scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Predictive scores in autoimmune thyroid disease: are they useful?

2019 ◽  
Vol 181 (3) ◽  
pp. R119-R131 ◽  
Author(s):  
Grigoris Effraimidis
Keyword(s):  
Thyroid Disease ◽  
Autoimmune Thyroid Disease ◽  
Prediction Models ◽  
Prediction Score ◽  
Predictive Score ◽  
Antithyroid Drugs ◽  
Newly Diagnosed ◽  
Endocrine Disease ◽  
Autoimmune Thyroid ◽  
Graves Orbitopathy

Prediction models are of a great assistance for predicting the development of a disease, detecting or screening undiagnosed patients, predicting the effectiveness of a treatment and helping toward better decision-making. Recently, three predictive scores in the field of autoimmune thyroid disease (AITD) have been introduced: The Thyroid Hormones Event Amsterdam (THEA) score: a predictive score of the development of overt AITD, the Graves’ Events After Therapy (GREAT) score: a prediction score for the risk of recurrence after antithyroid drugs withdrawal and the Prediction Graves’ Orbitopathy (PREDIGO) score: a prediction score for the development of Graves’ orbitopathy in newly diagnosed patients with Graves’ hyperthyroidism. Their construction, clinical applicability, the possible preventative measurements which can be taken to diminish the risks and the potential future developments which can improve the accuracy of the predictive scores are discussed in this review.

scholarly journals Thyroid Function and Human Reproductive Health

2010 ◽  
Vol 31 (5) ◽  
pp. 702-755 ◽  
Author(s):  
G. E. Krassas ◽  
K. Poppe ◽  
D. Glinoer
Keyword(s):  
Thyroid Function ◽  
Thyroid Disease ◽  
Autoimmune Thyroid Disease ◽  
Controlled Ovarian Hyperstimulation ◽  
Male Reproduction ◽  
Antithyroid Drugs ◽  
Premature Delivery ◽  
Ovarian Hyperstimulation ◽  
Autoimmune Thyroid ◽  
The Impact

Via its interaction in several pathways, normal thyroid function is important to maintain normal reproduction. In both genders, changes in SHBG and sex steroids are a consistent feature associated with hyper- and hypothyroidism and were already reported many years ago. Male reproduction is adversely affected by both thyrotoxicosis and hypothyroidism. Erectile abnormalities have been reported. Thyrotoxicosis induces abnormalities in sperm motility, whereas hypothyroidism is associated with abnormalities in sperm morphology; the latter normalize when euthyroidism is reached. In females, thyrotoxicosis and hypothyroidism can cause menstrual disturbances. Thyrotoxicosis is associated mainly with hypomenorrhea and polymenorrhea, whereas hypothyroidism is associated mainly with oligomenorrhea. Thyroid dysfunction has also been linked to reduced fertility. Controlled ovarian hyperstimulation leads to important increases in estradiol, which in turn may have an adverse effect on thyroid hormones and TSH. When autoimmune thyroid disease is present, the impact of controlled ovarian hyperstimulation may become more severe, depending on preexisting thyroid abnormalities. Autoimmune thyroid disease is present in 5–20% of unselected pregnant women. Isolated hypothyroxinemia has been described in approximately 2% of pregnancies, without serum TSH elevation and in the absence of thyroid autoantibodies. Overt hypothyroidism has been associated with increased rates of spontaneous abortion, premature delivery and/or low birth weight, fetal distress in labor, and perhaps gestation-induced hypertension and placental abruption. The links between such obstetrical complications and subclinical hypothyroidism are less evident. Thyrotoxicosis during pregnancy is due to Graves’ disease and gestational transient thyrotoxicosis. All antithyroid drugs cross the placenta and may potentially affect fetal thyroid function.

HLA-DR Expressing Peripheral T Regulatory Cells in Newly Diagnosed Patients with Different Forms of Autoimmune Thyroid Disease

Thyroid ◽  
2008 ◽  
Vol 18 (11) ◽  
pp. 1195-1200 ◽  
Author(s):  
Stelios Fountoulakis ◽  
George Vartholomatos ◽  
Nikolaos Kolaitis ◽  
Stathis Frillingos ◽  
George Philippou ◽  
...  
Keyword(s):  
Thyroid Disease ◽  
Autoimmune Thyroid Disease ◽  
T Regulatory Cells ◽  
Newly Diagnosed ◽  
Regulatory Cells ◽  
Autoimmune Thyroid ◽  
Hla Dr

scholarly journals MECHANISMS IN ENDOCRINOLOGY: Autoimmune thyroid disease: old and new players

2014 ◽  
Vol 170 (6) ◽  
pp. R241-R252 ◽  
Author(s):  
Grigoris Effraimidis ◽  
Wilmar M Wiersinga
Keyword(s):  
Thyroid Disease ◽  
Autoimmune Thyroid Disease ◽  
Twin Studies ◽  
Susceptibility Genes ◽  
Antithyroid Drugs ◽  
Autoimmune Thyroid ◽  
Increased Risk ◽  
Vitamin D Levels ◽  
Fetal Microchimerism ◽  
Low Selenium

The last 10 years have seen some progress in understanding the etiology of autoimmune thyroid disease (AITD). The female preponderance can now be explained – at least in part – by fetal microchimerism and X-chromosome inactivation. The number of identified susceptibility genes for AITD is increasing (among others now includingTSHR,TG,HLA,CTLA4,PTPN22,CD40,FCRL3,IL2RA, andFOXP3), but these genes together probably do not explain more than about 10% of the heritability of AITD. As twin studies indicate that genes contribute for 70% of AITD, it follows that there must be many more loci, each of them contributing a little. While the genetic studies have clarified why various autoimmune diseases so often cluster in the same patient, the molecular mechanism of action of these genetic polymorphisms (frequently located in introns) has hardly been explained. Polymorphisms in AITD susceptibility genes may become helpful in clinical practice, e.g. in assessing risk of recurrent Graves' hyperthyroidism (GH) after a course of antithyroid drugs. Moderate alcohol intake decreases the risk on overt GH and overt Hashimoto's hypothyroidism. Current smokers – as well known – are at increased risk for Graves' disease, but – surprisingly – at diminished risk for Hashimoto's thyroiditis. Low selenium and low vitamin D levels might increase the risk of developing AITD, but data are still inconclusive. Current options for preventive interventions in subjects at risk to develop AITD are very limited.

scholarly journals Predictive score for the development or progression of Graves’ orbitopathy in patients with newly diagnosed Graves’ hyperthyroidism

2018 ◽  
Vol 178 (6) ◽  
pp. 635-643 ◽  
Author(s):  
Wilmar Wiersinga ◽  
Miloš Žarković ◽  
Luigi Bartalena ◽  
Simone Donati ◽  
Petros Perros ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Subsequent Treatment ◽  
Current Smoker ◽  
Predictive Score ◽  
Antithyroid Drugs ◽  
Clinical Activity ◽  
Newly Diagnosed ◽  
Predictive Values ◽  
If Current ◽  
Graves Orbitopathy

Objective To construct a predictive score for the development or progression of Graves’ orbitopathy (GO) in Graves’ hyperthyroidism (GH). Design Prospective observational study in patients with newly diagnosed GH, treated with antithyroid drugs (ATD) for 18 months at ten participating centers from EUGOGO in 8 European countries. Methods 348 patients were included with untreated GH but without obvious GO. Mixed effects logistic regression was used to determine the best predictors. A predictive score (called PREDIGO) was constructed. Results GO occurred in 15% (mild in 13% and moderate to severe in 2%), predominantly at 6–12 months after start of ATD. Independent baseline determinants for the development of GO were clinical activity score (assigned 5 points if score > 0), TSH-binding inhibitory immunoglobulins (2 points if TBII 2–10 U/L, 5 points if TBII > 10 U/L), duration of hyperthyroid symptoms (1 point if 1–4 months, 3 points if >4 months) and smoking (2 points if current smoker). Based on the odds ratio of each of these four determinants, a quantitative predictive score (called PREDIGO) was constructed ranging from 0 to 15 with higher scores denoting higher risk; positive and negative predictive values were 0.28 (95% CI 0.20–0.37) and 0.91 (95% CI 0.87–0.94) respectively. Conclusions In patients without GO at diagnosis, 15% will develop GO (13% mild, 2% moderate to severe) during subsequent treatment with ATD for 18 months. A predictive score called PREDIGO composed of four baseline determinants was better in predicting those patients who will not develop obvious GO than who will.

scholarly journals PD-1/PD-L1 Expressions on Treg Cells in Patients with Autoimmune Thyroid Disease

2021 ◽  
Author(s):  
Lin Cui ◽  
Xiaotong Gu ◽  
Haixia Liu ◽  
Hong Zheng
Keyword(s):  
T Cells ◽  
Cell Death ◽  
Programmed Cell Death ◽  
Peripheral Blood ◽  
Thyroid Disease ◽  
Autoimmune Thyroid Disease ◽  
Treg Cells ◽  
Graves Disease ◽  
Newly Diagnosed ◽  
Autoimmune Thyroid

Abstract Background: Autoimmune thyroid disease(AITD) is a frequent autoimmune disease characterized by lymphocytic infiltration and thyroid autoantibody production caused by autoimmune dysfunction. Recent studies have shown that Treg cells can participate in the pathogenesis of AITD by inhibiting peripheral reactive T cells and thereby inhibiting the autoimmune responses. Programmed cell death-1 (PD-1)/programmed cell death ligand (PD-L1) pathway is a negative costimulatory pathway discovered in recent years, enhancing or blocking this pathway is associated with the immune process of AITD. PD-1/PD-L1 was simultaneously expressed on Treg cells. In this paper, the role of regulatory T cells and PD-1/PD-L1 signaling pathway in AITD was discussed.Methods: We detected the percentage of CD4+CD25+CD127lowT cells, the ratio of PD-1+Treg cells and PD-L1+Treg cells in peripheral blood of twenty patients newly diagnosed with graves disease (GD) and twenty-one patients newly diagnosed with Hashimotos’thyroiditis (HT) patients by flow cytometry, and samples from twenty healthy individuals served as control.Results: The results demonstrated that the proportion of CD4+CD25+CD127lowT cells in peripheral blood of HT patients was lower than that of healthy controls(HCs), the ratio of PD-1+Treg cells of HT patients was higher than that of the HCs and GD patients, the ratio of PD-1+Treg cells of GD patients was higher than that of the HCs, the ratio of PD-L1+Treg cells in Treg cells of HT patients was higher than that of the HCs and GD patients and the ratio of PD-L1+Treg cells of GD patients was higher than that of the HCs. All the above were statistically significant.Conclusions: The treg cells play an obvious role in hashimoto's thyroiditis, but not obvious in Graves' disease.

scholarly journals COVID-19 and thyroid diseases: a bidirectional impact

2021 ◽  
Author(s):  
Leonidas H Duntas ◽  
Jacqueline Jonklaas
Keyword(s):  
Thyroid Gland ◽  
Thyroid Disease ◽  
Autoimmune Thyroid Disease ◽  
Thyroid Diseases ◽  
Newly Diagnosed ◽  
Autoimmune Thyroid ◽  
Autoimmune Hypothyroidism ◽  
Spanish Influenza ◽  
Mesh Terms ◽  
The Impact

Abstract Background COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has become the most lethal and rapidly-moving pandemic since the Spanish influenza of 1918-1920, is associated with thyroid diseases. Methods References were identified through searches of PubMed and MEDLINE for articles published from Jan 1, 2019 to February 19, 2021 by use of the MeSH terms “hypothyroidism”, “hyperthyroidism”, “thyroiditis”, “thyroid cancer”, “thyroid disease”, in combination with the terms “coronavirus” and “COVID-19”. Articles resulting from these searches and references cited in those articles were reviewed. Results Though pre-existing autoimmune thyroid disease appears unlikely to render patients more vulnerable to COVID-19, some reports have documented relapse of Graves’ disease (GD) or newly diagnosed GD about 1 month following SARS-CoV-2 infection. Investigations are ongoing to investigate molecular pathways permitting the virus to trigger GD or cause subacute thyroiditis (SAT). While COVID-19 is associated with non-thyroidal illness, it is not clear whether it also increases the risk of developing autoimmune hypothyroidism. The possibility that thyroid dysfunction may also increase susceptibility for COVID-19 infection deserves further investigation. Recent data illustrate the importance of thyroid hormone in protecting the lungs from injury, including that associated with COVID-19. Conclusions The interaction between the thyroid gland and COVID-19 is complex and bidirectional. COVID-19 infection is associated with triggering of GD and SAT, and possibly hypothyroidism. Until more is understood regarding the impact of coronavirus on the thyroid gland, it seems advisable to monitor patients with COVID-19 for new thyroid disease or progression of pre-existing thyroid disease.

scholarly journals Asymmetric Graves’ Orbitopathy

2020 ◽  
Vol 11 ◽  
Author(s):  
Grigorios Panagiotou ◽  
Petros Perros
Keyword(s):  
Thyroid Disease ◽  
Autoimmune Thyroid Disease ◽  
Severe Disease ◽  
Significant Proportion ◽  
Older Age ◽  
Psychological Burden ◽  
Autoimmune Thyroid ◽  
Bilateral Disease ◽  
Graves Orbitopathy ◽  
Male Sex

Graves’ Orbitopathy (GO) is an autoimmune orbital disorder usually presenting as a sequala of autoimmune thyroid disease. The presence of GO is associated with increased psychological burden and, in severe cases may cause blindness. While most patients with GO present with bilateral disease, asymmetric or unilateral GO may affect a significant proportion of patients diagnosed with GO. Older age, male sex, active and severe disease correlate with asymmetric disease. However, the exact mechanisms causing asymmetry remain elusive. Herein, we review the literature on asymmetric GO and highlight its differences compared with bilateral GO.

Besondere Manifestationsformen der Autoimmunthyreopathie

Praxis ◽  
2002 ◽  
Vol 91 (27) ◽  
pp. 1151-1160
Author(s):  
Fajfr ◽  
Müller
Keyword(s):  
Thyroid Disease ◽  
Autoimmune Thyroid Disease ◽  
Chromosome 6 ◽  
Autoimmune Thyroid

Les maladies thyroïdiennes auto-immunes ou immunes (autoimmune thyroid disease, AITD) sont relativement fréquentes. Le terme de AITD comprend les thyréodites euthyroidiennes ou hypothyroïdiennes de Hashimoto avec ou sans goitre, les hyperthyroïdies classiques de Basedow et leurs variantes nettement plus rares euthyroïdiennes ou hypothyroïdiennes. Aucune des nombreuses classifications des AITD n'a pu s'imposer sur le plan international. La pathogénèse de toutes les formes d'AITD comprend une perturbation de la tolérance immune chez les individus prédisposés génétiquement (séquence HLA-DQAI*0501 sur le bras court du chromosome 6) qui provoque un processus auto-immun contre la glande thyroïdienne. Ces processus sont soit destructeurs ou inhibiteurs, soit stimulateurs, ce qui permet d'expliquer les formes très différentes de AITD. Dans de cas rares, ces processus peuvent se contrebalancer («balance hypotheseis»). Les anticorps anti-récepteurs TPO et TSH (TRAK) ont une place particulière dans le diagnostic des AITD. Les dosages de routine utilisent pour la mesure des TRAK des récepteurs qui ne peuvent pas différencier entre les anticorps stimulants ou bloquants contre les récepteurs TSH. C'est, entre autre pour ces raisons, que les résultats d'anticorps positifs ne sont utilisables qu'en connaissance de la clinique et / ou des paramètres de la fonction thyroïdienne. Ce travail présente quatre patients avec des formes plus complexes d'AITD et résume les connaissances actuelles.

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