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ObjectiveTo explore the effect of Buzhong Yiqitang on the immune imbalance of helper T cell 17 （Th17）/regulatory T cell （Treg） and Notch1 signaling pathway in mice with autoimmune thyroiditis （AIT）. MethodA total of 60 8-week-old NOD.H-2h4 mice were randomly divided into the normal group， model group， western medicine group （selenium yeast tablet， 32.5 mg·kg-1）， and low-dose （4.78 g·kg-1·d-1）， middle-dose （9.56 g·kg-1·d-1）， and high-dose （19 g·kg-1·d-1） Buzhong Yiqitang groups， with 10 mice in each group. The normal group was fed with distilled water， and the other groups were fed with water containing 0.05% sodium iodide for eight weeks. After the animal model of AIT was formed spontaneously， the mice were killed under anesthesia after intragastric administration for eight weeks. Serum anti-thyroglobulin antibodies （TGAb）， thyroid-stimulating hormone （TSH）， free triiodothyronine （FT3）， and free thyroid hormone （FT4） were detected by enzyme-linked immunosorbent assay （ELISA）， and thyroid tissue changes were observed by hematoxylin-eosin （HE） staining. The mRNA and protein expressions of retinoid-related orphan receptor-γt （RORγt）， interleukin （IL）-17， forkhead box P3 （FoxP3）， IL-10， Notch1， and hair division-related enhancer 1 （Hes1） in thyroid tissue were detected by Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） and Western blot， respectively. ResultCompared with the normal group， the thyroid structure of the model group was severely damaged， and lymphocytes were infiltrated obviously. The levels of serum TGAb， FT3， and FT4 contents were significantly increased， and TSH content was significantly decreased （P<0.01）. The mRNA and protein expression levels of RORγt， IL-17， Notch1， and Hes1 were significantly increased， while those of FoxP3 and IL10 were significantly decreased in the model group （P<0.01）. Compared with the model group， thyroid structural damage and lymphocyte infiltration were improved in the treatment groups， and serum TGAb， FT3， and FT4 contents were significantly decreased. TSH content was increased， and mRNA and protein expression levels of RORγt， IL-17， Notch1， and Hes1 were decreased. mRNA and protein expression levels of FoxP3 and IL-10 were increased to different degrees （P<0.05， P<0.01）， and the middle-dose Buzhong Yiqitang group had the most significant intervention effect. ConclusionBuzhong Yiqitang can alleviate the thyroid structural damage in AIT mice， and its mechanism may be related to improving the abnormal differentiation of Th17/Treg immune cells and inhibiting the activation of the Notch1 signaling pathway.
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La vacunación contra el SARS-CoV-2 no está exenta de efectos adversos. Se presenta dos casos de afectación endocrina asociada a la vacunación por la COVID-19. Mujer de 46 años que, luego de la primera dosis, presentó fiebre persistente y signos de tirotoxicosis, tras el diagnóstico de tiroiditis subaguda asociada a vacunación por la COVID-19, el cuadro remitió con el uso de corticoides. Varón de 71 años, que luego de la vacunación por la COVID-19, presentó hipoglicemias hiperinsulinemicas, con resultado positivo de anticuerpos antiinsulina. Se le diagnosticó con una hipoglicemia autoinmune asociada a la vacunación por la COVID-19 y recibió tratamiento con prednisona, controlando los episodios de hipoglicemia. En conclusión, las enfermedades endocrinas asociadas a vacunación por la COVID-19 son extremadamente raras y su detección oportuna permite su tratamiento adecuado.
SARS-CoV-2 vaccination is not free of adverse effects. We present two cases of endocrine involvement associated with COVID-19 vaccination. A 46-year-old woman who, after receiving the first COVID-19 vaccination dose, presented persistent fever and signs of thyrotoxicosis after being diagnosed with subacute thyroiditis associated with COVID-19 vaccination; the condition remitted with the use of corticoids. A 71-year-old male, who after COVID-19 vaccination, presented hyperinsulinemic hypoglycemia, testing positive for anti-insulin antibodies; he was diagnosed with autoimmune hypoglycemia associated with COVID-19 vaccination and received treatment with prednisone, controlling the episodes of hypoglycemia. In conclusion, endocrine diseases associated with COVID-19 vaccination are extremely rare and their timely detection allows adequate treatment.
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Humans , Male , Female , ThyrotoxicosisABSTRACT
La infección por SARS-CoV-2 podría gatillar la ocurrencia de numerosas patologías, algunas de ellas de tipo endocrinológico. Se presenta una revisión narrativa sobre la asociación entre COVID-19 y tiroiditis subaguda, en la que se describen aspectos epidemiológicos, fisiopatológicos, manifestaciones clínicas y de laboratorio, tratamiento y pronóstico. La prevalencia de alguna disfunción tiroidea en pacientes COVID-19 fluctúa entre 13 y 64%, específicamente en relación con tiroiditis subaguda se describe un cambio en la prevalencia de 0,5% a 10% entre los años 2019 y 2020. La tiroiditis subaguda se produce por la unión del virus SARS-CoV-2 con la enzima convertidora de angiotensina 2 (ACE-2) ampliamente expresada en la glándula tiroides, generando manifestaciones clínicas tipo tirotoxicosis, aunque la presentación de la tiroiditis subaguda asociada a COVID-19 puede ser atípica. Los elementos centrales del tratamiento son similares a los empleados ante cualquier tiroiditis subaguda. Se concluye la necesidad de considerar esta entidad en el diagnóstico diferencial de pacientes actual o previamente infectados por SARS-CoV-2 que presenten síndrome febril, elevación de parámetros inflamatorios o taquicardia persistente, sin etiología precisada.
SARS-CoV-2 infection can trigger the occurrence of numerous pathologies, some of them endocrinological. The present narrative review works on the association between COVID-19 and subacute thyroiditis, which describes epidemiological and pathophysiological aspects, clinical and laboratory manifestations, treatment, and prognosis. The prevalence of thyroid dysfunction in COVID-19 patients fluctuates between 13 and 64%, explicitly concerning subacute thyroiditis; it has been described as a change in prevalence from 0.5% to 10% between 2019 and 2020. The binding of the SARS-CoV-2 virus with the angiotensin-converting enzyme 2 receptor (ACE-2) widely expressed in the thyroid gland causes subacute thyroiditis, generating thyrotoxicosis-like clinical manifestations. However, the presentation of subacute thyroiditis associated with COVID-19 may be atypical. The central elements of the treatment are similar to those used in any subacute thyroiditis. We conclude that this entity must be considered in differential diagnoses of patients currently or previously infected with SARS-CoV-2 that present a febrile syndrome, elevated inflammatory parameters, or persistent tachycardia without a specified aetiology.
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ABSTRACT Objectives: To assess serum anti-Müllerian hormone (AMH) levels as an ovarian reserve marker in adolescent girls with autoimmune thyroiditis (AIT) and explore the relationship of this marker with autoimmunity and thyroid function biomarkers. Subjects and methods: This study included 96 adolescent girls with newly diagnosed AIT and 96 healthy, age- and sex-matched controls. All participants were evaluated with detailed history taking and physical examination, thyroid ultrasound, and measurement of levels of thyroid-stimulating hormone (TSH), free thyroxin (FT4), free triiodothyronine (FT3), antithyroid peroxidase antibodies (TPOAb), antithyroglobulin antibody (TGAb), estradiol, total testosterone, and anti-Müllerian hormone (AMH) levels. The LH/FSH ratio was also calculated. Among 96 patients evaluated, 78 were overtly hypothyroid and 18 were euthyroid. AMH levels were significantly lower in participants with overt hypothyroidism and euthyroidism compared with controls. Results: Serum levels of AMH correlated negatively with age, body mass index (BMI) standard deviation score (SDS), and TPOAb, TGAb, and TSH levels but positively with FT4 levels. In multivariate analysis, AMH levels correlated significantly with age (odds ratio [OR] = 1.65, 95% confidence interval [CI] 1.18-2.32, p = 0.05), BMI SDS (OR = 2.3, 95% CI, 2.23-3.50, p = 0.01), TSH (OR = 2.43, 95% CI 1.5-2.8, p = 0.01), and TPOAb (OR = 4.1, 95% CI 3.26-8.75, p = 0.001). Conclusions: Ovarian reserve of adolescent girls with AIT, as measured by serum AMH levels, is affected by thyroid autoimmunity and hypothyroidism, indicating a possible need for ovarian reserve monitoring in these patients.
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ABSTRACT Objective: Intrathyroidal injection using an insulin pen filled with a mixture of lidocaine and triamcinolone acetonide is a therapy for subacute thyroiditis (SAT) reported by us previously. We aimed to evaluate the clinical efficacy of ultrasound-guided intrathyroidal injection in the treatment of SAT. Subjects and methods: A total of 93 patients with SAT completed the study. All patients were evaluated via a history and clinical examination followed by thyroid function tests and ultrasonography of the thyroid. After ultrasound-guided intrathyroidal injection, the patients were followed up with respect to the injection frequency, treatment duration, and patient satisfaction. The visual numerical rating scale was used as a pain questionnaire for a given interval. Results: Thyroid pain instantly decreased to scores below 3.0 following the first injection. Sixty-three patients (67.74%) avoided relapse of thyroid pain within 3 injections, which occurred within only 3 days after the first injection. The pain in 27 patients (29.03%) disappeared completely after 4-6 injections. Only 3 patients (3.23%) were found to need more than 6 injections, with 10 cited as the maximum number of injections, the injection took only 17 days altogether. The mean treatment cycle of the intrathyroidal injection was 3.98 days. There were no other associated complications with the novel therapy except infrequent small subcutaneous hematomas, which could be prevented with skilled practice. The average patient satisfaction score was as high as 9.0. Conclusion: Intrathyroidal injection of lidocaine and triamcinolone acetonide using an insulin pen was found to be an advantageous and satisfactory treatment for SAT.
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Background: Thyroid gland is an endocrine organ. The non-neoplastic and neoplastic conditions affecting the gland can manifest as the swelling of the gland with thyroid dysfunction. Based on cytology, the diseases can be categorized into non-neoplastic, benign neoplastic, and malignant neoplastic conditions and according to hormone status, the lesions of thyroid can be categorized in hypothyroid, euthyroid, or hyperthyroid condition. Aims and Objectives: Our study was done to find out the various cytomorphological spectrum of thyroid diseases and to record their common clinical presentation along with hormonal status in a tertiary care hospital in Northern Odisha. Materials and Methods: A total of 220 cases of thyroid disorder were taken for analysis over a period of 2 years. Patients demographic data, brief clinical features, finding on FNAC (cytomorphology), and thyroid function status were analyzed with appropriate statistical method. Results: The predominant age group affected was 21–40 years and total female to male patient ratio was 5.5:1. Most common presentations were heat intolerance (22.27%), cold intolerance (28.63%), and tachycardia (27.72%) apart from thyroid enlargement. Most common non-neoplastic lesion were multinodular and colloid goiter constituting 38.18% of total cases and most common neoplastic lesion was papillary carcinoma constituting 14.55% of total cases. Thyroid function test showed predominantly euthyroid states for all conditions. Conclusion: As the rest part of India, this part of Odisha also showed that thyroid disorders are more common in females and the most affected age group is 21–40 years. Multinodular and colloid goiter are the most common thyroid lesions. Most of the cases present with euthyroid state.
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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.
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Hashimoto thyroiditis (HT) is one of the most common autoimmune thyroid disease, and its pathogenesis has not been fully clarified at present. Most people believe that it is induced by mental stress, overwork, infection, stress, environmental pollution, unreasonable diet structure (such as high iodine diet) and other factors on the basis of genetic defects and genetic susceptibility. Vitamin D is a steroid hormone that maintains the balance of calcium and phosphorus metabolism in the body, regulating bone and mineral salt metabolism. Monocyte chemoattractant protein-1 (MCP-1) is a member of the chemokine CC family. It binds to chemokine receptor (CCR) and participates in immune inflammatory response. In recent years, more and more studies have found that vitamin D and MCP-1 are involved in the occurrence and development of many immune diseases, including Hashimoto thyroiditis. This article reviews the new research progress of the role of vitamin D and MCP-1 in Hashimoto thyroiditis.
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Objective:To investigate the daily diet and living habits of Hashimoto's thyroiditis (HT) patients, and to explore the influencing factors of HT.Methods:The patients admitted to the Thyroid Surgery Clinic of Cancer Hospital Affiliated to Harbin Medical University from March to December 2021 were selected as the investigation subjects and were divided into observation group (106 patients with HT) and control group (63 healthy people). Questionnaire was used to collect the information of daily diet and living habits of the two groups, and physical examination was used to collect the information of height and weight. The levels of serum thyroid function indicators thyroid stimulating hormone (TSH), free triiodothyronine (FT 3) and free thyroxin (FT 4) were tested by automatic chemiluminescence immunoassay, and the comparison and analysis were conducted between the two groups. Multivariate logistic regression was used to analyze the influencing factors of HT. Results:The results of univariate analysis showed that there were significant differences in sex ratio and serum TSH levels between the two groups ( P < 0.05); the proportion of people in observation group who slept for less than 6 hours per day, frequently looked at their mobile phones, ate fried food ≥1 time per week, and ate meat ≥1 kg per week was higher than that in control group; however, the proportion of people in observation group who drank tea ≥1 time per week, smoked ≥1 time per week, had a salty daily taste, ate nuts ≥1 time per week, and ate vegetables ≥1 kg per week was lower than that in control group, and the differences were statistically significant ( P < 0.05). The results of multivariate logistic regression analysis showed that female, slept duration < 6 hours/day, weekly meat consumption ≥1 kg, and elevated serum TSH levels were risk factors for the onset of HT [odds ratios ( OR) = 3.37, 4.11, 2.48, 1.14, and 95% confidence intervals ( CI): 1.08 - 10.55, 1.46 - 11.59, 1.00 - 6.51, 1.00 - 1.30]; eating ≥1 kg of vegetables per week was a protective factor for the onset of HT ( OR = 0.36, 95% CI: 0.17 - 0.79). Conclusion:Female, poor diet and lifestyle habits are risk factors for the onset of HT.
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Objective To explore the influencing factors of autoimmune thyroid disease in Xindu region and provide a basis for preventing the occurrence of autoimmune thyroiditis.Methods Using case-control study, 581 autoimmune thyroid patients treated in 2016-2020 in Chengdu Xindu District Hospital of 2020, and 450 healthy patients were selected as the control group. Relevant data were obtained and the influencing factors of adult autoimmune thyroid disease were analyzed by univariate and multivariate logistic regression model. Results Univariate results showed that the observed BMI of 30.0 kg/m2, hyperlipidemia, metabolic syndrome and urinary iodine ( 200 μg/L) were higher than control group, with thyroid function [free triiodinated thyrigenine (FT3), free thyroxine (FT4) and thyroid stimulating hormone (TSH)), autothyroid antibody [thyroglobulin antibody (TGAb), antithyroid peroxidase antibody (TPOAb),] greater than control group (P <0.05).According to logistic regression analysis, body mass index 30.0, TGAb positive, TPOAb positive, hyperlipidemia, and metabolic syndrome were independent risk factors for adult autoimmune thyroiditis [OR (95% CI): 1.965 (1.340), 3.1262 (1.568-8.243), 3.089 (1.753-7.166), 2.507 (1.164 -4.956), 2.218 (1.207 -3.362), P <0.05]. Conclusion Body mass index of 30.0 kg/m2, hyperlipidemia and metabolic syndrome are the risk factors for adult autoimmune thyroiditis in Xindu region.Controlling weight, controlling autoimmune thyroiditis and metabolic syndrome are the key to reducing adult autoimmune thyroiditis in Xindu region.
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Subacute thyroiditis， a common inflammatory disease of the thyroid gland， needs drug therapies due to fever， pain and other symptoms. Glucocorticoids and non-steroidal anti-inflammatory drugs （NSAIDs） are mainly used to treat this disease， while they may lead to severe side effects and high recurrence. Traditional Chinese medicine （TCM） demonstrates definite efficacy in alleviating the symptoms and shortening the disease course. The theory of excessive Qi causing fire holds that the excessive Qi of six excesses， seven emotions， or Yang hyperactivity in the Zangfu organs turns into fire and heat， resulting in pathological changes. According to this theory， this paper proposes the research on the pathogenesis and therapies of subacute thyroiditis can be started from the perspectives of Qi and fire. The disordered daily life causes internal injury of body and mind， predominant Yang Qi， or deficiency fire flaming upward， which leads to the invasion of six excesses and pathogenic toxins. Both the internal and external disorders induce the stagnation and the abnormal ascending and descending of Qi. The excessive Qi generates fire， the accumulation of which causes phlegm and stasis in front of the neck， eventually leading to the occurrence of subacute thyroiditis. The clinical and pathogenic characteristics of subacute thyroiditis indicate that the occurrence of this disease is associated with Qi and fire. Therefore， the treatment should focus on purging fire and detoxifying， regulating Qi movement， activating blood， resolving phlegm， and dissipating mass. Shengjiangsan has the effect of clearing heat and toxin， resolving phlegm， dredging collaterals， and dissipating mass， demonstrating definite therapeutic effect on subacute thyroiditis. This paper expounds the mechanism of Shengjiangsan in treating subacute thyroiditis from purging fire and regulating Qi. Furthermore， we preliminarily elaborate on the anti-viral， immunomodulatory， anti-inflammatory， and pain-relieving effects of Shengjiangsan from modern medicine. This paper provides new ideas for the syndrome differentiation and treatment of subacute thyroiditis from the perspectives of Qi and fire and basic ethical support for the clinical and basic research on the treatment of subacute thyroiditis by Shengjiangsan.
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Objective:To study the value of CT texture analysis (CTTA) parameters in differential diagnosis of benign and malignant thyroid nodules in Hashimoto’s thyroiditis.Methods:From May. 2020 to Oct. 2021, 110 patients with thyroid nodules in the background of Hashimoto’s thyroiditis in the Radiology Department of Nanjing Integrated Hospital of Traditional Chinese and Western Medicine were selected, and CTTA was performed. CTTA parameters (entropy value, peak state and skewness) were counted. The pathological diagnosis results were taken as the "gold standard". Statistical pathological examination results were used to compare the general clinical characteristics and CTTA parameters of benign and malignant thyroid nodules. The receiver operating characteristic (ROC) was used to analyze the diagnostic value of CTTA parameters for thyroid nodules.Results:According to the clinicopathological examination, 43 of 110 patients with Hashimoto’s thyroiditis were malignant, accounting for 39.09%. Among them, 22 were papillary carcinoma, 13 were follicular carcinoma, 6 were medullary carcinoma, and 2 were malignant lymphoma; 67 cases were benign, accounting for 60.91%, including 32 nodular goiters, 20 Hashimoto’s nodules, 8 thyroid adenomas, and 7 focal inflammation. The levels of TSH, irregular shape, blurry border and calcification in patients with malignant thyroid nodules were higher than those in patients with benign thyroid nodules ( t/ χ2=13.167, 18.364, 20.180,17.621, P<0.001). In the background of Hashimoto’s thyroiditis, there was no significant difference in the peak and skewness of CTTA parameters between benign and malignant thyroid nodules ( t=1.633, 1.382, P=0.105, 0.170). The entropy value of patients with malignant thyroid nodules was higher than that of patients with benign thyroid nodules, and the difference was statistically significant ( t=9.862, P<0.001). ROC analysis showed that the cut-off value of entropy value for diagnosing benign and malignant thyroid nodules was 6.28, AUC value was 0.909, 95% CI was 0.839-0.955, sensitivity was 86.05% (37/43), and specificity was 88.06% (69/67) . Conclusion:CTTA parameters in Hashimoto’s thyroiditis patients with benign and malignant thyroid nodules are different, and CTTA parameters have certain diagnostic value for benign and malignant thyroid nodules.
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Objective:To discuss the effect of Hashimoto’s thyroiditis (HT) on papillary thyroid carcinoma (РТС) .Methods:The clinical features and pathological characteristics of 682 patients who underwent surgical treatment for the first time from Sep. 1st,2019 to May. 1st, 2021 in Department of Thyroid, Breast and Hernia Surgery, and confirmed by postoperative pathology as papillary thyroid carcinoma were retrospectively analyzed. There were 189 male patients, and 493 female patients, 529 patients < 55 years old and 153 patients ≥55 years old. 476 patients were classified as PTC group and 206 patients as PTC combined with HT group. Chi square test was used to compare the difference between two groups in gender, age, thyroglobulin antibody, thyroid stimulating hormone, thyroid peroxidase antibodies, thyroid peroxidase, number of lesions, metastasis lymph node in central region, thyroid stimulating hormone receptor antibody, carcinoembryonic antigen, whether microcarcinoma, vascular invasion, glandular outside violation, capsule and lateral transfer analysis, ultrasonic calcification, etc. At the same time, all patients were divided into the group without central lymph node metastasis (345 cases) and the group with central lymph node metastasis (337 cases) . The χ 2 test was used to compare the differences between the two groups in terms of sex, age, number of lesions, microcarcinoma, vascular invasion, extradular invasion, capsular invasion, lateral cervical lymph node metastasis, ultrasonic calcification and so on, so as to analyze the differences in clinical characteristics between the two groups. Results:There were 206 cases (30.21%) in PTC combined with HT group and 476 cases (69.79%) in PTC without HT group. There were significant differences in gender (12/194 vs 177/299) ( P=0.000) , age (175/31 vs 354/122) ( P=0.002) , TgAb (115/91 vs 455/21) ( P=0.000) ,TSH (13/175/18 vs 33/429/14) ( P=0.004) , TPOAb (90/116 vs 422/54) ( P=0.000) , number of lesions (114/92 vs 325/151) ( P=0.001) and lymph node metastasis in central area (87/119 vs 250/226) ( P=0.014) between the two groups ( P < 0.05) , but there were no significant differences in TRAb (196/10 vs 461/15) ( P=0.171) , CEA (205/1 vs 469/7) ( P=0.478) , microcarcinoma (136/70 vs 309/167) ( P=0.781) , vascular invasion (4/202 vs 16/460) ( P=0.446) , extraglandular invasion (52/154 vs 108/368) ( P=0.470) , capsule invasion (149/57 vs 358/118) ( P=0.429) , lateral neck lymph node metastasis (31/175 vs 72/404) ( P=0.979) or ultrasonic calcification (157/49 vs 392/84) ( P=0.063) . Compared with PTC group, PTC combined with HT group had the characteristics of more women, younger age, high TgAb, high TSH, high TPOAb, multiple lesions and high proportion of non central lymph node metastasis. There were 345 cases (50.59%) without central lymph node metastasis and 337 cases (49.41%) with central lymph node metastasis. Gender (71/274 vs 118/219) ( P=0.000) , age (246/99 vs 283/54) ( P=0.000) , exadular invasion (66/279 vs 94/243) ( P=0.007) , number of lesions (240/105 vs 199/138) ( P=0.004) , microcarcinoma (259/86 vs 186/151) ( P=0.000) , calcification on ultrasound (250/95 vs 299/38) ( P=0.000) , and HT (119/226 vs 87/250) ) ( P=0.014) had statistical significance ( P<0.05) but had no statistical significance in capsule invasion (250/95 vs 257/80) ( P=0.256) or vascular invasion (10/335 vs 10/327) ( P=0.958) . In addition, patients in the group with central lymph node metastasis were more male, younger, with multiple lesions, exadenocarcinoma, less microcarcinoma, and calcification on ultrasound without hashimoto. Univariate analysis showed that gender, age, number of lesions, extraglandular invasion, calcification, microcarcinoma and Hashimoto had significant effects on lymph node metastasis in the central region; Multivariate analysis showed that the presence of microcarcinoma, ultrasonic calcification, Hashimoto and the number of lesions were independent risk factors for central lymph node metastasis. Conclusion:HT may promote the occurrence of PTC, but at the same time inhibit its development, so that PC patients with HT have a better prognosis.
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Objective:To explore the risk factors of central lymph node metastasis (CLNM) in Hashimoto thyroiditis (HT) patients with thyroid micropapillary carcinoma (PTMC), and formulate a reasonable range of lymph node.Methods:Retrospective analysis of 448 cases of PTMC admitted to the People′s Hospital of Inner Mongolia Autonomous Region from September 2018 to September 2021 including 94 males and 354 females, with a male female ratio of 1.00∶3.77, all patients aged 21 to 82 years old, with the average of (46.9 ± 11.0) years old. According to whether Hashimoto thyroiditis (HT) is combined, it is divided into HT-PTMC group ( n=142) and non HT-PTMC group ( n=306).Single factor analysis and multiple factor analysis were used to explore whether the clinicopathological characteristics of patients such as gender, age, tumor diameter, number of lesions (single/multiple lesions), presence of capsule invasion, pretracheal/paratracheal lymph nodes, delphian lymph nodes, and lateral cervical lymph nodes were related to lymph node metastasis in the central region. SPSS 20.0 software was used for statistical analysis and logistic regression equation was established, The mathematical model was used to evaluate the predictive value of diagnosis and treatment. Results:There were significant differences between HT-PTMC group and non HT-PTMC group in terms of age, sex, metastasis of anterior laryngeal lymph nodes and lateral cervical lymph nodes ( P<0.05). Univariate analysis showed that tumor diameter, number of lesions, capsule invasion, calcification, lateral cervical lymph node metastasis were correlated with CLNM in HT-PTMC patients ( P<0.05). Multivariate logistic regression analysis showed that tumor diameter increase and capsule invasion were independent risk factors for CLNM ( P<0.05). Logistic regression mathematical model was established according to the above independent risk factors: (Y=-1.974+ 0.191 × Tumor diameter+ 1.139 × The area under the ROC curve for predicting CLNM in HT-PTMC patients was 0.669 (95% CI: 0.571- 0.766). When taking the maximum Jordan index, the sensitivity of prediction was 0.460, and the specificity was 0.859. Conclusions:For PTMC patients with HT, there is evidence that the tumor diameter increases or the capsule is invaded, and the risk of lymph node metastasis in the central region is increased. Preventive lymph node dissection in the central region is recommended.
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La tiroiditis subaguda (TSA) es un trastorno inflamatorio autolimitado de la glándula tiroides. Es más común en mujeres y se caracteriza por dolor cervical, síntomas inflamatorios sistémicos y disfunción tiroidea. La TSA se ha asociado a una infección viral previa, generalmente respiratoria o enteral. Múltiples virus se han relacionado con TSA. Desde mayo de 2020 se reportaron casos de TSA relacionados con la infección por SARS-CoV-2. Describimos 3 casos de SAT después de la vacuna COVID-19. Dos casos fueron inoculados con vacuna SARS-CoV-2 inactivada (CoronaVac) y uno con vacuna de ARNm Pfizer-BioNTech. Los síntomas clínicos comenzaron pocas semanas después de la inoculación. Presentaron dolor cervical anterior, fiebre, astenia y tirotoxicosis transitoria. En todos los casos la evolución fue favorable. Hasta donde sabemos, estos son los primeros casos de SAT posteriores a la vacuna COVID-19 descritos en Chile.
Subacute thyroiditis (SAT) is a self-limited inflammatory disorder of the thyroid gland. The disease is more common in women and is characterized by neck pain, systemic symptoms, and thyroid dysfunction. SAT It has been associated with viral, respiratory or enteral infection. Multiple viruses had been related to SAT. Since May 2020, cases of SAT related to SARS-CoV-2 infection were reported. We describe 3 cases of SAT following COVID-19 vaccine. Two cases were inoculated with inactivated SARS-CoV-2 vaccine (CoronaVac) and one with mRNA vaccine PfizerBioNTech. The clinical symptoms began few weeks after inoculation. They presented with neck pain, fever, general malaise and transient thyrotoxicosis. All cases revered spontaneously. To our knowledge, these are the first cases of SAT following COVID-19 vaccine described in Chile.
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Humans , Male , Female , Adult , Aged , Thyroiditis, Subacute/chemically induced , COVID-19 Vaccines/adverse effects , Vaccines, Inactivated/adverse effects , BNT162 Vaccine/adverse effectsABSTRACT
Subacute thyroiditis (SAT) is an inflammatory disease of the thyroid gland with multiple etiologies and clinical features, often challenging to recognize. The classic presentation is the painful, granulomatous thyroiditis (DeQuervain's) characterized by diffuse swelling of the gland, usually preceded by an upper respiratory tract infection. A painless variant, also referred to as autoimmune subacute thyroiditis, has been documented and is strongly linked to postpartum state, reported following ~10% of pregnancies. It can be differentiated from the former by the presence of anti-thyroid antibodies, which classifies it as an autoimmune thyroiditis. Any spontaneous development of painful swelling of the thyroid gland warrants a complete work up that includes thyroid hormones, thyroid autoimmune panel, acute phase reactant titers, and, if available, imaging that may lead to the diagnosis of an inflammatory or infectious cause of thyroiditis.
Tiroiditis Subaguda, es una enfermedad inflamatoria de la glándula Tiroides que tiene muchas etiologías y características clínicas, y frecuentemente difícil de reconocer. La presentación clásica es: tiroiditis granu-lomatosa dolorosa caracterizada de hinchazón difusa de la glándula del Tiroides, usualmente precedida de una infección respiratoria de las vías áreas superior (como una infección viral). Existe una variante sin dolor, tam-bién referida como tiroiditis subaguda autoinmune, ha sido documentado y es muy ligada al estado postparto, en un 10% de los embarazos. La Tiroiditis postparto Puede ser diferenciada de la anterior por la presencia de anticuerpos lo que la clasifica como una tiroiditis auto-inmune. Cualquier desarrollo espontaneo de una hin-chazón dolorosa de la tiroides garantiza su evaluación de una manera formal, que incluye las hormonas del tiroides, panel tiroideo de autoinmunidad títulos de los factores que reaccionan agudamente, y si está disponible imágenes como una ultrasonografía que conlleva al di-agnóstico de una Tiroiditis inflamatoria o de origen in-feccioso.
Subject(s)
Humans , Female , Adolescent , Thyroiditis, Subacute , Goiter, Nodular , Postpartum ThyroiditisABSTRACT
SUMMARY OBJECTIVE: Hashimoto's thyroiditis, also known as chronic lymphocytic thyroiditis or autoimmune thyroiditis, is a considerable part of the spectrum of chronic autoimmune thyroid gland disorders which is pathologically associated with various degrees of lymphocytic infiltration. The purpose of the present study was to evaluate whether cartilage thickness is affected in patients with Hashimoto's thyroiditis or not in thyroidology. METHODS: A total of 61 individuals had been evaluated in this case-control study, including 32 euthyroid Hashimoto's thyroiditis patients and 29 healthy subjects comparable in age, sex, and body mass index. The patients with a history of knee trauma or knee surgery, an additional systemic disease such as diabetes mellitus, or an inflammatory disease like rheumatoid arthritis, systemic lupus erythematosus, and scleroderma had not been included in the study. The thickness of the femoral articular cartilage was measured using B-mode ultrasonography, and the right lateral condyle, right intercondylar area, right medial condyle, left medial condyle, left intercondylar area, and left lateral condyle were also measured. RESULTS: No statistically significant difference between patients with Hashimoto's thyroiditis diagnosis and healthy controls in terms of age, age groups, gender, and body mass index (p>0.05). CONCLUSION: As a consequence, no obvious connection between autoimmune markers and cartilage thickness in patients with Hashimoto's thyroiditis was recognized. Although the diverse manifestation of Hashimoto's thyroiditis could be observed, it seems to be no liaison between thyroid autoimmunity and cartilage thickness.
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SUMMARY Acute suppurative thyroiditis is an uncommon disorder caused by a bacterial infection, usually presenting with normal thyroid function. It is a serious condition that requires a prompt diagnosis and treatment with antibiotics and supportive measures. A 62 years-old female presented with a painful cervical induration and odynophagia a week after a fish bone had been removed from her pharynx. She was febrile, and tachycardic and, on physical examination, a painful thyroid mass was detected. High inflammatory parameters and thyrotoxicosis were confirmed: thyroid stimulating hormone (TSH) < 0.01 mIU/L (normal range [NR] 0.27-4.2); free thyroxine (FT4) 3.86 ng/dL (NR 0.9-1.7) and anti-TSH receptor antibodies (TRABs) 5.3 U/L (NR < 1.5). Thyroid scintigraphy showed a diffuse uptake of the thyroid parenchyma suggesting Graves disease. Cervical ultrasonography revealed an abscess of the left thyroid lobe of 36 × 36 mm and fine needle aspiration biopsy (FNAB) with partial drainage was performed. Staphylococcus aureus and Streptococcus viridans were isolated, and directed antibiotic therapy was started. Clinical improvement was observed as well as a decrease of inflammatory parameters and the patient was discharged after 9 days of hospitalization. Eighteen days after discharge, thiamazole was initiated due to persistent thyrotoxicosis. Complete resolution of the abscess was documented within 6 months and the patient became euthyroid under thiamazole one year after initial presentation. To our knowledge, this is the third case reporting an association between acute thyroiditis and Graves disease. Furthermore, this is the first case detailing the simultaneous diagnosis of acute suppurative thyroiditis caused by a foreign body and Graves disease.
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The clinical and imaging data of 99 patients with Graves′ disease, 78 patients with thyroiditis and 28 patients with other diseases (resolving thyroiditis, non thyroid disease and simple goiter) who underwent thyroid scintigraphy in Beijing Shijingshan Hospital from January 2016 to March 2022 were retrospectively reviewed. The UR value of thyroid scintigraphy was calculated and ROC curve was used to assess the UR value in diagnosis of Graves′ disease. The UR value of patients with Graves′ hyperthyroidism was significantly higher than that of patients with thyroiditis and other diseases ( H=163.62, P<0.05). UR>4.84 was taken as optimal cutoff value to diagnose Graves′ hyperthyroidism, with the sensitivity and specificity of 95.0% and 98.1%, respectively.
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Objective:To investigate the clinical characteristics and related risk factors of thyroid gland injury (TGI) in patients with a malignant tumor treated with a programmed death-1 (PD-1) inhibitor.Methods:A Retrospective case-control study. Data from 198 patients with a malignant tumor who received treatment with a PD-1 inhibitor in Chinese PLA General Hospital from October 2019 to October 2021 were collected and analyzed retrospectively. According to the TGI incurred after receiving treatment with a PD-1 inhibitor, patients were divided into a thyroid gland normal (TGN) group and TGI group. The prevalence, type, time of occurrence, and outcome of TGI were analyzed. The risk factors that may contribute to TGI were analyzed further by logistic regression.Results:TGI prevalence was 29.8% (59/198 cases) after treatment with a PD-1 inhibitor. There were significant differences with respect to previous radiotherapy and targeted therapy between the TGN group and TGI group ( P<0.01 for both), but there were no significant differences with regard to sex, age, tumor type, previous surgery, previous chemotherapy, tumor metastasis, or type of PD-1 inhibitor ( P>0.05 for all). Patients in the TGI group included those with subclinical hypothyroidism (32.2%, n=19), hypothyroidism (27.1%, n=16), thyrotoxicosis (23.7%, n=14), subclinical thyrotoxicosis (10.2%, n=6), and thyroiditis with normal thyroid function (6.8%, n=4), and the median time of occurrence (months) was 3.00, 3.00, 1.50, 1.50, and 0.80 after treatment with a PD-1 inhibitor, respectively. Among 20 patients who presented initially with thyrotoxicosis or subclinical thyrotoxicosis, 12 cases developed hypothyroidism or subclinical hypothyroidism subsequently. Logistic regression analysis suggested that previous radiotherapy ( OR=3.737, 95% CI 1.390-10.046), targeted therapy ( OR=3.763, 95% CI 1.553-9.117), thyroglobulin antibodies at baseline ( OR=12.082, 95% CI 1.199-121.775), and thyroid-peroxidase antibodies at baseline ( OR=10.874, 95% CI 1.010-117.047) were risk factors associated with the TGI caused by treatment with a PD-1 inhibitor. Conclusions:After treatment with a PD-1 inhibitor, TGI prevalence was high, especially in those with hypothyroidism or subclinical hypothyroidism. Some patients had a transition from thyrotoxicosis to hypothyroidism. Patients who underwent radiotherapy previously, had targeted therapy, or were thyroid autoantibody-positive at baseline may carry an increased risk of TGI following treatment with a PD-1 inhibitor.