The impact of Hashimoto’s disease on skin, hair, and nails

The thyroid is an odd endocrine gland located in the neck. Hashimoto’s thyroiditis is a diseases of the gland which often leads to changes in skin and its appendages. The aim of this study was to investigate the relationship between hormonal disorders due to chronic autoimmune thyroiditis and skin, hair and nails conditions. This article presents the results and conclusions of a survey conducted in a group women suffering from Hashimoto’s thyroiditis, diagnosed for at least a year. The conclusions from the questionnaire showed that Hashimoto’s disease adversely affects skin, hair and nails.

Clinical Significance of Coexistence of Hashimoto Thyroiditis and Graves’ Disease with Differentiated and Medullary Thyroid Cancer

The association of Hashimoto thyroiditis and Graves’ disease with papillary, follicular, and medullary thyroid cancer has not been comprehensively investigated until now. This comparative clinicopathological study of consecutive patients thyroidectomized at a surgical referral center aimed to explore interdependencies between chronic autoimmune thyroiditis and thyroid cancer. Altogether, there were 852 (58.4%) patients with papillary thyroid cancer, 181 (12.4%) patients with follicular thyroid cancer, and 426 (29.2%) patients with sporadic medullary thyroid cancer, of whom 75 (5.1%) patients also had Hashimoto thyroiditis and 40 (2.7%) patients also had Graves’ disease. Patients with papillary (medians of 42 vs. 48 years; P =0.008) and follicular (medians of 33 vs. 63 years; P=0.022) thyroid cancer, unlike patients with medullary thyroid cancer (medians of 57.5 vs. 57 years; P=0.989), were younger at thyroidectomy when they had Hashimoto thyroiditis concomitantly. No such associations were seen with Graves’ disease. Primary thyroid cancers tended to be more localized in conjunction with Hashimoto thyroiditis, and less so with Graves’ disease, although patterns were not consistent across tumor types. In conclusion, Hashimoto thyroiditis, but not Graves’ disease, may be associated with differentiated (papillary and follicular) thyroid cancer but not with medullary thyroid cancer.

Effects of Selenium Supplementation on Sperm Parameters and DNA-Fragmentation Rate in Patients with Chronic Autoimmune Thyroiditis

Background: Selenium (Se) is an essential component of selenoenzymes, which have catalytic and antioxidant functions. A low Se status has been reported in patients with chronic autoimmune thyroiditis (AT) who benefit from Se supplementation. The role of Se in male reproduction is still a matter of debate. Although Se and selenoenzymes ensure sperm viability and protect against increased oxidative stress, only a few studies have assessed the effects of the administration of Se alone on sperm parameters, providing contrasting results. Aim: The aim of this study was to assess the effects of oral Se supplementation on conventional sperm parameters and DNA fragmentation (SDF) in patients with AT of reproductive age with normal thyroid function. Patients and Methods: Only patients with AT and normal thyroid function were selected for this study. All included patients underwent oral Se supplementation at the dose of 83 µg once daily (Syrel®, IBSA) for six months. Sperm conventional parameters, SDF, and thyroid function were assessed before and at the end of the treatment. Results: Twenty AT patients with normal weight were enrolled. After Se supplementation, they showed a higher sperm concentration, a higher percentage of sperm with progressive motility, and a higher percentage with normal morphology. They also had lower semen leukocyte concentration, and a lower percentage of spermatozoa with DNA fragmentation compared with pre-treatment values. Free-thyroxine serum levels increased significantly, whereas free triiodothyronine showed an upward trend. The thyroid-stimulating hormone did not change significantly. Conclusion: Se supplementation may represent a possible non-hormonal therapeutic choice for the treatment of male infertility, although further studies are needed to confirm this evidence. The possible thyroid hormone dependency of these findings needs to be clarified.

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

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.

Draft of the clinical recommendations for diagnosis and treatment of hypothyroidism

Hypothyroidism is one of the most common endocrine diseases. More than 99% of all cases of hypothyroidism in adults are due to primary hypothyroidism. Most often, hypothyroidism develops because of chronic autoimmune thyroiditis, as well as after medical manipulations (iatrogenic hypothyroidism) — postoperative or as a result of therapy with radioactive iodine. The article presents a draft of clinical guidelines for the diagnosis and treatment of hypothyroidism in different groups of patients, including pregnant women.

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.

AB0719 ASSOCIATION BETWEEN FIBROMYALGIA AND CHRONIC AUTOIMMUNE THYROIDITIS. RETROSPECTIVE OBSERVATIONAL DATA FROM A MONOCENTRIC ENDOCRINOLOGIST-RHEUMATOLOGIST COLLABORATIVE ANALYSIS

Background:Endocrine and metabolic imbalance conditions can affect the development of subjective abnormal perceptions within fibromyalgia (FMR). In the case of autoimmune thyroid disease (ATD), prolonged, clinically active states of impaired glandular function may be associated with an FMR-type condition. Less clear is the association between subclinical or rapidly well-controlled states of thyroid disease and the presence of FMR, since this assessment, although analysed in some previous studies, was usually performed on cohorts of subjects where the absence of any other confusing factors was not well defined.Objectives:To evaluate the prevalence of subclinical autoimmune thyroid disease, or functionally controlled autoimmune thyroid disease, in a retrospective cohort of consecutively diagnosed patients suffering from fibromyalgia condition.Methods:Over a 2 years period of time (2018-2019) a monocentric joint evaluation was activated with the endocrinology section of our healthcare area in order to consecutively monitor the subjects belonging to both specialist clinics. Patients with ATD were not unfrequently firstly evaluated in the rheumatology ambulatory. Diagnosis of FMR was defined according to the American College of Rheumatology 2010/2011 criteria. At the same time, at the rheumatology clinics, all cases addressed with diagnosis of fatigue or chronic pain of no defined origin were analysed in order to carefully identify any associated, comorbidity problems. The diagnosis of ATD was confirmed according to recognized international criteria. The following results will focus on subjects with chronic Hashimoto type Thyroiditis (HT).Results:Among the HT patients, 98% were women, aged between 28 and 64. Over the 2 years considered period of time, 65 subjects suffering from HT, showing no active disease or unstable endocrine function were addressed to the rheumatology clinics owing to FMR related symptoms. Among them, 55 (84.6%) had a confirmed diagnosis of FMR. Within this time, we recognized 239 consecutive diagnoses of FMR in subjects aging 22-76 years, with a number of 114 found to be devoid of factors (other than ATD) able to be responsible for chronic pain, except for a modest component of situational anxiety, or mild mood depression, not requiring any specific drug intervention. Among the 114, so called “primary” FMR, 35.6% showed to suffer from TCH, under confirmed clinical/hormonal remission, or in a preclinical, early stage of onset. Within the 125 subjects, carrying a FMR condition related to previous or associated fostering pathology, 26.8% were positive for current or previous thyroid problems. The prevalence of TCH, in the “secondary” FMR conditions differed significantly (p<0.01) from that of other FMR promoting diseases (eg connective tissue diseases, such as Sjogren Syndrome), except for moderate-severe mood disorders and/or anxiety, and the most severe chronic osteoarthritis conditions, showing a confirmed secondary neuropathy.Conclusion:Although limited in number, the here reported data confirm the hypothesis of a significant association between ATD and FMR, even in subjects who were considered to be in a subclinical condition or in full clinical remission by the endocrinology colleagues. The physiopathology of this association needs further appropriate insights.Acknowledgements:We thank Dr Alberto Petterle for his previous helpful contributionDisclosure of Interests:None declared

The diagnostic accuracy of fine-needle aspiration cytology for thyroid nodules is not affected by coexistent chronic autoimmune thyroiditis: Results from a cyto-histological series of patients with indeterminate cytology.

Objective Indeterminate cytological result at Fine-needle-aspiration-cytology (FNAC) remains a clinical challenge for endocrinologists. Aim of the present study was to evaluate whether a coexistent Chronic-Autoimmune-Thyroiditis (CAT) might affect the diagnostic accuracy of fine-needle aspiration cytology for thyroid nodules. Design and Methods A retrospective cohort study was designed including all nodules receiving an indeterminate cytology result (TIR3A or TIR3B) undergoing thyroid surgery and subsequent histological confirmation. Patients were stratified in two groups according to the presence or absence of CAT. The hypothesis to be tested was whether follicular cell alterations induced by CAT might increase the rate of indeterminate cytological results in histologically benign thyroid nodules. Additional control groups were represented by nodules with determinate cytology, either benign (TIR 2) or malignant (TIR5). Results: One-hundred-eighty-nine indeterminate thyroid nodules were included (67 TIR3A and 122 TIR3B). At post-surgical histology 46 nodules (24.3%) were malignant. No significant differences were observed in the rate of histologically proven malignancy between patients without CAT and patients with CAT in the TIR3B (29.4% vs 32.4%; p=0.843) nor TIR3A (13.0% vs 11.4%; p=1.000) nodules. The rate of coexistent CAT was similar between TIR3B and TIR5 nodules harboring PTC at histology (30.4% vs 39.4%, p=0.491) and between indeterminate nodules and a control group of TIR2 nodules (39.2% vs 37.0%; p=0.720). Conclusions: The similar rates of histologically proven malignancy found in cytologically indeterminate nodules in the presence or absence of concomitant CAT, would not support that CAT itself affects the diagnostic accuracy of fine-needle aspiration cytology.

Chronic periodontitis in a group of patients with chronic autoimmune thyroiditis – particularities of expression

Objectives. The intricacy of the inflammatory / infiltrative process common to chronic autoimmune thyroid disease and periodontal disease (CP) justifies the study of the incidence and expression peculiarities of periodontal lesions encountered in patients with chronic autoimmune thyroiditis (CAT). The presence of periodontal plaque correlated with the oral hygiene index represents a proof of the microbial aggression, as a "trigger" in initiating the pathological process with a progressive evolution. Material and method. The study included patients with CP: group 1 – associating CAT, group 2 – without thyroid disease. The periodontal status was assessed: mild, medium, aggravated. Statistically correlated variables: periodontal lesions, sex, age of patients, OHI-s, thyroid functional status (TSH), serum level of thyroid autoantibodies (ATPO / ATg) and antinuclear antibodies (ANA). Results. A heterogeneity of the distribution of periodontal lesions in both groups was found. The preponderance of lesions with statistical significance (p < 0.001) predominated for study group 1. Aggravated periodontal status: more common in group 1 (p = 0.043), was not influenced by the sex of the patients. The monofactorial linear regression finds the average interdependence between the OHI-s value and the age of the patients (r = 0.63; p = 0.018) and the TSH problem (r = 0.55; p = 0.0003). The multifactorial linear regression, however, attests a direct proportional relationship between OHI-s and TSH, ATPO, ATg (r = 0.56; p = 0.001) and intensified with age (r = 0.78, p <0.001). Effect on OHI-s calculated by ANOVA test: ATPO (Pr = 78.66%; r = 0.73; p = 0.05); ATg (Pr = 94.06%; r = 0.73; p = 0.042); both antibodies (Pr = 96.28%, r = 0.87; p = 0.003), correlated with age (r = 0.99; p <0.001). No statistical correlation for ANA was found. Conclusions. The presence and progressive characteristics of CP in patients with CAT attests the etiopathogenic interference of the two diseases and requests an interdisciplinary therapeutic attitude.