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Korkmaz HA, Devebacak A, Erbaş İM, Değirmenci C, Uyar N, Afrashi F, Özkan B. Comparison of Optical Coherence Tomography Angiography Findings between Healthy Children and Children with Type 1 Diabetes Mellitus and Autoimmune Thyroiditis. J Clin Res Pediatr Endocrinol 2023; 15:390-396. [PMID: 37470245 PMCID: PMC10683539 DOI: 10.4274/jcrpe.galenos.2023.2022-12-16] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 06/22/2023] [Indexed: 07/21/2023] Open
Abstract
Objective The aim of this study was to compare the development of early diabetic retinopathy (DR) findings, a microvascular complication, between patients with isolated type 1 diabetes mellitus (T1DM) (Group 1), concurrent T1DM and autoimmune thyroiditis (AT) (Group 2), and healthy controls (Group 3), who were matched for age, sex, number, and body mass index for comparison. Methods This was a prospective observational study that included individuals aged 10-20 years, and patients in Groups 1 and 2 had been followed up for ≥5 years. None of them developed clinical DR during the follow-up period. Optical coherence tomography angiography (OCTA) was used to evaluate the foveal avascular zone (FAZ) and parafoveal vascular density (PVD) for the development of early DR. OCTA findings were compared between patients and healthy controls. Results Thirty-five individuals were included in each of the groups. The mean FAZ and PVD differed significantly between the three groups (FAZ, p=0.016; PVD, p=0.006). The mean FAZ was higher in Groups 1 and 2 than in Group 3 (p=0.013 and p=0.119, respectively). The mean PVD was lower in Groups 1 and 2 than in Group 3 (p=0.007, respectively). No significant difference was found between Groups 1 and 2 in terms of the mean FAZ and PVD (p=0.832 and p=0.653, respectively). The mean glycated hemoglobin (HbA1c) level was significantly correlated with FAZ and PVD (FAZ: r=0.496, p<0.001; PVD: r=-0.36, p=0.001). Conclusion In patients with T1DM who did not develop clinical DR, OCTA findings revealed an increase in FAZ, which was associated with higher HbA1c levels. The mean PVD was significantly lower in the group with coexisting AT and T1DM than in the control group. These results suggest that the coexistence of AT and T1DM can contribute to the development of microvascular complications. However, studies with larger patient series are required.
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Affiliation(s)
- Hüseyin Anıl Korkmaz
- University of Health Sciences Turkey, İzmir Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Ali Devebacak
- Ege University Faculty of Medicine, Department of Ophtalmology, İzmir, Turkey
| | - İbrahim Mert Erbaş
- University of Health Sciences Turkey, İzmir Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Cumali Değirmenci
- Ege University Faculty of Medicine, Department of Ophtalmology, İzmir, Turkey
| | - Nilüfer Uyar
- University of Health Sciences Turkey, İzmir Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Filiz Afrashi
- Ege University Faculty of Medicine, Department of Ophtalmology, İzmir, Turkey
| | - Behzat Özkan
- University of Health Sciences Turkey, İzmir Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
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Park JE, Hwang SM, Hwang JY, Moon JH, Yang I, Woo JY, Lee HJ. The relationship between ultrasound findings and thyroid function in children and adolescent autoimmune diffuse thyroid diseases. Sci Rep 2021; 11:19709. [PMID: 34611214 PMCID: PMC8492727 DOI: 10.1038/s41598-021-99016-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/08/2021] [Indexed: 11/08/2022] Open
Abstract
To evaluate the association between thyroid echogenicity and heterogeneity seen on ultrasonography (US) and thyroid function in pediatric and adolescent populations with autoimmune diffuse thyroid diseases (AITD). From 2000 to 2020, we reviewed thyroid ultrasound (US) images and thyroid function statuses in 133 children and adolescent AITD patients. Our review of the images focused on decreased echogenicity and heterogeneity, which were classified into four grades. Among patients with overt hypothyroidism or overt hyperthyroidism, 94.2% (65/69) showed a US grade of 3 or 4. In patients with subclinical hyper/hypothyroidism or euthyroidism, 45.3% (29/64) showed grades 1 or 2. There were no overt hyper/hypothyroidism patients with US grade 1. When we compared US grades according to thyroid status, more severe thyroid dysfunction was significantly associated with higher US grade (p = 0.047). Thyroid stimulating hormone (TSH) level differed significantly according to US grades when we evaluated hyperthyroid (p = 0.035) and hypothyroid (p = 0.027) states independently. 11 patients showed both US grade and thyroid function status changes on follow-up US. In children and adolescent AITD patients, there was an association between decreased echogenicity and heterogeneity on US and thyroid dysfunction.
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Affiliation(s)
- Ji Eun Park
- Department of Radiology, Ajou University Hospital, School of Medicine, Ajou University, Suwon, Korea
| | - Sook Min Hwang
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Korea.
| | - Ji-Young Hwang
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Korea
| | - Jin Hee Moon
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Korea
| | - Ik Yang
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Korea
| | - Ji Young Woo
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Korea
| | - Hye Jin Lee
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Todorović J, Dinčić M, Nešović Ostojić J, Zaletel I, Lopičić S, Dundjerović D, Tatić S, Kovačević S, Paunović I, Puškaš N, Marković L. Differences in Chromatin Texture and Nuclear Fractal Dimension Between Hashimoto's and Lymphocytic Thyroiditis Lymphocytes. Microsc Microanal 2019; 25:762-768. [PMID: 30813976 DOI: 10.1017/s1431927619000163] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Previous evidence suggested that lymphocytic thyroiditis (LT) was a variant of Hashimoto's thyroiditis (HT), thus the aim of the current study is to quantify structural changes in histological specimens taken from HT and LT patients. A total of 600 images containing a single lymphocyte nucleus (300 nuclei per group) were obtained from 20 patients with HT and LT. In order to quantify changes in the nuclear architecture of investigated lymphocytes, the fractal dimension (FD) and some gray-level co-occurrence matrix texture parameters (angular second moment, inverse difference moment, contrast, entropy, and correlation) were calculated for each nucleus. A statistically significant difference in the FD of the "binary-outlined" nucleus and that of the corresponding "black-and-white" nucleus was detected between HT and LT lymphocyte nuclei. In addition, there was also a statistically significant difference in contrast and correlation between HT and LT lymphocyte nuclei. In conclusion, the results of this study suggested that there was a difference in structural complexity between investigated lymphocyte nuclei; additionally, LT lymphocytes possessed probably more complex texture and larger variations as well as more asymmetrical nuclei compared with HT lymphocytes. Accordingly, these findings indicate that LT is probably not a variant of HT; however, more complex studies are necessary to estimate differences between these types of thyroiditis.
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Affiliation(s)
- Jasna Todorović
- Faculty of Medicine,Institute of Pathological Physiology, University of Belgrade,Serbia
| | - Marko Dinčić
- Faculty of Medicine,Institute of Pathological Physiology, University of Belgrade,Serbia
| | | | - Ivan Zaletel
- Faculty of Medicine,Institute of Histology and Embryology, University of Belgrade,Serbia
| | - Srdjan Lopičić
- Faculty of Medicine,Institute of Pathological Physiology, University of Belgrade,Serbia
| | - Duško Dundjerović
- Faculty of Medicine,Institute of Pathology, University of Belgrade,Serbia
| | - Svetislav Tatić
- Faculty of Medicine,Institute of Pathology, University of Belgrade,Serbia
| | - Sanjin Kovačević
- Faculty of Medicine,Institute of Pathological Physiology, University of Belgrade,Serbia
| | - Ivan Paunović
- Faculty of Medicine,Center for Endocrine Surgery, Clinical Center of Serbia, University of Belgrade,Serbia
| | - Nela Puškaš
- Faculty of Medicine,Institute of Histology and Embryology, University of Belgrade,Serbia
| | - Ljiljana Marković
- Faculty of Medicine,Institute of Pathological Physiology, University of Belgrade,Serbia
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Januś D, Wójcik M, Taczanowska A, Sołtysiak P, Wędrychowicz A, Roztoczyńska D, Drabik G, Wyrobek Ł, Starzyk JB. Follow-up of parenchymal changes in the thyroid gland with diffuse autoimmune thyroiditis in children prior to the development of papillary thyroid carcinoma. J Endocrinol Invest 2019; 42:261-270. [PMID: 29872995 PMCID: PMC6394764 DOI: 10.1007/s40618-018-0909-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 05/30/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE To present the outcomes of ultrasound (US) follow-ups in children with autoimmune thyroid disease who did not have a thyroid nodule on admission but developed papillary thyroid carcinoma (PTC) and to characterize the parenchymal changes in the thyroid gland prior to the development of PTC. METHODS A retrospective thyroid US scan review of 327 patients diagnosed with AIT was performed. Forty patients (40/327, 12.2%) presented nodular AIT variant with a normoechogenic background. Eleven patients (11/327, 3.4%, 11/40, 27.5%) presenting this variant were diagnosed with PTC (nine females-mean age 15.3 years; two males aged 11 and 13 years). In five of 11 patients, the suspicious nodule that was later confirmed to be PTC was detected on the initial US at presentation. For the remaining six females (6/11) who developed PTC during the follow-up, we retrospectively analysed their US thyroid scans and these patients were selected for analysis in this study. RESULTS On admission, the US evaluation revealed an enlarged normoechogenic thyroid gland in three patients and a hypoechogenic thyroid gland with fibrosis as indicated by irregular, chaotic hyperechogenic layers in three patients. No thyroid nodules were identified. Ultrasound monitoring revealed increasing echogenicity of the thyroid parenchyma during the follow-up. PTC developed in a mean time of 4.6 years (1 9/12-7 4/12 years) since referral to the outpatient thyroid clinic and 2.9 years (6/12-6 9/12) since the last nodule-free US thyroid scan. CONCLUSIONS Sonographic follow-up assessments warrant further exploration as a strategy to determine PTC susceptibility in the paediatric population.
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Affiliation(s)
- D Januś
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland.
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland.
| | - M Wójcik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland
| | - A Taczanowska
- Department of Pediatric Surgery, University Children Hospital, Krakow, Poland
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - P Sołtysiak
- Department of Pediatric Surgery, University Children Hospital, Krakow, Poland
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - A Wędrychowicz
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland
| | - D Roztoczyńska
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland
| | - G Drabik
- Department of Clinical Immunology and Transplantation, Institute of Paediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Ł Wyrobek
- Department of Radiology, University Children Hospital, Krakow, Poland
| | - J B Starzyk
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland
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Hoffmann M, Neubauer-Geryk J, Wielicka M, Kowaleczko M, Myśliwiec M, Bieniaszewski L. The impact of autoimmune thyroiditis on skin microcirculation in children with non-complicated type 1 diabetes mellitus. Microvasc Res 2019; 123:68-73. [PMID: 30611746 DOI: 10.1016/j.mvr.2019.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/02/2019] [Accepted: 01/02/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The impairment of endothelial function in type 1 diabetes mellitus (DM1) is considered as the basis of microvascular complications. In DM1 patients autoimmune thyroiditis is a frequent comorbidity which may be responsible for further deterioration of microcirculation function. In studies investigating the relationship between cardiovascular risk factors and microvascular function, skin microcirculation is widely used. The aim of our study was to evaluate the impact of coexisting autoimmune thyroiditis on skin microcirculation in children with type I diabetes mellitus. SUBJECTS The study group consisted of 25 pediatric DM1 patients, 25 pediatric patients with type 1 diabetes and autoimmune thyroiditis (DM1 + AIT) and 29 control subjects matched for age and gender. The DM1 and DM1 + AIT patients were also matched for age at onset of DM and diabetes duration. METHODS Performed capillaroscopy studies employed non-selective stimuli such as post-occlusive reactive hyperemia (PORH) and venous occlusion (VO) tests. The relative area covered by capillaries (coverage) and the distance between capillaries were assessed. These measurements were performed before tests as well as after PORH and VO. RESULTS Coverage at baseline, after PORH and VO and distance after VO differ significantly between control subjects and the group DM1 + AIT. The coverage at baseline, after PORH and VO were significantly smaller in DM1 + AIT compared with the control group. Post-hoc analysis after controlling for lipids levels showed that differences between the DM1 + AIT and control group were remained only for coverage at baseline and after VO. Significant differences between DM1 + AIT and DM1 and control group for coverage after VO were also presented. CONCLUSIONS Coexisting autoimmune thyroiditis significantly deteriorates skin microcirculation function in pediatric non-complicated type 1 diabetic patients. This process is independent of patient age, diabetes duration and age of diabetes onset.
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Affiliation(s)
| | - Jolanta Neubauer-Geryk
- Clinical Physiology Unit, Medical Simulation Centre, Medical University of Gdańsk, Ul. Dębowa 25, 80-204 Gdańsk, Poland.
| | - Melanie Wielicka
- Medical University of Gdańsk, Ul. Dębowa 25, 80-204 Gdańsk, Poland
| | - Magdalena Kowaleczko
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdańsk, Ul. Dębowa 7, 80-211 Gdańsk, Poland
| | - Małgorzata Myśliwiec
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdańsk, Ul. Dębowa 7, 80-211 Gdańsk, Poland
| | - Leszek Bieniaszewski
- Clinical Physiology Unit, Medical Simulation Centre, Medical University of Gdańsk, Ul. Dębowa 25, 80-204 Gdańsk, Poland
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Huang KH, Tai MC, Lee LC, Weng TH, Chen YH, Lin LF, Chen JT, Lu DW, Chen CL. Positron emission tomography/computed tomography scan of Vogt-Koyanagi-Harada syndrome with associated autoimmune thyroid disease: A case report and literature review. Medicine (Baltimore) 2018; 97:e0047. [PMID: 29489658 PMCID: PMC5851737 DOI: 10.1097/md.0000000000010047] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
RATIONALE Vogt-Koyanagi-Harada (VKH) syndrome is a rare disease and could be associated with autoimmune thyroid disease (AITD). This report was aimed to investigate the utility of F-fludeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) for the diagnosis of VKH syndrome with AITD and to perform a literature review on the association between the 2 diseases. PATIENT CONCERNS A 55-year-old woman without the history of ocular trauma suffered from chronic headache. She was presented with painful blurred vision of both eyes with headache for 2 weeks. Ophthalmic evaluations revealed panuveitis, exudative retinal detachment, and papilloedema in both eyes. The clinical symptoms and presentations are compatible with the diagnosis of VKH syndrome. Other examinations for intraocular infection, malignancy, and lupus choroidopathy were of negative results. The result of contrast-enhanced computed tomography (CT) of the brain was normal. Due to the history of cancer in the patient's families, a F-FDG PET/CT whole-body scan was performed. The result indicated a focal of 2-fluoro-2-deoxy-D-glucose (FDG) uptake at the right upper lobe of the thyroid. Therefore, the patient's thyroid function was examined and the result indicated euthyroidism with detectable thyroid peroxidase/thyroglobulin antibodies. DIAGNOSES VKH syndrome with associated AITD. INTERVENTIONS Treatment with intravenous pulse systemic methylprednisolone (1000 mg daily) was prescribed for 3 days and then shifted gradually to tapered oral steroid medication. OUTCOMES Symptoms of papillitis and serous retinal detachment of VKH syndrome was relieved after steroid treatment LESSONS:: F-fludeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) can be used for the effective diagnosis of VKH syndrome with AITD.
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Affiliation(s)
- Ke-Hao Huang
- Department of Ophthalmology, Tri-Service General Hospital
- Department of Ophthalmology, Songshan Branch of Tri-Service General Hospital
| | - Ming-Cheng Tai
- Department of Ophthalmology, Tri-Service General Hospital
| | - Lung-Chi Lee
- Department of Ophthalmology, Tri-Service General Hospital
| | - Tzu-Heng Weng
- Department of Ophthalmology, Tri-Service General Hospital
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital
| | - Li-Fan Lin
- Department of Nuclear Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | | | - Da-Wen Lu
- Department of Ophthalmology, Tri-Service General Hospital
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Januś D, Wójcik M, Drabik G, Wyrobek Ł, Starzyk JB. Ultrasound variants of autoimmune thyroiditis in children and adolescents and their clinical implication in relation to papillary thyroid carcinoma development. J Endocrinol Invest 2018; 41:371-380. [PMID: 28866751 PMCID: PMC5823967 DOI: 10.1007/s40618-017-0758-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/26/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The prevalence of autoimmune thyroiditis (AIT) and papillary thyroid carcinoma (PTC) is rising in children and adolescents, and the coincidence of AIT and PTC is as high as 6.3-43%. OBJECTIVE To investigate the ultrasound manifestation of AIT in relation to PTC development in paediatric patients. PATIENTS 179 paediatric patients (133 females), mean (SD) age: 13.9 (3.03) years diagnosed with AIT and referred for ultrasound evaluation. Eight patients were diagnosed with PTC (6 females). METHODS Retrospective analysis of thyroid ultrasound scans of patients diagnosed with AIT. Thyroid and autoimmune status was assessed based on TSH, fT4, fT3 and increased aTPO and/or aTG and/or TRAB levels. In patients with PTC, total thyroidectomy was performed. RESULTS Analysis of thyroid US scans revealed that the following five ultrasound variants of AIT were observed in 179 patients: the most common in 35.2%-diffuse thyroiditis with hypoechogenic background and normoechogenic parenchyma, in 30.2%-diffuse thyroiditis with irregular background, in 18.9% nodular variant with normoechogenic background, in 11.7%-micronodulations and in 3.9%-diffuse hypoechogenic background. Eight cases of PTC were diagnosed in nodular variant of AIT with normoechogenic irregular background. CONCLUSION Patients with AIT and nodular variant with normoechogenic irregular background of the thyroid gland on US scans are in the risk group of developing PTC and should be followed up with regular neck US assessment.
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Affiliation(s)
- D Januś
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland.
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland.
| | - M Wójcik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland
| | - G Drabik
- Department of Clinical Immunology and Transplantation, Institute of Paediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Ł Wyrobek
- Department of Radiology, University Children Hospital, Krakow, Poland
| | - J B Starzyk
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland
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Janus D, Wojcik M, Kalicka-Kasperczyk A, Drabik G, Wyrobek L, Wedrychowicz A, Starzyk JB. Novel insights in ultrasound evaluation of thyroid gland in children with papillary thyroid carcinoma. Neuro Endocrinol Lett 2017; 38:367-374. [PMID: 29106792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 09/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The coincidence of autoimmune thyroiditis (AIT) in patients with papillary thyroid carcinoma (PTC) is ranging between 10 and 58% in the general population. MATERIAL AND METHODS In the present study retrospective ultrasound, clinical and autoimmune assessment of 24 patients diagnosed with papillary thyroid carcinoma between 2000-2016 was performed. RESULTS The coexistence of PTC and AIT was found in 50% of patients with PTC. Patients were divided into two groups. PTC AIT (+) group involved 12 children at the mean age 14.9 years (range 11-20 years, 9 girls) and PTC AIT (-) 12 children at the mean age 12.9 years (range 7-18 years, 5 girls). Papillary thyroid microcarcinoma (PTMC) was diagnosed in 6 patients (in 5 with AIT). US characteristics of PTC was heterogenous: hypoechogenic with/without increased vascularisation, normoechogenic with halo, with/without microcalcifications. In 70% PTC AIT (+) and in all PTC AIT (-) patients ultrasound analysis revealed that the thyroid tissue of the whole gland was normoechogenic. Local metastases in lymph nodes were found in 40% of PTMC AIT (+). CONCLUSION Lack of increased vascularization and microcalcifications and presence of``halo`in the nodule does not exclude malignancy. Due to the presence of lymph node involvement in PTMC in all children with PTC total thyroidectomy should be performed with lymph nodes verification.
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Affiliation(s)
- Dominika Janus
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Malgorzata Wojcik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Kalicka-Kasperczyk
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Grazyna Drabik
- Department of Clinical Immunology and Transplantation, Institute of Pediatrics, Jagiellonian University, Medical College, Krakow, Poland
| | - Lukasz Wyrobek
- University Children Hospital, Department of Radiology, Krakow, Poland
| | - Anna Wedrychowicz
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy B Starzyk
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
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Elenkova A, Аtanasova I, Кirilov G, Natchev Е, Ivanova R, Кovatcheva R, Vandeva S, Tcharaktchiev D, Zacharieva S. Autoimmune hypothyroidism is three times more frequent in female prolactinoma patients compared to healthy women: data from a cross-sectional case-control study. Endocrine 2017; 57:486-493. [PMID: 28726182 DOI: 10.1007/s12020-017-1372-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The potent immunomodulatory action of prolactin has been demonstrated in many experimental in vitro studies. In accordance with these data, our retrospective analyses revealed higher prevalence of autoimmune thyroid diseases in prolactinoma patients compared to general population. PURPOSE A cross-sectional case-control study was carried out in a single tertiary referral centre. The main aim was to assess the frequency of newly diagnosed autoimmune thyroid diseases in female patients with prolactinomas. METHODS The study population consisted of 260 females (154 patients and 106 sex-matched, ethnicity-matched, and age-matched healthy controls) enroled in a prospective manner. Physical exam, thyroid ultrasound, and laboratory testing (measurement of antibodies to thyroglobulin, thyroid peroxidase, TSH-receptor, serum TSH and FT4 levels) were performed in all study participants. RESULTS Autoimmune thyroid diseases were diagnosed in 29.9% of the patients and 10.4% of the healthy subjects (p = 0.0002). Subclinical hypothyroidism was found in 9.7% of the patients versus 2.8% of the controls (p = 0.044). Autoimmune hyperthyroidism was observed in 1.3% of all patients. CONCLUSIONS The prevalence of newly diagnosed autoimmune thyroid diseases, and especially the subclinical hypothyroidism, was significantly higher in our female prolactinoma patients in comparison to age-matched healthy women. Based on our results, we suggest routine screening for autoimmune thyroid diseases (thyroid function, immunology and ultrasound examination) in all female patients with prolactinoma at the time of diagnosis. We also recommend a close follow-up of thyroid function in these women in case of pregnancy and after delivery.
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Affiliation(s)
| | | | | | - Еmil Natchev
- University Hospital of Endocrinology, Sofia, Bulgaria
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Chen Y, Chen Y, Xia F, Wang N, Chen C, Nie X, Li Q, Han B, Zhai H, Jiang B, Shen Z, Lu Y. A Higher Ratio of Estradiol to Testosterone Is Associated with Autoimmune Thyroid Disease in Males. Thyroid 2017; 27:960-966. [PMID: 28558486 DOI: 10.1089/thy.2016.0661] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Autoimmune thyroid disease (AITD) is highly prevalent. Although AITD is less common in males, it is unclear whether estradiol (E2) combined with total testosterone (T) contributes to the prevalence of AITD. This study evaluated the association between the E2/T ratio and the prevalence of AITD in males. METHODS The data were obtained from a cross-sectional population-based study, the SPECT-China study, 2014-2015. A total of 4109 males ≥18 years of age were enrolled in this study. Participants underwent several checkups, which included assays of serum E2, T, thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb) levels, as well as thyroid ultrasonography (US). AITD was defined based on the presence of TPOAb and TgAb levels, and the presence of thyroid US findings. RESULTS Overall, the prevalence of positivity for TPOAb and/or TgAb (TPO/TgAb[+]) was 11.02%, and the positivity for TPOAb and/or TgAb together with US (TPO/TgAb[+] and US[+]) was 4.58%. The E2/T ratio levels were significantly higher in the TPO/TgAb(+) group and the TPO/TgAb(+) and US(+) group (7.91 ± 8.03 vs. 7.19 ± 10.30, p = 0.003; 8.78 ± 11.26 vs. 7.19 ± 10.30, p = 0.001) compared to the TPO and TgAb(-) group. The prevalence of TPO/TgAb(+) and US(+) significantly increased with an increasing E2/T ratio (p = 0.013). Binary logistic analysis showed that increased E2/T ratio levels were associated with an increased risk of AITD (TPO/TgAb[+]: odds ratio = 1.35, p = 0.002; TPO/TgAb[+] and US[+]: odds ratio = 1.48, p = 0.006). CONCLUSIONS AITD is highly prevalent in males in China. Higher E2/T ratios were significantly associated with AITD among males. Further studies will be needed to assess whether there is a causal relationship between E2/T ratios and AITD.
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Affiliation(s)
- Yi Chen
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine , Shanghai, China
| | - Yingchao Chen
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine , Shanghai, China
| | - Fangzhen Xia
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine , Shanghai, China
| | - Ningjian Wang
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine , Shanghai, China
| | - Chi Chen
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine , Shanghai, China
| | - Xiaomin Nie
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine , Shanghai, China
| | - Qin Li
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine , Shanghai, China
| | - Bing Han
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine , Shanghai, China
| | - Hualing Zhai
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine , Shanghai, China
| | - Boren Jiang
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine , Shanghai, China
| | - Zhoujun Shen
- 2 Department of Urology, Huashan Hospital, Fudan University , Shanghai, China
| | - Yingli Lu
- 1 Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine , Shanghai, China
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Solivetti FM, Di Donna V, Pontecorvi A. The lymph nodes of the central compartment during autoimmune chronic thyroiditis: incidence and ultrasonographic aspects. Endocrine 2017; 55:994-995. [PMID: 27553049 DOI: 10.1007/s12020-016-1063-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/12/2016] [Indexed: 11/30/2022]
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Holováčová D, Kužma M, Killinger Z, Payer J. Cross-sectional area of the median nerve is increased in primary autoimmune hypothyroidism and decreases upon treatment with thyroxine. Eur J Endocrinol 2016; 175:265-71. [PMID: 27418060 DOI: 10.1530/eje-16-0397] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 07/14/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this study was to assess changes in the cross-sectional area (CSA) of nervus medianus by ultrasound in newly diagnosed primary hypothyroid patients after thyroxine replacement treatment. PATIENTS AND METHODS The cohort comprised 30 patients with newly diagnosed primary autoimmune hypothyroidism. These were subsequently compared with 30 controls, matched for sex, BMI and age. Ultrasound evaluation, including measurement of CSA at the level of the pisiform bone or tunnel inlet was performed at baseline and after 3months. A CSA threshold of more than 10mm(2) was considered pathological. RESULTS CSA was increased in patients compared with controls (9.8±0.7mm(2) vs 7.2±1.1mm(2); P<0.001). Thyroxin substitution increased fT4 levels (baseline, 11.0±0.6pmol/L vs 15.5±0.4pmol/L; P<0.001) and decreased TSH (baseline, 23.9±6.0mIU/L vs 2.7±0.2mIU/L; P<0.001). Thyroxine treatment decreased CSA to 8.4mm(2)±0.3mm(2) (P=0.033). Before treatment, four patients experienced distal paresthesia in the median nerve distribution area. Increased CSA pathognomonic for carpal tunnel syndrome found in two symptomatic patients normalized after 3months. No clinical symptoms were observed after 3months. A positive correlation was found between TSH and CSA (R=0.155, P=0.05) before treatment. CONCLUSION Our study demonstrates that increase in median nerve CSA caused by primary autoimmune hypothyroidism can be fully reversible after achieving target levels of TSH and fT4.
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Affiliation(s)
- Dana Holováčová
- Comenius University Faculty of Medicine5th Department of Internal Medicine, University Hospital, Bratislava, Slovakia
| | - Martin Kužma
- Comenius University Faculty of Medicine5th Department of Internal Medicine, University Hospital, Bratislava, Slovakia
| | - Zdenko Killinger
- Comenius University Faculty of Medicine5th Department of Internal Medicine, University Hospital, Bratislava, Slovakia
| | - Juraj Payer
- Comenius University Faculty of Medicine5th Department of Internal Medicine, University Hospital, Bratislava, Slovakia
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Kim GR, Kim EK, Kim SJ, Ha EJ, Yoo J, Lee HS, Hong JH, Yoon JH, Moon HJ, Kwak JY. Evaluation of Underlying Lymphocytic Thyroiditis With Histogram Analysis Using Grayscale Ultrasound Images. J Ultrasound Med 2016; 35:519-526. [PMID: 26887447 DOI: 10.7863/ultra.15.04014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/23/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate diagnostic performance of histogram analysis using grayscale ultrasound (US) images in the diagnosis of lymphocytic thyroiditis. METHODS Three radiologists reviewed a total of 505 US images and classified the images according to the presence/existence of lymphocytic thyroiditis. After 2 months, each reviewer repeated the process with the same 505 images in a randomly mixed order. The intraobserver and interobserver variability was analyzed with a generalized κ value. Four histogram parameters (mean value, standard deviation, skewness, and kurtosis) were obtained, and an index was calculated from principal component analysis. Diagnostic performances were compared. RESULTS Of 505 patients, 125 (24.8%) had lymphocytic thyroiditis, and 380 (75.2%) had normal thyroid parenchyma on pathologic analysis. The κ value for intraobserver variance ranged from -0.002 to 0.781, and the overall κ values for interobserver variance were 0.570 and 0.214 in the first and second tests, respectively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for the 3 reviewers versus the principal component analysis index were 28.0% to 83.2%, 43.7% to 82.6%, 53.5% to 79.0%, 24.6% to 56.2%, and 75.2% to 88.9% versus 58.4%, 72.4%, 68.9%, 41.0%, and 84.1%. CONCLUSIONS Histogram analysis of grayscale US images provided confirmable and quantitative information about lymphocytic thyroiditis and was comparable with performers' assessments in diagnostic performance.
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Affiliation(s)
- Ga Ram Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K., E.-K.K., J.H.Y., H.J.M., J.Y.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (S.J.K.); Department of Radiology, Ajou University School of Medicine, Suwon, Korea (E.J.H.); Yonsei University College of Medicine, Seoul, Korea (J.Y.); and Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (H.S.L., J.H.H.)
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K., E.-K.K., J.H.Y., H.J.M., J.Y.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (S.J.K.); Department of Radiology, Ajou University School of Medicine, Suwon, Korea (E.J.H.); Yonsei University College of Medicine, Seoul, Korea (J.Y.); and Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (H.S.L., J.H.H.)
| | - Soo Jin Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K., E.-K.K., J.H.Y., H.J.M., J.Y.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (S.J.K.); Department of Radiology, Ajou University School of Medicine, Suwon, Korea (E.J.H.); Yonsei University College of Medicine, Seoul, Korea (J.Y.); and Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (H.S.L., J.H.H.)
| | - Eun Ju Ha
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K., E.-K.K., J.H.Y., H.J.M., J.Y.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (S.J.K.); Department of Radiology, Ajou University School of Medicine, Suwon, Korea (E.J.H.); Yonsei University College of Medicine, Seoul, Korea (J.Y.); and Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (H.S.L., J.H.H.)
| | - Jaeheung Yoo
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K., E.-K.K., J.H.Y., H.J.M., J.Y.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (S.J.K.); Department of Radiology, Ajou University School of Medicine, Suwon, Korea (E.J.H.); Yonsei University College of Medicine, Seoul, Korea (J.Y.); and Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (H.S.L., J.H.H.)
| | - Hye Sun Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K., E.-K.K., J.H.Y., H.J.M., J.Y.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (S.J.K.); Department of Radiology, Ajou University School of Medicine, Suwon, Korea (E.J.H.); Yonsei University College of Medicine, Seoul, Korea (J.Y.); and Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (H.S.L., J.H.H.)
| | - Jung Hwa Hong
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K., E.-K.K., J.H.Y., H.J.M., J.Y.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (S.J.K.); Department of Radiology, Ajou University School of Medicine, Suwon, Korea (E.J.H.); Yonsei University College of Medicine, Seoul, Korea (J.Y.); and Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (H.S.L., J.H.H.)
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K., E.-K.K., J.H.Y., H.J.M., J.Y.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (S.J.K.); Department of Radiology, Ajou University School of Medicine, Suwon, Korea (E.J.H.); Yonsei University College of Medicine, Seoul, Korea (J.Y.); and Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (H.S.L., J.H.H.)
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K., E.-K.K., J.H.Y., H.J.M., J.Y.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (S.J.K.); Department of Radiology, Ajou University School of Medicine, Suwon, Korea (E.J.H.); Yonsei University College of Medicine, Seoul, Korea (J.Y.); and Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (H.S.L., J.H.H.)
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K., E.-K.K., J.H.Y., H.J.M., J.Y.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (S.J.K.); Department of Radiology, Ajou University School of Medicine, Suwon, Korea (E.J.H.); Yonsei University College of Medicine, Seoul, Korea (J.Y.); and Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (H.S.L., J.H.H.).
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Kocova M, Zdraveska N, Kacarska R, Kochova E. Diagnostic approach in children with unusual symptoms of acquired hypothyroidism. When to look for pituitary hyperplasia? J Pediatr Endocrinol Metab 2016; 29:297-303. [PMID: 26587741 DOI: 10.1515/jpem-2015-0157] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 09/30/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pituitary hyperplasia secondary to primary longstanding hypothyroidism has been reported in the literature in adults and rarely in children. METHODS Here we present the clinical presentation and diagnostic procedures in eight children with pituitary hyperplasia due to autoimmune thyroiditis, highlighting common findings, such as growth delay, fatigue or gaining weight, but also exceptional findings such as pericardial effusion, rhabdomyolysis, isolated hypertrichosis, and Van Wyk-Grumbach syndrome, which have rarely or never been described. RESULTS AND CONCLUSIONS Surprisingly no thyroid enlargement was detected. We discuss the unusual presenting signs of autoimmune thyroiditis that should raise the suspicion of pituitary hyperplasia. We suggest that a more elaborate clinical assessment and even modification of the diagnostic approach to autoimmune thyroiditis is needed in order to avoid its serious complications.
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15
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Zandieh S, Bernt R, Zwerina J, Haller J, Knoll P, Seyeddain O, Mirzaei S. Acoustic Structure Quantification Analysis of the Thyroid in Patients with Diffuse Autoimmune Thyroid Disease. Ultrason Imaging 2016; 38:137-147. [PMID: 25855160 DOI: 10.1177/0161734615580766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of this study was to assess whether acoustic structure quantification (ASQ) can differentiate normal from pathological thyroid parenchyma in patients with diffuse autoimmune thyroid disease (AITD). We evaluated 83 subjects (72 [87%] women and 11 [13%] men) aged 19 to 94 years with a mean age of 53 years. We performed a prospective study (from March 2011 to November 2014) that included 43 (52%) patients with chronic autoimmune thyroiditis (CAT), 22 (26%) patients with Graves' disease (GD), and 18 (22%) healthy volunteers. The ASQ values were significantly lower in normal subjects than in subjects with CAT and GD (p < 0.001). In contrast, the differences between the GD and the CAT patients (p = 0.23) were not statistically significant. The optimal cutoff ASQ value for which the sum of sensitivity and specificity was the highest for the prediction of diffuse thyroid pathology was 103 (95% confidence interval = [0.79, 0.95]). At this cutoff value, the sensitivity was 83% and the specificity was 89%. Our findings suggest that ASQ is a useful method for the assessment of the thyroid in patients with AITD.
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Affiliation(s)
- Shahin Zandieh
- Institute of Radiology and Nuclear Medicine, Hanusch Hospital, Teaching Hospital of Medical University of Vienna, Austria
| | - Reinhard Bernt
- Institute of Radiology and Nuclear Medicine, Hanusch Hospital, Teaching Hospital of Medical University of Vienna, Austria
| | - Jochen Zwerina
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK; Department of Internal Medicine, Hanusch Hospital, Teaching Hospital of Medical University of Vienna, Austria
| | - Joerg Haller
- Institute of Radiology and Nuclear Medicine, Hanusch Hospital, Teaching Hospital of Medical University of Vienna, Austria
| | - Peter Knoll
- Institute of Nuclear Medicine with PET-Center, Wilhelminen Hospital, Teaching Hospital of Medical University of Vienna, Austria, Austria
| | - Orang Seyeddain
- Department of Ophthalmology, Paracelsus Medical University of Salzburg, Austria
| | - Siroos Mirzaei
- Institute of Nuclear Medicine with PET-Center, Wilhelminen Hospital, Teaching Hospital of Medical University of Vienna, Austria, Austria
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Müller K, Tuma J. [Ultrasonography 68. Evaluation of fatigue]. Praxis (Bern 1994) 2016; 105:229-232. [PMID: 26886703 DOI: 10.1024/1661-8157/a002275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - Jan Tuma
- 1 Institut für Sonographie, Uster
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Abstract
INTRODUCTION Autoimmune thyroiditis (AIT) is a predisposing factor for developing postpartum thyroid dysfunction (PPTD). AIM To study the characteristics of PPTD in women with AIT. METHODS Thirty-eight women with pre-existing AIT were included in the study. Thyroid-stimulating hormone, free triiodthyronine, free thyroxine, thyroid peroxidase antibodies, thyroglobulin antibodies were measured and ultrasound evaluation of the thyroid gland was performed in the first trimester of pregnancy and during the first year following delivery. RESULTS Thyroid dysfunction was recognized in 68.4% of the patients - 28.9% presented with hypothyroidism and 39.5 % with thyrotoxicosis. The immunological and morphological parameters did not differ between euthyroid women and those with thyroid dysfunction. At the end of the postpartum period restoration of euthyroid state (being on the treatment before pregnancy) was observed in 15.4% of patients with PPTD, while 84.6% required increase of the levothyroxine dose. The analysis found a significantly lower volume of the thyroid gland, shorter duration of the disease, a lower dose of levothyroxine before and during gestation in patients with impaired thyroid function at the end of the postpartum period. CONCLUSION The risk of PPTD in women with AIT predating pregnancy is higher among women with preserved thyroid functional capacity motivating a thorough assessment of thyroid hormone levels and close follow-up of those women during the postpartum period.
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Affiliation(s)
- Antoaneta Argatska
- a Department of Endocrinology and Metabolic Diseases , Medical University , Plovdiv , Bulgaria and
| | - Boyan Nonchev
- a Department of Endocrinology and Metabolic Diseases , Medical University , Plovdiv , Bulgaria and
| | - Maria Orbetzova
- a Department of Endocrinology and Metabolic Diseases , Medical University , Plovdiv , Bulgaria and
| | - Blagovest Pehlivanov
- b Department of Obstetrics and Gynecology , Medical University , Plovdiv , Bulgaria
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Vasiliu I, Preda C, Serban IL, Strungaru SA, Nicoară M, Plăvan G, Stoica B, Ciobanu DG, Bredeţean O, Vulpoi C. SELENIUM STATUS IN AUTOIMMUNE THYROIDITIS. Rev Med Chir Soc Med Nat Iasi 2015; 119:1037-1044. [PMID: 26793846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED Selenium (Se) is an important element that exerts its effects through selenoproteins. The thyroid gland has the highest Se concentration and specific selenoprotein enzymes families are crucial in the thyroid hormone metabolism. There is little evidence on the link between Se and thyroid autoimmune disease, therefore future studies are required to elucidate the nature of this associ ation. AIM To evaluate the Se status in euthyroid subjects with autoimmune thyroiditis. MATERIAL AND METHODS From January 2014 to January 2015 we recruited 100 consecutive euthyroid subjects with autoimmune thyroiditis, living in the same region and with normal iodine intake. Serum concentrations of Se, thyroid antibodies (antithyroperoxidase--TPOAb--and antithyroglobulin--TgAb), thyroid-stimulating hormone (TSH), and thyroid ultrasound were performed in all patients. RESULTS Mean age of the study group was 48.87 ± 12.83 years, range: 18-82 years. Since thyroid pathology is more frequent in the 5th - 6th decades of life we selected the age of 50 for the comparative analysis of the results (51% of patients were under 50). No statistical age-group differences in antibody levels were found: mean TPOAb = 420.95 IU/ml, p = 0.840; mean TgAb = 327.98 IU/ml, p = 0.977. TSH mean was 2.14 [μIU/ml, with no significant age-group differences (p = 0.176). Se levels ranged between 8.05 - 998.50 μg/ with a mean value of 294.96 μg/L and no significant differences between age groups (p = 0.158). Thyroid ultrasound showed inhomogeneity in 89%, nodules in 35% of patients, and a mean thyroid volume of 11.72ml, with no significant age-group differences (p = 0.366). The low TSH levels were associated with low Se levels in 11.6% of cases, but the direct correlation was statistically insignificant (r = 0.116; R2 = 0.0161; p = 0.371). Depend ing on TSH percentiles, mean Selevels showed no significant differences, however pointing out the highest mean value at the 25th percentile (F = 0.441, df = 61, p = 0.646). A negative correlation trend was found between Se and TPOAb (r = -0.2276) or TgAb (r = -0.2190) but lacking statistical significance (p=0.099). CONCLUSION Our results showed a weak negative correlation between Se and antithyroid antibodies, suggesting that selenium supplementation may improve the course of thyroid autoimmunity.
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Hekimoglu K, Yildirim Donmez F, Arslan S, Ozdemir A, Demir C, Yazici C. The role of shear wave elastography in the diagnosis of chronic autoimmune thyroiditis. Med Ultrason 2015; 17:322-326. [PMID: 26343080 DOI: 10.11152/mu.2013.2066.173.khu] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIMS The aim of this study is to assess the applicability of shear wave elastography (SWE) in the diagnosis of chronic autoimmune thyroiditis (CAT) patients. MATERIAL AND METHODS The study group consisted of 50 patients with first-diagnosed CAT and 40 control subjects (CS). In all patients with CAT and CS, sonoelastographic measurements were made in both thyroid lobes. Optimal cut-off values were chosen to maximize the sum of sensitivity and specificity. Positive predictive value (PPV), negative predictive value (NPV), and accuracy values were also calculated. RESULTS Quantitative elastographic analysis evaluated by SWE in CAT patients (2.56 +/- 0.30 m/s) was significantly higher compared with CS (1.63 +/- 0.12 m/s) (p<0.001). The optimal cut-off value was 2.42 m/s. SWE had 77% sensitivity, 71% specificity, 92% PPV, 81% NPV, and 87% accuracy for the presence of CAT. CONCLUSIONS Our data indicate that SWE correctly defines the elasticity of thyroid parenchyma, and this technique may assist in the diagnosis and treatment monitoring of CAT.
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Affiliation(s)
- Koray Hekimoglu
- Department of Radiology, Baskent University, School of Medicine, Ankara, Turkey.
| | | | - Serdar Arslan
- Department of Radiology, Baskent University, School of Medicine, Ankara, Turkey
| | - Adnan Ozdemir
- Department of Radiology, Baskent University, School of Medicine, Ankara, Turkey
| | - Canan Demir
- Department of Endocrinology, Baskent University, School of Medicine, Ankara, Turkey
| | - Canan Yazici
- Department of Biostatistics, Baskent University, School of Medicine, Ankara, Turkey
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Fukuhara T, Matsuda E, Endo Y, Takenobu M, Izawa S, Fujiwara K, Kitano H. Correlation between quantitative shear wave elastography and pathologic structures of thyroid lesions. Ultrasound Med Biol 2015; 41:2326-2332. [PMID: 26055967 DOI: 10.1016/j.ultrasmedbio.2015.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 04/16/2015] [Accepted: 05/04/2015] [Indexed: 06/04/2023]
Abstract
The aim of this study was to determine the correlation between shear wave velocity (SWV) generated by acoustic radiation force impulse and the pathologic structure of thyroid lesions. A total of 599 thyroid tissue samples were divided into four groups based on pathologic structure: 254 normal thyroid tissue samples as a control, 128 with chronic autoimmune thyroiditis (CAT) that demonstrated diffuse fibrosis, 165 with benign nodules that had high cell density and 52 with papillary thyroid carcinoma (PTC) that showed high cell density and fibrosis. The mean SWVs in each group were as follows: 1.60 ± 0.18 m/s in normal thyroid, 2.55 ± 0.28 m/s in CAT, 1.72 ± 0.31 m/s in benign nodules and 2.66 ± 0.95 m/s in PTC. The SWVs of CAT and PTC were significantly higher than those of normal thyroid, (p < 0.001). SWV was significantly affected by fibrosis.
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Affiliation(s)
- Takahiro Fukuhara
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
| | - Eriko Matsuda
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Yukari Endo
- Department of Pathology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Masao Takenobu
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Shoichiro Izawa
- Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Tottori University Faculty of Medicine, Yonago, Japan
| | - Kazunori Fujiwara
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Hiroya Kitano
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan
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Kwon H, Kim WG, Choi YM, Jang EK, Jeon MJ, Song DE, Baek JH, Ryu JS, Hong SJ, Kim TY, Kim WB, Shong YK. A cut-off value of basal serum calcitonin for detecting macroscopic medullary thyroid carcinoma. Clin Endocrinol (Oxf) 2015; 82:598-603. [PMID: 25041034 DOI: 10.1111/cen.12562] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 07/07/2014] [Accepted: 07/16/2014] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Serum calcitonin (CT) level is used to detect medullary thyroid carcinoma (MTC), but the cut-off level is unclear. We aimed at identifying the optimal cut-off value of basal serum CT levels for detecting MTC. DESIGN AND PATIENTS We retrospectively enrolled patients with hypercalcitoninemia (≥2·9 pmol/l) who had undergone thyroid ultrasonography (US) and subsequent work-up between 2001 and 2013 at Asan Medical Center. We divided patients into four groups: proven MTC (group 1, n = 93), pathologically proven non-MTC after surgery (group 2, n = 57), benign single nodule by cytology (group 3, n = 68) and patients without nodules on US (group 4, n = 24). MEASUREMENT Basal serum CT levels were evaluated. RESULTS The median CT level of group 1 (119·5 pmol/l) was significantly higher than those of other groups (4·0, 3·8 and 3·8 pmol/l, P < 0·001). When we adopted 19·0 pmol/l of CT level as a cut-off value, the sensitivity, specificity, and positive and negative predictive values were 77·4%, 98·7%, 97·3% and 87·8%, respectively. When we compared 29·2 pmol/l (100 pg/ml) and 19·0 pmol/l (65 pg/ml) as cut-off values, 19·0 pmol/l was more sensitive and accurate than 29·2 pmol/l. Factors associated with hypercalcitoninemia in non-MTC groups were autoimmune thyroiditis, chronic kidney disease, proton pump inhibitors and other malignancies. Serum CT levels tended to decrease spontaneously in non-MTC groups. CONCLUSION Basal serum CT levels higher than 19·0 pmol/l can be a useful cut-off value for detecting macroscopic MTC, even though values below 19·0 pmol/l cannot exclude the presence of MTC like small volume MTC or premalignant C-cell hyperplasia.
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Affiliation(s)
- Hyemi Kwon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
INTRODUCTION Autoimmune thyroiditis (AIT) is a common cause of goiter in children, and sonographic changes have been reported in more than one-third at presentation. The aim of this study was to evaluate the ultrasound (US) characteristics of the thyroid and the prevalence of thyroid nodules in children and adolescents presenting with goiter in the presence or absence of AIT. METHODS A retrospective review was conducted of the US characteristics of 154 children and adolescents aged <18 years of age with goiter from July 2008 to December 2010. US characteristics were analyzed according to each patient's age, sex, thyrotropin (TSH) levels, and thyroid peroxidase antibody titer (TPOAb). Heterogeneity and nodule prevalence were compared between antibody-positive and -negative goiter. RESULTS Heterogeneity was more common in TPOAb-positive (59/71, 83%) compared to TPOAb-negative goiter (24/46, 52%; p<0.001), but there was no correlation between the presence of heterogeneity and TPOAb titer within the antibody-positive group. Nodules were equally prevalent in children with (17%) and without (17.4%) TPOAb, and there was no correlation between the serum TSH level or TPOAb titer and the presence of nodules. Papillary thyroid cancer (PTC) was diagnosed in 3/71 with positive TPOAb compared to 1/46 with negative antibodies. Pseudonodules were identified in 11/71 antibody-positive and none of the antibody-negative patients. However, during follow-up, two of these were later identified as nodules and one was PTC. CONCLUSION The majority of children and adolescents with goiter had positive TPOAb (71/117). Sonographic heterogeneity was more common among TPOAb-positive patients. However, thyroid nodules and PTC were equally common in both groups. Only 15% of the nodules and none of the PTC were palpable. These data support the utility of thyroid US to detect unsuspected thyroid nodules and PTC in children with goiter. Prospective follow-up studies of children with goiter are needed to formulate recommendations for evaluation with US and fine-needle aspiration.
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Affiliation(s)
- Mamatha Kambalapalli
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Anshu Gupta
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Uma R. Prasad
- Department of Radiology, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Gary L. Francis
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
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Miranda DMC, Massom JN, Catarino RM, Santos RTM, Toyoda SS, Marone MMS, Tomimori EK, Monte O. Impact of nutritional iodine optimization on rates of thyroid hypoechogenicity and autoimmune thyroiditis: a cross-sectional, comparative study. Thyroid 2015; 25:118-24. [PMID: 25314342 DOI: 10.1089/thy.2014.0182] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Since several countries have established mandatory food iodine fortification, there has been a decrease in rates of iodine deficiency disorders in parallel with an increase in prevalence of autoimmune thyroid diseases. This study compared the nutritional iodine status and the prevalence of autoimmune thyroiditis and thyroid hypoechogenicity on ultrasound in schoolchildren in São Paulo (Brazil) in two distinct periods of time in which fortified salt had different concentrations of iodine. METHODS We conducted a cross-sectional study evaluating 206 children aged 7-14 years and without a history of thyroid disease. Assessments included measurements of thyrotropin (TSH), free thyroxine, antithyroperoxidase (anti-TPO), and antithyroglobulin (anti-TG) antibodies, urinary iodine concentration, and thyroid ultrasound. RESULTS Mean urinary iodine concentration was 165.1 μg/L. Eleven children (5.3%) were diagnosed with autoimmune thyroiditis based on at least two of four criteria adopted in our study: positive anti-TPO or anti-TG antibody, hypoechogenicity of the thyroid parenchyma on ultrasound, and a TSH >4.0 μU/mL. Comparing our results with those from a similar study conducted during a period in which concentrations of iodine in the salt were higher (median urinary iodine concentration >300 μg/L), we observed a trend toward a lower prevalence of autoimmune thyroiditis, although no definitive conclusion could be established. CONCLUSION The current nutritional iodine status in our cohort was within optimal levels and lower than levels found in 2003. The prevalence of autoimmune thyroiditis seems to be decreasing in parallel with a decrease in iodine intake, although we could not reach a definitive conclusion.
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Affiliation(s)
- Daniela M C Miranda
- 1 Faculdade de Ciência Médicas da Santa Casa de São Paulo , São Paulo, Brazil
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Choi YM, Kim WG, Kim TY, Bae SJ, Kim HK, Jang EK, Jeon MJ, Han JM, Lee SH, Baek JH, Shong YK, Kim WB. Low levels of serum vitamin D3 are associated with autoimmune thyroid disease in pre-menopausal women. Thyroid 2014; 24:655-61. [PMID: 24320141 PMCID: PMC3993051 DOI: 10.1089/thy.2013.0460] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Low serum vitamin D levels have been associated with several autoimmune diseases, but their association with thyroid autoimmunity is unclear. We evaluated the association of serum vitamin D levels with the prevalence of autoimmune thyroid disease (AITD). METHODS Our cross-sectional study included subjects who underwent routine health checkups, which included assays of serum 25-hydroxy vitamin D3 [25(OH)D3] and anti-thyroid peroxidase antibody (TPO-Ab), as well as thyroid ultrasonography (US) between 2008 and 2012 at the Asan Medical Center. We defined AITD according to the levels of TPO-Ab and US findings. RESULTS A total of 6685 subjects (58% male; 42% female) were enrolled for this study. Overall prevalence of TPO-Ab positivity and both TPO-Ab/US positivity were 10.1% (6.3% male; 15.3% female) and 5.4% (2.3% male; 9.7% female) respectively. In female subjects, mean serum 25(OH)D3 levels were significantly lower in the TPO-Ab(+) (22.0 vs. 23.5 ng/mL, p=0.030) and TPO-Ab(+)/US(+) groups (21.6 vs. 23.4 ng/mL, p=0.027) compared with the control group, respectively. According to the levels of serum 25(OH)D3, the prevalence of TPO-Ab positivity (21.2%, 15.5%, and 12.6% in deficient, insufficient, and sufficient group, respectively; p=0.001) and both TPO-Ab and US positivity (14.7%, 9.9%, and 7.1% in deficient, insufficient, and sufficient group, respectively; p<0.001) decreased in female subjects. Interestingly, this pattern was significant only in pre-menopausal women (p=0.003 and p<0.001; respectively), but not in postmenopausal women. Multivariate analysis indicated that the adjusted odds ratios (OR) for AITD among those in the 25(OH)D3-deficient [TPO-Ab(+): OR 1.95, p=0.001; TPO-Ab(+)/US(+): OR 2.36, p<0.001] and -insufficient groups [TPO-Ab(+): OR 1.31, p=0.043; TPO-Ab(+)/US(+): OR 1.50, p=0.017] were significantly increased when compared with the sufficient group. CONCLUSIONS The levels of serum vitamin D were significantly lower in pre-menopausal women with AITD. Vitamin D deficiency and insufficiency were significantly associated with AITD in pre-menopausal women.
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Affiliation(s)
- Yun Mi Choi
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Jin Bae
- Health Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hong-Kyu Kim
- Health Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Kyung Jang
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Min Han
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Hun Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
PURPOSE The association between autoimmune thyroid diseases (AITDs) and vitamin D deficiency is controversial. We aimed to evaluate the relationship between serum 25-hydroxy-vitamin D3 [25(OH)D3] and anti-thyroid antibody levels. MATERIALS AND METHODS 25(OH)D3, anti-thyroid antibodies, and thyroid function measured in 304 patients who visited the endocrinology clinic were analyzed. The patients were subgrouped into the AITDs or non-AITDs category according to the presence or absence of anti-thyroid antibodies. The relationship between anti-thyroid peroxidase antibody (TPOAb) and 25(OH)D3 was evaluated. RESULTS The patients with elevated anti-thyroid antibodies had lower levels of serum 25(OH)D3 than those who did not (12.6±5.5 ng/mL vs. 14.5±7.3 ng/mL, respectively, p<0.001). Importantly, after adjusting for age, sex, and body mass index, a negative correlation (r=-0.252, p<0.001) was recognized between 25(OH)D3 and TPOAb levels in the AITDs group, but this correlation did not exist in the non-AITDs group (r=0.117, p=0.127). 25(OH)D3 level was confirmed as an independent factor after adjusting for co-factors that may affect the presence of TPOAb in the AITDs group. CONCLUSION 25(OH)D3 level is an independent factor affecting the presence of TPOAb in AITDs. The causal effect of 25(OH)D3 deficiency to AITDs is to be elucidated.
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Affiliation(s)
- Dong Yeob Shin
- Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
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Latrofa F, Fiore E, Rago T, Antonangeli L, Montanelli L, Ricci D, Provenzale MA, Scutari M, Frigeri M, Tonacchera M, Vitti P. Iodine contributes to thyroid autoimmunity in humans by unmasking a cryptic epitope on thyroglobulin. J Clin Endocrinol Metab 2013; 98:E1768-74. [PMID: 24064687 DOI: 10.1210/jc.2013-2912] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT The mechanisms linking thyroid autoimmunity and iodine use in humans are unknown. OBJECTIVE Our aim was to correlate iodine intake, thyroid autoimmunity, and recognition of thyroglobulin (Tg) epitopes after implementation of iodine prophylaxis. SETTING The general community living in an Italian village was evaluated. MAIN OUTCOME MEASURES Thyroglobulin autoantibodies (TgAb), thyroperoxidase autoantibodies (TPOAb), and urinary iodine excretion were assessed in 906 iodized salt users (IS-users) and 389 nonusers (IS-nonusers). Ultrasound (US) was performed to identify thyroid hypoechogenicity, suggestive of Hashimoto thyroiditis (HT). TgAb epitope pattern in 16 IS-users and 17 IS-nonusers was evaluated by an inhibition binding assay to Tg, using human monoclonal TgAb-Fab directed to A, B, C, and D epitopes on Tg. RESULTS Median urinary iodine excretion was slightly higher in IS-users than in IS-nonusers (112.0 μg/L vs 86.5 μg/L; P < .01). TgAb, and not TPOAb, was more frequent in IS-users (18.9% vs 13.6%, P = .02). HT-US was found in 87 subjects, among whom both positive TgAb (58.4% vs 31.8%, P = .03) and TPOAb (61.5% vs 45.4%. P = .04) were more frequent in IS-users. In this group significantly higher serum levels of TgAb (median 108 U/mL vs 30 U/mL; P = .02), but not of TPOAb, were present. Iodized salt use had no effect on the 1208 non HT-US subjects. TgAb directed to the epitope B of Tg were more frequent in IS-users than in IS-nonusers (27.5% vs 3.0%, P = .047). CONCLUSIONS Iodine-induced thyroid autoimmunity is related to TgAb and the unmasking of a cryptic epitope on Tg contributes to this relationship in humans.
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Affiliation(s)
- Francesco Latrofa
- Endocrinology Unit, University Hospital, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
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Abstract
BACKGROUND Neck lymph nodes may be involved in the pathogenesis of chronic autoimmune thyroiditis (CAT). This study was undertaken to identify which of the sonographic features of cervical lymph nodes are readily applicable to patients affected by CAT compared to healthy control subjects. METHODS We recruited 106 patients (92 females and 14 males) with CAT and 70 control subjects (53 females and 17 males) without clinical, biochemical, and ultrasonographic evidence of thyroid and neck diseases. We performed laboratory tests (thyrotropin, antithyroperoxidase antibodies, antithyroglobulin antibodies, and ultrasonography) to evaluate in each group: (i) thyroid function, autoimmunity, and morphology; (ii) number, topographic distribution (levels I-VI), and morphology of neck nodes (long-axis diameter; short-axis diameter; short-axis/long-axis ratio; absence or presence of hilus). RESULTS Total number of neck nodes with long-axis diameter >10 mm was significantly higher in the CAT group than in the control group (mean±standard deviation [SD]: 3.7±2.4 vs. 0.8±1.3; p<0.001) with significantly increased differences in levels II (1.4±0.8 vs. 0.3±0.5; p<0.001), III (2±1.2 vs. 0.3±0.7; p<0.001), and IV (0.7±0.7 vs. 0.07±0.2; p<0.001). More nodes with a hilus were found in the CAT group than in the control group (mean number of nodes±SD: 2.8±1.9 vs. 0.7±1.1; p<0.001). Short-axis diameter of level III (4.4±1 vs. 3.7±1.2 mm; p=0.002) and level IV nodes (3.9±1 vs. 3.1±0.5 mm p=0.030) was increased in CAT patients when compared with healthy controls. CONCLUSIONS The present study is the first one aiming at a systematic description of the sonographic pattern of cervical lymph nodes in CAT. An increased number of benign hyperplastic neck nodes, especially in levels II-IV, appears to be a characteristic sonographic finding associated with CAT.
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Affiliation(s)
- Davide Brancato
- Department of Internal Medicine, Hospital of Partinico, Palermo, Italy.
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Abstract
Recent reports on Hashimoto's thyroiditis (HT) with increased numbers of IgG4-positive plasma cells suggest that this type of HT may have a close relationship to IgG4-related disease (IgG4-RD). This unique subgroup of HT is termed as IgG4 thyroiditis and reveals distinct clinical, serological, and sonographic features from the non-IgG4 thyroiditis group. On the basis of immunostaining for IgG4, HT was divided into an IgG4 thyroiditis group and a non-IgG4 thyroiditis group. Clinically, IgG4 thyroiditis was associated with younger age group, lower female-male ratio, higher levels of thyroid autoantibodies, diffuse low echogenicity, more rapid progress requiring surgical treatment and more subclinical hypothyroidism. Serum IgG4 concentrations elevated in IgG4 thyroiditis and decreased significantly after a thyroidectomy. Histopathologically, IgG4 thyroiditis showed a higher grade of stromal fibrosis, lymphoplasmacytic infiltration, and follicular cell degeneration than non-IgG4 thyroiditis. IgG4 thyroiditis may represent IgG4-RD of thyroid gland, because it shares common histopathological characteristics with IgG4-RD in other organs. The identification of IgG4-RD of the thyroid gland opens new insights not only for patient's treatment with HT but also for the development of new therapeutic approaches for this rapidly progressive destructive subtype of HT. This article mainly focuses on reviewing the unique histopathological, clinical, and serological features of IgG4 thyroiditis group of HT. The etiology and genetic changes of HT are also discussed.
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Affiliation(s)
- Kennichi Kakudo
- Department of Medical Technology, Faculty of Health Science, Kobe-Tokiwa University, Kobe 653-0838, Japan.
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Arabi M, Dvorak R, Smith LB, Kujawski L, Gross MD. Fluorodeoxyglucose positron emission tomography in primary thyroid lymphoma with coexisting lymphocytic thyroiditis. Thyroid 2011; 21:1153-6. [PMID: 21875367 DOI: 10.1089/thy.2011.0064] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Primary thyroid lymphoma is an uncommon neoplasm frequently associated with lymphocytic thyroiditis (LT). Once the pathologic diagnosis of primary thyroid lymphoma is established, imaging plays an important role in tumor staging and evaluating treatment response. The present case discusses the role of fluorodeoxyglucose positron emission tomography (18F-FDG PET)/computed tomography (CT) in this clinical setting along with the potential diagnostic challenges. PATIENT FINDINGS A 44-year-old man with a history of LT and hypothyroidism presented with an enlarging goiter. Initial imaging evaluation showed markedly enlarged gland with bilateral cervical and mediastinal adenopathy. Histopathologic evaluation confirmed the diagnosis of primary thyroid lymphoma on a background of LT. An 18F-FDG PET/CT revealed increased uptake in the gland and lymph nodes. Follow-up 18F-FDG PET/CT after chemotherapy showed interval decrease in FDG uptake in the thyroid gland associated with interval decrease in the size and metabolic activity of the cervical and superior mediastinal lymph nodes. CONCLUSIONS The frequent association of LT with primary thyroid lymphoma and the overlap of their clinical and pathologic findings pose a significant diagnostic challenge. While other imaging techniques are helpful in evaluating anatomic local and regional extent of primary thyroid lymphoma, 18F-FDG PET/CT can be of an added value in evaluating its metabolic activity and detecting regional and distant disease as well as in assessing response to treatment.
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Affiliation(s)
- Mohammad Arabi
- Division of Nuclear Medicine, Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan 48109-5028, USA.
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Slman R, Monpeyssen H, Desarnaud S, Haroche J, Fediaevsky LDP, Fabrice M, Seret-Begue D, Amoura Z, Aurengo A, Leenhardt L. Ultrasound, elastography, and fluorodeoxyglucose positron emission tomography/computed tomography imaging in Riedel's thyroiditis: report of two cases. Thyroid 2011; 21:799-804. [PMID: 21615310 DOI: 10.1089/thy.2010.0242] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Riedel's thyroiditis (RT) is a rare disease characterized by a chronic inflammatory lesion of the thyroid gland with invasion by a dense fibrosis. Publications of the imaging features of RT are scarce. To our knowledge, ultrasound elastography (USE) findings have not been previously reported. Therefore, we describe two patients with RT who were imaged with ultrasonography (US), USE, and fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT). SUMMARY Two women were referred for a large, hard goiter with compressive symptoms (dyspnea and dysphagia); in one patient, the goiter was associated with retroperitoneal fibrosis. In both cases, RT was confirmed by surgical biopsy with pathological examination. Thyroid US imaging was performed with a US scan and a 10-13 MHz linear transducer. The hardness of the tissues was analyzed using transient USE (ShearWave, Aixplorer-SuperSonic Imagine). PET/CT scanning was performed with a Philips Gemini GXL camera (GE Medical Systems). In the first patient, US examination revealed a compressive multinodular goiter with large solid hypoechoic and poorly vascularized areas adjacent to the nodules. The predominant right nodule was hypoechoic with irregular margins. The second patient had a hypoechoic goiter with large bilateral hypoechoic areas. In both cases, an unusual feature was observed: the presence of tissue surrounding the primitive carotid artery, associated with thrombi of the internal jugular vein. Further, USE showed heterogeneity in the stiffness values of the thyroid parenchyma varying between 21 kPa and 281 kPa. FDG-PET/CT imaging showed uptake foci in the thyroid gland. In both cases, US showed a decrease in the thyroid gland volume and the disappearance of encasement of the neck vasculature in response to corticosteroid treatment. In contrast, the FDG-PET/CT features remained unchanged. CONCLUSIONS US features, such as vascular encasement and improvement under corticosteroid treatment, seem to be specific to this rare disease. For the first time, USE documents the hardness of RT tissues. Apart from the FDG-PET/CT findings that merit further investigation, US and USE prove useful tools in the assessment of such a rare disease.
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Affiliation(s)
- Rouba Slman
- Department of Nuclear Medicine, Pitié Salpêtrière Hospital, Paris, France
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Skarpa V, Kousta E, Tertipi A, Anyfandakis K, Vakaki M, Dolianiti M, Fotinou A, Papathanasiou A. Epidemiological characteristics of children with autoimmune thyroid disease. Hormones (Athens) 2011; 10:207-14. [PMID: 22001131 DOI: 10.14310/horm.2002.1310] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Chronic autoimmune thyroiditis (AT) is the most common cause of thyroid disease in children. The aim of the study was to define the epidemiological clinical and laboratory characteristics of children and adolescents with AT. DESIGN Various parameters including thyroid ultrasonography of 228 children and adolescents aged 10.2 ± 2.5 yrs (mean ± SD) with AT, who attended our Pediatric Endocrine Unit during a 5-year period were retrospectively analysed. RESULTS 191 (83.8%) were female and 142 (62.3%) were pubertal. At AT diagnosis, 130 children (57.0%) were euthyroid, 75 (32.9%) had subclinical hypothyroidism, 19 (8.3%) had hypothyroidism and 4 (1.8%) had hyperthyroidism. There was a positive correlation between thyroid stimulating hormone (TSH) levels and thyroid volume SDS (r=0.15, p=0.02). Sixty-three children (28%) had a goiter and 32 (14%) had thyroid nodules. Three children (1.3%) had papillary thyroid carcinoma. Compared to euthyroid children, children with hypothyroidism were younger (9.2 ± 1.8 vs 10.6 ± 2.4 yrs, p<0.05) and had higher thyroid volume SDS (3.1 ± 1.9 vs 1.2 ± 1.2, p<0.05) and higher prevalence of goiter [11(57.9%) vs 29(22.3%), p<0.05]. CONCLUSIONS Children and adolescents with AT are mostly asymptomatic; the majority are female, pubertal and euthyroid. Hypothyroid children with AT have higher thyroid volume, higher prevalence of goiter and higher antithyroid antibodies titers compared to euthyroid children. Diagnosing AT at an early stage offers the opportunity for a timely intervention. The potential association of AT with papillary thyroid carcinoma is an additional reason for a careful follow-up of the patients with AT.
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Affiliation(s)
- Vasiliki Skarpa
- Department of Pediatric Endocrinology, 'P. & A. Kyriakou' Children's Hospital, Thivon & Levadias Str, Athens 11527, Greece
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Sporea I, Vlad M, Bota S, Sirli RL, Popescu A, Danila M, Sendroiu M, Zosin I. Thyroid stiffness assessment by acoustic radiation force impulse elastography (ARFI). Ultraschall Med 2011; 32:281-285. [PMID: 21321841 DOI: 10.1055/s-0029-1246048] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE To evaluate and compare the values of thyroid tissue elasticity in subjects without known thyroid pathology, in patients with Graves' disease and with chronic autoimmune thyroiditis (CAT). PATIENTS AND METHODS We performed a prospective study that included 74 subjects, 23 without thyroid pathology, 29 with Graves' disease and 22 with CAT (diagnosed by specific tests). In all patients, 10 elastographic measurements were performed in the right thyroid lobe (RTL) and 10 in the left thyroid lobe (LTL) using a 2-6 MHz convex probe. Median values were calculated for each thyroid lobe, measured in meters/second (m/sec). We calculated a mean ARFI value from measurements made in the RTL and LTL. RESULTS Thyroid stiffness was statistically significant lower in normal subjects vs. those with Graves' disease (2.07±0.44 m/sec vs. 2.82±0.47 m/sec, p<0.001) and with CAT (2.07±0.44 m/sec vs. 2.49±0.48 m/sec, p=0.004). We also found a statistically significant difference between subjects without thyroid pathology and those with autoimmune thyroid pathology (Graves' disease and CAT) (2.07±0.44 m/sec vs. 2.68±0.50 m/sec, p<0.001). CONCLUSION ARFI seems to be a useful method for the evaluation of diffuse thyroid gland pathology and is able to predict with sufficient accuracy the presence of thyroid diffuse diseases (AUROC=0.80).
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Affiliation(s)
- I Sporea
- Gastroenterology, University of Medicine and Pharmacy Timisoara, Timisoara, Romania.
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Calcaterra V, Klersy C, Muratori T, Caramagna C, Brizzi V, Albertini R, Larizza D. Thyroid ultrasound in patients with Turner syndrome: influence of clinical and auxological parameters. J Endocrinol Invest 2011; 34:260-4. [PMID: 20511728 DOI: 10.1007/bf03347082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To determine thyroid volume and structure by ultrasound (US) in patients with Turner syndrome (TS) compared to healthy controls; to evaluate the frequency and characteristics of autoimmune thyroid disease (ATD) and its association with clinical and auxological parameters. PATIENTS 73 patients and 93 height-matched healthy female controls in the same age range were included in the study. RESULTS Thirty-two TS patients (43.8%) presented ATD. They had a larger body mass index (BMI) and presented the 45,X karyotype more frequently than those without. They were older, with a higher prevalence of lymphoedema at birth and pterygium colli without statistical significance. Thyroid volume was 20% larger in the presence of ATD (p=0.037). A dyshomogeneous thyroid structure was observed in all patients with ATD and less frequently in those without (p=0.016). Dyshomogeneity in TS without ATD was also associated with older age (p<0.001), larger BMI (p=0.003) and larger thyroid volume (p=0.006). Six TS patients presented solitary thyroid nodules (5 benign nodules). We observed a significant interaction between diagnosis and height (p=0.035) and age (p=0.047), indicating that both age and height conditioned the observed differences in thyroid volume. CONCLUSIONS Most TS patients presented ATD with a normal thyroid function or subclinical hypothyroidism, without goiter. Dyshomogeneous thyroid structure was also observed in TS patients without ATD. In TS, the evaluation of thyroid volume according to chronological age does not seem to be efficient because of a link between height and thyroid volume. The prevalence of nodular thyroid disease is similar to that observed in the general population.
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Affiliation(s)
- V Calcaterra
- Department of Pediatrics, University of Pavia and IRCCS Policlinico San Matteo Foundation, P.le Golgi 2, 27100 Pavia, Italy.
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Solivetti FM, Papini E, Misischi I, Palermo A, Pantano AL, Bizzarri G, Papini L, Guglielmi R. "Hypoechoic triangle": a new sonographic sign or marker of advanced autoimmune thyroiditis. Thyroid 2011; 21:285-9. [PMID: 21323587 DOI: 10.1089/thy.2010.0007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Ultrasonography (US) changes have been noted in patients with autoimmune thyroiditis (AT). Here, we report that some patients with late stage AT have a distinctive, previously unreported finding on US that we call the "hypoechoic triangle sign" (HET). METHODS On US, the HET sign was characterized as a well-defined area of low echogenicity, about 10 mm in diameter, between the lateral margin of one or both thyroid lobes, the medial wall of the carotid artery, and, posteriorly, the prevertebral muscles. Twenty-six patients with AT who had the HET sign (Group 1) were compared with 71 patients with AT who had normal serum thyrotropin (TSH) and free thyroid hormones levels (Group 2) and with 154 normal controls (Group 3). TSH was tested at least twice, first as part of their regular clinical care and then in follow-up. The groups were similar in terms of age, sex, and body mass index. Thyroid volume by US, TSH, free triiodothyronine, free thyroxine, antithyroid antibodies, and l-thyroxine treatment were evaluated. Sonographic gray-scale analysis and three-dimensional reconstruction of HET region were performed in five of the Group 1 patients. RESULTS Thyroid volume was significantly smaller (p < 0.01) in Group 1 than in Groups 2 and 3 (6.9 ± 2.18 vs. 10.4 ± 2.1 and 9.8 ± 2.5 mL, respectively). In Group 1, 61.5% of subjects were taking l-thyroxine for hypothyroidism; none of the Group 2 or 3 patients was taking thyroid hormone. Serum TSH was significantly higher (p < 0.01) in Group 1 versus Groups 2 and 3 (3.6 ± 1.3 vs. 2.18 ± 1.4 and 1.9 ± 1.1 mIU/L, respectively). None of the Group 2 or 3 patients had the HET sign. Gray-scale US demonstrated an overlap between HET zone and the surrounding muscle tissue. CONCLUSIONS The HET sign seems to be specific for overt thyroid failure in patients with AT as it was not noted in patients with AT not having overt thyroid failure. The incidental finding of the HET sign during cervical US examination should prompt obtaining thyroid function tests to rule out hypothyroidism. Our study provides data regarding specificity but not sensitivity of the HET sign for AT and thyroid failure because a consecutive group of AT patients with thyroid failure was not studied. In addition, the specificity of the HET sign for AT needs to be evaluated further by studying a diverse group of thyroid diseases.
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Affiliation(s)
- Francesco M Solivetti
- Department of Radiology and Diagnostic Imaging, IRCCS Ospitale Dermosifilopatico di Santa Maria e San Gallicano, IFO, Rome, Italy.
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Jiskra J, Bartáková J, Holinka Š, Límanová Z, Springer D, Fait T, Antošová M, Telička Z, Potluková E. Low concordance between positive antibodies to thyroperoxidase and thyroid ultrasound autoimmune pattern in pregnant women. Endocr J 2011; 58:849-59. [PMID: 21873803 DOI: 10.1507/endocrj.ej11-0026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The diagnostic and prognostic role of thyroid ultrasound (TUS) in pregnant women positive for antibodies to thyroperoxidase (TPOAb) is unclear. The aim of our study was to compare the relation of ultrasound thyroid texture to the thyroid laboratory tests in pregnant women and controls. Using a semi-quantitative assessment we compared TUS in two groups of women with positive TPOAb and/or with thyroid dysfunction (TSH out of 0.06-3.67 mIU/L): 186 women in 1(st) trimester of pregnancy recruited from universal screening and 67 asymptomatic age-comparable non-pregnant non-postpartum women recruited from screening of general population (controls). Women with previous history of thyroid diseases were excluded. Only 64/131 (48.9 %) of TPOAb-positive pregnant women were TUS-positive (TUS with autoimmune pattern) in comparison with 35/49 (71.4 %) TPOAb-positive controls (p <0.011). Pregnant women had more often TSH >10.0 mIU/L if they were TPOAb-positive/TUS-positive as compared to those TPOAb-positive/TUS-negative (8/64 (12.5 %) vs. 0/67 (0 %), p = 0.009). The prevalence of preterm deliveries among TPOAb-positive women was significantly lower if TPOAb-positivity was not accompanied by TUS-positivity (2/67 (3.0 %) vs. 10/64 (15.6 %) in TPOAb-positive/TUS-positive women, p = 0.028). In conclusion, nearly half of the TPOAb-positive pregnant women did not have an autoimmune pattern in TUS. Normal TUS image in TPOAb-positive pregnant women might be a protective factor for preterm delivery.
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Affiliation(s)
- Jan Jiskra
- 3rd Department of Medicine, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic.
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Danilovic DLS, Mendes-Correa MC, Chammas MC, Zambrini H, Marui S. Thyroid hormonal disturbances related to treatment of hepatitis C with interferon-alpha and ribavirin. Clinics (Sao Paulo) 2011; 66:1757-63. [PMID: 22012048 PMCID: PMC3180154 DOI: 10.1590/s1807-59322011001000014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 07/04/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To characterize thyroid disturbances induced by interferon-alpha and ribavirin therapy in patients with chronic hepatitis C. INTRODUCTION Interferon-alpha is used to treat chronic hepatitis C infections. This compound commonly induces both autoimmune and non-autoimmune thyroiditis. METHODS We prospectively selected 26 patients with chronic hepatitis C infections. Clinical examinations, hormonal evaluations, and color-flow Doppler ultrasonography of the thyroid were performed before and during antiviral therapy. RESULTS Of the patients in our study, 54% had no thyroid disorders associated with the interferon-alpha therapy but showed reduced levels of total T3 along with a decrease in serum alanine aminotransferase. Total T4 levels were also reduced at 3 and 12 months, but free T4 and thyroid stimulating hormone (TSH) levels remained stable. A total of 19% of the subjects had autoimmune interferon-induced thyroiditis, which is characterized by an emerge of antithyroid antibodies or overt hypothyroidism. Additionally, 16% had non-autoimmune thyroiditis, which presents as destructive thyroiditis or subclinical hypothyroidism, and 11% remained in a state of euthyroidism despite the prior existence of antithyroidal antibodies. Thyrotoxicosis with destructive thyroiditis was diagnosed within three months of therapy, and ultrasonography of these patients revealed thyroid shrinkage and discordant change in the vascular patterns. DISCUSSION Decreases in the total T3 and total T4 levels may be related to improvements in the hepatocellular lesions or inflammatory changes similar to those associated with nonthyroidal illnesses. The immune mechanisms and direct effects of interferon-alpha can be associated with thyroiditis. CONCLUSION Interferon-alpha and ribavirin induce autoimmune and non-autoimmune thyroiditis and hormonal changes (such as decreased total T3 and total T4 levels), which occur despite stable free T4 and TSH levels. A thyroid hormonal evaluation, including the analysis of the free T4, TSH, and antithyroid antibody levels, should be mandatory before therapy, and an early re-evaluation within three months of treatment is necessary as an appropriate follow-up.
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Affiliation(s)
- Debora Lucia Seguro Danilovic
- Unidade de Tireóide, Laboratório de Endocrinologia Celular e Molecular, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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Mukasa K, Noh JY, Kunii Y, Matsumoto M, Sato S, Yasuda S, Suzuki M, Ito K, Ito K. Prevalence of malignant tumors and adenomatous lesions detected by ultrasonographic screening in patients with autoimmune thyroid diseases. Thyroid 2011; 21:37-41. [PMID: 20932180 DOI: 10.1089/thy.2010.0050] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Thyroid ultrasonography (US) is the most sensitive method for detecting thyroid nodules, and US-guided aspiration biopsy is the most accurate diagnostic procedure for thyroid nodules. We performed this retrospective study to establish the prevalence of thyroid nodules in Graves' disease and patients with Hashimoto's thyroiditis at the time of their initial visit. METHODS We performed thyroid US as routine screening in 1652 patients with Graves' disease and 2036 Hashimoto's thyroiditis and performed US-guided fine-needle aspiration biopsy when the diameter of a nodule >1 cm or a nodule was suspected of being malignant. RESULTS The prevalence of papillary carcinoma in the patients with Hashimoto's thyroiditis was higher than in the patients with Graves' disease (1.77% vs. 0.97%), and two patients with Hashimoto's thyroiditis (0.098%) were found to have malignant lymphoma. Adenomatous lesions were observed more frequently in the patients with Hashimoto's thyroiditis than in the patients with Graves' disease. The prevalence of adenomatous lesions increased in an age-dependent manner in both the patients with Graves' disease and those with Hashimoto disease; and adenomatous lesions were more frequent in younger patients with Hashimoto' s thyroiditis than in those with Graves' disease. CONCLUSIONS The prevalence of both thyroid papillary cancer and adenomatous lesions was greater in the patients with Hashimoto's thyroiditis than in those with Graves' disease; and adenomatous lesions were more frequent in younger patients with Hashimoto's thyroiditis. We recommend performing US at the time of the initial visit in patients with autoimmune thyroid disease, who have a high prevalence of thyroid papillary carcinoma, to detect malignant thyroid tumors and adenomatous lesions.
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Ertek S, Cicero AF, Caglar O, Erdogan G. Relationship between serum zinc levels, thyroid hormones and thyroid volume following successful iodine supplementation. Hormones (Athens) 2010; 9:263-8. [PMID: 20688624 DOI: 10.14310/horm.2002.1276] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Zinc is essential for many biochemical processes and also for cell proliferation. Thyroid hormones influence zinc metabolism by affecting zinc absorption and excretion. Additionally, zinc deficiency affects thyroid function. The aim of the present study was to evaluate a possible association of zinc levels with thyroid volume, thyroid hormones and thyroid autoantibody levels in healthy subjects, patients with autoimmune thyroid disease (AITD) and patients with nodular goitre following successful iodine supplementation. This is a cross-sectional study in which 201 subjects who were not under medical treatment and did not have previous thyroid surgery or radio-iodine treatment were evaluated. Seventy patients had nodular goitre, 67 AITD and 64 had normal thyroid. Thyroid volume was calculated by ultrasonographic measurements. Serum free T4, T3, TSH, anti-thyroglobulin and anti-thyroid peroxidase levels were determined by appropriate methodology. RESULTS In patients with normal thyroid, zinc levels were significantly positively correlated with free T3 levels (p<0.001). In the nodular goitre group, thyroid volume was negatively correlated with TSH and circulating zinc levels (p=0.014 and p=0.045, respectively). In the AITD group, thyroid autoantibodies and zinc were significantly positively correlated. Multiple regression analysis revealed a significant relationship between thyroid volume and zinc only in the patients with nodular goitre (p=0.043). CONCLUSION There was significant correlation of serum zinc levels with thyroid volume in nodular goitre patients, with thyroid autoantibodies in AITD and with free T3 in patients with normal thyroid.
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Affiliation(s)
- Sibel Ertek
- Ufuk University Medical Faculty, Department of Endocrinology and Metabolic Diseases, Ankara, Turkey.
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Li Y, Nishihara E, Hirokawa M, Taniguchi E, Miyauchi A, Kakudo K. Distinct clinical, serological, and sonographic characteristics of hashimoto's thyroiditis based with and without IgG4-positive plasma cells. J Clin Endocrinol Metab 2010; 95:1309-17. [PMID: 20097712 DOI: 10.1210/jc.2009-1794] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
CONTEXT IgG4-related sclerosing disease is a new syndrome characterized by high serum IgG4 levels and increased IgG4-positive plasma cells in the involved organs. Recently the first description was made by our group of a subsection of Hashimoto's autoimmune thyroiditis (HT) patients showing indistinguishable histopathological features with IgG4-related sclerosing disease, which was termed as IgG4 thyroiditis. OBJECTIVE The objective of the study was analysis of the immunophenotypic features of IgG4 in 70 cases of HT patients and to clarify the histopathological and clinical characteristics of the patients with IgG4 thyroiditis. DESIGN Thyroid tissue samples were obtained from 70 patients with HT who were treated surgically. Quantitative analyses of the expression of IgG4 and IgG were performed. Statistical analyses of clinical and histopathological parameters were also conducted. RESULTS On the basis of immunohistochemistry of IgG4 and IgG4/IgG ratio, the 70 patients with HT were divided into two groups: IgG4 thyroiditis (19 cases) and non-IgG4 thyroiditis (51 cases). Histopathologically, IgG4 thyroiditis showed higher grade of stromal fibrosis, lymphoplasmacytic infiltration, and follicular cell degeneration than non-IgG4 thyroiditis. Moreover, these two groups were also demonstrated to be related with different clinical features, with IgG4 thyroiditis associated more with male gender, rapid progress, subclinical hypothyroidism, more diffuse low echogenicity, and higher level of circulating antibodies. CONCLUSIONS From both clinical and histopathological aspects, IgG4 thyroiditis and non-IgG4 thyroiditis were demonstrated to be distinct entities. Measuring serum IgG4 concentration provides a useful method of distinguishing IgG4 thyroiditis from non-IgG4 thyroiditis.
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Affiliation(s)
- Yaqiong Li
- Department of Human Pathology, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
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Liu FH, Hsueh C, Chang HY, Liou MJ, Huang BY, Lin JD. Sonography and fine-needle aspiration biopsy in the diagnosis of benign versus malignant nodules in patients with autoimmune thyroiditis. J Clin Ultrasound 2009; 37:487-492. [PMID: 19750546 DOI: 10.1002/jcu.20633] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To correlate sonographic (US) characteristics and results of fine-needle aspiration biopsy (FNAB) of thyroid nodules in autoimmune thyroiditis (AT) with surgical pathological findings. METHOD Forty AT patients with 40 nodular lesions were analyzed retrospectively. Five sonographic characteristics were recorded for each nodule: diameter, echogenicity, microcalcification, halo sign, and margin. Preoperative sonograms and FNAB results were compared with postoperative histopathological findings. RESULT Twenty-four of the 40 nodules were malignant, including 20 papillary carcinomas, 3 follicular carcinomas, and 1 medullary carcinoma. Of the 16 benign nodules, 8 were nodular hyperplasia, 6 lymphocytic thyroiditis, and 1 each follicular adenoma and Hürthle cell adenoma. The only US parameter that was significant in malignant vs. benign nodules was the presence of poorly defined margins. Based on preoperative cytology, 22 of the 23 malignant nodules were correctly diagnosed, and 10 of the 14 benign nodules were correctly identified. The positive predictive value was 78.6%, and the negative predictive value was 93.7%. CONCLUSION No single US parameter can predict thyroid malignancy in patients with AT. A combination of US and FNAB provides the most sensitive and specific approach available preoperatively.
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Affiliation(s)
- Feng-Hsuan Liu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Kweishan, Taoyuan, Taiwan, ROC
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Giovanella L, Suriano S, Ceriani L. Decline in thyroid (18)fluorodeoxyglucose uptake associated with selenium supplementation in a patient with autoimmune thyroiditis. Thyroid 2009; 19:1291-2. [PMID: 19785520 DOI: 10.1089/thy.2009.0231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Fava A, Oliverio R, Giuliano S, Parlato G, Michniewicz A, Indrieri A, Gregnuoli A, Belfiore A. Clinical evolution of autoimmune thyroiditis in children and adolescents. Thyroid 2009; 19:361-7. [PMID: 19226198 DOI: 10.1089/thy.2008.0239] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Few studies have addressed the clinical evolution of autoimmune thyroiditis (AIT) occurring in childhood and scant data are available on the role of thyroid ultrasonography. We aimed to evaluate the natural history of AIT diagnosed in children and adolescents and to assess the possible prognostic role of ultrasonography. METHODS Retrospective case series prospectively followed up for a further 3-year period. RESULTS A series of 23 patients with AIT, diagnosed before 18 years of age from 1994 to 2004, was further followed up from 2005 to 2007 with clinical, laboratory, and ultrasound evaluation. Hypothyroid patients were treated with levothyroxine (LT(4)), while euthyroid patients were left untreated. Patients with subclinical hypothyroidism were also evaluated 40 days after LT(4) withdrawal. At diagnosis seven patients were euthyroid, 14 with subclinical hypothyroidism, and two with overt hypothyroidism. Median follow-up was 4.7 years. At last follow-up visit, none of the seven euthyroid patients had developed hypothyroidism. Three of the 14 patients with subclinical hypothyroidism recovered a normal thyroid function while only one patient showed an increase in TSH level. By serological screening we identified three patients with other autoimmune disorders. CONCLUSIONS In young patients with normal or mildly increased TSH levels and minimal echographic changes, AIT may remain stationary for years. In fact, patients with subclinical hypothyroidism recover a normal thyroid function in approximately 20% of cases. In patients with subclinical hypothyroidism and goiter, LT(4) therapy may induce thyroid size reduction. Screening for other autoimmune disorders is useful to identify patients that need further diagnostic assessment.
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Affiliation(s)
- Antonietta Fava
- Department of Clinical and Experimental Medicine, Campus Universitario, loc. Germaneto, University Magna Graecia, Catanzaro, Italy
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Serres-Créixams X, Castells-Fusté I, Pruna-Comella X, Yetano-Laguna V, Garriga-Farriol V, Gallardo-Agromayor E. Paratracheal lymph nodes: a new sonographic finding in autoimmune thyroiditis. J Clin Ultrasound 2008; 36:418-421. [PMID: 18626870 DOI: 10.1002/jcu.20504] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE To assess the clinical value of paratracheal lymph nodes (PLNs) as a novel sonographic finding in autoimmune thyroiditis (AT). METHODS A total of 309 consecutive patients underwent sonographic examinations of the thyroid between 1998 and 2003. A single radiologist assessed the sonographic findings of AT and PLNs. All patients underwent serological tests for antimicrosomal antibodies (AMAs). Patients with clinical, cytological, or laboratory findings of thyroiditis formed the AT group with a positive AMA test (n = 199). Controls were patients with no signs of nodular thyroid disease, normal thyrotropin, negative AMA, and benign cytology (n = 110). RESULTS PLNs were seen in 184 of 199 patients in the AT group and in 28 of 110 controls (P < 0.001) (sensitivity of 93.4%, specificity of 74.5% in the diagnosis of AT). PLNs in controls were fewer (2.8 +/- 1.5 versus 4.7 +/- 2.6; P < 0.001) and smaller (8.2 +/- 2.4 mm versus 10.7 +/- 3.3 mm; P < 0.001) than in the AT group. CONCLUSION PLNs are often present in patients with AT and are detectable with sonography. Radiologists should be aware of the importance of including the paratracheal region in the evaluation of the thyroid gland.
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Affiliation(s)
- Xavier Serres-Créixams
- Service of Diagnostic Radiology, Hospital de la Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
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Abstract
Graves' disease (GD) is characterized by circulating TSH receptor antibodies (TRAb), and so-called hyperthyroid autoimmune thyroiditis (H-AIT) generally shows negative TRAb results with first-generation assays. However, a positive titer was observed in up to 13% of patients with euthyroid or hypothyroid autoimmune thyroiditis (AIT) by second-generation TRAb assays, and a larger increase is expected in hyperfunctioning forms. A thyroid 99mTc-pertechnetate uptake (TcTUs) cutoff of 2% previously was shown to accurately discriminate between GD and H-AIT. Here we evaluated the relationship between second-generation TRAb assays and TcTUs in 139 patients with untreated autoimmune hyperthyroidism. An increase in TRAb levels was found in 114 of 139 patients (82%). All patients with TcTUs >2% and 66% of those with lower values had positive TRAb measurements. When the cutoff was increased to 5.9 U/l, positive TRAb occurred in 92.6% of those having higher TcTUs and in 1.4% of those with lower TcTUs. TRAb levels significantly increased in patients with TcTUs higher than 2% as compared with those having lower values, while no differences occurred in patients with TcTUs ranging from 0 to 1%, from 1.1 to 1.5%, or from 1.6 to 2%. A significant relationship between TRAb and TcTUs (as well as fT3, fT4, and thyroid volume) was found. TcTUs, fT4, fT3, and thyroid volume significantly increased in patients with positive TRAb (cutoff 1.5 U/l) compared with those testing negative. Our data indicate that a large proportion of patients with hyperthyroidism and hypoechoic thyroid, including those previously diagnosed as having H-AIT, actually have circulating TRAb. TRAb levels predicate the degree of iodine uptake (as measured by TcTUs) and thyroid hyperfunction. The role of baseline TRAb measurement by second-generation assays to predict patients' outcome needs to be further evaluated and compared with TcTUs in prospective studies.
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Affiliation(s)
- L Giovanella
- Department of Nuclear Medicine, PET-CT Center and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
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Marwaha RK, Tandon N, Kanwar R, Ganie MA, Bhattacharya V, Reddy DHK, Gopalakrishnan S, Aggarwal R, Grewal K, Ganguly SK, Mani K. Evaluation of the role of ultrasonography in diagnosis of autoimmune thyroiditis in goitrous children. Indian Pediatr 2008; 45:279-284. [PMID: 18451445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To evaluate the role of thyroid ultrasound in children with autoimmune thyroiditis diagnosed either on cytopathology or by the presence of thyroid peroxidase antibodies. DESIGN AND SETTINGS Children presenting for the first time to the Thyroid Clinic at the Institute of Nuclear Medicine and Allied Sciences for the complaint of goiter over a two year period (January 2005-December 2006) were studied. SUBJECTS 695 school children (244 boys and 451 girls) aged 5-18 year were studied. METHODS Children were subjected to thyroid ultrasound, cytopathology, thyroid peroxidase antibody and thyroid function tests. RESULTS Overall, 16% of goitrous children had hypoechogenicity on ultrasound, 15.2% had cytopathological evidence of thyroiditis, 10.6% had positive thyroid peroxidase antibodies and 25.2% had abnormal thyroid function tests. Subjects with hypoechogenicity had higher percentage of thyroiditis on cytopathology (41.4% vs. 10.3%; P<0.01), thyroid peroxidase antibody positivity (30.6% vs. 6.8%; P<0.01) and thyroid dysfunction (46.8% vs. 21.2%; P<0.01) than those with normal echogenicity. CONCLUSION Thyroid USG has a useful, though limited, role in excluding thyroid disease in children. The sensitivity of echogenicity for the diagnosis of autoimmune thyroiditis in children is less than that reported in adults.
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Affiliation(s)
- R K Marwaha
- Department of Endocrinology and Thyroid Research Center, Institute of Nuclear Medicine and Allied ciences, Timarpur, Delhi 110 054, India.
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Medeiros CCM, Lemos-Marini SHVD, Brícola Filho M, Camargo EE, Santos AO, Magna LA, Guerra Júnior G, Baptista MTM, Maciel-Guerra AT. [Evidences for subclinic chronic autoimmune thyroid disease in girls with Turner Syndrome]. Arq Bras Endocrinol Metabol 2007; 51:401-9. [PMID: 17546238 DOI: 10.1590/s0004-27302007000300007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2005] [Accepted: 11/10/2006] [Indexed: 05/15/2023]
Abstract
Patients with Turner syndrome (TS) frequently exhibit transient, recurrent and asymptomatic variations of TSH and/or thyroid hormones (TH). This work was carried out to evaluate thyroid function and structure in patients with TS who had had such variations in hormone concentrations. Our sample comprised 24 patients, 17 less than 20-years old. Evaluation included serum levels of TSH, free T4, total T3, TPO and Tg autoantibodies, thyroid ultrasound (US) and scintigraphy with 99mTc-pertechnetate. Thirteen patients had abnormal TSH and/or TH levels; 23 exhibited US features compatible with chronic thyroid disorder, particularly thyromegaly (established according to volume expected for stature) and heterogeneous echogenicity. Uptake was normal in 21 cases and tracer distribution was homogeneous in 22. The finding of abnormal hormone concentrations was independent of age, length of time since the first similar finding, thyroid autoantibodies, number of abnormalities at US and abnormal scintigraphic findings. Patients aged more than 20 years had higher frequency of thyroid antibodies and heterogeneous echogenicity, and thyroid volume was significantly correlated to length of time since detection of the first hormone variation, indicating progressive thyroid disease. These results suggest that subclinical thyroid dysfunction in TS is due to chronic autoimmune thyroid disease.
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Affiliation(s)
- Carla C M Medeiros
- Serviço de Endocrinologia Pediátrica, Departamento de Pediatria e Centro de Investigação em Pediatria, Faculdade de Ciências Médicas, UNICAMP, Campinas, SP
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Bunevicius R, Peceliuniene J, Mickuviene N, Bunevicius A, Pop VJ, Girdler SS. Mood and thyroid immunity assessed by ultrasonographic imaging in a primary health care. J Affect Disord 2007; 97:85-90. [PMID: 16837056 DOI: 10.1016/j.jad.2006.05.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Revised: 05/16/2006] [Accepted: 05/25/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Psychiatric morbidity is highly prevalent in the primary health care settings and it may be related to autoimmune thyroid disease (AITD). The aim of this study was to evaluate the impact of thyroid immunity, evident by hypo-echoic thyroid ultrasound pattern, on prevalence of depression and anxiety in a primary care setting. METHODS In a cross-sectional design, 504 consecutive primary care patients were invited to the study and 474 patients completed the study. They were screened for depression and anxiety using the Hospital Anxiety and Depression Scale (HADS), were interviewed for affective disorders using the Mini International Neuropsychiatric Interview, and were evaluated by ultrasonographic imagining of the thyroid gland. RESULTS Among patients with hypo-echoic thyroid (n=122) prevailed women and those patients were older than patients with normo-echoic thyroid (n=352). Women, but not men, with hypo-echoic thyroid compared to those with normo-echoic thyroid had higher scores on the anxiety subscale of the HADS (p=0.03). Among women with hypo-echoic thyroid, only those pre-menopause, but not those post-menopause, had greater prevalence of high scores on the depression subscale of the HADS (p=0.02) and a greater likelihood of using psychiatric medications (p=0.001). LIMITATIONS Lack of cytological evaluation of the thyroid gland; lack of serum thyroid antibodies concentrations; and lack of thyroid hormone concentrations. CONCLUSIONS Thyroid immunity is related to mood symptoms in primary care patients. These effects are gender specific and in women, they are most evident before menopause.
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Affiliation(s)
- Robertas Bunevicius
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7160, USA.
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Svensson J, Ericsson UB, Nilsson P, Olsson C, Jonsson B, Lindberg B, Ivarsson SA. Levothyroxine treatment reduces thyroid size in children and adolescents with chronic autoimmune thyroiditis. J Clin Endocrinol Metab 2006; 91:1729-34. [PMID: 16507633 DOI: 10.1210/jc.2005-2400] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The use of levothyroxine to reduce thyroid size in pediatric patients with goiter due to chronic autoimmune thyroiditis (AIT) remains controversial. In overtly hypothyroid patients, reductions in thyroid volume have been reported, whereas the effect in subclinically hypothyroid and euthyroid patients is less clear. OBJECTIVE The objective of the study was to evaluate the effect of levothyroxine treatment on thyroid size (determined with thyroid ultrasonography) in children and adolescents with AIT. DESIGN AND SETTING This study included patients with AIT treated at a university hospital outpatient clinic between 1987 and 2004. PATIENTS Ninety children with AIT (73 girls and 17 boys, aged 6.1-17.7 yr) were included in the study. INTERVENTION Intervention was treatment with levothyroxine for a median 2.8 yr (range 0.5-10.2). MAIN OUTCOME MEASURE Change in thyroid volume sd score (SDS) during the study period was measured. RESULTS Median thyroid volume SDS was reduced in patients euthyroid (-0.4 SDS, P < 0.001), subclinically hypothyroid (-1.4 SDS, P < 0.001), and overtly hypothyroid (-1.8 SDS, P < 0.002) at diagnosis of AIT. Both hypothyroid and euthyroid patients with goiter (thyroid volume > 2.0 SDS) at baseline reduced their median thyroid volume SDS (-1.6 and -0.9, respectively, P < 0.001). Hypothyroid patients without goiter also reduced median thyroid volume SDS (-1.2, P < 0.004), whereas no change was noticed in euthyroid children without goiter. CONCLUSIONS Levothyroxine treatment is effective in reducing thyroid volume in pediatric patients and is suggested in treatment of goiter caused by AIT, especially in cases of hypothyroid, but also in euthyroid children.
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Affiliation(s)
- Johan Svensson
- Department of Pediatrics, Malmö University Hospital, Lund University, SE-205 02 Malmö, Sweden.
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Gärtner R. [Modern diagnostic approach to autoimmune thyroiditis]. MMW Fortschr Med 2006; 148:41, 43-5. [PMID: 16688948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
High-resolution ultrasonography of the thyroid gland is the major primarytechnical diagnostic procedure in suspected autoimmune thyroiditis (AIT). A diffusely echo-poor thyroid is proof of the presence of AIT. Duplex sonography provides further information about the activity of the disease, and is of differential diagnostic importance for distinguishing postpartum thyroiditis from AIT, or for the investigation of an infiltrating carcinoma. Today, antibody determination serves merely to confirm the diagnosis, with TPO antibodies being the most specific for AIT. The TG antibodies may also be nonspecifically elevated in subacute thyroiditis (de Quervain) or irradiation or radioiodine treatment. For an evaluation of thyroid gland function in AIT, determination of basal TSH is needed.
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Affiliation(s)
- Roland Gärtner
- Medizinische Klinik Innenstadt der Universität München, Ziemssenstr. 1 D-80336, München.
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