Die Post-Alemtuzumab-Therapie-induzierte Schilddrüsendysfunktion bei schubförmig-remittierender MS (RRMS) – ein variantenreiches Krankheitsbild auf einem interdisziplinären Terrain

2017 ◽  
Vol 45 (01) ◽  
pp. 44-51
Author(s):  
Hans-Klaus Goischke
Keyword(s):  
Vitamin D ◽  
Thyroid Dysfunction ◽  
Interdisziplinäre Zusammenarbeit ◽  
Interdisziplinäres Management

ZusammenfassungAlemtuzumab-induzierte Schilddrüsendysfunktionen (engl.: Alemtuzumab-induced thyroid dysfunction; AITD) können die Lebensqualität von MS-Patienten wesentlich beeinträchtigen, wenn diese Nebenwirkung nicht rechtzeitig erkannt und adäquat von allen Fachrichtungen reagiert wird. Vor Alemtuzumab-Therapie sollten der TSH-Spiegel und die Schilddrüsen-AK untersucht werden. Bei Nachweis von TPO-AK vor Beginn der Behandlung betrug das Risiko 69 %, eine AITD zu entwickeln im Vergleich zu TPO-negativen Patienten mit nur 31 %.Trotzdem waren 85 %, die eine AITD später entwickelten, vor Therapie TPO-AK-negativ, sodass AK-Negativität basal kein Schutz vor AITD darstellt. Deshalb müssen die periodischen Tests streng durchgeführt werden. Eine interdisziplinäre Zusammenarbeit von Neurologen, Internisten (Endokrinologen) und Gynäkologen führt zum rechtzeitigen Erkennen des variantenreichen klinischen Verlaufes bei wechselnden biochemischen Befunden mit entsprechenden diagnostischen und therapeutischen Konsequenzen. Da die klinischen Symptome der Hypothyreose/Hyperthyreose sich mit denen der MS überschneiden können, ist die Bestimmung von laborchemischen Parametern auch im Verlauf rechtzeitig unerlässlich, insbesondere bei graviden Patientinnen. Durch die kostengünstige und gut verträgliche Add-on-Therapie mit Vitamin D mit multiplen Zielwirkungen – 1. auf die AITD, 2. auf die Reduktion der Krankheitsaktivität und 3. auf die positive Beeinflussung einer Gravidität (Verringerung einer niedrigen Geburtsgewichts-, Eklampsie- und Frühgeburtenrate, Reduktion der Übertragung der MS auf die Nachkommenschaft) – sollte trotz noch offener Fragen den Betroffenen die Chance zur Minderung der Progression nicht verwehrt werden. Der Arzt spielt eine wichtige Rolle in der Stärkung der Fähigkeit der Patienten, ihre eigene Krankheit zu managen, um die Krankheitsprogression zu vermindern. Im Arzt-Patienten-Gespräch sollte die Reduzierung von Risikofaktoren (z.B. Vit.-D-Mangel) thematisiert werden. Ein Engagement für ein optimales interdisziplinäres Management mit Therapieindividualisierung und Reduzierung von Arzneimittelnebenwirkungen verbessert die Lebensqualität von MS-Patienten.

Other risk factors and explanations

2019 ◽  
pp. 173-197
Author(s):  
Raj S. Bhopal
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Chronic Disease ◽  
Hypothesis Testing ◽  
Vitamin D Deficiency ◽  
Chronic Inflammation ◽  
Thyroid Dysfunction ◽  
South Asians ◽  
Evaluation Studies ◽  
Anatomy And Physiology

As is usual with medical and scientific puzzles, there have been numerous creative ideas to explain South Asians’ susceptibility to diabetes, CHD, and stroke that have not been developed into either fully articulated hypotheses or have rarely or never been included in hypothesis testing or evaluation studies. These include thyroid dysfunction, lactose intolerance, vitamin B12 and folate deficiency, infection, and chronic inflammation. Vitamin D deficiency has been studied intensively recently in relation to chronic disease including some work on South Asians. Cardiovascular anatomy and physiology has been explored in observational and though these explanations have little theoretical foundation but they need some consideration.

scholarly journals Cystatin C, Vitamin D and Thyroid Function Test Profile in Chronic Kidney Disease Patients

Diseases ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 5
Author(s):  
Marlene Tapper ◽  
Donovan A. McGrowder ◽  
Lowell Dilworth ◽  
Adedamola Soyibo
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Cardiovascular Diseases ◽  
Kidney Disease ◽  
Vitamin D Deficiency ◽  
Cystatin C ◽  
Thyroid Dysfunction ◽  
Serum Cystatin C ◽  
Serum Cystatin ◽  
25 Oh Vitamin D

Background: The progression of chronic kidney disease (CKD) is concomitant with complications, including thyroid dysfunction, dyslipidemia and cardiovascular diseases. The aim of this study is to determine serum cystatin C levels, and the prevalence of vitamin D deficiency and thyroid dysfunction in CKD patients. Methods: A cross-sectional study was conducted involving 140 CKD patients (stages 1–5) that were referred to a renal clinic. Demographic data was collected and thyroid function tests, serum 25-OH-vitamin D, cystatin C levels, and routine biochemistry tests were determined using cobas 6000 analyzer. Results: 129 (92.1%) of CKD patients had elevated serum cystatin C levels and there was a stepwise increase from stage 1–5. Overt hypothyroidism was present in one patient and nine had subclinical hypothyroidism. There was a stepwise reduction in serum 25-OH-vitamin D levels from stage 2–5, 31 (22.1%) had vitamin D insufficiency and 31 (22.1%) presented with deficiency. Conclusions: 25-OH-vitamin D deficiency and thyroid disorders are exhibited in chronic kidney disease patients and the severity of the former rises with disease progression, as indicated by elevated cystatin C levels. Routine screening and timely intervention is recommended so as to reduce the risk of cardiovascular diseases.

Vitamin D deficiency, insulin resistance and thyroid dysfunction in obese patients: is inflammation the common link?

2018 ◽  
Vol 78 (7-8) ◽  
pp. 560-565 ◽  
Author(s):  
Nicoleta Răcătăianu ◽  
Nicoleta Valentina Leach ◽  
Sorana D. Bolboacă ◽  
Angela Cozma ◽  
Eleonora Dronca ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Thyroid Dysfunction ◽  
Obese Patients ◽  
The Common

scholarly journals Comorbidities of alopecia areata in infancy and childhood. A small descriptive study in a tertiary hospital in Greece

2022 ◽  
Vol 13 (1) ◽  
pp. 101-102
Author(s):  
Eleni Klimi
Keyword(s):  
Vitamin D ◽  
Family History ◽  
Vitamin D Deficiency ◽  
Alopecia Areata ◽  
Thyroid Dysfunction ◽  
Pediatric Population ◽  
Descriptive Study ◽  
Tertiary Hospital ◽  
Infancy And Childhood ◽  
History Of

Sir, A small descriptive study in a tertiary hospital in Greece was conducted on the comorbidities of alopecia areata in infancy and childhood. Alopecia areata is a non-scarring alopecia of autoimmune origin linked also to genetic and environmental factors [1], affecting 2% of the general population and is considered a disease of young adults. Attempts have been made to detect the comorbidities in infants and children suffering from alopecia areata. Sorell Jennifer et al. established a strong association of alopecia areata with atopy, psoriasis thyroid disease, and juvenile idiopathic arthritis [2]. More recently, Comiz et al. [3] added anemia, obesity, vitamin D deficiency, hypothyroidism, vitiligo, psoriasis, hyperlipidemia, and depression to the list of the comorbidities detected in the pediatric population with alopecia areata. The purpose of the study was to detect the comorbidities in infants and children with alopecia areata in an outpatient dermatology clinic during a period of six years from 2013 through 2019. All those examined as outpatients and those hospitalized for several reasons in the pediatric ward who were diagnosed with alopecia areata were included in the study. Laboratory tests, a full blood count, and vitamin D, IgE, and thyroid tests were performed in the laboratories of our hospital. During these seven years, 71 patients were diagnosed with alopecia areata and 7 (approx. 10%) were children. Four (57.1%) were males, and the rest three were females. The males were aged 23 months, and 6-, 7-, and 11-years. The females were 2-, 7-, and 11-year-old. Clinical atopy confirmed by high levels of IgE in the serum was detected in two males and in all three females. Thyroid dysfunction, hypothyroidism, was only detected in one infant associated with atopy; this was in a 23-month-old who at the time of the diagnosis of alopecia areata was hospitalized with severe asthma. Vitamin D deficiency was found in one male patient. A family history of alopecia areata was found in only one male patient. A family history of atopy was reported in only one boy, aged 7 years. A family history of thyroid dysfunction was detected in two males 28%: The 23-month-old infant whose father suffered from hyperthyroidism and the 12-year-old male whose both parents suffered from hypothyroidism. A family history of rheumatoid arthritis was found in one female patient. All patients presented with a mild disease limited to the scalp at the time of diagnosis. No nail pitting was observed, and neither clinical signs of psoriasis, nor of vitiligo. Folliculitis of the scalp preceded the onset of alopecia areata in one of the females (Table 1). Although males comprised 57.1% of our cases, most studies have found a preponderance of females in the pediatric population with AA. Atopy was the most frequent comorbidity (5/7; 70%) and was more frequent in females; all three girls were atopic. The second most frequently found comorbidity was thyroid dysfunction, hypothyroidism., detected in one patient (14%). Vitamin D deficiency was noted in one (14%) patient. A family history of AA was found in one patient as well as a family history of atopy. A family history of thyroid dysfunction was found in two patients (28%). The precipitating factor in our case was staphylococcal infection of the scalp. Staphylococcus, probably acting as a super antigen, was observed in only one patient (14%). Both atopy and thyroid dysfunction should be sought for in pediatric patients with AA in this order.

Dermatologische Aspekte der Psoriasis 2010

2010 ◽  
Vol 30 (03) ◽  
pp. 129-138
Author(s):  
R. Salgo ◽  
C. Worlicek ◽  
D. Thaçi
Keyword(s):  
Diabetes Mellitus ◽  
Vitamin D ◽  
Interdisziplinäre Zusammenarbeit ◽  
Psoriasis Arthritis ◽  
Chronisch Entzündliche

ZusammenfassungDie Schuppenflechte, eine chronisch-entzündliche Dermatose, betrifft zwei bis drei Prozent der kaukasischen Bevölkerung. Sie ist durch scharf begrenzte erythematöse Plaques mit silbrigweißer Schuppung gekennzeichnet. 20 bis 30 Prozent der Patienten sind zusätzlich an einer Psoriasis-Arthritis erkrankt. In den vergangenen Jahren gilt die Aufmerksamkeit zunehmend den bei Schuppenflechte gehäuft auftretenden Komorbiditäten, wie Herz-Kreislauferkrankungen, Diabetes mellitus und Übergewicht. Die Therapie der Psoriasis muss individuell an die jeweilige Schwere und Aktivität der Erkrankung angepasst werden. Leichtere Formen können oft mit einer Lokal therapie beherrscht werden, hierbei gilt es, Besonderheiten der verschiedenen anatomischen Regionen zu berücksichtigen. In der topischen Therapie werden neben den „klassischen“ Antipsoriatika wie Cignolin, die v. a. im stationären Bereich Anwendung finden, heute überwiegend Vitamin-D-Analoga und Kortikosteroide eingesetzt. Die Phototherapie zeigt gute Wirksamkeit, ist aber mit hohem zeitlichem Aufwand verbunden. Moderaten und v. a. schweren Formen sind die Systemtherapien vorbehalten. Die „konventionellen“ Systemtherapien wie Methotrexat, CSA, Retinoide und Fumarsäureester sind in den vergangenen Jahren durch die Biologika (Etanercept, Adalimumab, Infliximab, Ustekinumab) ergänzt worden. Bei der Auswahl der Systemtherapien müssen die Komorbiditäten und Komedikation der Patienten Beachtung finden. Gerade bei Psoriasis-Arthritis ist eine interdisziplinäre Zusammenarbeit zwingend notwendig.

scholarly journals Prevalence of vitamin D deficiency and its relationship with thyroid autoimmunity in Asian Indians: a community-based survey

2009 ◽  
Vol 102 (3) ◽  
pp. 382-386 ◽  
Author(s):  
Ravinder Goswami ◽  
Raman Kumar Marwaha ◽  
Nandita Gupta ◽  
Nikhil Tandon ◽  
Vishnubhatla Sreenivas ◽  
...  
Keyword(s):  
Vitamin D ◽  
Thyroid Dysfunction ◽  
Thyroid Autoimmunity ◽  
Inverse Correlation ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Peroxidase ◽  
25 Hydroxy Vitamin D ◽  
D Values ◽  
The Relationship

25-Hydroxy vitamin D (25(OH)D) deficiency is linked with predisposition to autoimmune type 1 diabetes and multiple sclerosis. Our objective was to assess the relationship between serum 25(OH)D levels and thyroid autoimmunity. Subjects included students, teachers and staff aged 16–60 years (total 642, 244 males, 398 females). Serum free thyroxine, thyroid-stimulating hormone (TSH), and thyroid peroxidase autoantibodies (TPOAb), intact parathyroid hormone and 25(OH)D were measured by electrochemiluminescence and RIA, respectively. Thyroid dysfunction was defined if (1) serum TSH ≥ 5 μU/ml and TPOAb>34 IU/ml or (2) TSH ≥ 10 μU/ml but normal TPOAb. The mean serum 25(OH)D of the study subjects was 17·5 (sd 10·2) nmol/l with 87 % having values ≤ 25 nmol/l. TPOAb positivity was observed in 21 % of subjects. The relationship between 25(OH)D and TPOAb was assessed with and without controlling for age and showed significant inverse correlation (r − 0·08, P = 0·04) when adjusted for age. The prevalence of TPOAb and thyroid dysfunction were comparable between subjects stratified according to serum 25(OH)D into two groups either at cut-off of ≤ 25 or >25 nmol/l or first and second tertiles. Serum 25(OH)D values show only weak inverse correlation with TPOAb titres. The presence of such weak association and narrow range of serum 25(OH)D did not allow us to interpret the present results in terms of quantitative cut-off values of serum 25(OH)D. Further studies in vitamin D-sufficient populations with wider range of serum 25(OH)D levels are required to substantiate the findings of the current study.

scholarly journals Inference of link between diabetes, obesity, and thyroid dysfunction in data at a Saudi Arabian clinic

2021 ◽  
Vol 17 (1) ◽  
pp. 119-125
Author(s):  
Alsamghan S Awad ◽  
Keyword(s):  
Vitamin D ◽  
Medical Records ◽  
Metabolic Disorders ◽  
Thyroid Dysfunction ◽  
Saudi Arabian ◽  
Diabetic Patients ◽  
Obese Patients ◽  
Patients With Diabetes ◽  
Specialist Center ◽  
Thyroid Dysfunctions

The clinical link among diabetes, obesity, and thyroid dysfunction is of interest. Hence, medical records of 601 patients with diabetes, obesity, and thyroid dysfunctions at the Abha Specialist Center and Military Diabetic Endocrine Center we used in this analysis. Approximately 28% of diabetic patients had thyroid dysfunction, and 12.4% were vitamin D deficient. The patients with thyroid dysfunction had significantly elevated triglyceride levels compared to the patients without thyroid dysfunction (173.6 vs. 128. p=0.009). Vitamin D deficient obese patients were significantly younger (33.99±10.69 vs. 43.68±14.42; p<0.001) and had significantly lower levels of HbA1c (5.73±1.16 vs. 6.83±2.08; p=0.014) and lower systolic BP (120.26±11.75 vs. 124.58±13.63; p=0.049) than non-vitamin D deficient obese patients. Vitamin D deficient thyroid patients had significantly lower diastolic BP (71.4±9.9 vs. 74.9±9.7; p=0.040) and higher HbA1c (8.7±3.6 vs. 6.4±1.7; p=0.003) in comparison to non-vitamin D deficient thyroid patients. Hence, analysis of metabolic disorders in these patients will help combat complications in these cases.

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