Clinical characteristics of 527 patients of Tibetan nationality with vitiligo / 中华皮肤科杂志

Objective:To analyze clinical characteristics of patients of Tibetan nationality with vitiligo in the Tibet autonomous region.Methods:Clinical data were collected from 527 patients of Tibetan nationality with vitiligo, who visited Department of Dermatology, People′s Hospital of Tibet Autonomous Region from January 2018 to December 2019, including age, gender, seasons at onset, involved body sites, classification and stages of vitiligo, concomitant diseases and laboratory test results.Results:Among the 527 patients of Tibetan nationality with vitiligo, the ratio of male to female was 0.97∶1, and vitiligo usually occurred at 10 - 30 years of age. As for clinical staging, 335 (63.6%) patients were diagnosed with progressive vitiligo, and 192 (36.4%) with stable vitiligo; as for clinical classification, there were 97 (18.4%) patients with segmental vitiligo, 293 (55.6%) with vitiligo vulgaris, 79 (15%) with mixed vitiligo and 58 (11%) with unclassified vitiligo; vitiligo lesions were mainly located on the face and neck (253 cases, 48%) , followed by the trunk (148 cases, 28%) , upper limbs (64 cases, 12%) , lower limbs (46 cases, 9%) , and perineal and perianal mucosa (16 cases, 3%) ; vitiligo usually occurred in summer (198 cases, 37.6%) and spring (154 cases, 29.2%) , followed by autumn (98 cases, 18.6%) and winter (77 cases, 14.6%) ; 140 (26.6%) patients suffered from other diseases such as thyroid diseases (85 cases, 16.1%) , and 74 (14.0%) suffered from subclinical thyroid diseases; one or more serological abnormalities were observed in 22 patients, including 18 with progressive vitiligo. Compared with the patients with stable vitiligo, those with progressive vitiligo showed significantly increased thyroid stimulating hormone (TSH) levels ( P = 0.004) . Spearman rank correlation analysis showed that altitude was weakly correlated with the stage of vitiligo ( rs = -0.18, P < 0.001) , the stage of vitiligo was weakly negatively correlated with the TSH level ( rs = -0.12, P = 0.005) and complement C3 level ( rs = -0.09, P = 0.041) , and the classification of vitiligo was weakly correlated with the TSH level ( rs = -0.11, P = 0.011) . Conclusion:In this study, the patients of Tibetan nationality with vitiligo were mostly aged at 10 - 30 years, vitiligo lesions were mainly located on the face and neck, and usually occurred in spring and summer, and the prevalence of comorbid thyroid dysfunction was relatively high.

Graves' Patient with Thymic Expression of Thyrotropin Receptors and Dynamic Changes in Thymic Hyperplasia Proportional to Graves' Disease Activity

Thymic hyperplasia is frequently observed in Graves' disease. However, detectable massive enlargement of the thymus is rare, and the mechanism of its formation has remained elusive. This case showed dynamic changes in thymic hyperplasia on serial computed tomography images consistent with changes in serum thyrotropin receptor (TSH-R) antibodies and thyroid hormone levels. Furthermore, the patient's thymic tissues underwent immunohistochemical staining for TSH-R, which demonstrated the presence of thymic TSH-R. The correlation between serum TSH-R antibody levels and thymic hyperplasia sizes and the presence of TSH-R in her thymus suggest that TSH-R antibodies could have a pathogenic role in thymic hyperplasia.

A Case of Graves' Disease Occurring after Subacute Thyroiditis / 대한내과학회지

Graves' disease following subacute thyroiditis is uncommon. Some patients in these cases showed positive for thyroid antibody only transiently in the resolving phase. However, Graves' disease can rarely be caused by the presence of antibodies after subacute thyroiditis, although the pathophysiology of this is unclear. A 40-year-old woman presented with anterior neck pain and swallowing difficulty. Thyroid function testing showed reduced thyroid-stimulating hormone (TSH) and elevated free thyroxine levels. A thyroid scan revealed decreased uptake in the bilateral thyroid gland. The patient was initially diagnosed with subacute thyroiditis and treated with steroids. Five months later, thyroid function testing showed recurrent hyperthyroidism with positive conversion of TSH receptor antibody, indicating Graves' disease. Since then, she needed the long-term methimazole treatment. In summary, we herein report a case of Graves' disease occurring after subacute thyroiditis.

Analysis of the clinical features of 6 patients with Hashimoto′s Encephalopathy / 中国基层医药

Objective To investigate the clinical features of Hashimoto′s Encephalopathy(HE).Methods To retrospectively analyze the clinical data of 6 HE patients,admitted in Shanghai Changhai Hospital between 2010 and 2013.Results The age of onset were between 41 and 71 years;the male-to-female ratio was 1:5;the most common manifest was memory loss (5 patients);the ATPO of all the patients were significantly high ,but the test of ce-rebrospinal fluid ,electroencephalography and iconography were all non -specific;all of 6 patients responded well to the steroid therapy .Conclusion HE should be considered in those whose memory deteriorated and ATPO elevated , especially when they were sensitive to steroid treatment .

Correlation between the thyroid autoimmune state after 131I treatment and the early hypothyroidism in patients with Graves disease / 中国医师进修杂志

Objective To study the changes of the serum levels of thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) after 131I treatment in patients with Graves disease,and investigate the correlation between the early hypothyroidism and serum levels of TPOAb,TGAb after 131I treatment.Methods The serum levels of TPOAb and TGAb of 167 patients with Graves disease were detected before treatment and 3,6,12,18 months after 131I treatment.According to the levels of TPOAb and TGAb,all patients were divided into positive antibodies group (72 cases) and negative antibodies group(95 cases),and the incidence of the early hypothyroidism was compared between two groups after 131I treatment.According to the incidence of the early hypothyroidism,all patients were divided into early hypothyroidism group(64 cases) and non-early hypothyroidism group(103 cases),and the variations of thyroid function and thyroid autoantibody were detected.Results The incidence of hypothyroidism in 18 months after 131I treatment in positive antibodies group was 19.4％(14/72),while that in negative antibodies group was 7.4％(7/95),and there was significant difference between two groups (P ＜ 0.05).The positive rate of TPOAb and TGAb was highest in 6 months after 131I treatment,but there was no significant difference compared with that before treatment (P ＞ 0.05).The positive rate of TPOAb and TGAb was decreased in 3,12,18 months after 131I treatment.There was significant difference in the positive rate of TPOAb and TGAb between the time before treatment and 18 months after 131I treatment[15.6％(26/167),19.8％(33/167)](P＜ 0.01).The serum level of TPOAb and TGAb in early hypothyroidism group was higher than that in non-early hypothyroidism group [(433.2 ± 98.4) kU/L vs.(211.4 ± 76.5) kU/L; (165.7 ± 41.6) kU/L vs.(89.5 ± 21.1) kU/L,P ＜0.01].Conclusions The levels of TPOAb and TGAb before treatment is related to the probability of the early hypothyroidism,and play a guided role in 131I treatment of Graves disease.

Diagnostic Value of a Chimeric TSH Receptor (Mc4)-Based Bioassay for Graves' Disease

BACKGROUND/AIMS: Graves' disease (GD) is caused by thyroid-stimulating hormone receptor (TSHR) and thyroid-stimulating immunoglobulin (TSI). We used a recently introduced, technically enhanced TSI bioassay to assess its diagnostic value and determine the cut-off in patients in high iodine intake area. METHODS: In a cross-sectional setting, we collected serum from 67 patients with untreated GD, 130 with GD under treatment, 22 with GD in remission, 42 with Hashimoto's thyroiditis, 12 with subacute thyroiditis, 20 with postpartum thyroiditis, and 93 euthyroid controls. TSI was measured using the Thyretaintrade mark bioassay, which is based on Chinese hamster ovary cells transfected with chimeric TSHR (Mc4). TSI levels are reported as a specimen-to-reference ratio percentage (SRR%). RESULTS: The TSI levels in patients with GD (either treated or not) were significantly higher than those of the remaining patients (p < 0.05). The new bioassay showed a sensitivity of 97.0% and a specificity of 95.9% with a cut-off value of 123.0 SRR% for GD. A weak correlation was found between TSI and thyrotropin-binding inhibiting immunoglobulin (TBII) (rs = 0.259, p = 0.03), but no correlation was found between TSI and tri-iodothyronine or free thyroxine. CONCLUSIONS: The Mc4-CHO bioassay showed comparable diagnostic value for GD with the conventional TBII assay. We propose a cut-off of 123.0 SRR% in areas where iodine intake is high.

Detection of thyroglobulin antibody and thyroid peroxidase antibody in patients with vitiligo / 中华皮肤科杂志

Objective To investigate the clinical significance of thyroglobulin antibody (ATG) and thyroid peroxidase antibody (ATPO) in patients with vitiligo. Methods Venous blood samples were obtained from 87 patients with vitiligo and 90 age- and sex-matched normal human controls. Chemiluminescence was applied to measure the serum levels of ATG, ATPO, free triiodothyronine, free tetraiodothyronine and thyroid stimulating hormone (TSH). Results There was a significant increase in the positivity rates of ATG (23.0% vs 6.7%, P < 0.01) and ATPO (24.1% vs 7.8%, P < 0.01) as well as the serum level of TSH (3.4 ± 2.4 vs 2.4 ± 1.2 pmol/L, P < 0.05) in the patients with vitiligo compared with the normal human controls. It is worth mentioning that all patients positive for ATG or ATPO were diagnosed with vitiligo vulgaris. The positivity rates of ATG and ATPO in patients with vitiligo aged from 11 to 20 years and 21 to 40 years were significantly higher than those in age-matched normal controls (all P < 0.05). Also, female patients had a higher positivity rate of ATG and ATPO than female controls did (34.1% vs 8.5%, χ2 = 8.90, P < 0.01; 34.1% vs 10.6%,χ2 = 7.29, P < 0.05). The highest positivity rates of both ATG and ATPO were 53.3%, which were observed in vitiligo patients aged from 11 to 20 years, followed by patients from 21 to 40 years (ATG 34.5%, ATPO 34.5%). In patients with vitiligo positive for both ATG and ATPO, the occurrence of autoimmune thyroid disease was 70% (14/20), significantly higher than that in ATG- and ATPO- positive healthy controls (16.7%, χ2 = 5.4, P < 0.05). Conclusions ATG and ATPO were observed in young female patients with vitiligo vulgaris, and they may be associated with the development of autoimmune thyroid diseases.

Clinical analysis on 37 cases of chronic lymphocytic thyoiditis / 中国基层医药

Objective To explore the charcter and thesapeutic principlc of chronic lymphocytic thyoiditis.Methods 37 patients with chronical lymphocytic thyoiditis undergoing thyroidectomy were retrospectively analyzed.Results Compared with routine frozen section(FS) in operation FNA(fine needle aspiration) and the detecting of autoantibody had coincidence of 38%.Conclusion Exept preferred choosing of FNA and the detecting of autoantibody in early time,proper operation and the choose of indication is also important.

The Association of Chronic Urticaria and Thyroid Autoimmunity / 中华皮肤科杂志

Objective To investigate the role of thyroid autoimmunity in chronic urticaria. Methods The thyroid function, anti-thyroid auto-antibodies, and relevant cytokines were detected by RIA and ELISA methods in 56 patients with chronic urticaria and 40 healthy controls. Results Serum thyroid-stimulating hormone (TSH), anti-thyroglobulin antibody (TG-Ab) and anti-thyromicrosome antibody (TMA ) levels were increased in 8, 5 and 7 cases, respectively, in 56 patients, which were significantly higher than those in healthy controls (P