Angioedema in a Patient with Autoimmune Thyroiditis – A Case Report

AbstractWe present a case of a 29-year-old Bulgarian woman with autoimmune thyroiditis and recurrent angioedema. The patient presented with a one-year-long history of recurrent angioedema and Hashimoto’s thyroiditis. Physical examination showed oedema surrounded by erythema on the forearms, and erythematous, itchy plaques spreading over her face, neck, chest, abdomen, and extremities. Blood tests showed elevated total immunoglobulin E (IgE). The patient had been diagnosed with Hashimoto’s thyroiditis and hypothyroidism. She had been taking levothyroxine 50 μg/d, resulting in a good hormonal control; however, her anti-thyroid peroxidase (anti-TPO) antibodies were high. She was started on methylprednisolone and antihistamines. In three weeks, we observed a good therapeutic response to the treatment and the lesions remitted. IgE dropped within normal range. Levels of anti-TPO antibodies were persistently high. In conclusion, patients with angioedema should be tested for thyroid autoimmunity. Further delve into the pathogenesis of angioedema in them is warranted in order to explore the possibility of an underlying atopy in those not responding to the standard treatment with levothyroxine.

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Comparison of immunoglobulin E anti-thyroid peroxidase antibodies in patients with Hashimoto thyroiditis and chronic spontaneous urticaria

Medicine and Pharmacy Reports ◽

10.15386/mpr-1598 ◽

2021 ◽

Author(s):

Songül Çildağ ◽

Çiğdem Yenisey ◽

Mustafa Ünübol ◽

Taşkın Şentürk

Keyword(s):

Hashimoto’S Thyroiditis ◽

Immunoglobulin E ◽

Chronic Spontaneous Urticaria ◽

Hashimoto's Thyroiditis ◽

Unknown Etiology ◽

Enzyme Linked Immunosorbent Assay ◽

Thyroid Peroxidase ◽

Thyroid Peroxidase Antibodies ◽

Significant Difference ◽

History Of

Background and aim. Chronic spontaneous urticaria (CSU) is a disease of unknown etiology and autoimmunity has been thought to be an etiological factor. Immunoglobulin E (IgE)-anti-thyroid peroxidase antibodies (anti-TPO) may play a role in the pathogenesis of certain cases of urticaria. The aim of this study is to investigate IgE-anti-TPO in patients with chronic spontaneous urticaria and in patients with Hashimoto’s thyroiditis. Methods. A total of 175 -subjects were included in this study. 59 patients had chronic spontaneous urticaria without history of Hashimoto’s thyroiditis, while 58 patients had Hashimoto’s thyroiditis without history of urticaria. The control group consisted of 58 participants without history of Hashimoto’s thyroiditis and urticaria. Serum IgE-anti-TPO levels were analyzed by site-directed IgE capture Enzyme-Linked Immunosorbent Assay technique. We used this technique by modifying it. Results. IgE-anti-TPO antibodies were detected in all three groups and in all subjects. There was no significant difference between the three groups in terms of IgE-anti-TPO levels. Although total IgE and IgE-anti-TPO levels were higher in the IgG-anti-TPO positive chronic spontaneous urticaria, there was no significant difference. Conclusions. IgE-anti-TPO antibodies do not play a pathogenic role in the majority of patients with chronic spontaneous urticaria.

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Recovery of thyroid function with a decreased titre of antimicrosomal antibody in a hypothyroid man with Hashimoto's thyroiditis

Acta Endocrinologica ◽

10.1530/acta.0.1020531 ◽

1983 ◽

Vol 102 (4) ◽

pp. 531-534 ◽

Cited By ~ 9

Author(s):

Makiko Yamamoto ◽

Kazuro Kaise ◽

Hirofumi Kitaoka ◽

Katsumi Yoshida ◽

Nobuko Kaise ◽

...

Keyword(s):

Hashimoto’S Thyroiditis ◽

Serum Levels ◽

Hashimoto's Thyroiditis ◽

Thyroid Peroxidase ◽

Normal Range ◽

Surgical Biopsy ◽

Low Levels ◽

Serum Thyroid Hormones ◽

Antimicrosomal Antibody ◽

Serum Tsh

Abstract. A 36 year old man with a diffuse goitre, signs of mild hypothyroidism, strikingly low levels of T4 (0.9 μg/dl) and T3 (24 ng/dl), elevated TSH (140 μU/ml) and elevated microsomal haemagglutination antibody (MCHA, 1:409 600), subsequently became non-goitrous and euthyroid with a decreased titre of antimicrosomal antibody without any medication. At the time of surgical biopsy, serum levels of T4 and T3 had risen to the normal range (4.6 μg/dl and 73 ng/dl, respectively), serum TSH had decreased to 30 μU/ml and the titre of MCHA to 1:25 600. Thyroid specimens showed Hashimoto's thyroiditis. The activity of thyroid peroxidase (TPO) was normal. The latest examination, 1 year and 3 months after initial evaluation, showed that the patient remained euthyroid with no goitre, that serum thyroid hormones were within the normal range (T4 7.7 μg/dl and T3 97 ng/dl), and that TSH was not detectable. The titre of MCHA decreased strikingly to 1:400.

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Antibodies to Thyroid Peroxidase Arise Spontaneously with Age in NOD.H-2h4 Mice and Appear after Thyroglobulin Antibodies

Endocrine Reviews ◽

10.1210/edrv.31.4.9999 ◽

2010 ◽

Vol 31 (4) ◽

pp. 600-600

Author(s):

Chun-Rong Chen ◽

Sepehr Hamidi ◽

Helen Braley-Mullen ◽

Yuji Nagayama ◽

Catherine Bresee ◽

...

Keyword(s):

Hashimoto’S Thyroiditis ◽

Time Course ◽

Thyroid Autoimmunity ◽

Cross Reactivity ◽

Eukaryotic Cells ◽

Human Thyroid ◽

Hashimoto's Thyroiditis ◽

Thyroid Peroxidase ◽

Thyroglobulin Antibodies ◽

Self Tolerance

Abstract Hashimoto’s thyroiditis, a common autoimmune disease, is associated with autoantibodies to thyroglobulin (Tg) and thyroid peroxidase (TPO). TPO, unlike abundant and easily purified Tg, is rarely investigated as an autoantigen in animals. We asked whether antibodies (Abs) develop to both TPO and Tg in thyroiditis in mice that is induced (C57BL/6 and DBA/1 strains) or arises spontaneously (NOD.H-2h4). Screening for TPOAbs was performed by flow cytometry using mouse TPO-expressing eukaryotic cells. Sera were also tested for binding to purified mouse Tg and human TPO. The antibody data were compared with the extent of thyroiditis. Immunization with mouse TPO adenovirus broke self-tolerance to this protein in C57BL/6 mice, but thyroiditis was minimal and TgAbs were absent. In DBA/1 mice with extensive granulomatous thyroiditis induced by Tg immunization, TPOAbs were virtually absent despite high levels of TgAbs. In contrast, antibodies to mouse TPO, with minimal cross-reactivity with human TPO, arose spontaneously in older (7–12 months) NOD.H-2h4 mice. Unexpectedly, TgAbs preceded TPOAbs, a time course paralleled in relatives of probands with juvenile Hashimoto’s thyroiditis. These findings demonstrate a novel aspect of murine and human thyroid autoimmunity, namely breaking B cell self-tolerance occurs first for Tg and subsequently for TPO.

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The Effect of Hypolipidemic Agents on Thyroid Autoimmunity in Women with Hashimoto’s Thyroiditis Treated with Levothyroxine and Selenomethionine

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/s-0043-120342 ◽

2017 ◽

Vol 126 (05) ◽

pp. 321-326 ◽

Cited By ~ 1

Author(s):

Robert Krysiak ◽

Witold Szkróbka ◽

Bogusław Okopień

Keyword(s):

Hashimoto’S Thyroiditis ◽

Plasma Lipids ◽

Thyroid Autoimmunity ◽

Hdl Cholesterol ◽

Hashimoto's Thyroiditis ◽

Thyroid Peroxidase ◽

Free Triiodothyronine ◽

Hypolipidemic Agents ◽

Antibody Titers ◽

Group B

Abstract Background Levothyroxine and selenomethionine were found to reduce thyroid antibody titers in patients with Hashimoto’s thyroiditis. The same effect was produced by intensive statin therapy. The aim of the present study was to assess whether hypolipidemic agents modulate the impact of thyroid hormone supplementation and selenomethionine on thyroid autoimmunity. Methods The study included 62 women with Hashimoto's thyroiditis treated for at least 6 months with levothyroxine and selenomethionine. On the basis of plasma lipids, women were divided into three groups: women with isolated hypercholesterolemia (group A; n=20), women with isolated hypertriglyceridemia (group B; n=17), and women with normal plasma lipids (group C; n=25). Group A were then treated with atorvastatin (20 mg daily), while group B received micronized fenofibrate (200 mg daily). Serum titers of thyroid peroxidase and thyroglobulin antibodies, as well as serum levels of thyrotropin, free thyroxine and free triiodothyronine were measured at the beginning of the study and 6 months later. Results Fenofibrate decreased triglycerides and increased HDL cholesterol, while simvastatin decreased total and LDL cholesterol. Fenofibrate reduced titers of thyroid peroxidase and, to a lesser extent, thyroglobulin antibodies. Atorvastatin tended to increase thyroid peroxidase antibodies. No changes in thyrotropin, free thyroxine and free triiodothyronine were observed in any treatment group. Fenofibrate-induced changes in thyroid antibody titers correlated with baseline antibody titers, as well as with treatment-induced changes in HDL cholesterol and insulin sensitivity. Conclusions The obtained results indicate that only fibrates may potentiate the effect of selenomethionine and levothyroxine on thyroid autoimmunity in women.

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Thyroid function in children and adolescents with Hashimoto's thyroiditis after l-thyroxine discontinuation

Endocrine Connections ◽

10.1530/ec-17-0023 ◽

2017 ◽

Vol 6 (4) ◽

pp. 206-212 ◽

Cited By ~ 7

Author(s):

Giorgio Radetti ◽

Mariacarolina Salerno ◽

Chiara Guzzetti ◽

Marco Cappa ◽

Andrea Corrias ◽

...

Keyword(s):

Children And Adolescents ◽

Thyroid Function ◽

Hashimoto’S Thyroiditis ◽

Outcome Measure ◽

Hashimoto's Thyroiditis ◽

Pediatric Endocrinology ◽

Normal Range ◽

Discontinuation Of Treatment ◽

One Year ◽

Serum Tsh

Objective Thyroid function may recover in patients with Hashimoto’s thyroiditis (HT). Design To investigate thyroid function and the need to resume l-thyroxine treatment after its discontinuation. Setting Nine Italian pediatric endocrinology centers. Patients 148 children and adolescents (25 m and 123 f) with HT on treatment with l-thyroxine for at least one year. Intervention and main outcome measure Treatment was discontinued in all patients, and serum TSH and fT4 concentrations were measured at the time of treatment discontinuation and then after 2, 6, 12 and 24 months. Therapy with l-thyroxine was re-instituted when TSH rose >10 U/L and/or fT4 was below the normal range. The patients were followed up when TSH concentrations were between 5 and 10 U/L and fT4 was in the normal range. Results At baseline, TSH was in the normal range in 139 patients, and was between 5 and 10 U/L in 9 patients. Treatment was re-instituted after 2 months in 37 (25.5%) patients, after 6 months in 13 patients (6.99%), after 12 months in 12 patients (8.6%), and after 24 months in an additional 3 patients (3.1%). At 24 months, 34 patients (34.3%) still required no treatment. TSH concentration >10 U/L at the time of diagnosis was the only predictive factor for the deterioration of thyroid function after l-thyroxine discontinuation. Conclusions This study confirms that not all children with HT need life-long therapy with l-thyroxine, and the discontinuation of treatment in patients with a TSH level <10 U/L at the time of diagnosis should be considered.

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MULTIPLE CRANIAL NERVE PALSIES ASSOCIATED WITH THYROID AUTOIMMUNITY: HASHIMOTO'S THYROIDITIS- A CASE REPORT

10.36106/ijar/1802014 ◽

2021 ◽

pp. 51-52

Author(s):

Neeraja Ponnala ◽

Stephen Abraham Suresh Kumar ◽

J.Senthil Nathan

Keyword(s):

Hashimoto’S Thyroiditis ◽

Cranial Nerve ◽

Thyroid Autoimmunity ◽

Cranial Nerves ◽

Hashimoto's Thyroiditis ◽

Thyroid Peroxidase ◽

Cranial Nerve Involvement ◽

Cognitive Changes ◽

Cranial Nerve Palsies ◽

Multiple Cranial Nerve

Hashimotos's encephalopathy is an uncommon neurologic syndrome associated with Hashimoto's thyroiditis. Sometimes it may manifest years before onset of thyroid disease. The patients are usually euthyroid or midly hypothyroid. Antibodies against thyroid peroxidase are useful diagnostic marker of Hashimoto's thyroiditis. High levels of this antibody are associated with high 1 prevalence of hashimoto's encephalopathy . Clinical features are variable includes behavioral and cognitive changes, myoclonus, seizures, hemiparesis, involuntary movements, cerebellar signs, psychosis and coma, with relapsing and progressive course. Diagnosis is often overlooked but it is important as it is treatable cause of encephalopathy. Multiple cranial nerves involvement in Hashimoto's thyroiditis was reported in a very few patients, a rare association. Here we present a case of multiple cranial nerve involvement in a case of hashimoto's thyroiditis.

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Serum resolvin E1 levels and its relationship with thyroid autoimmunity in Hashimoto’s thyroiditis: a preliminary study

BMC Endocrine Disorders ◽

10.1186/s12902-021-00730-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jing Song ◽

Rongxin Sun ◽

Yuanyuan Zhang ◽

Jing Ke ◽

Dong Zhao

Keyword(s):

Hashimoto’S Thyroiditis ◽

Protective Factor ◽

Thyroid Autoimmunity ◽

Hashimoto's Thyroiditis ◽

Enzyme Linked Immunosorbent Assay ◽

Thyroid Peroxidase ◽

Healthy Controls ◽

Omega 3 ◽

Free T4 ◽

Ordinal Logistic Regression Analysis

Abstract Background Omega-3 polyunsaturated fatty acids (PUFAs) produce lipid mediators with both anti-inflammatory and pro-resolution properties, including resolvins. The purpose of this study was to detect serum resolvin E1 (RVE1) levels in Hashimoto’s thyroiditis (HT) patients and healthy controls (HCs) and to evaluate the relationship of RVE1 with thyroid autoimmunity. Methods A total of 57 participants were recruited, including 30 untreated HT patients and 27 age- and sex‐matched HCs. The levels of RVE1 in serum were measured via enzyme-linked immunosorbent assay (ELISA). An electrochemiluminescence immunoassay was used for the measurement of thyroid-stimulating hormone (TSH), total T4 (TT4), TT3, free T4 (FT4), FT3, anti-thyroid peroxidase antibody (TPOAb) and anti-thyroglobulin antibody (TgAb) levels. Hemogram tests and routine biochemical analyses were performed on each sample. Results The serum level of RVE1 of HT patients (24.09, 15.76–34.38 pg/mL) was significantly lower than that of healthy controls (28.51, 20.76–51.23 pg/mL) (P = 0.027). RVE1 levels showed a downward trend with increasing TgAb levels (P for trend = 0.001). Multivariable ordinal logistic regression analysis showed that RVE1 levels were negatively correlated with increasing TgAb levels in both the unadjusted (OR = 0.9446, 95 % CI = 0.9111–0.9782, P = 0.002) and adjusted models (OR = 0.9380, 95 % CI = 0.8967–0.9811, P = 0.005). Conclusions Decreased RVE1 levels might be a sign that HT is associated with inflammatory resolution dysfunction. RVE1 may serve as a protective factor against increased TgAb levels.

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Effects of vitamin D on thyroid autoimmunity markers in Hashimoto’s thyroiditis: systematic review and meta-analysis

Journal of International Medical Research ◽

10.1177/03000605211060675 ◽

2021 ◽

Vol 49 (12) ◽

pp. 030006052110606

Author(s):

Jingwen Zhang ◽

Yuting Chen ◽

Hongyan Li ◽

Hong Li

Keyword(s):

Vitamin D ◽

Hashimoto’S Thyroiditis ◽

Meta Analysis ◽

Thyroid Autoimmunity ◽

Vitamin D Supplementation ◽

Cochrane Library ◽

Secondary Outcome ◽

Hashimoto's Thyroiditis ◽

Thyroid Peroxidase ◽

Randomized Controlled

Objective To perform a meta-analysis of randomized controlled trials to evaluate the efficacy of vitamin D supplementation on thyroid autoimmunity markers in Hashimoto’s thyroiditis (HT). Methods This meta-analysis included randomized controlled clinical trials identified by a systematic search of electronic databases (PubMed®, MEDLINE®, EMBASE, The Cochrane Library, China National Knowledge Infrastructure) from inception to August 2020. All studies included patients with HT that received vitamin D supplementation irrespective of the doses administered or the duration of treatment. The primary and secondary outcome measures were thyroid peroxidase antibody (TPOAb) and/or thyroglobulin antibody (TGAb) titres. Results Eight studies ( n = 652) were included. There was significant heterogeneity between the studies. Using a random-effect model, vitamin D supplementation reduced TPOAb titre (standardized mean difference [SMD]: –1.11; 95% confidence interval [CI]: 1–1.92, –0.29) and TGAb titre (SMD: –1.12; 95% CI: –1.96, –0.28). A subgroup analysis demonstrated that vitamin D supplementation for >3 months resulted in a decrease in TPOAb titre (SMD: –1.66, 95% CI: –2.91, –0.41) but treatment ≤3 months was ineffective. Treatment with vitamin D3 decreased TPOAb titre (SMD: –1.48; 95% CI: –2.53, –0.42) whereas vitamin D did not. Conclusion These data suggest that vitamin D reduces autoantibody titre in patients with HT.

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Antibodies to Thyroid Peroxidase Arise Spontaneously with Age in NOD.H-2h4 Mice and Appear after Thyroglobulin Antibodies

Endocrinology ◽

10.1210/en.2010-0321 ◽

2010 ◽

Vol 151 (9) ◽

pp. 4583-4593 ◽

Cited By ~ 47

Author(s):

Chun-Rong Chen ◽

Sepehr Hamidi ◽

Helen Braley-Mullen ◽

Yuji Nagayama ◽

Catherine Bresee ◽

...

Keyword(s):

Hashimoto’S Thyroiditis ◽

Time Course ◽

Thyroid Autoimmunity ◽

Cross Reactivity ◽

Eukaryotic Cells ◽

Human Thyroid ◽

Hashimoto's Thyroiditis ◽

Thyroid Peroxidase ◽

Thyroglobulin Antibodies ◽

Self Tolerance

Hashimoto’s thyroiditis, a common autoimmune disease, is associated with autoantibodies to thyroglobulin (Tg) and thyroid peroxidase (TPO). TPO, unlike abundant and easily purified Tg, is rarely investigated as an autoantigen in animals. We asked whether antibodies (Abs) develop to both TPO and Tg in thyroiditis that is induced (C57BL/6 and DBA/1 mice) or arises spontaneously (NOD.H-2h4 mice). Screening for TPOAbs was performed by flow cytometry using mouse TPO-expressing eukaryotic cells. Sera were also tested for binding to purified mouse Tg and human TPO. The antibody data were compared with the extent of thyroiditis. Immunization with mouse TPO adenovirus broke self-tolerance to this protein in C57BL/6 mice, but thyroiditis was minimal and TgAbs were absent. In DBA/1 mice with extensive granulomatous thyroiditis induced by Tg immunization, TPOAbs were virtually absent despite high levels of TgAbs. In contrast, antibodies to mouse TPO, with minimal cross-reactivity with human TPO, arose spontaneously in older (7–12 months) NOD.H-2h4 mice. Unexpectedly, TgAbs preceded TPOAbs, a time course paralleled in relatives of probands with juvenile Hashimoto’s thyroiditis. These findings demonstrate a novel aspect of murine and human thyroid autoimmunity, namely breaking B cell self-tolerance occurs first for Tg and subsequently for TPO.

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Serum Resolvin E1 Levels and Its Relationship with Thyroid Autoimmunity in Hashimoto's Thyroiditis

10.21203/rs.3.rs-80993/v1 ◽

2020 ◽

Author(s):

Jing Song ◽

Rongxin Sun ◽

Yuanyuan Zhang ◽

Jing Ke ◽

Dong Zhao

Keyword(s):

Hashimoto’S Thyroiditis ◽

Protective Factor ◽

Thyroid Autoimmunity ◽

Thyroid Stimulating Hormone ◽

Hashimoto's Thyroiditis ◽

Thyroid Peroxidase ◽

Omega 3 ◽

Clinical Indicators ◽

Thyroglobulin Antibody ◽

Ordinal Logistic Regression Analysis

Abstract Objective: Omega-3 polyunsaturated fatty acids (PUFAs) can produce lipid mediators with both anti-inflammatory and pro-resolution properties, including resolvins. Resolvins have been associated with autoimmune disorders. This study aimed to measure the level of resolvin E1 (RVE1) in the serum of Hashimoto's thyroiditis (HT) patients and healthy controls (HCs) and to further analyze its correlation with thyroid autoantibodies and other clinical indicators.Design, patients and measurements: Fifty-seven participants were recruited—30 untreated HT patients and 27 sex‐ and age‐matched HCs. Levels of serum RVE1 were measured by ELISA according to the manufacturer’s protocol. Serum total T3 (TT3), TT4, free T3 (FT3), FT4, thyroglobulin antibody (TgAb), thyroid peroxidase antibody (TPOAb) and thyroid-stimulating hormone (TSH) levels were measured using an electrochemiluminescence immunoassay. Routine biochemical and hemogram tests were performed on each sample.Results: Serum RVE1 levels in HT patients (24.09, 15.76-34.38 pg/mL) were significantly lower than those in HCs (28.51, 20.76-51.23 pg/mL) (P=0.027). As the TgAb level increased, the RVE1 content showed a decreasing trend (P for trend=0.001). Multivariable ordinal logistic regression analysis showed that RVE1 was negatively correlated with increasing TgAb in both the unadjusted (OR=0.9446, 95% CI=0.9111-0.9782, P=0.002) and adjusted models (OR=0.9380, 95% CI=0.8967-0.9811, P=0.005).Conclusions: Decreased RVE1 levels indicate impaired resolution of inflammation in HT patients. RVE1 may be a protective factor for elevated TgAb levels.

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