Thyroiditis Research Articles

Metastases to lymph nodes from monofocal and multifocal papillary thyroid malignant tumors in patients with autoimmune thyroiditis

The aim of this work was to study the risk factors for metastasis to the central and lateral neck lymph nodes in papillary thyroid carcinoma (PTC) and multifocal papillary thyroid carcinoma (MPTC), especially in patients with Hashimoto’s thyroiditis (TH).Methods: A retrospective analysis of 763 patients after thyroidectomy with bilateral central lymphadenectomy (CLE) was performed at the interterritorial Center for Endocrine Surgery in Krasnodar during the period from October 2011 to October 2021. All patients had official histological diagnoses of TH. To identify risk factors for metastasis (Mts) to the lymph nodes of the neck, a multifactorial logistic regression analysis was performed.Results: In our study, 277 patients with SCLC and TC showed relatively low rates of Mts to the central lymph nodes (CLU) compared with patients with SCLC without TC (37.2 % vs. 54.7 %, P 140 IU / ml was established as the most sensitive and specific level for predicting MPCT based on the study. Antibodies to AT-TPO, age, tumor size, and multifocal tumor shape demonstrated the ability to predict Mts in the central nervous system in patients with PCT on the background of TC with a probability of 81.1 % based on a multidimensional model. TH was associated with an increased prevalence of multifocal tumor with invasion of the gland capsule.Conclusions: TH detection demonstrated the reduced risk of metastases to the CLN in patients with PCT and MPCT and indicated a potential protective effect. We found that the prognostic model is applicable for predicting a multifocal tumor and metastasis to the central nervous system in patients with PCT and TH.

Genetic Alterations in Papillary Thyroid Carcinoma With Hashimoto's Thyroiditis： ANK3, an Indolent Maintainer of Papillary Thyroid Carcinoma.

Hashimoto’s thyroiditis (TH) is a risk factor for the occurrence of papillary thyroid carcinoma (PTC), which is considered to be the most common type of thyroid cancer. In recent years, the prevalence of PTC with TH has been increasing, but little is known about the genetic alteration in PTC with TH. This study analyzed the mutation spectrum and mutation signature of somatic single nucleotide variants (SNV) for 10 non-tumor and tumor pair tissues of PTC with TH using whole-exome sequencing. The ANK3 protein expression was evaluated by immunohistochemistry in PTC with TH and PTC samples. Moreover, the functional role of ANK3 in PTC cells was determined by CCK-8 proliferation assay, colony formation assays, cell cycle analysis, cell invasion and migration and in vivo study through overexpression assay. Our results showed three distinct mutational signatures and the C>T/G>A substitution was the most common type of SNV. Gene-set enrichment analysis showed that most of the significantly mutated genes were enriched in the regulation of actin cytoskeleton signaling. Moreover, NCOR2, BPTF, ANK3, and PCSK5 were identified as the significantly mutated genes in PTC with TH, most of which have not been previously characterized. Unexpectedly, it was found that ANK3 was overexpressed in cytoplasm close to the membrane of PTC cells with TH and in almost all PTC cases, suggesting its role as a diagnostic marker of PTC. Ectopic expression of ANK3 suppressed invasion and migration, increased apoptosis of B-CPAP and TPC-1 cells. Moreover, our findings revealed that enhanced ANK3 expression inhibits growth of PTC cells both in vitro and in vivo. Ectopic expression of ANK3 significantly enhanced E-cadherin protein expression and inhibited PTC progression, at least in part, by suppression of epithelial-mesenchymal transition (EMT). Our study shows that ANK3 exerts an anti-oncogenic role in the development of PTC and might be an indolent maintainer of PTC.

Динаміка розмірів щитоподібної залози у хворих на дифузний і вузловий зоб, автоімунний тиреоїдит на тлі монотерапії препаратом Альба® в різних регіонах України

Метою роботи була оцінка динаміки розмірів зоба у хворих на автоімунний тиреоїдит (АІТ), дифузний нетоксичний зоб (ДНЗ) і вузловий зоб (ВЗ) при проведенні монотерапії препаратом Альба® в різних регіонах України. Матеріали та методи. Дослідження проводилося лікарями-ендокринологами в 56 медичних установах України. У дослідження запрошувалися хворі, які перебувають на диспансерному обліку з приводу АІТ, ДНЗ або ВЗ. Хворим пропонувалося проведення монотерапії препаратом Альба® упродовж шести місяців у режимі дозування по одній капсулі двічі на день. До початку лікування, через 3 і 6 місяців лікування оцінювався об’єм щитоподібної залози (ЩЗ) у кубічних сантиметрах. Результати. Ймовірність зменшення розмірів ЩЗ (на 15 % і більше за 6 місяців) для пацієнтів з АІТ на фоні лікування Альбою® пов’язана з початковим розміром ЩЗ. Ймовірність досягнення ефекту зростає (p = 0,001; ВШ = 1,07; 95% ДІ 1,03–1,11) на кожний кубічний сантиметр збільшення початкового розміру. Ймовірність зменшення розмірів ЩЗ (на 15 % і більше за 6 місяців) для пацієнтів із діагнозом ДНЗ після застосування Альби® пов’язана з початковим розміром ЩЗ. Ймовірність досягнення ефекту зростає (p < 0,001; ВШ = 1,09; 95% ДІ 1,04–1,14) на кожний кубічний сантиметр збільшення початкового розміру. Висновки. Встановлена клінічна ефективність застосування препарату Альба® в плані зменшення розмірів ЩЗ у хворих на АІТ, ДНЗ і ВЗ.

Чи існує зв’язок між хворобою Хашимото і рівнем йоду в сечі?

Мета. Хвороба Хашимото (ХХ) є автоімунним захворюванням, у патогенезі якого відіграють роль як генетичні, так і зовнішні чинники. До останніх належить надходження йоду з їжею. Виведення йоду з сечею при збалансованому харчуванні рівною мірою відповідає його надходженню ззовні. Існує думка, згідно з якою висока концентрація йоду в сечі може бути пов’язана з автоімунним захворюванням щитоподібної залози. Мета нашої роботи — вивчити, чи підвищений рівень йоду в сечі у пацієнтів з ХХ порівняно з загальною популяцією. Матеріали та методи. Дослідження включало 64 пацієнтів з ХХ і 39 здорових добровольців. У всіх пацієнтів вивчали такі показники: вік, стать, рівень у сироватці крові вільного трийодтироніну (сТ3), вільного тироксину (сТ4), тиреотропного гормона (ТТГ), антитіл до тиреоїдної пероксидази (АТ-ТПО), антитіл до тиреоглобуліну (АТГ), а також концентрацію йоду в сечі. Було проведено ультрасонографію щитоподібної залози. Концентрацію йоду в сечі визначали з використанням реакції Санделла — ­Колтхофа. Результати. У нашому дослідженні не було виявлено вірогідного зв’язку між загальним обсягом щитоподібної залози і концентрацією йоду в сечі (p > 0,05). Також не було виявлено вірогідної різниці між рівнями сТ3, сТ4, АТ-ТПО, АТГ і об’ємом щитоподібної залози в осіб із концентрацією йоду в сечі вище і нижче від 100 мкг/л. Різниця сягала вірогідного рівня тільки при порівнянні показників ТТГ (р = 0,04). Не було виявлено різниці між загальним обсягом щитоподібної залози. У нашому дослідженні не було виявлено зв’язку між ХХ і рівнем йоду в сечі. З огляду на те, що поширеність ХХ у нашій країні відповідає даним, зазначеним у літературі, постає питання про роль йоду, що надходить з їжею, в патогенезі захворювання. Висновки. У йододефіцитних регіонах, до яких належить зокрема й наша країна, необхідно вивчати зв’язок між рівнем йоду в сечі та ХХ.

Abstract #1000694: A Case of Graves’ Thyroiditis followed by Infective Hypopituitarism

Abstract #1000694: A Case of Graves’ Thyroiditis followed by Infective Hypopituitarism

Hashimoto Encephalopathy

Hashimoto encephalopathy (HE) has been recognized as a new clinical disease based on an autoimmune mechanism associated with Hashimoto's thyroiditis. HE is successfully treated with steroids. In 2005, we discovered serum autoantibodies against the NH2-terminal of α-enolase (NAE) as a highly specific diagnostic biomarker for HE. We analyzed the serum anti-NAE autoantibodies and clinical features in many cases of HE from institutions in Japan and other countries. Approximately half of the patients with HE had anti-NAE antibodies. In our study, HE was widely distributed in patients aged 50-60 years. Most patients with HE were in euthyroid states, and all patients had anti-thyroid antibodies. The common neuropsychiatric features of these patients were consciousness disturbance and psychosis, followed by cognitive dysfunction, involuntary movements, seizures, and ataxia. Abnormalities in EEG and decreased cerebral blood flow on the brain SPECT were common findings. In contrast, abnormalities on the brain MRI were rare except for diffuse subcortical lesions and limbic lesions. Patients with HE had varied clinical phenotypes, including acute encephalopathy, chronic psychiatric form, and other particular clinical presentations, such as limbic encephalitis, progressive cerebellar ataxia, and Creutzfeldt-Jakob disease (CJD)-mimic form. The cerebellar ataxic form of HE clinically mimics spinocerebellar degeneration (SCD) and is characterized by the absence of nystagmus, absent or mild cerebellar atrophy, and lazy background activities on electroencephalography (EEG). Taken together, these features should indicate the possibility of encephalopathy associated with thyroid disorders.

68Ga-FAPI PET/CT imaging in a patient with thyroiditis.

68Ga-FAPI PET/CT imaging in a patient with thyroiditis.

Tireoidite de Hashimoto após quadro inicial de doença de graves: relato de caso

INTRODUCTION: Hashimotos thyroiditis (TH) and Graves disease (GD) are common autoimmune thyroid disorders in medical practice; however, spontaneous transformation of GD into hypothyroidism due to autoimmune thyroiditis is uncommon, especially in children. Thus, being a rare entity, the pathophysiology remains unknown. METHODS: Report a case of a GD quickly evolution into HT. CASE REPORT: An 11-year-old girl presented with inicial symptoms of GD, evolueting into TH within a few months after her initial diagnosis and treatment. The spectrum of clinical manifestations was evidenced, as well as laboratory tests. DISCUSSION: Graves disease and Hashimotos thyroiditis are opposite manifestations within the spectrum of autoimmune thyroid diseases, and migration from one pole to another may occur, but this manifestation has been rarely reported in the literature. CONCLUSION: In view of the possible conversion of a GD into a TH, monitoring of thyroid function and possible clinical manifestations in patients with GD even after initial remission with drug treatment should be considered.

Zachowania zdrowotne, stopień akceptacji choroby i poziom wiedzy żywieniowej osób chorych na niedoczynność tarczycy i autoimmunologiczne zapalenie tarczycy typu Hashimoto. Badanie wstępne

Zachowania zdrowotne, stopień akceptacji choroby i poziom wiedzy żywieniowej osób chorych na niedoczynność tarczycy i autoimmunologiczne zapalenie tarczycy typu Hashimoto. Badanie wstępne

Investigation of aggregation disorders before and after levotyroxin therapy in patients with hashimato thyroiditis

Investigation of aggregation disorders before and after levotyroxin therapy in patients with hashimato thyroiditis

Genetic and Environmental Factors in the Pathophysiology of Hashimoto's Thyroiditis.

Finding multiple familial patients with Hashimoto thyroiditis in our clinic a search in the literature confirms that genetic factors, in addition to environmental factors, seem involved in the etiology of this disease.

Protective role of selenium on thyroid morphology in iodine-induced autoimmune thyroiditis in Wistar rats.

Excess iodine may induce and exacerbate autoimmune thyroiditis (AIT) in humans and animals. In order to assess the potential protective mechanisms of selenium (Se) in thyroid autoimmunity, the effects of inorganic Se (sodium selenite) administration on thyroid morphology and follicular cytology were investigated in adult Wistar rats with iodine-induced AIT. A total of 48 adult Wistar rats (24 females, 24 males) were allocated to one of four dietary regimens: C0, control; C1, only potassium iodine (KI); C2, concomitant KI and Se; C3, only KI initially, followed by Se administration. For AIT induction the rats were fed with 0.05% KI for 56 days. Se-treated rats received 0.3 mg/l sodium selenite in drinking water. Thyroid tissues were collected for pathologic diagnosis after 7 days in C0 group, 56 days in C1 and C2 groups, and 112 days in C3 group. In C1 group, moderate to severe thyroiditis was observed in 83% of males and 50% of female rats (P=0.223). In C3 group 16.7% of male rats developed moderate thyroiditis and none in C2 group, whereas no females were identified with moderate to severe thyroiditis in C2 or C3 group. Thus, the administration of Se was proven to have protective effects against thyroiditis cytology in both male and female Wistar rats.

Abstract #807062: Parathyroidectomy Induced Thyroiditis

Abstract #807062: Parathyroidectomy Induced Thyroiditis

The characteristics and clinical significance of serum TRAb IgG subtype in patients with thyroid associated ophthalmopathy

Objective To explore the distribution of serum TRAb IgG subtypes in patients with thyroid-associated ophthalmopathy(TAO) at different stages and its value in assessing TAO activity. Methods Forty-three patients with TAO, 30 patients with Graves′ disease (GD group), 19 patients with Hashimoto′s thyroiditis (HT group), and 50 healthy subjects (NC group)admitted to the First Affiliated Hospital of Zhengzhou University were collected from August 2018 to February 2019. According to the clinical activity score (CAS), the patients with TAO were further divided into the active period group (AP group, CAS≥3 points, 22 cases) and the inactive period group (IP group, CAS<3 points, 21 cases). The basic clinical data of subjects in each group were collected. The serum concentrations of FT3, FT4, TSH, thyroperoxidase antibody (TPOAb), thyroglobulin antibody (TgAb), and thyroid-stimulating hormone receptor antibody (TRAb) were detected by chemiluminescence immunoassay and the binding rate in percentage (B) of serum TRAb IgG and IgG subtypes were detected by ELISA. The positive rate in each group and relative content of positive samples were compared. Results (1)Compared with HT group, the positive rates of IgG1 and IgG2 in TAO group and GD group were significantly decreased (P 0.05). (2)Compared with the IP group, IgG1(B) and the positive rates of IgG1 in the AP group were increased while IgG4(B) and the relative contents of IgG4 were reduced (P<0.05). (3)IgG1(B)was positively correlated with TAO activity (B=6.190, P=0.007), and higher IgG4(B)indicated more inclinations to the inactive period (B=-16.390, P=0.052). (4) The area under the curve of receiver operating characteristic (ROC) for TAO developing into active period assessed by activity rate was 0.859 (95%CI 0.746-0.973, P<0.05). When the activity rate was 4.29, the Jordon index showed the largest, with sensitivity of 81.8% and specificity of 81.0%. Conclusions Elevated levels of TRAb IgG1 in the patients with TAO indicate a tendency to active period, while elevated levels of TRAb IgG4 indicate a tendency to inactive period. The activity rate can provide a reference for assessing whether TAO is active or not. Key words: Thyroid-associated ophthalmopathy; IgG subtype; Clinical activity score

Study on the clinical features of Hashimoto′s thyroiditis with elevated serum IgG4

Objective To investigate the clinical features of Hashimoto′s thyroiditis(HT) with elevated serum IgG4 levels and to guide the clinical practice. Methods Serum IgG4 concentrations were detected in patients with HT by nephelometric immunoassay. These patients were classified into two groups according to the IgG4 levels: positive group(IgG4≥1.35 g/L), and negative group(IgG4<1.35 g/L). The clinical characteristics of these two groups, including age, gender, medical history, serological features, and ultrasound were compared. Results Nine out of 111 patients with HT were positive with IgG4(8.11%), all of them were women. There was no significant difference in gender, age, BMI, dose of levothyroxine administration, FT3, FT4, and TSH levels between the two groups. The volume of thyroid in positive group was larger than that in negative group [57.81(38.36, 74.93) ml vs 25.07(18.48, 42.14) ml, P=0.015], and the level of thyroglobulin antibodies(TgAb; P=0.011) and thyroid peroxidase antibodies(TPOAb; P=0.025) in positive group were also significantly higher than those in negative group. Moreover, the positive group had a slightly higher risk of PTC than that of negative group(11.1% vs 2.94%, P=0.290), though the difference was not significant. Correlation analysis showed that IgG4 was positively associated with TgAb, TPOAb, and thyroid volume. Conclusions The levels of TgAb and TPOAb are higher, the volume of thyroid gland is greater, and the risk of PTC with lymph node metastasis is more frequent in HT patients with elevated serum IgG4. For HT patient with elevated serum IgG4, their thyroid function and morphology should be more closely monitored. Key words: IgG4; Hashimoto′s thyroiditis; Papillary thyroid carcinoma

Influence of selenium yeast combined with levothyroxine sodium on outcomes in type 2 diabetes mellitus patients complicated with chronic lymphocytic thyroiditis

Objective To investigate the clinical efficacy of combination therapy of selenium yeast and levothyroxine sodium in the treatment of type 2 diabetes mellitus complicated with chronic lymphocytic thyroiditis(CLT). Methods A total of 96 patients with type 2 diabetes mellitus complicated with CLT who admitted to Wenling Hospital of Traditional Chinese Medicine from June 2017 to December 2018 were randomly divided into control group and treatment group according to the digital table, with 48 patients in each group.On the basis of stable blood sugar control, the control group received routine treatment with levothyroxine sodium tablets.The treatment group was given selenium yeast on the basis of the control group.The blood glucose, thyroid, clinical efficacy within 3 months of treatment were recorded. Results The total effective rate of the study group was 95.83%(46/48), which was significantly higher than 68.75%(33/48) of the control group(χ2=12.080, P 0.05). Conclusion The clinical efficacy of selenium yeast and levothyroxine in the treatment of type 2 diabetes with CLT is significantly better than traditional treatment. Key words: Diabetes mellitus, type 2; Thyroiditis; Lymphocytes; Selenium compounds; Thyroxine; Blood glucose; C-Peptide

Incidence and risk factors of inadvertent parathyroidectomy during thyroid surgery: A single-center retrospective study

Context: Thyroidectomy is considered a relatively safe surgery with morbidity of <5% when undertaken by experienced surgeons. Inadvertent parathyroidectomy (IP) means pathology report has found parathyroid tissue in the thyroid specimen, and it was reported to range from 2.9% to 31%. Aims: The aim of this study is to measure the incidence rate and to evaluate the significant relationship between risk factors and IP during thyroid surgery. Settings and Design: A retrospective chart review study was carried out in King Fahad Armed Forces Hospital, Jeddah, between June 2015 and December 2019. Subjects and Methods: All consecutive patients undergoing unilateral or bilateral thyroidectomy were enrolled in this study. Histopathology reports were reviewed to identify the specimens that included parathyroid tissue and underlying thyroid disease, and these were compared to patients with no parathyroidectomy in terms of gender, pathological features, re-operation, Hashimoto thyroiditis, extrathyroidal extension, and central neck dissection. Statistical Analysis Used: Statistical analysis was carried out using the Statistical Package for the Social Sciences. Results: Retrospective analysis of 181 consecutive thyroidectomy cases reveals that 34 (18.7%) patients had IP. Significant risk factors for IP included extra-thyroid extension (P = 0.008), total thyroidectomy (P = 0.017), and Hashimoto thyroiditis (P = 0.021). Other risk factors, including gender, malignancy, central neck dissection, and re-operation, were not statistically significant in this study. Conclusions: IP during thyroid surgery is not uncommon (18.7%). Total thyroidectomy, hashimoto thyroiditis, and extrathyroidal extension of the tumor were found to be significant risk factors. We recommend more meticulous intra-operative identification of parathyroid glands, particularly for patients with these risk factors.

Value of ultrasonography in the differential diagnosis of benign and malignant thyroid nodules with Hashimoto′s thyroiditis

高频超声为鉴别诊断甲状腺良恶性结节的主要影像学手段，而桥本甲状腺炎声像图的复杂多变增加了其伴发结节良恶性鉴别的难度，联合超声造影及超声弹性等新技术可以提高甲状腺结节的定性诊断效能。本文就桥本甲状腺炎背景下鉴别诊断甲状腺良恶性结节的相关研究进行综述。

Analysis of risk factors for lymph node meta-stasis in papillary thyroid microcarcinoma

Objective To investigate the clinical and pathological characteristics of cervical lymph node metastasis in papillary thyroid microcarcinoma (PTMC), and provide a basis for the individualized surgical procedure. Methods Retrospectively analyzed the clinical data of 940 PTMC patients admitted to the Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, from January 2016 to June 2018, including 206 males and 734 females, with a gender ratio of 1.0∶3.6. Age ranged from 18 to 78, with an average of (45.5±10.6) years. The correlation between gender, age, cancer size, multifocality, BRAFV600E gene mutation, complicated with hashimoto′s thyroiditis, extrathyroidal extension and lymph node metastasis were analyzed. SPSS 21.0 software was used for statistical analysis. Chi-square test or rank sum test was adopted for comparison between groups, and logistic regression analysis was adopted for multivariate analysis. Results There were 397 (42.2%) patients with central lymph node metastasis (CLNM) and 104 (11.1%) patients with lateral lymph node metastasis (LLNM). Univariate analysis showed that male, age < 55 years old (χ2=24.485, P<0.001), bilateral cancer foci (χ2=8.100, P=0.004), larger length-diameter (Z=-0.016, P<0.001), and BRAFV600E gene mutation (χ2= 4.918, P=0.027) had a higher CLNM positive proportion, and LLNM positive proportion was higher in male (χ2=6.584, P=0.010), bilateral cancer foci (χ2=26.669, P<0.001), larger length-diameter (Z=-4.991, P<0.001), extra-glandular invasion (χ2=16.862, P<0.001) . Multivariate logistic regression analysis showed that gender (OR=2.091, P<0.001), age (OR=1.551, P=0.010), cancer lesion length (OR=5.285, P<0.001) and BRAFV600E gene mutation (OR=1.648, P=0.038) were independent risk factors for CLNM in PTMC patients. Gender (OR=1.657, P=0.032), bilateral lesion (OR=2.610, P<0.001), tumor length diameter (OR=7.420, P<0.001) and extrathyroidal extension (OR=2.611, P=0.005) were independent risk factors for LLNM. The optimal critical values of tumor lesion length-diameter for risk assessment in CLNM and LLNM were 0.6 cm and 0.8 cm, respectively. Conclusions For PTMC patients with negative cervical lymph node had risk factors for lymph node metastasis, preventive dissection of central lymph nodes was recommended, and preventive dissection of lateral lymph nodes should also be comprehensively considered, by evaluating the extrathyroidal extension. Key words: Surgical procedures, operative; Lymphatic metastasis; Neck dissection; Papillary thyroid microcarcinoma

Effects of prednisone combined with indomethacin in the treatment of patients with subacute thyroiditis

Objective To investigate the application effects of prednisone combined with indomethacin in the treatment of patients with subacute thyroiditis. Methods From January 2015 to January 2017, 140 patients with subacute thyroiditis in Yantai Mountain Hospitalwere chosen in this research, and they were randomly divided into control group and research group according to the digital table, with 70 cases in each group.Both two groups were treated with prednisone, the research group was given indomethacin on this basis.The time of fever extinction, the time of goiter subside, the time of thyroid ache extinction, ESR, thyroid hormone, adverse reaction and recurrence of the two groups were compared. Results The time of fever extinction, the time of goiter subside, the time of thyroid ache extinction of the research group were (1.65±0.89)d, (2.54±0.92)d, (7.63±1.57)d, which were all shorter than those of the control group [(2.07±1.03)d, (2.96±1.35)d, (8.45±1.84)d], the differences were statistically significant(t=2.581, 2.151, 2.836, all P 0.05). There were 6 cases(8.57%) occurred adverse reaction in the research group, and 15 cases(21.42%) in the control group, the difference was statistically significant(χ2=4.538, P 0.05). Conclusion Prednisone combined with indomethacin has similar effects as prednisone in the treatment of patients with subacute thyroiditis, but the combination has faster improvement of improving fever, pain, swelling, etc, and with better safety. Key words: Thyroiditis, subacute; Indomethacin; Prednisone; Glucocorticoids; Treatment outcome; Safety