A Fine Line Between Schizophrenia and Hashimoto Encephalopathy

IntroductionHashimoto encephalopathy (HE) is an uncommon syndrome associated with Hashimoto thyroiditis. The relationship between these entities is unclear. Even being rare, it appears to be underrecognized.ObjectivesReport a case of an atypical presentation of psychosis in a patient with elevated serum levels of antithyroid antibodies and review the literature about similar situations.MethodsAccess clinical process, research PubMed, using the mesh terms “Hashimoto encephalopathy” and “psychosis”.ResultsA 21-year-old Portuguese female was conducted by authorities to our emergency department after she called for help and was spotted walking barefoot on the streets. Throughout clinical course she presented persecutory ideas, thought blocks, auditory hallucinations, soliloquies, perplexity, total insomnia, bizarre behaviors like coprophagia, trichotillomania and self-injured burns. After some tests, it was found that the patient had high serum levels of antithyroid peroxidase antibody (TPO) and antithyroglobulin antibody (TGO) and reduced folic acid, without other changes. Trials with corticosteroids showed clinical improvement for short periods, as with antipsychotics. No consistent remission was achieved with either approaches.ConclusionHE is an uncommon syndrome presenting with high titers of antithyroid antibodies that may preconize an acute state of atypical psychosis. Usually, it responds to corticosteroids and so, has a generally good prognosis when treated accordingly. Evidence suggests that HE is an autoimmune disorder instead of thyroid disease.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

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Gastro-intestinal polypeptides in patients treated for medullary carcinoma of the thyroid

Acta Endocrinologica ◽

10.1530/acta.0.1060112 ◽

1984 ◽

Vol 106 (1) ◽

pp. 112-115 ◽

Cited By ~ 7

Author(s):

Bente Rasmusson

Keyword(s):

Serum Gastrin ◽

Clinical Course ◽

Elevated Serum ◽

Medullary Carcinoma ◽

Serum Levels ◽

High Serum ◽

Serum Concentrations ◽

Serum Calcitonin ◽

Basal Serum ◽

Previously Treated

Abstract. In 12 patients treated 2 to 58 months previously for medullary carcinoma of the thyroid, basal serum concentrations of calcitonin, gastrin, vasoactive intestinal polypeptide, glucagon, insulin, and pancreatic polypeptide were measured in search of any correlation between these and the clinical course of the disease. All patients had elevated serum calcitonin levels indicating present disease. One patient had increased serum concentrations of several hormones. Another had achlorhydria and high serum gastrin levels. No relationship between calcitonin and gastro-intestinal polypeptides was found in 11 patients. No correlations were found between serum levels of polypeptides and the occurrence of diarrhoea in 5 patients. It is concluded that gastro-intestinal polypeptides, which are produced by other apudomas, are not secreted in more than normal concentrations under basal conditions, by the majority of patients previously treated for medullary carcinoma of the thyroid.

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Serum Levels of Bone Morphogenetic Proteins 2 and 4 in Patients with Acute Myocardial Infarction

Cells ◽

10.3390/cells9102179 ◽

2020 ◽

Vol 9 (10) ◽

pp. 2179

Author(s):

Maria Kercheva ◽

Anna M. Gusakova ◽

Tamara R. Ryabova ◽

Tatiana E. Suslova ◽

Julia Kzhyshkowska ◽

...

Keyword(s):

Myocardial Infarction ◽

Serum Level ◽

Bone Morphogenetic Proteins ◽

Elevated Level ◽

Elevated Serum ◽

Serum Levels ◽

Left Ventricular ◽

High Serum ◽

High Serum Level

Background: Bone morphogenetic proteins-2 and -4 (BMPs) have been implicated in left ventricular remodeling (LVR) processes such as an inflammation and fibrogenesis. We hypothesized that this knowledge could be translated into clinics. Methods: We studied the dynamics of serum levels of BMPs, its correlation with markers of LVR and with parameters of echocardiography in patients (n = 31) during the six-month follow-up period after myocardial infarction (MI). Results: Elevated serum levels of BMPs decreased by the six-month follow-up period. BMP-2 decreased from the first day after MI, and BMP-4 decreased from the Day 14. The elevated level of BMP-2 at Day 1 was associated with a lower level of troponin I, reperfusion time and better left ventricular ejection fraction (LV EF) at the six-month follow-up. Elevated serum level of BMP-4 at Day 1 was associated with a lower level of a soluble isoform of suppression of tumorigenicity 2 (sST2), age and reperfusion time. An elevated level of BMP-2 at the six-month follow-up was associated with higher levels of BMP-4, high-sensitivity C-reactive protein (hCRP) and sST2. High serum level of BMP-2 correlated with high levels of hCRP and matrix metalloproteinase (MMP)-9 on Day 7. High serum level of BMP-4 correlated with low levels of hCRP, MMP-9 at Day 3, sST2 at Day 1 and with decreased LV EF on Day 7. The findings of multivariate analysis support the involvement of BMP-2 in the development of post-infarction LVR. Conclusions: Our research translates experimental data about the BMPs in the development of adverse LVR into the clinic. Elevated serum levels of BMPs decreased by the end of the six-month period after MI. BMP-2 decreased from the first day and BMP-4 decreased from Day 14. BMP-2 and BMP-4 were associated with the development of LVR. Their correlations with markers of inflammation, degradation of the extracellular matrix, hemodynamic stress and markers of myocardial damage further support our hypothesis. Diagnostic and predictive values of these BMPs at the development of post-infarction LVR in vivo should be investigated further.

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Two Patients with Extremely Elevated Tumor Markers: Where Is the Malignancy?

Gastroenterology Research and Practice ◽

10.1155/2011/123743 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 8

Author(s):

Patrick P. J. van der Veek ◽

Wouter H. de Vos tot Nederveen Cappel ◽

Alexandra M. J. Langers ◽

Bart van Hoek

Keyword(s):

Tumor Markers ◽

Malignant Disease ◽

Elevated Serum ◽

Serum Levels ◽

Stone Disease ◽

High Serum ◽

Response To Treatment ◽

Serum Tumor Markers ◽

Painless Jaundice ◽

Very High

Serum tumor markers are useful to evaluate a cancer's response to treatment, for early detection of cancer relapse, and, in some cases, to diagnose malignancy. In this paper, we present two patients with significantly elevated serum tumor markerswithoutevidence of malignant disease. An 18-year-old patient suffering from autoimmune hepatitis had markedly increased alpha-fetoprotein (aFP) levels (2,002 μg/L; normal <10 ug/L). Extensive imaging showed no signs of hepatocellular carcinoma or other cancer, and treatment with Prednisone led to rapid normalization of both liver enzymes and aFP. The second patient, a 60-year-old female with painless jaundice due to biliary stone disease, had very high serum levels of CA19-9 (18,000 kU/L, normal <27 kU/L). Liver biochemistry and serum CA19-9 concentration decreased to almost normal values (45 kU/L) after biliary stenting. These cases demonstrate that serum tumor markers can be elevated in benign disease and are therefore not appropriate to diagnose cancer.

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High Levels of Growth Differentiation Factor 15 in Patients with Congenital Dyserythtopoietic Anemia Type I

Blood ◽

10.1182/blood.v112.11.3456.3456 ◽

2008 ◽

Vol 112 (11) ◽

pp. 3456-3456

Author(s):

Hannah Tamary ◽

Hanna Shalev ◽

Galit Avraham ◽

Meira Zoldan ◽

Itai Levi ◽

...

Keyword(s):

Transferrin Receptor ◽

Elevated Serum ◽

Serum Levels ◽

High Serum ◽

Type I ◽

Soluble Transferrin Receptor ◽

Ineffective Erythropoiesis ◽

Growth Differentiation Factor 15 ◽

Differentiation Factor ◽

A Minor

Abstract Growth differentiation factor 15 (GDF15) is a member of the TGF-beta superfamily of cytokines previously found to suppress hepcidin in primary human hepatocytes. GDF15 is secreted from human erythroblasts, and extremely high serum levels are present in β-thalassemia patients (Tanno et al., Nat. Med. 2007, 13, 1096–1101). To determine if elevated GDF15 levels are unique for thalassemia or more generally associated with iron-loading related to ineffective erythropoiesis, we determined the GDF15 levels, as well as, serum hepcidin (Swinkels DW et al, PLoS ONE PLoS ONE. 2008;3:e2706), ferritin, erythropoietin (EPO) and soluble transferrin receptor (sTfR) in patients with the congenital dyserythropoietic anemia type I (CDA I). Seventeen Israeli Bedouins with CDA I were studied, all homozygous for the founder R1040W mutation in the CDAN1 gene. All of the patients studied were young adults with a mean age of 29 years. Two patients previously underwent splenectomy, and one patient is currently transfusion-dependent. For comparison, ten healthy volunteers (HV) were studied. The mean level of GDF15 in CDA I patients was significantly elevated [10,239 ± 3,049 pg/ml (range 5,530–17,008) compared to 269 ± 238 pg/ml in healthy controls; p = 1.5×10−10]. Consistent with a previous study of dyserythropoietic anemia patients, significantly higher levels of soluble transferrin receptor were detected among the CDA I population (sTfR; CDA I, 86.4 ± 14.0 nmol/L; HV, 21.4 ± 6.2 nmol/L, p = 7.4×10−15). Serum EPO levels were also elevated (EPO; CDA I, 118 ± 59 IU/dL; HV, 2.0 ± 1.5 IU/dL, p = 2.3×10−7). For iron analyses, three patients with extensive transfusion histories were excluded. Among the remaining 14 patients, iron overload was demonstrated by elevated serum ferritin (CDA I, 916 ± 507 ng/ml; HV, 72 ± 60 ng/ml, p = 1.4×10−5). Despite the significant elevation in iron stores, significantly elevated levels of hepcidin 25 (Hep25) were not detected in the CDA I patients. Instead, a minor decrease in serum Hep25 levels were detected (Hep25; CDA I, 3.3 ± 2.8 nM; HV, 4.1 ± 3.0 nM, p = 0.27). Correlation analyses were performed between the iron parameters (Ferritin and Hep25) and GDF15, sTfR, or EPO levels. Only GDF15 demonstrated a significant positive correlation with ferritin and significant inverse correlations with Hep25 and the Hep25/Ferritin ratio. Weaker correlations with EPO were identified. Unexpectedly, the correlation trends for sTfR were opposite those of GDF15 in this group. These results demonstrate that GDF15 is immensely over-expressed in CDA I, and further suggest this cytokine contributes to hepcidin dysregulation and secondary hemochromatosis in humans with ineffective erythropoiesis.

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Elevated Serum Levels of Soluble CD163 in Polymyositis and Dermatomyositis: Associated with Macrophage Infiltration in Muscle Tissue

The Journal of Rheumatology ◽

10.3899/jrheum.141307 ◽

2015 ◽

Vol 42 (6) ◽

pp. 979-987 ◽

Cited By ~ 18

Author(s):

Qing-Lin Peng ◽

Yin-Li Zhang ◽

Xiao-Ming Shu ◽

Han-Bo Yang ◽

Lu Zhang ◽

...

Keyword(s):

Muscle Tissue ◽

Laboratory Data ◽

Elevated Serum ◽

Clinical Manifestations ◽

Serum Levels ◽

High Serum ◽

Macrophage Infiltration ◽

Healthy Controls ◽

Soluble Cd163 ◽

Cell Counts

Objective.To investigate serum levels of soluble CD163 (sCD163) in patients with polymyositis (PM) and dermatomyositis (DM), and to correlate these to clinical manifestations and laboratory data.Methods.Serum levels of sCD163 were detected in 24 patients with PM, 84 patients with DM, and 46 healthy controls by using the ELISA method. Immunohistochemistry staining of macrophage infiltration in muscle tissue using anti-CD163 monoclonal antibody was conducted on muscle biopsy specimens from 13 patients with PM and 17 with DM.Results.Serum levels of sCD163 were significantly increased in patients compared with healthy controls (p < 0.001). Patients with interstitial lung disease (ILD) had statistically higher sCD163 levels than patients without ILD (p < 0.001). High serum sCD163 levels were associated with increased incidence of antinuclear antibody (p < 0.05), higher serum levels of immunoglobulin G (p < 0.01) and immunoglobulin A (p < 0.05), and increased erythrocyte sedimentation rates (p < 0.01). Serum sCD163 levels were inversely correlated with CD3+ T cell counts in peripheral blood of patients (r = −0.306, p < 0.01). Cross-sectional assessment and longitudinal study revealed a significant correlation between serum sCD163 levels and disease activity. Patients with high serum sCD163 levels showed a higher incidence of CD163+ macrophage infiltration in muscle tissue than patients with normal sCD163 levels (chi-square value = 10.804, p < 0.01).Conclusion.Serum levels of sCD163 were significantly elevated and correlated with disease severity in patients with PM/DM, suggesting serum sCD163 as a promising biomarker in the disease evaluation of PM/DM. Our finding of elevated serum sCD163 levels associated with muscle macrophage infiltration highlights the role activated macrophage plays in the pathogenesis of PM/DM.

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Characterisation of asthma subgroups associated with circulating YKL-40 levels

European Respiratory Journal ◽

10.1183/13993003.00800-2017 ◽

2017 ◽

Vol 50 (4) ◽

pp. 1700800 ◽

Cited By ~ 31

Author(s):

Jose L. Gomez ◽

Xiting Yan ◽

Carole T. Holm ◽

Nicole Grant ◽

Qing Liu ◽

...

Keyword(s):

New York ◽

Transcriptome Analysis ◽

Elevated Serum ◽

Airflow Obstruction ◽

Research Programme ◽

Serum Levels ◽

Asthma Severity ◽

High Serum ◽

New York University ◽

Asthma Phenotypes

The chitinase-like protein YKL-40 mediates airway inflammation and serum levels are associated with asthma severity. However, asthma phenotypes associated with YKL-40 levels have not been precisely defined.We conducted an unsupervised cluster analysis of asthma patients treated at the Yale Center for Asthma and Airways Disease (n=156) to identify subgroups according to YKL-40 level. The resulting YKL-40 clusters were cross-validated in cohorts from the Severe Asthma Research Programme (n=167) and the New York University/Bellevue Asthma Repository (n=341). A sputum transcriptome analysis revealed molecular pathways associated with YKL-40 subgroups.Four YKL-40 clusters (C1–C4) were identified. C3 and C4 had high serum YKL-40 levels compared with C1 and C2. C3 was associated with earlier onset and longer duration of disease, severe airflow obstruction, and near-fatal asthma exacerbations. C4 had the highest serum YKL-40 levels, adult onset and less airflow obstruction, but frequent exacerbations. An airway transcriptome analysis in C3 and C4 showed activation of non-type 2 inflammatory pathways.Elevated serum YKL-40 levels were associated with two distinct clinical asthma phenotypes: one with irreversible airway obstruction and another with severe exacerbations. The YKL-40 clusters are potentially useful for identification of individuals with severe or exacerbation-prone asthma.

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Impaired 1,25 dihydroxyvitamin D3 action and hypophosphatemia underlie the altered lacuno-canalicular remodeling observed in the Hyp mouse model of XLH

PLoS ONE ◽

10.1371/journal.pone.0252348 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0252348

Author(s):

Ye Yuan ◽

Supriya Jagga ◽

Janaina S. Martins ◽

Rakshya Rana ◽

Paola Divieti Pajevic ◽

...

Keyword(s):

Fibroblast Growth Factor 23 ◽

Elevated Serum ◽

Cathepsin K ◽

Serum Levels ◽

High Serum ◽

Bone Resorption Marker ◽

Antibody Treatment ◽

Dihydroxyvitamin D3 ◽

Dihydroxyvitamin D ◽

Osteocyte Lacunae

Osteocytes remodel the perilacunar matrix and canaliculi. X-linked hypophosphatemia (XLH) is characterized by elevated serum levels of fibroblast growth factor 23 (FGF23), leading to decreased 1,25 dihydroxyvitamin D3 (1,25D) production and hypophosphatemia. Bones from mice with XLH (Hyp) have enlarged osteocyte lacunae, enhanced osteocyte expression of genes of bone remodeling, and impaired canalicular structure. The altered lacuno-canalicular (LCN) phenotype is improved with 1,25D or anti-FGF23 antibody treatment, pointing to roles for 1,25D and/or phosphate in regulating this process. To address whether impaired 1,25D action results in LCN alterations, the LCN phenotype was characterized in mice lacking the vitamin D receptor (VDR) in osteocytes (VDRf/f;DMP1Cre+). Mice lacking the sodium phosphate transporter NPT2a (NPT2aKO) have hypophosphatemia and high serum 1,25D levels, therefore the LCN phenotype was characterized in these mice to determine if increased 1,25D compensates for hypophosphatemia in regulating LCN remodeling. Unlike Hyp mice, neither VDRf/f;DMP1Cre+ nor NPT2aKO mice have dramatic alterations in cortical microarchitecture, allowing for dissecting 1,25D and phosphate specific effects on LCN remodeling in tibial cortices. Histomorphometric analyses demonstrate that, like Hyp mice, tibiae and calvariae in VDRf/f;DMP1Cre+ and NPT2aKO mice have enlarged osteocyte lacunae (tibiae: 0.15±0.02μm2(VDRf/f;DMP1Cre-) vs 0.19±0.02μm2(VDRf/f;DMP1Cre+), 0.12±0.02μm2(WT) vs 0.18±0.0μm2(NPT2aKO), calvariae: 0.09±0.02μm2(VDRf/f;DMP1Cre-) vs 0.11±0.02μm2(VDRf/f;DMP1Cre+), 0.08±0.02μm2(WT) vs 0.13±0.02μm2(NPT2aKO), p<0.05 all comparisons) and increased immunoreactivity of bone resorption marker Cathepsin K (Ctsk). The osteocyte enriched RNA isolated from tibiae in VDRf/f;DMP1Cre+ and NPT2aKO mice have enhanced expression of matrix resorption genes that are classically expressed by osteoclasts (Ctsk, Acp5, Atp6v0d2, Nhedc2). Treatment of Ocy454 osteocytes with 1,25D or phosphate inhibits the expression of these genes. Like Hyp mice, VDRf/f;DMP1Cre+ and NPT2aKO mice have impaired canalicular organization in tibia and calvaria. These studies demonstrate that hypophosphatemia and osteocyte-specific 1,25D actions regulate LCN remodeling. Impaired 1,25D action and low phosphate levels contribute to the abnormal LCN phenotype observed in XLH.

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Dynamics of TNF-α and IFN-γ in adult patients with measles depending on the development of complications

Zaporozhye Medical Journal ◽

10.14739/2310-1210.2021.6.237573 ◽

2021 ◽

Vol 23 (6) ◽

pp. 834-838

Author(s):

S. O. Bilokobyla ◽

O. V. Riabokon ◽

Yu. Yu. Riabokon ◽

N. V. Onishchenko

Keyword(s):

Elevated Serum ◽

Serum Levels ◽

High Serum ◽

Adult Patients ◽

Medical Laboratory ◽

Enzyme Linked Immunosorbent Assay ◽

Healthy Individuals ◽

Acute Period ◽

Tnf Α ◽

Ifn Γ

The aim is to define the dynamics of TNF-α and IFN-γ serum levels in adult patients with measles depending on the development of complications. Materials and methods. An examination of 175 adult patients with measles revealed a range of complications and dynamics of serum TNF-α and IFN-γ depending on the development of complications. The serum contents of TNF-α (Invitrogen, Austria) and IFN-γ (Invitrogen, Austria) in patients and 30 healthy individuals were determined by enzyme-linked immunosorbent assay on the basis of the Training Medical Laboratory Center of Zaporizhzhia State MedicalUniversity. Results. It was shown that the vast majority of hospitalized adult patients with measles developed complications (70.6 %) and these latter were predominantly respiratory (61.7 %) and gastrointestinal (44.0 %). In the period of measles rash, on day 4.8 ± 0.2 in the presence of complications, the serum TNF-α content was 11 times higher than that in healthy individuals (P < 0.05) and in patients with uncomplicated measles (P < 0.05), and did not differ from healthy individuals (P > 0.05) in the absence of complications. The development of measles complications in adult patients was associated with higher serum levels of TNF-α both at hospitalization (P = 0.003) and after 10 days of the disease (P = 0.005). The serum content of IFN-γ in adult measles patients with rash at hospitalization on day 4.8 ± 0.2 exceeded that in healthy individuals both in the presence of complications (P < 0.05) and in uncomplicated measles (P < 0.05). The serum content of IFN-γ was 19.3 times (P < 0.05) higher in patients with complicated measles than that in patients without complications. High serum levels of IFN-γ were associated with the development of complications during acute period of measles (P = 0.0001). Conclusions. Complications occurred in most hospitalized adult patients with measles (70.6 %), that was accompanied by more pronounced immunological changes. The development of measles complications in adult patients was associated with higher serum levels of TNF-α both at hospital admission on day 4.8 ± 0.2 (gamma 0.77; P = 0.003) and in the dynamics after 10 days of the disease (gamma 0.56; P = 0.005). Elevated serum levels of IFN-γ were associated with the development of complications during the acute period of measles (gamma ratio 0.46; P = 0.0001).

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Orbital Pseudotumor: Uncommon Initial Presentation of IgG4-Related Disease

Case Reports in Rheumatology ◽

10.1155/2015/324365 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Teresa Carbone ◽

Ricardo Azêdo Montes ◽

Beatriz Andrade ◽

Pedro Lanzieri ◽

Luis Mocarzel

Keyword(s):

Elderly Patient ◽

Plasma Cells ◽

Elevated Serum ◽

Lymphocytic Infiltration ◽

Serum Levels ◽

High Serum ◽

Orbital Pseudotumor ◽

Related Disease ◽

Igg4 Related Disease ◽

Serum Igg4

IgG4-related disease (IgG4-RD) encompasses a group of fibroinflammatory conditions recognized in recent times. The main clinical features include variable degrees of tissue fibrosis, tumorlike expansions, perivascular lymphocytic infiltration rich in IgG4-positive plasma cells, and elevated serum IgG4. A case has been reported of an elderly patient with an unexplained unilateral exophthalmia; biopsy was performed and revealed lymphocytic infiltration, suggesting IgG4-RD. High serum levels of IgG4, in association with a good response to steroid therapy and to the exclusion of other diagnoses, confirmed the hypothesis of orbital pseudotumor by IgG4-RD.

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Transient neonatal pseudohypoparathyroidism

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0710566j ◽

2007 ◽

Vol 135 (9-10) ◽

pp. 566-568

Author(s):

Maja Jesic ◽

Milos Jesic ◽

Silvija Sajic ◽

Svjetlana Maglajlic ◽

Mirjana Tomanovic ◽

...

Keyword(s):

Serum Level ◽

Elevated Serum ◽

Serum Levels ◽

Final Diagnosis ◽

High Serum ◽

Oral Calcium ◽

Elevated Serum Level ◽

Normal Limits ◽

Number Of Patients ◽

Withdrawal Of Therapy

Introduction Pseudohypoparathyroidism (PHP) is a heterogeneous group of diseases characterized by end organ unresponsiveness to parathormone (PTH), due to receptor or postreceptor defects. The characteristic biochemical disturbances include hypocalcaemia, hyperphosphataemia and high serum parathormone levels. Case outlineWe present a 17-day old male baby who was brought to our hospital because of seizures. He was found to have hypocalcaemia, hyperphosphataemia and an elevated serum level of parathyroid hormone. The diagnosis of PHP was based on the elevated serum level of PTH during hypocalcaemia and persistence of normocalcaemia after administering alphacalcidiol with oral calcium. After 4 months of therapy, with tapering of the oral calcium doses, the treatment was discontinued. During the following six months without therapy, the infant did not have seizures and the serum levels of calcium and phosphorus were normal, so we established the final diagnosis of transient neonatal pseudohypoparathyroidism. Conclusion At the time when the newborn was diagnosed to have PHP, there was no indication whether it was of a permanent or transient form. A considerably lower number of patients have a transitory form of PHP, which is then confirmed in the infant period by a gradual reduction and withdrawal of therapy, with sustaining serum calcium and PTH within normal limits.

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