Determination of Serum Thyroglobulin Concentration in Simple Diffuse Goiter Patients with Known Iodine Status

Background: Thyroglobulin (TG) seems to be a valuable indicator of thyroid function and iodine nutrition status. Aim of the study: The aim of the study was to observe the relationship between serum thyroglobulin and urinary iodine (UI) in simple diffuse goiter patients.Methods:This cross-sectional observational study was conducted at the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. The study duration was 2 years, starting from May 2014 to March 2016. Total 87 patients with simple diffuse goiter attending the OPD Department of Endocrinology of BSMMU had been recruited as study population. A purposive sampling technique was followed for sample selection.Results:Serum thyroglobulin (ng/mL, mean±SD and median) was lowest in the age group 12-16 years (6.0±4.5, 5.16 ng/mL) followed by age>31 years (8.8±8.1, 6.16 ng/mL), whereas other age groups showed level around 13.0 and 10.0 ng/mL (p= 0.520). Mean (±SD) Urinary Iodine was not statistically different among age groups (347.4± 226.5 vs. 337.08±188.9 vs. 300.5± 95.37 vs. 337.7± 225.42 vs. 278.3± 105.7, µg/L; F 0.451, p=0.771) while median values were 325.26 vs. 355.68 vs. 325.80 vs. 338.86 and 300.90 µg/L respectively. Neither thyroglobulin (5.76±5.72 vs. 11.60± 13.50; 3.47 vs. 8.9 ng/mL, m±SD and median; p=0.294) nor Urinary Iodine (373.5± 44.5 vs. 317.2± 180.32; 378.1 vs. 308.9 µg/L, m±SD and median; p=0.450) were statistically different between the gender groups. Similarly, thyroglobulin and Urinary Iodine were also statistically similar for grade-1 and grade-2 goiter (thyroglobulin: 6.79±4.33 vs. 11.67±13.69 and 6.74 vs. 8.02 ng/mL, m±SD and median, p=0.319; Urinary Iodine: 361.33± 51.60 vs. 317.09± 182.44, 362.69 vs. 305.35 µg/L, m±SD and median, p=0.498).Conclusion:Thyroglobulin seems to have an inverse association in iodine deficiency state and positive association in over sufficient state with UI. There was no statistically significant difference of TG concentration between males and females nor between Grade-1 and Grade-2 goiter.

The Potential Prebiotic Berberine Combined With Methimazole Improved the Therapeutic Effect of Graves’ Disease Patients Through Regulating the Intestinal Microbiome

Graves’ disease, a typical metabolism disorder, causes diffuse goiter accompanied by ocular abnormalities and ocular dysfunction. Although methimazole (MI) is a commonly used drug for the treatment of GD, the efficacy of methimazole is only limited to the control of clinical indicators, and the side effects of MI should be seriously considered. Here, we designed a 6-month clinical trial that divided the patients into two groups: a methimazole group (n=8) and a methimazole combined with potential prebiotic berberine group (n=10). The effects of both treatments on thyroid function and treatment outcomes in patients with GD were assessed by thyroid index measurements and gut microbiota metagenomic sequencing. The results showed that the addition of berberine restored the patients’ TSH and FT3 indices to normal levels, whereas MI alone restored only FT3. In addition, TRAb was closer to the healthy threshold at the end of treatment with the drug combination. MI alone failed to modulate the gut microbiota of the patients. However, the combination of berberine with methimazole significantly altered the microbiota structure of the patients, increasing the abundance of the beneficial bacteria Lactococcus lactis while decreasing the abundance of the pathogenic bacteria Enterobacter hormaechei and Chryseobacterium indologenes. Furthermore, further mechanistic exploration showed that the addition of berberine resulted in a significant upregulation of the synthesis of enterobactin, which may have increased iron functioning and thus restored thyroid function. In conclusion, methimazole combined with berberine has better efficacy in patients with GD, suggesting the potential benefit of berberine combined with methimazole in modulating the composition of intestinal microbes in the treatment of GD, providing new strong evidence for the effectiveness of combining Chinese and Western drugs from the perspective of modulating the intestinal microbiota.

Graves’ Disease

Graves’ disease (GD) is an autoimmune disorder characterized by presence of TSH receptor autoantibody. It is most common cause of hyperthyroidism worldwide. Though GD can occur any age but peak incidence is seen during adulthood in between 20 to 50 years of age. GD is more commonly seen in female. GD is primarily disease of thyroid gland but affects multi organ system i.e. heart, liver, muscle, eye and skin. Symptoms and signs are result from hyperthyroidism or a consequence of underlying autoimmunity. Weight loss, fatigue, heat intolerance, tremor, and palpitations are the most common symptoms. Diffuse goiter presents in most of younger patients with thyrotoxicosis but less common in older patients. Graves’ ophthalmopathy and pretibial myxedema are extrathyroidal manifestations of GD which results from action of TSHR autoantibodies on TSHR present onfibroblast, adipocyte and T cells in extrathyroidal tissue. Treatment of GD remains in between antithyroid drugs, radioiodine or surgery. In this review we discuss the diagnosis and management of GD.

Development of Graves' Disease After SARS-CoV-2 mRNA Vaccination: A Case Report and Literature Review

Background: Mounting evidence has revealed the interrelationship between thyroid and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to explain the thyroid dysfunction and autoimmune thyroid disorders observed after coronavirus disease 2019 (COVID-19). There are limited reports of thyroid dysfunction after SARS-CoV-2 vaccination.Methods: We report a case of a 40-year-old Chinese woman who developed Graves' disease after BNT162b2 mRNA vaccine. A search of PubMed and Embase databases from 1 September 2019 to 31 August 2021 was performed using the following keywords: “COVID,” “vaccine,” “thyroid,” “thyroiditis,” and “Graves.”Results: A 40-year-old Chinese woman who had 8-year history of hypothyroidism requiring thyroxine replacement. Her anti-thyroid peroxidase and anti-thyroglobulin antibodies were negative at diagnosis. She received her first and second doses of BNT162b2 mRNA vaccine on 6 April and 1 May 2021, respectively. She developed thyrotoxicosis and was diagnosed to have Graves' disease 5 weeks after the second dose of vaccine, with positive thyroid stimulating immunoglobulin level, diffuse goiter with hypervascularity on thyroid ultrasonography and diffusely increased thyroid uptake on technetium thyroid scan. Both anti-thyroid peroxidase and anti-thyroglobulin antibodies became positive. She was treated with carbimazole. Literature search revealed four cases of Graves' disease after SARS-CoV-2 vaccination, all after mRNA vaccines; and nine cases of subacute thyroiditis, after different types of SARS-CoV-2 vaccines.Conclusion: Our case represents the fifth in the literature of Graves' disease after SARS-CoV-2 vaccination, with an unusual presentation on a longstanding history of hypothyroidism. Clinicians should remain vigilant about potential thyroid dysfunction after SARS-CoV-2 vaccination in the current pandemic.

Case Report: A Rare Association of Diffuse Thyroid Lipomatosis with Amyloid Deposition

Diffuse thyroid lipomatosis is a rare histopathological condition of unknown etiology, characterized by diffuse fatty infiltration of the thyroid stroma, which can result in diffuse goiter with compressive symptoms. We report a case of a 46-year-old man with 1-year history of progressive goiter enlargement with compressive symptoms. Imaging studies revealed multiple coalescent nodules. The patient underwent surgery, and the microscopic appearance revealed a diffuse infiltration of thyroid stroma by mature adipose tissue with associated amyloid deposition. A final diagnosis of diffuse lipomatosis of the thyroid gland was established. This patient represents one of the few reported cases of diffuse lipomatosis with coexisting deposition of amyloid protein of the thyroid gland and contributes to the better understanding of this extremely rare condition.

Gambaran Pemeriksaan Ultrasonografi pada Pasien Struma di Bagian/SMF Radiologi RSUP DR. M. Djamil Periode Januari–Desember 2019

Background: A goiter is an enlargement of the thyroid gland caused by abnormalities of the thyroid gland in the form of malfunctioning or disorders of the structure of the gland and its morphology. According to WHO, the incidence of goiter is still quite high with iodine deficiency as the main cause. Objective: This study aims to determine the description of ultrasound examinations in goiter patients in Department of Radiology DR. M. Djamil January-December 2019 period. Method: This research was a retrospective descriptive study using cross sectional method using secondary data on 123 patients with thyroid goiter who meet the inclusion criteria in RSUP DR. M. Djamil Padang period January 2019-December 2019. The sampling method used a total sampling technique. Result: The results showed that 112 patients with thyroid goiter disorders met the inclusion criteria. The most clinical diagnosis results were goiter nodusa as many as 61 people (54.5%). The highest incidence was in the age range 41-50 years with 35 people (31.3%). The most gender was 88 women (78.6%). The results of ultrasonography in most goiter patients were diffuse in 43 people (38%).Conclusion: The conclusion of this study, it was found that the most age group of patients suffering from goitre were 41-50 years old, the majority of goiters occurred in the female compared to the male and the results of the most thyroid ultrasound images were diffuse goiter

Graves’ Disease

DG presents with three main presentations: hyperthyroidism with diffuse goiter, infiltrative ophthalmopathy and pre-tibial myxedema. Patients with Graves’ disease can rarely develop severe hyperthyroidism. The hyperthyroidism of Graves’ disease is characterized immunologically by the lymphocytic infiltration of the thyroid gland and by the activation of the immune system with elevation of the circulating T lymphocytes. In GD, goiter is characteristically diffuse. May have asymmetric or lobular character, with variable volume. The clinical manifestations of hyperthyroidism are due to the stimulatory effect of thyroid hormones on metabolism and tissues. Nervousness, eye complaints, insomnia, weight loss, tachycardia, palpitations, heat intolerance, damp and hot skin with excessive sweating, tremors, hyperdefecation and muscle weakness are the main characteristics. In the laboratory diagnosis, biochemical and hormonal exams will be done to assess thyroid hormones and the antithyroid antibodies. Additionally, imaging tests may be performed, such as radioactive iodine capture in 24 hours, ultrasonography, thyroid scintigraphy and fine needle aspiration. It is necessary to make the differential diagnosis of Graves’ disease for thyrotoxicosis, subacute lymphocytic thyroiditis and toxic nodular goiter. The treatment of DG aims to stop the production of thyroid hormones and inhibit the effect of thyroid hormones on the body. Hyperthyroidism caused by DG can be treated in the following ways: it may be the use of synthetic antithyroid medicines, thionamides, MMI being a long-term medicine, it allows a single daily dose, and adherence to treatment occurs, a disadvantage is that it cannot be used in pregnant women; beta-blockers, preferably used in the initial phase of DG with thionamides; radioactive iodine therapy (RAI), being the best cost–benefit and preventing DG recurrence; finally the total thyroidectomy, causing the withdrawal of the thyroid gland. Therefore, it should be discussed with the patient what is the best treatment for your case, with a view to the post and against each approach. If the patient develops Graves ophthalmopathy, in lighter cases the artificial tears should be used, and in more severe cases can be used as treatment, corticosteroids, orbital decompression surgery, prisms and orbital radiotherapy. In addition, the patient should keep their body healthy, doing exercise and healthy eating, following the guidance of their doctor.

Prevalence of nodular goiter in patients with breast diseases

Introduction. Various studies have reported conflicting results regarding the relationship between breast and thyroid diseases. The exact pathogenesis behind this association is not clear. The aim of this study was to determine the prevalence of thyroid disease in patients presenting with breast diseases and to examine whether thyroid screening is required in patients with breast diseases. Methodology. All patients attending the department of General Surgery in our institution with breast diseases during the period from December 2015 to September 2017 were enrolled for the study. A thorough clinical examination which included an examination of the neck was done. Thyroid profile and ultrasonography neck were performed in all patients and the pathology in all radiologically diagnosed cases of nodular goiter was confirmed by cytology. Results. We had 128 patients with breast diseases enrolled in the study of which 62 (48%) patients had malignant breast disease and 66 (52%) patients had benign breast disease. None of the patients in our study had a palpable thyroid nodule or a diffuse goiter. Of the 61 patients having malignant breast diseases, 26 (42.6%) patients had a radiologically detected thyroid disease and among the 64 patients with benign breast diseases, 10 (15.6%) had radiologically detected thyroid diseases. Conclusions. In our study the prevalence of nodular goiter was higher in patients with malignant breast diseases than patients with benign breast diseases. However, this prevalence or clinical relevance is not significant enough to warrant screening for thyroid disease in patients with breast diseases.