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Iwamoto Y, Kimura T, Itoh T, Mori S, Sasaki T, Sugisaki T, Nakao E, Ohnishi M, Kusano T, Takenouchi H, Iwamoto H, Sanada J, Fushimi Y, Katakura Y, Tatsumi F, Shimoda M, Nakanishi S, Mune T, Kaku K, Kaneto H. Structural and functional differences in auto-antibody positive compared to auto-antibody negative hypothyroid patients with chronic thyroiditis. Sci Rep 2023; 13:15542. [PMID: 37731007 PMCID: PMC10511552 DOI: 10.1038/s41598-023-42765-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 09/14/2023] [Indexed: 09/22/2023] Open
Abstract
Most primary hypothyroidism in adults is caused by chronic thyroiditis. Autoantibodies such as anti-thyroglobulin antibody (TgAb) and anti-thyroid peroxidase antibody (TPOAb) are involved in the pathogenesis of chronic thyroiditis. On the other hand, the clinical features of antibody-negative hypothyroidism are not clear. In this study, we aimed to determine the prevalence of thyroid-related autoantibodies in patients with primary hypothyroidism and to evaluate the differences in thyroid structure between antibody-positive and antibody-negative hypothyroidism. Among 804 patients who attended Kawasaki Medical School Hospital for thyroid hormone abnormalities or thyroid gland enlargement between January 1, 2010 and December 31, 2021, 237 patients with primary hypothyroidism who underwent thyroid antibody measurement and thyroid ultrasound examination were included. Participants were divided into groups according to antibody positivity/negativity, and differences in antibody positivity and thyroid structure were evaluated. In this study, 34.6% of patients had antibody-negative hypothyroidism. The positive rate of each antibody was 62.0% for TgAb and 49.4% for TPOAb. The participants with antibody-positive hypothyroidism had significantly larger thyroid gland on thyroid ultrasound examination (p < 0.05). Thyroid-stimulating hormone was significantly higher in participants with antibody-positive compared to antibody-negative hypothyroidism. The present study reveals a positive rate of thyroid-related autoantibodies in patients with hypothyroidism and the differences in thyroid structure between patients with and without antibodies. This study clearly show that the prevalence of antibody-negative chronic thyroiditis is quite high among hypothyroid patients, although this point needs confirmation by further investigations. The data in this study would be useful for the treatment of antibody-negative hypothyroid patients.
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Affiliation(s)
- Yuichiro Iwamoto
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan.
| | - Tomohiko Kimura
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Takashi Itoh
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Shigehito Mori
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Taku Sasaki
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Toshitomo Sugisaki
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Erina Nakao
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Mana Ohnishi
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Takashi Kusano
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Haruka Takenouchi
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Hideyuki Iwamoto
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Junpei Sanada
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Yoshiro Fushimi
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Yukino Katakura
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Fuminori Tatsumi
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Masashi Shimoda
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Shuhei Nakanishi
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Tomoatsu Mune
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Kohei Kaku
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Hideaki Kaneto
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
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Yao S, Zhang B, Fei X, Xiao M, Lu L, Liu D, Zhang S, Cui J. AI-Assisted Ultrasound for the Early Diagnosis of Antibody-Negative Autoimmune Thyroiditis. J Multidiscip Healthc 2023; 16:1801-1810. [PMID: 37404960 PMCID: PMC10315148 DOI: 10.2147/jmdh.s408117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/12/2023] [Indexed: 07/06/2023] Open
Abstract
The prevalence of antibody-negative chronic autoimmune thyroiditis (SN-CAT) is increasing. The early diagnosis of SN-CAT can effectively prevent its further development. Thyroid ultrasound can diagnose autoimmune thyroiditis and predict hypothyroidism. Primary hypothyroidism with a hypoechoic pattern suggested by thyroid ultrasound and negative thyroid serum antibodies is the main basis for the diagnosis of SN-CAT. However, for early SN-CAT, only hypoechoic thyroid changes and serological antibodies are currently available. This study explored how to achieve an accurate and early diagnosis of SN-CAT and prevent the development of SN-CAT combined with hypothyroidism. The diagnosis of a hypoechoic thyroid by artificial intelligence is expected to be a breakthrough in the accurate diagnosis of SN-CAT.
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Affiliation(s)
- Shengsheng Yao
- China Medical University - Department of Thyroid and Breast Surgery, Liaoning Provincial People’s Hospital, Shenyang, Liaoning Province, 110015, People’s Republic of China
| | - Bo Zhang
- Department of Science and Education, The 10th Division of Xinjiang Production and Construction Corps, Beitun General Hospital, Beitun City, Xinjiang Province, 831300, People’s Republic of China
| | - Xiang Fei
- Department of Thyroid and Breast Surgery, People’s Hospital of China Medical University (Liaoning Provincial People’s Hospital), Shenyang, Liaoning Province, 110015, People's Republic of China
| | - Mingming Xiao
- Department of Pathology, People’s Hospital of China Medical University (Liaoning Provincial People’s Hospital), Shenyang, Liaoning Province, 110015, People’s Republic of China
| | - Li Lu
- Department of Endocrinology, People’s Hospital of China Medical University (Liaoning Provincial People’s Hospital), Shenyang, Liaoning Province, 110015, People’s Republic of China
| | - Daming Liu
- Department of Ultrasound, People’s Hospital of China Medical University (Liaoning Provincial People’s Hospital), Shenyang, Liaoning Province, 110015, People’s Republic of China
| | - Siyuan Zhang
- Department of Thyroid and Breast Surgery, The 10th Division of Xinjiang Production and Construction Corps, Beitun General Hospital, Beitun City, Xinjiang Province, 831300, People’s Republic of China
| | - Jianchun Cui
- Department of Thyroid and Breast Surgery, People’s Hospital of China Medical University (Liaoning Provincial People’s Hospital), Shenyang, Liaoning Province, 110015, People's Republic of China
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Croce L, Chytiris S, Coperchini F, Ferraro G, Minelli L, Navarra A, Magri F, Chiovato L, Trimboli P, Rotondi M. Unexplained Hyperthyrotropinemia: A Biochemical and Clinical Challenge. J Clin Med 2023; 12:jcm12082934. [PMID: 37109270 PMCID: PMC10146086 DOI: 10.3390/jcm12082934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/31/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND A raised serum TSH in the absence of a clear etiology, or "unexplained hyperthyrotropinemia" (UH), can be challenging for clinicians. The aim of the present study was to evaluate potential strategies aimed at a clinical and biochemical characterization of UH patients. METHODS We compared 36 patients with UH with a control group of 14 patients with chronic autoimmune thyroiditis (CAT) and subclinical hypothyroidism. The two groups were compared in terms of the following: (i) the rate of normalization of TSH after repeating with another assay; (ii) the rate of normalization of TSH over time with the same assay; (iii) the reduction in TSH after precipitation with polyethilenglycole (PEG); and (iv) free thyroxine (FT4) levels. RESULTS Similar TSH levels were observed in UH [5.65 (5.21-6.37)] and CAT [5.62 (5.17-8.50)] (p = 0.489). TSH measurement with another assay method showed a normal TSH value in 41.9% of UH vs. 46.1% of CAT patients (p = 0.797). After repeating the TSH measurement in time with the same assay method, an increased TSH value was confirmed in all cases, in both groups (0% in the UH group vs. 0% in the CAT group, p = 1.000). TSH recovery after PEG precipitation was similar in the two groups (% precipitable post-PEG: 68.75 ± 3.14 in UH vs. 68.67 ± 7.18 in CAT, p = 0.960). FT4 levels were similar in the two groups (FT4 1.02 ± 0.20 ng/dl in UH vs. 1.00 ± 0.20 ng/dl in CAT, p = 0.789). CONCLUSIONS The results do not support the concept that laboratory interferences are more frequent in UH patients, suggesting that patients with UH should be managed in the same way as patients with CAT until proven otherwise.
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Affiliation(s)
- Laura Croce
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
- Unit of Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
| | - Spyridon Chytiris
- Unit of Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
| | - Francesca Coperchini
- Unit of Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
| | - Giovanni Ferraro
- Laboratory Service, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
| | - Linda Minelli
- Unit of Internal Medicine, Medical-Oncologic Department, ASST Lodi, 26900 Lodi, Italy
| | - Antonella Navarra
- Laboratory Service, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
| | - Flavia Magri
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
- Unit of Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
| | - Luca Chiovato
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
- Unit of Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
| | - Pierpaolo Trimboli
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Mario Rotondi
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
- Unit of Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
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Lenti MV, Rossi CM, Melazzini F, Gastaldi M, Bugatti S, Rotondi M, Bianchi PI, Gentile A, Chiovato L, Montecucco C, Corazza GR, Di Sabatino A. Seronegative autoimmune diseases: A challenging diagnosis. Autoimmun Rev 2022; 21:103143. [PMID: 35840037 DOI: 10.1016/j.autrev.2022.103143] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/10/2022] [Indexed: 12/19/2022]
Abstract
Autoimmune diseases (AID) are increasingly prevalent conditions which comprise more than 100 distinct clinical entities that are responsible for a great disease burden worldwide. The early recognition of these diseases is key for preventing their complications and for tailoring proper management. In most cases, autoantibodies, regardless of their potential pathogenetic role, can be detected in the serum of patients with AID, helping clinicians in making a definitive diagnosis and allowing screening strategies for early -and sometimes pre-clinical- diagnosis. Despite their undoubted crucial role, in a minority of cases, patients with AID may not show any autoantibody, a condition that is referred to as seronegative AID. Suboptimal accuracy of the available laboratory tests, antibody absorption, immunosuppressive therapy, immunodeficiencies, antigen exhaustion, and immunosenescence are the main possible determinants of seronegative AID. Indeed, in seronegative AID, the diagnosis is more challenging and must rely on clinical features and on other available tests, often including histopathological evaluation and radiological diagnostic tests. In this review, we critically dissect, in a narrative fashion, the possible causes of seronegativity, as well as the diagnostic and management implications, in several AID including autoimmune gastritis, celiac disease, autoimmune liver disease, rheumatoid arthritis, autoimmune encephalitis, myasthenia gravis, Sjögren's syndrome, antiphospholipid syndrome, and autoimmune thyroid diseases.
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Affiliation(s)
- Marco Vincenzo Lenti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Carlo Maria Rossi
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Federica Melazzini
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Serena Bugatti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Unit of Rheumatology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Mario Rotondi
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Pavia, Italy
| | - Paola Ilaria Bianchi
- Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Antonella Gentile
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Luca Chiovato
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Pavia, Italy
| | - Carlomaurizio Montecucco
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Unit of Rheumatology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Gino Roberto Corazza
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy.
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Rizzardi C, Franceschi R, Cauvin V, Bellizzi M, Liguori A, Longhi S, Lupi F, Soffiati M, Radetti G. Seronegative phenotype in a pediatric population with Hashimoto's thyroiditis. Hormones (Athens) 2022; 21:271-276. [PMID: 35377135 DOI: 10.1007/s42000-022-00355-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 02/08/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim was to verify in a pediatric population with Hashimoto's thyroiditis whether there is a relationship between antithyroid antibodies and inflammatory status on thyroid ultrasound and thyroid function. SUBJECTS AND METHODS A total of 154 children and adolescents, aged 4 to 18 years, diagnosed with Hashimoto's thyroiditis with normal body weight were followed up for 1 year. RESULTS Patients with only antiperoxidase antibodies presented with higher TSH levels than subjects with only antithyroglobulin antibodies (p 0.027) but with similar FT4 levels and thyroid score. Prevalence of seronegative Hashimoto's thyroiditis in this cohort was 12.3% (19/154). At diagnosis, the seronegative group presented with lower prevalence of overt hypothyroidism, symptoms of hypothyroidism, and thyroid score, meaning less severe thyroid involvement. In contrast, similar TSH and FT4 values were found at diagnosis and during follow-up in both the seronegative and seropositive groups. A comparison between patients with seronegative Hashimoto's thyroiditis and an overweight/obese antibody-negative population, who presented superimposable altered parenchymal pattern on thyroid ultrasound without circulating antithyroid antibodies, presented similar clinical data. CONCLUSION We report for the first time in the literature that seronegative Hashimoto's thyroiditis in the pediatric age group has a less severe pattern. The seronegative group presents similar characteristics to those of overweight/obese children and adolescents with ultrasound changes, but, according to the established knowledge, the latter condition is reversible and does not need follow-up examinations.
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Affiliation(s)
- Caterina Rizzardi
- Division of Paediatrics, S. Chiara General Hospital, Largo Medaglie d'oro 9, 38122, Trento, Italy
| | - Roberto Franceschi
- Division of Paediatrics, S. Chiara General Hospital, Largo Medaglie d'oro 9, 38122, Trento, Italy.
| | - Vittoria Cauvin
- Division of Paediatrics, S. Chiara General Hospital, Largo Medaglie d'oro 9, 38122, Trento, Italy
| | - Maria Bellizzi
- Division of Paediatrics, S. Chiara General Hospital, Largo Medaglie d'oro 9, 38122, Trento, Italy
| | - Alice Liguori
- Division of Paediatrics, S. Chiara General Hospital, Largo Medaglie d'oro 9, 38122, Trento, Italy
| | - Silvia Longhi
- Division of Paediatrics, General Hospital Bolzano, Bolzano, Italy
| | - Fiorenzo Lupi
- Division of Paediatrics, General Hospital Bolzano, Bolzano, Italy
| | - Massimo Soffiati
- Division of Paediatrics, S. Chiara General Hospital, Largo Medaglie d'oro 9, 38122, Trento, Italy
| | - Giorgio Radetti
- Division of Paediatrics, General Hospital Bolzano, Bolzano, Italy
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Corona G, Croce L, Sparano C, Petrone L, Sforza A, Maggi M, Chiovato L, Rotondi M. Thyroid and heart, a clinically relevant relationship. J Endocrinol Invest 2021; 44:2535-2544. [PMID: 34033065 PMCID: PMC8572180 DOI: 10.1007/s40618-021-01590-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/10/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Thyroid disorders, both overt and subclinical, are highly prevalent conditions in the general population. Although a clear relationship between overt thyroid dysfunctions and cardiovascular complications has long been established, data regarding subclinical thyroid dysfunction are by far more controversial. PURPOSE The present review will be aimed at providing a summary of most recent evidence coming from meta-analyses regarding the complex relationship between thyroid dysfunction and cardiovascular disease. CONCLUSIONS The review will summarize, in the first part, the physiopathological link between thyroid hormone imbalances and the cardiovascular system. In the second part the review will outline the evidence coming from meta-analyses regarding the cardiovascular risk related with both overt and subclinical thyroid dysfunctions. Particular attention will be put towards studies showing data stratified for patient's age, TSH levels and pre-existing cardiovascular disease. Finally, an overview regarding the effects of specific therapy for subclinical thyroid diseases in terms of amelioration of cardiovascular outcomes will be included.
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Affiliation(s)
- G Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Azienda-Usl Bologna, Bologna, Italy
| | - L Croce
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
- PHD Course in Experimental Medicine, University of Pavia, 27100, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy
| | - C Sparano
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - L Petrone
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - A Sforza
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Azienda-Usl Bologna, Bologna, Italy
| | - M Maggi
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - L Chiovato
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy
| | - M Rotondi
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy.
- Department of Internal Medicine and Therapeutics, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy.
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Ferrari SM, Ragusa F, Elia G, Paparo SR, Mazzi V, Baldini E, Benvenga S, Antonelli A, Fallahi P. Precision Medicine in Autoimmune Thyroiditis and Hypothyroidism. Front Pharmacol 2021; 12:750380. [PMID: 34867359 PMCID: PMC8635786 DOI: 10.3389/fphar.2021.750380] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/21/2021] [Indexed: 12/31/2022] Open
Abstract
Autoimmune thyroid diseases (AITD) are T-cell-mediated organ specific autoimmune disorders, deriving from an altered response of the immune system that leads to the immune attack to the thyroid. Hashimoto’s thyroiditis (HT) and Graves’ disease (GD) are the two principal AITD clinical presentations. Hypothyroidism and thyrotoxicosis are, respectively, the clinical hallmarks of HT and GD. Patients with autoimmune thyroiditis are treated daily with synthetic L-thyroxine (L-T4) at the dose of 1.5–1.7 μg/kg. Various L-T4 formulations are commercially available (tablet, liquid solution, or soft gel capsule). L-T4 in tablets is generally prescribed to treat hypothyroidism, whereas the liquid formulation, or soft gel capsules, can be administered in hypothyroid patients in case of malabsorption or in patients in therapy with drugs interfering with L-T4 absorption. Furthermore, myoinositol has a crucial role in thyroid autoimmunity and function. Clinical studies reported a significant decline in TSH and antithyroid autoantibodies levels after treatment with myoinositol + selenium in patients with subclinical hypothyroidism and autoimmune thyroiditis. Moreover, thyroidectomy can be rarely recommended in patients with autoimmune thyroiditis, with cosmetic reasons for a goiter, or with important signs or symptoms of local compression, or nodular disease with a “suspicious” cytology for malignancy. Furthermore, a recent randomized trial suggested that total thyroidectomy can improve quality of life and fatigue, while medical therapy did not. In this review, we overview currently available evidence in personalized medicine in patients with autoimmune thyroiditis and hypothyroidism. Further research is needed in larger population to investigate the effect of these new treatments on quality of life.
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Affiliation(s)
| | - Francesca Ragusa
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giusy Elia
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | | | - Valeria Mazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Enke Baldini
- Department of Experimental Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Master Program on Childhood, Adolescent and Women’s Endocrine Health, University of Messina, Messina, Italy
- Interdepartmental Program of Molecular and Clinical Endocrinology and Women’s Endocrine Health, Azienda Ospedaliera Universitaria Policlinico “G. Martino”, I-98125, Messina, Italy
| | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
- *Correspondence: Alessandro Antonelli,
| | - Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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8
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Sun C, Zhu M, Li L, Fan H, Lv F, Zhu D. Clinical Observation of Levothyroxine Sodium Combined with Selenium in the Treatment of Patients with Chronic Lymphocytic Thyroiditis and Hypothyroidism and the Effects on Thyroid Function, Mood, and Inflammatory Factors. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:5471281. [PMID: 34745288 PMCID: PMC8566043 DOI: 10.1155/2021/5471281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/13/2021] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to investigate the therapeutic effects of levothyroxine sodium combined with selenium treatment and single levothyroxine sodium treatment on patients with chronic lymphocytic thyroiditis and hypothyroidism and to analyze the effects of different treatment regimens on patients' thyroid function, mood, and inflammatory factors, with the aim of providing a reference for clinical treatment. The subjects of the current study were 138 chronic lymphocytic thyroiditis (CLT) patients with hypothyroidism admitted to our hospital from May 2016 to September 2019 and were randomly divided into a control group taking levothyroxine sodium (LT4) treatment and a combined group of LT4 combined with selenium treatment, with 69 cases each. Patients in both groups were evaluated for efficacy after 3 months of treatment, and their thyroid function was observed by total triiodothyronine (TT3), total thyroxine (TT4), thyroid stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), and thyroid globulin antibody (TGAb), and their mood changes were observed by Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores. The levels of inflammatory factors such as interleukin-2 (IL-2), interleukin-10 (IL-10), and tumor necrosis factor-α (TNF-α) were measured, and the occurrence of adverse drug reactions during the treatment period was observed and recorded in all patients. The results showed that the total effective rate of the combined group was significantly higher than that of the control group. The levels of TT3, TT4, TSH, TgAb, and TPOAb, SAS and SDS scores, and levels of inflammatory factors such as IL-2, IL-10, and TNF-α were significantly improved in both groups after treatment. Compared with the control group, TGAb, TPOAb, IL-2, TNF-α levels, and SAS and SDS scores decreased more and IL-10 levels increased more in the combined group, while the differences of other indexes were not statistically significant. This suggests that LT4 has certain efficacy in treating CLT with hypothyroidism, and the combined selenium treatment can improve the therapeutic effect of LT4 and can play a greater role in improving patients' mood and immune and inflammatory responses.
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Affiliation(s)
- Chunping Sun
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Anhui Gerietric Institute, Hefei, Anhui 230022, China
| | - Min Zhu
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Anhui Gerietric Institute, Hefei, Anhui 230022, China
| | - Li Li
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Anhui Gerietric Institute, Hefei, Anhui 230022, China
| | - Hua Fan
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Anhui Gerietric Institute, Hefei, Anhui 230022, China
| | - Fang Lv
- Department of Endocrinology, The Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Defa Zhu
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Anhui Gerietric Institute, Hefei, Anhui 230022, China
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9
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Oueslati I, Chatti H, Yazidi M, Chaker F, Chihaoui M. A diffuse large B-cell thyroid lymphoma presented as a compressive goiter in a young woman with no evidence of Hashimoto's thyroiditis. Clin Case Rep 2021; 9:e04436. [PMID: 34267915 PMCID: PMC8271253 DOI: 10.1002/ccr3.4436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 04/25/2021] [Accepted: 05/18/2021] [Indexed: 01/08/2023] Open
Abstract
Thyroid lymphoma should be suspected in case of rapid enlargement of the thyroid gland even in a young patient with no history of Hashimoto thyroiditis. The confirmation is based on histopathology and immunohistochemistry.
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Affiliation(s)
- Ibtissem Oueslati
- Department of EndocrinologyLa Rabta University HospitalFaculty of MedicineUniversity of Tunis El ManarTunisTunisia
| | - Hiba‐Allah Chatti
- Department of EndocrinologyLa Rabta University HospitalFaculty of MedicineUniversity of Tunis El ManarTunisTunisia
| | - Meriem Yazidi
- Department of EndocrinologyLa Rabta University HospitalFaculty of MedicineUniversity of Tunis El ManarTunisTunisia
| | - Fatma Chaker
- Department of EndocrinologyLa Rabta University HospitalFaculty of MedicineUniversity of Tunis El ManarTunisTunisia
| | - Melika Chihaoui
- Department of EndocrinologyLa Rabta University HospitalFaculty of MedicineUniversity of Tunis El ManarTunisTunisia
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10
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Zeng Y, He H, Wang X, Zhang M, An Z. Climate and air pollution exposure are associated with thyroid function parameters: a retrospective cross-sectional study. J Endocrinol Invest 2021; 44:1515-1523. [PMID: 33159683 DOI: 10.1007/s40618-020-01461-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/26/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES There are still controversies about the impact of climatic and environmental factors on thyroid function parameters in healthy populations. We investigated the relationships between climate, air pollution exposure, and thyroid function fluctuations. METHODS We retrospectively reviewed 327,913 individuals attending routine health checks from December 2013 to December 2018. We analyzed the associations between thyroid function and climatic factors using Spearman's correlation analysis. We explored the relationships between thyroid function and air pollution exposure using multiple linear regression analysis, after adjusting for age, sex, season, and outdoor temperature. We also performed subgroup analyses by age and sex and sensitivity analyses of different anti-thyroid peroxidase antibody status. RESULTS Thyroid-stimulating hormone (TSH) and free triiodothyronine (FT3) were negatively associated with outdoor temperature (r = - 0.66, P < 0.001; r = - 0.55, P < 0.001), while free thyroxine (FT4) and FT4/FT3 were positively associated with temperature (r = 0.35, P < 0.001; r = 0.79, P < 0.001). An increase of 10 μg/m3 in fine particulate matter ≤ 2.5 μm (PM2.5) was associated with a decrease of 0.12 pmol/L in FT4 and an increase of 0.07 pmol/L in FT3 (both P < 0.01). FT4/FT3 was significantly negatively associated with PM2.5 (coefficient: - 0.06, P < 0.01). These results remained robust in hierarchical analyses and sensitivity analyses. CONCLUSIONS Thyroid function parameters are associated with climate and air pollution exposure. These factors may influence variations in thyroid function. Our results also highlight the importance of public health interventions to reduce air pollution.
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Affiliation(s)
- Y Zeng
- Department of Laboratory Medicine, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Chengdu, China
| | - H He
- Department of Laboratory Medicine, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Chengdu, China
| | - X Wang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Chengdu, China
| | - M Zhang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Chengdu, China.
| | - Z An
- Department of Endocrine and Metabolism, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Chengdu, China.
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11
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Docimo G, Cangiano A, Romano RM, Pignatelli MF, Offi C, Paglionico VA, Galdiero M, Donnarumma G, Nigro V, Esposito D, Rotondi M, Candela G, Pasquali D. The Human Microbiota in Endocrinology: Implications for Pathophysiology, Treatment, and Prognosis in Thyroid Diseases. Front Endocrinol (Lausanne) 2020; 11:586529. [PMID: 33343507 PMCID: PMC7746874 DOI: 10.3389/fendo.2020.586529] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/15/2020] [Indexed: 12/12/2022] Open
Abstract
The human microbiota is an integral component in the maintenance of health and of the immune system. Microbiome-wide association studies have found numerous diseases associated to dysbiosis. Studies are needed to move beyond correlations and begin to address causation. Autoimmune thyroid diseases (ATD) are one of the most common organ-specific autoimmune disorders with an increasing prevalence, higher than 5% worldwide. Most frequent manifestations of ATD are Hashimoto's thyroiditis and Graves' disease. The exact etiology of ATD remains unknown. Until now it is not clear whether bacterial infections can trigger ATD or modulate the efficacy of treatment and prognosis. The aim of our review is to characterize the microbiota and in ATD and to evaluate the impact of dysbiosis on treatment and prognosis. Moreover, variation of gut microbiome has been associated with thyroid cancer and benign nodules. Here we will characterize the microbioma in benign thyroid nodules, and papillary thyroid cancer to evaluate their implications in the pathophysiology and progression.
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Affiliation(s)
- Giovanni Docimo
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, School of Medicine, Naples, Italy
| | - Angelo Cangiano
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, School of Medicine, Naples, Italy
- *Correspondence: Angelo Cangiano,
| | - Roberto Maria Romano
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, School of Medicine, Naples, Italy
| | - Marcello Filograna Pignatelli
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, School of Medicine, Naples, Italy
| | - Chiara Offi
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, School of Medicine, Naples, Italy
| | - Vanda Amoresano Paglionico
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Marilena Galdiero
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giovanna Donnarumma
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Vincenzo Nigro
- Department of Precision Medicine, University of Campania ”Luigi Vanvitelli”, Naples, Italy
| | - Daniela Esposito
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mario Rotondi
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, University of Pavia, Pavia, Italy
| | - Giancarlo Candela
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, School of Medicine, Naples, Italy
| | - Daniela Pasquali
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
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