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Chen P, Xia Y, Lei W, Zhong S, Jiang H, Ren L, Qian W, Liu H. Case report: Hashimoto’s thyroiditis after CD19 chimeric antigen receptor T-cell therapy. Front Immunol 2022; 13:995496. [PMID: 36389794 PMCID: PMC9646589 DOI: 10.3389/fimmu.2022.995496] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/03/2022] [Indexed: 11/24/2022] Open
Abstract
Chimeric antigen receptor (CAR)-T cell therapy is a novel cell therapeutic approach that is increasingly being used to treat patients with relapsed refractory B-cell lymphoma. Despite the efficacy of CAR T cell therapy, it has various adverse effects that can affect any organ in the body. The application of immune checkpoint inhibitors such as programmed death 1 (PD-1), programmed death ligand 1 (PDL-1), and cytotoxic T-lymphocyte antigen 4 (CTLA-4) antibodies has previously been reported to be associated with immune-related adverse events such as thyroid dysfunction and thyroiditis. Reports of immune-related adverse reactions after CAR T therapy are currently extremely rare, with only one case of a cytokine storm (CRS) combined with severe arthritis in a patient with ALL after treatment. Here, we describe two cases of Hashimoto’s thyroiditis secondary to CAR T therapy. Two patients with relapsed refractory diffuse large B-cell lymphoma developed elevated peroxidase and globulin antibodies secondary to CAR-T cell therapy and developed Hashimoto’s thyroiditis. Complete remission was achieved in two patients at 1 and 3 months after CAR-T cell therapy. The inflammation of the thyroid tissue may be directly or indirectly related to CAR T cell therapy, and the mechanisms needs to be further investigated.
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Affiliation(s)
- Panpan Chen
- Department of Hematology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yongming Xia
- Department of Hematology, Yuyao People’s Hospital of Zhejiang Province, The Affiliated Yangming Hospital of Ningbo University, Ningbo, China
| | - Wen Lei
- Department of Hematology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuhan Zhong
- Department of Hematology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huawei Jiang
- Department of Hematology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lingling Ren
- Department of Hematology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenbin Qian
- Department of Hematology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Liu
- Department of Hematology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Hui Liu,
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Capezzone M, Tosti-Balducci M, Morabito EM, Caldarelli GP, Sagnella A, Cantara S, Alessandri M, Castagna MG. Silent thyroiditis following vaccination against COVID-19: report of two cases. J Endocrinol Invest 2022; 45:1079-1083. [PMID: 35034341 PMCID: PMC8761095 DOI: 10.1007/s40618-021-01725-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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] [Received: 11/25/2021] [Accepted: 12/07/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE It is well established that thyroiditis and other thyroid disorders can be induced by COVID-19 infection, but there is limited information about the autoimmune/inflammatory syndrome induced by adjuvants (ASIA) after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. We report two cases of thyrotoxicosis following SARS-CoV-2 vaccine. METHODS AND RESULTS Two young health care peoples (wife and husband) received a first dose of SARS-CoV-2 vaccine, and few weeks later developed clinical manifestations of thyroid hyperactivity, with increased thyroid hormone levels on thyroid function tests, suppressed thyroid-stimulating hormone and negative antithyroid antibodies, despite being healthy before vaccination. They were diagnosed at the 4th week after first dose of SARS-Cov-2 vaccine as silent thyroiditis and followed without treatment, since their symptoms were not severe. At the 6th week, the patients became wholly asymptomatic and their thyroid function returned to normal. CONCLUSIONS Thyrotoxicosis can occur after SARS-CoV-2 vaccination probably related to silent thyroiditis.
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Affiliation(s)
- M Capezzone
- Unit of Endocrinology, Department of Internal Medicine, Misericordia Hospital, 58100, Grosseto, Italy.
| | - M Tosti-Balducci
- Unit of Nuclear Medicine, Misericordia Hospital, Grosseto, Italy
| | - E M Morabito
- Unit of Endocrinology, Department of Internal Medicine, Misericordia Hospital, 58100, Grosseto, Italy
| | - G P Caldarelli
- Laboratory Medicine Functional Area, Hospital Misericordia of Grosseto, Grosseto, Italy
| | - A Sagnella
- Section of Endocrinology and Metabolism, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - S Cantara
- Section of Endocrinology and Metabolism, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - M Alessandri
- Unit of Endocrinology, Department of Internal Medicine, Misericordia Hospital, 58100, Grosseto, Italy
| | - M G Castagna
- Section of Endocrinology and Metabolism, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
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Pujol A, Gómez LA, Gallegos C, Nicolau J, Sanchís P, González-Freire M, López-González ÁA, Dotres K, Masmiquel L. Thyroid as a target of adjuvant autoimmunity/inflammatory syndrome due to mRNA-based SARS-CoV2 vaccination: from Graves' disease to silent thyroiditis. J Endocrinol Invest 2022; 45:875-882. [PMID: 34792795 PMCID: PMC8598936 DOI: 10.1007/s40618-021-01707-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [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: 08/11/2021] [Accepted: 11/07/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND As COVID-19 became a pandemic, the urgent need to find an effective treatment vaccine has been a major objective. Vaccines contain adjuvants which are not exempt from adverse effects and can trigger the autoimmune/inflammatory syndrome induced by adjuvants (ASIA). There is very little information about autoimmune endocrine disease and the ASIA after the use of mRNA-based SARS-CoV2 vaccination. CASE SERIES We report three cases and also review the literature showing that the thyroid gland can be involved in the ASIA induced by the mRNA-based SARS-CoV2 vaccination. We present the first case to date of silent thyroiditis described in the context of SARS-CoV2 vaccination with Pfizer/BioNTech. Also, we discuss the first subacute thyroiditis in the context of SARS-CoV2 vaccination with the Moderna's vaccine. Finally, we provide another case to be added to existing evidence on Graves' disease occurring post-vaccination with the Pfizer/BioNTech vaccine. DISCUSSION Adjuvants play an important role in vaccines. Their ability to increase the immunogenicity of the active ingredient is necessary to achieve the desired immune response. Both the Moderna and the Pfizer/BioNTech vaccines use mRNA coding for the SARS-CoV2 S protein enhanced by adjuvants. In addition, the cross-reactivity between SARS-CoV2 and thyroid antigens has been reported. This would explain, at least, some of the autoimmune/inflammatory reactions produced during and after SARS-CoV2 infection and vaccination. CONCLUSION The autoimmune/inflammatory syndrome induced by adjuvants involving the thyroid could be an adverse effect of SARS-CoV2 vaccination and could be underdiagnosed.
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Affiliation(s)
- A. Pujol
- Endocrinology and Nutrition Department, Son Llàtzer University Hospital, Palma, Baleares Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
| | - L.-A. Gómez
- Endocrinology and Nutrition Department, Son Llàtzer University Hospital, Palma, Baleares Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
| | - C. Gallegos
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
- Microbiology Department, Son Llàtzer University Hospital, Palma, Baleares Spain
| | - J. Nicolau
- Endocrinology and Nutrition Department, Son Llàtzer University Hospital, Palma, Baleares Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
| | - P. Sanchís
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
- Chemistry Department, University of Balearic Islands, Palma, Baleares Spain
| | - M. González-Freire
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
| | - Á. A. López-González
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
- ADEMA University School, Palma, Baleares Spain
| | - K. Dotres
- Endocrinology and Nutrition Department, Son Llàtzer University Hospital, Palma, Baleares Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
| | - L. Masmiquel
- Endocrinology and Nutrition Department, Son Llàtzer University Hospital, Palma, Baleares Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Baleares Spain
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Abstract
BACKGROUND COVID-19 is now a worldwide pandemic. Among the many extra-pulmonary manifestations of COVID-19, recent evidence suggested a possible occurrence of thyroid dysfunction. PURPOSE The Aim of the present review is to summarize available studies regarding thyroid function alterations in patients with COVID-19 and to overview the possible physio-pathological explanations. CONCLUSIONS The repercussions of the thyroid of COVID-19 seem to be related, in part, with the occurrence of a "cytokine storm" that would, in turn, induce a "non-thyroidal illness". Some specific cytokines and chemokines appear to have a direct role on the hypothalamus-pituitary-thyroid axis. On the other hand, some authors have observed an increased incidence of a destructive thyroiditis, either subacute or painless, in patients with COVID-19. The hypothesis of a direct infection of the thyroid by SARS-Cov-2 stems from the observation that its receptor, ACE2, is strongly expressed in thyroid tissue. Lastly, it is highly probable that some pharmaceutical agents largely used for the treatment of COVID-19 can act as confounding factors in the laboratory evaluation of thyroid function parameters.
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Affiliation(s)
- L Croce
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
- PHD Course in Experimental Medicine, University of Pavia, 27100, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy
| | - D Gangemi
- Postgraduate School in Endocrinology and Metabolism, University of Pavia, 27100, Pavia, Italy
| | - G Ancona
- Postgraduate School in Endocrinology and Metabolism, University of Pavia, 27100, Pavia, Italy
| | - F Liboà
- Postgraduate School in Endocrinology and Metabolism, University of Pavia, 27100, Pavia, Italy
| | - G Bendotti
- Postgraduate School in Endocrinology and Metabolism, University of Pavia, 27100, Pavia, Italy
| | - L Minelli
- Postgraduate School in Endocrinology and Metabolism, University of Pavia, 27100, Pavia, Italy
| | - L Chiovato
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy.
- Department of Internal Medicine and Therapeutics, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy.
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Abstract
We have reviewed the available literature on thyroid diseases and coronavirus disease 2019 (COVID-19), and data from the previous coronavirus pandemic, the severe acute respiratory syndrome (SARS) epidemic. We learned that both SARS and COVID-19 patients had thyroid abnormalities. In the limited number of SARS cases, where it was examined, decreased serum T3, T4 and TSH levels were detected. In a study of survivors of SARS approximately 7% of the patients had hypothyroidism. In the previous evaluation evidence was found that pituitary function was also affected in SARS. Others suggested a hypothalamic-pituitary-adrenal axis dysfunction. One result published recently indicates that a primary injury to the thyroid gland itself may play a key role in the pathogenesis of thyroid disorders in COVID-19 patients, too. Subacute thyroiditis, autoimmune thyroiditis and an atypical form of thyroiditis are complications of COVID-19. Thyroid hormone dysfunction affects the outcome by increasing mortality in critical illnesses like acute respiratory distress syndrome, which is a leading complication in COVID-19. Angiotensin-converting enzyme 2 is a membrane-bound enzyme, which is also expressed in the thyroid gland and the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) uses it for docking, entering as well as replication. Based on the available results obtained in the SARS-CoV-2 pandemic, beside others, we suggest that it is necessary to monitor thyroid hormones in COVID-19.
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Affiliation(s)
- Gábor Speer
- Department of Endocrinology, Municipal Clinic Biatorbágy, H-2051, Biatorbágy, Hungary
| | - Péter Somogyi
- Department of Orthopaedics, Municipal Clinic Biatorbágy, H-2051, Biatorbágy, Hungary
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6
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Bellastella G, Maiorino MI, Esposito K. Endocrine complications of COVID-19: what happens to the thyroid and adrenal glands? J Endocrinol Invest 2020; 43:1169-1170. [PMID: 32488724 PMCID: PMC7265876 DOI: 10.1007/s40618-020-01311-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/26/2020] [Indexed: 12/30/2022]
Affiliation(s)
- G Bellastella
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania ''Luigi Vanvitelli'', Piazza L. Miraglia 2, 80138, Naples, Italy.
| | - M I Maiorino
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania ''Luigi Vanvitelli'', Piazza L. Miraglia 2, 80138, Naples, Italy
| | - K Esposito
- Diabetes Unit, Department of Advanced Medical and Surgical Sciences, University of Campania ''Luigi Vanvitelli'', 80138, Naples, Italy
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Pinxterhuis TH, Out M, van den Broek RWF, Wouters RSME, van der Kleij FGH. Transient thyroiditis after parathyroidectomy for tertiary hyperparathyroidism. Neth J Med 2019; 77:119-121. [PMID: 31012430] [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: 06/09/2023]
Abstract
Thyrotoxicosis due to thyroiditis is predominantly caused by infection or autoimmune disease of the thyroid. Parathyroid surgery however, is a lesser known cause of thyroiditis, due to thyroid manipulation. We treated a patient who developed transient symptomatic thyroiditis following parathyroid surgery for tertiary hyperparathyroidism. Therefore, the differential diagnosis for patients with symptoms after parathyroid surgery should include transient thyroiditis.
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Affiliation(s)
- T H Pinxterhuis
- Department of Cardiology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
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8
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Kaneko A, Kubo K, Fukata S, Inoue N. Destructive Thyroiditis Caused by Accidental Ingestion of a Press-Through-Package. Thyroid 2018; 28:952-953. [PMID: 29764318 DOI: 10.1089/thy.2017.0300] [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] [Indexed: 11/12/2022]
Affiliation(s)
- Akihiro Kaneko
- 1 Department of Gastroenterology, Kobe Rosai Hospital , Kobe, Japan
| | - Kiminori Kubo
- 1 Department of Gastroenterology, Kobe Rosai Hospital , Kobe, Japan
| | - Shuji Fukata
- 2 Department of Internal Medicine, Kuma Hospital , Kobe, Japan
| | - Nobutaka Inoue
- 3 Department of Cardiovascular Medicine, Kobe Rosai Hospital , Kobe, Japan
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Hanew K, Tanaka T, Horikawa R, Hasegawa T, Yokoya S. Prevalence of diverse complications and its association with karyotypes in Japanese adult women with Turner syndrome-a questionnaire survey by the Foundation for Growth Science. Endocr J 2018. [PMID: 29515055 DOI: 10.1507/endocrj.ej17-0401] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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] [Indexed: 11/23/2022] Open
Abstract
The reported prevalence of complications in Turner Syndrome (TS) was highly variable because of the rarity and the limited numbers analyzed. Again, possible presence of other complications that are not described as specific for TS, is also speculated. To resolve these issues, a questionnaire survey was conducted in hGH treated 492 patients with adult TS (17-42 years). The possible association with these complications and karyotypes were also analyzed. The complications and their prevalence were as follows: chronic thyroiditis (25.2%), inflammatory bowel disease (1.8%), congenital cardiovascular anomaly (11.8%), urinary tract malformation (11.8%), low bone mineral density (BMD) (42.9%), scoliosis (8.4%), hearing loss (6.2%), epilepsy (2.8%) and schizophrenia (0.9%). The majority of prevalence of these diseases in TS was higher than in the general population. In distribution, the most frequent karyotype was 45,X monosomy (28.9%), followed by 45,X/46,X,Xi (16.9%), 46,X,Xi (9.1%), and 45,X/46,XX (6.3%), while other mosaic 45,X was noted in 29.9%. Regarding the karyotype, cardiovascular anomaly was more frequent in the 45,X group and less in the 46,X,Xi group. Urinary tract malformation and epilepsy were frequently associated with the chromosome 45,X. The prevalence of low BMD was noticed more in the chromosome 46,X,Xi and 45,X/46,X,Xi, and less in other mosaic 45,X. In conclusion, the more exact prevalence of diverse complications was clarified and it exceeded the prevalence of the majority of complications in general population. As novel findings, it was observed that the prevalence of epilepsy was significantly high, and epilepsy and low BMD were frequently associated with the specific karyotypes.
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Affiliation(s)
- Kunihiko Hanew
- Growth Hormone Therapy Research Committee, Foundation for Growth Science, Tokyo, Japan
| | - Toshiaki Tanaka
- Growth Hormone Therapy Research Committee, Foundation for Growth Science, Tokyo, Japan
| | - Reiko Horikawa
- Growth Hormone Therapy Research Committee, Foundation for Growth Science, Tokyo, Japan
| | - Tomonobu Hasegawa
- Growth Hormone Therapy Research Committee, Foundation for Growth Science, Tokyo, Japan
| | - Susumu Yokoya
- Growth Hormone Therapy Research Committee, Foundation for Growth Science, Tokyo, Japan
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O’Sullivan BJ, Yekollu S, Ruscher R, Mehdi AM, Maradana MR, Chidgey AP, Thomas R. Autoimmune-Mediated Thymic Atrophy Is Accelerated but Reversible in RelB-Deficient Mice. Front Immunol 2018; 9:1092. [PMID: 29872433 PMCID: PMC5972300 DOI: 10.3389/fimmu.2018.01092] [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] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/01/2018] [Indexed: 01/28/2023] Open
Abstract
Polymorphisms impacting thymic function may decrease peripheral tolerance and hasten autoimmune disease. The NF-κB transcription factor subunit, RelB, is essential for the development and differentiation of medullary thymic epithelial cells (mTECs): RelB-deficient mice have reduced thymic cellularity and markedly fewer mTECs, lacking AIRE. The precise mechanism of this mTEC reduction in the absence of RelB is unclear. To address this, we studied mTECs and dendritic cells (DCs), which critically regulate negative selection, and thymic regulatory T-cells (tTreg) in RelB-/- mice, which have spontaneous multiorgan autoimmune disease. RelB-/- thymi were organized, with medullary structures containing AIRE- mTECs, DCs, and CD4+ thymocytes, but fewer tTreg. Granulocytes infiltrated the RelB-/- thymic cortex, capsule, and medulla, producing inflammatory thymic medullary atrophy, which could be treated by granulocyte depletion or RelB+ DC immunotherapy, with concomitant recovery of mTEC and tTreg numbers. These data indicate that central tolerance defects may be accelerated by autoimmune thymic inflammation where impaired RelB signaling impairs the medullary niche, and may be reversible by therapies enhancing peripheral Treg or suppressing inflammation.
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Affiliation(s)
- Brendan J. O’Sullivan
- Diamantina Institute, Translational Research Institute, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Suman Yekollu
- Diamantina Institute, Translational Research Institute, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Roland Ruscher
- Diamantina Institute, Translational Research Institute, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Ahmed M. Mehdi
- Diamantina Institute, Translational Research Institute, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Muralidhara Rao Maradana
- Diamantina Institute, Translational Research Institute, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Ann P. Chidgey
- Stem Cells and Immune Regeneration Laboratory, Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia
| | - Ranjeny Thomas
- Diamantina Institute, Translational Research Institute, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia
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Cai XY, Vijayaratnam N, McEwan AJB, Reif R, Morrish DW. Comparison of 30 mCi and 50 mCi I-131 doses for ablation of thyroid remnant in papillary thyroid cancer patients. Endocr Res 2018; 43:11-14. [PMID: 28742421 DOI: 10.1080/07435800.2017.1346662] [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] [Indexed: 10/19/2022]
Abstract
PURPOSE OF THE STUDY To compare efficacy of thyroid remnant ablation using 30 mCi or 50 mCi 131-I in papillary thyroid cancer patients. MATERIALS AND METHODS Five hundred and fifteen consecutive patients with Tumor-Node-Metastasis (TNM) stages T1-T3 N1/N0/NX receiving either 30 mCi or 50 mCi I-131 were analyzed for the effectiveness of remnant ablation using rhTSH-stimulated serum thyroglobulin. One hundred and five consecutive patients receiving 100 mCi I-131 were analyzed for the incidence of radiation thyroiditis and sialadenitis. RESULTS AND CONCLUSIONS Doses of 30 mCi and 50 mCi were equally effective for low- and moderate-risk disease but 30 mCi was less effective for T1T2NX disease, and 50 mCi was less effective for T3 compared to T1T2 disease. Low dose radiation hypersensitivity or unknown more extensive disease may have accounted for observed differences. Radiation thyroiditis and sialadenitis were more common in a comparison series of 100 mCi dose compared to 30 mCi, but not more common than in 50 mCi doses.
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Affiliation(s)
- Xiao Yue Cai
- a Department of Medicine , University of Alberta , Edmonton , Alberta , Canada
| | | | | | - Rebecca Reif
- b Department Oncology , University of Alberta , Edmonton , Alberta , Canada
| | - Donald W Morrish
- a Department of Medicine , University of Alberta , Edmonton , Alberta , Canada
- b Department Oncology , University of Alberta , Edmonton , Alberta , Canada
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12
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Napier C. Managing thyrotoxicosis in the acute medical setting. Acute Med 2018; 17:44-48. [PMID: 29589605] [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: 06/08/2023]
Abstract
Thyrotoxicosis is common and can present in numerous ways with patients exhibiting a myriad of symptoms and signs. It affects around 1 in 2000 people annually in Europe1. The thyroid gland produces two thyroid hormones - thyroxine (T4) and triiodothyronine (T3). Thyroxine is inactive and is converted by the tissues and organs that need it into tri-iodothyronine. In health, the production of these thyroid hormones is tightly regulated by the secretion of thyroid stimulating hormone (TSH; thyrotropin) from the pituitary gland. The term 'thyrotoxicosis' refers to the clinical manifestations of hyperthyroidism.
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Affiliation(s)
- C Napier
- MBBS MRCP (UK), Endocrine Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP UK
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13
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Abstract
Hyperthyroidism is caused by an increased synthesis of thyroid hormones or release of preformed thyroid hormones due to destruction of thyroid tissue, or there is an exogenous extrathyroidal source. The term thyroiditis describes a heterogeneous group of disorders, which result in destruction of thyroid tissue and release of preformed thyroid hormones. Although a less common condition, a thyroiditis remains an important differential diagnosis for thyrotoxicosis, and a symptomatic therapy is the cornerstone of treatment. Because of the classical triphasic clinical course a 'wait and see strategy' is reasonable, especially during the first and self-limited hyperthyroid phase. Usually a transient hypothyroid phase follows, before the euthyroid function is restored within a year. However, as permanent hypothyroidism may result, regular follow-up and in that case treatment with levothyroxine is mandatory.
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Affiliation(s)
- Lea Slahor
- 1 Endokrinologie/Diabetologie, Luzerner Kantonsspital, Luzern
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14
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Oueslati I, Khiari K, Elfaleh E, Znaidi N, Mchirgui N, Rammeh S, Ben Abdallah N. A rare coexistence of Riedel's and Hashimoto's thyroiditis. Tunis Med 2017; 95:385-386. [PMID: 29509224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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15
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Abstract
BACKGROUND The optimum therapy for Graves' disease (GD) is chosen following discussion between physician and patient regarding benefits, drawbacks, potential side effects, and logistics of the various treatment options, and it takes into account patient values and preferences. This cohort study aimed to provide useful information for this discussion regarding the usage, efficacy, and adverse-effect profile of radioactive iodine (RAI), antithyroid drugs (ATDs), and thyroidectomy in a tertiary healthcare facility. METHODS The cohort included consecutive adults diagnosed with GD from January 2002 to December 2008, who had complete follow-up after treatment at the Mayo Clinic, Rochester, Minnesota. Data on treatment modalities, disease relapses, and adverse effects were extracted manually and electronically from the electronic medical records. Kaplan-Meier analyses were performed to evaluate the association of treatments with relapse-free survival. RESULTS The cohort included 720 patients with a mean age of 49.3 years followed for a mean of 3.3 years. Of these, 76.7% were women and 17.1% were smokers. The initial therapy was RAI in 75.4%, ATDs in 16.4%, and thyroidectomy in 2.6%, while 5.6% opted for observation. For the duration of follow-up, ATDs had an overall failure rate of 48.3% compared with 8% for RAI (hazard ratio = 7.6; p < 0.0001). Surgery had a 100% success rate; 80% of observed patients ultimately required therapy. Adverse effects developed in 43 (17.3%) patients treated with ATDs, most commonly dysgeusia (4.4%), rash (2.8%), nausea/gastric distress (2.4%), pruritus (1.6%), and urticaria (1.2%). Eight patients treated with RAI experienced radiation thyroiditis (1.2%). Thyroidectomy resulted in one (2.9%) hematoma and one (2.85%) superior laryngeal nerve damage, with no permanent hypocalcemia. CONCLUSIONS RAI was the most commonly used modality within the cohort and demonstrated the best efficacy and safety profile. Surgery was also very effective and relatively safe in the hands of experienced surgeons. While ATDs allow preservation of thyroid function, a high relapse rate combined with a significant adverse-effect profile was documented. These data can inform discussion between physician and patient regarding choice of therapy for GD.
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Affiliation(s)
- Vishnu Sundaresh
- Division of Endocrinology, Metabolism, and Diabetes, University of Utah, Salt Lake City, Utah
- Geriatrics and Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Juan P. Brito
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, Minnesota
| | - Prabin Thapa
- Department of Health Sciences Research, Division of Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Rebecca S. Bahn
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Marius N. Stan
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
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Chen TY, Hsu CC, Feng IJ, Wang JJ, Su SB, Guo HR, Huang CC, Lin HJ. Higher risk for thyroid diseases in physicians than in the general population: a Taiwan nationwide population-based secondary analysis study. QJM 2017; 110:163-168. [PMID: 27521582 DOI: 10.1093/qjmed/hcw140] [Citation(s) in RCA: 14] [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] [Received: 05/27/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Physicians have high work stress, responsibility for night shifts and chances of exposure to medical radiation, which may increase the risk for thyroid diseases. AIM We conducted this study to assess the risk for thyroid diseases in physicians, which remain unclear. DESIGN We used a secondary analysis of the Taiwan National Health Insurance Research Database for this study. METHODS After excluding thyroid diseases occurring before 2006 and residents, physicians and general population were identified by matching with age and sex in 2009 in a 1:2 ratio. The risk for thyroid diseases was compared between the physicians and general population and among physicians by tracing their medical histories between 2006 and 2012. RESULTS In total, 28,649 physicians and 57,298 general population were identified. Physicians had a higher risk for overall thyroid diseases than the general population [odds ratio (OR): 1.27; 95% confidence interval (CI): 1.10-1.47], including individual thyroid disease: thyroid cancer (OR: 1.89; 95% CI: 1.22-2.95), hypothyroidism (OR: 1.64; 95% CI: 1.23-2.18) and thyroiditis (OR: 1.48; 95% CI: 1.00-2.19). CONCLUSIONS We showed that physicians had a significantly higher risk for thyroid diseases than the general population. This reminds us to pay more attention to thyroid diseases in physicians. Further studies about the underlying mechanisms are warranted.
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Affiliation(s)
- T-Y Chen
- From the Section of Neuroradiology, Department of Medical Imaging, Chi-Mei Medical Center, Tainan 710, Taiwan
- Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan 711, Taiwan
| | - C-C Hsu
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan 710, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan 710, Taiwan
| | - I-J Feng
- Department of Medical Research, Chi-Mei Medical Center, Tainan 710, Taiwan
| | - J-J Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan 710, Taiwan
| | - S-B Su
- Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan 710, Taiwan
- Department of Occupational Medicine, Chi-Mei Medical Center, Tainan 710, Taiwan
- Department of Medical Research, Chi-Mei Medical Center, Liouying, Tainan 736, Taiwan
| | - H-R Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan
| | - C-C Huang
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan 710, Taiwan
- Department of Occupational Medicine, Chi-Mei Medical Center, Tainan 710, Taiwan
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Bachelor Program of Senior Service, Southern Taiwan University of Science and Technology, Tainan 710, Taiwan
- Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan 710, Taiwan
| | - H-J Lin
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan 710, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan 710, Taiwan
- Department of Emergency Medicine, Taipei Medical University, Taipei 110, Taiwan
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Calil-Silveira J, Serrano-Nascimento C, Laconca RC, Schmiedecke L, Salgueiro RB, Kondo AK, Nunes MT. Underlying Mechanisms of Pituitary-Thyroid Axis Function Disruption by Chronic Iodine Excess in Rats. Thyroid 2016; 26:1488-1498. [PMID: 27461375 DOI: 10.1089/thy.2015.0338] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 02/06/2023]
Abstract
BACKGROUND Iodine is essential for thyroid hormone synthesis and is an important regulator of thyroid function. Chronic iodine deficiency leads to hypothyroidism, but iodine excess also impairs thyroid function causing hyperthyroidism, hypothyroidism, and/or thyroiditis. This study aimed to investigate the underlying mechanisms by which exposure to chronic iodine excess impairs pituitary-thyroid axis function. METHODS Male Wistar rats were treated for two months with NaI (0.05% and 0.005%) or NaI+NaClO4 (0.05%) dissolved in drinking water. Hormone levels, gene expression, and thyroid morphology were analyzed later. RESULTS NaI-treated rats presented high levels of iodine in urine, increased serum thyrotropin levels, slightly decreased serum thyroxine/triiodothyronine levels, and a decreased expression of the sodium-iodide symporter, thyrotropin receptor, and thyroperoxidase mRNA and protein, suggesting a primary thyroid dysfunction. In contrast, thyroglobulin and pendrin mRNA and protein content were increased. Kidney and liver deiodinase type 1 mRNA expression was decreased in iodine-treated rats. Morphological studies showed larger thyroid follicles with higher amounts of colloid and increased amounts of connective tissue in the thyroid of iodine-treated animals. All these effects were prevented when perchlorate treatment was combined with iodine excess. CONCLUSIONS The present data reinforce and add novel findings about the disruption of thyroid gland function and the compensatory action of increased thyrotropin levels in iodine-exposed animals. Moreover, they draw attention to the fact that iodine intake should be carefully monitored, since both deficient and excessive ingestion of this trace element may induce pituitary-thyroid axis dysfunction.
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Affiliation(s)
- Jamile Calil-Silveira
- 1 Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo , São Paulo, Brazil
| | - Caroline Serrano-Nascimento
- 1 Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo , São Paulo, Brazil
| | - Raquel Cardoso Laconca
- 1 Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo , São Paulo, Brazil
| | - Letícia Schmiedecke
- 1 Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo , São Paulo, Brazil
| | - Rafael Barrera Salgueiro
- 1 Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo , São Paulo, Brazil
| | - Ayrton Kimidi Kondo
- 1 Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo , São Paulo, Brazil
| | - Maria Tereza Nunes
- 1 Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo , São Paulo, Brazil
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18
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Erisen L, Coskun H, Parlak M, Ozmen A. Fourth Branchial Arch Anomaly and Pyriform Sinus Fistula as a Rare Cause of Recurrent Retropharyngeal Abscess and Thyroiditis in an Adult. Otolaryngol Head Neck Surg 2016; 133:644. [PMID: 16213961 DOI: 10.1016/j.otohns.2004.09.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2003] [Accepted: 09/22/2004] [Indexed: 11/24/2022]
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Reechaipichitkul W, Thanasatirakul P. NOCARDIOSIS REVEALED BY THYROID ABSCESS AND PNEUMONIA IN A LIVER TRANSPLANT RECIPIENT. Southeast Asian J Trop Med Public Health 2015; 46:1055-1062. [PMID: 26867364] [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
Nocardia thyroid abscess with pneumonia is a rare clinical presentation. We reported a liver transplant recipient with Nocardia thyroiditis and pneumonia after receiving high dose immunosuppressants to preserve his graft. The patient is a 50-year-old male who developed hepatitis C virus-related liver cirrhosis and received a liver transplant. Seven months post-transplantation the patient developed graft rejection, which was treated with 3 days pulse dose methyl-prednisolone followed by an increased dose of his tracolimus, mycophenolate and prednisolone. He presented to the hospital with a 2 week history of fever, tenderness in his anterior neck and dry cough. On admission his temperature was 39.5°C. The right wing of his thyroid gland was swollen to 3 cm in size, fluctuant and tender. On auscultation of his lungs there were fine crepitations and increased vocal resonance in the right middle lung field. On laboratory testing, a complete blood count (CBC) revealed leukocytosis (19,900/mm3) with neutrophils (97%). A chest X-ray showed an patchy infiltrates and round circumscribed densities in the superior segment of the right lower lobe of his lung. A CT scan of his neck revealed a diffusely enlarged right wing of the thyroid gland, 3.8 cm in diameter that had an abnormal hyposignal area. A CT of his chest revealed consolidation of the superior segment of the right lower lobe and necrotic right paratracheal lymph nodes with inflamed strap muscles. Fine needle aspiration of the right lobe of thyroid gland was performed. Modified acid-fast bacilli (MAFB) staining showed partially acid-fast beaded branching filamentous organisms and a culture grew out Nocardia asteroides. He was treated with trimethoprim-sulfamethoxazole for 6 months. He improved clinically and his chest X-ray also cleared.
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Maleki N, Tavosi Z. Evaluation of thyroid dysfunction and autoimmunity in gestational diabetes mellitus and its relationship with postpartum thyroiditis. Diabet Med 2015; 32:206-12. [PMID: 25186500 DOI: 10.1111/dme.12580] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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] [Received: 03/05/2014] [Revised: 06/17/2014] [Accepted: 08/22/2014] [Indexed: 12/29/2022]
Abstract
AIMS To evaluate thyroid dysfunction and autoimmunity in women with gestational diabetes and to investigate the frequency of postpartum thyroiditis in women with gestational diabetes. MATERIALS AND METHODS A total of 350 women with gestational diabetes and 350 healthy pregnant women were enrolled in the study. We studied the thyroid hormone profiles of the women in each group during pregnancy (at 24-28 weeks' gestation) and after delivery (at 6 weeks, 3, 6 and 9 months, and 1 year postpartum). RESULTS A total of 342 women with gestational diabetes and 313 healthy pregnant women completed the follow-up during pregnancy and 1 year after delivery. Of the women with gestational diabetes, 16.6% had thyroid dysfunction, while of the healthy pregnant women, 6.1% had thyroid dysfunction. The prevalence of postpartum thyroiditis was higher in the women with a history of gestational diabetes (19.6%) than in the healthy pregnant women (10.2%), and this difference was statistically significant. CONCLUSION According to the results of the present study, the prevalence of postpartum thyroiditis was higher in women with a history of gestational diabetes than in healthy women. We recommend that all women with gestational diabetes and women who have previous thyroid dysfunction should be screened for thyroid hormonal abnormalities during pregnancy and for 1 year after pregnancy.
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MESH Headings
- Adult
- Autoantibodies/analysis
- Autoimmunity
- Cross-Sectional Studies
- Diabetes, Gestational/blood
- Diabetes, Gestational/immunology
- Diabetes, Gestational/physiopathology
- Diagnosis, Differential
- Female
- Follow-Up Studies
- Hospitals, Public
- Hospitals, University
- Hospitals, Urban
- Humans
- Iran/epidemiology
- Postpartum Period
- Pregnancy
- Prevalence
- Prospective Studies
- Risk
- Thyroid Gland/immunology
- Thyroid Gland/physiopathology
- Thyroiditis/diagnosis
- Thyroiditis/epidemiology
- Thyroiditis/etiology
- Thyroiditis/immunology
- Thyroiditis, Autoimmune/diagnosis
- Thyroiditis, Autoimmune/epidemiology
- Thyroiditis, Autoimmune/etiology
- Thyroiditis, Autoimmune/immunology
- Young Adult
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Affiliation(s)
- N Maleki
- Department of Internal Medicine, Shohadaye Khalije Fars Hospital, Bushehr University of Medical Sciences, Bushehr, Iran
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Sheng Q, Lv Z, Xiao X, Zheng S, Huang Y, Huang X, Li H, Wu Y, Dong K, Liu J. Diagnosis and management of pyriform sinus fistula: experience in 48 cases. J Pediatr Surg 2014; 49:455-9. [PMID: 24650477 DOI: 10.1016/j.jpedsurg.2013.07.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [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: 05/31/2013] [Revised: 07/01/2013] [Accepted: 07/20/2013] [Indexed: 12/14/2022]
Abstract
PURPOSE Pyriform sinus fistula (PSF) is often overlooked, and presents diagnostic and management challenge. The aim of this study was to highlight the value of intraoperative endoscopy-assisted intubation or methylene blue injection through the internal opening as a guide in searching for the fistula. METHODS The charts of 48 patients diagnosed with PSF during January 1990 until January 2013 were retrospectively reviewed. The records were analyzed for sex, side of lesion, age at onset/diagnosis, initial presentations, diagnostic methods, microbiologic cultures, pathologic findings, treatments and outcomes. RESULTS There were 22 males and 26 females, with a median age at onset and diagnosis of 2 years (range, 8 months to 9 years) and 4 years (range, 12 months to 13 years), respectively. The lesions were predominantly left sided (93.7%). The most common presentation was neck abscess (62.5%). Other presentations were acute suppurative thyroiditis/thyroid abscess (7), neck mass with or without dyspnea (9), and thyroid nodule (2). Barium esophagography showed the sinus tract in 100% cases. The positive predictive value of other modalities was oral-contrast CT 88.9%, intravenous contrast-enhanced CT 53.8%, noncontrast CT 33.3%, and sonography 7.9%. Thyroid function were reported normal in most tested cases (14/15, 93.3%). The fistula tract was lined with pseudostratified squamous epithelium or ciliated columnar epithelium, often associated with inflammatory changes. Bacteria cultured from the discharge were found to be oral flora. Partial thyroidectomy was operated on 11 cases. Two patients (2/8, 25%) who underwent open surgery without endoscopic assistance exhibited recurrence, while no recurrence was noted in children with the help of intraoperative endoscopy. Postoperative results were good in majority (93.7%). CONCLUSION PSF should be considered in any children with repeated neck or thyroid infection/mass. The combination of barium esophagography, CT scan and ultrasound is useful to establish the diagnosis. Intraoperative endoscopy-assisted intubation or methylene blue injection through the internal opening as a guide can facilitate identification of the tract during dissection.
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Affiliation(s)
- Qingfeng Sheng
- Department of General Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai 200040, P.R. China
| | - Zhibao Lv
- Department of General Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai 200040, P.R. China.
| | - Xianmin Xiao
- Department of Surgery, Children's Hospital of Fudan University, Shanghai 201102, P.R. China
| | - Shan Zheng
- Department of Surgery, Children's Hospital of Fudan University, Shanghai 201102, P.R. China
| | - Yimin Huang
- Department of General Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai 200040, P.R. China
| | - Xiong Huang
- Department of General Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai 200040, P.R. China
| | - Hui Li
- Department of General Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai 200040, P.R. China
| | - Yibo Wu
- Department of General Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai 200040, P.R. China
| | - Kuiran Dong
- Department of Surgery, Children's Hospital of Fudan University, Shanghai 201102, P.R. China
| | - Jiangbin Liu
- Department of Surgery, Children's Hospital of Fudan University, Shanghai 201102, P.R. China
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Rizzo LFL, Mana DL, Bruno OD. [Non-autoimmune thyroiditis]. Medicina (B Aires) 2014; 74:481-492. [PMID: 25555013] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
The term thyroiditis comprises a group of thyroid diseases characterized by the presence of inflammation, including autoimmune and non-autoimmune entities. It may manifest as an acute illness with severe thyroid pain (subacute thyroiditis and infectious thyroiditis), and conditions in which the inflammation is not clinically evident evolving without pain and presenting primarily thyroid dysfunction and/or goiter (drug-induced thyroiditis and Riedel thyroiditis). The aim of this review is to provide an updated approach on non-autoimmune thyroiditis and its clinical, diagnostic and therapeutic aspects.
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Affiliation(s)
- Leonardo F L Rizzo
- Dirección Médica Química Montpellier SA, Buenos Aires, Argentina. E-mail:
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23
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Tran HA, Jones TL, Ianna EA, Foy A, Reeves GEM. Thyroid disease in chronic hepatitis C infection treated with combination interferon-α and ribavirin: management strategies and future perspective. Endocr Pract 2013; 19:292-300. [PMID: 23186968 PMCID: PMC4134094 DOI: 10.4158/ep12195.ra] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Hepatitis C virus (HCV) infection is one of the major epidemics afflicting young people in both developed and developing countries. The most common endocrine disorder associated with this infection, especially in conjunction with interferon-α (IFN-α)-based therapy, is thyroid disease (TD). This review examines the development of TD before, during, and after the completion of treatment with combination IFN-α and ribavirin (RBV) for chronic HCV infection. We also summarize the current understanding of the natural history of the condition and propose management and follow-up guidelines. METHODS PubMed was searched up to June 30, 2011 for English-language publications that contained the search terms "hepatitis C virus," "chronic hepatitis C," "HCV," "thyroid disease," "thyroiditis," "autoimmunity," "interferon-alpha," and "ribavirin." Additional publications were identified from the reference lists of identified papers. The included studies were original research publications and included combination IFN-α and RBV use in patients that developed TD. RESULTS The prevalence of TD before combination IFN-α and RBV therapy ranges from 4.6 to 21.3%; during therapy, 1.1 to 21.3%; and after therapy, 6.7 to 21.3%. The most common TD is thyroiditis. Thyroid function testing (TFT) frequency and diagnostic criteria for various thyroid conditions are not standardized, and many of the existing studies are retrospective. CONCLUSION Patients undergoing this therapy should be assessed with a standardized protocol to appropriately detect and manage developed TD. Based on the currently available literature, we recommend that patients receiving combination interferon-α and RBV therapy undergo monthly thyrotropin (TSH) level testing.
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Affiliation(s)
- Huy A Tran
- Department of Clinical Chemistry, Hunter Area Pathology Service, Newcastle, New South Wales, Australia.
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24
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Buffet C, Groussin L. [Thyroiditis]. Rev Prat 2013; 63:171-177. [PMID: 23513772] [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] [Indexed: 06/01/2023]
Abstract
The diagnosis of thyroiditis encompasses a broad spectrum of thyroid disorders. Analysis of signs and symptoms, biochemical changes, neck ultrasound characteristics and radioactive iodine uptake values allows an accurate diagnosis. Recent studies of the whole genome have helped to identify many susceptibility genes for autoimmune thyroiditis. However, none of these genes contribute to a significant increase in risk of developing this thyroiditis. Clinical awareness of the characteristic presentations of exceptional thyroiditis (acute suppurative thyroiditis, Riedel's thyroiditis) is an important issue. Selenium administration seems to be beneficial for reducing the incidence of thyroiditis. Finally, certain drug-induced thyroiditis remains a therapeutic challenge for the physician.
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Affiliation(s)
- Camille Buffet
- Service de médecine nucléaire, groupe hospitalier La Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
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25
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Rotondi M, Coperchini F, Pignatti P, Sideri R, Groppelli G, Leporati P, La Manna L, Magri F, Mariotti S, Chiovato L. Interferon-γ and tumor necrosis factor-α sustain secretion of specific CXC chemokines in human thyrocytes: a first step toward a differentiation between autoimmune and tumor-related inflammation? J Clin Endocrinol Metab 2013; 98:308-13. [PMID: 23118425 DOI: 10.1210/jc.2012-2555] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [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 Chemokines are chemotactic cytokines responsible for the attraction and recruitment of different cell types during leukocyte infiltration, the histopathological hallmark of autoimmunity. Previous data demonstrate that thyrocytes secrete CXC chemokines, particularly CXCL8 and CXCL10. However, the physiopathological significance of such secretion and the effects of a combination of proinflammatory stimuli in terms of preferential CXCL8 and CXCL10 release remain unclear. OBJECTIVE The aim of this study was to investigate whether the secretion of chemokines by human thyrocytes is a generalized inflammatory response or whether it is dependent upon specific proinflammatory stimuli. METHODS CXCL8 and CXCL10 were measured in supernatants of human thyrocytes in primary cultures basally and after 24 h stimulation with interferon-γ (IFNγ) (1000 U/ml) and TNFα (10 ng/ml), alone or in combination. RESULTS CXCL8 but not CXCL10 was detected in basal conditions. The two chemokines showed differences in their response to proinflammatory cytokines. Indeed, significant secretion of CXCL10 was induced by IFNγ (P < 0.01) and not TNFα, whereas CXCL8 was secreted in response to TNFα (P < 0.01) being inhibited by IFNγ (P < 0.01). The combination of TNFα plus IFNγ synergistically increased the IFNγ-induced CXCL10 secretion (P < 0.01) and reversed the TNFα-induced CXCL8 secretion (P < 0.01). CONCLUSIONS These results confirm that human thyrocytes secrete CXC chemokines and demonstrate that the secretion of CXCL8 and CXCL10 is sustained by specific proinflammatory cytokines or their combination, which ultimately determines the nature of the infiltrating lymphocytes in human thyroid diseases. These results indirectly support a major role for CXCL10 in thyroid autoimmunity whereas CXCL8 might be involved in tumor-related inflammation.
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Affiliation(s)
- Mario Rotondi
- Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri Istituto di Ricovero e Cura a Carattere Scientifico, University of Pavia, Via S. Maugeri 10, I-27100, Pavia, Italy
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Zaïnine R, Sethom A, Kharrat S, Tabbabi S, Beltaïef N, Sahtout S, Besbes G. [Riedel's thyroiditis]. Tunis Med 2012; 90:262. [PMID: 22481187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Mizumoto K, Sumikawa Y, Niihara H, Morita E. Case of carbamazepine-induced hypersensitivity syndrome associated with human leukocyte antigen-A*3101. J Dermatol 2011; 39:791-2. [PMID: 22168592 DOI: 10.1111/j.1346-8138.2011.01421.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Makita N, Isojima T, Hiwatari M, Kitanaka S, Ida K, Iiri T. Painful thyroiditis and subsequent atrophic hypothyroidism after cord blood transfusion. Thyroid 2011; 21:1157-8. [PMID: 21875364 DOI: 10.1089/thy.2010.0352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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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Abstract
CONTEXT Riedel's thyroiditis is a rare inflammatory process involving the thyroid and surrounding cervical tissues and is associated with various forms of systemic fibrosis. Riedel's presentation is complex, including a thyroid mass associated with local symptoms, characteristic biochemical abnormalities such as hypocalcemia and hypothyroidism, as well as the involvement of a wide range of other organ systems. Diagnosis of Riedel's thyroiditis requires histopathological confirmation, but due to high complication rates, the role of surgical intervention is limited to airway decompression and diagnostic tissue retrieval. Unique among processes of the thyroid, Riedel's is commonly treated with long-term antiinflammatory medications to arrest progression and maintain a symptom-free course. Due to its rarity, Riedel's may not be immediately diagnosed, so clinicians benefit from recognizing the constellation of findings that should make prompt diagnosis possible. EVIDENCE ACQUISITION A review of print and electronic reviews was conducted. Source references were identified, and available literature was reviewed. A search of the PubMed database using the search term "Riedel's thyroiditis" was cross-referenced with associated clinical findings, systemic fibrosis diagnoses, and therapeutic search terms. Because most of the literature consisted of case reports and very small series, inclusion of identified articles was based on clinical descriptions of the subjects included and the criteria for diagnosis reported. More weight was attributed to series, using contemporary criteria for diagnosis. Case reports were included if the diagnosis was clear and clinical presentation was unique to illustrate the spectrum of disease. EVIDENCE SYNTHESIS Because the majority of therapeutic intervention data were based upon case reports and very small series, an evidence-based approach was problematic, but information is presented as objectively and with as much balance as the limited quality of the data allows. CONCLUSIONS Clinical awareness of the characteristic presentations of Riedel's thyroiditis should enhance our ability to make this diagnosis in a timely and focused manner. Recognition of certain clinical finding patterns will increase the likelihood of recognizing Riedel's thyroiditis promptly. Local restrictive or infiltrative symptoms out of proportion to a demonstrable mass or simultaneous biochemical deficiencies especially of calcium should lead the clinician to consider this diagnosis. Likewise in this setting, the surgeon alert to this possibility may minimize overly aggressive surgical intervention, thus avoiding complications. Once Riedel's thyroiditis is diagnosed, the application of antiinflammatory therapies may greatly enhance the clinical outcome. Understanding the pathophysiological relationship of this entity with other forms of systemic fibrosis and the role that IgG4 may play in this process should result in enhanced diagnostic and therapeutic tools in the future.
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Affiliation(s)
- James V Hennessey
- Beth Israel Deaconess Medical Center, Division of Endocrinology, 330 Brookline Avenue, GZ-6, Boston, Massachusetts 02215.
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Abstract
Autoimmune thyroid diseases (AITD) are postulated to develop as a result of a complex interplay between several genetic and environmental influences. The pathogenesis of AITD is still not clearly defined. However, among the implicated triggers (e.g. iodine, infections, medications), more recent data confirmed strong associations of AITD with the hepatitis C virus (HCV) infection and interferon-α (IFNα) therapy. Moreover, it is likely that HCV and IFN act in synergism to trigger AITD in patients. Indeed, approximately 40% of HCV patients develop either clinical or subclinical disease while receiving IFNα. Interferon induced thyroiditis (IIT) can manifest as non-autoimmune thyroiditis (presenting as destructive thyroiditis, or non-autoimmune hypothyroidism), or autoimmune thyroiditis [presenting with clinical features of Graves' disease (GD) or Hashimoto's thyroiditis (HT)]. Although not yet clearly understood, it is thought that IFNα can induce thyroiditis via both immune stimulatory and direct toxic effects on the thyroid. In view of the high frequency of IIT, routine screening and surveillance of HCV patients receiving IFNα is recommended to avoid the complications, such as cardiac arrhythmias, associated with thyrotoxicosis. In summary, IIT is a common clinical problem that can be readily diagnosed with routine thyroid function screening of HCV patients receiving IFN. The treatment of IIT consists of the standard therapy for differing clinical manifestations of IIT such as GD, HT, or destructive thyroiditis. However, anti-thyroid medications are not recommended in this setting since they can potentially be hepatotoxic.
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Affiliation(s)
- F Menconi
- Division of Endocrinology, Department of Medicine, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA.
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Lin JD, Hsueh C, Huang BY. Papillary thyroid carcinoma with different histological patterns. Chang Gung Med J 2011; 34:23-34. [PMID: 21392471] [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] [Indexed: 05/30/2023]
Abstract
Tumor-node-metastasis (TNM) staging is the most commonly used model for evaluating therapeutic strategies for papillary thyroid cancer (PTC). Additionally, different histopathological patterns and variants of PTC have been reported to influence the prognosis of these patients. We reviewed the clinical presentation, cancer recurrence, and cancer-specific mortality of the most frequent histological patterns, including the follicular variant (FVPTC), insular pattern, tall cell pattern, diffuse sclerosing type, PTC with Hashimoto's thyroiditis, and multicentric PTC. The tall cell variant of PTC is a more aggressive variant than classical PTC and has a poor prognosis. The high expression of Muc 1 and type IV collagenase in these tumors may facilitate stromal degradation and increase the invasive potential. In contrast, approximately 18% of PTC patients have been identified as having FVPTC. FVPTC patients have a better survival rate than those with follicular thyroid cancer, and fewer instances of lymph node or soft tissue invasion than control patients with classical PTC. The diffuse sclerosing variant of PTC predominantly observed in young patients is a rare aggressive tumor that requires intensive treatment. Despite characteristic clinical and histological features that facilitate easy diagnosis, pre-operative fine needle aspiration cytological diagnosis of this variant is often challenging. Different histological variants of PTC with other histological patterns are important for predicting cancer recurrence. In addition to TNM staging, high-risk histological patterns of PTC require more aggressive follow-up examinations and postoperative adjuvant therapies.
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Affiliation(s)
- Jen-Der Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Agrawal NK. Thyroiditis. J Assoc Physicians India 2011; 59 Suppl:46-50. [PMID: 21819004] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- N K Agrawal
- Department of Endocrinology and Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221005. India
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Iwamoto S, Kakei S, Tanaka H, Fujii T, Toda T, Matsui N. [Adult male with tubulointerstitial nephritis and uveitis syndrome complicated with thyroiditis]. Nihon Jinzo Gakkai Shi 2010; 52:523-528. [PMID: 20560474] [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] [Indexed: 05/29/2023]
Abstract
Renal dysfunction was detected by routine medical examination in a 46-year-old man (blood urea nitrogen : 26 mg/dL, creatinine : 2.4 mg/dL and moderate proteinuria). A few weeks later, he visited a local ophthalmologist complaining of left eye pain and red eye. He was diagnosed as left uveitis, prescribed eye-drops and referred to our hospital for further examination. At the first visit, test results pointed to renal dysfunction and a high level of thyroid hormones (creatinine : 1.8 mg/dL, free T3 : 7.41 microg/mL, free T4 : 3.18 ng/dL, thyroid stimulating hormone : 0.010micro IU/mL). Gallium scintigraphy showed an increased uptake of the tracer in bilateral thyroid glands, parotid glands and kidneys. No autoantibodies to thyroid gland were detected. Ultrasonography of the thyroid gland revealed no abnormal findings. Renal biopsy showed interstitial nephritis with minor glomerular abnormalities except for a few sclerotic changes. As no improvement was observed after stopping all drugs, and no disease causing uveitis was detected, he was diagnosed as tubulointerstitial nephritis and uveitis syndrome (TINU syndrome). After oral glucocorticoid was prescribed (prednisolone 15 mg/day), both renal function and thyroid abnormalities were normalized gradually. TINU syndrome with hyperthyroidism is rare. Although the precise etiology is not known, the same mechanism might occur in the thyroid gland as in TINU syndrome where abnormal cellular immunity, especially in helper T cell is said to play a role. In conclusion, in cases of TINU syndrome, systemic investigation, including the thyroid gland should be mandatory.
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Affiliation(s)
- Shunsuke Iwamoto
- Division of Nephrology, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
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Neves C, Alves M, Delgado L, Medina JL. [Post-partum thyroiditis]. ACTA MEDICA PORT 2009; 22:599-608. [PMID: 19944044] [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] [Received: 03/27/2008] [Accepted: 09/22/2009] [Indexed: 05/28/2023]
Abstract
In the post-partum period the immune alterations are associated with the multiple autoimmune diseases relapse. After birth, immune-tolerance variation slowly disappear, and is observed a return to a normal state - after an exacerbation period - of autoimmune reactivity, during which a great increase in T cells and autoantibodies is observed. In this period - 3 to 9 months after birth - the thyroid autoimmune disease relapses or reappears. The reactivation of the immune system in the post-partum period unchains an acute phase of celular destruction which characterizes the post-partum thyroiditis.
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Affiliation(s)
- Celestino Neves
- Serviço de Endocrinologia. Hospital de São João/Faculdade de Medicina do Porto. Porto
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Córdoba F, Piñera JG, Anselmi EH, Cano RR. [Acute thyroiditis and cervical abscesses as manifestations of the pyriform sinus fistulae]. Cir Pediatr 2009; 22:157-161. [PMID: 19957866] [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] [Indexed: 05/28/2023]
Abstract
Pyriform sinus fistula is a rare malformation causing recurrent cervical abscesses and acute suppurative thyroiditis, with a low incidence in general, as the thyroid gland is remarkably resistant to infections. The aim of this paper is to describe the clinical data, diagnosis, treatment and evolution of four cases of pyriform sinus fistulas treated at our institution over the last 15-year period. All appeared at the beginning with left laterocervical inflammatory tumours, with radiological signs of acute suppurative thyroiditis in one case and with heterogeneous masses near the isthmus of the thyroid gland in the rest of them. The fistulous tracts were delineated by barium studies and/or fibro-laryngoscopy. The treatment of the acute phase consisted of broad-spectrum antibiotic therapy with an initial incision and drainage procedures. At the end, a subsequent fistulectomy was made. A left hemithyroidectomy was accomplished at two cases. All the patients remained asymptomatic after the treatment except one girl that suffered recurrence seven years later. For a suitable diagnosis a high index of suspicion are necessary. The best therapeutic option is a good delineation and complete excision of the fistulous tract by cervical approach until disconnecting it of its origin at the hypopharynx. In order to avoid recurrences, the resection of the portion of the involved thyroid gland is recommended.
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Affiliation(s)
- Fernández Córdoba
- Servicio de Cirugía Pediátrica, Complejo Hospitalario Universitario de Albacete, Albacete.
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Nicoucar K, Giger R, Pope HG, Jaecklin T, Dulguerov P. Management of congenital fourth branchial arch anomalies: a review and analysis of published cases. J Pediatr Surg 2009; 44:1432-9. [PMID: 19573674 DOI: 10.1016/j.jpedsurg.2008.12.001] [Citation(s) in RCA: 126] [Impact Index Per Article: 8.4] [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: 10/05/2008] [Revised: 12/01/2008] [Accepted: 12/01/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND/PURPOSE Congenital fourth branchial arch anomalies are uncommon entities, heretofore described only in case reports, affecting primarily children, and typically presenting as a cervical inflammatory process. The aim of the study was to collect appropriate data on the diagnosis, treatment, and outcome of this condition and to suggest guidelines for its management. METHODS We conducted a structured review of the literature for cases explicitly identified as congenital fourth branchial arch anomalies or meeting anatomical criteria for this condition. We computed descriptive statistics and performed several post hoc 2-way comparisons of subgroups of cases. RESULTS We located and critically evaluated 526 cases. Fourth arch anomalies were usually located on the left (94%) and generally presented as acute suppurative thyroiditis (45%) or recurrent neck abscess (42%). Barium swallow and direct laryngoscopy were the most useful diagnostic tools. Treatment options differed mainly in recurrence rates: incision and drainage, 89%; open neck surgery and tract excision, 15%; endoscopic cauterization of the sinus tract opening, 15%; and open neck surgery with partial thyroidectomy, 8%. Complications after surgery occurred primarily in children 8 years or younger. CONCLUSION Fourth arch anomalies are more common than once thought. Treatment of these disorders with repeated incision and drainage yields high rates of recurrence; thus, complete excision of the entire fistula tract during a quiescent period appears preferable. Combining this surgery with partial thyroidectomy may further decrease recurrence rates. Complications can likely be minimized by using antibiotic treatment of acute infections or endoscopic cauterization in children 8 years or younger, and delaying open neck surgery.
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Affiliation(s)
- Keyvan Nicoucar
- Department of Otolaryngology, Head and Neck Surgery, University Hospital, 1211 Geneva, Switzerland.
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Desailloud R, Goffard A, Page C, Kairis B, Fronval S, Chatelain D, Strunski V, Dubreuil A, Hober D. Detection of enterovirus RNA in postoperative thyroid tissue specimens. Clin Endocrinol (Oxf) 2009; 70:331-4. [PMID: 18616703 DOI: 10.1111/j.1365-2265.2008.03331.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [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: 11/30/2022]
Abstract
CONTEXT Autoimmune thyroiditis is a very common disease. A genetic predisposition and environmental factors such as viruses are thought to contribute to the development of autoimmune thyroiditis. Enteroviruses, which are involved in other autoimmune diseases, are attractive candidates. OBJECTIVE To investigate the presence of enteroviral genome sequences in postoperative thyroid tissues with lymphocytic infiltration, a common histological feature of thyroiditis. SUBJECTS AND METHODS Postoperative thyroid specimens collected prospectively from 86 patients were blindly frozen at -80 degrees C. The presence of EV genome sequences in the samples was blindly investigated by real-time RT-PCR. Clinical data, histological findings and levels of anti-TPO antibodies were collected. RESULTS EV-RNA detection was positive (up to 36 cycles) or weakly positive (37-39 cycles) in 22 out of 86 patients (25%). EV-RNA (positive or weakly positive signal) was detected in 5 out of 27 (18.5%) thyroid specimens with lymphocytic infiltration, and in 17 out of 59 (29%) thyroid specimens without lymphocytic infiltration (P = 0.4). No correlation was observed between EV-RNA detection in thyroid and the presence of anti-TPOAb. EV-RNA was detected in 3 out of 11 patients histologically diagnosed as thyroiditis (27.3%) and in 18 out of 74 patients (24.3%) with thyroid tumours (multinodular goitre, adenoma and carcinoma) (P = 0.5) and in one patient with a normal thyroid. CONCLUSION EV-RNA can be detected in thyroid tissue from patients with various thyroid diseases, but there is no relationship between the presence of EV-RNA and thyroiditis. Further studies are needed to clarify the role of EV in thyroid diseases.
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Affiliation(s)
- Rachel Desailloud
- Laboratoire de Virologie/UPRES EA3610 Faculté de Médecine, Université Lille 2, CHRU Lille, Lille, France
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Abstract
OBJECTIVE Lymphocytic hypophysitis (LH) is a rare chronic inflammatory disorder characterized by lymphocytic infiltration of the pituitary gland commonly affecting women during pregnancy or post-partum period. The pathogenesis remains uncertain, however an autoimmune process is frequently implicated. There is limited data on the occurrence of LH outside the setting of autoimmunity. CASE We describe a 37-year-old man presenting with diarrhoea, nausea, weight loss, low-grade fever, headache and cerebrospinal fluid analysis consistent with aseptic meningitis. Magnetic resonance imaging (MRI) demonstrated a homogenously enlarged pituitary gland with biochemical testing revealing partial hypopituitarism with adenocorticotrophic hormone and gonadotrophin deficiency. Notably, his free thyroid hormone levels were elevated with a suppressed thyroid-stimulating hormone and a suppressed thyroid technetium scan consistent with thyroiditis. Tissue antibodies including thyroid antibodies were negative. Following introduction of hydrocortisone, he developed transient diabetes insipidus which spontaneously resolved after 4 months. Thyrotoxicosis resolved after 5 weeks and thyroxine was commenced as he developed secondary hypothyroidism. Repeat MRI 3 months later showed a reduction in the size of the pituitary gland which by 6 months had returned to normal size. He remains well on hydrocortisone, thyroxine and testosterone replacement. CONCLUSIONS Based on clinical and radiological grounds, the diagnosis was consistent with lymphocytic hypophysitis associated with subacute thyroiditis. This is only the second report of this combination in the absence of autoimmunity and the first report of LH and thyroiditis with associated aseptic meningitis in the absence of tissue autoantibodies. We propose a possible viral illness as the unifying aetiological cause.
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Affiliation(s)
- Sarina Lim
- Department of Endocrinology, Waikato Hospital, Hamilton, New Zealand.
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Cherk MH, Kalff V, Yap KSK, Bailey M, Topliss D, Kelly MJ. Incidence of radiation thyroiditis and thyroid remnant ablation success rates following 1110 MBq (30 mCi) and 3700 MBq (100 mCi) post-surgical 131I ablation therapy for differentiated thyroid carcinoma. Clin Endocrinol (Oxf) 2008; 69:957-62. [PMID: 18419785 DOI: 10.1111/j.1365-2265.2008.03276.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [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: 11/29/2022]
Abstract
OBJECTIVE To evaluate the relationships between thyroid remnant (131)I uptake, radiation thyroiditis and remnant ablation success rate between lower (1110 MBq) and higher (3700 MBq) initial ablative (131)I dose for post-surgical ablation therapy for differentiated thyroid cancer. DESIGN Patients having post-surgical administration of 1110 MBq (68 patients) or 3700 MBq (115 patients) (131)I were retrospectively reviewed. Thyroid remnant (131)I uptake on a 48 h post-administration scan was correlated with neck symptoms experienced. Patients were classified as having insignificant, mild or severe thyroiditis based on symptoms. Absent thyroid bed (131)I uptake on a follow-up 74 MBq (131)I study was considered successful ablation. RESULTS 183 patients were included. Median (131)I remnant uptake was 37 MBq. 21% (39/183) of patients developed thyroiditis. Incidence and severity of thyroiditis increased with increasing remnant (131)I activity (P <or= 0.0001). Risk of thyroiditis increased by 64% for every 37 MBq increase in remnant (131)I uptake. OR = 1.64 [1.36-1.99]. Severe thyoriditis was only seen with remnant (131)I uptake > 73 MBq. For patients treated with 1110 MBq and 3700 MBq, incidence of thyroiditis was 12% and 27% (P = 0.02) and remnant ablation success rate was 76% and 84% (P = NS), respectively. Occurrence of thyroiditis did not correlate with successful ablation. CONCLUSIONS Incidence and severity of radiation thyroiditis following (131)I remnant ablation therapy is directly related to thyroid remnant (131)I uptake. As 1110 MBq (131)I is associated with a significantly lower frequency of thyroiditis but similar remnant ablation rate to 3700 MBq, it warrants consideration for thyroid remnant ablation particularly in patients with low risk disease.
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Affiliation(s)
- Martin H Cherk
- Department of Nuclear Medicine, The Alfred Hospital, Melbourne, Victoria 3004, Australia.
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Kasayama S, Kitamura T, Inaba M, Otsuki M, Asanuma N, Kouhara H. Painless thyroiditis occurring during post-menopausal period, following remission of Graves' disease. J Endocrinol Invest 2008; 31:92-3. [PMID: 18296912 DOI: 10.1007/bf03345573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/25/2022]
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Abstract
Factors that should be considered when studying the effect of dietary iodine in the development of thyroid cancer include pathological criteria, diagnostic techniques, screening programs, radioactive fallout, and standard of medical care in the studied population. In most surveys, papillary carcinoma forms the largest group of thyroid malignancies, both before and after iodine prophylaxis where an increase in the papillary:follicular carcinoma ratio is also noted. Undifferentiated carcinomas decrease after salt prophylaxis. In Salta, Argentina, the increasing incidence of clinically significant papillary thyroid cancer and the decrease of undifferentiated carcinoma after iodine prophylaxis are probably due to better access to health centers and consequent earlier detection of differentiated precursor tumors. Autoimmune focal and diffuse or Hashimoto's thyroiditis are linked to dietary iodine. Pathological studies made in different regions indicate that these types of thyroiditis occur more frequently in areas of iodine sufficiency than in areas of iodine deficiency, and increase after iodine prophylaxis both in non-goitrous and iodine-deficient areas like Salta, Argentina. An increase of lymphocytic thyroiditis could be linked to an increased incidence of primary thyroid lymphoma, and thyroiditis is more commonly associated with papillary carcinoma than with other types of thyroid follicular or C-cell derived carcinomas regardless of iodine intake.
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MESH Headings
- Adenocarcinoma, Follicular/epidemiology
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/prevention & control
- Adenoma/epidemiology
- Adenoma/pathology
- Adenoma/prevention & control
- Argentina
- Carcinoma, Papillary, Follicular/epidemiology
- Carcinoma, Papillary, Follicular/pathology
- Carcinoma, Papillary, Follicular/prevention & control
- Diet
- Female
- Goiter, Endemic/complications
- Goiter, Endemic/epidemiology
- Goiter, Endemic/prevention & control
- Humans
- Iodine/administration & dosage
- Iodine/adverse effects
- Male
- Models, Biological
- Sodium Chloride, Dietary/administration & dosage
- Sodium Chloride, Dietary/adverse effects
- Thyroid Neoplasms/epidemiology
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/prevention & control
- Thyroiditis/epidemiology
- Thyroiditis/etiology
- Thyroiditis/pathology
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Affiliation(s)
- H Rubén Harach
- Servicio de Patología, Hospital "Dr. A. Oñativia", E. Paz Chain 36, 4400 Salta, Argentina.
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Lynn WRD, Lynn JA. Tailor treatment to the patient in thyrotoxicosis. Practitioner 2007; 251:37, 39, 41 passim. [PMID: 17784663] [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] [Indexed: 05/17/2023]
Abstract
All the management options for thyrotoxicosis have advantages and disadvantages. It is important to have a full discussion with the patient to ensure that a treatment option is selected that is tailored to the individual.
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Inoue M, Kojima Y, Shinde A, Satoi H, Makino F, Kanda M, Shibasaki H. [Concurrence of myasthenia gravis, polymyositis, thyroiditis and eosinophilia in a patient with type B1 thymoma]. Rinsho Shinkeigaku 2007; 47:423-8. [PMID: 17710886] [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: 05/16/2023]
Abstract
We presented a 43-year-old Japanese woman who acutely developed weakness of all extremities and difficulty in swallowing and drooping of eyelids, characterized by easy fatigability at the end of December, 2005. On general physical examination, she had moderate goiter. No cervical lymphadenopathy, cardiac murmur, or skin rash was noted. Neurologically, she had blepharoptosis, more on the right, only in the upright position with easy fatigability and marked weakness in the neck flexor, trunk, and all limb muscles much more proximally than distally. She had neither muscular atrophy nor upper motor neuron sign. Laboratory data showed slight leukocytosis with eosinophilia (up to 31%), and serum creatine kinase was markedly increased to over 2,000 IU/l. TSH receptor antibody (11.9%) and anti-acetylcholine receptor antibody (46.6 nmol/L) were also increased. Edrophonium test was positive. Electrophysiologically, muscle evoked potentials by repetitive motor nerve stimulation showed 13% and 50% waning in abductor pollicis brevis and deltoid muscle, respectively, at low frequency and no waxing at high frequency. Needle EMG showed fibrillation potentials and positive sharp waves in proximal muscles. Polymyositis was diagnosed by muscle biopsy which showed infiltration of lymphocytes in the endomysium and around non-necrotic muscle fibers. Upper arm muscle MRI showed multifocal high signal intensity lesions on T2-weighted images which were likely related to myositis. This finding is atypical for polymyositis. X-ray and CT of chest showed a mass lesion in the left pulmonary hilum, which was histologically diagnosed as type B1 thymoma. Thus, the present case had myasthenia gravis, polymyositis, thyroidititis and eosinophilia associated with type B1 thymoma. After the thymectomy, corticosteroid administration and immunoadsorption therapy, clinical symptoms and all laboratory abnormalities markedly improved.
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Affiliation(s)
- Manabu Inoue
- Department of Neurology, Ijinkai Takeda General Hospital
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Abstract
Prolonged intake of large amounts of iodide has been reported to increase the incidence of goiter and/or hypothyroidism in humans as well as animals prone to spontaneous autoimmune thyroiditis. In the current study, we investigated the role of dietary iodide on the development of hypothyroidism, as well as thyroiditis, in strains of mice that do not develop spontaneous autoimmune thyroiditis. Intake of 0.05% NaI via drinking water for 10 wk induced hypothyroidism in SJL/J mice as indicated by elevated TSH and depressed total T(4) values in serum and formation of colloidal goiter with an inactive flattened thyroid epithelium. Hypothyroidism did not appear to have an autoimmune basis because only focal mononuclear cell infiltrates were found intrathyroidally, and antithyroglobulin antibodies or increased organification of iodide were not detected. These phenomena were not observed in similarly treated CBA/J mice, suggesting polymorphisms in genes controlling events downstream of iodide uptake by thyrocytes. Interestingly, RT-PCR analysis indicated that unlike CBA/J, SJL/J mice could not down-regulate Na/I symporter gene expression during the NaI treatment. No significant temporal or strain differences were observed regarding the expression of thyroglobulin, pendrin, thyroid peroxidase, and DUOX1 and DUOX2 genes after NaI intake. Our results point to the generation of a mouse model for the study of iodine-induced hypothyroidism, which does not seem to have an autoimmune basis.
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Affiliation(s)
- Haiyan S Li
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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Abstract
Neck masses are common and have a variety of infectious agents and noninfectious causes. This article reviews the more common infectious causes of neck masses-cervical lymphadenitis, suppurative parotitis, thyroiditis, and infected cysts. Important clinical pearls, diagnostic evaluation including laboratory studies, and imaging are summarized. Methods for prevention are highlighted.
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Affiliation(s)
- Nawaf Al-Dajani
- Division of Infectious and Immunological Diseases, Department of Pediatrics, BC Children's Hospital, 4480 Oak Street, University of British Columbia, Vancouver, BC V6H 3N1, Canada
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Affiliation(s)
- Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
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Affiliation(s)
- Elizabeth N Pearce
- Boston University Medical Center, 88 East Newton Street, Evans 201, Boston, MA 02118, USA.
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Kamijo K. [Painless thyroiditis]. Nihon Rinsho 2006; Suppl 1:430-3. [PMID: 16776182] [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] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
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Gemma R. [Riedel's thyroiditis]. Nihon Rinsho 2006; Suppl 1:441-4. [PMID: 16776185] [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] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
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