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PubMed2002

Reversible white matter alterations in encephalopathy associated with autoimmune thyroid disease.

Encephalopathy associated with autoimmune thyroid disease is an underdiagnosed clinical condition. No specific disease marker exists and to date, imaging techniques have not proven useful. The disease is characterized by seizures, stroke-like events and psychiatric symptoms. Here, we present the report of a patient with encephalopathy associated with autoimmune thyroid disease in which a reversible white matter disorder was detected by MR imaging. This encephalopathy was alleviated and later disappeared following corticosteroid treatment. We conclude that the white matter is the principal brain tissue involved in this condition and that brain MRI studies may prove to be a useful tool in the diagnosis of patients suffering this treatable disease.

Anti-Inflammatory Agents↗
PubMed2000

Thyroid disease in primary Sjögren syndrome. Study in a series of 160 patients.

We studied 160 consecutive patients (147 female and 13 male) with primary Sjögren syndrome (SS) to determine the prevalence and clinical significance of thyroid disease in a large series of patients with primary SS from our unit and to compare the prevalence and significance with those in 75 individuals without SS from a primary care center. Serum levels of thyroid hormones (free thyroxine, triiodothyronine, and thyroid-stimulating hormone) and autoantibodies against thyroglobulin (TgAb) and thyroid peroxidase (TPOAb) were measured in all SS patients and in 75 control patients. Fifty-eight (36%) of the 160 patients with primary SS had evidence of thyroid disease. Autoimmune thyroid disease (ATD) was diagnosed in 32 (20%) patients and nonautoimmune thyroid disease (NATD) in 26 (16%). No significant differences were found when these prevalences were compared with those in control patients. On the other hand, comparing those patients with altered hormonal profiles, patients with NATD showed mainly hyperthyroidism (10/17, 59% versus 2/20, 10% in patients with ATD, p = 0.001). Finally, when clinical and immunologic manifestations of SS were analyzed in patients with and without thyroid disease, respectively, we found that patients with thyroid disease had a higher prevalence of female gender (98% versus 88%, p = 0.03), antiparietal cell autoantibodies (33% versus 12%, p = 0.002), TgAb (30% versus 5%, p < 0.001), and TPOAb (40% versus 5%, p < 0.001). In conclusion, thyroid disease occurred in more than one-third of patients with primary SS; the main cause was ATD, which was present in 20% of the patients studied. We note that no significant differences were observed when the prevalence of thyroid disease (either ATD or NATD) was compared with that in a control group of similar age and gender. Our results indicate that middle-aged women (with or without SS) should be screened periodically for thyroid function.

Adult↗
PubMed1991

Thyroid disease in middle-aged and elderly Swedish women: thyroid-related hormones, thyroid dysfunction and goitre in relation to age and smoking.

The prevalence of thyroid disease and the concentration of thyroid hormones and thyrotropin were studied in a random population sample of 1154 women, aged 50-72 years, with special reference to the effect of age and smoking. The prevalence of spontaneous hypothyroidism was 3.3% (previously unknown overt and mild disease 1.3%) and the prevalence of hyperthyroidism was 2.5% (previously unknown disease 0.2%). Clinically suspected hyper- or hypothyroidism (very weak to strong) was recorded in 288 women, but was only verified in three cases. The prevalence of visible and palpable thyroid enlargement was 2.1% and 13-14%, respectively. Total thyroxine concentrations increased and free tri-iodothyronine levels decreased significantly with age (P less than 0.001). The serum thyrotropin concentrations were lower in smoking women than in non-smokers in the 50- and 58-year age groups (P less than 0.05). There was no increase in the prevalence of thyroid disease or goitre in the women who were smokers at the time of the study.

Age Factors↗
PubMed1989

[Evaluation of fine needle aspiration cytology in the diagnosis of thyroid diseases].

The role of fine needle aspiration cytology (FNA) was examined in 384 patients with thyroid diseases referred to the thyroid clinic from May 1984 to June 1988. The cytological diagnoses were 65 (16.9%) malignant neoplasms, 137 (35.7%) benign neoplasms, 135 (35.2%) chronic thyroiditis, 20 (5.2%) thyroid cysts, and 27 (7.0%) other thyroid diseases including Graves' disease and subacute thyroiditis. Ninety-eight patients were selected for thyroidectomy based on criteria, which included clinical and cytological diagnosis, and the following pathological diagnoses of resected specimens were obtained: 45 (45.9%) papillary carcinoma, 9 (9.2%) follicular carcinoma, 26 (25.5%) follicular adenoma, 1 (1.0%) papillary adenoma, 14 (14.3%) adenomatous goiter, and 3 (3.1%) Hürthle cell adenoma. The accuracy of diagnosis of goiter by FNA was examined by comparing with that by histological findings. False negative rate, false positive rate, true positive rate, and true negative rate of FNA were 5.7%, 10.0%, 94.3%, and 90.0% respectively. The calculated sensitivity, specificity, and accuracy of FNA were 92.6%, 92.3% and 92.5% respectively. These results indicate that the FNA is a safe and reliable method for routine use in the evaluation of nodular thyroid disease.

Adult↗
PubMed2000

Estrogen receptor alpha dinucleotide repeat polymorphism in Japanese patients with autoimmune thyroid diseases.

BACKGROUND: The autoimmune thyroid diseases (AITDs), comprising Graves' disease (GD) and Hashimoto's thyroiditis (HT), appear to develop as a result of complex interactions between predisposing genes and environmental triggers. Susceptibility to AITDs is conferred by genes in the human leukocyte antigen (HLA) and genes unlinked to HLA, including the CTLA-4 gene. Recently, an association to some estrogen receptor (ER)alpha genotypes with breast cancer, hypertension, osteoporosis, generalized osteoarthritis, and some autoimmune diseases such as rheumatoid arthritis has been reported. We have analyzed a dinucleotide (TA)n repeat polymorphism lying upstream of the human ERalpha gene in patients with AITDs and in normal subjects. RESULTS: Seventeen different alleles were found in 130 patients with GD, 93 patients with HT, and 190 control subjects. There was no significant difference in the distributions of ERalpha alleles between patients and controls. CONCLUSIONS: The present results do not support an association between the ERalpha gene and AITD in the Japanese population.

Journal Article↗
PubMed2002

Thoughts on prevention of thyroid disease in the United States.

In the realm of preventive medicine, there are three distinct types of prevention that can be defined. Primary prevention is the prevention of new disease in previously healthy individuals, usually achieved by decreasing risk factors for disease. Secondary prevention is the prevention of progression of mild or latent disease to more severe disease, and typically involves screening for occult disease. Tertiary prevention is the term used by some to describe medical care intended to improve already established disease. The role of primary prevention of thyroid disease in the United States is uncertain, because iodine deficiency is not clearly known to be a problem. In the case of secondary prevention of thyroid disease, this would necessarily involve screening of individuals for subclinical hyperthyroidism or hypothyroidism with thyrotropin (TSH) testing. Using data from a large prevalence study and from the 2000 U.S. Census, it can be calculated that approximately 15 million adults have unrecognized thyroid disease, mostly subclinical hypothyroidism. If detected, secondary prevention might also entail treatment with antithyroid drugs/radioiodine or thyroxine to prevent sequelae or progression to a more advanced degree of thyrotoxicosis or thyroid failure, respectively. Over the next 20 years, it can be calculated that approximately 5 million people, mostly with subclinical hypothyroidism, will progress to overt disease. Tertiary prevention of thyroid disease would involve avoiding iatrogenic disease, such as thyroid hormone overdose. From epidemiologic data it can be calculated that approximately 600,00 elderly individuals have iatrogenic hyperthyroidism from thyroid hormone overdose, putting them at risk for atrial fibrillation and osteoporosis. Together, these data suggest that the notion of preventive medicine in the United States should be expanded to include thyroid disease as a target for secondary and tertiary intervention.

Humans↗
PubMed2004

Thyroid disease in Tikur Anbessa Hospital: a five-year review.

Diseases of the thyroid are not uncommon particularly in the highlands of Ethiopia. To see the pattern of surgical thyroid disorders, a review of operated cases of thyroid diseases in the period 1997-2001 was conducted in Tikur Anbessa Hospital, Addis Ababa. During the period, 472 patients underwent surgery for goiter. Of these, records of 377 patients could be retrieved and form the basis for this analysis. The mean age was 35 (range, 15-73) years. The sex ratio, M : F was 1: 3.8. The mean duration of symptoms on admission was 7 years. The most frequent presenting feature was goiter. Symptoms of airway obstruction and hyperthyroidism were not rare. About 12% of patients were clinically and biochemically categorized toxic. Location of goiter was specified in 349 cases. Of these, 56.7% had bilateral disease. Nodular colloid goiter was the most common pathological type. Neoplasm of the thyroid appeared not to be rare. The mean pre- and postoperative hospital stays were 12 and 6 days, respectively. About 66% of patients had partial or subtotal thyroidectomy. Significant intraoperative hemorrhage requiring blood transfusion occurred in 12 (3%) patients. Some post operative complications including pneumonia, wound infection, recurrent nerve or parathyroid gland injury, and recurrent goiter or hyperthyroidism were noted. One case developed thyroid crisis. Less radical surgical procedures, we believe, are adequate for all benign and most malignant goiters in Ethiopia. In areas where thyroxin is in short supply and follow-up is erratic total thyroidectomy as is recommended else where should be reserved for only few selected cases.

Adolescent↗
PubMed2002

Thyroid disease and the skin.

Cutaneous manifestations of thyroid disease are protean in nature and can be divided into specific lesions such as the thyroglossal duct cyst and cutaneous metastases from thyroid malignancy, nonspecific signs secondary to thyroid hormone imbalance, and associated dermatologic and systemic disorders. This review represents a summary and update of thyroid disease and the skin.

Autoimmune Diseases↗
PubMed2004

Stromal cell-derived factor-1 chemokine gene variant in patients with type 1 diabetes and autoimmune thyroid disease.

Type 1 diabetes is a heterogenous autoimmune disease and is frequently associated with other organ-specific autoimmune diseases, including autoimmune thyroid disease (AITD). Type 1 diabetic patients with AITD are known to have clinical and immunological features distinct from patients without AITD. This study investigated whether stromal cell-derived factor (SDF)-1 gene polymorphism is associated with susceptibility to type 1 diabetes and AITD. SDF-1 is a powerful chemokine that upregulates T-cell migration and activation, and the gene for SDF-1 is located near type 1 diabetes susceptibility locus IDDM10. The SDF1-3'A variant (801 G to A in the 3'-untranslated region) was determined by the PCR-RFLP technique in 54 type 1 diabetic patients with AITD, 75 type 1 diabetic patients without AITD, 137 nondiabetic patients with AITD, and 106 healthy subjects in a case-control study. No significant differences on the allele and genotype frequencies of the SDF1 gene polymorphism were found, not only in type 1 diabetic patients with AITD compared with normal controls but also between nondiabetic patients with AITD and healthy control subjects. These results suggest that the SDF1-3'A variant is not associated with genetic susceptibility to type 1 diabetic patients and AITD.

Autoimmune Diseases↗
PubMed1991

Autosomal dominant inheritance of autoantibodies to thyroid peroxidase and thyroglobulin--studies in families not selected for autoimmune thyroid disease.

Recently the tendency to produce autoantibodies to thyroid peroxidase (TPO Ab) and thyroglobulin (Tg Ab) was shown to be inherited as an autosomal dominant characteristic in women but not in men. Because of potential bias in this study which was carried out in families with autoimmune thyroid disease (AITD), the inheritance of thyroid autoantibodies has been evaluated in 49 families unselected for autoimmune thyroid disease. Among these families (24 with facioscapulohumeral disease, 10 with Friedreich's ataxia, and 15 with schizophrenia) the prevalences of TPO Ab and Tg Ab were 27.8% and 26.7%, respectively, in women and 9.2% and 11.7%, respectively, in men. In 40 families where one or more individual had TPO Ab and/or Tg Ab, segregation analysis showed that the tendency to make antibodies was consistent with a Mendelian dominant trait in women but not in men. In young women, however, the prevalence of both TPO Ab and Tg Ab increased with age, rising from 14% and 10%, respectively, at age 15-24 to 35% and 40% at age 35-44. As this is inconsistent with a simple dominant hypothesis, a further segregation analysis by age was carried out in the families unselected for thyroid disease together with 16 pedigrees with AITD previously studied and two additional large AITD families. The results of the combined analysis provided strong support for the hypothesis of dominant inheritance but also showed significant reduction in gene expression among women aged 15-24 yr.

Adolescent↗
PubMedDate not supplied

[Analysis for the diagnosis of auto-immune thyroid disease: contribution of the laboratory].

Autoimmune thyroid diseases occur in subjects with genetic predisposition, and are responsible for a large spectrum of clinical manifestations. They have in common the presence of intra-thyroid lymphocytic infiltrate and serum antibodies against thyroid constituents. The main thyroid antigens are thyroglobulin (Tg), thyroperoxidase (TPO), thyrotropin receptor (RTSH) and sodium/iodide symporter (NIS) which has been recently cloned. The assays for antiTg and antiTPO antibodies have high specificity and sensitivity, but standardisation problems still exist. Second generation antiRTSH assays are now available. The discrimination between the stimulating and the blocking activities can been studied using cellular culture. The antiTPO antibodies are the more sensitive and the more specific diagnostic markers for autoimmune thyroid diseases but their use for therapeutic decision is limited. They are good predictive factors for a thyroid dysfunction during pregnancy, during amiodaron, lithium, and cytokines treatments. The antiTg antibodies search enables the validation of a Tg assay. The antiRTSH antibodies are precious tools for the diagnostic and the follow-up of Graves' diseases and fetal pathologies caused by the antibodies crossing over the placental barrier. The utility of antiNIS antibodies determination is not yet proved.

Autoantibodies↗
PubMed2000

Autoimmune thyroid disease and antiphospholipid antibodies.

OBJECTIVE: Autoimmune thyroid disease (ATD) is associated with circulating autoantibodies reactive with epitopes on thyroid tissue and that are thought to be pathogenic in the development of these diseases. Antiphospholipid antibodies (APLA) are a family of immunoglobulins that recognize a variety of plasma proteins in association with anionic phospholipids. These antibodies may lead to a number of clinical syndromes including venous and arterial thromboses, thrombocytopaenia, and recurrent fetal loss. We have studied the prevalence of APLA in patients with ATD and have determined the prevalence of the APLA syndrome among APLA-positive patients. DESIGN: The study was a retrospective survey of patients with autoimmune thyroid disease attending the endocrinology clinic of a tertiary care academic hospital. PATIENTS AND MEASUREMENTS: One hundred and thirty patients with autoimmune thyroid disease from the endocrinology clinic at our hospital were studied. 84% had chronic thyroiditis and 16% had Graves' disease. Free T4 and thyroid stimulating hormone (TSH) levels, antimicrosomal and antithyroglobulin antibodies, and an antiphospholipid antibody test were performed on all subjects. RESULTS: 43% of patients with chronic thyroiditis and 43% of patients with Graves' disease were APLA positive, with an overall rate of 43% APLA positivity among patients with ATD. Of the 56 patients that were APLA positive, forty-eight (86%) had APLA of the IgG subtype, four (7%) had IgM antibodies, and nine (16%) had both IgG and IgM antibodies. None of the patients had clinical evidence of the APLA syndrome. CONCLUSIONS: We conclude that the prevalence of APLA in ATD is increased compared to healthy individuals but that this is likely to be an epiphenomenon. However, prolonged follow up is necessary in order to determine the true clinical significance of these antibodies in ATD patients.

Antibodies, Antiphospholipid↗
PubMed1995

Thyroid disease and associated illness in the elderly.

Unlike younger populations with thyroid disease, elderly patients often have multiple complex illnesses coincident with their thyroid disease. This article focuses on common geriatric problems that interact with thyroid disease, including osteoporosis, diabetes mellitus, lipid abnormalities, autoimmune diseases, dementia, and malnutrition. Recognition that thyroid disease can cause or aggravate these disorders will lead to their early detection and appropriate therapy.

Aged↗
PubMed1975

Insoluble particulate antigen(s) in cell-mediated immunity of autoimmune thyroid disease.

Cell-mediated immunity (CMI) in patients with Grave's disease, chronic thyroiditis, and primary hypothyroidism was observed by assay of lymphocyte-mediated cytotoxicity (LMC) and leukocyte migration inhibition (LMC). Lymphocyte responsivity to phytohemagglutinin (PHA) is normal in these disease. In the LMC assay, lymphocytes of patients in each category responded to the antigens of thyroid homogenates, but not purified human thyroglobulin. Cytotoxicity is least in Graves disease and most obvious in primary hypothyroidism. In the LMI assay, patients lymphocytes responded to thyroid microsomal--mitochondrial antigens, but not to thyroid cell sap. Lymphocytes of Graves disease patients also responded to liver microsomal mitochondrial antigens. The particulate antigens lost activity when solubilized by ultrasonication or KCL extraction. There is no correlation between the PHA responsivity of lymphocytes and thyroid function, or between CMI and serum antithyroid antibodies or thyroid size. Treated and untreated patients had similar evidence of CMI. These data indicate that function of thymus-derived lymphocyte in vitro is not disturbed in autommune thyroid disease and that CMI against thyroid antigens can be demonstrated by assay of LMC and LMI. Insoluble particulate antigens appear more important than soluble antigens in CMI. LMC, resumably induced by soluble cytotoxic factor, "lymphotoxin," may play an important role in the progress of the autoimmune thyroid disease to hypothyroidism.

Antigens↗
PubMed1991

Association between autoimmune thyroid disease and familial Alzheimer's disease.

OBJECTIVE: To determine the prevalence of autoimmune thyroid disease in Familial Alzheimer's Disease kindreds and to ascertain whether there is any evidence for genetic linkage between the two conditions. DESIGN: Retrospective study of Familial Alzheimer's Disease kindreds. PATIENTS: Seventy affected and unaffected family members from 12 kindreds. MEASUREMENTS: Anti-thyroglobulin and anti-microsomal autoantibody status was determined using an enzyme-linked immunosorbent assay. Thyrotrophin levels were determined by an immunoradiometric assay. RESULTS: Of the family members, 41.4% had evidence of autoimmune thyroid disease, with significant co-segregation between the presence of thyroid autoantibodies and the development of Alzheimer's disease (P less than 0.01). CONCLUSIONS: This study demonstrates a very high prevalence of autoimmune thyroid disease in Familial Alzheimer's Disease kindreds and suggests that a genetic factor contributing towards the development of autoimmune thyroid disease may be located on chromosome 21 within close proximity to the Familial Alzheimer's Disease gene.

Adult↗
PubMed2003

Association of interleukin-18 gene promoter polymorphisms in type 1 diabetes and autoimmune thyroid disease.

Type 1 diabetes is a heterogeneous autoimmune disease and is often associated with other organ-specific autoimmune diseases, including autoimmune thyroid disease (AITD). IL-18 is a potent proinflammatory cytokine capable of inducing IFN-gamma production that is associated with the development of type 1 diabetes and AITD. The gene for IL-18 is located near Idd2 and has been reported to be associated with a susceptibility to type 1 diabetes. To test the putative involvement of IL-18 gene polymorphism in predisposition to type 1 diabetes and AITD, we conducted a case-control study in Japanese population. The SNPs at position -607 (C/A) and -137 (G/C) in the promoter region of the IL-18 gene were analyzed by sequence-specific PCR in 74 nondiabetic patients with AITD, 47 type 1 diabetic patients with AITD, and 114 normal controls. There was no significant increase in the genotype and allele frequencies not only in nondiabetic patients with AITD compared with normal controls, but also in type 1 diabetic patients with AITD compared with normal controls. The distribution of IL-18 gene haplotypes was also similar between both patient groups and normal controls. These results suggest that polymorphisms of the IL-18 gene are not associated with a susceptibility to AITD and type 1 diabetes coexistent with AITD in Japanese population.

Adult↗
PubMedDate not supplied

Ultrasound measurement of the horizontal external eye muscles in patients with thyroid disease. Is orbital involvement associated with thyroid autoantibodies?

PURPOSE: To describe ophthalmic findings with emphasis on exophthalmometry and ultrasonic assessment of extraocular eye muscle diameter in a consecutive group of females with Graves' disease (GD), compared with healthy controls and patients with other thyroid diseases. We also investigated the relationship with biochemical markers of thyroid autoimmunity such as TSH receptor antibodies (TRAb) and anti-thyroid peroxidase antibodies (anti-TPO). METHODS: Seventy adult women (age 26-74 years) with various types of thyroid disease consecutively entered the study at a tertiary referral center for thyroid-associated ophthalmopathy (TAO). Twenty-three had long-standing GD with TAO. Clinically, TAO was mainly absent in 22 with newly diagnosed GD and in seven with relapse of GD. Nine with Hashimoto's thyrolditis and nine with multinodular goiter were included for comparison and 18 healthy females served as controls. A full ophthalmic status included B-scan ultrasonic assessment of the four horizontal rectus muscle thicknesses, and a clinical NOSPECS score was attempted for each. RESULTS AND CONCLUSIONS: Besides higher NOSPECS scores, the TAO subgroup had higher exophthalmometry and muscle thickness. The GD groups without significant TAO also scored higher in these ratings compared to controls. Hertel recordings, NOSPECS and muscle thicknesses were all correlated in GD but showed no correlation to thyroid antibodies (TRAb and anti-TPO). Thus, the muscle thickness did not correlate with thyroid autoimmune activity. Nevertheless, we found extraocular muscle assessment useful since a) thicker muscles were usually found in patients with GD, with or without evidence of TAO, and b) other space-occupying orbital lesions could be excluded, thereby reducing the need for the more elaborate imaging techniques (CT, MRI, etc.).

Adult↗
PubMed1981

Antibody inducing lymphocyte cytotoxicity (ADCC) and lymphocyte-mediated cytotoxicity in auto-immune thyroid diseases.

Addition of heat-inactivated serum from patients with autoimmune thyroid diseases to normal nonadherent human lymphoid cells caused significant lysis of thyroglobulin or crude thyroid extract-coated erythrocytes. Serum from 9/10 patients with Hashimoto's thyroiditis induced significant chromium release by normal lymphocytes at higher dilution (greater than 1 : 1 000) than in other thyroid diseases, the mean highest positive dilution being 1 : 535 in Grave's disease and approximately 1 : 200 in primary hypothyroidism, hyperthyroidism without exophthalmos and non toxic goitres. Lymphocyte-mediated cytotoxicity in the absence of serum was found positive on one half of the patients with lymphocyte-dependent antibody. Besides an appraisal of autoimmunization in thyroid diseases, such cell-mediated reactions may indicate how the gland is damaged in autoimmune thyroid diseases.

Adolescent↗