Evaluation of the structure, autoimmunity, and functions of the thyroid gland in familial Mediterranean fever patients

ABSTRACT Objective Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disorder that is frequently seen in the eastern Mediterranean region. The thyroid gland can be affected in FMF patients through autoimmunity or amyloidosis. Here, we aimed to evaluate the structure and functions of the thyroid gland in addition to possible autoimmunity in FMF patients. Subjects and methods The study was conducted by the Endocrinology and Metabolism and Internal Medicine Departments. Thirty FMF patients and 30 age and gender-matched healthy controls were enrolled in the study. Free thyroxin (fT4), free triiodothyronine (fT3), thyroid-stimulating hormone (TSH), and anti-thyroid peroxidase (anti-TPO) autoantibodies were investigated. Detailed thyroid grayscale and Doppler Ultrasonography examinations and shear-wave elastosonography (SWE) were performed in the patient and control groups. Results Anti-TPO was detected in 24% (n = 7) of the patients. On the grayscale US, mean thyroid volumes were similar between the FMF and the control groups (p > 0.05). By Doppler US, thyroid vascularity observed was detected in 10.3% (n = 3) of the patients. SWE revealed that the mean velocity value of right vs. left lobe in the patient group was 1.77 ± 0.45 m/s and 1.95 ± 0.51 m/s, respectively. Compared to the control group, the mean velocity values were significantly higher in the right (p = 0.004) and left (p = 0.01) lobes of the patient group. The mean stiffness value in the patient group was also significantly higher in the right and left lobes [10.13 ± 5.65 kPa (p = 0.005) and 12.24 ± 6.17 kPa (p = 0.02), respectively]. Conclusion Recognizing the complications of FMF early in the course of the disease is as important as the early diagnosis of the disorder. Based on this, thyroid functions and changes in its structure should be evaluated carefully for early diagnosis of a possible coexisting thyroid disorder. Arch Endocrinol Metab. 2020;64(1):66-70

Discrepancia en concentraciones de hormonas tiroideas libres medidas por distintos inmunoensayos / Discrepancy in concentrations of free thyroid hormones measured by different immunoassays

Abstract: Thyroid function is assessed by measuring thyrotropin and free and total thyroid hormone concentrations. There are interferences with the results of immunoassays that can lead to an incorrect diagnosis, of which the most frequent are the binding of thyroid hormones to heterophile antibodies, rheumatoid factor, anti-Ruthenium antibodies, the intake of biotin and anti-streptavidin antibodies. We present three cases of clinically euthyroid patients, with normal TSH, high free T4 and T3, and normal total T4 and T3 performed in a Roche Diagnostics ® COBAS 8000 device. When the test was repeated on a Siemens® Immulite device, the free and total hormones were within normal ranges. In the Roche Diagnostics ® assay, the presence of biotin or anti-Ruthenium or anti-streptavidin antibodies interferes with the formation of the complex responsible for the emission of light that allows inferring concentrations of thyroid hormones. The Siemens test works differently since the emission of light depends on the binding of T4 to an antibody conjugated with alkaline phosphatase not participating in the process biotin, streptavidin or ruthenium so this interference is avoided. This possible interference in immunoassays should be taken into account in case clinical manifestations differ from these laboratory determinations, to avoid a diagnosis and potential inappropriate treatment.

Resumen: La función tiroidea se evalúa midiendo tirotropina y concentraciones de hormonas tiroideas libres y totales. Existen interferencias con los resultados de inmunoensayos que pueden llevar a un diagnóstico incorrecto, de ellas, las más frecuentes son la unión de hormonas tiroideas a anticuerpos heterófilos, el factor reumatoide, anticuerpos anti Rutenio, la ingesta de biotina y anticuerpos anti estreptavidina. Se presentan tres casos de pacientes clínicamente eutiroideos, con TSH normal, T4 y T3 libres elevadas, y T4 y T3 totales normales realizadas en un equipo COBAS 8000 de Roche Diagnostics®. Cuando se repitió el ensayo en un equipo Immulite de Siemens®, las hormonas libres y totales estaban dentro de rangos normales. En el ensayo de Roche Diagnostics ®, la presencia de biotina o anticuerpos anti Rutenio o anti estreptavidina, interfiere con la formación del complejo responsable de la emisión de luz que permite inferir las concentraciones de las hormonas tiroideas. El ensayo de Siemens funciona de manera diferente ya que la emisión de luz depende de la unión de la T4 a un anticuerpo conjugado con fosfatasa alcalina no participando en el proceso biotina, estreptavidina o Rutenio por lo que se evita esta interferencia. Esta posible interferencia en inmunoensayos debe ser tenida en cuenta en caso de que las manifestaciones clínicas difieran de estas determinaciones de laboratorio, para evitar un diagnóstico y potencial tratamiento inadecuado.

Thyroid dysfunction and autoimmunity in females in goitre endemic area

To study thyroid dysfunction and thyroid autoimmunity among females with and without goitre in goitre endemic area. A cross sectional survey was carried out during the year 2007 in Chakar, district Muzafarabad. A group of 100 females 18-65 years of age were included; among them 50% having goitre were included in group I as cases and 50% asymptomatic females were included in group II as asymptomatic controls. Goitre was graded according to World Health Organization recommended criteria. For each study participant thyroid function status was assessed by T3, T4, thyroid stimulating hormone levels and thyroid autoimmunity by anti thyroid peroxidase and anti thyroglobin antibody levels. Data was analyzed using SPSS 12. Mean thyroid stimulating hormone levels were found higher [18.0 +/- 7.4] in cases [group I] than in asymptomatic controls [group II] [3.2 +/- 1.6]. On the basis of thyroid stimulating hormone, among cases 32 [64%] were primary hypothyroid, 11 [22%] were subclinical hypothyroid and 7 [14%] were euthyroid, whereas among asymptomatic controls it was 10 [20%], 13 [26%] and 27 [54%] respectively. Mean thyroid stimulating hormone decreased from 27.3 to 13.0 mIU/ml in goitre and from 5.6 to 1.2 mIU/ml in non-goitre at 16-65 years of age. Frequency of anti thyroid peroxidase and anti thyroglobin antibody was found 22 [44%] and 18 [36%] among cases, while 16 [32%] and 15 [30%] among asymptomatic controls respectively. No association was found between age and presence of goitre with anti thyroglobin or anti thyroid peroxidase positive antibodies [p>0.05], whereas association between anti thyroglobin and anti thyroid peroxidase antibodies with high thyroid stimulating hormone levels among study groups was found significant [p<0.05]. High proportions of anti thyroid peroxidase and anti thyroglobin positive cases were found between ages 26-45 years. The frequency of thyroid dysfunction and autoantibody in females of goitre endemic area was high, but showed no relation with the presence of goitre. Thyroid stimulating hormone had an inverse relationship with age among goitre and non-goitre cases. Positive anti thyroid peroxidase and anti thyroglobin antibodies were not age related, however they were found to be associated with elevated levels of thyroid stimulating hormone

Prevalência de disfunção tireoidiana e anticorpos antitireoidianos em pacientes portadores de diabetes melito tipo 1 e em seus familiares de primeiro grau / Prevalence of thyroid dysfunction and antithyroid antibodies in type 1 diabetic mellitus patients and their first degree relatives

O diabetes melito tipo 1 (DM1) freqüentemente encontra-se associado à doença auto-imune da tireóide (DAT). A prevalência de DAT varia de 3 por cento a 50 por cento entre diabéticos, e é maior também entre seus familiares, comparada à população geral. OBJETIVOS: Investigar a prevalência da DAT em pacientes com DM1, avaliar possíveis diferenças de comportamento clínico-evolutivo do DM1 entre diabéticos com e sem DAT e estudar a prevalência de DAT nos familiares dos pacientes diabéticos. MATERIAIS E MÉTODOS: Os prontuários de 124 diabéticos tipo 1 foram revisados e coletados os dados referentes à função e aos anticorpos tireoidianos; pacientes com e sem DAT foram comparados em relação à média de Hb glicosilada, complicações agudas e crônicas, idade ao diagnóstico e tempo de evolução do DM, dose de insulina e outros. Um estudo caso-controle foi realizado com 54 familiares em primeiro grau destes pacientes; foram avaliadas a função tireoidiana e a presença de anticorpos antitireoidianos em 32 familiares de diabéticos sem DAT e 22 familiares de diabéticos com DAT. RESULTADOS: As prevalências de DAT e de disfunção hormonal entre os diabéticos foram de 35,5 por cento e 19,3 por cento, respectivamente. Quanto à avaliação dos parâmetros de evolução do DM1, comportamento clínico e controle metabólico não houve diferenças significantes entre os diabéticos com e sem DAT. Houve maior prevalência de DAT nos familiares de diabéticos com DAT do que no grupo dos familiares dos diabéticos sem DAT, sem diferença significativa quanto à prevalência de disfunção hormonal. CONCLUSÕES: A prevalência de doença auto-imune de tireóide em diabéticos e em seus familiares é elevada, justificando-se, nesses casos, a investigação rotineira da função tireoidiana, particularmente dos familiares de primeiro grau de diabéticos com DAT.

Diabetes Mellius Type 1 (DM1) is frequently associated to Autoimmune Thyroid Disease (AITD). The prevalence of AITD among diabetic patients varies between 3 to 50 percent and the incidence is also big among their family members, when compared to the population in general. OBJECTIVES: To investigate the prevalence of AITD in patients with DM1; to evaluate possible differences concerning the clinical-evolutive behavior of DM1 among diabetic patients with or without AITD and to study the prevalence of AITD among the diabetes patients' relatives. MATERIALS AND METHODS: 124 prontuaries of diabetic patients (type 1) were revised and data was gathered concerning the thyroid function and the anti-thyroid antibodies. Patients with and without AITD were compared in relation to the level of glycosylated hemoglobin, the presence of acute and chronic complications, the age of the patient at the time of the diagnosis, time of evolution of the disease, daily dose of insulin and other factors. A control case study was conducted with 54 first degree relatives of the diabetic patients who took part in the study; the thyroid function as well as the presence of anti-thyroid antibodies were evaluated in 32 of those first degree relatives with AITD, and in 22 of those without AITD. RESULTS: The prevalence of AITD and of hormonal dysfunction among diabetic patients was 35.5 percent and 19.3 percent, respectively. No significant differences were found between groups in respect to clinical outcome or to diabetic chronic complications. However, prevalence of AITD and hormonal dysfunction were found to be higher among first degree relatives of diabetic patients with AITD than among relatives of diabetic patients without AITD. CONCLUSIONS: The prevalence of autoimmune thyroid disease in diabetic patients and in their first degree relatives is high. Thyroid function screening is therefore justified in these cases, especially in first degree relatives of diabetics ...

Prevalence of thyroid autoimmunity in patients with pemphigus vulgaris

El pénfigo vulgar (PV)es una enfermedad ampollar clásica de etiología autoinmune que se caracteriza por la presenciade lesiones intraepiteliales. Para establecer la prevalencia de anormalidades tiroideas en el PV, realizamos unestudio prospectivo en 15 pacientes consecutivos que consultaron a la División Dermatología debido a PV y enun grupo de 15 voluntarios sanos (Grupo Control). La función tiroidea se evaluó a través de la medición de T3,T4 y TSH y la presencia de bocio se determinó por medio de la palpación tiroidea. La autoinmunidad se investigóusando un ensayo IRMA para la medición de anticuerpos antitiroperoxidasa (ATPO). En cada grupo había9 mujeres y 6 hombres que fueron apareados por edad y sexo, con edades comprendidas entre 25 y 65 años(promedio 48.2 años) en el grupo PV, y entre 25 y 69 años (promedio 45.4 años) en el grupo control. Se encontróque 7 pacientes (46.6%) del grupo PV y uno (6.6%) del grupo control presentaron alteraciones tiroideas,(p<0.015). La presencia de ATPO positivos se observó en 6 pacientes con PV y en un voluntario del grupocontrol. Un paciente con PV presentó un bocio difuso asociado a un hipotiroidismo subclínico con ATPO negativos.De los 7 casos con ATPO positivos, solo un paciente del grupo PV presentó una tiroiditis de Hashimotomanifiesta. Todos los demás casos solo tuvieron ATPO positivos sin evidencias clínicas de tiroiditis crónica. ElPV se asocia frecuentemente con ATPO positivos, aunque la mayoría de los pacientes no presentan enfermedadestiroideas que se expresen clínicamente..

Urticaria cronica con alteraciones de la funcion tiroidea y anticuerpos antiperoxidasa tiroidea / Chronic urticaria with alterations of the thyroid function and thyroid peroxidase antibodies

La urticaria crónica es una enfermedad frecuente, caracterizada por la presencia de ronchas y/o angioedema con una duración superior a las 6 semanas. En un número importante de pacientes se comporta como una enfermedad autoinmune asociada frecuentemente con alteraciones en la función tiroidea y com la presencia de anticuerpos antitiroideos. Presentamos una serie de 70 pacientes consecutivos con diagnóstico de urticaria crónica a los cuales les investigamos la función tiroidea y la presencia de anticuerpos antiperoxidasa tiroidea. Siete (10%) tenían diagnóstico de enfermedad tiroidea previa al momento de la consulta. A los 63 pacientes restantes se les estudió los niveles de tirotrofina sérica, 11 de los cuales (17%) presentaron valores anormales, que sumados a los 7 con enfermedad previa llegan a 18 (26%) con función tiroidea alterada. A 61 pacientes se les investigo anticuerpos antiperoxidasa tiroidea, 22 (36%) fueron positivos. De 57 pacientes sin diagnóstico de patología tiroidea previa al momento de la consulta por urticaria, a los que se les estudió tanto los niveles de tirotrofina sérica como la presencia de anticuerpos antiperoxidasa tiroidea, 24 (42%) presentaron alguno de los estudios alterados. El alto porcentaje de alteraciones tiroideas en nuestra serie de pacientes resalta la necesidad de estudiar la función tiroidea y la presencia de anticuerpos antiperoxidasa tiroidea en pacientes con urticaria crónica.

Early changes in thyroid-stimulating antibody activity following radio iodine therapy

The aim of this study was to determine whether or not the titre of thyroid-stimulating hormone receptor antibody with stimulating [TRAb-S] activity changes in patients with Graves' disease [GD] or toxic multinodular goitres [TMNG] 3 months after treatment with sodium iodide [131I]. Subjects and Serum specimens were obtained from 21 hyperthyroid patients [15 with GD and 6 with TMNG] at a median 0.5 months before and 3 months after 131I treatment using a standard ablative dose of 555 MBq. TRAb-S activity was measured in a sensitive and specific luminescent bioassay employing the lulu cell line and expressed as a stimulation index [SI; normal 1.5]. The mean TRAb-S in the GD patients was 2.72 SI [95% CI: 1.51-4.03] 0.5 months before administration of 131I and 3.98 SI [95% CI: 1.20-6.76] 3 months after administration of 131I. The difference was not statistically significant at p < 0.8. It was not elevated in the TMNG patients before [0.57 SI; 95% CI: 0.41- 0.73] and after [1.00 SI; 95% CI: 0.74-1.26] treatment either. Conclusions: Radioiodine therapy for GD or TMNG did not induce a significant change in TRAb-S activity at 3 months after treatment with 131I, probably due to effective antithyroid therapy or the timing of samples

Macroadenomas näo-funcionantes da hipófise: estudo imuno-histoquímico / Functionless pituitary macroadenomas: immunohistochemical study

Cinqüenta e nove adenomas hipofisários, do tipo nao-funcionante, foram analisados pelo método imuno-histoquímico. Os tumores foram estudados através da técnica da peroxidase - avidina - biotina (ABC) e pesquisados os seguintes hormônios, com anticorpos primários específicos: prolactina (PRL), hormônio do crescimento (HS), corticotrofina (ACTH), gonadotrofinas (HCG) e tireotrofina (TSH). Trinta e oito tumores nao reagiram a nenhum anticorpo, 8 tumores apresentaram imunorreaçao positiva à prolactina, 5 tumores eram imunorreativos ao HS, 6 eram imunorreativos ao ACTH, e 10 tumores eram imunorreativos às gonadrotofinas, sendo que 5 ao LH e 5 ao FSH. Dos tumores que apresentaram imunorreatividade ao hormônio do crescimento e à prolactina houve manifestaçao clínica em apenas um, cujo paciente evoluiu com altas taxas de prolactina sangüínea.

Interet du dosage anticorps antirecepteurs a la tsh

TSH receptor antibodies [TRAB] was performed by binding assay in seventy-seven patients [47 with Graves disease, 32 with other thyroid abnormalities] the sensitivity and specificity of our assay were respectively 81% and 96.5% these resultrs were similar to the results found in medical literature. The association of ophthalmopathy with Graves disease does not increase the sensitivity of the test. In this study we conclude that TRAB assay is of great interest in confirming the diagnosis and in the following of Graves disease