Evaluation of frequency of autoimmune hepatitis autoantibodies in children with type 1 diabetes / Frecuencia de anticuerpos de hepatitis autoinmune en niños con diabetes tipo I

Background: Diabetes mellitus type 1 (T1DM) is one of the childhood diseases with growing prevalence. Various accompanying autoimmune diseases were seen with type 1 diabetes. The most common autoimmune diseases with T1DM are autoimmune thyroiditis and celiac disease. In some reports, autoimmune hepatitis has been reported in association with DM-1. Objectives: The aim of this study was to evaluate autoimmune hepatitis autoantibodies in children with T1DM. Materials and methods: In this crosssectional study, 202 children with T1DM were evaluated (47.5% were males and 52.5% were girls). Liver enzymes, autoimmune hepatitis related autoantibodies such as anti-nuclear antibodies (ANA), anti-smooth muscle (ASMA) and anti liver and kidney microsomal antibodies (LKM-1) were measured. Liver ultrasound was done for participants and biopsy of liver was taken for children with increased echogenicity of the liver, hepatomegaly or elevated liver enzymes. Results analyzed by statistical software spss-16, Descriptive statistics and chi-square test, paired T-TEST. Level of less than 5% was considered statistically significant. Results: In 6 patients ANA and in 4 patients (2%) ASMA was positive,1 patient was ASMA positive but ANA negative. None of the patients were Anti LKM-1 positive. 3 patients had positive ANA and ASMA, and increased liver echogenicity on ultrasound simultaneously. Histological evaluation was showed that 2 patients had findings in favor of autoimmune hepatitis. Conclusion: Auto antibodies were positive in 10 cases. ANA was positive in 6 (2.97%) of all cases. ASMA was positive in 4 (1.98%) cases. Increased echogenicity was found in 3 cases. Histological evaluation showed 2 patients had biopsy confirmed autoimmune hepatitis. AIH-2 was not seen among our cases.

Antecedentes: La diabetes mellitus tipo 1 (DM1) es una de las enfermedades infantiles con mayor prevalencia. Se observaron varias enfermedades autoinmunes acompañantes con diabetes tipo 1. Las enfermedades autoinmunes más comunes con DM1 son la tiroiditis autoinmune y la enfermedad celíaca. En algunos reportes, se ha encontrado hepatitis autoinmune en asociación con DM-1. Objetivos: El objetivo de este estudio fue evaluar los autoanticuerpos de hepatitis autoinmunes en niños con DM1. Materiales y métodos: En este estudio transversal, se evaluaron 202 niños con DM1 (47,5% eran hombres y 52,5% eran niñas). Se midieron las enzimas hepáticas, los autoanticuerpos autoinmunes relacionados con la hepatitis, como los anticuerpos antinucleares (ANA), el músculo liso (ASMA) y los anticuerpos microsomales hepáticos y renales (LKM-1). Se realizó una ecografía hepática para los participantes y se tomó una biopsia del hígado para niños con mayor ecogenicidad del hígado, hepatomegalia o enzimas hepáticas elevadas. Los resultados fueron analizados por el software estadístico spss-16 usando estadística descriptiva y prueba de chi-cuadrado, T-TEST pareado. Se consideró estadísticamente significativo un nivel menor del 5%. Resultados: En 6 pacientes con ANA y en 4 pacientes (2%) ASMA fue positiva, 1 paciente fue ASMA positiva pero ANA negativa. Ninguno de los pacientes fue anti LKM-1 positivo. 3 pacientes tuvieron ANA y ASMA positivas, y aumentaron la ecogenicidad hepática en la ecografía simultáneamente. La evaluación histológica mostró que 2 pacientes tenían hallazgos a favor de la hepatitis autoinmune. Conclusión: Los autoanticuerpos fueron positivos en 10 casos. ANA fue positivo en 6 (2,97%) de todos los casos. La ASMA fue positiva en 4 (1,98%) casos. Se encontró mayor ecogenicidad en 3 casos. La evaluación histológica mostró que 2 pacientes tenían biopsia confirmada de hepatitis autoinmune. AIH-2 no fue visto entre nuestros casos.

Diffuse Thyroid Uptake Incidentally Found on 18F-Fluorodeoxyglucose Positron Emission Tomography in Subjects without Cancer History

OBJECTIVE: We investigated the clinical significance of incidental diffuse thyroid uptake (DTU) on 18F-FDG PET in subjects without a history of cancer. MATERIALS AND METHODS: This study included 2062 studies from adults who underwent 18F-FDG PET as a cancer screening program. Subjects were divided into the following two groups: with (group I) or without (group II) DTU. The presence of DTU and the thyroid visual grading score were compared with thyroid function tests, serum anti-microsomal antibody (AMA) levels, and the presence of diffuse parenchymal change (DPC) on ultrasonography (USG). RESULTS: DTU was found in 6.6% of the scans (137/2062). Serum thyroid stimulating hormone (TSH) and AMA levels were significantly higher in group I than in group II. Increased AMA level (55.1%) and DPC (48.7%) were more frequently found in group I (p < 0.001). The proportion of subjects with any abnormal results in serum free thyroxine, triiodothyronine, TSH, or AMA levels or DPC on USG was significantly higher in group I than in group II (71.5% vs. 10.6%, p < 0.001), and was significantly and gradually increased according to the visual grading score group (0 vs. 1-2 vs. 3-4 = 10.6% vs. 58.5% vs. 90.9%, p < 0.001). TSH and is AMA levels were significantly increased according to the visual grading score. CONCLUSION: The presence or degree of incidental DTU on 18F-FDG PET is closely correlated with increased serum AMA and TSH levels, and the presence of DPC on USG. Therefore, the most plausible pathological cause of DTU may be cell damage by an autoimmune mechanism.

Prevalência de anticorpos antimicrossomais em pacientes com esclerose múltipla / Prevalence of antimicrosomal antibodies in patients with multiple sclerosis

O objetivo deste estudo consiste em avaliar a prevalência de anticorpos antimicrossomais (AAM), a função tireóidea e a ocorrência de sintomas relacionados ao hipotireoidismo em pacientes com esclerose multipla (EM). Em um grupo de 21 pacientes com EM, foi realizado exameclínico, foram dosados o TSH, T4 e T4 livre e pesquisados AAM. A média de idade foi 41,05 anos e a média de tempo de doença foi 85,9 meses. Os sintomas relacionados ao hipotireoidismo foram fadiga, fraqueza, letargia e parestesias. Os AAM foram encontrados em 4 pacientes (19 por cento). O tempo de doença foi dividido em três períodos: <60 meses (3 pacientes AAM+/7AAM-), 60-120 meses (8 pacientes AAM-) e >120 meses (1 paciente AAM+/2 AAM-). Dois pacientes apresentaram níveis de T4 livre diminuídos, porém com T4 e TSH normais. Em 1 paciente, constatou-se hipotireoidismo subclínico, e em outro, hipotireoidismo clássico. Conclui-se que na avaliação dos pacientes com EM, em vista da falta de precisão na avaliação clínica do hipotireoidismo ocasionada pela sobreposição de sintomas referentes à EM, devam ser incorporadas as dosagens das provas de função tireóidea (PFT) e dos AAM.

Graves' disease: evolution and prognosis after eight months of treatment with methimazole

We studied 26 patients with Graves' disease, from a population with sufficient iodine supply, treated with high doses of methyl mercaptoimidazole (MMI) during eight moths. We evaluated: a) their evolution after treatment withdrawal; b) the correlation between evolution and TSH-receptor antibodies (TRAb), thyroid hormone levels, microsomal antibodies (MAb), T3/T4 index and clinical data; c) their prognosis. The patients were followed during 12-60 months, and blood samples were collected before treatment withdrawal. Out of 26 patients, 20 relapsed, with T3/T4 index and TRAb significantly higher than those under remission. The T3/T4 index correlated with TRAb. All the TRAb-positive patients, and only 57.1% of the negatives, relapsed. The relapses were significantly more frequent prior to the 6th month in the TRAb-positive patients than afterwards. The TRAb-negatives who relapsed during that period, showed TRAb and age means significantly higher than those under remission. The TRAb test, as a prognostic marker of evolution, showed a sensitivity of 60% and a specificity of 100%. No significant differences were found between evolution to relapse or to remission and the other parameters. It can be concluded that TRAb and T3/T4 index were different in the group that relapsed from that which remitted, and that a TRAb positive value, at the moment of treatment withdrawal, is a useful marker of relapse

Aspectos inmunológicos de los pacientes psicóticos / Immunological aspects of psychotic patients

En un estudio de pacientes con tiroideopatías en el Hospital Escuela de Tegucigalpa, se encontraron cuatro pacientes con psicosis y valores altos de anticuerpos antimicrosomales y antitiroglobulinas. En un estudio control la presencia de anticuerpos antitiroideos (ATT) esta asociada con alta incidencia de antecedentes familiares de enfermedades inmunológicas, tiroideas y mentales, especialmente esquizofrenia

Prevalence of thyroid autoimmunity in insulin dependent diabetes mellitus in the Bayamon region

El propósito de este estudio es describir muestra experiencia en la Región de Bayamón con respecto a la prevalencia de autoinmunidad tiroidea en la población de pacientes pedía ricos con diabetes mellitus insulinodependiente. Se examinaron 78 pacientes con diabetes para determinar si tenían bocio. Se obtuvieron muestras de sangre para funci[on tiroidea y anti cuerpos microsomales en 65 de ellos las que fueron computados utilizando Chi cuadrado para poder correlacionar entre disfunción tiroidea, autoinmunidad y sexo. Nuestros resultados reflejan una prevalencia de autinmunidad tiroidea en nuestros pacientes de 15%, de los cuales 40% tenían bocio (p < 001), la mayoría mujeres (9 de 12). Esta es la prevalencia de autoinmunidad tiroidea en pacientes pediátricos mas baja reportada en Hispanos en Estados Unidados hasta este momento

Prevalence of autoantibodies in simplex and multiplex families of Brazilian insulin-dependent diabetic patients

Forty-one simplex and 6 multiplex families of Brazilian IDDM patients were studied by the indirect immunofluorescence technique to determine the prevalence of the following autoantibodies: islet cells (ICA), islet cells which fix complement (ICA-CF), thyroid microsomes (TMA), thyroglobulin (TGA), and gastric-parietal cells (PCA). A total of 54 IDDM patients belonging to two family groups were analyzed. A significantly higher frequency of ICA-CF and TMA was detected among the siblings from multiplex families than among those from simplex families (18.7% vs 1.7%). A prospective study of ICA-positive siblings was undertaken, and 2 who later became diabetic were found to be positive to both ICA and ICA-CF. The prevalence of islet-cell antibodies in these 54 Brazilian IDDM patients and their unaffected first-degree relatives from generally mixed groups suggest that the humoral autoimmune mechanisms of the disease are probably identical to those observed in other population of different ethnic backgrounds

Effectiveness of different methods to eliminate interference by thyroglobulin antibodies in the ELISA for thyroid microsomal autoantibodies.

Thyroid microsomal autoantibodies (TMA) have been mostly detected by means of either immunofluorescence (IF), tanned red cell haemagglutination (TRCH), or radioimmunoassay (RIA) until the recent development of ELISA. False positives in the ELISA for the detection of TMA due to interference by thyroglobulin antibodies (TGA) present in some test sera reacting with thyroglobulin (Tg) present as a contaminant in the thyroid microsomal preparation (TMP) appears to be common. In this study we tried various ways of removing any Tg contaminant in the TMP by further gel filtration, affinity chromatography of the microsomal preparation or preincubation of the test sera with either Tg or Tg-sepharose 4B immunoadsorbent to absorb out TGA present in the sera. Further gel filtration and affinity purification of the TMP failed to totally remove all the contaminating Tg. Preincubation with Tg effectively removed any TGA present in the test sera but resulted in inhibition of the TMA-thyroid microsomal antigen reaction in the test sera including those without TGA. Preincubation with Tg-immunoadsorbent equally effectively absorbed out any TGA present in the test sera but without significant inhibition of the assay reaction in TGA-free sera. The preincubation of the TMP with Tg-immunoadsorbent is an effective way of removing TGA present in sera without inhibiting the test reaction and thus resulting in false negatives especially in low-titre sera as occurs with the presence of free Tg in the test system.