Endocrine ophthalmopathy: state-of-the-art approaches

2013 ◽  
Vol 58 (6) ◽  
pp. 24-32 ◽  
Author(s):  
N. A. Petunina ◽  
L. V. Trukhina ◽  
N. S. Martirosyan
Keyword(s):  
T Lymphocytes ◽  
Autoimmune Thyroiditis ◽  
Thyroid Dysfunction ◽  
State Of The Art ◽  
Clinical Manifestations ◽  
Eye Disease ◽  
Graves Disease ◽  
Challenging Problem ◽  
Chronic Autoimmune Thyroiditis ◽  
Endocrine Ophthalmopathy

The issues pertaining to etiology, pathogenesis, clinical manifestations, and treatment of endocrine ophthalmopathy (EOP) are discussed. EOP is a heterogeneous autoimmune eye disease most frequently associated with Graves’ disease even though it is just as well encountered both in the patients presenting with chronic autoimmune thyroiditis and in the absence of thyroid dysfunction. Although pathogenesis of EOP remains to be elucidated its autoimmune nature with the involvement of sensitized T-lymphocytes and autoantibodies against orbital tissues leaves no doubt. The understanding of mechanisms underlying the development of EOP gave impetus to the creation of new groups of medicines selectively acting on various pathogenic processes associated with this disease. The management of EOP remains a challenging problem requiring a multi-disciplinary approach for its solution.

Different aetiologies in post-partum thyroiditis?

1983 ◽  
Vol 104 (2) ◽  
pp. 195-200 ◽  
Author(s):  
Per Anders Dahlberg ◽  
Rolf Jansson
Keyword(s):  
Thyroid Function ◽  
Autoimmune Thyroiditis ◽  
Thyroid Dysfunction ◽  
Post Partum ◽  
Lymphocytic Infiltration ◽  
Graves Disease ◽  
Thyroid Autoantibodies ◽  
Radioiodine Uptake ◽  
Thyroid Cytology

Abstract. During a 4 year period 19 women with post-partum onset of thyroid dysfunction have been seen in our clinic. Five women had high radioiodine uptake thyrotoxicosis (Graves' disease). Twelve women had hypothyroid symptoms starting within 3–6 months of delivery. All of these women had thyroid microsomal and/or cytoplasmic autoantibodies and thyroid lymphocytic infiltration suggesting aggravation of pre-existing subclinical autoimmune thyroiditis (Hashimoto's disease). At follow-up thyroid function gradually improved in all but signs of persistent thyroid hypofunction remained in seven. Thus women developing symptomatic postpartum hypothyroidism should be followed regularly and when thyroxine treatment is commenced in the post-partum period, it has to be continued indefinitely in many cases. Two women presented with transient low radioiodine uptake thyrotoxicosis and a small painless goitre. Thyroid cytology revealed thyroiditis but they had no thyroid autoantibodies. When followed after a succeeding delivery none of these women developed post-partum thyroid dysfunction in contrast to women in the autoimmune group. Probably the aetiology of thyroid dysfunction in these 2 women was different.

Graves' disease, endocrine ophthalmopathy and smoking

1993 ◽  
Vol 128 (2) ◽  
pp. 156-160 ◽  
Author(s):  
Brita Winsa ◽  
Agneta Mandahl ◽  
F Anders Karlsson
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Eye Disease ◽  
Graves Disease ◽  
Retrospective Survey ◽  
Eye Problems ◽  
Increased Risk ◽  
Endocrine Ophthalmopathy ◽  
History Of ◽  
Receptor Antibodies

We have evaluated the association between smoking, Graves' disease and endocrine ophthalmopathy in a case-control study of 208 patients with newly diagnosed Graves' disease and carried out a retrospective survey of 72 patients treated for Graves' disease and admitted to our ward because of endocrine ophthalmopathy. In the prospective study, patients with Graves' disease smoked significantly more than their healthy controls (41% vs 30%, p<0.01 for current smokers, odds ratio 1.6, 95% confidence interval 1.1-2.3, and p<0.05 for patients with a history of smoking, odds ratio: 1.4, 95% confidence interval 1.0-1.9). Among the patients with endocrine ophthalmopathy at diagnosis, there were slightly more patients with a history of smoking (p <0.05, odds ratio 2.1, 95% confidence interval 1.1-3.9), but not more current smokers when compared with the remaining group. The patients with eye problems tended to have a more active disease with higher levels of thyroxine and TSH-receptor antibodies, but no difference was seen in thyrogastric autoantibodies. No effect of smoking on thyroid hormone and autoantibody levels could be detected. In the retrospective survey we found 64%, 71% and 87% smokers among patients with moderate, severe and malignant eye disease, respectively. In summary, the results show that smoking is associated with an increased risk of contracting Graves' disease and that it enhances the severity of the eye disease in cases that develop endocrine ophthalmopathy during the course of treatment.

scholarly journals Macro-TSH in patients with primary hypothyroidism due to autoimmune thyroiditis

2021 ◽  
Vol 17 (4) ◽  
pp. 17-20
Author(s):  
A. G. Saribekian ◽  
D. A. Petrenko ◽  
D. A. Trukhina ◽  
A. G. Kuzmin ◽  
L. K. Dzeranova ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Thyroid Gland ◽  
Autoimmune Thyroiditis ◽  
Thyroid Dysfunction ◽  
Clinical Manifestations ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Common Phenomenon ◽  
Functional Disorders ◽  
Key Indicators

Thyroid stimulating hormone (TSH) is one of the key indicators in the diagnosis of the thyroid gland functional disorders. Minor changes in TSH concentration make it possible to suspect thyroid dysfunction even before clinical manifestations, which increases the value of correct and timely measurement of it. In the clinical practice, an endocrinologist often encounter the well-known phenomenon of macroprolactinemia; a much less common phenomenon is macrotyrotropinemia (macro-TSH). The presence of macro-TSH complexes can be suspected when the serum detects atypically high TSH values with reference values of FT4 without any signs of hypothyroidism. Since the phenomenon is based on an autoimmune mechanism, macro-TSH can often be detected in patients with autoimmune thyroiditis (AIT). This article presents clinical cases of patients with a combination of the macro-TSH phenomenon and primary hypothyroidism due to AIT.

scholarly journals Biochemical and immunological markers of autoimmune thyroiditis

2016 ◽  
Vol 62 (4) ◽  
pp. 458-465
Author(s):  
E.M. Biktagirova ◽  
L.I. Sattarova ◽  
G.R. Vagapova ◽  
Y.V. Skibo ◽  
E.N. Chuhlovina ◽  
...  
Keyword(s):  
Cell Death ◽  
Thyroid Gland ◽  
Autoimmune Thyroiditis ◽  
Thyroid Dysfunction ◽  
Annexin V ◽  
Healthy Controls ◽  
Healthy Individuals ◽  
Correlation Dependence ◽  
Chronic Autoimmune Thyroiditis ◽  
Immunological Markers

Correlations between biochemical and immunological markers of programmed cell death (apoptosis), and the functional state of the thyroid gland (hyperthyroidism, euthyroidism, hypothyroidism) have been investigated in autoimmune thyroiditis (AT) (also known as chronic autoimmune thyroiditis). Annexin V, TRAIL and TNF-a, as well as DNA-hydrolyzing antibodies were used as the main markers. Increased levels of TRAIL were found in the serum of AT patients (hyperthyroidism>hypothyroidism>euthyroidism) compared with healthy individuals. The highest frequency of antibodies to denatured DNA (Abs-dDNA) had the highest frequency in AT patients (97%) compared with healthy controls. Among these patients, 75% had hyperthyroidism, 85% had hypothyroidism, and 84.7% had euthyroidism. Abs hydrolyzing activity demonstrated correlation dependence with symptoms of the thyroid dysfunction.

scholarly journals Anti-CD38 autoimmunity in patients with chronic autoimmune thyroiditis or Graves' disease

2001 ◽  
Vol 126 (3) ◽  
pp. 426-431 ◽  
Author(s):  
A. Antonelli ◽  
P. Fallahi ◽  
C. Nesti ◽  
C. Pupilli ◽  
P. Marchetti ◽  
...  
Keyword(s):  
Autoimmune Thyroiditis ◽  
Graves Disease ◽  
Chronic Autoimmune Thyroiditis

scholarly journals Hypothyroidism in a physician’s practice: difficulties of diagnostics and treatment

2020 ◽  
pp. 206-212
Author(s):  
A. F. Verbovoy ◽  
Yu. A. Dolgikh
Keyword(s):  
Cardiovascular Disease ◽  
Body Weight ◽  
Autoimmune Thyroiditis ◽  
Clinical Manifestations ◽  
Drug Dose ◽  
Iodine Intake ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Peroxidase ◽  
Chronic Autoimmune Thyroiditis ◽  
Cardiovascular Therapy

Hypothyroidism is the most common endocrine disease after diabetes mellitus. Its frequency depends on age, sex and iodine intake. The highest prevalence of hypothyroidism is observed in older women. Chronic autoimmune thyroiditis is the most common cause of this condition. The peculiarity of hypothyroidism is an erased clinical picture, diversity and nonspecific symptoms. This makes it difficult to diagnose the disease, leads to an erroneous diagnosis and later detection of thyroid insufficiency. This article discusses the various «masks» of hypothyroidism and peculiarities of clinical manifestations. The main «masks» are: cardiological, dermatological, urological, gastroenterological, endocrine and reproductive system disorders, neurological, psychiatric, hematological, rheumatological. Free thyroxine and thyroid-stimulating hormone are used to diagnose hypothyroidism, as well as antibody titer to thyroid peroxidase and thyroglobulin to detect chronic autoimmune thyroiditis. Levothyroxine preparations are used as a substitution therapy. The dose of the drug depends on the age of the patient and the presence of cardiovascular disease. Patients under 50 years of age without a severe concomitant cardiovascular disease are given 1.6 µg of levothyroxine per kg of body weight. In persons over 50 years of age with cardiovascular diseases, the drug dose is prescribed at the rate of 0.9 µg per kg of body weight. The therapy starts with small doses, slowly increasing it under the control of electrocardiography. At occurrence or strengthening of symptoms of angina a dose of levothyroxine is reduced to the previous one and the cardiovascular therapy is corrected. Evaluation of the effectiveness of the treatment is carried out on the level of thyroid hormone.

Thyroid disease after pregnancy: postpartum thyroiditis

2011 ◽  
pp. 552-557 ◽  
Author(s):  
Nobuyuki Amino ◽  
Sumihisa Kubota
Keyword(s):  
Autoimmune Thyroiditis ◽  
Thyroid Disease ◽  
Postpartum Period ◽  
Thyroid Dysfunction ◽  
Thyroid Autoimmunity ◽  
Graves Disease ◽  
Postpartum Thyroiditis ◽  
Transient Hypothyroidism ◽  
Postpartum Thyroid Dysfunction

Postpartum thyroiditis is defined as an exacerbation of autoimmune thyroiditis during the postpartum period (1). Patients do not develop thyroid autoimmunity at the onset of postpartum thyroiditis, but have ‘subclinical autoimmune thyroiditis’ beforehand which is exacerbated after delivery. Typically an exacerbation induces destructive thyrotoxicosis followed by transient hypothyroidism. However, various types of thyroid dysfunction may occur, including Graves’ disease. Therefore, any kind of thyroid dysfunction observed during the postpartum period, is referred to as ‘postpartum thyroid dysfunction’.

scholarly journals Screening Leads to Overestimated Associations of Thyroid Dysfunction and Thyroiditis with Thyroid Cancer Risk

Cancers ◽  
2021 ◽  
Vol 13 (21) ◽  
pp. 5385
Author(s):  
Young Shin Song ◽  
Kyung Soo Kim ◽  
Soo Kyung Kim ◽  
Young Wook Cho ◽  
Hyo Geun Choi
Keyword(s):  
Thyroid Cancer ◽  
Cancer Risk ◽  
Autoimmune Thyroiditis ◽  
Thyroid Disease ◽  
Thyroid Dysfunction ◽  
Large Population ◽  
Graves Disease ◽  
Thyroid Function Tests ◽  
Subgroup Analyses ◽  
Thyroid Cancer Risk

We aimed to assess the relationships of functional thyroid disease and thyroiditis with subsequent thyroid cancer, which is controversial due to various confounders, and the effect of thyroid disease workup on this association. We used the cohort data from 2002 to 2015 (Study I, n = 28,330) and the entire data from 2002 to 2019 (Study II, n = 883,074) of the Korean National Health Insurance Service database, and performed logistic regression and subgroup analyses with various covariates. In Study I, hypothyroidism, thyroiditis, autoimmune thyroiditis, hyperthyroidism, and Graves’ disease showed positive associations with thyroid cancer. In Study II, after adjustment for covariates including the number of thyroid function tests, the ORs for thyroid cancer were significantly reduced in all thyroid diseases. Hypothyroidism, thyroiditis, and autoimmune thyroiditis were positively associated (adjusted odds ratio, OR (95% confidence interval, CI) 1.28 (1.25–1.32), 1.36 (1.31–1.42), and 1.17 (1.11–1.24), respectively), whereas hyperthyroidism and Graves’ disease were negatively associated with thyroid cancer (adjusted OR (95% CI) 0.80 (0.77–0.83) and 0.69 (0.65–0.74), respectively). Multiple subgroup analyses in both studies showed consistent results. In this large population-based, nationwide study, we confirmed that thyroid disease workup leads to overestimation of associations of thyroid dysfunction and thyroiditis with thyroid cancer risk.

scholarly journals SAT-463 Thyrotoxicosis from Nivolumab in a Patient with Preexisting Graves’ Disease

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Preethi Polavarapu ◽  
Padmaja Akkireddy
Keyword(s):  
Adverse Events ◽  
Thyroid Function ◽  
Autoimmune Thyroiditis ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Thyroid Dysfunction ◽  
Checkpoint Inhibitors ◽  
Graves Disease ◽  
Thyroid Function Tests ◽  
Free T4

Abstract Introduction Thyroid dysfunction is one of the common immune-related adverse events associated with immune checkpoint inhibitors like Nivolumab. Thyroiditis or primary hypothyroidism is the most commonly reported presentation. Graves’ disease is less frequently reported. We report a case of preexisting Graves’ disease patient, on antithyroid meds who developed thyrotoxicosis followed by hypothyroidism after receiving Nivolumab therapy. Case 66 y/o female patient with newly diagnosed metastatic melanoma presented to us for evaluation of abnormal thyroid test after her second cycle of Nivolumab. She has a long-standing history of Graves’ disease and has been on methimazole since her diagnosis. Her baseline thyroid labs before the start of Nivolumab were within normal limits (on methimazole 2.5 mg daily). She presented with weight loss, palpitations, and tremors four weeks after the start of Nivolumab. On exam, she was tachycardic with tremors noted to outstretched hands and had diffusely enlarged thyroid. Repeat lab work done before her second cycle revealed suppressed TSH 0.02 (0.4-4.5 uIU/ml) with elevated free T4 and T3. Her TSI titers were elevated. Methimazole dose was increased to 10 mg daily, and follow up labs done in a month revealed TSH of 89 uIU/ml, Free T4 0.16 (0.76-1.8 ng/dl). Methimazole was completely stopped at this time. She continued to have elevated TSH despite being off of methimazole for more than a month, concerning for the development of hypothyroidism. She was started on levothyroxine, after which labs returned to normal. The patient continued on immunotherapy during this period. Discussion Immune checkpoint inhibitors have been increasingly used for cancer therapy. Endocrinopathies are the most common immune-related adverse events associated with the use of these agents, with thyroid dysfunction being more common. Our patient had well-controlled Graves’ disease and was on a stable dose of methimazole for years. She developed autoimmune thyroiditis four weeks after receiving immunotherapy and subsequently developed hypothyroidism. The literature search did not reveal cases of autoimmune thyroiditis in a patient with preexisting Graves’ disease. One study reported that the timeline for developing the thyrotoxic phase is five weeks, which is followed by the rapid development of either euthyroid or hypothyroid phase. Management during the thyrotoxic phase is usually beta-blockers. Current guidelines recommend checking thyroid function test before initiation of therapy and every two weeks after the diagnosis of thyrotoxicosis until they become euthyroid or hypothyroid. Our case illustrates that patients with preexisting Graves’ disease can develop thyroiditis after receiving immune checkpoint inhibitors, and hence, frequent monitoring with thyroid function tests is needed.

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