Thyroiditis Research Articles

Autoimmune diseases secondary to drug hypersensitivity syndrome

Drug hypersensitivity syndrome, also called drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) , is a severe systemic adverse drug reaction usually caused by exposure to specific drugs. Several reports have shown that after remission of DRESS syndrome, some patients developed autoimmune diseases, such as type-1 diabetes mellitus, Grave's disease, Hashimoto's thyroiditis, lupus erythematosus, sjogren syndrome, vitiligo, graft-versus host disease (GVHD) and other diseases. However, the exact pathogenesis of these autoimmune diseases remains unclear, and mainly involves regulatory T cell dysfunction, virus infection and autoantibody production. This review mainly summarizes DRESS syndrome-related autoimmune diseases and their pathogenesis. Key words: Drug eruptions; Autoimmune diseases; Eosinophilia; Autoantibodies; Drug-induced hypersensitivity syndrome

Growth Hormone Treatment and Adverse Events.

We compiled the major adverse events included in the Annual Research Reports of the Foundation for Growth Research published in and after 2000. We conducted a review of approximately 32,000 patients treated with growth hormone (GH) who subsequently developed leukemia and who were registered with the Foundation for Growth Research (from 1975 to December 31 1997). We performed a literature review and found that GH therapy was not associated with leukemia onset in patients with no risk factors for leukemia. We also reported the onset of diabetes mellitus (DM), scoliosis, and respiratory problems in patients with Prader-Willi syndrome who were treated with GH. Osteoporosis, Hashimoto thyroiditis, and hyperlipemia were relatively frequent complications of Turner syndrome (TS).

Expression of micro RNA-125b in female patients with nodular goiter and Hashimoto′s thyroiditis

Twenty four female patients underwent thyroidectomy between June 2015 and August 2016, among whom 11 cases were pathologically diagnosed as nodular goiter (NG group), and 13 cases were diagnosed as nodular goiter complicated with Hashimoto′s thyroiditis (NG+ HT group); meanwhile, 17 female patients with Hashimoto′s thyroiditis (HT group) and 20 healthy females (control group) were also recruited in the study. The expression of micro RNA( miR)-125b was evaluated by quantitative real-time PCR(qRT-PCR), the expression level of tumor necrosis factor α (TNF-α) was analyzed by Western blotting in thyroid nodules and adjacent thyroid tissue in NG and NG+ HT groups. Serum expression of miR123b was detected in all 4 groups. qRT-PCR results showed that the expression of miR-125b was down regulated by 0.55 fold in thyroid nodules of NG+ HT group compared to NG group (t=2.873, P<0.01). The serum expression levels of miR-125b in control group, NG group, HT group and NG+ HT group were 1.00, 1.06, 0.92 and 0.79, respectively, the expression level in NG+ HT group was significantly lower than that of control group (q=4.717, P<0.01). Western blot showed that the expression of TNF-α in thyroid nodules of NG+ HT group was significantly higher than those in nodules of NG group and adjacent thyroid tissues of both groups. The results suggest that miR-125b might serve as a promising diagnostic biomarker of Hashimoto′s thyroiditis in patients with nodular goiter. Key words: Hashimoto′s disease; Goiter, nodular; miR-125b

Outcome of radioiodine therapy in patients with papillary thyroid carcinoma concurrent with Hashimoto′s thyroiditis

Objective To evaluate the impact of low-dose 131I therapy and high-dose 131I therapy on the clinical outcome in PTC patients coexisting with Hashimoto′s thyroiditis (HT). Methods A total of 140 non-distant metastatic PTC patients (16 males, 124 females, age range: 16-66 years) from July 2010 to December 2014 were enrolled in this retrospective study. Patients concurrent with HT (n=84, group A) were divided into low-dose group (1 110 MBq, n=56, group A1) and high-dose group (5 550 MBq, n=28, group A2) according to 131I ablation dose. Patients without HT (n=56) were enrolled as control group (group B), and received 1 110 MBq of 131I. The thyroid remnant ablation outcome was evaluated according to 131I diagnostic whole-body scan (Dx-WBS), neck ultrasonography (US), serum Tg and TgAb level 6-8 months after 131I ablation therapy. The successful ablation rates were compared by χ2 test. Kruskal-Wallis rank sum test was also used. Results There were no significant differences among the 3 groups in terms of both clinicopathological features and postoperative remnant thyroid (H: 0.203-2.944, χ2: 0.271-0.970, all P>0.05). When negative Dx-WBS and US were deemed as successful ablation criterion, complete ablation rate was found significantly more in group B (94.6%, 53/56) than that in group A1 (82.1%, 46/56; χ2=4.264, P 0.05). When combining negative sTg (sTg 0.05), and no difference was observed between group A2 (12/15) and group A1 (χ2=1.320, P>0.05). Conclusion Non-distant metastatic PTC patients coexisting with HT has undesirable 131I ablation outcome compared with those without HT, increasing 131I dose is unhelpful to enhance efficiency of remnant ablation for PTC patients with HT. Key words: Thyroid neoplasms; Hashimoto disease; Radiotherapy; Iodine radioisotopes; Treatment outcome

Current status of screening and management of thyroid diseases during pregnancy

Objective To investigate the current status of screening and management of thyroid diseases during pregnancy, and to provide evidence for further improvement of clinical management. Methods Clinical data of 5 981 pregnant women who delivered at Peking University First Hospital between September 1, 2013 and September 30, 2014 were analyzed retrospectively. Their average age was (30±4) years (18-47 years) and average gestational week was (39.2±1.6) weeks (25.5-42.0 weeks). The reference range of thyroid stimulating hormone (TSH) was 0.1-2.5 mU/L recommended by the American Thyroid Association (ATA). The reference range of free thyroxine (FT4) was 11.48-22.70 pmol/L and the cut-off value of thyroid peroxidase antibody (TPOAb) was 34 U/ml both recommended by the kit. The specific reference range of TSH was obtained from normal pregnant women in this study (0.23-4.08 mU/L in the first trimester). Pregnant women with hypothyroidism were divided into two groups according to their TSH level at the first trimester: TSH≥2.5-<4.08 mU/L group and TSH≥4.08 mU/L group. T test, Chi-square or Fisher's exact test were applied for statistical analysis. Results (1) Screening status: Of the 5 981 pregnant women, there were 13 cases (0.2%) of hyperthyroidism and 146 cases (2.4%) of hypothyroidism diagnosed before conception (133 cases of Hashimoto thyroiditis, eight cases after operation for thyroid cancer, and five cases after 131I therapy because of hyperthyroidism). Among the 5 822 cases requiring screening, 4 044 cases (69.5%) received screening tests of TSH, FT4 and TPOAb during early pregnancy according to Chinese Guidelines, and 1 778 cases received neither standard screening nor screening test. (2) Treatment of hypothyroidism: Hypothyroidism treatment rate was only 61.5% (107/174) according to the reference range recommended by the ATA, lower than that of 88.1% (52/59) according to the reference range of this study (χ2=14.430, P<0.05). There were 60 cases receiving no treatment in TSH≥2.5-<4.08 mU/L group. Forty-three of these cases were reexamined, and one of them was abnormal, with a rate of 2.3% (1/43). There were seven cases without treatment in TSH≥4.08 mU/L group; six of them were reexamined among which one was abnormal, with a rate of 1/6. (3) Thyrotoxicosis: Among the 4 044 pregnant women, 99 cases had TSH <0.1 mU/L, including 11 cases with FT4 ≥22.70 pmol/L (22.82-60.96 pmol/L). Only three cases were positive for thyrotrophin receptor antibody, and then diagnosed as hyperthyroidism and treated with propylthiouracil. (4) Thyroid cancer: Among the 5 981 pregnant women, six cases were diagnosed as thyroid cancer during pregnancy and lactation, with an incidence of 100.3/100 000. Of the six cases, five were diagnosed during pregnancy, and one at one month postpartum. All of the six cases underwent operation and were confirmed to be papillocarcinoma by pathology. Conclusions The screening rate of thyroid diseases during pregnancy is high, but the clinical management is not fully standardized. We suggested that each center should established its own normal reference range for thyroid function test. The incidence of thyroid cancer during pregnancy is increasing, thus attention should be paid to its diagnosis. Key words: Thyroid diseases; Pregnancy complications; Thyrotropin; Thyroxine; Iodide peroxidase; Reference values

Thyroid hormone resistance syndrome with papillary thyroid carcinoma and Hashimoto′s thyroiditis: One case report and literature review

Thyroid hormone resistance syndrome with papillary thyroid carcinoma and Hashimoto′s thyroiditis: One case report and literature review

The effect of Vitamin D treatment on thyroid function and the levels of thyroid autoantibodies, TNF-α, IL-6, IL-1β in patients with autoimmune thyroiditis

SUMMARY Objective : To investigate the relationship between autoimmune thyroid disease and vitamin D treatment. Method : Fifty four (54) patients with both vitamin D deficiency and newly diagnosed euthyroid Hashimoto’s thyroiditis (HT) were recruited for this study. The patients were given intramuscular administration of cholecalciferol at a dose of 300,000 IU/month for 3 months. At the time of diagnoses and after the treatment of vitamin D, free T3 (FT3), free T4 (FT4), thyroid stimulating hormone (TSH), antithyroid peroxidase (anti-TPO), antithyroglobulin (anti-TG), 25 (OH) D3, parathormone (PTH), calcium (Ca), phosphorus (P) and alkaline phosphatase (ALP) levels were measured in all patients; TNF-a, IL-6 and IL-1s levels were measured in only 43 patients. Results: A statistically significant difference (p˂0.05) was observed between the pre and post treatment FT4, TSH, antiTPO, antiTG, PTH and ALP levels. After the treatment of vitamin D, a statistically significant increase was found in 25 (OH) D3 and FT4 levels, and a significant decrease was found in TSH, antiTPO, antiTG, PTH and ALP levels, whereas no significant difference was noted in FT3, Ca, P, TNF- a, IL-6 and IL-1s levels. Further, levels of vitamin D were not correlated with FT3, FT4, TSH, antiTPO, antiTG, TNF-a, IL-6 and IL-1s levels (p˃0.05). Conclusions: For patients with both vitamin D deficiency and newly diagnosed HT, treatment of vitamin D had a positive effect on the thyroid antigenicity and thyroid function. Keywords: Autoimmune thyroid disease, Hashimoto's thyroiditis, Vitamin D deficiency OZET Amac: D vitamini tedavisinin otoimmun tiroid hastaligi ile iliskisini arastirdik. Yontem: Calismaya D vitamini yetersizligi ve beraberinde yeni tani alan Hashimoto tiroiditi olan (HT) 54 hasta alindi. Hastalara 3 ay sureyle ayda bir 300.000 IU kolekalsiferol intramuskuler olarak verildi. Tani esnasinda ve D vitamini tedavisi sonrasinda serbest T3(FT3), serbest T4 (FT4), tiroid stimulan hormon (TSH), anti tiroid peroksidaz (TPO) ve anti tiroglobulin (TG), 25(OH)D3, parathormon (PTH), kalsiyum (Ca), fosfor (P) ve alkalen fosfataz (ALP) seviyeleri ve yalniz 43 hastada TNF- α, IL-6, IL-1b seviyeleri olculdu. Bulgular: Tedavi oncesi ve sonrasi FT4, TSH, antiTPO, antiTG, PTH ve ALP seviyeleri acisindan arada istatistiksel olarak anlamli fark vardi (p<0.05). D vitamini tedavi sonrasinda 25 (OH) D3 ve FT4 seviyelerinde istatiksel olarak onemli bir artis olurken TSH, antiTPO, antiTG, PTH ve ALP seviyelerinde ise onemli bir dusus gozlendi. FT3, Ca, P, TNF- α, IL-6 ve IL-1b acisindan onemli bir fark yoktu. D vitamini seviyesi ile FT3, FT4, TSH, antiTPO, antiTG, TNF- α, IL-6 ve IL-1b arasinda bir korelasyon yoktu. Sonuc: D vitamini eksikligi ve yeni tani HT’i olan hastalarda D vitamini tedavisinin tiroid antijenitesi ve tiroid fonksiyonu uzerine olumlu yonde etkisi vardir. Anahtar sozcukler: Otoimmun tiroid hastaligi, Hashimoto tiroiditi, D vitamini yetersizligi

Turner syndrome with type 1 diabetes, Hashimoto′s thyroiditis, and severe osteoporosis: One case report and literature review

Turner syndrome with type 1 diabetes, Hashimoto′s thyroiditis, and severe osteoporosis: One case report and literature review

Clinical features of lymph node metastasis in papillary thyroid microcarcinoma with (131)I treatment

Objective To analyze the clinical features of lymph node metastasis in papillary thyroid microcarcinoma(PTMC). Methods 198 patients with PTMC who have underwent total thyroidectomy and at least one 131I treatment were divided into two groups according to the occurrence of lymph node metastasis. The clinical features of lymph node metastasis in PTMC were retrospective analyzed, and independent risk factors of the central and lateral lymph node metastasis in PTMC patients were further analyzed. Results Clinical features of PTMC patients with cervical lymph node metastasis: (1)Most of them were<45 years old(63.4% vs 44.9%, P=0.012); (2)More patients with cancer in bilateral lobes and extrathyroidal extension in lymph node metastasis groups(56.7% vs 42.0%, P=0.043; 63.6% vs 36.4%, P=0.034); (3)The average tumor size of the patients of lymph node metastasis was larger than that of the patients without lymph node metastasis[(0.71±0.25 vs 0.64±0.24)cm, P=0.047]; (4)Preoperative thyroglobulin antibody(TgAb)level of PTMC patients with cervical lymph node metastasis was higher than the control group[(65.27±139.179 vs 36.36±95.647)IU/L, P=0.03]; (5)After the 131I treatments and by 1-6 years of follow-up, it is found no statistically significant difference in cure rate between patients with cervical lymph node metastasis after total thyroidectomy and its control group. But the frequency of 131I treatment required in patients with cervical lymph node metastasis was higher than that of the control group(1.77±0.77 vs 1.49±0.74, P=0.006). Univariate analysis revealed that central lymph node metastasis was correlated with age, tumor size and other factors. There were more patients with cancer in bilateral lobes and extrathyroidal extension in lymph node metastasis group. And lateral lymph node metastasis was correlated with Hashimoto′s thyroiditis. Multivariate analysis showed that age, tumor size, involvement of bilateral glandular lobes and extrathyroidal extension were independent risk factors for central lymph node metastasis. Conclusion The risk factors of lymph node metastasis should be fully evaluated to carry out individualized treatment for the first operation of PTMC patients. (Chin J Endocrinol Metab, 2016, 32: 900-905) Key words: Papillary thyroid microcarcinoma; Lymph node metastasis; Clinical feature; Risk factors

Clinical analysis of 49 patients with primary thyroid diffuse large B-cell lymphoma

Objective To analyze the clinical characteristics, prognostic factors, and treatment methods for patients with primary thyroid diffuse large B-cell lymphoma(PTDLBCL). Methods The clinical characteristics, treatment methods, and prognosis factors of 49 patients diagnosed as PTDLBCL in Tianjin Medical University Cancer Hospital from January 2000 to December 2014 were retrospectively analyzed. Results The median age of 49 patients was 68(35-86)years, including 20 males and 29 females. According to Ann Arbor stage, there were 15 patients for stage I, 24 for stage II, 4 for stage III, and 6 for stage IV. 15 patients had a history of Hashimoto′s thyroiditis. According to Eastern Collaborative Oncology Group(ECOG), 34 cases were with a performance status score 0-1, and 15 patients were over score 1. According to international prognostic index(IPI), 26 patients were referred to score 0-1(low risk), 14 to score 2(Low-intermediate risk), 4 to score 3(Intermediate-high risk), and 5 to score 4-5(high risk). According to Hans typing, 17 patients were germinal center(GCB)type, 19 patients non-germinal center(Non-GCB), and 13 patients unknown. For the treatment, surgery alone was performed for 13 patients, chemotherapy alone for 6, surgery followed by chemotherapy for 21, and radiotherapy plus chemotherapy for 2, and surgery followed by radiotherapy and chemotherapy for 7 patients. After the median follow-up of 3.46(0.34-15.35)years, 10 patients(52.6%)achieved complete remission(CR)in the surgery/chemotherapy alone group, 25 patients achieved CR in the local treatment plus chemotherapy group(chemotherapy+ radiotherapy, surgery+ chemotherapy, surgery+ radiotherapy+ chemotherapy). The 5-year survival rates of two group were 26.1% and 70.0%, with significant difference(P=0.022). Univariate analysis revealed that lactate dehydrogenase level, ECOG, age, and treatment modality were prognostic factors of survival. Cox multiple factors analysis showed that ECOG was an independent prognostic factor. Conclusion PTDLBCL usually occurs in older patients, with poor prognosis. ECOG is an independent prognostic factor for it. Surgery combined with radiotherapy and chemotherapy may, to some extent, improve the long-term survival. (Chin J Endocrinol Metab, 2016, 32: 830-836) Key words: Diffuse large B-cell lymphoma; Thyroid; Clinical characteristics; Prognosis; Treatment methods

The outcome of thyroid disease induced by interferon plus ribavirin in patients with chronic hepatitis C

Objective To explore the long-term outcome of thyroid disease occurred during and after peg-interferon plus ribavirin therapy (PR therapy) in patients with chronic hepatitis C (CHC). Methods CHC patients admitted to Henan People′s Hospital during January 2009 to December 2012 treated with peg-interferon plus ribavirin were included in this study. The thyroid functions were tested before treatment, at week 12, week 24, week 48, week 72 of treatment, and at week 24, week 48, week 96, week 144 after end of treatment. Thyroid function test frequency was increased according to the patients′ test results and medication was registered. Measurement data was analyzed using t test and count data was compared using chi square test or Fisher exact probability test. Results A total of 358 patients was included with mean age of (43±12) years (range 18 to 65 years), of whom 200 were male and 158 were female. There are 300 cases (83.8%) with HCV genotype-1 infection, 56 cases (15.6%) with genotype-2 infection and 2 cases (0.6%) with genotype 3 infection. Eighty out of 358 patients (22.3%) developed thyroid disease, among whom 71 cases (88.75%) were diagnosed with autoimmune thyroiditis and 9 cases (11.25%) were non-autoimmune thyroiditis. At week 144 after end of treatment, 21 (29.6%) cases with autoimmune thyroiditis completely recovered and 9 cases with non-autoimmune thyroiditis fully restored. The comparison between two groups had statistical significance (F=16.69, P=0.00). Patients were divided into non-thyroid disease and thyroid disease groups. The were no significant differences of baseline viral load, HCV genotype, transaminase levels and age between the two group (all P>0.05). The differences of gender, baseline levels of thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb) and treatment outcome were statistically significant (all P<0.05). Conclusions Interferon-induced autoimmune thyroiditis could not be completely reversed. Some patients develop chronic thyroiditis and require long-term drug therapy. Patients with positive TPOAb and TgAb induced by interferon have high risk of developing Hashimoto′s thyroiditis and Graves′disease during follow-up. Appropriate treatment for thethyroid disease induced by interferon does not affect the antiviral treatment. Clinicians should monitor the thyroid function during and after antiviral therapy in patients with CHC. Key words: Hepatitis C, chronic; Thyroid diseases; Interferon; Thyroid Autoantibodies

INTRODUCTING A RARE THYROID LYMPHOMA IN HASHIMOTO THYROIDITIS AIRWAY OBSTRUCTION AND RESPIRATORY AEERST

Primary thyroid lymphoma is an uncommon tumor that in almost the majority of patients occurs in the setting of lymphocytic thyroiditis or Hashimoto’s disease. Hashimoto thyroiditis is one of the autoimmune inflammatory diseases in the thyroid gland that is characterized with elevated levels of serum thyroid auto-antibodies. A 39-year-old woman was referred with dyspenea in last two months and in initial histological examination, Hashimoto thyroiditis was reported. Due to recurrence of symptoms and airway obstruction, she underwent total thyroidectomy. During surgery, a mass which was attached to the thrachea was seen, which was completely removed. In the final pathologic study, lymphoma arising from Hashimoto thyroiditis was introduced.

Diagnosis and treatment of autoimmune pancreatitis

Diagnosis and treatment of autoimmune pancreatitis

Thyroidectomy in carcinoma thyroid - a three years experience

Twenty-five patients were operated for thyroid malignancy in dept. of Surgery, SRGH, Lahore over a period of 3 years. From Nov 2001 to Nov 2004. Carcinoma was diagnosed on FNAC in 10 pts (40%) and Total Thyroidectomy planned as first and definite procedure. In rest of 15 patents (60%) complete thyroidectomy was performed after initial total lobectomy and subsequent Histopathology. Eight pts were found to have follicular carcinoma and 16 had papillary carcinoma revealed on H/P of resected specimen. Thyroid function tests in almost all showed euthyroid status. The only exception was a female pt who`s hormonal assay showed hypothyroidism but she was operated for FNAC suggested follicular adenoma. All the pts had Iodine-131 whole body scan for residual thyroid and metastatic disease. No thyroxin was started before Iodine-131 scan. Twenty pts were given single dose of 50-75 miCu ff radioiodine, followed by thyroxin in suppressive dose. No recurrence of tumor noted during follow-up 2 years. Only one pt diagnosed finally as thyroiditis on histology of resected specimen. On FNAC, she had suspicion of follicular neoplasm mandating thyroidectomy. A female prepondondrance with age ranging from 15-45 yrs was observed.

Approach to the patient with hypokalemia caused by Hashimoto's thyroiditis associated with primary Sjogren's syndrome and renal tubular acidosis

Hypokalemia is a common clinical symptom. It is quite important to clarify the cause of hypokalemia. Autoimmune thyroid disease and primary Sjogren syndrome(pSS)have a common genetic predisposition. The coexistence of both diseases is frequent. Renal tubular acidosis(RTA)is one of the causes of hypokalemia, which can be primary and secondary to other diseases in etiology. Primary RTA is more common in children. As for adults, RTA is often secondary to pSS. In this paper, we reported a case of hypokalemia caused by Hashimoto's thyroiditis associated with primary Sjogren's syndrome and renal tubular acidosis in order to call attention to the special cause and treatment of hypokalemia. (Chin J Endocrinol Metab, 2016, 32: 349-352) Key words: Hypokalemia; Hashimoto's thyroiditis; Primary Sjogren's syndrome; Renal tubular acidosis

Morphological evaluation of non neoplastic lesions of the thyroid gland

Objective: This study was conducted to see the frequency of non neoplastic lesions of thyroid glands in patients who underwent thyroid surgery at Mayo hospital, Lahore. Study design: It was a descriptive cross sectional study. Place and Duration of study: It was a retrospective and prospective study commencing from Ist July 1999 to 30th June 2002 and was conducted at Pathology Department King Edward Medical University, Lahore. Materials and methods: All thyroid samples submitted and reported at the Department of Pathology, King Edward Medical University, Lahore during a three year period commencing from Ist July 1999 to 30th June 2002 were included in this study. Results: Out of the total number of 1136 thyroid surgical specimens, 855 specimens (75.26%) were shown to comprise of non-neoplastic lesions and were more common in females (77.2%) as compared to males (22.8%) giving a male to female ratio of 1:3.4. Regarding non neoplastic lesions maximum comprised of diffuse(74%) and multi nodular goiters (16% ). Others consisted of inflammatory conditions (5%), hyperplastic nodules(4%) and simple colloid filled cysts 1%. Inflammatory conditions included Hashimotos` thyroiditis (67.3%) deQuervain`s thyroiditis (granulomatous thyroiditis) (16.3 %), Lymphocytic thyroiditis (11.7%), and Riedel`s thyroiditis(4.7%). Conclusions: Non neoplastic thyroid lesions are more common than neoplastic lesions, especially in females. The frequency of diffuse colloid goiter was very high, while among inflammatory lesions Hashimotos` thyroiditis was the commonest lesion. Most of the cases of hypothyroidism were associated with iodine deficiency.

The exploration and discovery of the impacts of selenium on thyroid

The effects of selenium on human health and the related researchs of the impacts of selenium on thyroid were introduced at home and abroad in recent years. The selenium deficiency was correlated with incidence of subclinical and clinical hypothyroidism and autoimmune thyroiditis. Supplement of selenium can improve immune status and thyroid function in patients with autoimmune thyroiditis. There is no definitive evidence for the influence of selenium on Graves disease. Key words: Selenium; Thyroid; Autoimmune thyroiditis; Thyroid peroxidase antibody

PKC epsilon involvement in Th17 in vitro differentiation: implications in psoriasis pathogenesis

Psoriasis is a noncontagious, arytematous-squamose dermatitits affecting both sexes and all races. Although its exact etiology is largely unknown, it is now recognized as one of the most common immune-mediated disorders and several studies demonstrate an impairment of regulatory T-cells (Tregs) function and an up-regulation of IL-17 levels produced by T-helper 17 lymphocytes (Th17)(1,2). Protein kinase C epsilon (PKCe) is a serine/threonine kinase which plays a key role in the proliferation and differentiation of epidermal cells. We have previously demonstrated a role for PKCe in the pathogenesis of the autoimmune disease Hashimoto’s thyroiditis (3). PKCe is over-expressed in CD4+ T lymphocytes isolated from PBMC fraction in patients affected by this pathology and its forced down-modulation primed the TGF-mediated in vitro Treg polarization of human T CD4+ cells. Since it has been demonstrated that PKC-signalling is altered in psoriatic keratinocytes (4), we investigated the involvement of PKCe in Th17 in vitro differentiation and its potentially implication in immune response correlated to psoriasis. Using western blot and real time PCR, we have observed that PKCe protein levels and mRNA increase during Th17-lineage in vitro differentiation from naive CD4+ T cells with a similar trend of Th17 markers of differentiation STAT3 and RoRyT. Moreover, PKCe overexpression significantly increases STAT3 and phosphorylated STAT3 levels, suggesting that PKCe boosts Th17 polarization. Thereafter, we sought to investigate PKCe expression in CD4+ lymphocytes obtained from peripheral blood of psoriatic patients and we observed that PKCe expression levels are significantly higher compared with healthy donors. Intriguingly, we observed a closely correlation of PKCe expression with PASI index, suggesting an involvement of the kinase with the severity of the disease. Collectively these data suggest that PKCe might be involved in Th17 differentiation, that it could be a key factor to regulate Th17 pathological expansion and therefore a potential psoriatic pharmacological target.

The value and controversy of thyroid peroxidase antibody in the diagnosis and treatment of autoimmune thyroid disease

Thyroid peroxidase antibody (TPOAb) play an important role in the diagnosis of autoimmune thyroid disease. Chemiluminescence immunoassay (CLIA) is a new method been strongly recommended in recent years. The definition of positive value of TPOAb is inconsistent. The definition of TPOAb positive value is important for exploring the development of autoimmune thyroid disease. TPOAb is significantly increased in Hashimoto′s disease and the titer is associated with the degree of infiltration and destruction of thyroid follicular. It is essential to monitor TPOAb in postpartum thyroiditis and early pregnancy. The positive of TPOAb is closely related to the adverse pregnancy outcomes caused by various risk factors. Graves disease combined with Hashimoto′s must to be considered. (Chin J Lab Med, 2015, 38: 884-887) Key words: Thyroid Diseases; Thyroiditis, autoimmune; Iodide peroxidase; Autoantibody

Correlation btween IgG4, TGF-β1, CTGF and fibrosis in Hashimoto thyroiditis

Objective To explore the correlation among serum immunoglobulin G4 (IgG4), transforming growth factor-β1 (TGF-β1), connective tissue growth factor (CTGF) and Hashimoto thyroiditis(HT) thyroid fibrosis. Methods Case-control study. A total of 159 patients with HT visiting the Wuhan Union Hospital were collected from May 2013 to March 2015. All patients were divided into IgG4 HT group (IgG4≥1.35 g/L, n=39) and non-IgG4 HT group (IgG4<1.35 g/L, n=120). The serum IgG4, TGF-β1 and CTGF were determined by enzyme-linked immunosorbent assays. The levels of serum thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb) were measured by electrochemiluminescence immunoassay. Meanwhile, ultrasound of the thyroid gland was performed. Statistical analysis was performed by use of SPSS 17.0 software. The Mann-Whitney U test was used to compare two independent samples of non-normal distribution data, Fisher′s exact test was employed to analyze thyroid imaging differences, correlation test was performed to examine various correlations, multivariate Logistic regression analysis was used to evaluate thyroid fibrosis risk factors. Results Compared with that of non-IgG4 HT group, IgG4 HT group: TPOAb [(455.2±169.7) vs. (186.5±102.3), U=27.0, P=0.003], TgAb [(984.6±452.7) vs. (289.3±245.1), U=30.5, P=0.017], TGF-β1 [(1.45±0.97) vs. (0.30±0.22), U=119.0, P=0.035] and CTGF [(88.65±14.39) vs. (62.21±8.76), U=69.0, P=0.039] were significantly higher, thyroid ultrasound showed obvious fibrosis (35/4 vs. 32/88, χ2=48.03, P=0.000); significant positive linear correlation between IgG4 and TPOAb (r=0.719, P=0.000), CTGF and TGF-β1 (r=0.500, P<0.01) respectively. Logistic regression analysis indicated that all the serum IgG4, TPOAb, TGF-β1 and CTGF were independent risk factors of thyroid fibrosis [IgG4, odds ratio (OR)=1.968, P=0.014, 95%confidence interval (CI)=1.287-2.041; TPOAb, OR=2.537, P=0.012, CI=1.322-2.869; TGF-β1, OR=1.549, P=0.023, CI=1.105-1.498; CTGF, OR=1.185, P=0.046, CI=1.204-1.625]. Conclusion The highlevel of circulating antibodies, IgG4, TGF-β1 and CTGF were significantly associated with thyroid fibrosis, and were independent risk factors of HT fibrosis.(Chin J Lab Med, 2015, 38: 848-851) Key words: Hashimoto disease; Fibrosis; Immunoglobulin G; Transforming growth factor beta1; Connective tissue growth factor