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PubMed1994

Thyroid disease in children.

Among thyroid diseases occurring in children are congenital hypothyroidism, acquired hypothyroidism, Graves' disease, subacute thyroiditis and thyroid nodules. Evaluation for suspected hypothyroidism or hyperthyroidism can be accomplished efficiently with a serum free thyroxine level and the new, highly sensitive thyroid-stimulating hormone assays. Rarely, measuring various thyroid antibody titers may be required to better define a particular thyroid disease. Solitary thyroid nodules in children occasionally represent malignancy. Evaluation of such lesions with radioisotope scanning and ultrasonography is helpful. In children, however, surgical excision is still required to definitively determine whether a nodule is malignant.

Child, Preschool↗
PubMed2001

Celiac disease in children with autoimmune thyroid disease.

Ninety children and adolescents with autoimmune thyroid disease were screened for celiac disease. All 90 patients were typed for HLA antigen class I and II and for HLA-DQA1 and DQB1 heterodimers. Celiac disease and DQA1*0501, DQB1*02 were found in 7 (7.8%) patients. The prevalence of celiac disease was 1 of 13. Screening for celiac disease is recommended in children with autoimmune thyroid disease.

Adolescent↗
PubMed1993

New animal models for human autoimmune thyroid disease. Xenografts of human thyroid tissue in severe combined immunodeficient (SCID) and nude mice.

We have been employing two mouse models for the study of human thyroid xenografts from patients with autoimmune thyroid disease (AITD). The first mouse strain is that of the athymic "nude" mouse which accepts human thyroid xenografts, but the passenger lymphocytes are lysed in this model over several weeks; in the second model, the severe combined immunodeficient (SCID) mouse, both the xenograft and its lymphocytes survive. The AITD thyroid xenograft returns to normal function and morphology in the nude mouse over several weeks whereas the same AITD thyroid xenografts undergo aggravation of their lesions in the SCID mouse. Normalized ("cleansed") thyroid tissue in the nude mouse, now bereft of the passenger lymphocytes, can be removed and then re-xenografted into SCID mice. There it will remain normal unless autologous peripheral blood mononuclear cells are added, whereupon the AITD lesion will be reproduced. Autologous "irrelevant" muscle tissue having undergone the same process will not show such lesions. There is thus no evidence for a primary thyroid cell disturbance in AITD, the abnormality appearing to be only in the immune system. Moreover peripheral blood mononuclear cells appear to contain sufficient memory cells to be able to mount an immune assault on the autologous normalized thyroid tissue (to which they had been previously sensitized) but not on irrelevant autologous (muscle) tissue.

Animals↗
PubMed1976

Measurement of circulating thyroid microsomal antibodies by the tanned red cell haemagglutination technique: its usefulness in the diagnosis of autoimmune thyroid diseases.

Thyroid-microsomal antibodies were quantitated by a new technique utilizing tanned sheep red blood cells coated with human thyroid microsomal antigens. This haemagglutination assay (MCHA) correlated with the immunofluorescent antibody (FAB) but not with the thyroglobulin haemagglutination antibodies (TGHA) assay. Of forty-one patients with Hasmimoto's thyroiditis, thirty-nine (95%) were MCHA but only twenty-four (59%) TGHA positive. Titres were similar for the hypothyroid and euthyroid patients. Patients less than 20 years of age had either negative (50%) or low titre (less than 1:160) TGHA but 100% positive MCHA at titres greater than 1:1280. Of twenty-one patients with Graves' disease eighteen (86%) were MCHA and six (29%) TGHA positive. Of thirty-two patients without thyroid disease eleven (34%) were MCHA and/or TGHA positive. On the basis of family history and associated abnormalities, in eight of eleven, positive antibodies may have been due to subclinical Hashimoto's thyroiditis. Fourteen subjects of a control group (10%) were MCHA positive. Seven of ten examined had goitres. MCHA is a simple and quantitative test, useful in the diagnosis of autoimmune thyroid diseases.

Autoantibodies↗
PubMed2002

Benign thyroid disease and dietary factors in thyroid cancer: a case-control study in Kuwait.

We conducted a population-based study of 313 case-control pairs in Kuwait to examine the aetiology of thyroid cancer, the second most common neoplasm among women in this and several other countries in the Gulf region. Among the demographic variables, individuals with 12+ years of education had a significantly reduced risk of thyroid cancer (OR=0.6; 95% CI: 0.3-0.9). The average age at diagnosis (+/-s.d.) of thyroid cancer was 34.7+/-11 years in women and 39+/-13.4 years in men. History of thyroid nodule was reported only by cases (n=34; 10.9%; lower 95% CI: 12.0); and goitre by 21 cases and four controls (OR=5.3; 95% CI: 1.8-15.3). There was no significant increase in risk with history of hypothyroidism (OR=1.8) or hyperthyroidism (OR=1.7). For any benign thyroid disease, the OR was 6.4 (95% CI: 3.4-12.0); and the population attributable risk was about 26% (95% CI: 21.1-30.9). Stepwise regression analysis showed that high consumption of processed fish products (OR=2.2; 95% CI: 1.6-3.0) fresh fish (OR=0.5; 95% CI: 0.4-0.7) and chicken (OR=1.7; 95% CI: 1.2-2.3) were independently associated with thyroid cancer with significant dose-response relationships. Among the thyroid cancer patients who reported high consumption of fish products, a large majority also reported high consumption of fresh fish (98%) and shellfish (68%). No clear association emerged with consumption of cruciferous vegetables. These data support the hypothesis that hyperplastic thyroid disease is strongly related to thyroid cancer; and that habitual high consumption of various seafoods may be relevant to the aetiology of thyroid cancer. The association with chicken consumption requires further study.

Adolescent↗
PubMedDate not supplied

Histology and aspiration cytology of benign thyroid diseases.

The thyroid is an endocrine gland involved in the homeostatic regulation of the organism by means of its products, the hormones thyroxine (T4) and triiodothyronine (T3). Its basic morphologic unit is the follicle, composed of thyrocytes producing the inactive hormonal form thyroglobulin which is stored in the center of the follicle. The diseases affecting the thyroid are classified into benign and malignant. Benign diseases include goiter, either diffuse (Graves' disease when hyperfunctioning) or nodular (nodular hyperplastic goiter), thyroiditis (including Hashimoto's autoimmune form) and benign neoplasms (adenomas). All benign thyroid diseases can be investigated preoperatively with a fine-needle aspiration biopsy. This technique is simple and safe and allows an accurate cytological diagnosis of these benign lesions.

Adenoma↗
PubMed2004

Impact of disease activity on thyroid diseases in patients with acromegaly: basal evaluation and follow-up.

In patients with acromegaly, the exact incidence of thyroid disorders is still controversial and less is known about the impact of disease activity and successful treatment. To address this issue, we investigated 73 acromegalic patients (age 55 +/- 13 yr; mean +/- SD) by ultrasonography in comparison to an age-matched control group (54 +/- 1 yr) in the same moderate iodine deficient area (retrospective study). These non-acromegalic volunteers (n = 199) were examined in the same clinic during a thyroid screening test. At the time of examination, 52 (71.2 %) of the acromegalic patients were active, 17 (23.3 %) were cured, and 4 (5.5 %) were controlled with somatostatin analogues. The prevalence of goiter (normal range < 18 ml female, < 25 ml male) was significantly higher (82.2 %) in the mixed group of acromegalics (active, well controlled, cured; n = 73) and in the active group (90.4 %) than in the control group (n = 199, 18.1 %, p < 0.001). Thyroid nodules were found in 63.0 % of the mixed group of acromegalics and in 71.2 % of patients with active disease (33.1 % in controls, p < 0.001). (99 m)Tc scintigraphy revealed thyroid autonomy in 9/73 (12.3 %) and cold nodules in 19/73 (26.0 %) patients. Thyroid cancer was diagnosed in 4 (5.5 %) of acromegalic patients (3 papillary and 1 follicular carcinoma). We found a weak correlation between the disease duration and the initial thyroid volume (r = 0.54, p < 0.0056). Thirty-seven newly diagnosed acromegalics were followed over a period of 7.3 +/- 4.1 years. 5 (13.5 %) of these patients remained active, 8 (21.6 %) were controlled with somatostatin analogues, and 24 (64.9 %) were cured. The mean age, sex distribution, disease duration, prevalence of TSH-deficiency, and initial thyroid volume (46 +/- 11 ml in active, 42 +/- 7 ml in controlled, and 45 +/- 5 ml in cured patients) did not differ statistically between the three groups. In patients with active acromegaly, thyroid volume increased by 19.5 +/- 8.1 %. In contrast, thyroid volume decreased in the group of medically controlled and cured acromegalics (- 21.5 +/- 7.1 %; p < 0.005 and - 24.2 +/- 5.7 %; p < 0.002, respectively). No correlation was found between thyroid volume and TSH levels, levothyroxine and/or iodide administration neither in TSH sufficient nor in TSH insufficient patients. In conclusion, successful treatment of patients with active acromegaly decreases thyroid volume. Cold nodules and thyroid cancer frequently occur in acromegalic patients.

Acromegaly↗
PubMed1989

Thyroid disease in pregnancy.

Thyroid disease may be pre-existing or rarely may arise de novo during pregnancy. It may have profound effects on the feto-maternal unit. Diagnosis depends on clinical suspicion and confirmation by biochemical tests of thyroid function. However, pregnancy masks the signs of thyroid disease and may alter the interpretation of thyroid function tests.

Female↗
PubMed2003

[The effect of surgical treatment of benign thyroid disease on serum anti-thyroid antibodies].

The mechanisms of development of benign thyroid disease are still not entirely clarified. Immune disorders are possibly engaged in the thyroid pathological conditions. The aim of this prospective study was to follow up the dynamics of serum levels of anti-thyroid antibodies in patients with benign thyroidal disease as well as the local lymphocytic reaction. The autoantibodies to thyroglobulin and thyroid microsomes were detected prior to the surgery and on the 12th month after it using microhemaglutination test. Thyroid resection was performed depending on changes in patients. Lymphocytic infiltration of the thyroid gland from surgical histological specimens was found in various degree in the patients. Serum titres of anti-thyroid antibodies tended to fall in the majority of the patients a year after the surgical treatment. Anti-thyroglobulin antibodies were found in 60% of the patients prior to the surgery and anti-microsomal--in 31.4%. A year after surgery they were detected in 4.3% and 1.4% of the patients respectively. The described changes show that the dynamics of anti-thyroid antibodies may correlate with the effect of surgical treatment and eventual prognosis of relapse.

Adult↗
PubMed2003

Detection and localization of chemokine gene expression in autoimmune thyroid disease.

OBJECTIVE: Autoimmune thyroid disease (Hashimoto's thyroiditis and Graves' disease) is characterized by lymphocytic infiltration of the thyroid gland. Chemokines are cytokines with chemoattractant properties for a range of immune effector cells and might therefore play a significant role in the initiation and maintenance of the autoimmune process. The aim of this study was to analyse chemokine gene expression in autoimmune thyroid tissue and in cultured thyroid follicular cells (TFC). DESIGN AND PATIENTS: Immunocytochemistry and reverse-transcriptase polymerase chain reaction (RT-PCR) amplification were used to analyse the expression of monocyte chemoattractant protein (MCP)-1, RANTES (regulated upon activation, normal T cell expressed and secreted), macrophage inflammatory protein (MIP)-1 alpha, MIP-1 beta, interferon (IFN)-gamma-inducible protein (IP)-10 and monokine induced by IFN-gamma (Mig) in thyroid tissue from patients with Hashimoto's thyroiditis (n = 4), Graves' disease (n = 6) and nonautoimmune multinodular goitre (n = 4). Chemokine gene expression was also examined in cultured TFC by RT-PCR. RESULTS: Expression of MCP-1, RANTES, MIP-1 alpha, MIP-1 beta, IP-10 and Mig was demonstrated in all Hashimoto's and most Graves' thyroid specimens but very little expression was detected in the nonautoimmune goitre samples. In thyroid tissue from Graves' disease patients, positive staining for chemokines was largely restricted to the lymphocytic cell infiltrate. Within thyroid tissue from Hashimoto's patients, there was evidence for the expression of all chemokines by thyroid follicular cells, suggesting a role for local chemokine synthesis by the glandular epithelial cells in the recruitment of inflammatory cells into the gland in autoimmunity. The present work also showed that expression all the chemokine genes analysed could be induced in cultured thyroid cells by IFN-gamma and interleukin (IL)-1 alpha. Expression of all the chemokines examined was not stimulated by TSH. CONCLUSION: We postulate that TFC may play a role in the pathogenesis of autoimmune thyroid disease as they are able to express the chemokines MIP-1 alpha, MIP-1 beta, MCP-1, RANTES, IP-10 and Mig that would promote the infiltration of immune cells into the thyroid gland.

Adult↗
PubMed1989

Management of thyroid disease in pregnancy.

Thyroid disease occurs in pregnant at the rate of 0.2-0.6%. Graves' disease is the most common thyroid disorder in our pregnant patients. Thyroid disease is suspected if a significant goitre is detected during pregnancy. Confirmation by thyroid function tests is necessary but their interpretation requires an understanding of changes in the maternal thyroid physiology. Pharmacotherapy with the thionamides is the treatment of choice. Changes in dosage are influenced by the effect of pregnancy on the disease and the optimal level of control for the mother and the foetus. The dose is best titrated against the free thyroxine index or free thyroxine level. The outcome of pregnancy depends on early diagnosis and skillful manipulation of antithyroid drugs.

Congenital Hypothyroidism↗
PubMed1993

T-cell receptor V gene use in autoimmune thyroid disease: direct assessment by thyroid aspiration.

We have examined the hTcR V gene family use of T-cells present in the aspiration thyroid biopsy specimens of patients with hyperthyroid Graves' disease (n = 8) and Hashimoto's autoimmune thyroiditis (n = 5). Nine of the 13 specimens had cytologically identified thyroid follicular cells, and 12 of the 13 contained human thyroglobulin-specific mRNA, confirming successful sampling. Of 18 hTcR V alpha and 19 hTCR V beta gene families tested for in the individual aspirates, a mean +/- SEM of 6.8 +/- 0.9 V alpha and 9.6 +/- 1.4 V beta gene families were present in the Graves' aspirates, while 12.2 +/- 1.7 and 16.8 +/- 0.4 V alpha and V beta gene families were present in the aspirates of patients with Hashimoto's thyroiditis. These samples, which offer a window onto the natural history of autoimmune thyroid disease, demonstrate significant hTcR V alpha and beta gene restriction in hyperthyroid Graves' disease, but much less restriction of both V alpha and V beta gene families in Hashimoto's disease. Such data extend our earlier information based only on examination of highly selected surgical specimens of patients with autoimmune thyroid disease to the much more typical patient. We conclude that hTcR V gene restriction of varying degrees is present in the majority of patients with autoimmune thyroid disease, but appears to be more easily detected in Graves', rather that Hashimoto's, disease.

Adult↗
PubMed1987

Detection of thyroid-stimulating antibodies in thyroid diseases, employing rat thyroid fragment perifusion.

The technique of perifusing rat thyroid fragments was used to investigate the presence of thyroid-stimulating antibodies (TSAb) in the sera of 48 patients. Response to IgG was measured by determining the mean rate of release of T4 (R) during a 30-min perifusion and the secretion peak (Imax) by means of samples taken every 5 min. Values found to be above the mean + 2 SD of the control values of R or Imax were considered to be positive. TSAb were found in all the 17 patients with untreated Graves' disease (GD) and in the 2 treated with antithyroid drugs, but not in the 3 who had undergone surgery or 131I treatment or in the 2 on corticosteroid treatment. TSAb were also found in 2 out of 3 patients with untreated nodular toxic goiter (UNTG) and in 6 out of 8 with diffuse nontoxic goiter (DNG) but at lower levels. In the untreated GD group, R and Imax correlated significantly with the corresponding IgG concentrations (from 90 to 800 micrograms/ml), suggesting TSAb activity which can be compared from one patient to another. TSAb activity did not correlate with thyroid function tests in any group. In all the groups it induced an early secretion peak followed by a decreasing response throughout the stimulation period, as was previously found with 65 mIU/ml TSH. The specificity of this technique was verified by five different control methods: the perifusion technique was checked by using KRBG buffer alone; sera were studied from a group of healthy controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

Thyroid function after assisted reproductive technology in women free of thyroid disease.

OBJECTIVE: To evaluate thyroid function in women undergoing a first assisted reproductive technology (ART) procedure and to compare women with ongoing pregnancy or miscarriage. DESIGN: Prospective cohort study. SETTING: Tertiary referral center. PATIENT(S): Seventy-seven women free of thyroid disease. INTERVENTION(S): Serum TSH and FT4 were determined before and 2, 4, and 6 weeks after ET. All women received the same ART protocol. MAIN OUTCOME MEASURE(S): Thyroid function. RESULT(S): Forty-five women had ongoing pregnancies, and 32 suffered a miscarriage after 6.7 weeks (range 5-11). Mean age and number of ET were similar in both groups. Compared with baseline values, TSH and FT4 increased significantly 2 weeks after ET (ongoing pregnancies group: TSH 2.5 +/- 1.3 vs. 1.6 +/- 0.8 mU/L and FT4 13.8 +/- 1.4 vs. 12.4 +/- 1.8 ng/L; miscarriage group: TSH 2.1 +/- 1.0 vs. 1.5 +/- 0.7 mU/L and FT4 14.2 +/- 2.0 vs. 12.4 +/- 1.9 ng/L). Pregnancy outcome did not affect thyroid function and its evolution over time. CONCLUSION(S): In women free of thyroid diseases, thyroid function changed significantly after ART, but these changes were not different between women with ongoing pregnancy and miscarriage.

Abortion, Spontaneous↗
PubMed2006

Transient hyperthyroxinemia in newborns from women with autoimmune thyroid disease and raised levels of thyroid peroxidase antibodies.

OBJECTIVE: Although it is well established that maternal thyroid disease and increased levels of thyrotropin receptor antibodies (TRab) during pregnancy are associated with a number of complications, is the significance of increased levels of thyroid peroxidase antibodies (TPOab) alone a matter for discussion? The aim of the present study was to examine whether transplacental passage of TPOab from women with autoimmune thyroid disease (AITD) interferes with thyroid function in the neonate. METHODS: Pregnant women with AITD (raised levels of TPOab) and their neonates were monitored with regard to variations of thyroid hormones, thyrotropin (TSH), and TPOab. Pregnant women with non-AITD served as controls. RESULTS: The neonates from mothers with AITD, independently of the presence also of TRab in the mothers, had a transient hyperthyroxinemia one week following birth. Neonatal TPOab correlated with that of the mothers at gestation and was cleared concomitantly with normalization of thyroxine. A high frequency (21%) of severe hyperbilirubinemia was observed in neonates from mothers with AITD. CONCLUSION: Children of mothers with raised levels of TPOab, have a transient hyperthyroxinemia one week after birth accompanied by a high frequency of hyperbilirubinemia suggesting that clinical examination and blood testing should be performed consecutively during the first postnatal week.

Autoantibodies↗
PubMed1990

[Analysis on the traditional Chinese medicine syndromes of the patients with autoimmune thyroid diseases. Changes in the thyroid and immune functions in 109 cases].

Eighty-nine cases of hyperthyroidism and 20 cases of hypothyroidism caused by Hashimoto's thyroiditis were observed in order to analyse the thyroid and immune functions of the patients, and their relationship with the syndromes of TCM. The results showed that, in the patients with Yin deficiency syndrome, the contents of total T4, T3 were higher than normal and TSH lower than normal, while in Yang deficient patients, the contents of total T4, T3 were lower than normal and TSH higher than normal. This results suggested that the states of thyroid functions were closely related to the TCM syndromes. It was also found that the percentage of OKT 4+ cells and the self-recognizing ability of lymphocytes were lower than normal in patients with hyperthyroidism and Yin deficiency. While in patients with hypothyroidism and Yang deficiency, they were higher than normal. These meant that the abilities of lymphocyte autoreaction in Yin deficient patients were in contrary tendency with those in Yang deficient patients. The former had the manifestation of over-inhibition while the latter, hyperaction. Besides, the contents of auto-antibodies were higher than normal in both the patients with hyperthyroidism and hypothyroidism, which manifested itself as a common character of autoimmune thyroid diseases. The results indicated that there were common characters as well as individual characters of thyroid and immune functions between hyperthyroid patients and hypothyroid patients, and these characters might well be the material bases of various syndromes in TCM.

Adult↗