Hashimotothyreoïditis bij kinderen en adolescenten: klinische, hormonale en echografische kenmerken bij de diagnosestelling

2021 ◽  
Author(s):  
G. MASSA ◽  
B. HOESSELS ◽  
H. GWOREK ◽  
R. ZEEVAERT
Keyword(s):  
Thyroid Gland ◽  
Children And Adolescents ◽  
Growth Retardation ◽  
Clinical Manifestations ◽  
Thyroid Peroxidase ◽  
Free T4 ◽  
Thyroglobulin Antibodies ◽  
Work Up

Hashimoto’s thyroiditis in children and adolescents: clinical, hormonal and ultrasound features at diagnosis The clinical, biochemical and sonographic features of 51 children and adolescents (45 girls) being diagnosed with hashimotothyroiditis (HT) were studied. HT was diagnosed based on the presence of thyroid peroxidase and/or thyroglobulin antibodies, together with thyroid ultrasound compatible with thyroiditis or manifest hypothyroidism characterized by decreased free T4 and increased TSH levels. The median age of the patients was 12.8 years (range: 5.9 and 16.5 years). At the time of diagnosis, 18 patients (35.3%) were euthyroid, 16 (31.3%) subclinically hypothyroid, 13 (25.5%) hypothyroid, and 4 (7.8%) hyperthyroid. The reasons for referral were an enlargement of the thyroid gland (39.2%), symptoms suggestive of hypothyroidism (35.3%) or an accidental finding on work-up for an unrelated problem (25.4%). The most common clinical manifestations were a goiter (60.8%), fatigue (60.8%), weight gain (25.0%), constipation (11.8%), hair loss (11.8%) and growth retardation (5,9%). A goiter was most common in the euthyroid children. Growth retardation was only observed in three hypothyroid children. On ultrasound an enlarged thyroid gland was diagnosed in 80.0% of the patients. Associated coeliac disease was diagnosed in four patients; one patient developed type 1 diabetes mellitus during the follow-up period and one patient developed Hashimoto’s encephalopathy.

Monogenic Diabetes: Genetics and Relevance on Diabetes Mellitus Personalized Medicine

2020 ◽  
Vol 16 (8) ◽  
pp. 807-819 ◽  
Author(s):  
Madalena Sousa ◽  
Jácome Bruges-Armas
Keyword(s):  
Diabetes Mellitus ◽  
Complex Disease ◽  
Clinical Manifestations ◽  
Neonatal Diabetes ◽  
Monogenic Diabetes ◽  
Diabetes Genetics ◽  
Individualize Treatment

Background: Diabetes mellitus (DM) is a complex disease with significant impression in today's world. Aside from the most common types recognized over the years, such as type 1 diabetes (T1DM) and type 2 diabetes (T2DM), recent studies have emphasized the crucial role of genetics in DM, allowing the distinction of monogenic diabetes. Methods: Authors did a literature search with the purpose of highlighting and clarifying the subtypes of monogenic diabetes, as well as the accredited genetic entities responsible for such phenotypes. Results: The following subtypes were included in this literature review: maturity-onset diabetes of the young (MODY), neonatal diabetes mellitus (NDM) and maternally inherited diabetes and deafness (MIDD). So far, 14 subtypes of MODY have been identified, while three subtypes have been identified in NDM - transient, permanent, and syndromic. Discussion: Despite being estimated to affect approximately 2% of all the T2DM patients in Europe, the exact prevalence of MODY is still unknown, accentuating the need for research focused on biomarkers. Consequently, due to its impact in the course of treatment, follow-up of associated complications, and genetic implications for siblings and offspring of affected individuals, it is imperative to diagnose the monogenic forms of DM accurately. Conclusion: Currently, advances in the genetics field allowed the recognition of new DM subtypes, which until now, were considered slight variations of the typical forms. Thus, it is imperative to act in the close interaction between genetics and clinical manifestations, to facilitate diagnosis and individualize treatment.

New glycemic metrics and traditional clinical and laboratory profiles of children and adolescents with type 1 diabetes mellitus in an outpatient follow-up

2021 ◽  
Vol 173 ◽  
pp. 108680
Author(s):  
Ricardo Rodrigues ◽  
Isabela Cristina Borges Rossi ◽  
Bruno Franco Rossi ◽  
Débora Cristiane Gomes ◽  
Nilson Penha-Silva
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Children And Adolescents

Surgery in autoimmune pancreatitis

2021 ◽  
Author(s):  
Sara Nikolic ◽  
Poya Ghorbani ◽  
Raffaella Pozzi Mucelli ◽  
Sam Ghazi ◽  
Francisco Baldaque- Silva ◽  
...  
Keyword(s):  
Autoimmune Pancreatitis ◽  
University Hospital ◽  
Premalignant Lesions ◽  
Single Centre ◽  
Age At Surgery ◽  
Diagnostic Work ◽  
Work Up

Introduction: Autoimmune pancreatitis (AIP) is a disease that may mimic malignant pancreatic lesions both in terms of symptomatology and imaging appearance. The aim of the present study is to analyse experiences of surgery in patients with AIP in one of the largest European cohorts. Methods: We performed a single-centre retrospective study of patients diagnosed with AIP at the Department of Abdominal Diseases at Karolinska University Hospital in Stockholm, Sweden, between January 2001 and October 2020. Results: There were 159 patients diagnosed with AIP, and among them 35 (22.0%) patients had surgery: 20 (57.1%) males and 15 (42.9%) females; average age at surgery was 59 years (range 37-81). Follow-up period after surgery was 67 months (range 1-235). AIP type 1 was diagnosed in 28 (80%) patients and AIP type 2 in 7 (20%) patients. Malignant and premalignant lesions were diagnosed in 8 (22.9%) patients for whom AIP was not the primary differential diagnosis but, in all cases, it was described as a simultaneous finding and recorded in retrospective analysis in histological reports of surgical specimens. Conclusions: Diagnosis of AIP is not always straightforward, and, in some cases, it is not easy to differentiate it from the malignancy. Surgery is generally not indicated for AIP but might be considered in patients when suspicion of malignant/premalignant lesions cannot be excluded after complete diagnostic work-up.

scholarly journals Increased prevalence of thyroglobulin antibodies in Sri Lankan schoolgirls--is iodine the cause?

2000 ◽  
pp. 185-188 ◽  
Author(s):  
LD Premawardhana ◽  
AB Parkes ◽  
PP Smyth ◽  
CN Wijeyaratne ◽  
A Jayasinghe ◽  
...  
Keyword(s):  
Iodine Deficiency ◽  
Age Groups ◽  
Thyroid Volume ◽  
Thyroid Peroxidase ◽  
Sri Lankan ◽  
Free T4 ◽  
Thyroglobulin Antibodies ◽  
Age Related ◽  
High Prevalence ◽  
Urine Iodine

OBJECTIVE: Iodine deficiency was the likely cause of a high prevalence of goitre previously in Sri Lankan schoolchildren. Salt iodination was made compulsory in 1993 but there has been no recent study, using modern techniques, of its benefits or harmful effects. METHODS: Three hundred and sixty-seven schoolgirls between the ages of 11 and 16 years had ultrasound thyroid volume, free thyroxine (T4), free tri-iodothyronine (T3), thyrotrophin (TSH), anti-thyroglobulin (TgAb) and thyroid peroxidase (TPOAb) antibodies, and urine iodine concentrations measured. RESULTS: Median ultrasound thyroid volume ranged from 4.8 ml (11-year-old girls) to 8.6 ml (16-year-old girls) with an age-related increase. Median urine iodine concentrations ranged from 105 to 152 microg/l. Free T4 and free T3 were normal in all, but TSH was elevated in four subjects (5. 53-41.29 mU/l). However, the prevalence of TgAb was markedly raised, ranging between 14.3% (11-year-old girls) and 69.7% (16-year-old girls) (P<0.03). In contrast, the prevalence of TPOAb was 10% or less in all age groups. CONCLUSIONS: Normal median thyroid volumes, iodine concentrations and thyroid function would indicate that iodine deficiency is not a major problem in this group. The high prevalence of TgAb, hitherto unreported, most likely reflects excessive iodination of Tg resulting in increased immunogenicity. There is an urgent need to continuously monitor the adequacy and risks of iodination in this population.

scholarly journals Restricted thyroglobulin antibody epitope specificities in subjects with type 1 diabetes mellitus

2009 ◽  
Vol 161 (3) ◽  
pp. 489-493 ◽  
Author(s):  
O E Okosieme ◽  
C N Wijeyaratne ◽  
J H Lazarus ◽  
L D K E Premawardhana
Keyword(s):  
Thyroid Peroxidase ◽  
Thyroglobulin Antibodies ◽  
Autoimmune Thyroid ◽  
Thyroglobulin Antibody ◽  
High Prevalence ◽  
Patients At Risk ◽  
Healthy Control ◽  
A Prospective Study ◽  
Design And Methods

ObjectivesFollowing iodisation in Sri Lanka we observed a high prevalence of thyroglobulin antibodies (TgAbs) in type 1 diabetic (T1DM) patients. The clinical significance of these TgAbs is uncertain. We sought to obtain a detailed epitope analysis of TgAbs in T1DM patients recruited from diabetes clinics and to compare these with TgAb epitope specificities in patients with autoimmune thyroid disease (AITD) and healthy individuals in that country.Design and methodsWe used a panel of 10 Tg-MAbs in competitive ELISA reactions in a prospective study of subjects recruited from Colombo, to determine the epitopes recognised by TgAb-positive patients with T1DM (n=58, 34F:24M, median age 16 years), AITD patients (n=42, 33F:9M, median age 37 years) and healthy subjects (n=50, 39F:11M, median age 27 years). The outcomes were a comparison of reactivity with six Tg clusters (I–VI) in these subjects, and the relation of epitope specificity patterns with free thyroxine and TSH.ResultsPatients with T1DM and AITD but not healthy control subjects preferentially recognised the immunodominant clusters, I, III and IV. Patients with these narrow epitope specificities had higher median TSH levels (1.60 vs 1.06;P=0.01), and were more frequently positive for antibodies to thyroid peroxidase than those with broad specificities (52.3 vs 7.1%;P=0.004).ConclusionsThe TgAb epitope specificities in euthyroid Sri Lankans with T1DM are similar to AITD patients. TgAb epitope studies may potentially identify T1DM patients at risk of thyroid dysfunction.

scholarly journals Estimating indirect costs in a pediatric trial: patient diaries and interview data collection

2019 ◽  
Author(s):  
Anaïs LE JEANNIC ◽  
Hassani Maoulida ◽  
Sophie Guilmin-Crépon ◽  
Corinne Alberti ◽  
Nadia Tubiana-Rufi ◽  
...  
Keyword(s):  
Case Report ◽  
Data Collection ◽  
Children And Adolescents ◽  
Real Time ◽  
Controlled Trial ◽  
Indirect Costs ◽  
Economic Evaluations ◽  
Case Report Form

Abstract Background: In France the pertinence of including indirect costs in economic evaluations of therapeutic strategies is left to author judgment. However productivity losses represent a significant amount of resources in particular for chronic pediatric conditions when caregivers are involved in addition to patients. In order to explore how best to collect indirect cost information, we investigated whether or not a patient diary provided additional information compared to retrospective investigator-led interviews and whether a diary filled intermittently produced more or less information than a continuous diary. The main objective of this study was to identify which type of data collection was most effective to obtain information on indirect costs over a 9-month study period. Methods : Start-In! is a randomized controlled trial comparing the efficacy of three strategies of real-time continuous glucose monitoring (CGM) for 12 months in children and adolescents with type 1 diabetes. We designed an ancillary study to compare three collection methods of indirect costs: 1) retrospectively by investigators during quarterly follow up visits and prospectively with diaries filled by children or families used 2) either continuously or 3) intermittently. Were collected the amount of information on absence from school and work, and carer time for diabetes cares, and compared to the information given to the investigator during the quarterly follow up visit in the case report form. Results: At the end of the 9-month study 42% participants had not returned their diary, less than 10% of data were collected in patients’ diaries versus 82% in investigators’ filled case report forms. Conclusions: Our study only supports the hypothesis that data collection by investigators during quarterly visits would lead to fewer missing data than a diary, that it be filled up on a trimester or every three months. Diaries might represent an important additional burden to children and their families. Trial registration: Start-In! trial registry name: Study of Insulin Therapy Augmented by Real Time Sensor IN Type 1 Children and Adolescents (START-IN!). ClinicalTrials.gov Identifier: NCT00949221. Registered on July 30, 2009.

scholarly journals The effects of vitamins and trace minerals on chronic autoimmune thyroiditis

2014 ◽  
Vol 83 (2) ◽  
pp. 167-172
Author(s):  
Małgorzata Włochal ◽  
Marcin A. Kucharski ◽  
Marian Grzymisławski
Keyword(s):  
Thyroid Gland ◽  
Hashimoto’S Thyroiditis ◽  
Essential Element ◽  
Hashimoto Thyroiditis ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Peroxidase ◽  
Chronic Lymphocytic Thyroiditis ◽  
Thyroid Cells ◽  
Thyroglobulin Antibodies ◽  
Chronic Autoimmune Thyroiditis

Hashimoto’s thyroiditis (HT), also known as chronic lymphocytic thyroiditis is one of the most frequent types of inflammation of the thyroid gland. The prevalence of the overt HT is about 2% but it is believed that Hashimoto thyroiditis is more frequent than expected. Hashimoto’s thyroiditis is characterized by dysfunction of the immune system, which leads to impaired tolerance of own tissues and increased production of autoantibodies against the thyroid cells. Thyroid peroxidase antibodies (anti-TPO), thyroglobulin antibodies (anti-Tg) and/or TSH receptors antibodies are the principal markers of the disease. The essential element of the treatment of HT is the supplementation of L-thyroxine. In Hashimoto’s disease, like in many other autoimmune diseases, researchers attempted to support pharmacological treatment by adequate nutrition. The aim of this paper was to review the existing literature on the levels of antioxidants (vitamin A, C, E, selenium, zinc) and vitamin D in patients with HT, as well as the influence of the nutritional supplementation of the above mentioned elements on the metabolism of the thyroid gland hormones and the level of anti-thyroid peroxidase (anti-TPO) antibodies.

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