Hashimoto's Encephalopathy Masquerading as Rapidly Progressive Dementia and Extrapyramidal Failure

Hashimoto's encephalopathy is a rare immune-mediated disorder characterized by subacute encephalopathy with elevated thyroid antibodies. Hashimoto's encephalopathy is also known as steroid-responsive encephalopathy associated with autoimmune thyroiditis. We report a rare presentation of Hashimoto's encephalopathy presenting with acute neuropsychiatric disturbances, rapidly progressive dementia, seizures, and extrapyramidal failure. Neuroimaging revealed multifocal vasculitides of major cerebral vessels that support the autoimmune vasculitic theory as the underlying pathogenesis for Hashimoto's encephalopathy. Unfortunately, permanent irreversible cerebral damage has already ensued before her presentation to our center, which rendered steroid therapy ineffective. Serological testing for Hashimoto's thyroiditis must be in the investigation of all rapidly progressive dementias as early diagnosis and timely management of autoimmune thyroiditis may salvage sizable and eloquent cerebral tissues. The rarity of the condition should not preclude the investigation of Hashimoto's disease even in the presence of normal levels of thyroid hormones. Delayed diagnosis may result in irreversibly catastrophic encephalopathy in patients who once presented with potentially curable dementia.

Autoimmune thyroiditis: organizational and medical measures for early detection in the Republic of Belarus

Objective. To evaluate the effectiveness of conducted organizational and medical measures for early detection and medical examination of patients with autoimmune thyroiditis (AIT) in the regions of the Republic of Belarus and to develop measures to enhance them.Materials and methods. Data on the incidence rates of AIT and primary hypothyroidism (PGT) in the Republic of Belarus from 1997 to 2017 were analyzed, data of a sociological study were presented and patients` records were analyzed. Epidemiological and sociological methods were used.Results. In the Republic of Belarus, two organizational and medical approaches to early diagnosis of AIT have been developed. The study has found a low competence level among therapists (general practitioners) of the Brest and Gomel regions and showed the absence of patients with AIT at Gomel Regional Endocrinological Dispensary even if there is a pathognomonic ultrasound picture and a high level of AT-TPO titer, which indicates that the incidence is undercounted.Conclusion. As a result of the performed study, the algorithm for organizational and medical measures has been developed and implemented for early detection and clinical examination of AIT patients aimed at PGT prevention.

The Association Between Three Adipocytokines (Adiponectin, Resistin and Visfatin) And Thyroid Status in Patients With Type 2 Diabetes Mellitus and Autoimmune Thyroiditis

Autoimmune thyroiditis (AIT) and type 2 diabetes mellitus (DM2) are the most common endocrinological diseases worldwide. Relation between these diseases explains several hypotheses. One of them is influence of some adipocytokines. This study evaluated association between three adipocytokines (adiponectin, resistin and visfatin) and thyroid and glycid status in patients with DM2 and AIT compared to the control group (CG). The group consisted of four subgroups: patients with DM2 without thyreopathies, patients with AIT on substitution therapy without diabetes and prediabetes, patients with DM2 and AIT on substitution therapy and healthy subjects as the CG. We investigated parameters of thyroid and glucose metabolism and serum levels of three adipocytokines. The mean level of resistin in the group of patients with diabetes and thyroiditis was significantly higher than in patients with thyroiditis without diabetes and than in the CG. We found a weak negative correlation between visfatin and fasting glucose levels in patients with thyroiditis without diabetes. We detected a weak negative correlation between resistin and glycated hemoglobin and a weak negative correlation between visfatin and thyroid gland volume in patients with diabetes without thyroiditis. In the CG we determined a weak positive correlation between visfatin and free thyroxin. Our results are consistent with several studies, which confirmed association between AIT and adipocytokines.

Elemental state of the organism of workers and population as manifestation of adaptation to the technogenic effect of metals: new methodological approaches

The problem of adaptive, prepathological and pathological reactions of the body to the action of exogenous chemicals is closely intersected with the assessment of the norm and its fluctuations. The imbalance of chemical elements in the human body directly affects the functioning of almost all organs and systems, causing significant stress of adaptation mechanisms. In this article we study the elemental state of the human body depending on the physiological state (endocrine pathology and professional contact with heavy metals), analyze the correlation between macro- and microelements and assess the degree of adaptability of the body. In the work the elemental state of the human body, taking into account not only the absolute values of the concentrations of elements in the hair and whole blood was studied, the adaptability of the body according to the indicators of elemental imbalance in the blood and hair of volunteers, individuals with endocrine pathology (autoimmune thyroiditis and type II diabetes mellitus) and for those working in conditions of contact with heavy metals (for jewelers, welders and batterymen) is analyzed. The results of the study indicate that various non-specific adaptation reactions are accompanied by changes in the elemental state of a person. Under the prevailing pathology of the endocrine system (diabetes mellitus or autoimmune thyroiditis), the adaptation of the body was determined as a stage of tension and is associated with the duration of the disease. In persons exposed to professional contact with heavy metals (Mn, Cr, Pb, Ag), adaptation depended on the nature and duration of professional contact with them: the highest tension of adaptation processes was found in jewelers, and the least in welders and batterymen, which is associated with the duration of professional contact with these metals. The high number of connections between the elements indicates the tension of adaptive reactions in people with endocrine pathology and especially in jewelry workers. Adaptation to the high content of metals in the air of welders and batteries due to the longer experience of these workers and adaptation to production conditions with a decrease in the number of correlations between the elements, as a means of reliable operation.

Lymphatic self-massage for enhancing immunity during a pandemic

The article is devoted to the problem of improving immunity during the COVID-19 pandemic and the related effect of lymphatic self-massage.The article analyzes the general concepts of the lymphatic system and its functions, as well as lymphatic self-massage and its effect on cardiovascular and lymphatic systems.It is noted that the lymph flow stimulation through movements activates and normalizes the most important body functions. Using Skype, the authors surveyed medical students about knowledge on benefits and techniques of lymphatic selfmassage.Further, a master class was held on the technique of lymphatic self-massage. The authors studied the awareness of students about the benefits of lymphatic selfmassage, revealed a tendency to chronic diseases and assessed the benefits after the procedure.Based on the data obtained, it was revealed that viral infections, namely COVID-19, provoke one of the most common diseases — autoimmune thyroiditis. So, 64% of the respondents noted about it.Using lymphatic self-massage, the manifestations of this pathology decreases, the facial muscles relax and the blood and lymph outflow improves.Thus, there is an undoubted benefit of lymphatic self-massage for the prevention of diseases with immune involvement, including COVID-19.

A case of vitiligo regression in a patient with psoriasis and psoriatic arthritis receiving adalimumab therapy

The article discusses the common pathogenetic pathways of autoimmune skin diseases – psoriasis and vitiligo. Currently proposed treatments for vitiligo do not significantly reduce or completely restore skin pigmentation. The use of adalimumab for 6 years in a patient suffering from psoriasis, psoriatic arthritis (PsA), vitiligo and autoimmune thyroiditis made it possible to control the activity of psoriasis and PsA, and also contributed to the regression of depigmentation foci. The use of biologic disease-modifying antirheumatic drug therapy in this group of patients in order to achieve repigmentation may be promising.

Normobaric interval hypoxytherapy in the correction of neuroimmunoendocrine disorders in children and adolescents with autoimmune thyroiditis

130 children and adolescents aged 6 to 16 years with a diagnosis of autoimmune thy-roiditis (AIT) at the stage of hypothyroidism underwent a course of hypoxytherapy. The high ef-ficiency of the normobaric interval hypoxic training method in the treatment of hypothyroidism on the background of AIT is shown. An increase in the function and number of CD8+ cells after a course of hypoxytherapy prevents the progression of the autoimmune process and promotes the restoration of thyroid function, which in turn leads to positive dynamics in the neurological status of patients: improved indicators of mental performance and fine coordination of move-ments. Key words: autoimmune thyroiditis, hypothyroidism, hypoxytherapy, interval hypoxic training, neuroimmunoendocrine disorders.

THYROID FUNCTION OF RATS WITH EXPERIMENTAL AIT AT AN EARLY PERIOD AFTER THE INJECTION OF BIOPREPARATIONS OF CORD BLOOD

The development of new methods for the treatment of autoimmune thyroid disease is an actual problem of endocrinology. The aim of research was studying of the cell-free effect biological product of cord blood with immunomodulatory properties "Cryocell-Cryocord " on rats’ thyroid function with AIT simulated at an early period of the study. Simulation of autoimmune thyroiditis was carried out by immunization with a suboperatively isolated human thyroid antigen in combination completing Freund's adjuvant on 30 adult male rats weighing 130 - 150 g. Correction was carried out by parenteral ingection of the "Cryocell-Cryocord". Hormonal research (determination of the content of thyroid hormones and antibodies to thyroglobulin (TG-AT) were effected by using standard test kits for enzyme-linked immunosorbent assay at early stages after exposure (7 days, 1 month). Statistical maintained of the results was carried out using the methods of variation statistics. It was used normal distribution to unpaired Student's test to compare indicators. The difference was considered significant at p<0.05. It has been shown the biological preparation of cord blood "Cryocell - Cryocord" has a positive effect with induced autoimmune thyroiditis. It has been noted the normalizing result of the effected correction on the thyroid function of animals in the early period of the studying. It has been proved after the introduction of the biological preparation "Cryocell - Cryocord" in animals with experimental autoimmune thyroiditis observed the inhibition of the manifestations of autoimmune aggression and the normalization of the functional activity of the thyroid gland. These investigations can be the foundation for the development of a new approach to the treatment of patients.