Construção e validação de um Bundle para avaliação da função tireoidiana em pacientes com cirrose hepatica / Construction and validation of a bundle for evaluation of thyroid function in patients with cirrhosis

ABSTRACT Background: Thyroid dysfunction has been reported in association with several chronic diseases, including advanced liver disease. This disease and its management are often neglected in clinical practice. The bundle discussed here is aimed at proposing systematic assistance according to the best evidence-based practices available. Objective: To construct and validate a bundle to evaluate thyroid function in patients with liver cirrhosis. Methods: The process of constructing and validating the bundle was carried out in the following stages: a) bibliographic survey; b) bundle elaboration; and c) content validation. The bibliographic survey was carried out in an integrative review about evidence related with the thyroid function of patients with liver cirrhosis. The findings from the integrative review were considered as supporting evidence for the elaboration of the bundle. The tool then created used accessible language and was evidence-based, ensuring that information was based on current literature. Results: The bundle was restructured to provide guidance on the management of patients with liver dysfunctions, including: cirrhosis due to general causes, cirrhosis due to hepatitis C, non-alcoholic fatty liver disease, primary biliary cholangitis, and hepatocellular carcinoma. The orientations in the bundle included: exams to be requested to screen for thyroid disorders, and guidance about the treatment of these dysfunctions and their associated complications. We analyzed specialist evaluation of the bundle using the Content Validity Index (CVI). We carried out a binomial test to evaluate consistency and specialist agreement regarding the items in the bundle, considering values >0.61 as a good level. The items in the bundle were considered to be valid (CVI >0.80). The general CVI of the instrument was 0.95 (CI95%: 0.91-0.98). Conclusion: The bundle was considered valid to facilitate medical decision making, aiding physicians to manage, in a practical and effective approach, the thyroid function of patients with liver cirrhosis. This tool should not be used as a replacement for individual, evaluation of the physician providing assistance. We recommend the structured bundle to be added to medical practice, considering its simple application, low cost, and potential to contribute for the management of these patients.

RESUMO Contexto: A disfunção tireoidiana tem sido relatada em associação com várias doenças crônicas, incluindo a doença hepática avançada. O seu reconhecimento e manejo são, muitas vezes, negligenciados na prática clínica. O bundle consiste em um pacote de cuidados, com a finalidade de promover a assistência de forma sistematizada, a partir da melhor prática baseada em evidências. Objetivo: Construir e validar um bundle para avaliação da função tireoidiana em pacientes com cirrose hepática. Métodos: O processo de construção e validação do bundle foi realizado a partir das seguintes etapas: a) levantamento bibliográfico; b) elaboração do bundle; e c) validação do conteúdo. O levantamento bibliográfico foi realizado a partir de revisão integrativa sobre as evidências relacionadas à função tireoidiana em pacientes com cirrose hepática. Os achados encontrados na revisão integrativa foram considerados como subsídios para construção do bundle. A ferramenta construída se baseou em evidências científicas, de forma a garantir informação pautada em literatura atual e com linguagem acessível. Resultados: O bundle foi estruturado com base nas seguintes finalidades: fornecer orientações sobre o manejo de pacientes com disfunção hepática, categorizado por: cirrose por causas gerais, cirrose por vírus da hepatite C, doença hepática gordurosa não alcoólica, colangite biliar primária e carcinoma hepatocelular. As orientações do bundle incluíram: exames a serem solicitados no rastreio dos distúrbios tireoidianos; orientações sobre indicação de tratamento destas disfunções e possíveis complicações associadas. A análise da avaliação do bundle pelos especialistas foi realizada a partir do cálculo do Índice de Validade do Conteúdo (IVC). Foi feito o cálculo do teste binomial para avaliar a concordância e consistência dos especialistas em relação aos itens do bundle, aceitando-se como bom nível o valor >0,61. Os itens do bundle foram considerados validados (IVC >0,80). O instrumento apresentou IVC geral de 0,95 (IC95%: 0,91-0,98). Conclusão: O bundle foi considerado válido para facilitar a tomada de decisão para o médico conduzir, de maneira prática e efetiva, o manejo da função tireoidiana em pacientes com cirrose hepática. Defende-se que a ferramenta não deve ser utilizada em substituição à avaliação individualizada e autonomia do médico assistente. Recomenda-se que a forma estruturada seja incorporada ao atendimento médico tendo em vista a fácil aplicabilidade, o baixo custo e o potencial para contribuir com o manejo desses pacientes.

Review on ultrasonographic diagnosis of thyroid diseases based on deep learning / 生物医学工程学杂志

In recent years, the incidence of thyroid diseases has increased significantly and ultrasound examination is the first choice for the diagnosis of thyroid diseases. At the same time, the level of medical image analysis based on deep learning has been rapidly improved. Ultrasonic image analysis has made a series of milestone breakthroughs, and deep learning algorithms have shown strong performance in the field of medical image segmentation and classification. This article first elaborates on the application of deep learning algorithms in thyroid ultrasound image segmentation, feature extraction, and classification differentiation. Secondly, it summarizes the algorithms for deep learning processing multimodal ultrasound images. Finally, it points out the problems in thyroid ultrasound image diagnosis at the current stage and looks forward to future development directions. This study can promote the application of deep learning in clinical ultrasound image diagnosis of thyroid, and provide reference for doctors to diagnose thyroid disease.

Caracterización de los pacientes operados de afecciones nodulares de tiroides / Characterization of Patients Operated on for Nodular Thyroid Conditions

Introducción: Los nódulos tiroideos son un problema frecuente, deben ser estudiados, sobre todo por la posibilidad de que puedan ser malignos. Objetivo: Caracterizar el comportamiento de los pacientes con afecciones quirúrgicas del tiroides en la provincia de Cienfuegos desde el 1 de enero del 2015 al 31 de diciembre del 2017. Métodos: Se realizó un estudio descriptivo, retrospectivo de 225 pacientes con afecciones quirúrgicas del tiroides en el Servicio de Cirugía del Hospital General Universitario "Dr. Gustavo Aldereguía Lima" en la provincia Cienfuegos durante un trienio. Las variables analizadas fueron: edad, sexo, lóbulo afectado, características físicas y ecográficas de los nódulos, modalidades de biopsias utilizadas y su correlación, técnica quirúrgica, variedad histológica y complicaciones posoperatorias. Se empleó modelo recolector de datos con las variables de interés, presentándose en tablas de frecuencia, números y porciento. Resultados: Predominaron las féminas (87,1 por ciento), el grupo etareo 41 - 50 años (34,7 por ciento) y el lóbulo izquierdo (45,3 por ciento). Prevalecieron los nódulos únicos, móviles, renitentes y ecogénicos. Predominó el carcinoma papilar (59,6 por ciento) y el bocio multinodular (25,3 por ciento). La hemitiroidectomía, el procedimiento quirúrgico más empleado (44,9 por ciento) y la disfonía transitoria (4,9 por ciento) complicación más frecuente. Conclusiones: En la práctica clínica cotidiana de las afecciones del tiroides se evidencia la necesaria interrelación entre endocrinólogos, cirujanos, oncólogos, imaginólogos y patólogos, entre otros, para el abordaje multi e interdisciplinario en el diagnóstico y el tratamiento de estos pacientes(AU)

Introduction: Thyroid nodules are a frequent problem; they should be studied, especially because of the possibility that they may be malignant. Objective: To characterize patients with thyroid surgical conditions in Cienfuegos Province, from January 1, 2015 to December 31, 2017. Methods: A descriptive and retrospective study of 225 patients with thyroid surgical affections was carried out in the surgery service of Dr. Gustavo Aldereguía Lima General University Hospital, in Cienfuegos Province, during a three-year period. The variables analyzed were age, sex, affected lobe, physical and ultrasound nodular characteristics of nodules, used biopsy modalities and their correlation, surgical technique, histological variety and postoperative complications. A data collection model was used with the variables of interest, presented in tables of frequency, numbers and percentages. Results: Females predominated (87.1 percent), together with the age group 41-50 years (34.7 percent) and the left lobe (45.3 percent). Single, mobile, refractory and echogenic nodules prevailed. Papillary carcinoma (59.6 percent) and multinodular goiter (25.3 percent) predominated. Hemithyroidectomy was the most employed surgical procedure (44.9 percent) and transient dysphonia (4.9 percent) was the most frequent complication. Conclusions: The daily clinical practice of thyroid conditions evidences the necessary interrelation between endocrinologists, surgical doctors, oncologists, imaginologists and pathologists, among others, for the multi- and interdisciplinary approach in the diagnosis and managment of these patients(AU)

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.

An epidemiological survey of thyroid disease in adults in different water iodine areas of Shanxi Province / 中华地方病学杂志

Objective:To investigate the prevalence of thyroid disease in adults in different water iodine areas and to explore the association between iodine and thyroid disease.Methods:In May of 2016, using cross-sectional survey, Gaoche Village and Maxi Village of Wenshui County were selected in Shanxi Province as a high-iodine area and a low-iodine area, respectively, Xiwenzhuang Village of Taiyuan City as an appropriate-iodine area. Questionnaire surveys, urinary iodine levels, thyroid ultrasound, determination of thyroid function and autoantibody were conducted for permanent residents aged 18 - 65.Results:A total of 898 people were investigated, including 288 in high-iodine area, 324 in low-iodine area and 286 in appropriate-iodine area. The medians urinary iodine were 417.8, 126.6 and 216.5 μg/L in high, low and appropriate-iodine areas, respectively, and the difference was statistically significant ( H = 288.61, P < 0.05). After age and sex standardization, the detection rates of hyperthyroidism in low, appropriate and high-iodine areas were 0.27%, 1.06% and 1.43%, respectively. The detection rates of sub-clinical hyperthyroidism were 0.57%, 0.31% and 0.30%, respectively. The detection rates of hypothyroidism were 1.45%, 1.15% and 1.85%, respectively. The detection rates of sub-clinical hypothyroidism were 19.34%, 28.50% and 32.76%, respectively. The detection rates of thyroid nodule were 20.51%, 20.17% and 33.78%, respectively. The positive rates of anti-thyroglobulin antibodies (TgAb) were 18.13%, 19.41% and 11.99%, respectively. The positive rates of thyroid peroxidase antibody (TPOAb) were 9.25%, 12.04% and 8.97%, respectively. The appropriate-iodine area was used as control, logistic regression analysis showed that only the detection rate of thyroid nodule in high-iodine area was significantly higher than that in appropriate-iodine area [odds ratio ( OR) = 0.488 5, 95% confidence interval ( CI) = 0.327 2 - 0.729 2 , P < 0.05]. Conclusion:In Shanxi Province, the detection rate of thyroid nodules is different in different areas of water iodine, and the detection rate of thyroid nodule in adults in high-iodine area is higher than that in other areas.

The effect of modified Miccoli surgery in the treatment of patients with benign thyroid diseases and its influence on the postoperative aesthetic degree of scar score and the expression of pain factors / 中国医师进修杂志

Objective:To investigate the effect of modified Miccoli surgery in the treatment of patients with benign thyroid disease and its intervention on the postoperative aesthetic degree of scar score and the expression of pain factors.Methods:The clinical data of 114 patients with benign thyroid diseases in Hankou Hospital from February 2018 to February 2020 were collected, 57 cases with traditional open thyroid surgery were enrolled in the open group, and 57 cases with modified Miccoli surgery were enrolled in the modified group. The surgery related indicators, postoperative recovery indicators, complications and preoperative, postoperative 1, 3 d serum pain factors substance P (SP), β-endorphin (β-EP), dynorphin ( DYN), immune function indexes CD 3+, CD 4+, CD 8+, parathyroid function related indexes parathyrotropic hormone(PTH), blood calcium, 3 months and 6 months after surgery of observer scar evaluation scale (OSAS), Vancouver scar scale (VSS) scores were compared between the two groups. Results:The length of incision, recovery time of neck movement, and hospital stay and the intraoperative blood loss were lower than those in the open group: (2.2 ± 0.4) cm vs. (6.5 ± 0.7) cm, (19.6 ± 4.8) h vs. (28.2 ± 7.8) h, (4.8 ± 1.4) d vs. (7.1 ± 1.8) d, (21.9 ± 5.1) ml vs. (39.5 ± 7.0) ml, the differences were statistically significant ( P<0.05). The levels of serum SP, β-EP and DYN in the modified group were lower than those in the open group at 1 and 3 d after operation: 1 d after surgery:(87.40 ± 12.25) ng/L vs. (114.96 ± 15.79) ng/L, (149.34 ± 21.49) ng/L vs.(192.15 ± 26.43) ng/L, (1.14 ± 0.21) mg/L vs. (1.59 ± 0.30) mg/L; 3 d after surgery: (80.18 ± 10.79) ng/L vs.(96.24 ± 12.36) ng/L, (137.46 ± 18.57) ng/L vs. (168.24 ± 21.50) ng/L, (0.94 ± 0.16) mg/L vs. (1.27 ± 0.25) mg/L, the differences were statistically significant ( P<0.05). The levels of CD 3+ and CD 4+ in the modified group were higher than those in the open group at 1 and 3 d after the operation, and the CD8+ level was lower than that of the open group: 1 d after surgery: 0.597 ± 0.053 vs. 0.542 ± 0.049, 0.382 ± 0.041 vs. 0.362 ± 0.036, 0.308 ± 0.048 vs. 0.332 ± 0.060; 3 d after surgery: 0.615 ± 0.060 vs. 0.580 ± 0.055, 0.408 ± 0.051 vs. 0.385 ± 0.046, 0.290 ± 0.038 vs. 0.317 ± 0.045, and the differences were statistically significant ( P<0.05). The levels of serum PTH and blood calcium in the modified group were higher than those in the open group at 1 and 3 d after operation: 1 d after surgery: (29.12 ± 6.58) ng/L vs. (20.67 ± 5.14) ng/L, (1.86 ± 0.22) mmol/L vs. (1.59 ± 0.10) mmol/L; 3 d after surgery: (36.39 ± 7.65) ng/L vs. (24.08 ± 5.97) ng/L, (2.03 ± 0.18) mmol/L vs. (1.72 ± 0.14) mmol/L, the differences were statistically significant ( P<0.05). The OSAS and VSS scores of the modified group were lower than those of the open group at 3 and 6 months after surgery: 3 months after surgery: (15.9 ± 3.3) scores vs. (24.7 ± 6.9) scores, (4.4 ± 1.5) scores vs. (8.1 ± 3.2) scores; 6 months after surgery: (10.3 ± 2.7) scores vs. (17.1 ± 5.4) scores, (3.3 ± 1.2) scores vs. (6.9 ± 2.4) scores, the differences were statistically significant ( P<0.05). The incidence of postoperative complications in the modified group was lower than that in the open group: 3.51%(2/57) vs. 15.79%(9/57), the difference was statistically significant ( P<0.05). Conclusions:The application of modified Miccoli surgery in patients with benign thyroid diseases can reduce the length of the incision, reduce the impact on postoperative pain stress, immune function, and parathyroid function, speed up the process of postoperative recovery, improve the appearance of postoperative aesthetic degree of scar, and reduce the risk of complications.

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.

Association between non-thyroidal illness syndrome and pre-sarcopenia in elderly patients / 中华老年医学杂志

Objective:To explore the association between non-thyroid illness syndrome(NTIS)and pre-sarcopenia in the elderly.Methods:In the retrospective study, a total of 219 patients aged 60-85 years in Department of Geriatrics, Sir Run Run Hospital, Nanjing Medical University from April 2018 to March 2021, included 60 patients with NTIS and 159 patients without NTIS.Clinical data, laboratory results and body composition data were collected.Pre-sarcopenia was diagnosed based on human composition determination data and diagnostic criteria of pre-sarcopenia.Logistic regression analysis, Pearson's correlation analysis and the area under receiver operator characteristic curve(ROC)were used to explore the correlation between serum thyroid hormone levels and diagnostic data level of pre-sarcopenia.Results:Of 54 pre-sarcopenia patients, 30.3%(36/119)were male, 18.0%(18/100)were female with statistically significantly differences( P<0.01). Mean age was higher in both male and female patients in the NTIS group than in the non-NTIS group( P<0.01). The body mass index, levels of triiodothyronine(T3), free triiodothyronine(FT3), hemoglobin, and albumin were lower in NTIS group than in non-NTIS group( P<0.05). The prevalence of presarcopenia in female patients was higher in the NTIS group than in the non-NTIS group[42.9%(10/17) vs.10.6%(8/83), χ2=9.564, P<0.01]. Multivariate logistic regression analysis showed that the risk of pre-morbidity of sarcopenia was significantly higher in NTIS patients than in non-NTIS patients.FT3 was positively correlated with skeletal muscle mass index, fat-free body weight, and phase angle, and negatively correlated with visceral fat area( r=-0.17, P<0.05). While, free thyroxine(FT4)was negatively correlated with skeletal muscle mass index( r=-0.21), fat-free body weight( r=-0.16)and phase Angle( r=-0.2, P<0.01 or P<0.05), and was positively correlated with body fat percentage and visceral fat area( r=0.20 and 0.22, respectively, P<0.01). The use of area under ROC curve(AUC)of FT3 predicting sarcopenia stage showed that the AUC was 0.768(95% CI: 0.691~0.844). Conclusions:In elderly patients, NTIS is correlated with the pre-sarcopenia in the elderly, and FT3 and FT4 are related to muscle mass.The low level of FT3 can predict the pre-validation of pre-sarcopenia.

Emerging therapeutic role of Prunella vulgaris in thyroid disease / 中草药·英文版

Thyroid disease is characterized by unusual levels of thyroid hormones, which results in either hyperthyroidism or hypothyroidism. The pathology of a particular type or stage of thyroid disease is very complicated, and always linked to a variety of biological functions. Although the mortality rate is not high, thyroid dysfunction could lead to metabolic and immunological disorders that can subsequently cause discomfort. To date, many drugs are suggested to have curative effects on thyroid disease, however, drug toxicity and long treatment periods encourage the search for more promising ones. Prunella vulgaris L. (Labiatae) is a popular herb that has shown great potential for improving human immunity and organ protection. It has been extensively used in the treatment of many diseases but its ability to treat specific diseases has not been fully reported. In this review, a literature search regarding herbs and herbal recipes for treating thyroid disease were carried out, organized, and summarized. In addition, this study conducted a literature search on the current situation and progress of P. vulgaris treatment for various diseases. Finally, this study discussed studies regarding P. vulgaris treatment of goiter, and the mechanism of treatment through the regulation of apoptosis. Accordingly, a combination therapy of herbs and Western medicine can provide significant therapeutic effects in the clinical treatment of thyroid disease. Furthermore, the association between P. vulgaris and various diseases suggests that P. vulgaris is rich in a variety of active substances that can fight oxidation and participate in the regulation of apoptosis, thus having a protective effect on the thyroid. Here, a comprehensive literature review regarding the application of herbs or herbal recipes in the treatment of thyroid disease was presented. It is concluded that there is strong evidence for further research regarding the use of P. vulgaris in the treatment of thyroid diseases.

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)

Enfermedad nodular tiroidea en personas con diagnóstico de acromegalia / Nodular thyroid disease in people diagnosed with acromegaly

La aparición de nódulos tiroideos en las personas con acromegalia es una consecuencia de la elevación crónica de la hormona de crecimiento y el factor de crecimiento similar a la insulina tipo 1. Su naturaleza varía según la zona geográfica, suficiencia de yodo y antecedentes patológicos familiares, entre otros factores. No se han publicado estudios cubanos sobre la enfermedad nodular tiroidea en estas personas. Objetivos: Describir las características clínicas, bioquímicas y ultrasonográficas de la glándula tiroidea, según la presencia o no de la enfermedad nodular tiroidea. Métodos: Estudio observacional descriptivo, transversal, que incluyó 73 pacientes con acromegalia entre enero de 2003 y diciembre de 2017. Se estudiaron las variables: edad, sexo, color de la piel, antecedentes familiares de la enfermedad nodular tiroidea, niveles de la hormona de crecimiento, hormona estimulante del tiroides, T4 libre, anticuerpos contra la peroxidasa tiroidea y contra la tiroglobulina, volumen tiroideo, patrón ecográfico nodular y estudio citológico. Resultados: La enfermedad nodular tiroidea se presentó en el 75,3 por ciento de los casos, con predominio del bocio multinodular. La edad al diagnóstico fue menor en los pacientes con la enfermedad (43,53 ± 9,67), que en los que no la tenían (49,33 ± 6,96 años) (p = 0,02). La hormona de crecimiento al diagnóstico de acromegalia, resultó menor en los pacientes con este padecimiento (18,73 ± 11,33 µg/L vs. 35,91 ± 21,68 µg/L; (p = 0,00). El volumen tiroideo mostró diferencias significativas entre ambos grupos (14,2 ± 4,5 mL en los casos positivos de la enfermedad nodular tiroidea y 10,5 ± 2,8 mL en los casos negativos; p = 0,002), siendo el nódulo de baja sospecha de malignidad el más frecuente. El resto de las variables resultaron similares entre los pacientes con y sin la enfermedad. La citología se informó como benigna en el 75 por ciento en los nódulos únicos, el 80 por ciento de los bocios nodulares y el 90 por ciento de los bocios multinodulares (p = 0,51). Conclusiones: La enfermedad nodular tiroidea fue frecuente en los casos de acromegalia, y se asoció a la menor edad y los niveles inferiores de la hormona de crecimiento al diagnóstico. El bocio multinodular constituyó la forma clínica más frecuente y los parámetros hormonales y de autoinmunidad no se asociaron al tipo de la enfermedad nodular tiroidea(AU)

The appearance of thyroid nodules in people with acromegaly is a consequence of chronic elevation of growth hormone (GH) and insulin-like growth factor type 1 (IGF-1). Its nature varies according to the geographical area, the iodine sufficiency and family pathological history, among other factors. No Cuban studies on thyroid nodular disease (TND) in these people have been published. Objectives: Describe some clinical characteristics, as well as biochemical and ultrasonographic ones related to the thyroid gland, according to the presence or not of TND, and to identify the possible association of clinical, biochemical, ultrasonographic and cytological factors with the different types of TND in patients with acromegaly. Methods: A descriptive, cross-sectional observational study that included 73 patients with acromegaly between January 2003 and December 2017. The following variables were studied: age, sex, skin color, family history of TND, GH levels, thyroid stimulating hormone, free T4, antibodies against thyroid peroxidase and thyroglobulin, thyroid volume, nodular ultrasound pattern and cytological study. Results: TND occurred in 75.3 percent of cases, with a predominance of multinodular goiter. The age at diagnosis time was lower in patients with TND (43.53 ± 9.67) than in those who did not have it (49.33 ± 6.96 years) (p=0.02). GH at diagnosis time of acromegaly was lower in patients with TND (18.73±11.33µg/L vs 35.91±21.68µg/L; (p=0.00). The thyroid volume showed significant differences between both groups (14.2±4.5mL in positive cases of TND and 10.5±2.8mL in negative cases; p=0.002), being the most frequent the nodule with low suspicion of malignancy. The rest of the variables were similar between patients with and without TNDs. Cytology was reported as benign in 75 percent in single nodules, 80 percent of nodular goiters and 90 percent of multinodular goiters (p=0.51). Conclusions: TND was frequent in cases of acromegaly, and was associated with lower age and lower GH levels at diagnosis time. Multinodular goiter was the most frequent clinical form and hormonal and autoimmunity parameters were not associated with the type of TND(AU)

Historia familiar de enfermedad tiroidea y riesgo de hipotiroidismo congénito en neonatos con síndrome de Down / Family history of thyroid disease and risk of congenital hypothyroidism in neonates with Down syndrome

Resumen Introducción: La historia familiar de enfermedad tiroidea (HFET) como factor de riesgo para hipotiroidismo congénito (HC), en síndrome de Down (SD) aún no ha sido explorada. Objetivo: Determinar si la HFET está asociada a mayor riesgo de HC en neonatos con SD. Método: Estudio de casos y controles en 220 neonatos con SD. Se compararon las pruebas de función tiroidea (PFT) de 37 con SD e HFET (casos), frente a las PFT de 183 recién nacidos con SD sin HFET (grupo de referencia). Se realizó análisis de regresión logística multivariante y se calculó la razón de momios (RM) y sus respectivos intervalos de confianza del 95 % (IC 95 %). Resultados: Nueve casos HC (4.1 %). El HC mostró asociación con la HFET (RMa = 8.3, IC 95 %: 2.0-34.3), particularmente en los varones (RMa = 9.0, IC 95 %: 1.6-49.6). La ausencia de HFET tuvo una RM de protección para HC (RMa = 0.4, IC 95 %: 0.1-0.8). Conclusiones: La HFET puede es una estrategia fácil y accesible para identificar pacientes con SD con mayor riesgo de HC.

Abstract Introduction: Family history of thyroid disease (FHTD) as risk factor for congenital hypothyroidism (CH) in patients with Down syndrome (DS) has not yet been explored. Objective: To determine whether FHTD is associated with an increased risk for CH in DS. Method: Case-control study in 220 neonates with DS. Thyroid function tests of 37 infants with DS and FHTD (cases) were compared with those of 183 DS newborns without FHTD (reference group). Data were analyzed using multivariate logistic regression analysis and adjusted odds ratios (aORs) with their respective 95 % confidence intervals (CI) were calculated. Results: Nine newborns with DS in our sample had CH (4.1 %). FHTD showed an association with CH in neonates with DS (aOR = 8.3, 95 % CI: 2.0-34.3), particularly in males (aOR = 9.0, 95 % CI: 1.6-49.6). In contrast, newborns with DS without FHTD were less likely to suffer from CH (aOR = 0.4, 95 % CI: 0.1-0.8). Conclusions: FHTD detailed evaluation can be an easy and accessible strategy to identify those newborns with DS at higher risk for CH.

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.

Investigation and analysis of benign thyroid disease during pregnancy in Dali, Yunnan Province / 中华地方病学杂志

Objective:To investigate and analyze the prevalence of thyroid disease during pregnancy in Dali, Yunnan Province, and to provide scientific basis for prevention and treatment of benign thyroid disease during pregnancy in the region.Methods:From July to December 2014, Dali in Yunnan Province was divided into 5 sampling areas according to east, west, south, north and middle. One township (town) was selected from each area, and at least 20 women in early, middle and late pregnancy, respectively, were selected from each township (town). To conduct this investigation, medical history data was collected, thyroid ultrasound examination and serological indexes of thyroid function test were performed based on the normal reference value of specific thyroid function serological indexes during pregnancy in this region.Results:A total of 370 cases of pregnant women were investigated, including 120 cases in early pregnancy (61 cases in urban areas and 59 cases in rural areas), aged 19 - 40 years; 126 cases in middle pregnancy (60 cases in urban areas and 66 cases in rural areas), aged 19 - 45 years; and 124 cases in late pregnancy (57 cases in urban areas and 67 cases in rural areas), aged 19 - 44 years. The detection rate of thyroid disease in pregnant women was 27.57% (102/370). The detection rate of thyroid dysfunction was 7.57% (28/370), the positive detection rate of thyroid antibody was 11.62% (43/370), and the detection rate of thyroid nodule was 13.51% (50/370). The detection rates of thyroid diseases in early, middle and late pregnancy were 33.33% (40/120), 23.02% (29/126), 26.61% (33/124), respectively, and the difference was not statistically significant(χ 2 = 3.362, P > 0.05). Conclusions:In Daliy, Yunnan Province, there is a high detection rate of thyroid diseases during pregnancy, especially in early pregnancy. Therefore, it is necessary to carry out further large-scale investigation and study to provide a more reliable scientific basis for prevention and treatment of thyroid disease during pregnancy in this region.

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.

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)

Incidence of Ulcerative Colitis (UC) and Crohn’s Disease in Thyroid Disorders

Aim: In patients with ulcerative colitis (UC) and Crohn’s disease (CD), an increase in thyroid dysfunction has been reported compared to normal people. This study was held to assess the thyroid disease prevalence in the inflammatory bowel disease patients group. Study Design: A retrospective study. Place and Duration: In the Medicine Department of Isra University Hospital, Hyderabad for one-year duration from March 2018 to March 2019. Methods: Total of 155 patients were included (120 UC, 35 CDs) and 63 healthy control subjects. Patients with free T3 (FT3), T4 (FT4), anti-TPO serum and TSH were evaluated retrospectively and with the group of control were compared. These patients were examined using nuclear imaging (scintigraphy) and thyroid ultrasound. Results: 42.9 ± 12.4 years was the average age of patients with IBD (76 women). The control group consisted of 42 women and 40.9 ± 12.1 years was the average age. In 18 patients (9.5%, 8 women, 6 men) out of 155 patients with inflammatory bowel disease, thyroid disease was diagnosed. The thyroid disorders frequency was higher in IBD group than in the group of control (18/155 vs. 1/63, p=0.042). There was no substantial dissimilarity in the frequency of thyroid orders in cases of CD and UC (5/40 vs. 13/115, p=0.912). In 4 (2.7%) IBD patients, Hashimoto’s thyroiditis were noted. Conclusion: According to many studies issued in the literature, we have noted a greater fraction of thyroid disease in inflammatory bowel disease patients.

Interpretación de las pruebas de función tiroidea / Interpretation of thyroid function tests

Los desórdenes de la glándula tiroides son comunes y pueden afectar hasta el 10% de la población en general. En muchas ocasiones los síntomas pueden ser inespecíficos, por lo que el médico en busca de un trastorno tiroideo debe llegar a un diagnóstico funcional y anatómico. Las mediciones séricas de las hormonas tiroideas confirman si hay un exceso, un déficit o si las concentraciones son normales. Para ello, se requiere un rango de referencia de la población local, y específicamente por grupos de edad, para una correcta interpretación de las pruebas de función tiroidea. Las hormonas tiroideas juegan un papel fundamental en el sistema endocrino, controlan el metabolismo general del cuerpo, el desarrollo neural, el crecimiento normal y la maduración de los huesos, así como funciones cardiovasculares y renales, entre otras. En esta revisión se pretende dar una aproximación a las pruebas tiroideas más relevantes, partiendo de la biosíntesis y secreción de las hormonas tiroideas, hasta llegar al abordaje para un diagnóstico inicial del paciente con trastorno tiroideo, mencionando los aspectos más importantes de los diferentes patrones tiroideos. El tratamiento detallado de cada uno de ellos, supera las expectativas de esta revisión

Thyroid gland disorders are common and can affect up to 10% of the general population. In many cases the symptoms can be nonspecific, so the physician in search for a thyroid disorder should reach a functional and anatomical diagnosis. Serum measurements of thyroid hormones confirm if there is an excess, a deficit, or if concentrations are normal. For this, reference ranges of the local population, and specifically by age groups, are required for a correct interpretation of thyroid function tests. Thyroid hormones play a fundamental role in the endocrine system, control of the general metabolism of the body, neural development, normal growth and maturation of bones, as well as in cardiovascular and renal functions, among others. In this review, the most relevant thyroid tests will be described, starting with the biosynthesis and secretion of thyroid hormones, and continuing with an approach to reach an initial diagnosis. Finally, the most important aspects of the different thyroid patterns will be mentioned. It is beyond the scope of this review, to describe the treatment for thyroid disorders.