IL-6 and IL-10 gene polymorphisms and susceptibility to autoimmune thyroid disease: a Meta analysis / 中华地方病学杂志

Objective:To clarify the relationship between interleukin (IL)-6, IL-10 gene polymorphisms and autoimmune thyroid disease (AITD).Methods:Literature search was conducted through databases such as PubMed, Web of Science, CNKI, Embase, Wanfang Database and VIP.com, and domestic and foreign literatures related to IL-6, IL-10 gene polymorphisms and AITD were included in the study. The time limit was from the self-built of the databases to July 2021. Meta-analysis was performed with STATA 16.0 software, the odds ratio ( OR) and 95% confidence interval ( CI) were used as effect indicators, random-effect or fixed-effect model was selected according to the heterogeneity results, and the source of heterogeneity was explored through subgroup analysis. Publication bias was assessed using funnel plots and Egger's test. Results:Finally, 19 literatures were included, all in English. There were 12 studies on IL-6 genes and 11 studies on IL-10 genes, including 4 studies on both IL-6 and IL-10 genes. In the whole population, the loci associated with AITD were IL-6 -174 G/C site (GG vs CC + GC: OR =1.94, 95% CI = 1.01 - 3.76), IL-6 -572 G/C site (GG + GC vs CC: OR = 0.49, 95% CI = 0.29 - 0.84; GG vs CC + GC: OR = 0.76, 95% CI = 0.60 - 0.96; GG + CC vs GC: OR = 0.63, 95% CI = 0.49 - 0.81), IL-10 -819 T/C site (TT + TC vs CC: OR = 1.84, 95% CI = 1.01 - 3.34; T vs C: OR = 1.59, 95% CI = 1.00 - 2.51), and IL-10 -1 082 A/G site (AA + AG vs GG: OR = 0.77, 95% CI = 0.64 - 0.92; AA vs GG + AG: OR = 2.03, 95% CI = 1.16 - 3.58; A vs G: OR = 0.76, 95% CI = 0.61 - 0.94). The results of subgroup analysis showed that in Asian population, the loci associated with AITD were IL-6 -174 G/C site (GG vs CC + GC: OR = 4.61, 95% CI = 1.11 - 19.23; G vs C: OR = 0.65, 95% CI = 0.44 - 0.97); IL-6 -572 G/C site (GG vs CC + GC: OR = 0.64, 95% CI = 0.41 - 0.99; GG + CC vs GC: OR = 0.60, 95% CI = 0.38 - 0.94); IL-10 -819 T/C site (TT + TC vs CC: OR = 2.51, 95% CI = 1.48 - 4.25; T vs C: OR = 1.91, 95% CI = 1.05 - 3.46); and IL-10 -1 082 A/G site (AA + AG vs GG: OR = 0.66, 95% CI = 0.52 - 0.84; AA vs GG + AG: OR = 2.83, 95% CI = 1.54 - 5.21; A vs G: OR = 0.66, 95% CI = 0.53 - 0.82). Conclusion:IL-6 -174 G/C, IL-6 -572 G/C, IL-10 -819 T/C and IL-10 -1 082 A/G polymorphisms are associated with the susceptibility to AITD, especially in Asians.

Single-cell transcriptome analysis of T cells in thyroid and peripheral blood of patients with Hashimoto′s thyroiditis / 中华内分泌代谢杂志

Objective:To construct single-cell transcription landscape of T cell in peripheral blood mononuclear cells(PBMCs) and thyroid tissue of patients with Hashimoto ′s thyroiditis(HT), and to analyze the changes in the proportion and functionality of T cell clusters in HT disease state.Methods:Single cell RNA sequencing was performed on PBMCs and thyroid tissue from 5 HT patients. Single cell RNA sequencing data of PBMCs from 5 healthy individuals were retrieved from public databases. After preliminary clustering, the clusters expressing CD3E were extracted and clustering again, and the names of each cluster were determined according to the known cell markers. The proportion of each cell subtype was compared, and the differentially expressed genes in different samples were analyzed.Results:After quality control, the 71 533 T cells were classified into 19 cell clusters. Among them, the proportion and function of C1_CD4 + Naive T cell clusters, C3_CD4 + Treg cell clusters, C7_CD8 + Naive T cell clusters, C8_GNLY -CD8 + T cell clusters, C10_RORC + CD8 + T cell clusters, C11_ GZMK + CD8 + T cell clusters, C12_CCL4 + CD8 + T cell clusters, and C18_PTGDS + NK cell clusters in thyroid tissue of HT patients were significantly different from those in PBMCs of healthy controls and HT patients. Conclusion:The proportion of multiple T cells in thyroid tissue of HT patients were significantly different from those in PBMCs. Among them, the proportion of three of CD8 + T cell subsets with high expression of cell killing-related genes in thyroid tissue T cells of HT patients is higher than that in PBMCs T cells, and it is statistically significant. In addition, the functionality of various T cells in the thyroid tissue of HT patients are also significantly different from those in PBMCs. A cluster of GZMK + CD8 + T cells showes significantly lower expression of genes related to PD1 pathway in thyroid tissues of HT patients compared with cells in PBMCs of HT patients, also a cluster of CCL4 + CD8 + T cells showes significantly lower expression of genes related to IL-12 pathway.

Incidence of TPOAb over a 4-year follow-up period: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

ABSTRACT Objective: Although some previous data have suggested a high iodine intake in Brazil, the prevalence of antithyroperoxidase antibodies (TPOAb) in the country is compatible with rates from countries with adequate iodine intake. This observation emphasizes the importance of knowing the incidence of TPOAb in Brazil. Materials and methods: This prospective analysis included euthyroid participants with negative TPOAb at baseline and a thyroid function assessment at a 4-year follow-up. TPOAb was measured by electrochemiluminescence and considered positive when titers were ≥34 IU/mL. TSH and free T4 (FT4) levels were determined by a third-generation immunoenzymatic assay. The incidence of TPOAb is expressed in percentage per year or as a cumulative incidence within the 4-year follow-up period. Results: Of 8,922 euthyroid participants (mean age 51.1 years; 50.9% women) with a negative TPOAb test at baseline, 130 presented incident TPOAb at the 4-year follow-up, yielding an annual incidence of TPOAb of 0.38%/year (95% confidence interval [95% CI], 0.37-0.39%/year) and a cumulative incidence over 4 years of 1.46% (95% CI, 1.21-1.71%). In men, the annual incidence was 0.32% (95% CI, 0.31-0.33%), and the cumulative incidence over 4 years was 1.23% (95% CI, 0.90-1.56%). In women, the annual incidence was 0.43%/year (95% CI, 0.42-0.44%/year) and the cumulative incidence over 4 years was 1.67% (95% CI, 1.30-2.04%). The only factor associated with incident TPOAb was the occurrence of thyroid diseases at follow-up. No differences in TPOAb incidence were detected across ELSA-Brasil research centers. Conclusion: Based on the results of this study, the incidence of TPOAb per year and at a 4-year follow-up period are compatible with those of a country with adequate iodine intake.

Disfunción tiroidea y diabetes mellitus tipo 1 / Thyroid dysfunction and type 1 diabetes mellitus

Introducción: La diabetes mellitus tipo 1 es una enfermedad autoinmunitaria que se relaciona con alteraciones tiroideas. Objetivo: Describir la relación que existe entre diabetes mellitus tipo 1 y enfermedad tiroidea autoinmune. Métodos: Se realizó una revisión de la literatura nacional e internacional de los últimos 15 años en bases de datos, en español y en inglés. Se utilizaron las siguientes palabras clave: diabetes mellitus tipo 1, autoinmunidad, enfermad tiroidea autoinmune, disfunción tiroidea y anticuerpos antitiroideos. Análisis e integración de la información: La alteración más frecuente es el hipotiroidismo subclínico y se presenta con mayor frecuencia en el sexo femenino, por lo que se sugiere realizar periódicamente el perfil tiroideo a estos pacientes. Conclusiones: Se debe tener en cuenta en la práctica clínica estas implicaciones para brindar un tratamiento oportuno, mejorar complicaciones derivadas como las enfermedades cardiovasculares y disminuir las cifras de morbilidad y mortalidad(AU)

Introduction: Type 1 diabetes mellitus is an autoimmune disease that is related to thyroid abnormalities. Objective: Describe the relationship between type 1 diabetes mellitus and autoimmune thyroid disease. Methods: A review of the national and international literature of the last 15 years was carried out in databases, in Spanish and in English. The following keywords were used: type 1 diabetes mellitus, autoimmune, autoimmune thyroid disease, thyroid dysfunction and antithyroid antibodies. Analysis and integration of information: The most common alteration is subclinical hypothyroidism and it occurs most often in the female sex, so it is suggested to periodically perform the thyroid profile to these patients. Conclusions: These implications should be taken into account in clinical practice to provide timely treatment, improve complications such as cardiovascular disease and reduce morbidity and mortality figures(AU)

Research Progress of Intervention in Autoimmune Thyroid Diseases Based on Th17/ Treg Signal Axis with Traditional Chinese Medicine / 中国实验方剂学杂志

Autoimmune thyroid disease （AITD） is a complex organ-specific autoimmune disease， associated with many factors such as genetic susceptibility， environmental factors， immune system disorders， and intestinal microbiota imbalance， which seriously affect the quality of life. At present， oral medicine， iodine 131 treatment and surgical treatment are mainly adopted in clinical parctice of western medicine. Although they can exert a certain curative effect， they still have surgical risks and side effect. Modern research shows that， traditional Chinese medicine（TCM） has the characteristics of stable curative effect， multi-targeted regulation and less side effect. It has definite efficacy and unique advantages in the prevention and treatment of AITD. Helper T lymphocyte cell 17 （Th17） mediate inflammation to induce immune promotion， while regulatory T lymphocyte cell （Treg） mediate immunosuppression， Th17 and Treg cooperate to maintain the balance of the immune microenvironment. During AITD progress， Inflammatory Th17 can be high， and the levels of mediated immunosuppressive Treg are relatively decreased. The restoration of balance between the two plays a key role in the inflammatory and immune processes of AITD. In recent years， based on Th17/Treg cell axis， a large number of clinical and experimental studies on the intervention of TCM on Th17/Treg balance in AITD have been carried out in the field of TCM， and some results have been achieved. Studies have shown that intervention in the Th17/Treg signaling axis is an important mechanism for the treatment of autoimmune thyroid diseases. This paper summarizes and analyzes the previous studies on the intervention effect of Chinese medicine monomer， Chinese medicine composition and Chinese medicine compound on Th17/Treg cell axis in AITD， mainly from the aspects of intervention related inflammatory factor secretion， regulation of antibody titer and the expression of related genes of related genes. These studies will help people to understand the mechanism of TCM in interfering with the Th17/Treg balance in AITD more accurately and comprehensively， and provide references for the rational application of TCM in the prevention and treatment of autoimmune thyroid diseases in clinical practice.

Relationship between thyroid volume and autoantibodies in patients with autoimmune thyroid disease / 中华地方病学杂志

Objective:To study the relationship between thyroid volume (TV) and thyroid autoantibodies in patients with autoimmune thyroid disease (AITD), and to explore the factors affecting goiter in patients with AITD.Methods:The newly diagnosed AITD adult patients in the Affiliated Hospital of Shanxi Institute for Endemic Disease Prevention and Control from November 2019 to October 2020 were selected for questionnaire survey, physical examination, thyroid function and thyroid autoantibody test, determination of serum iodine content and thyroid ultrasound, and the correlation between thyroid volume and thyroid autoantibody was analyzed.Results:A total of 147 newly diagnosed adult AITD patients were included, including 63 cases of Graves' disease (GD, 30 males and 33 females) and 84 cases of chronic lymphocytic thyroiditis (HT, 29 males and 55 females). The TV of male and female patients with GD was positively correlated with the levels of thyrotropin receptor antibody (TRAb) ( rmen = 0.515, rwomen = 0.412, P < 0.05). The TV of male and female patients with HT was not correlated with the levels of thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb, rmen = - 0.137, 0.168, rwomen = 0.184, - 0.088, P > 0.05). There were no correlation between TPOAb levels and TGAb levels in male and female HT patients ( rmen = 0.153, rwomen = 0.102, P > 0.05). The TV of male and female patients with GD or HT was not correlated with the serum levels of iodine ( rmen = 0.230, 0.013, rwomen = 0.096, 0.069, P > 0.05). Conclusion:TRAb level is positively correlated with the TV in GD patients.

Immune mechanisms involved in the coexistence of oral lichen planus and autoimmune thyroid diseases / 浙江大学学报·医学版

Oral lichen planus (OLP) is a chronic inflammatory oral mucosal disease with unclear etiology. Autoimmune thyroid diseases (AITD) is a type of autoimmune disease characterized by increased thyroid-specific antibodies. In recent years, more and more studies have found that the incidence of AITD is increased in OLP patients. The occurrence and development of OLP and AITD may be related to the expression of thyroid autoantigen in oral keratinocytes, the imbalance of thyroid hormone （Th）1/Th2 and Th17/Treg cell subsets, the abnormal quantity and function of follicular helper T cells and chemokines and the specific killing ability of CD8 T cells to target cells. In this article, the possible immune mechanisms involved in the coexistence of OLP and AITD are reviewed to provide insights for the diagnosis, treatment and prevention of these two diseases from the perspective of immunology.

Autoinmunidad tiroidea en mujeres con Síndrome de Ovario Poliquístico / Thyroid autoimmunity in women with polycystic ovary syndrome

Introducción: Las bases fisiopatológicas del Síndrome de ovario poliquístico pueden predisponer a mayor riesgo de autoinmunidad a las mujeres que tienen esta condición y existen evidencias, aunque escasas, de mayor prevalencia de autoinmunidad tiroidea en ellas. Objetivos: Determinar la frecuencia de marcadores serológicos de autoinmunidad tiroidea en mujeres con Síndrome de ovario poliquístico e identificar si existe asociación entre la presencia de ellos y las concentraciones de progesterona y testosterona. Métodos: Se realizó un estudio en 50 mujeres con Síndrome de ovario poliquístico y 50 sin el síndrome. Se realizaron determinaciones de autoanticuerpos tiroideos (anti tiroglobulina (Anti-Tg) y anti peroxidasa (anti-TPO) a las mujeres de ambos grupos de estudio. Se realizaron determinaciones de hormonas (testosterona y progesterona) solo al grupo de estudio de mujeres con SOP. Se crearon categorías por anticuerpos: Positivo si los títulos fueron superior al rango de referencia y negativo dentro del rango. Se consideró respuesta autoinmune positiva, cuando al menos uno de los anticuerpos se encontró elevado. Para la asociación entre la presencia de autoinmunidad y las variables independientes se hicieron análisis bivariados mediante comparación de medias y test no paramétricos. Se consideró un nivel de significancia de α = 0,05. Resultados: En las mujeres con Síndrome de ovario poliquístico, 62 por ciento mostraron anticuerpos positivos y 14 por ciento en las sin el síndrome. En las mujeres sin síndrome, de las 7 mujeres con marcadores de autoinmunidad positivos, en 6 (85,7 por ciento) el anti-Tg fue el que dio positivo. No hubo diferencias significativas en cuanto a la asociación con los niveles de testosterona y progesterona. Conclusiones: Las mujeres con Síndrome de ovario poliquístico tienen mayor frecuencia de desarrollar respuesta autoinmune tiroidea, independiente de los niveles de progesterona y testosterona(AU)

Introduction: The physio-pathological bases of polycystic ovary syndrome may predispose women with this condition to a higher risk of autoimmunity and there is evidence, albeit scarce, of higher prevalence of thyroid autoimmunity in them. Objectives: Determine the frequency of serological markers of thyroid autoimmunity in women with polycystic ovary syndrome and identify whether there is an association between the presence of them and progesterone and testosterone concentrations. Methods: A study was conducted in 50 women with polycystic ovary syndrome and 50 without the syndrome. Determinations of thyroid autoantiantibodies (anti-thyroglobulin (Anti-Tg) and anti-peroxidase (anti-TPO) were made to women in both study groups. Hormone determinations (testosterone and progesterone) were made only to the study group of women with PCOS. Categories were created by antibodies: Positive if the titles were greater than the reference range, and negative if within the range. It was considered a positive autoimmune response when at least one of the antibodies was found increased. For the association between the presence of autoimmunity and independent variables, bivariate analyses were performed by means comparison and non-parametric tests. It was considered a significance level of α =0.05. Results: In women with polycystic ovary syndrome, 62 percent showed positive antibodies and 14 percent in those without the syndrome. In women without the syndrome, of the 7 women with positive autoimmune markers, in 6 (85.7 percent) the anti-Tg was the one that tested positive. There were no significant differences in the association with testosterone and progesterone levels. Conclusions: Women with polycystic ovary syndrome are more often able to develop thyroid autoimmune response, independently from the progesterone and testosterone levels(AU)

Cytotoxic T Lymphocyte-associated Antigen 4 Polymorphisms Correlated with Graves' Disease in Patients of Han Ethnicity in Yunnan, China / Polimorfismos del antígeno 4 del linfocito T citotóxico correlacionados con la enfermedad de Graves en pacientes de la etnia Han en Yunnan, China

ABSTRACT Objective: To investigate the correlations between polymorphisms at position 49 in exon 1 and position 318 in the promoter of the cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) gene and autoimmune thyroid diseases in a Han Chinese population. Methods: Polymerase chain reaction-restriction fragment length polymorphism was utilized. The MseI and BbvI restriction endonucleases were used to detect and analyse position 49 in exon 1 and position 318 in the promoter as well as the T/C alleles of the CTLA-4 gene in peripheral blood samples from 112 patients with Graves' disease (GD), 101 with Hashimoto's thyroiditis (HT) and 100 healthy individuals. Results: At position 49 of exon 1, the frequencies of the GG genotype and the G allele in the GD group (χ2 = 12.147; p = 0.002) were statistically significantly higher than those in the control group (χ2 = 9.925; p = 0.002), while no statistically significant differences were found between the frequencies of the GG genotype and the G allele in the HT group (χ2 = 1.195; p = 0.550) and those in the control group (χ2 = 0.984; p = 0.321). No statistically significant differences in the promoter (−318) or the T/C alleles were observed among the three groups. Position 49 in the 17th codon of exon 1 of the CTLA-4 gene may be a candidate susceptibility marker in patients of Han ethnicity with GD. Conclusion: This finding helps us to better understand the genetic risks for GD and provides a direction for targeted gene therapy.

RESUMEN Objetivo: Investigar las correlaciones entre los polimorfismos en la posición 49 en el exón 1 y la posición 318 en el promotor del gen del antígeno 4 asociado al linfocito T citotóxico (CTLA-4), con las enfermedades autoinmunes de la tiroides en una población China de Han. Métodos: Se utilizó la reacción en cadena de la polimerasa-polimorfismo de la longitud de los fragmentos de restricción. Las endonucleasas de restricción de MseI y BbvI se utilizaron para detectar y analizar la posición 49 en el exón 1 y la posición 318 en el promotor, así como los alelos T/C del gen CTLA-4 en muestras de sangre periférica de 112 pacientes con enfermedad de Graves (EG), 101 con tiroiditis de Hashimoto (TH) y 100 individuos sanos. Resultados: En la posición 49 de exón 1, las frecuencias del genotipo GG y el alelo G en el grupo de EG (χ2 = 12.147; p = 0.002) fueron estadísticamente significativamente más altas que las del grupo de control (χ2 = 9.925; p = 0.002), pero no se encontraron diferencias estadísticamente significativas entre las frecuencias del genotipo GG y el alelo G en el grupo de TH (χ2 = 1.195; p = 0.550) y las del grupo de control (χ2 = 0.984; p = 0.321). No se observaron diferencias estadísticamente significativas en el promotor (−318) ni en los alelos T/C entre los tres grupos. La posición 49 en el codón17.° del exón 1 del gen CTLA-4 puede ser un marcador de susceptibilidad candidato en pacientes de la etnia Han con EG. Conclusión: Este hallazgo nos ayuda a comprender mejor los riesgos genéticos de la EG y ofrece una dirección para la terapia génica dirigida.

Association between Serum 25 (OH) Vitamin D level and Thyroiditis in Western Saudi Arabian Population

The association of low vitamin D status with Autoimmune Thyroid Disease (AITD), which includes Hashimoto’s Thyroiditis (HT), is controversial. (HT) is a chronic autoimmune thyroid disease caused by an interaction between genetic factors and environmental conditions, both of which are yet to be fully understood. The management of HT depends on its clinical manifestations, commonly including diffuse or nodular goiter with euthyroidism, subclinical hypothyroidism and permanent hypothyroidism. The aim of this study was to investigate mainly the correlation between vitamin D deficiency and HT. Methods: This study was carried out in tertiary hospitals, included patients who visited the hospital for thyroid evaluation or follow-up. Results: A total of 310 subjects were included, of whom 84 participants were healthy, and 226 patients with hypothyroid disease, 119 subjects were diagnosed as having HT (AITD), 107 Non-AITD. Conclusion: The prevalence of vitamin D deficiency was significantly higher in HT group than in non AITD (48.9 % vs. 37.4 %, p=0.013). Among HT cases, patients with overt hypothyroidism had a significantly higher prevalence of vitamin D insufficiency than HT with euthyroidism, subclinical hypothyroidism (60.4% vs. 44.1%, 29.7%, respectively, p 0.009, 0.017, 0.026). Conclusion: Considering current evidence, presented in this study, screening for vitamin D deficiency and careful vitamin D supplementation, when required, may be recommended for patients with HT.

Effect of parity on autoimmune thyroid disease / 中华内分泌代谢杂志

The objective of this study was to evaluate parity as a risk factor for autoimmune thyroid disease ( AITD) by comparing features of thyroid autoantibodies of pregnant women with different parities. This prospective cohort study included 477 women of first trimester of pregnancy in Peking University International Hospital from October 2016 to April 2017. Subjects were categorized as never parturition group ( n=287) or previously parturition group(n=190). All pregnant women in this study voluntarily signed informed consents. Thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb), thyrotropin (TSH), and free T4 were measured in the first trimester of pregnancy( from 7 to 12 weeks) . Meanwhile, height, weight, blood pressure, gestational weeks and pregnancy history were recorded. Data were statistically analyzed. The positive rates of thyroid autoantibodies including TPOAb and TGAb in previously parturition group were higher than those in no parturition group(10.0％vs 5.2％, P<0.05). The previously parturition group tended to be older and had lower TSH levels than the never pregnant group( P<0.05) . TSH 2.5 mIU/L and 4.0 mIU/L were used as upper reference limits respectively. The rate of abnormality of thyroid function was higher in the never parturition group than those in previously parturition ones ( 33. 33 by 29. 5％, 21. 2％ by 10. 8％) . In both previously parturition and never parturition groups, the commonest diseases of abnormal thyroidal function were SCH and subclinical thyrotoxicosis, and there was significant difference in disease of abnormal thyroidal function abnormal(χ2=15.704, P<0.05 and χ2=14.560, P<0.05). Parity was associated with AITD after adjustment for age, BMI, and gestational week [OR=2.346(1.075-5.121)]. Parity may affect AITD. Pregnant women should be monitored for thyroid function and thyroid autoantibodies even if they did not suffer from thyroid disease in the first pregnancy.

Application of Vitamin E in Pregnant Women with Autoimmune Thyroid Disease / 现代医院

Objective To investigate the changes of serum vitamin E in pregnant women with autoimmune thyroid diseases and provide evidence for clinical prevention of adverse pregnancy caused by oxidative stress. Methods Randomly selecting 221 cases of obstetrics and gynecology pregnant women in outpatient clinics in Chancheng District Central Hospital. A double antibody one-step sandwich enzyme-linked immunosorbent assay (ELISA) was used to detect vitamin E concentration. Results The results of 221 subjects were normally distributed. The vitamin E concentration in the disease group was (353. 93 ± 141. 28) mmol/L, and the control group was (310. 49 ± 105. 49) mmol/L. There was a significant difference between the two groups (P＜0. 05). The concentration of vitamin E in different gestational weeks gradually decreased with the increase of pregnancy, and the difference between them was statistically significant (F = 8. 417, P＜0. 05). Conclusion The presence of oxidative stress during pregnancy in women with autoimmune thyroid diseases should be valued by clinicians.

Prevalence of pancreatic autoantibodies in non-diabetic patients with autoimmune thyroid disease and its relation to insulin secretion and glucose tolerance

ABSTRACT Objective We evaluated the prevalence of glutamic acid decarboxylase (GADA) and tyrosine phosphatase-protein antibodies (IA2A), their titers and their relation to first phase insulin response (FPIR) and glucose tolerance in autoimmune thyroid diseases (ATDs) patients. Subjects and methods Graves' disease (GD; n = 181) and Hashimoto's thyroiditis (HT; n = 143) patients in addition to healthy controls (n = 93) were studied. Secondly, FPIR and oral glucose tolerance tests (OGTT) were performed in 11 anti-pancreatic islet-cell (+) and in 20 anti-pancreatic-cell (-) patients. Results There was a non significant trend for higher prevalence of GADA positivity in GD vs HT (7.2% vs 2% p = 0.06), but the GADA titers were higher in HT. We also did not find a significant difference in IA2 prevalence (0.7% vs 0.0%) between these two groups or compared to the control group. In the subsequent analysis, low FPIR was found in 10% of these patients but without statistical difference for OGTT between pancreatic antibody-positive and -negative patients. Conclusion A trend for greater prevalence of GADA was observed for GD patients than for HT or control. However, the titers of these autoantibodies were higher in HT patients, but there was no significant relation to insulin secretion and glucose tolerance at that moment and stage of autoimmune diseases.

Síndrome poliglandular autoinmunitario tipo II (síndrome de Schmidt): enfermedad de Addison y tiroiditis de Hashimoto asociado con vitíligo / Polyglandular autoimmune syndrome type II (Schmidt syndrome): Addison's disease and Hashimoto's thyroiditis associated to vitiligo

Resumen Los síndromes poliglandulares autoinmunitarios son afecciones poco frecuentes que se distinguen por la coexistencia de al menos dos enfermedades glandulares autoinmunitarias. Se clasifican en tipo I (o juvenil) y tipos II y III (o del adulto). El tipo II o síndrome de Schmidt se caracteriza por enfermedad de Addison, enfermedad tiroidea autoinmunitaria o diabetes mellitus tipo 1 que pueden vincularse con otras alteraciones de naturaleza autoinmunitaria, como vitíli go, hepatitis autoinmunitaria, miastenia gravis, anemia perniciosa, enfermedad celiaca y alopecia areata, entre otras. Se comunica el caso de una paciente de 61 años de edad con vitíligo a quien se le diagnosticó enfermedad de Addison y tiroiditis de Hashimoto (síndrome de Schmidt).

Abstract Autoimmune polyglandular syndromes are rare conditions characterized by the coexistence of at least two autoimmune glandular diseases. They can be classified in type I (or juvenile) and type II and III (or adult). Type 2 or Schmidt's syndrome is characterized by Addison's disease, autoimmune thyroid disease and/or type 1 diabetes mellitus and may be associated with other disorders of autoimmune nature, such as vitiligo, autoimmune hepatitis, myasthenia gravis, pernicious anemia, celiac disease or alopecia areata, among others. We communicate the case of a 61 year-old woman with vitiligo diagnosed with Addison's disease and Hashimoto's thyroiditis (Schmidt's syndrome).

Prevalencia de autoinmunidad tiroidea en mujeres subfértiles / Prevalence of thyroid autoimmunity in subfertile women

Resumen OBJETIVO: estimar la prevalencia de enfermedad tiroidea autoinmunitaria en pacientes subfértiles y saber si existe asociación entre enfermedad tiroidea autoinmunitaria aislada en mujeres eutiroideas y los resultados en técnicas de reproducción asistida. MATERIALES Y MÉTODOS: estudio observacional, transversal, ambispectivo, que evaluó mujeres de 18 a 43 años de edad atendidas en el servicio de Reproducción Humana del Instituto Nacional de Perinatología Isidro Espinosa de los Reyes que tuvieran una determinación del perfil tiroideo con anticuerpos antitiroideos en la primera consulta de infertilidad. RESULTADOS: la prevalencia de enfermedad tiroidea autoinmunitaria en mujeres infértiles fue de 19%. El 48% tuvieron seropositividad para anticuerpos antitiroideos, 32% para anticuerpos antitiroglobulina más anticuerpos antiperoxidasa y 20% restante solo para anticuerpos antitiroglobulina. En el grupo de pacientes con enfermedad tiroidea autoinmunitaria se observó una prevalencia de hipotiroidismo clínico de 8% y subclínico de 48%. La media de TSH para las mujeres con enfermedad tiroidea autoinmunitaria fue de 4.6 μUI/L. Las mujeres con enfermedad tiroidea autoinmunitaria aislada eutiroideas representaron 8.3% de la población y tuvieron una alta tasa de abortos espontáneos previos (45.5%) y de fracaso en técnicas de reproducción asistida (70%). CONCLUSIÓN: la determinación de la autoinmunidad tiroidea debe ralizarse de manera rutinaria en la población de mujeres.

Abstract OBJECTIVE: To estimate the prevalence of autoimmune thyroid disease in subfertile patients who come to the Human Reproduction service of the National Institute of Perinatology Isidro Espinosa de los Reyes, Mexico city. MATERIAL AND METHODS: A retrospective, cross-sectional, observational, ambispective study evaluating 18- to 43-year-old women from the INPer "Isidro Espinosa de los Reyes" human reproduction service with a thyroid profile determination with anti-thyroid antibodies in The first consultation of infertility. RESULTS: The prevalence of TEE in the population of infertile women is 19%. 48% have seropositivity for Ac-TPO, 32% for Ac-tiroglobulina plus Ac-TPO and the remaining 20% only for Ac-tiroglobulina. A prevalence of clinical hypothyroidism of 8% and subclinical of 48% was observed in the group of patients with ATE. The mean TSH for women with ATE was 4.6 μUI/L. Women with isolated euthyroid ETA represent 8.3% of the population and have a high rate of previous spontaneous abortions (45.5%) as well as failure in assisted reproduction techniques (70%). CONCLUSION: Determination of thyroid autoimmunity should be routinely performed in the female population.

An association of myasthenia gravis with Hashimoto’s thyroiditis in in a patient with a multinodular goitre

Introduction: The association of myasthenia gravis (MG) with other autoimmune diseases including autoimmune thyroid disease (ATD) is well recognised, although rare. The occurrence of both diseases can occur in two ways: either disease preceding the other, or concurrently. The presentation of MG in association with ATD can range from ocular to generalised disease. Case Summary: A 26-year-old Malay female with persistent hyperthyroidism secondary to Hashimoto’s thyroiditis in multinodular goitre was diagnosed with generalised MG after 2 years. She presented with right eye ptosis (ocular) and difficulty in swallowing and chewing (bulbar). The diagnosis of MG was confirmed by fatigability testing, electromyography and the presence of AChR antibodies. Her symptoms showed improvement with pyridostigmine (Mestinon) 60 mg 6-hourly. Her antithyroid drug was tapered down according to her thyroid function test. Throughout a year of follow-ups, her hyperthyroidism and fatigability symptoms improved with treatment. She was later counselled for total thyroidectomy and thymectomy. Conclusion: Myasthenia gravis and hyperthyroidism may present with similar symptoms such as dysphagia due to neuromuscular weakness or fatigue. When the diseases occur together, one of the diagnoses may be missed. Therefore, the occurrence of new symptoms in a patient with underlying ATD should should trigger the early identification of other autoimmune diseases by primary care doctors.

Usefulness of SPECT/CT in Parathyroid Lesion Detection in Patients with Thyroid Parenchymal (99m)Tc-Sestamibi Retention / 대한핵의학회잡지

PURPOSE: Parathyroid adenoma detection with dual-phase (99m)Tc-sestamibi (MIBI) scintigraphy depends on differential MIBI washout from thyroid. However, autoimmune thyroid disease (AITD) may cause MIBI to be retained in the thyroid gland and reduce parathyroid detection.We evaluated the impact of AITD on MIBI thyroid retention and additional benefit of SPECT/CT in these patients.METHODS: Dual phase planar MIBI and SPECT/CT was performed on 82 patients. SPECT/CTwas performed immediatelyafter delayed planar scan. Thyroid density (Hounsfield unit, CT-HU) and size were measured on CT component of SPECT/CT. MIBI uptake in early scans and retention in delayed scans were visually graded and correlated with clinical factors and CT findings. Finally, planar and SPECT/CT findings were compared for parathyroid lesion visualization according to thyroid MIBI retention.RESULTS: In early scan, multivariate analysis showed only thyroid size predicted early uptake. In delayed scan, multivariate analysis showed higher visual grade in early scan, lower CTHU or AITD were significant predictors for delayed thyroid parenchymal retention. Overall, ten more parathyroid lesions were visualized on SPECT/CT compared to planar scans (57 vs. 47, p = 0.002). SPECT/CT was especially more useful in patients with thyroidal MIBI retention, as eight out of the ten additional lesions detected were found in patients with thyroid MIBI retention.CONCLUSION: AITD is an important factor for MIBI thyroid parenchymal retention on delayed scans, and may impede parathyroid lesion detection. Patients with MIBI retention in the thyroid parenchyma on delayed scans are likely to benefit from an additional SPECT/CT.

The investigation on the detection value of thyrotropin receptor antibody in children with autoimmune thyroid disease / 国际检验医学杂志

Objective To investigate the detection value of thyrotropin receptor antibody(TRAb)in children with autoimmune thyroid disease.Methods During the January 2015 and October 2016,a total of 72 cases of children with autoimmune thyroid dis-ease admitted to our hospital were selected,including 36 cases of Graves disease as the Graves disease group,and 36 cases of Hashi-moto's thyroiditis as Hashimoto's thyroiditis group;36 cases of healthy children in this hospital at the same period were selected as the control group.Children in the Graves disease group and Hashimoto's thyroiditis group were taken routine treament,ane the changes of the serum TRAb level before the treatment and one year after the treatment between the two groups.The positive value range of TRAb level is more than 1.75 U/L,and the positive rate of serum TRAb level before the treatment and one year after the treatment was recorded in the two groups.Results Before treatment,TRAb level of the Graves disease group[(12.79 ± 6.38)U/L]was higher than those in Hashimoto's thyroiditis group[(2.03 ± 0.29)U/L]and the control group[(0.85 ± 0.23)U/L],and the difference was statistically significant(P<0.05);TRAb level of the Hashimoto's thyroiditis group[(2.03 ± 0.29)U/L]was significantly higher than that of the control group[(0.85 ± 0.23)U/L],(P<0.05).After treatment:TRAb level of the Graves disease group[(9.36 ± 12.14)U/L]was significantly higher than those in Hashimoto's thyroiditis group[(1.78 ± 0.38)U/L]and the control group[(0.84 ± 0.29)IU/L],and the difference was statistically significant(P<0.05);TRAb level of the Hashimoto's thyroiditis group was significantly higher than the control group,and the difference was statistically significant(P<0.05).TRAb levels in patients with graves'disease and Hashimoto thyroiditis after treatment were significantly lower than those before treat-ment,and the difference was statistically significant(P<0.05).The positive rates of TRAb level in the Graves disease group before and after treatment were 100%,and the positive rate of TRAb level in Hashimoto's thyroiditis group after treatment(11.11%)de-creased in comparison with the one before treatment(22.22%),and the difference was statistically significant(P<0.05).Conclusion There is a significant change of TRAb level in children with autoimmune thyroid disease.Especially,the change of TRAb level in Graves disease before and after treatment may provide a reference for clinical diagnosis and prognosis evaluation of Graves disease.

The positive rate analysis of langerhans islets β-cells autoantibodies (anti-GAD) in young children with chronic autoimmune thyroiditis / 中国生化药物杂志

Objective To explore the anti-islet cells in patients with chronic autoimmune thyroiditis. Methods Glutamate decarboxylase antibody was quantitatively detected by ELISA method, and the frequency of anti-GAD antibody in children with chronic autoimmune thyroiditis was compared with that in healthy control group. Results Of the 41 patients with chronic autoimmune thyroiditis, 4 (9.8%) were GAD antibody positive. The positive rate of GAD in chronic autoimmune thyroiditis group was significantly higher than that in the control group (P<0.05). Conclusion This study found that GAD antibody positive rate in patients with autoimmune thyroiditis was significantly higher. Our findings supported the concept of autoimmune thyroid disease patients who may develop into type 1 diabetes in future life.

The positive rate analysis of langerhans islets β-cells autoantibodies (anti-GAD) in young children with chronic autoimmune thyroiditis / 中国生化药物杂志

Objective To explore the anti-islet cells in patients with chronic autoimmune thyroiditis. Methods Glutamate decarboxylase antibody was quantitatively detected by ELISA method, and the frequency of anti-GAD antibody in children with chronic autoimmune thyroiditis was compared with that in healthy control group. Results Of the 41 patients with chronic autoimmune thyroiditis, 4 (9.8%) were GAD antibody positive. The positive rate of GAD in chronic autoimmune thyroiditis group was significantly higher than that in the control group (P<0.05). Conclusion This study found that GAD antibody positive rate in patients with autoimmune thyroiditis was significantly higher. Our findings supported the concept of autoimmune thyroid disease patients who may develop into type 1 diabetes in future life.