Coexistence of Hyperparathyroidism and Multinodular Goiter with Hashimotos Thyroiditis and Hyperthyroidism � A Rare Case Report

Thyroid disease and hyperparathyroidism (HPT) are among the most common endocrine disorders. Thyroid hormones play an important role in bone and calcium metabolism. The rate of HPT is greater in patients with thyroid disease than in the general medical population. Simultaneous occurrence of hyperthyroidism and hyperparathyroidism in the same patient is a rare combination. The clinical manifestations of hyperthyroidism may overshadow the more subtle and varied symptoms and signs of primary hyperparathyroidism. It poses difficult diagnostic and therapeutic problems. Both diseases, however, may have a profound influence on calcium metabolism. The resulting disturbances in thyrotoxicosis may simulate hyperparathyroidism. Contrariwise, the diagnosis of an associated parathyroid adenoma may be missed, or unnecessarily delayed because hypercalcemia is known to occur in hyperthyroidism. The coexistence of thyroiditis and thyroid nodules with parathyroid disorders is also known. Graves� disease (GD) and primary hyperparathyroidism (PHPT) are two common endocrine disorders. However the co- occurrence of hyperthyroidism and primary hyperparathyroidism (PHPT) is rare. However, the link between the two disorders remains unclarified. Hypercalcemia in Graves' hyperthyroidism should warrant a thorough investigation for concomitant primary hyperparathyroidism. Concomitant thyroid nodular disease and hyperparathyroidism (PHPT) disease has been also documented. PHPT is also reported in patients with thyroid malignancy. We hereby report a rare case of a patient who presented with coexistence of Hyperparathyroidism and Multinodular Goiter with Hashimotos Thyroiditis and Hyperthyroidism.

Incidence of thyroid pathologies requiring thyroid surgeries in a tertiary care hospital

Background: Diseases of the thyroid gland are one of the most common endocrine disorders in India and the world, many of these diseases require surgery for their treatment. The incidence of thyroid diseases differs from one geographical area to another. This study was aimed at finding out the thyroid pathologies for which thyroid surgeries were performed in D. Y. Patil Hospital, Nerul, Navi Mumbai.Methods: It is a retrospective analysis of all the patients who have undergone thyroid surgeries (lobectomy, hemithyroidectomy, subtotal or near total thyroidectomy or total thyroidectomy) in D. Y. Patil hospital, Nerul, Navi Mumbai from 1st January 2018 to 31st December 2019 (2 years duration).Results: Most common pathology for which thyroidectomy was performed was colloid goitre (41.33%). Benign diseases of the thyroid was much more common (76%) than malignant diseases (24%). Most common malignancy was papillary carcinoma thyroid. Thyroid surgeries were most commonly performed on women in their 5th decade of life.Conclusions: Colloid goitre was the most common pathology for which thyroid surgeries were performed and females in their 5th decade of life were the most common patients undergoing thyroidectomy.

The proportional changes of B regulatory cells and suppressor T cells in peripheral blood of patients with Hashimotos' thyroiditis / 中华内分泌代谢杂志

Objective To explore the proportional changes of regulatory B lymphocyte cells (Bregs) and suppressor T lymphocyte cell (Ts) in the peripheral blood of patients with Hashimotos' thyroiditis (HT).Method Sixty-one cases of HT and 38 healthy subjects with matched age and gender were recruited.Flow cytometry technology was used to detect the proportional changes of CD19+ CD24+ CD27 + B cells,CD19+ CD24hi CD38hi B cells,CD19+ IL-10+B cells,and CD8+CD28-T cells.Result Compared with control group,CD19+CD24+CD27+B cells in HT group increased significantly(P＜0.05).With the increase of thyroid peroxidase antibody,CD19+ CD24hi CD38hi B cells were decreased significantly.With the increase of antithyrogloblin antibody (TGAb),CD8 + CD28-T cells were decreased markedly (P＜0.05).TT3 was positively related with CD19 + CD24hi CD38 hiB cells while TT4 had a negative correlation with CD8+ CD28-T cells and positive correlation with CD19+ CD24+ CD27+ B cells.Logistic regression analysis showed that TGAb and FT4 were independent risk factors for decreased CD8+ CD28-T cells in lymphocyte percentage(P＜0.05).TSH was an independent risk factor for the decreased proportion of CD19+ CD24hi CD38hiB cell.FT4 was the independent risk factors for increased CD19+CD24+CD27+B cells(P＜0.05).Conclusion The percentage of Ts cells in patients with HT was lowered,while the different phenotypic Bregs cells showed various changes.Thyroid autoantibodies and thyroid function were closely associated with the immunological changes in HT patients.

Expression and influencing factors of CD54 in Hashimotos thyroiditis / 第三军医大学学报

Objective To dectect the expression of CD54 in thyroid tissue of Hashimotos thyroiditis patients,and expression changes of CD54 on thyroid cells interferred by different agents.Methods The thyroid tissues from 41 cases of Hashimotos thyroiditis were collected and 26 normal thyroid tissues served as normal controls.All thyroid tissues were identified by pathological examination.The positive expression rate and area of CD54 were investigated by immunohistochemical method and quantitative analysis of image analysis system in all thyroid tissues.The expression changes of CD54 in the isolated thyroid cells interferred by 100,500,1 000 pg/ml IL-1? or 10 mg/L NaI or 1 000 pg/ml IL-1? and 10 mg/L NaI for 48 h were detected by flow cytometry.Results The positive expression rate of CD54 in Hashimotos thyroiditis tissues was much more than that of control tissues(P

A Case of Hashimotos Thyroiditis with Anti-Triiodothyronine Autoantibody / 대한내분비학회지

Autoantibodies against thyroid hormones can be detected in the sera of patients with both thyroidal and non-thyroidal disorders. These antibodies interfere with the radioimmunoassay of serum total and free thyroid hormone concentrations, resulting in a discrepancy between the measured hormone levels and clinical features. This can in turn lead to an erroneous diagnosis and patients may receive unnecessary treatment from physicians who are unaware of the presence of the autoantibodies. We experienced a woman having Hashimotos' thyroiditis with a spurious elevation of total T3 and free T3 values according to one-step analog-tracer radioimmunoassay who was had been treated as Graves' disease in past. Through the use of a polyethylene glycol precipitation method, she was subsequently revealed to have anti-triiodothyronine autoantibodies. We report this case with a review of related literature.

A Case of Autoimmune Hemolytic Anemia & Pericardial Effusion Developed in Hashimoto's Thyroiditis Patient / 대한내분비학회지

Hashimotos thyroiditis has been associated with a various autoimmune disorders. The immunologic mechanisms involved in the pathogenesis of these disorders have not always been thought to be the same. Although it was demonstrated that there were high prevalence of abnormal thyroid function and autoantibody in autoimmune hemolytic anemia(AIHA) and Fisher-Evans syndrome(FES), AIHA combined with Hashimotos thyroiditis is rare in Korean literature. It was suggested that a common immunologic mechanism may be involved in the pathogenesis of both disease and the possibility of multiple autoimmune syndrome might present in autoimmune hematologic disorders. We experienced a 74-year old woman with a 12-year history of a hypothyroidism due to Hashimotos thyroiditis was hospitalized with sudden development of warm AIHA with positive Direct & Indirect Coombs test and pericardial effusion. Her thyroid function test showed subclinical hypothyroidism with the maintenance dosage of levothyroxine(100pg/day). With glucocorticoid and plasmapheresis, AIHA and pericardial effusion were corrected successfully. It is suggested that the prudent immunologic study is needed for the anemia developed in patients with Hashimotos thyroiditis with or without hypothyroidism.

Clinical Significance and Immunological Characteristics of Blocking TSH Receptor Antibodies in Patients with Hashimoto's Thyroiditis / 대한내분비학회지

BACKGROUND: TSH receptor blocking antibody (TRBAb) is a pathogenic factor in the vast majority of patients with primary myxedema. It has been reported that TRBAbs are found in some patients with chronic goitrous autoimmune thyroiditis (Hashimoto's thyroiditis), but the significance or the role of TRBAb in Hashimotos thyroiditis is not clear, We recently reported that hTSHR-CHO cells which express the functional human TSH receptors are more sensitive and are better in detecting functional TSH receptor antibodies in Graves patients than FRTL-5 cells. We are to investigate the biological role of TRBAb in Hashimotos thyroiditis by measuring thyroid stimulation blocking antibody (TSBAb) activities of Hashimoto's IgG's using hTSHR-CHO cells. Moreover, we are to see if there is any difference in epitope recognition between Hashimotos TRBAb and myxedema's TRBAb by measuring TSBAb activities with mutant receptor expressing cell lines, Mcl+2 and Mc 2 in those patients. METHOD: We measured TSBAb activities of IgGs from patients with primary myxedema (PM, n= 10) and those with hypothyroid (n 20) or euthyroid (n 17) Hashimoto's thyroiditis (HT) using wild type hTSHR-CHO cells (WT) and two chimeric receptor expressing cell lines, Mcl+2 and Mc2. RESULTS: TSBAb activities measured by WT were higher in hypothyroid HT than in euthyroid HT (30.0+-23.2% vs. 6.1+-28.7, p<0.05), and TSBAb-positive rate tend to be higher in the former (20%, 5/20) than in the latter (0%, 0/17, p=0.07). TRBAbs from PM (n=4) had high TBII activities and had persistent blocking activities despite of the replacement of amino acid residue 8~165 of extracellular domain of TSHR with those of rat LH/CGR (Mcl +2). However, TRBAbs from HT (n=4) had no TBII activity at all and lost blocking activities when measured with Mcl+2. CONCLUSION: TRBAbs are found in 20% of hypothyroid patients with Hashimotos thyroiditis in assay using hTSHR-CHO cells, and they seem to play a role in the development of hypothyroidism in some patients with Hashimotos thyroiditis. TRBAbs of Hashimotos thyroiditis are different in epitope recognition from TRBAbs of primary myxedema.

Graves' disease associated with Hashimoto's thyroiditis / 대한내분비학회지

Hashimotos thyroiditis and Graves disease have been thought to be the autoirnmune diseases having their distinct and separate clinical and pathologic features. Because of the partial and complete simi1arity in histologic feature, it has been hypothesized that Hashimoto's thyroiditis and Oraves disease may be interrelated. Several patients who had been diagnosed as Graves disease showed features of hypothyroidism, and were proven to have histologie features of Hashimotos thyroiditis in their thyroid tissue. Two meehanisms had been suggested to explain tbis phenomenon. One is that the combined Hashimotos thyroiditis in Graves' disease may become predominant with time, The other is that the amount of TSH receptor blocking antibody may increase in the course of Graves disease. Early recognition of these patients would be impartant to estabilish therapeutic plan. Futhermcee, extensive study of these patients would give more understanding of the mechanism of these diseases. Here we report 5 cases of clinically diagnosed Graves disease with pathologic features of Hashimotos thyroiditis or focal lymphocytic thyroiditis.