Presence Of Autoimmune Thyroid Disease Research Articles

Exploring the link between obesity and hypothyroidism in autoimmune thyroid diseases: a metabolic perspective.

Background: The management of primary hypothyroidism demands a comprehensive approach that encompasses both the implications of autoimmune thyroid disease and the distinct effects posed by obesity and metabolic irregularities. Despite its clinical importance, the interplay between obesity and hypothyroidism, especially in the context of metabolic perspectives, is insufficiently explored in existing research. This study endeavors to classify hypothyroidism by considering the presence of autoimmune thyroid disease and to examine its correlation with various metabolic obesity phenotypes. Method: This research was conducted by analyzing data from 1,170 individuals enrolled in the Thyroid Disease Database of Shandong Provincial Hospital. We assessed four distinct metabolic health statuses among the participants: Metabolically Healthy No Obese Metabolically Healthy Obese Metabolically Unhealthy No Obese and Metabolically Unhealthy Obese Utilizing logistic regression, we investigated the association between various metabolic obesity phenotypes and hypothyroidism. Results: The study revealed a significant correlation between the Metabolically Unhealthy Obese (MUO) phenotype and hypothyroidism, particularly among women who do not have thyroid autoimmunity. Notably, the Metabolically Unhealthy No Obese (MUNO) phenotype showed a significant association with hypothyroidism in individuals with thyroid autoimmunity, with a pronounced prevalence in women. Furthermore, elevated levels of triglycerides and blood glucose were found to be significantly associated with hypothyroidism in men with thyroid autoimmunity and in women without thyroid autoimmunity. Conclusion: Effective treatment of hypothyroidism requires a thorough understanding of the process of thyroid autoimmune development. In patients without concurrent thyroid autoimmunity, there is a notable correlation between obesity and metabolic issues with reduced thyroid function. Conversely, for patients with thyroid autoimmunity, a focused approach on managing metabolic abnormalities, especially triglyceride levels, is crucial.

Predictive factors of lymph node metastasis in papillary thyroid cancer.

This study aimed to evaluate factors that predict lymph node metastasis (LNM) in papillary thyroid cancer (PTC). This retrospective cross-sectional study compared the demographic, clinical, and ultrasonographic findings of patients with PTC with and without LNM. Subgroup analysis was conducted for micro-PTCs (<1 cm). Among total (n = 512; mean age, 47.3 ± 12.7 years) and micro-PTC patients (n = 312), 35.7% and 19.6% had LNM, respectively. Younger age, male sex, tumor size, bilaterality, and suspicious ultrasound features of the tumor were associated with LNM. In multiple logistic regression analysis, among all patients, age, tumor size, and extrathyroidal extension were independent risk factors for LNM (all p<0.05). In the micro-PTC subgroup, age, extrathyroidal extension, bilaterality of tumor, and presence of autoimmune thyroid disease were independent risk and protective factors for LNM (all p<0.05). In the receiver operating characteristic analysis, the accuracy of the multivariable logistic regression model for predicting LNM among all patients and micro-PTC was acceptable (area under the curve = 0.729 and 0.733, respectively). Age, sex, tumor size, and extrathyroidal extension can assist in predicting LNM in PTC patients. Additionally, the bilaterality of tumors and presence of autoimmune thyroid disease can assist in predicting LNM in micro-PTCs.

Prevalence of autoimmune diseases in patients with type 1 diabetes mellitus. DIACAM 1 study 2010–2020

ObjectiveTo evaluate the prevalence of autoimmune diseases (AD) associated with type 1 diabetes mellitus (T1DM). Patients and methodsAnalytical cross-sectional study, nested in a multicenter prospective cohort of 1121 ADults with DM1 with active follow-up in endocrinology clinics. Sociodemographic and clinical variables and the presence of AD were analysed in 2010 and 2020. ResultsIn this second analysis, 49,5% were male, mean age was 49.4±12.8 years, median T1DM duration was 27,1 years (20,7–35,1) and mean glycated hemoglobin was 7.66±1.06%. There is an absolute increase of 13% (95% CI 11–15) (P<.001) of patients with at least one AE and an absolute increase of 11.6% (95% CI 9.7–13.5) (P<.0001) of any type of autoimmune thyroid disease (ATD) after 10 years of follow-up. Likewise, the prevalence of celiac disease, autoimmune gastritis and other AD increased statistically significantly. In the multivariate logistic regression analysis, the factors that were independently associated with the presence of ATD were female gender [OR 2.9 (95% CI 2.3–3.7); P<.0001] and the presence of type 1b diabetes [OR 0.5 (95% CI 0.3–0.9); P=.041]. ConclusionsAfter 10 years of follow-up, there is a substantial increase in other types of AE in patients with DM1. It seems necessary to carry out a systematic screening of these AD to optimize the follow-up of patients with 1TDM, mainly of the ATD.

Incidence of Hashimoto's thyroiditis and its relationship to age, sex, smoking and blood groups.

This study was aimed to demonstrate the incidence of Hashimoto's disease in Iraqi patients and its correlation to some of the sociodemographic features. The research groups involved (50 patients with Hashimoto?s disease and 50 healthy subjects). All of them were subjected to the estimation of levels of free triiodothyronine (FT3), free thyroxine (FT4), TSH, anti-thyroid peroxidase (anti-TPO), and anti-thyroglobulin (anti-Tg). The results demonstrated that there is a dramatic increase in the occurrence of HT in older patients. The age group (41-50 years old) was the most age group affected by Hashimoto's disease, followed by the age groups (31-40, 21-30, and 9-20 years old) respectively. A significant proportional correlation (R:0.952, P:0.024) was found between HT disease and aging. According to the gender, the results found that the vast majority (82%) of patients were females (P = 0.01). Also, the smoking percent was (40%) of patients. The presence of autoimmune thyroid disease in one or more individuals within the family (family history) was also evaluated and the results found that (28%) of the Hashimoto?s disease group have a positive family history of thyroid autoimmune diseases. It can be concluded from these results that females are more prone to developing Hashimoto?s disease compared to males, in other words, the female gender is a risk factor for the occurrence of autoimmune hypothyroidism. Also, the negative impact of smoking and family history gives an indication that these parameters are independent and don’t associate with Hashimoto?s disease at least in the current study.

Prevalencia de enfermedades autoinmunes en pacientes con diabetes mellitus tipo 1. Estudio DIACAM 1 2010-2020

ObjectiveTo evaluate the prevalence of autoimmune diseases (AD) associated with type 1 diabetes mellitus (T1DM). Patients and methodsAnalytical cross-sectional study, nested in a multicenter prospective cohort of 1121 adults with DM1 with active follow-up in endocrinology clinics. Sociodemographic and clinical variables and the presence of AD were analysed in 2010 and 2020. ResultsIn this second analysis, 49,5% were male, mean age was 49.4 ± 12.8 years, median T1DM duration was 27,1 years (20,7-35,1) and mean glycated hemoglobin was 7.66 ± 1.06%. There is an absolute increase of 13% (95% CI 11-15) (p < 0.001) of patients with at least one AE and an absolute increase of 11.6% (95% CI 9.7-13.5) (p < 0.0001) of any type of autoimmune thyroid disease (ATD) after 10 years of follow-up. Likewise, the prevalence of celiac disease, autoimmune gastritis and other AD increased statistically significantly. In the multivariate logistic regression analysis, the factors that were independently associated with the presence of ATD were female gender [OR 2.9 (95% CI 2.3-3.7); p < 0.0001] and the presence of type 1 b diabetes (OR 0.5 [95% CI 0.3-0.9]; p = 0.041). ConclusionsAfter 10 years of follow-up, there is a substantial increase in other types of AE in patients with DM1. It seems necessary to carry out a systematic screening of these AD to optimize the follow-up of patients with 1 TDM, mainly of the ATD.

Impact of Thyroid Disease on Bone Mineral Density Preservation in Patients With Osteoporosis and Idiopathic Hypercalciuria

Background: Idiopathic hypercalciuria (IHC) is associated with reduced bone mineral density (BMD) and increased risk of osteoporotic fractures. It is not known if thyroid disease impacts the degree of urine and bone mineral abnormalities in patients with IHC and osteoporosis (OPO). Methods: Retrospective chart review from a private endocrinology clinic identified 62 consecutive patients with OPO (fragility fracture and/or t-score ≤-2.5 on bone density scan) and concomitant diagnosis of IHC (urine calcium > 4.0 mg/kg weight/d when intaking low-moderate calcium amounts). Patients were classified into two groups: those with thyroid disease (Thy+, if presence of autoimmune thyroid disease [AITD] with high antibody titers and/or long-term thyroid medication use) and those without (Thy-). Comparisons were made between the two groups for severity of renal disease (urine calcium) and bone disease (number of fragility fractures, and BMD response to therapy). Results: Of 55 women and 7 men identified with both OPO and IHC, 30 were Thy+ (4 with Graves’, 11 with confirmed Hashimoto’s, 13 taking levothyroxine for presumed Hashimoto’s and 2 with thyroid cancer), and 32 were Thy- (including 2 with type 1 DM, 1 with vitiligo, and 6 with non-toxic nodular goiters requiring biopsies). Thy+ were compared to Thy- with respect to: mean age (70.7 ± 7.3 vs. 70.8 ± 9.3 y), sex (97% vs. 81% women), 24-hr urine calcium at diagnosis (317 ± 75 vs. 311 ± 68 mg), presence of fragility fracture (50% vs. 59%), use of thiazide (83% vs. 78%), and use of anti-fracture pharmacotherapy (73% vs. 84%).50 patients had adequate comparative longitudinal BMD data. A (+) BMD response was based on consistent increases in BMD and/or t-scores across all spine and hip sites, and a (-) BMD response was classified by decreased BMD and/or t-scores across all sites. For Thy+ vs. Thy- patients, there were 25% vs. 69% (+) BMD response, 38% vs. 12% (-) BMD response, 21% vs. 4% with no significant BMD response, and 17% vs. 15% with mixed BMD responses. Conclusions: In this group at high risk for future fragility fractures, much lower rates of BMD preservation was seen in the Thy+ as compared to the Thy- patients. Overall, AITD and medical thyroid disease was very common (48%) in this cohort of patients with IHC and OP. However, this high rate may be confounded by the selective nature of the specialty clinic population. Further research needs to delineate the impact of AITD and thyroid medication use on the progression and treatment of patients with IHC and OPO.

Association of thyroid autoimmunity and the response to recombinant human growth hormone in Turner syndrome

Short stature and thyroid autoimmunity are common comorbidities in Turner syndrome (TS). Recombinant human growth hormone (rhGH) significantly improves height growth in TS individuals. This study aims to investigate the association of thyroid autoimmunity and the response to rhGH treatment in TS patients. Medical records of 494 patients with TS were reviewed. Among 126 patients who regularly tested for thyroid autoantibodies, 108 patients had received rhGH treatment. Clinical characteristics, including karyotype and the presence of autoimmune thyroid diseases, as well as rhGH treatment records were analyzed. Height velocity (HV) of patients with or without thyroid autoimmunity was compared to assess the response to rhGH treatment. For patients who developed thyroid autoantibodies during rhGH treatment, HV before and after antibody presence were compared. 45XO monosomy presented in 36% (176/496) of patients. 42.1% of patients (53/126) had elevated circulating anti-thyroid peroxidase antibody and anti-thyroglobulin antibody. In 108 patients who received rhGH treatment, HVs were significantly correlated to age, height, weight and BMI at the initiation of treatment. For patients who developed thyroid autoantibodies during rhGH treatment, HVs after thyroid autoantibody presence significantly decreased compared with HVs before thyroid autoantibody detection (n=44, p=0.0017). Our data suggested that in TS patients who developed thyroid autoantibodies during rhGH treatment, the response to rhGH is negatively associated with the development of thyroid autoimmunity.

Precision Medicine with 3D Ultrasound.

Introduction: Currently, B-mode ultrasound (US) is the primary imaging modality in diagnosing thyroid nodules (TNs). B-mode is a two-dimensional US (2D US) imaging display. Recent studies suggest a role for strain and shear wave elastography for evaluating TN as well. Three-dimensional US (3D-US) has the potential to enhance the diagnostic accuracy and precision for thyroid cancer (TC) detection.Materials and Methods: An experienced ultrasonographer (G.A.) evaluated the patient using the following techniques: B-mode, strain and shear wave elastography, and 3D-US followed by fine needle aspiration biopsy (FNAB). Laboratory measurements were performed at LabCorp. Informed consent was obtained.Case: A 28-year-old woman referred for hypothyroidism. Her primary doctor initiated levothyroxine 50 mcg daily 6 months prior. At the time of her visit, her thyroid stimulating hormone (TSH) was 2.8 (0.45–4.5 uIU/mL) and both thyroid peroxidase and thyroglobulin antibodies were elevated, suggestive of Hashimoto's thyroiditis. Her thyroid US showed a heterogeneous gland with an isoechoic TN in the right lobe measuring 7.7 × 6.3 × 7 mm. Strain elastography showed diffuse and patchy tissue stiffness throughout the gland, suggestive of tissue fibrosis caused by Hashimoto's thyroiditis. This study did not distinguish target TN from the surrounding tissue. Shear wave elastography of the TN revealed moderately increased stiffness compared with surrounding tissue. The shear wave velocity (SWV) measurement for the TN was 3.1 m/s. 3D-US examination demonstrated an isoechoic TN with irregular margins, and the volume was 0.119 cm3. FNAB of the TN was performed. Cytopathology was diagnostic for papillary thyroid cancer (PTC), Bethesda Category VI. Subsequent total thyroidectomy confirmed a 7 mm PTC with positive surgical margins caused by thyroid capsule invasion and no clear-cut evidence of extra-thyroid extension.Discussion: This case showcases the recent technological advances in TN imaging. Our objective is to provide an improved approach to TN management. The American College of Radiology Thyroid Imaging Reporting and Data System stratifies the malignancy risk of TN primarily based on the size and B-mode US features. This model does not recommend FNAB for any TN <10 mm regardless of malignancy risk.1 This is our observation that with 3D-US the size cutoff of TN might not be an issue as with B-mode or elastography. Irregularities of the TN can be seen with 3D-US with small and large nodules equally. The finding of irregular margins on 3D-US and consulting with the patient lead us to perform FNAB. Recent publications in the journal of VideoEndocrinology showed utilizations of 3D-US in diagnosing parathyroid adenomas and TNs. 3D-US technology improves view of the target lesion by adding a third dimension, coronal view, to the transverse and longitudinal views of B-mode US.2,3 B-mode imaging provides excellent view of TNs. However, it has a low sensitivity for predicting TC.4 Prospective TN studies have demonstrated that adding elastography to B-mode imaging improves sensitivity of US technology for detecting TC.5–10 In a prospective study with 707 TN, we showed that a single cutoff analysis for predicting malignancy in TNs, a maximum SWV of 3.54 m/s had the best sensitivity. The mean SWV for benign nodules was 2.71 m/s. The mean SWV for malignant nodules was 3.96 m/s.6 In this particular case strain and shear wave were not as helpful. The discrepancy between the two systems has been described in cases with severe Hashimoto's thyroiditis associated with tissue fibrosis.6 In our experience, the presence of autoimmune thyroid disease increases the risk for malignancy. Recent publications reported an association between differentiated TC and autoimmune thyroid disease and/or TSH when all Bethesda classifications were included.11–13Conclusion: 3D-US technology in conjunction with B-mode may improve diagnostic accuracy in detecting TC.No competing financial interests exist.Runtime of video: 2 mins 30 secs

Tip 1 Diabetes Mellitus Tanılı Çocuklarda Otoimmün Poliendokrinopati Tip 3b Sıklığı

Amaç: Tip 3 otoimmün poliendokrinopati sendromu (OPS), Addison hastalığı olmaksızın otoimmün tiroid hastalığı ile diğer bir otoimmün hastalık birlikteliği olarak tanımlanmaktadır. Hastada otoimmün bir gastrointestinal hastalık olursa klinik tablo tip 3b OPS olarak tanımlanır. Bu incelemede çocukluk çağında tip 1 diyabet (T1D) tanısı almış hastalarda tip 3b OPS sıklığı araştırılması amaçlandı. Gereç ve Yöntemler: Çalışmaya 01.06.2013-31.08.2019 tarihleri arasında takibi yapılmış 232’si erkek 446 T1D’li çocuk çalışmaya alındı. Hashimoto tiroiditi (HT), pozitif anti TPO ve/veya anti-Tg pozitifliği ile otoimmün enteropati ise anti-doku transglutaminaz Ig A pozitifliğini takiben yapılmış ince bağırsak biyopsisinde çölyak hastalığı (ÇH) ile uyumlu histoloji varlığı ile tanımlandı. Bulgular: Hastaların 61’inde (%13,7) HT ve 34’ünde (%7,6) ÇH tespit edildi. Hastaların 87’sinde (%19,5) HT veya ÇH varken, aynı hastada hem HT hem de ÇH varlığı (tip 3b OPS) sadece 3’ü kız 4 hastada (%0,9) tespit edildi. Tip 3b OPS’li hastaların T1D tanı yaşı sadece HT veya sadece ÇH olanlar ve her iki hastalığı olmayanlar ile karşılaştırıldığında daha düşük olmakla birlikte istatistiksel bir farksaptanmadı (p=0,087). Sonuç: Çocukluk çağında tanı almış T1D’li çocukların yaklaşık beşte birinde HT veya ÇH tespit edilirken tip 3b OPS sıklığının oldukça nadir olduğu tespit edilmiştir.

Higher TSH Is Not Associated With Thyroid Cancer Risk in the Presence of Thyroid Autoimmunity.

Higher-but-within-normal thyrotropin (thyroid-stimulating hormone, TSH) is associated with higher risk for differentiated thyroid cancer (DTC) in surgical series. Our recent clinical observations suggest that this is not the case in the presence of autoimmune thyroid disease (AITD). We designed the present study to clarify this controversy. We analyzed our prospectively collected database of patients referred for thyroid surgery at 2 tertiary care referral centers in Greece and the United States. We collected data for preoperative TSH, postoperative pathology, and thyroid peroxidase (TPO) antibodies titers. Subjects were subdivided into 2 groups, those with AITD (i.e., lymphocytic thyroiditis) and non-AITD. We excluded subjects with Graves disease, abnormal TSH (< 0.40 or > 4.50 mIU/mL), or recent use of levothyroxine. We compared the serum TSH among different groups using the Mann-Whitney test. A total of 3973 subjects were screened; 1357 met exclusion criteria. After all exclusions, data from 1731 non-AITD subjects and 329 AITD subjects were included in the analysis. AITD subjects had higher TSH than non-AITD subjects (2.09 vs 1.48; P < 0.0001). TSH values were higher in DTC compared with benign histology only in non-AITD subjects (1.65 vs 1.40; P < 0.0001). Progressively higher TSH was associated with higher incidence of DTC only in non-AITD subjects (P < 0.0001). In AITD subjects, TSH was similar between groups with or without DTC (2.02 vs 2.14; P = 0.21). TSH concentrations are not associated with the risk of developing DTC in the presence of thyroid autoimmunity, even though this seems to be the case for all other patients.

Thyroid autoimmunity markers in women with polycystic ovary syndrome and controls

This study was performed to compare the prevalence of autoimmune thyroid disease (AITD) assessed by thyroid peroxidase antibody (anti-TPO Ab) and thyroid ultrasonography (USG) in Korean women with polycystic ovary syndrome (PCOS) (n = 210) and age-matched controls (n =343). We also compared the clinical features of women with PCOS according to the presence of AITD. Patients and controls were enrolled from a population who visited a screening centre for a general health check-up. There was no difference in the frequency of anti-TPO Ab positivity between the women with PCOS and the controls (4.8% (5/104) in patients and 7.6% (18/238) in controls). The frequency of heterogeneous or hypoechoic parenchyma on USG also did not differ between the patients and controls (9.3% (11/118) in patients and 12.3% (40/325) in controls). Within the PCOS group, the subjects with AITD (who had either Ab positivity or sonographic findings compatible with thyroiditis) showed significantly higher body mass indexes, waist circumferences and homeostasis model assessment for insulin resistance levels than the patients without AITD. In conclusion, AITD was not more prevalent in women with PCOS than in controls. However, among women with PCOS, subjects with AITD showed significantly higher adiposity and insulin resistance index than those without AITD.

Use of strain ultrasound elastography versus fine-needle aspiration cytology for the differential diagnosis of thyroid nodules: a retrospective analysis

OBJECTIVE:Fine-needle aspiration cytology is the risk stratification tool for thyroid nodules, and ultrasound elastography is not routinely used for the differential diagnosis of thyroid cancer. The current study aimed to compare the diagnostic parameters of ultrasound elastography and fine-needle aspiration cytology, using surgical pathology as the reference standard.METHODS:In total, 205 patients with abnormal thyroid function test results underwent ultrasound-guided fine-needle aspiration cytology on the basis of the American College of Radiology Thyroid Imaging-Reporting and Data System classification and strain ultrasound elastography according to the ASTERIA criteria. Histopathological examination of the surgical specimens was performed according to the 2017 World Health Organization classification system. Moreover, a beneficial score analysis for each modality was conducted.RESULTS:Of 265 nodules, 212 measured ≥1 cm. The strain index value increased from benign to malignant nodules, and the presence of autoimmune thyroid diseases did not affect the results (p>0.05 for all categories). The sensitivities of histopathological examination, ultrasound elastography, and fine-needle aspiration cytology for detection of nodules measuring ≥1 cm were 1, 1, and 0.97, respectively. The working area for detecting nodule(s) in a single image was similar between strain ultrasound elastography and fine-needle aspiration cytology for highly and moderately suspicious nodules. However, for mildly suspicious, unsuspicious, and benign nodules, the working area for detecting nodule(s) in a single image was higher in strain ultrasound elastography than in fine-needle aspiration cytology.CONCLUSION:Strain ultrasound elastography for highly and moderately suspicious nodules facilitated the detection of mildly suspicious, unsuspicious, and benign nodules.

1737-P: Prevalence of Autoimmune Diseases in Longstanding Diabetes: Results from the Canadian Study of Longevity in Type 1 Diabetes

Objective: Type 1 diabetes (T1D) predisposes to higher lifetime autoimmune (AI) disease risk; the magnitude of this risk is not known with certainty. To approximate lifetime risk, we aimed to determine the prevalence of AI diseases in those exceeding 50 years T1D duration, as well as to explore sex-specific differences and associations with complications. Methods: Descriptive analysis of the Canadian Study of Longevity in T1D, a nationwide questionnaire study initiated in 2013 that recruited 374 T1D participants with duration &amp;gt;50 years. The questionnaire collected diabetes management variables, general medical history with a focus on AI disease, and diabetes-related complications. Clinical and laboratory data were obtained from primary care providers. The χ2-test and Student’s t-test were used for simple comparisons. Results: The 374 participants with longstanding T1D had median age of 66 [59, 71] years, T1D duration 53 [51, 58] years and HbA1c 7.5±1.0%. AI diseases were reported in 184/374 (49.3%). Thyroid disease was most prevalent, 154/374 (41.2%) reported thyroid disease or was prescribed thyroid hormone replacement therapy. Addison’s disease or prescribed glucocorticoid and mineralocorticoid therapy was reported in 5/374 (1.3%). Autoimmune polyendocrine syndrome type 2 (APS-2), defined by the presence of thyroid disease, Addison’s disease and T1D, was present in 3/374 (0.8%). We observed a sex-specific difference in AI disease prevalence (34.6 females vs. 14.8% in males; p&amp;lt;0.0001), driven by the difference in thyroid disease (29.5 females vs. 11.5% males, p&amp;lt;0.0001). No difference in HbA1c was observed (7.5±1.1 vs. 7.6±1.0%, p=0.62). There was a trend toward lower CAD prevalence among those with AI disease (12.1 vs. 16.9%, p=0.05). Conclusions: We estimate that in a population with longstanding T1D, the lifetime risk of AI disease approaches half, driven primarily by the presence of autoimmune thyroid disease, and with greater risk in females. Disclosure N. Cardinez: None. L. Lovblom: None. A. Orszag: None. D. Cherney: Other Relationship; Self; AbbVie Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Merck &amp; Co., Inc., Mitsubishi Tanabe Pharma Corporation, Prometic Life Sciences Inc., Sanofi. B.A. Perkins: Advisory Panel; Self; Abbott, Boehringer Ingelheim International GmbH, Boehringer Ingelheim International GmbH, Insulet Corporation. Research Support; Self; Boehringer Ingelheim International GmbH. Other Relationship; Self; Abbott, Boehringer Ingelheim International GmbH, Lilly Diabetes, Medtronic, Novo Nordisk Inc., Sanofi. Funding JDRF (17-2013-312)

Autoimmune thyroid disease in Egyptian patients with rheumatoid arthritis

Aim of the workTo determine the frequency of autoimmune thyroid disease (AITD), anti-thyroglobulin (ATG) and anti-thyroid peroxidase (ATPO) antibodies in Egyptian patients with rheumatoid arthritis (RA). Patients and methods60 RA patients and 60 matched controls were enrolled. Clinical and laboratory data were examined in the patients. The disease activity score (DAS28) and modified health assessment questionnaire (MHAQ) were evaluated. Presence of AITD, ATG and ATPO antibodies were assessed. ResultsThe mean age of the patients was 41 ± 10.5 years, 43 (71.7%) were females and had a disease duration of 8.6 ± 4.1 years. Their mean anti-cyclic citrullinated peptide level was 31.8 ± 33.5 IU/ml), DAS28 (4 ± 1.4) and MHAQ was 1.5 ± 0.5. The thyroid hormones (T3, T4 and thyroid stimulating hormone) were comparable to that of the control. The ATG (80.7 ± 39.3 IU/ml) and ATPO (70.3 ± 39.7 IU/ml) antibodies were significantly increased in RA patients compared to the control (21.5 ± 6.6 IU/ml and 20.5 ± 11.2 IU/ml respectively; p < 0.001). Thyroid dysfunction was present in 38.3% compared to 6.7% in controls (p < 0.001). The frequencies of AITD, ATG and ATPO were higher in patients (23.3%, 26.7% and 33.3% respectively) compared to controls (0%, 3.3% and 6.7%). ATG antibodies, ATPO antibodies and AITD positivity in patients were significantly associated with younger age, female gender, erythrocyte sedimentation rate and DAS28. ConclusionAITD is frequent among patients with RA. Therefore, there is a need of screening of thyroid hormone dysfunction as well as of presence of ATPO and ATG antibodies as markers of AITD in RA patients particularly in young patients, females and those with high disease activity.

Association of Autoimmune Thyroid Disease with Anti-GAD Antibody ELISA Test Positivity and Risk for Insulin Deficiency in Slowly Progressive Type 1 Diabetes.

The presence of antiglutamic acid decarboxylase antibody (GADA) is required for the diagnosis of slowly progressive type 1 diabetes (SPT1D). We examined the factors influencing GADA determination by radioimmunoassay (GADA-RIA) and by enzyme-linked immunosorbent assay (GADA-ELISA). Sixty patients with SPT1D and 154 patients with type 2 diabetes were examined by both GADA-RIA and GADA-ELISA and for the presence of autoimmune thyroid disease (AITD). We compared the clinical characteristics of these patients based on the positivity or negativity of GADA-RIA and GADA-ELISA, and the existence or nonexistence of AITD. Thirty of 60 (50.0%) GADA-RIA-positive patients were GADA-ELISA negative, whereas none of the 154 GADA-RIA-negative patients were GADA-ELISA positive. Concomitant AITD was significantly less in patients with GADA-RIA and without GADA-ELISA and was significantly more in patients with GADA-RIA and GADA-ELISA. In GADA-RIA-positive patients, there was no significant difference in the GADA-RIA titer among the GADA-ELISA-negative patients with and without AITD, and the GADA-ELISA-positive patients without AITD; whereas the frequency of insulin deficiency was significantly higher in the patients with AITD and/or GADA-ELISA than in those without AITD and GADA-ELISA. Examination of GADA-ELISA and AITD in GADA-RIA-positive patients might be useful in predicting insulin deficiency in these patients.

Insulin resistance is associated with larger thyroid volume in adults with type 1 diabetes independently from presence of thyroid autoimmunity

To investigate the effect of insulin resistance (IR) on thyroid function, thyroid autoimmunity (AIT) and thyroid volume in type 1 diabetes (T1DM). 100 consecutive patients with T1DM aged 29 (±6) years with diabetes duration 13 (±6) years were included. Exclusion criteria were: history of thyroid disease, current treatment with L-thyroxin or anti-thyroid drugs. Evaluation of thyroid stimulating hormone (TSH), free thyroid hormones and anti-thyroid antibodies was performed. Thyroid volume was measured by ultrasonography. IR was assessed using the estimated glucose disposal rate (eGDR) formula. In the study group 22% of subjects had insulin resistance defined as eGDR lower or equal to 7.5 mg/kg/min. The prevalence of thyroid autoimmunity (positivity for ATPO or ATg or TRAb) in the study group was 37%. There were no significant differences in the concentration of TSH, FT3, FT4, the prevalence of AIT and hypothyroidism between IR and insulin sensitive (IS) group. Mean (±SD) thyroid volume was 15.6 (±6.2) mL in patients with IR and 11.7 (±4.7) mL in IS subjects (p = .002). Thyroid volume correlated inversely with eGDR (r = –0.35, p < .001). In a multivariate linear regression model the association between thyroid volume and eGDR was independent of sex, age, duration of diabetes, daily insulin dose, BMI, cigarette smoking, TSH value and presence of thyroid autoimmunity (beta: –0.29, p = .012). Insulin resisance is associated with larger thyroid volume in patients with type 1 diabetes independently of sex, body mass index, TSH value and presence of autoimmune thyroid disease.

Vitamin D in Hashimoto's thyroiditis and its relationship with thyroid function and inflammatory status.

Several studies have shown the correlation between vitamin D [25(OH)D] deficiency and thyroid autoimmunity and reducing of thyroid autoantibodies in patients with normal levels of vitamin D combining with thyroid hormone replacement. However, other authors not agree with this association. It is still unclear whether the low 25(OH)D levels are the result of HT disease or a part of its cause. We studied 88 patients with HT regarding vitamin D status and thyroid autoimmunity markers as well as the relationship with cytokines produced by Th1, Th2, and Th17 cells compared with a control group of 71 euthyroid healthy subjects. The present study demonstrated that vitamin D concentrations were similar in patients HT and the control group. The reduction of free T4 levels was a predictor of vitamin D insufficiency for Hashimoto's thyroiditis, but not for the control group. Lower concentrations of TNF-α was a predictor of lower levels of vitamin D. Differences in the association between HT and vitamin D insufficiency remain unresolved in the literature. The thyroid hormone status would play a role in the maintenance of vitamin D sufficiency, and its immunomodulatory role would influence the presence of autoimmune thyroid disease. The positive correlation between free T4 and vitamin D concentrations suggests that adequate levothyroxine replacement in HT would be an essential factor in maintaining vitamin D at sufficient levels.

High Prevalence of Hypothyroidism In Systemic Lupus Erythematosus Patients Without an Increase in Circulating Anti-Thyroid Antibodies

Because routine investigations are necessary for the early detection of thyroid disease, this study aimed to assess the prevalence of autoimmune thyroid disease (ATD) and thyroid dysfunction (TD) in patients with systemic lupus erythematosus (SLE). Seventy-nine SLE patients (American College of Rheumatology criteria) and 159 control patients with no diagnosis of autoimmune diseases (except for ATD) were consecutively evaluated regarding changes in laboratory assessments of thyroid function and the presence of ATD. ATD was detected in 11.4% of the SLE patients and 13.8% of the control patients (P = .747), whereas TD was detected in 25.3 and 9.4% (P = .002), hypothyroidism was detected in 21.5 and 6.9% (P = .002), and hyperthyroidism was detected in 3.8 and 2.5% (P = .426) of the SLE and control patients, respectively. The mean duration of SLE was longer in patients with TD (P = .036). Mild hypothyroidism was more frequent in the SLE patients with anti-Smith antibodies (P = .029). Because hypothyroidism was more frequent in SLE patients and the frequency of ATD was high in both groups, the authors suggest that TSH and anti-thyroid antibody levels be assessed in SLE patients. ACA = anti-cardiolipin antibodies; ANF = anti-nuclear factor; anti-CCP = anti-cyclic citrullinated peptide; anti-dsDNA = anti-double-stranded DNA; anti-RNP = anti-ribonucleoprotein; anti-Scl70 = anti-topoisomerase I antibodies; anti-SM = anti-Smith antigen antibodies; anti-SS-A/Ro = anti-Sjögren syndrome-related antigen A (Ro); anti-SS-B/La = anti-Sjögren syndrome-related antigen B (La); anti-Tg = anti-thyroglobulin; anti-TPO = anti-thyroid peroxidase; ATD = autoimmune thyroid disease; ENA = extractable nuclear antigen; fT4 = free thyroxine; OR = odds ratio; RF = rheumatoid factor; SLE = systemic lupus erythematosus; SLEDAI = SLE Disease Activity Index; TD = thyroid dysfunction; TSH = thyroid-stimulating hormone; TT3 = total triiodothyronine.

Prevalence of Cancer in Patients with Thyroid Nodules in the Island of Cyprus: Predictive Value of Ultrasound Features and Thyroid Autoimmune Status

Background: The purpose of this study was to determine the prevalence of thyroid carcinoma in patients who underwent ultrasound-guided fine needle aspiration biopsy (USgFNA) of thyroid nodules in the island of Cyprus. Ultrasound features as well as the presence of autoimmune thyroid disease were evaluated as risk factors for malignancy. Methods: 322 consecutively examined patients (272 females/50 males, age 13-81) underwent USgFNA of thyroid nodules in a referral endocrine clinic between July 2007 and July 2009. The ultrasonographic characteristics examined were: echogenicity, margin irregularity, composition, calcifications, presence of increased vasculature and nodule size. The presence or absence of autoimmune thyroid disease was recorded. Results: From the 548 nodules examined, 74 (13.6%) were classified as THY3, 4 or 5. 75 patients (123 nodules) underwent surgical resection. 46 patients (64 nodules) proved to have thyroid carcinoma by histology. There was a significant correlation of suspicious/malignant cytology with solid composition, hypoechogenicity, irregular margins and the presence of calcifications. A significant association was also noted between the presence of positive antithyroglobulin antibodies (p < 0.05) and Graves' disease (p = 0.01) with suspicious/malignant cytology. Conclusion: The overall prevalence of thyroid cancer was 14.3%. Ultrasound characteristics were highly predictive of thyroid malignancy. Thyroid autoimmunity should be considered as a risk factor.

Real-time shear wave elastography may predict autoimmune thyroid disease.

To evaluate and compare the values of the elasticity index as measured by shear wave elastography in healthy subjects and in patients with autoimmune thyroid disease, in order to establish if this investigation can predict the occurrence of autoimmune thyroid disease. A total of 104 cases were included in the study group: 91 women (87.5%), out of which 52 (50%) with autoimmune thyroid disease diagnosed by specific tests and 52 (50%) healthy volunteers, matched for age and gender. For all the subjects, three measurements were performed on each thyroid lobe and a mean value was calculated. The data were expressed in kPa. The investigation was performed with an Aixplorer system (SuperSonic Imagine, France), using a linear high-resolution 15-4 MHz transducer. The mean value for the elasticity index was similar in the right and the left thyroid lobes, both in normal subjects and in patients with autoimmune thyroid disease: 19.6 ± 6.6 vs. 19.5 ± 6.8 kPa, p = 0.92, and 26.6 ± 10.0 vs. 25.8 ± 11.7 kPa, p = 0.71, respectively. This parameter was significantly higher in patients with autoimmune thyroid disease than in controls (p < 0.001). For a cut-off value of 22.3 kPa, which resulted in the highest sum of sensitivity and specificity, the elasticity index assessed by shear wave elastography had a sensitivity of 59.6% and a specificity of 76.9% (AUROC = 0.71; p < 0.001) for predicting the presence of autoimmune thyroid disease. Quantitative elasticity index measured by shear wave elastography was significantly higher in autoimmune thyroid disease than in normal thyroid parenchyma and may predict the presence of autoimmune thyroid disease.