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.

scholarly journals Increase of interferon-γ inducible α chemokine CXCL10 but not β chemokine CCL2 serum levels in chronic autoimmune thyroiditis

2005 ◽  
Vol 152 (2) ◽  
pp. 171-177 ◽  
Author(s):  
Alessandro Antonelli ◽  
Mario Rotondi ◽  
Poupak Fallahi ◽  
Paola Romagnani ◽  
Silvia Martina Ferrari ◽  
...  
Keyword(s):  
Autoimmune Thyroiditis ◽  
Multinodular Goiter ◽  
Thyroid Volume ◽  
Serum Levels ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Peroxidase ◽  
Newly Diagnosed ◽  
Linear Regression Models ◽  
Chronic Autoimmune Thyroiditis ◽  
Hypothyroid Patients

Objective: To measure serum levels of CXCL10 and CCL2 prototype chemokines of the two major subclass (CXC and CC) in patients with newly diagnosed chronic autoimmune thyroiditis (AT), and relate the findings to the clinical phenotype. Design and methods: Serum CXCL10 and CCL2 were assayed in 70 consecutive patients with newly diagnosed chronic AT, in sex- and age-matched healthy volunteers (n = 37) and in 20 patients with non-toxic multinodular goiter, extracted from a random sample of the general population from the same geographic area. Results: CXCL10 serum levels were significantly higher in patients with thyroiditis than in controls or multinodular goiter patients, while comparable CCL2 levels were found between groups. CXCL10 levels were significantly increased in hypothyroid patients and in those with an hypoechoic pattern (P = 0.0004 and P = 0.0001, respectively) while serum CCL2 levels were significantly increased in patients older than 50 years and in those with hypothyroidism (P = 0.0001 and P = 0.03, respectively). No correlation between CXCL10 and CCL2 serum levels could be demonstrated. CXCL10 and CCL2 were studied separately in relation to clinical features of AT patients. Two separate multiple linear regression models for CXCL10 and CCL2 were performed, including age, thyroid volume, thyroid stimulating hormone (TSH), FT4, anti-thyroid peroxidase (AbTPO), hypoechoic pattern, and the presence of hypervascularity, demonstrating that ln of serum CXCL10 levels was associated with TSH independently of other possible confounders levels [regression coefficient (R.C.) 0.143 confidence interval (C.I.) (0.042–0.245); P = 0.0059], while serum CCL2 were significantly associated only with age [R.C. 5.412 C.I. (3.838–6.986); P < 0.0001]. Conclusion: Our results, obtained in a large cohort of newly diagnosed AT patients demonstrate increased CXCL10 especially in hypothyroid patients with a more aggressive disorder, and normal CCL2 serum levels in AT.

scholarly journals The association of neuropsychiatric disorders and endocrine parameters in hashimoto thyroiditis

2020 ◽  
Vol 11 (4) ◽  
pp. 55-68
Author(s):  
Polina A. Sobolevskaia ◽  
Boris V. Andreev ◽  
Anton N. Gvozdetckii ◽  
Anastasia A. Dolina ◽  
Anna M. Stepochkina ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Autoimmune Thyroiditis ◽  
Psychiatric Symptoms ◽  
Clinical Manifestations ◽  
Neuropsychiatric Disorders ◽  
Hashimoto Thyroiditis ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Peroxidase ◽  
Free Triiodothyronine ◽  
Antithyroid Autoantibodies

Hashimoto thyroiditis is the most common thyroid disease. This form of pathology has a diverse clinical picture, including neuropsychiatric disorders. There are frequent cases of comorbidity of autoimmune thyroiditis and psychiatric forms of pathology, along with such a nosological entity as Hashimotos encephalopathy (aka: Steroid-responsive encephalopathy of autoimmune thyroiditis), characterized by an increased level of antithyroid autoantibodies and various mental disorders, with still unclear pathogenesis. The question arises, how to regard patients with psychiatric disorders and Hashimoto thyroiditis either as patients having autoimmune thyroiditis, comorbid with psychiatric forms of pathology, or as patients with Hashimotos encephalopathy? We studied groups of patients with autoimmune thyroiditis free from any psychiatric disorders, autoimmune thyroiditis comorbid with psychiatric forms of pathology, and a group of healthy donors similar as regards to their age and sex. We also studied medical history, clinical manifestations of the disease, instrumental data and the serum levels of thyrotropin, thyroid hormones, various antithyroid autoantibodies, and prolactin. We analyzed the correlation of laboratory and instrumental parameters and clinical data in all groups of patients. Therewas a significant relationship (p 0,05) between various psychiatric symptoms and a decreased level of free thyroxine, an increased level of thyroid stimulating hormone (TSH), an increased level of prolactin and an increased volume of a thyroid gland. Asignificant relationship (p 0,05) was also found between various symptoms of hypothyroidism and a decreased level of free triiodothyronine (FT3), an increased level of antibodies to thyroglobulin (anti-TG Ab), and an increased level of antibodies to thyroid peroxidase (anti-TPO Ab).

scholarly journals Combined Treatment with Myo-Inositol and Selenium Ensures Euthyroidism in Subclinical Hypothyroidism Patients with Autoimmune Thyroiditis

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Maurizio Nordio ◽  
Raffaella Pajalich
Keyword(s):  
Autoimmune Thyroiditis ◽  
Subclinical Hypothyroidism ◽  
Controlled Trial ◽  
Combined Treatment ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Peroxidase ◽  
Chronic Lymphocytic Thyroiditis ◽  
Double Blind ◽  
Chronic Autoimmune Thyroiditis ◽  
Tsh Levels

Background. Hashimoto's thyroiditis (HT), also known as chronic lymphocytic thyroiditis or chronic autoimmune thyroiditis, is the most common form of thyroiditis affecting more than 10% of females and 2% of males. The present study aims to evaluate the beneficial effect of a combined treatment, Myo-Inositol plus selenomethionine, on subclinical hypothyroidism.Methods. The study was designed as a double-blind randomized controlled trial. Eligible patients were women diagnosed with subclinical hypothyroidism having Tg antibodies (TgAb) titer higher than 350 IU/mL. Outcome measures were Thyroid Stimulating Hormone (TSH) levels, thyroid peroxidase antibodies (TPOAb) and TgAb titer, selenium, and Myo-Inositol plasma concentration.Results. In the present paper, we demonstrated that the beneficial effects obtained by selenomethionine treatment on patients affected by subclinical hypothyroidism, likely due to the presence of autoantibody (TPOAb and TgAb), are further improved by cotreatment with Myo-Inositol.Conclusions. Indeed, due to its action as TSH second messenger, Myo-Inositol treatment reduces TSH levels closer to physiological concentrations.

scholarly journals Relationship Between Thyroid Hormonal Status in Patients with a Hypothyroid Form of Hashimoto’s Thyroiditis and Iodine Concentrations in Drinking Water

2021 ◽  
Author(s):  
Olha Kasiyan ◽  
Halyna Tkachenko ◽  
Natalia Kurhaluk ◽  
Svitlana Yurchenko ◽  
Alek Manenko
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Iodine Concentration ◽  
Iodine Intake ◽  
Thyroid Stimulating Hormone ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Peroxidase ◽  
Supply Network ◽  
Thyroid Status ◽  
Thyroglobulin Antibodies ◽  
Regressive Analysis

AbstractThe current study aimed to identify correlative and regressive dependencies between the water iodine concentration and the levels of TSH (thyroid-stimulating hormone), thyroglobulin antibodies (TgAbs), and thyroid peroxidase (TPOAb) in the serum of 168 in patients (34 men and 134 women) with a hypothyroid form of Hashimoto’s thyroiditis who use water from the supply network and individual wells. Based on the water iodine concentration, low and moderate degrees of iodine endemia in the location of the patients were determined. In the groups of men and women using water from different water supply sources, there were direct correlations between the water iodine concentrations and the TgAbs and TPOAb titers as well as an inverse dependence between iodine and TSH levels. Multivariate regressive analysis indicated that TgAb and TSH in the group of women using water from a supply network and TPOAb titers in the group of women using well water were independent factors associated with water iodine concentrations. Statistically significant correlations and regressive dependencies between the water iodine concentrations and the biomarkers of the thyroid status of the patients indicate the risk of Hashimoto’s thyroiditis progression, especially among women with additional iodine intake.

Expression of TIGIT and FCRL3 is Altered in T Cells from Patients with Distinct Patterns of Chronic Autoimmune Thyroiditis

2018 ◽  
Vol 127 (05) ◽  
pp. 281-288 ◽  
Author(s):  
Mario Štefanić ◽  
Stana Tokić ◽  
Mirjana Suver-Stević ◽  
Ljubica Glavaš-Obrovac
Keyword(s):  
T Cells ◽  
Autoimmune Thyroiditis ◽  
Thyroid Volume ◽  
Thyroid Peroxidase ◽  
Mrna Levels ◽  
Expression Levels ◽  
Chronic Autoimmune Thyroiditis ◽  
End Stage ◽  
Hypothyroid Patients

Abstract Background Co-inhibitory receptors (IR), such as TIGIT and FCRL3, provide a checkpoint against highly destructive immune responses. Co-expression of TIGIT and FCRL3, in particular, has been linked to the HELIOS+ subset of regulatory CD4+FOXP3+T-cells. Of these, CD4+FOXP3-exon(E)2+ cells have higher expression of IR and exhibit strongest suppressive properties. Nevertheless, how the expression of TIGIT, FCRL3, HELIOS, and FOXP3E2 is regulated in chronic autoimmune thyroiditis (AT), is not known. Methods Thirty patients with AT [encompassing spontaneously euthyroid (euAT), hypothyroid-untreated and L-thyroxine-treated cases)] and 10 healthy controls (HC) were recruited. FCRL3, TIGIT, HELIOS and FOXP3E2 mRNA expression levels in peripheral blood (PB) T cells were measured via quantitative real-time PCR and compared to clinicopathological factors. Results The TIGIT and FCRL3 expression levels from T cells of AT cases were inversely related to the thyroid volume, and were significantly increased in hypothyroid patients (on+off L-thyroxine), but not euAT cases. The FCRL3 expression in PB T cells positively correlated with thyroid-peroxidase autoantibody levels; by contrast, T cells from aged AT patients and combined samples (AT+HC) accumulated more TIGIT mRNA. The patients with higher TIGIT mRNA levels had a greater prevalence of hypothyroidism, showing higher peak thyrotropin levels at diagnosis or at follow-up. Conclusions Multiple IR, namely FCRL3 and TIGIT, but not the transcription factors HELIOS and FOXP3E2, showed increased mRNA levels in PB T cells from end-stage, long-standing and/or more aggressive AT, in proportion to disease severity. A relation with major clinical subphenotypes was observed, thereby identifying IR as potentially important players in AT.

Thyroglobulin and Thyroid Peroxidase Share Common Epitopes Recognized by Autoantibodies in Patients with Chronic Autoimmune Thyroiditis

1988 ◽  
Vol 67 (5) ◽  
pp. 899-907 ◽  
Author(s):  
YOICHI KOHNO ◽  
NAOKAZU NAITO ◽  
YOSHIO HIYAMA ◽  
NAOKI YOSHIO ◽  
NORIAKI SUZUKI ◽  
...  
Keyword(s):  
Autoimmune Thyroiditis ◽  
Thyroid Peroxidase ◽  
Chronic Autoimmune Thyroiditis

scholarly journals “Vitamin D Deficiency Is More Common in Women with Autoimmune Thyroiditis: A Retrospective Study”

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Nino Turashvili ◽  
Lali Javashvili ◽  
Elene Giorgadze
Keyword(s):  
Vitamin D ◽  
Retrospective Study ◽  
Vitamin D Deficiency ◽  
Autoimmune Thyroiditis ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Thyroid Autoantibody ◽  
Chronic Autoimmune Thyroiditis ◽  
Antithyroglobulin Antibodies ◽  
Stimulating Hormone

Background. Vitamin D is a hormone that is mainly produced in the skin upon ultraviolet B radiation exposure and has important influence on various organs. In recent years, data have been collected that vitamin D deficiency plays an important role in the development of various nonskeletal diseases, including autoimmune diseases. Chronic autoimmune thyroiditis (Hashimoto’s thyroiditis) is one of the most common organ-specific autoimmune endocrine diseases. It is characterized by increased level of antithyroid peroxidase and/or antithyroglobulin antibodies in blood, which often leads to thyroid dysfunction and structural changes of the gland. There is an opinion that vitamin D deficiency may be considered as an important risk factor for development of chronic autoimmune thyroiditis, but data of various small studies are controversial. Despite the fact that Georgia is a sunny country, vitamin D deficiency is a widespread problem here. Thyroid diseases, including the chronic autoimmune thyroiditis, are also very common in Georgia. The aim of our research was to compare the level of vitamin D between the patients with chronic autoimmune thyroiditis and the healthy subjects. Methods. This retrospective study enrolled subjects, who were 18–70 years old and visited the clinics “Cortex” and “National Institute of Endocrinology” in 2018 or in 2019 from mid-spring to mid-summer. Data of thyroid-stimulating hormone, free thyroxine, antithyroid peroxidase antibodies, antithyroglobulin antibodies, thyroid ultrasonography, and 25(OH) vitamin D were retrospectively analysed based on medical history. In total, data of 1295 patients were collected. The statistical processing of data was performed through the SPSS 20 program. Results. The negative association between thyroid-stimulating hormone, antithyroid peroxidase antibodies, antithyroglobulin antibodies, heterogeneous parenchyma of thyroid gland, and vitamin D was found in women. Statistically significant association was not detected in men. Conclusions. Serum vitamin D is lower in women with autoimmune thyroiditis and primary hypothyroidism. Further studies are needed to evaluate the influence of vitamin D supplementation on thyroid autoantibody positivity or primary hypothyroidism.

scholarly journals Transcriptome analysis of the effect of diosgenin on autoimmune thyroiditis in a rat model

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chengfei Zhang ◽  
Lingling Qin ◽  
Boju Sun ◽  
You Wu ◽  
Fengying Zhong ◽  
...  
Keyword(s):  
Autoimmune Thyroiditis ◽  
Calcium Binding ◽  
Binding Protein ◽  
Thyroid Tissue ◽  
Intervention Group ◽  
Camp Response Element Binding ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Peroxidase ◽  
Free Triiodothyronine ◽  
Element Binding Protein

AbstractIn a mouse model of Graves’ disease (GD), diosgenin has been shown to have a therapeutic effect on GD by alleviating goitre. However, research on the effect of diosgenin on autoimmune thyroiditis (AIT) is lacking. In this study, transcriptomics was used to comprehensively analyse the protective effect of diosgenin against AIT in rats and the possible mechanism. The results showed that in the diosgenin-intervention group, compared to the model group, the expression of serum triiodothyronine, thyroxine, free triiodothyronine, and free thyroxine was decreased and that of thyroid-stimulating hormone was increased; these changes were accompanied by the downregulation of thyroglobulin, TSH receptor antibody and thyroid peroxidase expression in serum. Furthermore, transcriptome detection, RT-qPCR and immunohistochemistry verification revealed that in thyroid tissue, the relative mRNA and protein expression of cyclic adenosine 3′,5′-monophosphate (cAMP), protein kinase A (PKA) and cAMP response element-binding protein (Creb) were increased and the mRNA expression of S100 calcium-binding protein A9 (S100A9) was decreased in the diosgenin groups. In summary, diosgenin alleviates the development of AIT, possibly via the activation of the cAMP/PKA/Creb pathway and downregulation of S100A9 gene expression.

Subclinical hypothyroidism

2019 ◽  
Vol 12 (3) ◽  
pp. 131-135
Author(s):  
Adam Grice
Keyword(s):  
Cardiovascular Disease ◽  
Subclinical Hypothyroidism ◽  
Thyroid Stimulating Hormone ◽  
Normal Serum ◽  
Overt Hypothyroidism ◽  
Thyroid Peroxidase ◽  
Autoimmune Thyroid ◽  
Thyroid Peroxidase Antibodies ◽  
Increased Risk ◽  
Stimulating Hormone

Subclinical hypothyroidism is a common condition associated with a raised thyroid-stimulating hormone and a normal serum free thyroxine that affects about 10% of females over 55 years in age. The most common cause is autoimmune thyroid disease, with 2.5% of patients with subclinical hypothyroidism progressing to clinically overt hypothyroidism each year. The rate of progression is higher in patients with anti-thyroid peroxidase antibodies and higher levels of thyroid-stimulating hormone. Only a small proportion of patients with subclinical hypothyroidism have symptoms, and although there is some debate in the literature about which patients should be treated, the National Institute for Health and Care Excellence clinical knowledge summaries give clear recommendations. There is an increased risk of cardiovascular disease in patients with subclinical hypothyroidism; it is uncertain whether treatment with levothyroxine reduces this risk. When deciding whether to treat subclinical hypothyroidism consider the patient’s age, symptoms, presence of anti-thyroid peroxidase antibodies, thyroid-stimulating hormone levels and risk factors such as cardiovascular disease.

scholarly journals An Case of Poems Syndrome With Primary Adrenal Insufficiency

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A114-A115
Author(s):  
Anne Sillars ◽  
Stephen Cleland ◽  
Jillian Tough
Keyword(s):  
Diagnostic Criteria ◽  
Clinical Manifestations ◽  
Sensory Neuropathy ◽  
Thyroid Stimulating Hormone ◽  
Poems Syndrome ◽  
Thyroid Peroxidase ◽  
High Dose ◽  
Inadequate Response ◽  
Adrenal Failure ◽  
Skin Changes

Abstract POEMS syndrome is rare multi-system disorder characterised by a paraneoplastic plasma cell disorder. The acronym POEMS stands for Polyneuropathy, Organomegaly, Endocrinopathy, M protein, and Skin changes. The underlying mechanisms are poorly understood, but chronic overproduction of pro-inflammatory cytokines have an integral role in the disorder. Diagnosis of POEMS is difficult owing to the variety of clinical manifestations. Mandatory diagnostic criteria are (a) one major criterion of either polyneuropathy or monoclonal gammopathy, in association with (b) one minor criterion including, but not limited to, organomegaly, endocrinopathy or skin changes. Endocrinopathies have been identified in 67–84% of patients with POEMS [1]. While hypogonadism and hypothyroidism are relatively common, primary adrenal failure is rarely reported. We present a 54-year-old woman who was found to have a raised hemoglobin, hematocrit and thrombocytosis on routine blood testing. She was concomitantly investigated for a rapidly-ascending, bilateral peripheral motor and sensory neuropathy. Diagnosis of POEMS was made and she underwent chemotherapy with Lenalidomide and high dose dexamethasone in 2015. Since then, she has not received endogenous glucocorticoids. She had an unplanned admission in April 2020 with a likely viral illness and was found to be glucocorticoid deplete. A 250-mcg short synacthen test demonstrated an inadequate response in cortisol, from 4.31 µg/dl to 6.13 µg/dl, with a raised adrenocorticotrophic hormone (ACTH) level of 66 mU/L. Adrenal antibodies were not detected. CT scan of the abdomen reported no adrenal gland abnormalities. The patient denied symptoms of mineralocorticoid deficiency, with no postural blood pressure (BP) drop - sitting BP 123/69 mmHg and standing BP 131/74 mmHg. Serum electrolytes were normal (renin and aldosterone levels are pending) and androgen screen was within normal limits. Thyroid stimulating hormone (TSH) was 8.07 mIU/L, free thyroxine (fT4) levels 0.93 ng/dL, and thyroid receptor and thyroid peroxidase antibodies were both negative. The patient is now established on Hydrocortisone therapy: 10mg (morning), 5mg (lunchtime). In summary, we present a 54-year-old woman with POEMS syndrome with subacute primary adrenal failure, characterised by glucocorticoid deficiency and ACTH excess. Although rare, it is important for all clinicians to be aware of POEMS syndrome as a potential diagnosis if the diagnostic criteria described above are filled, and for Endocrinologists to be aware that POEMS endocrinopathies can occur in any gland, including the adrenal glands. 1.Gandhi, G.Y., et al., Endocrinopathy in POEMS syndrome: the Mayo Clinic experience. Mayo Clin Proc, 2007. 82(7): p. 836–42.

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