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PubMed1995

Autoimmunity and thyroid function in patients with chronic active hepatitis treated with recombinant interferon alpha-2a.

The occurrence of thyroid abnormalities and the appearance of organ- and non-organ-specific autoantibodies during long-term recombinant interferon alpha-2a (IFN-alpha) therapy were studied in 86 and 51 consecutive outpatients with hepatitis C and B virus-related chronic active hepatitis (CAH-HCV and CAH-HBV), respectively. Most patients had longstanding community-acquired hepatitis. At baseline, 9.3% of CAH-HCV and 3.9% of CAH-HBV patients showed clinical and/or biochemical signs of thyroid dysfunction. The remaining patients were euthyroid, although anti-thyroid autoantibodies were found in 33/78 (42.3%) of CAH-HCV and in 5/49 (10.2%) of CAH-HBV patients. During IFN-alpha treatment, increased anti-thyroid autoantibody levels were seen in 40% of CAH-HCV initially negative patients, while they became detectable in no more than 10% of CAH-HBV patients. Interferon-alpha-induced hypo- or hyperthyroidism was recorded in 12 of 35 CAH-HCV patients treated for 12 months (34.3%). Only one CAH-HBV patient developed hyperthyroidism. High titers of anti-nuclear autoantibodies (ANA) were recorded at enrollment in 5/36 (13.8%) of CAH-HCV and in 3/16 (18.7%) of CAH-HBV patients. Only one CAH-HCV patient displayed anti-parietal cell antibodies (PCA). After IFN-alpha treatment, ANA were found in 10/28 (35.7%) and PCA in 2/28 (7.1%) of CAH-HCV patients, while an additional CAH-HBV patient developed PCA, but not ANA. However, no signs of systemic autoimmune disease were recorded.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

[Hypothyroidism in patients treated for laryngeal cancer: preliminary results].

OBJECTIVE: The reported incidence of hypothyroidism following surgery and/or irradiation for laryngeal cancer varies widely and the condition often is misdiagnosed. This study examines the incidence of thyroid dysfunction in patients with laryngeal cancer. MATERIAL AND METHODS: Thyroid function tests were carried out in 75 patients with stage III and IV laryngeal carcinoma who were treated in our center with surgery (13 cases), radiotherapy (13 cases), or surgery and radiotherapy (49 cases) at least 18 months earlier. The clinical and histological variables recorded included T4 and TSH concentrations. Univariate and multivariate analysis was carried out with the BMDP program from UCLA (1995 version) to examine the relationship between hypothyroidism and clinical and pathological factors. RESULTS: Twenty-nine patients (38.6%) had high TSH or low T4 concentrations and were diagnosed as having hypothyroidism. Hypothyroidism was significantly related with date of surgery (before 1993) and the treatment used on the neck. Thyroid function was rarely affected in patients who underwent functional neck dissection, but radical neck dissection and irradiation of the neck always were followed by hypothyroidism. CONCLUSIONS: Thyroid testing should be performed routinely in the follow-up of laryngeal cancer. Many psychological symptoms attributed to total laryngectomy may be due to hypothyroidism, an easily treated condition.

Carcinoma, Squamous Cell↗
PubMed2005

[Autoimmune thyroid disease: a case report].

Autoimmune thyroid disease is the most common cause of subclinical thyroid dysfunction (hypo and hyperthyroidism) in the western countries. Autoimmune thyroid diseases with clinical relevance (Graves' disease and autoimmune hypothyroidism) are common and can present with a large clinical and laboratorial spectrum. Hypo and hyperthyroidism can exist in the same patient, on different times. Progression from Graves hyperthyroidism to chronic autoimmune thyroiditis and hypothyroidism is now well-recognized and the inverse might also occur, although being rare. We describe a case report of Graves' disease in a patient with a chronic autoimmune hypothyroidism of long course (diagnosed 21 years ago).

Aged↗
PubMed1984

Normal reference interval for thyrotropin response to thyroliberin: dependence on age, sex, free thyroxin index, and basal concentrations of thyrotropin.

We measured the thyrotropin response (delta TSH) to 200 micrograms of thyroliberin in 131 subjects without thyroid dysfunction or other disease and with basal values for thyroid function that were within the normal reference intervals for our laboratory. By univariate and multivariate statistical methods we found delta TSH to be significantly influenced by the basal concentration of thyrotropin (TSH0) and the free thyroxin index (FT4I). When the effects of variations in TSH0 and FT4I were eliminated, delta TSH in men under 40 years of age did not differ from that in women. A decrease in delta TSH with increasing age was found in men but not in women. Thus a reference interval for delta TSH should consider TSH0, FT4I, and, in men, age. On the basis of multiple linear regression analysis, we constructed a formula for delta TSH reference intervals that takes into account individual values for TSH0 and FT4I. The formula should be applicable for women, regardless of age, up to 77 years and for men under 40 years. For older men a correction for the age-related decrease in delta TSH must be applied.

Adult↗
PubMedDate not supplied

[Thyroid function in different clinical variants of glomerulonephritis in children].

The paper shows that children with glomerulonephritis develop autoimmune disorders and stable thyroid dysfunction. That's why it is valid to include thyroid function correcting drugs in the combined regimens. The drugs should be assigned with consideration of individual clinical syndromes of acute and clinical forms of chronic glomerulonephritis.

Acute Disease↗
PubMed1976

[Infantile and juvenile hypothyroidism with the gland in place and low radio-iodide uptake].

27 hypothyroid infants of children, with a low iodine uptake in spite of a thyroid gland or thyroid tissue in normal pretracheal place, have been studied. 21 cases are related to primary thyroid involvement leading to vanishing iodine or technetium uptake. In 8 of these cases, clinical onset in late childhood, high frequency of antithyroid antibodies and of familial thyroid dysfunction were similar to those found in childhood's thyroiditis. 8 other cases had a precocious onset (first months in 6, first year in 1, second year in 1) with some pretracheal iodine uptake when first studied and no uptake at further examinations, 1 patient having received no treatment from first to second study, the others being without treatment from more than two months and certain of them receiving injections of TSH. The last 5 cases of this group were those of children born to 2 mothers with treated hypothyroidism, with low iodine uptake in pretracheal place. The role of genetic factors and auto-immunity in theses cases is discussed. The 6 other patients had clinically isolated hypothyroidism secondary to TSH deficiency, eventually associated to clinically inapparent GH or ACTH deficiencies, most of them by hypothalamic defect with normal response to TRH.

Adolescent↗
PubMed2005

[Autoimmune thyroid disease and brain].

Changes of the affective and cognitive function are usually associated with thyroid gland dysfunction. In autoimmune thyroid disease, these changes can be caused by thyroid dysfunction (hypo- or hyperthyroidism) or associated with the presence of antithyroid antibodies. Even a small change in thyroid hormone concentration is associated with change of cognitive function. In euthyroid older males, variation of total and free thyroxin accounts for about 10% of Wechsler adult intelligence test variance. In euthyroid females, lower cognitive function, measured by Mini Mental test, also correlates with blood thyroxin. Short-term (4 weeks) hypothyroidism induces clinically significant cognitivedysfunction, which is reversible by thyroid hormone substitution. Mild hypothyroidism (TSH less than 10) also induces reversible cognitive dysfunction. In hypothyroidism, PET scanning shows global reduction of brain blood flow and glucose metabolism. Hashimoto's encephalopathy is characterized by corticosteroid reversible encephalopathy associated with the presence of antithyroid antibodies. Encephalopathy can be manifested as multiple stroke-like episodes (vasculitis like), or as diffuse, progressive type characterized by dementia and psychiatric symptoms. In euthyroid patients with Hashimoto's thyroiditis and no evidence of neurological disease, SPECT showed brain perfusion abnormalities. Post mortem and brain biopsy findings can be normal or show perivascular lymphocytic infiltration. Recently, presence of antineuronal antibodies has been found in patients with Hashimoto's thyroiditis. Specific high reactivity against human alpha-enolase was high in patients with Hashimoto's encephalopathy, but absent in patients with other neurological disorders and healthy subjects. Specific antineural antibodies were found in another group of Hashimoto's encephalopathy patients. Furthermore, Ferracci et al, found antithyroid antibodies in the CSF of patients with Hashimoto's encephalopathy.

Autoimmune Diseases↗
PubMed2002

[Pituitary diseases in elderly patients with chronic renal insufficiency].

Chronic renal failure (CRF) in the elderly is a cause of multiple endocrine dysfunctions. The three most common pituitary axes involved are the thyrotrope, lactotrope and gonadotrope axes. Thyroid dysfunction may be the consequence of thyroid or pituitary failure. Hyperprolactinemia results in gonadal failure and is present in 30% of patients. Early presentation of menopause and andropause are common in patients with CRF. Sexual hormonal replacement is controversial and must be individually tailored. We propose a systematic screening in the elderly with CRF: determination of TSH, TPO antibodies and cervical palpation, measures of PRL, LH, FSH and testosterone to explore lactotrope and gonadotrope axis.

Aged↗
PubMed1991

Thyroid gland size and function in patients with cirrhosis of the liver.

Thyroid dysfunction has long been reported in patients with liver disease, but limited information is available on thyroid gland size in cirrhosis. Most studies were carried out on small, selected series of patients, and no study has measured thyroid volume in relation to the etiology of liver disease. Thyroid volume was measured at ultrasound in 118 consecutive patients with cirrhosis of different etiology and 48 healthy subjects matched for age and sex. No subjects had evidence of overt thyroid disease. The mean volume was increased by 17% (from 16.0 [SD 5.2] ml in controls to 18.8 [7.6] in cirrhosis; P less than 0.025), and thyroid enlargement (antero-posterior diameter greater than 20 mm) was present in 38% of cases, in the presence of hormone values indicative of low-T3 syndrome. No significant differences in thyroid gland size were observed in relation to the extent of liver dysfunction or to the etiology of liver disease. The prevalence of thyroid nodules was similar in controls and in patients with cirrhosis. In only 8% of cases were laboratory values indicative of hypothyroidism, with low free triiodothyronine and raised thyroid-stimulating hormone levels; in these patients thyroid volume was decreased on average by 26%. This was mainly the case with patients with primary biliary and alcoholic cirrhosis. The largest mean thyroid volume was observed in patients with HBsAg + ve postnecrotic cirrhosis, whose thyroid volume was increased on average by 37%, and 53% of subjects had thyroid enlargement. This finding raises the question of a possible direct involvement of the thyroid in hepatitis B virus infection.

Female↗
PubMed1987

Thyroid disease and reproductive dysfunction: a review.

Thyroid disorders are often ubiquitous and insidious in their presentation. They have been implicated in a broad spectrum of reproductive disorders ranging from abnormal sexual development to menstrual irregularities and infertility. If pregnancy occurs in a patient with thyroid disease, the physician must ensure that therapeutic measures instituted to restore the health of the mother do not adversely affect the developing fetus. This review examines the role of thyroid disease in disorders confronting the obstetrician/gynecologist and provides a theoretical framework upon which to base practical management decisions.

Congenital Hypothyroidism↗
PubMed1994

Impaired local deiodination of thyroxine to triiodothyronine in dogs with symmetrical truncal alopecia.

Thyroid dysfunction causes certain dermatological alterations in dogs. Insufficient delivery of thyroid hormone to the skin may originate not only from inadequate thyroid function but also from impaired local activation of thyroxine in the target organ. Thyroid parameters and deiodination were investigated in healthy dogs (group C) and in dogs with cutaneous lesions associated with hypothyroidism (group H) or with a low-T3 syndrome (group LT). The ability of the skin to convert T4 to T3 was impaired in both groups H and LT but not in the controls. It is concluded that impaired local deiodination may contribute to skin problems in dogs.

Alopecia↗
PubMed1996

Nonhepatic manifestations and combined diseases in HCV infection.

Infection with hepatitis C virus (HCV) may affect not only the liver but also various nonhepatic tissues and organs and may combine with many etiologically unrelated diseases and morbid conditions. Numerous nonhepatic manifestations in HCV infection have been previously reported. For some (eg, cryoglobulinemia), the association is well established. For others, such as sialadenitis and lichen planus, the association is probable (but not completely documented) and, for the remainder, the associations are weak. Extrahepatic manifestations may result from immunological mechanisms as well as virus invasion and replication in the affected extrahepatic tissues and organs. Thyroid abnormalities, primarily Hashimoto's disease, and isolated increases of anti-thyroid antibodies (ATPO) appear to be more frequent in chronic hepatitis C than B or D, with high ATPO titers clustering mainly among females. Interferon-alpha (IFN-alpha) therapy is associated with development of thyroid dysfunction in 5.5-12.9% of patients, usually exposing preexisting subclinical thyroid abnormalities. Mixed cryoglobulinemia (MC) is commonly found (36-45%) in patients with chronic HCV infection; however, only in a minority of cases does it become clinically manifested as systemic vasculitis with purpura, neuropathy, or Raynaud's phenomenon. In a number of patients, MC may terminate in non-Hodgkin's B-cell lymphoma. Treatment of these lymphoproliferative disorders with IFN-alpha is advocated. Idiopathic thrombocytopenia is now recognized more frequently in association with chronic HCV infection and is usually aggravated by IFN-alpha therapy. Patients with porphyria cutanea tarda (PCT) have demonstrated serological markers of HCV infection in 62-82% of cases. The usefulness of IFN-alpha in PCT remains to be demonstrated. Lichen planus has also been found in association with chronic HCV infection, particularly when severe or affecting the oral cavity. Other nonhepatic manifestations have also been reported in HCV infection such as diabetes, corneal ulceration, uveitis, and sialadenitis. These manifestations deserve further study and documentation. Finally, markers of autoimmunity occur with high frequency in chronic HCV infection; however, combination with the classical syndrome of autoimmune hepatitis is rare. In the presence of various autoantibodies, the clinical features of chronic hepatitis C do not appear to be modified and, contrary to general perception, IFN-alpha therapy within randomized controlled trials should not be withheld since the response rate to IFN-alpha does not appear to differ in the presence or absence of low titers of these markers.

Autoimmune Diseases↗
PubMed2000

Value of thyroid function tests in routine screening of women investigated for infertility.

Women presenting with infertility traditionally have been screened for thyroid function, yet recent guidelines have indicated that this is unnecessary in asymptomatic patients. A retrospective analysis of the results of routine thyroid function screening showed that occult thyroid dysfunction is common: 5.1% of the population studied had abnormal thyroid function tests. Therefore, it is recommended that assessment of thyroid function in women attending an infertility clinic should be continued.

Journal Article↗
PubMed2006

No apparent damage in the thyroid of transgenic mice expressing antiapoptotic FLIP.

FLIP is an antiapoptotic protein that has been demonstrated to play an important role in inflammation, cancer, and autoimmune diseases. However, it is not known whether increased expression of FLIP (FLICE inhibitory protein) in thyrocytes would alter the development of the thyroid and/or pathogenesis of thyroiditis. To examine the effects of overexpression of this antiapoptotic molecule on the thyroid, we have developed transgenic mouse lines that specifically express FLIP in thyrocytes. A DNA construct designed with an in-frame coding sequence for the E8 protein, a viral FLIP, was put under the control of the thyroglobulin (Tg) promoter (the Tg-FLIP transgene). In 8 of 12 resultant transgenic mouse lines, FLIP expression in thyrocytes driven by the Tg promoter was documented, and confirmed at RNA and protein levels. These Tg-FLIP transgenic mice were monitored for 1 year. Throughout the entire observation period, the transgenic mice remained alive and healthy without evidence of thyroid dysfunction. Adult mice were able to breed. Histologic examination of thyroids obtained at various time points did not reveal significant differences between transgenic mice and their control littermates. Therefore, transgenic mice with thyrocyte-specific expression of FLIP have normal thyroid development with no significant changes in thyroid cell death or proliferation.

Animals↗
PubMed2006

Lower TSH and higher T4 levels are associated with current depressive syndrome in young adults.

OBJECTIVE: The relationship of individual thyroid function indices to depression in those without a history of prior thyroid dysfunction is uncertain. METHOD: We examined the relationship between thyroid-stimulating hormone (TSH) and thyroxine (T4) levels and current or lifetime history of depressive symptoms using information from 6869 participants, aged 17-39 years, in the Third National Health and Nutrition Examination Survey without history of thyroid-related illness. RESULTS: We found that lower TSH and higher T4 levels were associated with current depressive syndrome in men, but only higher T4 levels correlated with current depressive syndrome in women. Lifetime depressive syndrome was associated with neither TSH level nor T4 levels in men or women. CONCLUSION: These findings suggest that transient or 'state dependent' changes are associated with depression in those without a history of thyroid illness. Further studies to discern whether these depression-associated changes represent distinct endophenotypes of depression should be encouraged.

Adolescent↗
PubMed2000

Thyroid disease: a review for primary care.

Manifestations of thyroid disease include hyperthyroidism and hypothyroidism. In the past, the diagnosis of thyroid disease has been perplexing due to the multisystemic effects of thyroid hormone and the lack of specificity in laboratory tests. New methods of measuring thyroid function have made screening and diagnosis of thyroid dysfunction both more accurate and cost-effective. Testing for thyroid stimulating hormone (TSH) is now a first-line diagnostic procedure and, in some cases, may be the only test indicated. The general pathophysiology of thyroid, the diagnosis and management of thyroid disease, and current screening recommendations are reviewed here.

Humans↗
PubMed2006

Anti-thyroid peroxidase antibody and vitiligo: a controlled study.

BACKGROUND: Vitiligo is an acquired depigmenting disorder due to destruction of melanocytes. Although many theories have been suggested for its pathogenesis, the role of autoimmunity is the most popular one. The association of vitiligo with autoimmune thyroid diseases and the increased prevalence of autoantibodies including thyroid autoantibodies in vitiligo favor this role. Our objective was to compare the frequency of thyroid peroxidase antibody (anti-TPO) in vitiligo patients with healthy subjects in Iran. METHODS: Ninety-four cases of vitiligo (46 female and 48 male) and 96 control subjects (49 female and 47 male) were enrolled in this controlled study. Patients with known thyroid disease, history of thyroid surgery and those receiving thyroid medications were not included. The two groups were matched regarding gender and age. The demographic data, symptoms related to thyroid diseases and results of skin and thyroid examinations were recorded in a questionnaire for each subject. Thyroid function tests including free T3, free T4 and TSH-IRMA were performed. Anti-TPO levels were assessed as well. The collected data were analyzed by SPSS version-11 in vitiligo patients and subgroups according to gender, age, extent, and duration of the disease compared with the control group. RESULTS: Anti-TPO was detected in 17 (18.1%) of patients affected by vitiligo, while this figure was 7 (7.3%) in the control group; the difference was significant with p-value < 0.025 (Phi & Cramer's V = 0.162). When analyzing subgroups, the difference in the frequency of anti-TPO remained significant only in females (p-value < 0.044) (Phi & Cramer's V = 0.207) and in patients in the age ranges of 18-25 (p-value < 0.05) (Phi & Cramer's V = 0.28) and 26-35 year-old (p-value < 0.042) (Phi & Cramer's V = 0.304). The difference of the frequency of anti-TPO was not significant regarding the duration and extent of vitiligo. In addition, there was no significant difference in the levels of free T3, free T4, and TSH in vitiligo patients compared with the control group. CONCLUSION: According to our study, anti-TPO was shown to be significantly more common in vitiligo patients especially in young women, compared with control group. As this antibody is a relatively sensitive and specific marker of autoimmune thyroid disorders including Hashimoto thyroiditis and Graves' disease, and considering the fact that vitiligo usually precedes the onset of thyroid dysfunction, periodic follow-up of vitiligo patients for detecting thyroid diseases is further emphasized especially in young women with increased level of anti-TPO.

Adult↗
PubMed1978

Responses to TRH and T3 suppression tests in euthyroid subjects with a family history of Graves' disease.

The relationship of Graves' disease and heredity was studied in 97 clinically and biochemically euthyroid relatives (resin T3 uptake and serum T3, T4, and TSH within normal ranges) who had more than two thyrotoxic relatives within the second degree relationship. TRH tests were preformed in all 97 cases. In 56 of the 97, T3 suppression tests were performed shortly after the TRH test. Results revealed that 29 of the 97 (29.9%) showed an abnormal response to TRH. fourteen of these (14.4%) revealed no response or a hyporesponse, and 15 (15.5%) revealed a hyperresponse to TRH. Four of 56 (7.1%) were T3 nonsuppressible. Seven individuals who showed no response or a hyporesponse to TRH consisted of 2 nonsuppressible and 5 suppressible subjects. In 14 non- or hyporesponsive cases, serum T3 (1.51 +/- 0.05 ng/ml; mean +/- SE) and T4 (9.91 +/- 0.31 micrograms/dl) were significantly higher compared with those of normal responders (1.30 +/- 0.04 ng/ml, 8.57 +/- 0.21 micrograms/dl; P less than 0.001) or hyperresponders (1.16 +/- 0.06 ng/ml, 7.77 +/- 0.63 micrograms/dl; P less than 0.01). There was no correlation between TRH responsiveness and T3 suppressibility. A relatively high occurrence of thyroglobulin and microsomal antibodies was observed, further suggesting a hereditary predisposition. The findings indicate that even in euthyroid relatives with a family history of Graves' disease who have no clinical or biochemical abnormalities of thyroid dysfunction, many have abnormalities in TRH responsiveness, T3 suppressibility, and thyroidal antibodies.

Adolescent↗