Subclinical thyroid dysfunction and autoantibodies in acute ischemic and hemorrhagic stroke patients: relation to long term stroke outcome

Background Data regarding the relation between both subclinical thyroid dysfunction, thyroid autoantibodies and clinical outcomes in stroke patients are limited. This study aimed to evaluate subclinical thyroid dysfunction and thyroid autoantibodies production in acute stroke patients and their relation to long term stroke outcome. We recruited 138 patients who were subjected to thorough general, neurological examination and brain imaging. Blood samples were collected for measurement of levels of serum thyroid function [free tri-iodothyronine (FT3), free thyroxin (FT4), thyroid stimulating hormone (TSH)], thyroid autoantibodies within 48 h after hospital admission. FT4 and TSH after 1 year were done. The stroke severity was assessed at admission by the National Institutes of Health Stroke Scale (NIHSS). The stroke outcome was assessed at 3 months and after 1 year by the modified Rankin Scale (mRS). We divided the patients into two groups according to thyroid autoantibodies (positive and negative groups). Results Subclinical hyperthyroidism was found in 23% of patients, and subclinical hypothyroidism in 10% of patients. Euthyroidism was detected in 67% of patients. 34% patients had positive thyroid autoantibody. Positive thyroid autoantibodies were commonly found in those with subclinical hyperthyroidism (28%), followed by subclinical hypothyroidism (21%) and euthyroidism (14%). 73% and 59% of stroke patients had poor outcomes (mRS was > 2) at 3 months and 1 year respectively with no significant difference between ischemic and hemorrhagic stroke patients. In the positive group final TSH level, NIHSS score at admission, and disability at 1 year were significantly higher compared with the negative group. Poor outcome was significantly associated with higher NIHSS score at admission, positive thyroid autoantibodies, subclinical hyperthyroidism, and atrial fibrillation. Conclusions Subclinical thyroid dysfunction could be found in stroke patients with positive thyroid autoantibodies. Subclinical hyperthyroidism and thyroid autoantibodies were associated with a poor outcome at 1 year in first-ever acute stroke patients especially in those presented with atrial fibrillation and higher NIHSS score at admission.

Increased risk of thyroid dysfunction by PD-1 and CTLA-4 blockade in patients without thyroid autoantibodies at baseline

Background Previous studies showed that although the risk of thyroid dysfunction (thyroid immune-related adverse events [irAEs]) induced by anti-programmed cell death-1 antibodies (PD-1-Ab) was as low as 2–7% in patients negative for anti-thyroid-antibodies (ATAs) at baseline, it was much higher (30–50%) in patients positive for ATAs. However, whether a similar increase occurs with combination therapy using PD-1-Ab plus anti-cytotoxic T-lymphocyte antigen-4 antibody (CTLA-4-Ab) is unknown. Methods A total of 451 patients with malignancies treated with PD-1-Ab, CTLA-4-Ab, or a combination of PD-1-Ab plus CTLA-4-Ab (PD-1/CTLA-4-Abs) were evaluated for ATAs at baseline and for thyroid function every 6 weeks for 24 weeks after treatment initiation, and then observed until the last clinical visit. Results Of the 451 patients, 51 developed thyroid-irAEs after immunotherapy [41 of 416 (9.9%) treated with PD-1-Ab, 0 of 8 (0%) with CTLA-4-Ab, and 10 of 27 (37.0%) with PD-1/CTLA-4-Abs]. The cumulative incidence of thyroid-irAEs was significantly higher in patients who were positive versus negative for ATAs at baseline after both PD-1-Ab [28/87 (32.2%) vs. 13/329 (4.0%), p < 0.001] and PD-1/CTLA-4-Abs [6/10 (60.0%) vs. 4/17 (23.5%), p < 0.05] treatments. The risk of thyroid-irAEs induced by PD-1/CTLA-4Abs, which was significantly higher than that induced by PD-1-Ab, in patients negative for ATAs at baseline was not statistically different from that induced by PD-1-Ab in patients positive for ATAs at baseline. Conclusions This study showed that the incidence of thyroid-irAEs was high and not negligible after PD-1/CTLA-4-Abs treatment even in patients negative for ATAs at baseline.

Thyroid Autoantibodies in Egyptian Patients with Systemic Autoimmune Connective Tissue Diseases with or without Clinical Thyroid Disorders

Background Autoantibodies against the thyroid seem to be more common in patients with rheumatic diseases than in the normal population. Their appearance may be linked to an associated autoimmune thyroid disease, although sometimes they lack a clear clinical meaning. The major antigens driving the appearance of thyroid autoantibodies are thyroglobulin (Tg), thyroid peroxidase (TPO) and thyroid-stimulating hormone receptor (TSH-R). Rheumatoid arthritis (RA) is a systemic autoimmune disease that is characterized by joint destruction and deformity, affecting millions of people worldwide. However, RA is more than a symmetrical inflammation of the joints, as increasing evidence supports a higher risk of other autoimmune disorders. Systemic lupus erythematosus (SLE) is an autoimmune disease affecting mostly joints, skin, blood vessels, heart, lungs, kidneys, liver, and nervous system, in which the immune system attacks tissues and cells leading to inflammation and damage. Objective To estimate the prevalence of thyroid autoantibodies among patients with systemic rheumatic disease (SLE, RA and SSc) with or without thyroid disease and its association with disease activity and functional impairment. Patients and Methods In the present study, we aimed to estimate the prevalence of thyroid autoantibodies among patients with systemic rheumatic diseases (SLE, RA and SSc) with or without clinical thyroid disorders and its association with disease activity and functional impairment. Our study was carried out at Ain Shams University Hospital. That was a cross sectional observational study; included 3 groups and compared with 20 healthy persons as control group; Group I 20 patients with SLE. Group II 20 patients with RA. Group III 20 patients with SSc. Our patients were recruited randomly from Rheumatology Outpatient clinic and the inpatient of Internal medicine department, Ain shams University Hospital. Results In our study, there was no statistically significant difference between SLE patients with positive & negative thyroid Abs as regard disease activity (SLEDAI score) and SLICC/ACR damage index. No statistically significant difference between RA patients with positive & negative thyroid Abs as regard disease activity and functional impairment (measured by DAS 28 score and HAQ score respectively).And also no statistically significant difference in SSc patients with positive &negative thyroid Abs as regard disease activity and functional impairment (measured by Rodnan modified index and Medsger index respectively). Conclusion The prevalence of thyroid autoantibodies thyroglobulin (Tg), thyroid peroxidase (TPO) in SLE and SSc patients were higher than that with RA with and without thyroid disorders. No link could be established between the presence of thyroid autoantibodies and the results from any of the instruments used to measure inflammatory activity and functional impairment in these cases of rheumatic diseases.

What Basophil Testing Tells Us About CSU Patients – Results of the CORSA Study

Basophil testing is the most effective single approach for diagnosing type-IIb autoimmune chronic spontaneous urticaria (TIIbaiCSU). A positive basophil test has been linked to long disease duration, higher disease activity, a poor response to antihistamines and omalizumab, and a better response to cyclosporine and fenebrutinib. As of now it is unclear what other features are connected to a positive basophil test in chronic spontaneous urticaria (CSU). We aimed to identify features of basophil test-positive CSU patients. We performed a cross-sectional study of 85 CSU patients. Basophil testing was done with the basophil activation test (BAT) and the basophil histamine release assay (BHRA). Data were analysed using SPSS: Student’s t-test, Chi-square test, Odds Ratio, Spearman’s correlation test. Of 85 CSU patients, 44% and 28% tested positive with the BAT and BHRA, respectively. These patients showed higher disease activity and impact, lower levels of disease control and total serum IgE, as well as higher rates of having a positive autologous serum skin test (ASST), angioedema, nocturnal symptoms, symptoms for >5 days/week, and thyroid autoantibodies. The ASST, by itself, was not a good predictor of basophil test results, but it predicted a positive basophil test in up to 100% of cases when combined with angioedema, thyroid autoantibodies or low IgE. In conclusion, a positive basophil test is linked to known features of TIIbaiCSU and novel characteristics including nocturnal symptoms. Further studies on basophil test-positive and -negative CSU patients can help to better understand CSU endotypes and to develop better management approaches.

ANTITHYROID ANTIBODIES - A POSSIBLE INVOLVEMENT IN THE DEVELOPMENT OF CHRONIC PERIODONTITIS

Objectives. Identification of periodontal lesions in patients with chronic autoimmune thyroiditis (CAT) assessed differently depending on their severity and the average serum level of thyroid autoantibodies. Material and methods. The study was initiated in a group of patients (n = 133) diagnosed with chronic autoimmune thyroiditis in conditions of normal thyroid function and without other comorbidities. Examination of the oral cavity identified lesions characteristic of chronic periodontitis (CP) classified according to their intensity in - mild, medium and aggravated in a group of 109 patients. The serum level of thyroid autoantibodies – as a mean value – was analyzed in a group of 77 patients with similar periodontal lesions related to their classification. Results. Characteristic ethological changes of chronic periodontitis were identified in 85% of patients being classified as: mild (40.2%), medium (31.9%), aggravated (28.5%). Thyroid autoantibodies were present: 62.3% for antithyroperoxidase antibodies (ATPO), 23.8% for both ATPO and antithyroglobulin antibodies (ATG); 13.7% for ATG. The differentiated statistical calculation of the average values of antibodies found for ATPO presented a high statistical significance (p < 0.0002) for spontaneous bleeding, all degrees of tooth mobility, depth of periodontal pockets, root fork and dental occlusion. No statistical significance was found for ATPO in bacterial plaque and gingival regression. No statistical significance was recorded for the mean level of ATG. Conclusions. The correlation of the serum level of thyroid autoantibodies with the specificity of periodontal lesions certify a possible differentiated involvement of them. For ATPO, extra-thyroid systemic effects can be suggested as a priority.