved ophthalmopathy. TSI and TBII antibodies remain positive and continue to downtrend. Conclusion: As partial thyroidectomy for low-risk thyroid carcinoma is becoming increasingly convenient method of therapy we may encounter more surgically triggered autoimmune thyroid disorders in the future.

Association between Hashimoto’s Thyroiditis and Thyroid Cancer in 64,628 Patients

The incidence of thyroid cancer (TC) is increasing although explanatory causes are lacking. A link between cancer and inflammation is well documented but unclear for autoimmune thyroid diseases and TC. We aimed to systematically review the association between Hashimoto's thyroiditis (HT) and papillary, follicular, medullary, anaplastic thyroid carcinoma, and thyroid lymphoma (TL). PubMed, OVID Medline, Google Scholar, and the Cochrane Library were searched from 1955 to 2016. The inclusion criteria were age >18 years, ≥20 cases of HT or TC. We collectively examined the incidence of HT in TC and of TC in HT. We identified 36 studies (64,628 subjects) published between 1955 and 2016 from 13 countries. We found a relative risk (RR) of HT among papillary thyroid cancer (PTC) of 2.36 [95% confidence intervals (CIs) 1.55-3.29, p < 0.001], an RR of PTC among HT of 1.40 (95% CI 1.07-1.85, p = 0.016), and an RR of TL among HT of 9.74 (95% CI 3.93-24.13, p < 0.001). We report an association between HT and PTC and between HT and TL. No association was found between HT and follicular, medullary, or anaplastic thyroid cancer.

Allergic rhinitis and its relationship with autoimmune thyroid diseases.

Autoimmune thyroid diseases are the most common of all autoimmune diseases. In the literature, Hashimoto thyroiditis (HT) is considered to be a T-helper (Th) type 1 dominant condition, and Graves disease is considered a Th2-dominant condition. The aim of this study was to highlight a new aspect of the relationships among Th cell subgroups by determining the incidence of autoimmune thyroid disease in patients with allergic rhinitis (AR). Patients were diagnosed with AR based on their medical histories, physical examinations, and skin-prick test results in an outpatient clinic. The levels of free triiodothyronine, free thyroxine, thyroid-stimulating hormone, thyroid peroxidase antibodies, and thyroglobulin antibodies were measured in peripheral blood samples from all study subjects. A total of 1239 patients with AR and 700 consecutive, age- and sex-matched healthy subjects were included in the study. Thyroid function tests showed that 1037 patients with AR (83.7%) had normal thyroid function, 171 (13.8%) had euthyroid HT, and 31 (2.5%) had hypothyroid HT. Among the control subjects, thyroid function test results showed that 688 subjects (98.2%) had normal thyroid function, 10 subjects (1.4%) had euthyroid HT, and 2 subjects(0.4%) had hypothyroid HT. The incidence of HT in the general population is 1.5%; in contrast, it was observed in 16.3% of our patients with AR, which represented a much higher rate than that in the overall population. Graves disease was not detected in our study subjects. A high incidence of HT in patients with AR, in which Th2 responses are dominant, indicates that further studies of the relationships among atopy, autoimmune diseases, and Th cell subgroups are needed.

Cytomorphologic spectrum of Hashimoto's thyroiditis and its clinical correlation: A retrospective study of 52 patients.

Background:Hashimoto's thyroiditis (HT) is an autoimmune disease and it is more prevalent in Asians. The incidence of HT seems to be increasing in the recent times. It is one of the most common cause of hypothyroidism. The purpose of this study is to review the cytomorphologic spectrum of HT and correlate it with clinical findings including thyroid function and antibody profile.Materials and Methods:We retrospectively analyzed the fine-needle aspiration (FNA) features of 52 HT patients. Based on cytomorphologic features patients were categorized into three groups. Clinical findings including thyroid function and thyroid peroxidase (TPO) antibody profile were correlated with cytomorphologic features in all three groups.Results:Majority of the patients were females and in 2nd, 3rd and 4th decades. Diffuse goiter and thyroid hypofunction were the common findings. Significant number of patients had thyroid hyperfunction. Increased lymphocytes on the background and lymphocytic infiltration of thyroid follicular cell clusters in cytology smears were diagnostic of HT. The 32 patients showed elevated titers of TPO antibodies. In the early stages and mild form of the disease, results of thyroid function and anti TPO antibodies are quite variable.Conclusions:HT is a disease of young and middle age and mostly occur in females. Clinical findings alone may not be adequate for definitive diagnosis. FNA is the gold standard for diagnosis. In the presence of abundant colloid, follicular hyperplasia or co-existing neoplasm, careful interpretation of cytology smears should be done. Aspiration from more than one site minimizes the diagnostic pitfalls.

The co-occurrence of Hashimoto thyroiditis in primary Sjogren’s syndrome defines a subset of patients with milder clinical phenotype

To evaluate in a cohort of 100 consecutive patients affected by primary Sjogren's syndrome (pSS) the incidence of Hashimoto thyroiditis (HT) and to compare the clinical features and the laboratory parameters of patients affected by pSS with and without concomitant HT. In 100 consecutive patients affected by pSS, the occurrence of other autoimmune diseases was recorded and a full examination of thyroid function obtained. HT was associated with pSS in 27 cases. The comparison between pSS cases with and without HT showed that only patients with isolated pSS had low C4 level [p = 0.032, OR (IC 95 %) 230 (13.13-4,046)]. In addition, only patients affected by pSS without HT had evidence of cryoglobulins, cutaneous vasculitis with palpable purpura, peripheral neuropathy, and development of lymphoma, although all these manifestations were observed in a 4.1-8.2 % of the cases, without reaching statistical significance. The association of HT in patients suffering from pSS defines a subset of patients with milder disease and normal C4 levels.

The incidence of lymphocytic thyroid infiltration and Hashimoto's thyroiditis increased in patients operated for benign goiter over a 31-year period

The incidence of Hashimoto's thyroiditis (HT) seems to have increased over the last several decades. Since there is a lack of recent studies in the literature that evaluate this phenomenon on a histological basis, we aimed to assess the incidence of lymphocytic thyroid infiltration (LTI) in our large surgical patient collective over a 31-year period. In our study, a total of 1,050 patients who had undergone uni- or bilateral thyroid surgery for benign goiter were included (150 patients in each group, during 1979 to 2009). The stored histological sections of the removed thyroid specimens were re-analyzed, including routine grading of LTI severity on a scale of 0-4, according to Williams and Doniach. Positive correlations were seen for the incidences of LTI grading (0-4) (r = 0.077, p = 0.013) and HT (r = 0.044, p = 0.078) over the years. Furthermore, when comparing the years 1979-1989 and 1994-2009, i.e., before and after the second iodine prophylaxis had been introduced in Austria, a higher incidence of HT was found for the later years (2 out of 450, 0.4%, vs. 6 out of 600, 1.0%, respectively; p < 0.0001). In conclusion, the data demonstrate that the incidence of LTI and HT has increased substantially over the last 31years.

Complications of Hashimoto thyroiditis surgery.

In recent years, several reports have suggested that the incidence of Hashimoto thyroiditis is on the rise 1 and that there is an added risk of thyroid cancer in the presence of this disease. 2 Surgical opinion is virtually unanimous that many symptomatic cases of chronic thyroiditis will inevitably progress to a state of permanent and frequently refractory myxedema. 3 Consequently, the role of surgery is a secondary one. It serves as an instrument for diagnosis in the presence of solitary nodules and as a method of decompression for enlarging glands. The surgeon ordinarily must deal with this disease under circumstances which predispose to errors in preoperative diagnosis. Frequently his patient either has recently developed an asymptomatic thyroid nodule or is experiencing pressure symptoms from an enlarging goiter, without physical or laboratory evidence to indicate an inflammatory process in the gland. One feature of Hashimoto thyroiditis which has not received