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Wang L, Zhang L, Wang D, Chen J, Su W, Sun L, Jiang J, Wang J, Zhou Q. Predicting central cervical lymph node metastasis in papillary thyroid carcinoma with Hashimoto's thyroiditis: a practical nomogram based on retrospective study. PeerJ 2024; 12:e17108. [PMID: 38650652 PMCID: PMC11034492 DOI: 10.7717/peerj.17108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/22/2024] [Indexed: 04/25/2024] Open
Abstract
Background In papillary thyroid carcinoma (PTC) patients with Hashimoto's thyroiditis (HT), preoperative ultrasonography frequently reveals the presence of enlarged lymph nodes in the central neck region. These nodes pose a diagnostic challenge due to their potential resemblance to metastatic lymph nodes, thereby impacting the surgical decision-making process for clinicians in terms of determining the appropriate surgical extent. Methods Logistic regression analysis was conducted to identify independent risk factors associated with central lymph node metastasis (CLNM) in PTC patients with HT. Then a prediction model was developed and visualized using a nomogram. The stability of the model was assessed using ten-fold cross-validation. The performance of the model was further evaluated through the use of ROC curve, calibration curve, and decision curve analysis. Results A total of 376 HT PTC patients were included in this study, comprising 162 patients with CLNM and 214 patients without CLNM. The results of the multivariate logistic regression analysis revealed that age, Tg-Ab level, tumor size, punctate echogenic foci, and blood flow grade were identified as independent risk factors associated with the development of CLNM in HT PTC. The area under the curve (AUC) of this model was 0.76 (95% CI [0.71-0.80]). The sensitivity, specificity, accuracy, and positive predictive value of the model were determined to be 88%, 51%, 67%, and 57%, respectively. Conclusions The proposed clinic-ultrasound-based nomogram in this study demonstrated a favorable performance in predicting CLNM in HT PTCs. This predictive tool has the potential to assist clinicians in making well-informed decisions regarding the appropriate extent of surgical intervention for patients.
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Affiliation(s)
- Lirong Wang
- Department of Ultrasound, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Lin Zhang
- Department of Ultrasound, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Dan Wang
- Department of Ultrasound, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Jiawen Chen
- Department of Otolaryngology-Head and Neck Surgery, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Wenxiu Su
- Department of Pathology, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Lei Sun
- Department of Ultrasound, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Jue Jiang
- Department of Ultrasound, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Juan Wang
- Department of Ultrasound, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Qi Zhou
- Department of Ultrasound, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
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Kim HY, Park NH. Concurrent Medullary Carcinoma and Hashimoto's Thyroiditis: A Case Report with an Emphasis on US Features. J Korean Soc Radiol 2023; 84:1146-1151. [PMID: 37869111 PMCID: PMC10585087 DOI: 10.3348/jksr.2022.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/12/2022] [Accepted: 02/08/2023] [Indexed: 10/24/2023]
Abstract
Medullary thyroid carcinoma (MTC) is a rare malignancy that originates from the parafollicular cells of the thyroid gland. Hashimoto's thyroiditis (HT) is an autoimmune thyroid disease and is the most common cause of hypothyroidism. Previous studies have frequently discussed the association among HT, papillary thyroid carcinoma, and thyroid lymphoma. However, there have been few reports on the ultrasonographic findings of concomitant HT and MTC. In the present case, a heterogeneous hypoechoic background parenchymal echogenicity, with intraglandular echogenic strands, and increased vascularity were observed. A concurrent, ill-defined, parallel-oriented, heterogeneous hypoechoic mass with central microcalcifications was located at the left thyroid gland, consistent with reported US findings of medullary thyroid carcinoma except for an ill-defined margin in our case.
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Sacristán-Gómez P, Serrano-Somavilla A, Castro-Espadas L, Sánchez de la Blanca Carrero N, Sampedro-Núñez M, Muñoz-De-Nova JL, Molina-Jiménez F, Rosell A, Marazuela M, Martínez-Hernández R. Evaluation of Epithelial-Mesenchymal Transition Markers in Autoimmune Thyroid Diseases. Int J Mol Sci 2023; 24:3359. [PMID: 36834770 PMCID: PMC9965822 DOI: 10.3390/ijms24043359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
A state of chronic inflammation is common in organs affected by autoimmune disorders, such as autoimmune thyroid diseases (AITD). Epithelial cells, such as thyroid follicular cells (TFCs), can experience a total or partial transition to a mesenchymal phenotype under these conditions. One of the major cytokines involved in this phenomenon is transforming growth factor beta (TGF-β), which, at the initial stages of autoimmune disorders, plays an immunosuppressive role. However, at chronic stages, TGF- β contributes to fibrosis and/or transition to mesenchymal phenotypes. The importance of primary cilia (PC) has grown in recent decades as they have been shown to play a key role in cell signaling and maintaining cell structure and function as mechanoreceptors. Deficiencies of PC can trigger epithelial-mesenchymal transition (EMT) and exacerbate autoimmune diseases. A set of EMT markers (E-cadherin, vimentin, α-SMA, and fibronectin) were evaluated in thyroid tissues from AITD patients and controls through RT-qPCR, immunohistochemistry (IHC), and western blot (WB). We established an in vitro TGF-β-stimulation assay in a human thyroid cell line to assess EMT and PC disruption. EMT markers were evaluated in this model using RT-qPCR and WB, and PC was evaluated with a time-course immunofluorescence assay. We found an increased expression of the mesenchymal markers α-SMA and fibronectin in TFCs in the thyroid glands of AITD patients. Furthermore, E-cadherin expression was maintained in these patients compared to the controls. The TGF-β-stimulation assay showed an increase in EMT markers, including vimentin, α-SMA, and fibronectin in thyroid cells, as well as a disruption of PC. The TFCs from the AITD patients experienced a partial transition to a mesenchymal phenotype, preserving epithelial characteristics associated with a disruption in PC, which might contribute to AITD pathogenesis.
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Affiliation(s)
- Pablo Sacristán-Gómez
- Department of Endocrinology, Hospital Universitario de la Princesa, Instituto de Investigación Princesa, Universidad Autónoma de Madrid, C/Diego de León 62, 28006 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER GCV14/ER/12), 28029 Madrid, Spain
| | - Ana Serrano-Somavilla
- Department of Endocrinology, Hospital Universitario de la Princesa, Instituto de Investigación Princesa, Universidad Autónoma de Madrid, C/Diego de León 62, 28006 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER GCV14/ER/12), 28029 Madrid, Spain
| | - Lía Castro-Espadas
- Department of Endocrinology, Hospital Universitario de la Princesa, Instituto de Investigación Princesa, Universidad Autónoma de Madrid, C/Diego de León 62, 28006 Madrid, Spain
| | - Nuria Sánchez de la Blanca Carrero
- Department of Endocrinology, Hospital Universitario de la Princesa, Instituto de Investigación Princesa, Universidad Autónoma de Madrid, C/Diego de León 62, 28006 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER GCV14/ER/12), 28029 Madrid, Spain
| | - Miguel Sampedro-Núñez
- Department of Endocrinology, Hospital Universitario de la Princesa, Instituto de Investigación Princesa, Universidad Autónoma de Madrid, C/Diego de León 62, 28006 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER GCV14/ER/12), 28029 Madrid, Spain
| | - José Luis Muñoz-De-Nova
- Department of General and Digestive Surgery, Hospital Universitario de la Princesa, Instituto de Investigación Princesa, Universidad Autónoma de Madrid, C/Diego de León 62, 28006 Madrid, Spain
| | - Francisca Molina-Jiménez
- Gastroenterology Research Unit, Hospital Universitario de la Princesa, Instituto de Investigación Princesa, Universidad Autónoma de Madrid, C/Diego de León 62, 28006 Madrid, Spain
| | - Alejandra Rosell
- Pathology Unit, Hospital Universitario de la Princesa, Instituto de Investigación Princesa, Universidad Autónoma de Madrid, C/Diego de León 62, 28006 Madrid, Spain
| | - Mónica Marazuela
- Department of Endocrinology, Hospital Universitario de la Princesa, Instituto de Investigación Princesa, Universidad Autónoma de Madrid, C/Diego de León 62, 28006 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER GCV14/ER/12), 28029 Madrid, Spain
| | - Rebeca Martínez-Hernández
- Department of Endocrinology, Hospital Universitario de la Princesa, Instituto de Investigación Princesa, Universidad Autónoma de Madrid, C/Diego de León 62, 28006 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER GCV14/ER/12), 28029 Madrid, Spain
- Faculty of Medicine, Universidad San Pablo CEU, Urbanización Montepríncipe, Alcorcón, 28925 Madrid, Spain
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Nodehi M, Ajami A, Izad M, Asgarian Omran H, Esfahanian F, Yekaninejad S, Hemmatabadi M, Amouzegar A, Chahardoli R, Mansouri F, Saboor-Yaraghi AA. The Frequency of CD4 + T Cells in Women with Hashimoto's Thyroiditis. Int J Endocrinol Metab 2021; 19:e110013. [PMID: 35069748 PMCID: PMC8762522 DOI: 10.5812/ijem.110013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 08/14/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hashimoto's thyroiditis (HT) is the most prevalent autoimmune disease, and there is no definitive treatment available for this disease. To find the appropriate therapeutic approach, it is necessary to determine the mechanism of this disease. To achieve this purpose, the frequency of CD4+ T cells was evaluated in patients with HT and compared with healthy individuals. METHODS Twenty-six female patients with HT, aged 20 - 45 years, enrolled in this study. Based on the level of thyroglobulin antibody (anti-TG) and anti-thyroid peroxidase antibody (anti-TPO) in serum of patients with HT, they were divided into two groups. The serum level of anti-TPO was above 100 IU/mL in the group 1 (n = 13), whereas the serum levels of both anti-TPO and anti-TG were above 100 IU/mL in the group 2 (n = 13). Eleven healthy women were considered control group, or group 3. Using flow cytometry, the frequency of T helper (Th)1, Th2, Th17, T regulatory type 1 (Tr1), and LT CD4+IL-4+IL-17+ cells and mean fluorescent intensity (MFI) of their related cytokines were evaluated. RESULTS The frequency of Th2 cells in the groups 1 (anti-TPO > 100) and 2 (anti-TPO > 100 and anti-TG > 100) were more than control group. Only the difference between groups 3 (healthy control) and 2 was significant (P = 0.022). The frequency of LT CD4+IL-4+IL-17+ cells in the group 1 was significantly more than group 3 (P = 0.027); However, the difference between group 2 and 3 was not significant (P = 0.126). The expression of interferon-gamma (IFN-γ) in the group 2 (P = 0.001) and group 1 (P = 0.001) was significantly higher than group 3. The frequency of Th17, Th1, and Tr1 cells and MFI of IL-17 and IL-10 were not significantly different between the study groups. CONCLUSIONS In the present study, no significant differences were observed in the frequency of Th17 and Tr1 cells and in MFI of IL-17 and IL-10 in comparison to healthy individuals. Therefore, trying to make a change in the population of these cells probably does not have a significant therapeutic effect. Since Th2 cells and the expression of IFN-γ increased in women with HT, reducing the frequency of Th2 cells or the expression of IFN-γ may be effective in controlling the disease progression. It may be helpful for these patients to prevent the progression of the disease.
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Affiliation(s)
- Masoume Nodehi
- Department of Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolghasem Ajami
- Department of Immunology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Izad
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Asgarian Omran
- Department of Immunology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fatemeh Esfahanian
- Department of Endocrinology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahbobeh Hemmatabadi
- Department of Endocrinology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Chahardoli
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Mansouri
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbar Saboor-Yaraghi
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Dayal D, Pepper O, Ramakrishnan R, Baildam E, Dharmaraj P, Cleary G, McCann L, Pain C, Senniappan S. Hypercalcaemic Pancreatitis, Adrenal Insufficiency, Autoimmune Thyroiditis and Diabetes Mellitus in a girl with Probable Sarcoidosis. Int J Endocrinol Metab 2017; 15:e57199. [PMID: 29344035 PMCID: PMC5750676 DOI: 10.5812/ijem.57199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/22/2017] [Accepted: 07/25/2017] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Sarcoidosis is a multisystemic granulomatous disease with diverse and often non-specific symptoms during childhood. The clinical manifestations sometimes include endocrinopathies related to sarcoid infiltration of various endocrine organs, but more commonly due to the associated autoimmune endocrine disorders. There are only a few reports of multiple autoimmune and non-autoimmune endocrine problems occurring simultaneously in patients with sarcoidosis. We report a girl with probable sarcoidosis who also had Hashimoto's thyroiditis, Type 1 diabetes (T1D) and secondary adrenal insufficiency. CASE PRESENTATION A 9-year-old girl previously diagnosed with autoimmune hypothyroidism and vitamin D deficiency, presented with hypercalcemic pancreatitis after initiating vitamin D supplementation that lead to a diagnosis of probable sarcoidosis. Secondary adrenal insufficiency and T1D were subsequently diagnosed. Her angiotensin converting enzyme levels on 2 occasions were 106 and 135 nmol/mL/min (normal range 10 - 43). All investigations conducted to exclude several infectious and malignant conditions that may mimic sarcoidosis were negative. The patient showed a good response to treatment with hydrocortisone, levothyroxine, insulin and methotrexate. CONCLUSIONS To our knowledge, ours is the youngest ever patient reported in the literature with sarcoidosis to develop multiple autoimmune and non-autoimmune endocrinopathies.
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Affiliation(s)
- Devi Dayal
- Department of Paediatric Endocrinology, Alder Hey Children’s Hospital, Liverpool, UK
| | - Olivia Pepper
- Department of Paediatric Endocrinology, Alder Hey Children’s Hospital, Liverpool, UK
| | - Renuka Ramakrishnan
- Department of Paediatric Endocrinology, Alder Hey Children’s Hospital, Liverpool, UK
| | - Eileen Baildam
- Department of Paediatric Rheumatology, Alder Hey Children’s Hospital, Liverpool, UK
| | - Poonam Dharmaraj
- Department of Paediatric Endocrinology, Alder Hey Children’s Hospital, Liverpool, UK
| | - Gavin Cleary
- Department of Paediatric Rheumatology, Alder Hey Children’s Hospital, Liverpool, UK
| | - Liza McCann
- Department of Paediatric Rheumatology, Alder Hey Children’s Hospital, Liverpool, UK
| | - Clare Pain
- Department of Paediatric Rheumatology, Alder Hey Children’s Hospital, Liverpool, UK
| | - Senthil Senniappan
- Department of Paediatric Endocrinology, Alder Hey Children’s Hospital, Liverpool, UK
- Corresponding author: Dr. Senthil Senniappan MD, PhD, Consultant Paediatric Endocrinologist and Honorary Senior Lecturer, Department of Paediatric Endocrinology, Alder Hey Children’s Hospital NHS Trust, East Prescot Road, Liverpool, L14 5AB, UK. Tel: +44-1512525281, Fax: +44-1512824606, E-mail:
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Lepez T, Vandewoestyne M, Deforce D. Fetal microchimeric cells in autoimmune thyroid diseases: harmful, beneficial or innocent for the thyroid gland? Chimerism 2013; 4:111-8. [PMID: 23723083 PMCID: PMC3921191 DOI: 10.4161/chim.25055] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Autoimmune thyroid diseases (AITD) show a female predominance, with an increased incidence in the years following parturition. Fetal microchimerism has been suggested to play a role in the pathogenesis of AITD. However, only the presence of fetal microchimeric cells in blood and in the thyroid gland of these patients has been proven, but not an actual active role in AITD. Is fetal microchimerism harmful for the thyroid gland by initiating a Graft versus Host reaction (GvHR) or being the target of a Host versus Graft reaction (HvGR)? Is fetal microchimerism beneficial for the thyroid gland by being a part of tissue repair or are fetal cells just innocent bystanders in the process of autoimmunity? This review explores every hypothesis concerning the role of fetal microchimerism in AITD.
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Makhdoomi R, Mustafa F, Malik R, Bhat S, Alam K, Bashir H, Samoon N, Rasool M, Baba KM. Coexistent Papillary Carcinoma of Thyroid and Hashimoto's Thyroiditis - Diagnosis on Fine Needle Aspiration Cytology. Int J Endocrinol Metab 2013; 11:191-4. [PMID: 24348592 PMCID: PMC3860114 DOI: 10.5812/ijem.7453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 08/12/2012] [Accepted: 09/13/2012] [Indexed: 11/28/2022] Open
Abstract
Hashimoto's thyroiditis is associated with an increased risk of developing papillary carcinoma of thyroid. We hereby report a case of Hashimoto's thyroiditis with papillary carcinoma in a 45-year-old ear old female diagnosed on fine needle aspiration cytology (FNAC) which was later confirmed on histopathological examination .Such an occurrence, when both lesions are picked up on FNAC in a patient with no palpable thyroid nodule is rare. The case is presented here for its rarity.
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Affiliation(s)
- Rumana Makhdoomi
- Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar-190 011, India
- Corresponding author: Rumana Makhdoomi, Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar-190 011, India. Tel: +94-19081223, Fax:+94-1942426958, E-mail:
| | - Farhat Mustafa
- Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar-190 011, India
| | - Rais Malik
- Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar-190 011, India
| | - Salma Bhat
- Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar-190 011, India
| | - Khurshid Alam
- Department of Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar-190 011, India
| | - Humaira Bashir
- Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar-190 011, India
| | - Nuzhat Samoon
- Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar-190 011, India
| | - Mohsin Rasool
- Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar-190 011, India
| | - Khalil Mohammed Baba
- Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar-190 011, India
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