Relación entre tiroiditis autoinmune y lupus eritematoso sistémico / Relationship between autoinmune thyroiditis and systemic lupus erythematosus

Introducción: El lupus eritematoso sistémico es una enfermedad autoinmune que se caracteriza por la presencia de autoanticuerpos, los cuales, junto con el proceso inflamatorio, son los responsables de las manifestaciones clínicas de la enfermedad. Se puede asociar con otras afecciones como la tiroiditis autoinmune, la que, en ocasiones, precede al diagnóstico de lupus. Objetivo: Describir la relación entre tiroiditis autoinmune y lupus eritematoso sistémico. Métodos: Estudio descriptivo, correlacional y retrospectivo, realizado en la Consulta Externa del Hospital Andino de Chimborazo en el periodo comprendido entre enero de 2017 y julio de 2018. El universo estuvo constituido por la totalidad de los pacientes (137) que acudieron a consulta y que presentaron diagnóstico de lupus eritematoso sistémico. La muestra quedó conformada por los 97 pacientes que cumplieron los criterios de inclusión y exclusión definidos para la investigación. Se empleó la correlación de Pearson para establecer la relación existente entre tiroiditis autoinmune y lupus eritematoso sistémico. Resultados: El promedio de edad de los pacientes fue de 36,32 años, con predominio de edad entre 26 y 35 años. Predominó el sexo femenino (91,75 por ciento) y el tiempo de evolución fue menor de 3 años (46,40 por ciento). El 32,99 por ciento de los casos con lupus eritematoso sistémico presentaron también diagnóstico de tiroiditis autoinmune, que precedió al diagnóstico de lupus en un 90,63 por ciento de los casos. Conclusiones: Existe una relación entre tiroiditis autoinmune y lupus eritematoso sistémico. Ambas afecciones comparten mecanismos autoinmunes comunes, pero no queda totalmente esclarecido el mecanismo que las interrelaciona(AU)

Introduction: Systemic lupus erythematous is an autoimmune disease characterized by the presence of autoantibodies, in adition to the inflammatory process are responsible for the disease's clinical manifestations. It can be associated with other conditions such as autoimmune thyroiditis, this affection, sometimes, precedes the diagnosis of lupus. Objective: To describe the relationship between autoimmune thyroiditis and systemic lupus erythematous. Method: It is a descriptive, correlational and retrospective study, carried out in the outpatient clinic of the Andean hospital of Chimborazo in the period between January 2017 and July 2018. The universe was constituted by the totality of patients (137) who attended the consultation and who presented a diagnosis of systemic lupus erythematous. The sample was constituted by 97 patients who met the inclusion and exclusion criteria defined for the investigation. Pearson correlation was used to establish the relationship between autoimmune thyroiditis and systemic lupus erythematous. Results: The average age of 36.32 years with predominance of patients between 26 and 35 years of age. The female sex is predominated (91.75 percent) and the evolution time is less than three years (46.40 percent. 32.99 percent. of the cases with SLE also present a diagnosis of autoimmune thyroiditis that preceded the diagnosis of lupus in 90.63 percent. Conclusions: The relationship between autoimmune thyroiditis and systemic lupus erythematous is described; both conditions share common autoimmune mechanisms, but the mechanism which interrelate both conditions is not completely clarified(AU)

Encefalopatía asociada a enfermedad tiroídea, un diagnóstico a tener en mente / Encephalopathy associated with thyroid disease, a diagnosis to take into account

Mujer de 54 años con antecedentes de Hipertensión arterial e Hipotiroidismo. Historia de aproximadamente 3 meses de evolución caracterizado al inicio por ánimo bajo, cambios en el comportamiento con aparición progresiva de conductas extraña, ideas delirantes y alucinaciones visuales y auditivas, junto con disminución en requerimientos de hormonas tiroídeas hasta la suspensión. Consulta en varios centros donde se cataloga como Trastorno depresivo severo con síntomas psicóticos, Síndrome confusional, Síndrome Psicótico. En este contexto se pesquisa Hipertiroidismo con títulos elevados de Anticuerpos Antitiroídeos e inicia tratamiento con Metimazol y Betabloqueo. Tras extenso estudio que descartan causas infecciosas, neoplásicas y autoinmunes; se inicia tratamiento con pulsos de Metilprednisolona con excelente y rápida respuesta clínica, la cual mantiene durante el curso del seguimiento con dosis decrecientes de corticoides.

A 54-year-old woman with a history of arterial hypertension and hypothyroidism. History of approximately 3 months of evolution characterized at the beginning by low mood, changes in behavior with progressive appearance of bizarre behaviors, delusional ideas and visual and auditory hallucinations. Consultation in several centers where it is classified as severe Depressive disorder with psychotic symptoms, Confusional syndrome, Psychotic syndrome. Hyperthyroidism is investigated with high titers of Antithyroid Antibodies and initiates treatment with Methimazole and Betablock. After extensive study that ruled out infectious, neoplastic and autoimmune causes; Treatment with Methylprednisolone pulses is initiated with excellent and rapid clinical response, which is maintained during the course of follow-up with decreasing doses of corticosteroid.

Familial autoimmunity and polyautoimmunity in 60 Brazilian Midwest patients with systemic sclerosis / Autoimunidade familial e poliautoimunidade em 60 pacientes portadores de esclerose sistêmica da região Centro-Oeste do Brasil

ABSTRACT Introduction: Systemic sclerosis (SSc) is a connective tissue disease of unknown etiology, characterized by a triad of vascular injury, autoimmunity and tissue fibrosis. It is known that a positive family history is the greatest risk factor already identified for the development of SSc in a given individual. Preliminary observation of a high prevalence of polyautoimmunity and of familial autoimmunity in SSc patients support the idea that different autoimmune phenotypes may share common susceptibility variants. Objectives: To describe the frequency of familial autoimmunity and polyautoimmunity in 60 SSc patients in the Midwest region of Brazil, as well as to report the main autoimmune diseases observed in this association of comorbidities. Methods: A cross-sectional study with recruitment of 60 consecutive patients selected at the Rheumatology Department, University Hospital, Medicine School, Federal University of Mato Grosso do Sul (FMUFMS), as well as interviews of their relatives during the period from February 2013 to March 2014. Results: A frequency of 43.3% of polyautoimmunity and of 51.7% of familial autoimmunity in SSc patients was found. Patients with the presence of polyautoimmunity and familial autoimmunity presented primarily the diffuse form of SSc, but this indicator did not reach statistical significance. The autoimmune diseases most frequently observed in polyautoimmunity patients were: Hashimoto's thyroiditis (53.8%), Sjögren's syndrome (38.5%), and inflammatory myopathy (11.5%). The main autoimmune diseases observed in SSc patients' relatives were: Hashimoto's thyroiditis (32.3%), rheumatoid arthritis (22.6%), and SLE (22.6%). The presence of more than one autoimmune disease in SSc patients did not correlate with disease severity or activity. Conclusions: From the high prevalence of coexisting autoimmune diseases found in SSc patients, we stress the importance of the concept of shared autoimmunity, in order to promote a continued vigilance and promptly diagnose other possible autoimmune disease in patients, or in their kin.

RESUMO Introdução: A esclerose sistêmica (ES) é uma enfermidade do tecido conjuntivo de etiologia desconhecida, caracterizada pela tríade de injúria vascular, autoimunidade e fibrose tecidual. Sabe-se que uma história familiar positiva representa o maior fator de risco já identificado para o desenvolvimento da ES em um determinado indivíduo. Observação prévia de alta prevalência de poliautoimunidade e de autoimunidade familiar em pacientes com ES reforça a ideia de que fenótipos autoimunes distintos podem dividir variantes comuns de susceptibilidade. Objetivos: Descrever a frequência de autoimunidade familiar e de poliautoimunidade em 60 pacientes com ES da região Centro-Oeste do Brasil, bem como relatar as principais doenças autoimunes observadas nessa associação de comorbidades. Métodos: Estudo transversal com recrutamento de 60 pacientes consecutivos, selecionados no Serviço de Reumatologia do Hospital Universitário da Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul (FMUFMS), bem como entrevista de seus parentes, de fevereiro de 2013 a março de 2014. Resultados: Foi encontrada uma frequência de 43,3% de poliautoimunidade e de 51,7% de autoimunidade familiar nos pacientes com ES. Os pacientes com presença de poliautoimunidade e de autoimunidade familiar eram principalmente da forma difusa de ES, porém esse índice não atingiu significância estatística. As doenças autoimunes mais comumente observadas nos pacientes com poliautoimunidade foram: tireoidite de Hashimoto (53,8%), síndrome de Sjögren (38,5%) e miopatia inflamatória (11,5%). As principais doenças autoimunes observadas nos parentes dos pacientes com ES foram: tireoidite de Hashimoto (32,3%), artrite reumatoide (22,6%) e LES (22,6%). A presença de mais de uma enfermidade autoimune em pacientes com ES não se correlacionou com maior gravidade ou atividade da doença. Conclusões: A partir da alta prevalência encontrada de doenças autoimunes coexistentes em pacientes com ES, salientamos a importância do conceito de autoimunidade compartilhada, de forma a promover uma vigilância constante e diagnosticar prontamente uma possível outra doença autoimune nos pacientes ou em seus parentes.

The association of autoimmune thyroiditis and non-functional adrenal incidentalomas with insulin resistance

Objective Patients with incidental nonfunctioning adrenal adenoma are associated with increased risk of obesity, impaired glucose tolerance and dyslipidemia. We aimed to investigate the relationship between thyroid function, serum lipids and insulin resistance in patients with nonfunctioning adrenal incidentaloma. Subjects and methods Forty patients who had diagnosed as adrenal incidentaloma (AI) in our department were included in the study. Serum free triiodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), anti-thyroperoxidase antibody (anti-TPO Ab) and anti-thyroglobulin antibody (anti-Tg Ab), lipid profile, hs-CRP, fasting insulin levels were measured and insulin resistance calculated by HOMA-IR. Thyroid volume (TV) was assessed. Results None of the patients showed specific signs and symptoms of hormone excess. TV, TSH and fT3 levels in the patient and control groups did not differ significantly (p > 0.05). The serum fT4, anti-TG Ab, anti-TPO Ab levels in the patient group were significantly higher than in the control group (p = 0.013, p < 0.0001, p = 0.016 respectively). The HOMA-IR, hs-CRP and HDL cholesterol levels in the AI patients were significantly higher than the control group (p = 0.034, p = 0.041, p = 0.002, respectively). Statistically significant relationship was found between HOMA-IR and thyroid volume (r = 0.373, p = 0.018), fT4 (r = 0.382, p = 0.015), hs-CRP (r = 0.512, p = 0.001), HDL cholesterol (r = 0,351 p = 0.026) in AI patients. There were significant correlation between anti-TG Ab, anti-TPO Ab and TSH levels in AI patients (r = 0.431 p = 0.006, r = 0.402 p = 0.012). Conclusions Patients with nonfunctioning adrenal incidentaloma have several metabolic disturbances. At the same time autoimmune thyroid disorders are more frequent in nonfunctioning adrenal incidentaloma patient so that thyroid functions must be evaluated in those patients. Arch Endocrinol Metab. 2015;59(1):42-6 .

Prevalence and clinical features of celiac disease in patients with autoimmune thyroiditis: cross-sectional study / Prevalência e características clínicas da doença celíaca em pacientes com tireoidite autoimune: estudo transversal

CONTEXT AND OBJECTIVE: Celiac disease is an autoimmune disorder with an average prevalence of 1% in Europe and the United States. Because of strong European ancestry in southern Brazil, this study aimed to evaluate the seroprevalence of celiac disease among autoimmune thyroiditis patients. DESIGN AND SETTING: Cross-sectional study in a public university hospital. METHODS: This cross-sectional prevalence study included autoimmune thyroiditis patients who were tested for anti-endomysial and anti-transglutaminase antibodies between August 2010 and July 2011. RESULTS: Fifty-three patients with autoimmune thyroiditis were included; 92.5% were women, with mean age of 49.0 ± 13.5 years. Five patients (9.3%) were serologically positive for celiac disease: three of them (5.6%) were reactive for anti-endomysial antibodies and two (3.7%) for anti-transglutaminase. None of them exhibited anemia and one presented diarrhea. Endoscopy was performed on two patients: one with normal histology and the other with lymphocytic infiltrate and villous atrophy. CONCLUSION: The prevalence of celiac disease among patients with autoimmune thyroid disease was 9.3%; one patient complained of diarrhea and none presented anemia. Among at-risk populations, like autoimmune thyroiditis patients, the presence of diarrhea or anemia should not be used as a criterion for indicating celiac disease investigation. This must be done for all autoimmune thyroiditis patients because of its high prevalence. .

CONTEXTO E OBJETIVO: A doença celíaca é uma doença autoimune, com prevalência média de 1% na Europa e nos Estados Unidos. Em função da forte ascendência europeia no sul do Brasil, este estudo objetiva relatar a soroprevalência de doença celíaca em indivíduos com tireoidite autoimune. TIPO DE ESTUDO E LOCAL: Estudo transversal em um hospital público universitário. MÉTODOS: Este estudo transversal de prevalência incluiu pacientes com tireoidite autoimune que foram submetidos a testes de anticorpos antiendomísio e antitransglutaminase entre agosto de 2010 e julho de 2011. RESULTADOS: Foram incluídos 53 pacientes com tireoidite autoimune, 92,5% mulheres, com idade média de 49,0 ± 13,5 anos. Cinco (9,3%) pacientes apresentaram sorologia positiva para doença celíaca, sendo três (5,6%) com anticorpo antiendomísio positivo e dois (3,7%) com antitransglutaminase positivo. Nenhum paciente apresentou anemia e um apresentou diarreia. Apenas dois pacientes realizaram endoscopia: um com histologia normal e outro apresentou infiltrado linfocitário e atrofia vilositária. CONCLUSÕES: A prevalência de doença celíaca entre pacientes com doença autoimune da tireoide foi de 9,3%; um paciente queixou-se de diarreia e ninguém apresentou anemia. Em populações de risco, como é o caso de pacientes com tireoidite autoimune, a presença de diarreia ou anemia não devem ser utilizados como critério para indicar investigação de doença celíaca, que deve ser feita em todos os indivíduos com tireoidite autoimune devido a sua alta prevalência. .

Screening of celiac disease in patients with autoimmune thyroid disease from Southern Brazil / Pesquisa de doença celíaca em pacientes com doença autoimune de tireoide do sul do Brasil

Objective: The objective of this study was to determine the prevalence of celiac disease (CD) in adults with autoimmune thyroid disease (ATD) from the endocrinology outpatient setting in a university hospital in Southern Brazil. Subjects and methods: From the years 2007 to 2011, 254 patients with ATD were enrolled consecutively, Grave’s disease was diagnosed in 143 (56.3%) and Hashimoto’s thyroiditis in 111 (43.7%) of them. All patients answered a questionnaire related to symptoms that could be associated with CD and serum samples to screen for IgA anti-endomysial (EmA-IgA) were collected. EmA-IgA-positive patients were offered upper gastrointestinal endoscopy and biopsy of duodenum. Results: A total of 254 patients were included; 222 (87.4%) female, mean age 45.4 ± 13.43 years (18 to 79 years). EmA-IgA was positive in seven patients (2.7%) and five done endoscopy with biopsy. Of these, three diagnosis of CD was confirmed (1.2%). All the three patients with CD had higher EmA-IgA titration, were female and had Hashimoto’s thyroiditis. Like other patients with ATD, CD patients had nonspecific gastrointestinal symptoms, such as heartburn and gastric distention. In our study, one in each 85 patients confirmed the diagnosis of CD. Conclusion: We found a prevalence of 1.2% (1:85) of confirmed CD among Brazilian patients with ATD. Although some IgA-EmA positive patients had Graves’ disease and one was male, all three patients with confirmed CD were female and had Hashimoto’s thyroiditis. Arq Bras Endocrinol Metab. 2014;58(6):625-9 .

Objetivo: O objetivo do presente estudo foi determinar a prevalência de doença celíaca (DC) em adultos com doenças autoimunes de tireoide (DAT) que foram atendidos em um serviço de endocrinologia de um hospital universitário do sul do Brasil. Sujeitos e métodos: Entre os anos de 2007 a 2011, 254 pacientes com DAT foram consecutivamente incluídos, sendo 143 (56,3%) desses diagnosticados com doença de Graves e 111 (43,7%) com doença de Hashimoto. Todos os pacientes responderam a um questionário relatando sintomas que poderiam ser associados com DC, e amostras de soro para a pesquisa de anticorpo antiendomisial (EmA-IgA) foram coletadas. Os pacientes com sorologia positiva foram encaminhados para endoscopia gastrointestinal com biópsia duodenal. Resultados: No total, 254 pacientes foram incluídos, sendo 222 (87,4%) mulheres com média de idade 45,4 ± 13,43 anos (18 a 79 anos). EmA-IgA foi positivo em sete (2,7%) pacientes e cinco fizeram endoscopia com biópsia. Desses, três (1,2%) tiveram o diagnóstico de DC confirmada. Todos os três pacientes com DC apresentaram altos títulos de EmA-IgA, eram mulheres e tinham doença de Hashimoto. Assim como outras pacientes com DAT, os pacientes celíacos tinham sintomas gastrointestinais inespecíficos, como queimação e distensão gástrica. Em nosso estudo, um em cada 85 pacientes com DAT tiveram o diagnóstico de DC confirmado. Conclusão: Em nosso estudo, foi observada prevalência de 1,2% (1:85) de DC confirmada entre os pacientes com DAT, sendo todas mulheres e com doença de Hashimoto. Arq Bras Endocrinol Metab. 2014;58(6):625-9 .

Prevalence of coeliac disease among adult patients with autoimmune hypothyroidism in Jordan

The prevalence of coeliac disease among patients with autoimmune hypothyroidism has not been studied before in Jordan and other Arab countries. A cross-sectional record-based review was made of all adult autoimmune hypothyroidism patients who attended a referral centre in Jordan, during an 8-month period. Coeliac disease in these patients was diagnosed by the attending physician based on positive serological tests for anti-endomysial antibodies IgA and IgG followed by duodenal biopsy to confirm the diagnosis of coeliac disease. Of 914 patients recruited, 117 [12.8%] were seropositive for coeliac disease. Of 87 seropositive patients who underwent duodenal biopsy, 39 had positive histological findings of coeliac disease [44.8%]. Extrapolating from these findings the overall rate of coeliac disease among autoimmune hypothyroidism patients was estimated to be 5.7%. In multivariate logistic regression coeliac disease was significantly associated with older age [> 40 years], presence of other autoimmune diseases, vitamin B12 deficiency and anaemia

Rare Acute Kidney Injury Secondary to Hypothyroidism-Induced Rhabdomyolysis

PURPOSE: Acute kidney injury (AKI) caused by hypothyroidism-induced rhabdomyolysis is a rare and potentially life-threatening syndrome. The aim of this study was to investigate the clinical characteristics of such patients. MATERIALS AND METHODS: We retrospectively analyzed five patients treated at the Second Affiliated Hospital of Chongqing Medical University with AKI secondary to hypothyroidism-induced rhabdomyolysis from January 2006 to December 2010. RESULTS: Of the five cases reviewed (4 males, age range of 37 to 62 years), adult primary hypothyroidism was caused by amiodarone (1 case), chronic autoimmune thyroiditis (1 case), and by uncertain etiologies (3 cases). All patients presented with facial and lower extremity edema. Three patients presented with weakness, while two presented with blunted facies and oliguria. Only one patient reported experiencing myalgia and proximal muscle weakness, in addition to fatigue and chills. Creatine kinase, lactate dehydrogenase, and renal function normalized after thyroid hormone replacement, except in two patients who improved through blood purification. CONCLUSION: Hypothyroidism should be considered in patients presenting with renal impairment associated with rhabdomyolysis. Moreover, further investigation into the etiology of the hypothyroidism is warranted.

Autoimmune thyroiditis presenting as interstitial granulomatous dermatitis / Dermatite intersticial granulomatosa como apresentação de tireoidite autoimune

A 54-year-old female presented with recurrent, widespread, erythematous, painful plaques, over a 3-month period. Skin biopsy was compatible with interstitial granulomatous dermatitis. Additional investigation revealed hypothyroidism and positive anti-thyroid antibodies. Normalization of thyroid function and high-potency topical corticosteroids provided only transitory improvement of the dermatosis. Interstitial granulomatous dermatitis is a histologic inflammatory reaction, with variable cutaneous expression. It has been reported in association with several drugs, lymphoproliferative diseases and autoimmune disorders, such as rheumatoid arthritis, systemic lupus erythematosus and vasculitis, but association with autoimmune thyroiditis is rare. Optimal therapy for this condition is yet to be established, but topical corticosteroids have been a mainstay of treatment. In most cases, this disease is characterized by flares and remissions.

Uma doente de 54 anos foi avaliada por placas eritematosas, dolorosas, disseminadas, recorrentes, com 3 meses de evolução. A biopsia cutânea foi compatível com dermatite intersticial granulomatosa. Os restantes exames laboratoriais revelaram hipotiroidismo e anticorpos anti-tiroideus positivos. Apesar da normalização da função tiroideia e de tratamento com corticóide tópico de alta potência, a dermatose melhorou apenas parcialmente. Dermatite intersticial inflamatória é um diagnóstico histopatológico, com expressão clínica variável. Tem sido associada a vários fármacos, doenças linfoproliferativas e autoimunes, nomeadamente artrite reumatóide, lupus eritematoso sistémico e vasculites, mas a associação com tireoidite autoimune é rara. Até ao momento, não foi definido nenhum tratamento específico, mas os corticóides tópicos são dos fármacos mais utilizados. A doença caracteriza-se por períodos de agravamento e remissão.

Autoimmune thyroid disease as a risk factor for angioedema in patients with chronic idiopathic urticaria: a case-control study / Doença autoimune da tireoide como um fator de risco para angioedema em pacientes com urticária crônica idiopática: um estudo caso-controle

CONTEXT AND OBJECTIVE: An association between chronic idiopathic urticaria (CIU) and autoimmune thyroid disease (ATD) has been reported. However, there have not been any reports on whether ATD raises the risk of angioedema, which is a more severe clinical presentation of CIU. Thus, the aim of the present study was to evaluate whether the risk of angioedema is increased in patients with CIU and ATD. DESIGN AND SETTING: Case-control study including 115 patients with CIU at a tertiary public institution. METHODS: The patients were evaluated with regard to occurrence of angioedema and presence of ATD, hypothyroidism or hyperthyroidism. RESULTS: Angioedema was detected in 70 patients (60.9%). There were 22 cases (19.1%) of ATD, 19 (16.5%) of hypothyroidism and nine (7.8%) of hyperthyroidism. The risk among patients with ATD was 16.2 times greater than among those without this thyroid abnormality (confidence interval, CI = 2.07-126.86). The odds ratio for hypothyroidism was 4.6 (CI = 1.00-21.54) and, for hyperthyroidism, 3.3 (CI = 0.38-28.36). CONCLUSIONS: Patients with CIU and ATD presented greater risk of angioedema, which reinforces the idea that a relationship exists between this allergic condition and thyroid autoimmunity. This finding could imply that such patients require specifically directed therapy.

CONTEXTO E OBJETIVO: A associação de urticária crônica idiopática (UCI) com doença autoimune da tireoide (DAT) é relatada. Porém, não foram encontrados relatos se a DAT eleva o risco de angioedema, uma apresentação clínica mais grave da UCI. Assim, o objetivo do presente estudo foi avaliar se o risco de angioedema está aumentado em pacientes com UCI e DAT. TIPO DE ESTUDO E LOCAL: Estudo caso-controle, incluindo 115 pacientes com UCI em uma instituição pública terciária. MÉTODOS: Os pacientes foram avaliados quanto à ocorrência de angioedema e à presença de DAT, hiper ou hipotireoidismo. RESULTADOS: Angioedema ocorreu em 70 pacientes (60,9%). Foram observados 22 (19,1%) casos de DAT, 19 (16,5%) de hipotireoidismo e 9 (7,8%) de hipertireoidismo. Os pacientes com DAT apresentaram risco 16,2 vezes maior de angioedema do que os sem a alteração tireoidiana (intervalo de confiança, IC = 2.07-126.86). O odds ratio, para hipotireoidismo, foi de 4,6 (IC = 1.00-21.54) e para hipertireoidismo foi de 3,3 (IC = 0.38-28.36). CONCLUSÕES: Pacientes com UCI e DAT apresentaram maior risco de angioedema, reforçando a ideia de existência de relação entre o quadro alérgico e autoimunidade tireoidiana. Este achado poderia implicar em um direcionamento terapêutico específico para tais pacientes.

Niña con hiperlipemia grave, secundaria a hipotiroidismo por tiroiditis atrófica autoinmunitaria / Severe hyperlipidemia, secondary to hypothyroidism due to atrophic thyroiditis in a girl

Se presenta una niña de 5 años y 8 meses de edad afectada de hiperlipemia grave, no sólo por valores elevados de colesterol total y colesterol asociado a lipoproteínas de baja densidad, sino también por depósito ectópico de grasa en pericardio visceral. Fue tratada con dieta y colestiramina sin diagnóstico de su enfermedad causal. Al momento de la consulta presentaba detención del crecimiento, pérdida de peso, signos clínicos de hipometabolismo y Rx con edad ósea retrasada. El perfil tiroideo confirmó el diagnóstico de hipotiroidismo. Por anticuerpos antitiroideos positivos y franca disminución del volumen tiroideo se hizo diagnóstico de tiroiditis atrófica autoinmunitaria, patología de presentación muy rara en la primera infancia. El diagnóstico tardío afectó el crecimiento lineal.

Prevalência de doenças tireoidianas auto-imunes em pacientes com lúpus eritematoso sistêmico / Prevalence of thyroid autoimmune disease in patients with systemic lupus erythematosus

INTRODUÇÃO: As doenças tireoidianas auto-imunes têm sido associadas com inúmeras desordens reumatológicas, incluindo o lúpus eritematoso sistêmico (LES). OBJETIVO: Avaliar a prevalência de alterações tireoidianas em pacientes com LES. MÉTODOS: Estudo de coorte transversal comparando prevalência de alterações tireoidianas em 106 pacientes com LES e grupo-controle de 102 pacientes. Os pacientes foram submetidos à avaliação clínica e laboratorial, com dosagens de anticorpos anti-TPO e anti-Tg, TSH, T4 livre e T3. RESULTADOS: Detectou-se aumento de prevalência de hipotireoidismo subclínico (11 por cento) e clínico (13 por cento) no grupo de pacientes com LES, comparados a 7 por cento e 1 por cento, respectivamente, no grupo-controle (p < 0,001). Não houve diferença de prevalência de hipertireoidismo entre os grupos comparados. A positividade de anticorpos antitireoidianos foi maior no grupo de LES (23 por cento versus 19 por cento, p = 0,025). O risco relativo de pacientes com LES apresentarem alterações tireoidianas foi de 1,60. CONCLUSÃO: As alterações tireoidianas são mais freqüentes em pacientes com LES que na população geral.

INTRODUCTION: Thyroid autoimmune diseases have been associated with a variety of rheumatologic diseases, including systemic lupus erythematosus (SLE). OBJECTIVE: To estimate the prevalence of thyroid autoimmune diseases in patients with SLE. METHODS: Transversal study to compare the prevalence of thyroid disorders in 106 patients with SLE and a control group of 102 patients. The patients were submitted to a clinical and a laboratorial evaluation; the tests included antiperoxidase and antithyroglobulin antibodies, TSH, free T4 and T3. RESULTS: We detected high prevalence of subclinical hypothyroidism (11 percent) and clinical hypothyroidism (13 percent) in the group of patients with SLE when they were compared to the control group, 7 percent and 1 percent, respectively (p < 0,001). The hyperthyroidism occurred in a same frequency in the two groups. The positivity of antithyroid antibodies was higher in the group with SLE (23 percent versus 19 percent, p = 0,025). The relative risk of the patients with SLE to develop thyroid dysfunctions was 1,6. CONCLUSION: The thyroid disorders were more prevalent in patients with LES than in general population.

Avaliação da associação entre doença auto-imune de tireóide e urticária crônica idiopática / Assessment of association between autoimmune thyroid disease and chronic urticaria

Vários estudos encontraram maior prevalência de Doença Auto-imune de Tireóide (DAT) em pacientes com Urticária Crônica (UC). Essa relação pode ocorrer devido à possível etiologia auto-imune em até um terço dos casos de Urticária Crônica Idiopática (UCI). No entanto, a freqüência de DAT variou de 1,14 por cento a 28,6 por cento. O princípio deste estudo foi determinar se ocorre associação entre DAT e UCI em uma população atendida em um mesmo centro de saúde. Comparamos a freqüência de anticorpos anti-tireoidianos e disfunção tireoidiana entre 49 pacientes com UCI (grupo 1) e 112 controles (grupo 2). Com a finalidade de fortalecer o resultado encontrado, estudamos a prevalência de UCI em 60 pacientes com DAT (grupo 3) comparados com 29 com doença não auto-imune de tireóide (DNAT) (grupo 4). Não encontramos diferença estatística quanto à presença de anticorpos anti-tireoidianos ou disfunção tireoidiana entre os grupos 1 e 2 (12,24 por cento x 9,82 por cento e 12,24 por cento x 7,14 por cento, respectivamente). O mesmo ocorreu quanto à presença de UCI entre os grupos 3 e 4 (3,33 por cento x 3,44 por cento). Em nosso estudo não foi possível demonstrar uma relação entre DAT e UCI, o que significa que diferentes populações podem apresentar maior ou menor grau de associação entre essas doenças.

Several studies found a higher prevalence of Autoimmune Thyroid Disease (ATD) in patients with Chronic Urticaria (CU). This relationship may be due to the possible autoimmune etiology in up to one third of the cases of Chronic Idiopathic Urticaria (CIU). However, the frequency of ATD ranged from 1.14 percent to 28.6 percent. The study began by determining whether there is an association between ATD and CU, in a population seen at the same clinic. We compared the frequency of anti-thyroid antibodies and thyroid dysfunction in 49 patients with CIU (group 1) and 112 controls (group 2). In order to support the result found, we studied the prevalence of CIU in 60 patients with ATD (group 3) and compared with 29 patients who had non-immune thyroid disease (NITD) (group 4). We did not find a statistical difference for the presence of anti-thyroid antibodies or thyroid dysfunction between groups 1 and 2 (12.24 percent x 9.82 percent and 12.24 percent x 7.14 percent, respectively). The same occurred for the presence of CIU among groups 3 and 4 (3.33 percent x 3.44 percent). In our study it was not possible to demonstrate a relationship between ATD and CIU, which means that different populations may present a higher or lower degree of association between these illnesses.

Hashimoto's encephalopathy in an adolescent boy.

Hashimoto's encephalopathy is an under-recognized cause of acute encephalopathy both in children and adults. We hereby describe a 12.5 yr old boy with this rare disorder that presented with an acute onset of episodic psychosis with hallucinations along with seizures and had elevated antithyroid antibodies. Symptoms improved with thyroxine replacement and anticonvulsants and EEG normalized 3 mth into follow up. Hashimoto's encephalopathy should be considered in patients with unexplained encephalopathy and seizures, as prompt recognition and management can lead to an excellent outcome.

Ocular myasthenia gravis and auto-immune thyroiditis in children.

A 7-year-old girl presented at a university hospital with ptosis of the left eye. This resolved spontaneously within 4 weeks but then the right eye became similarly affected but responded to prostigmine. Left hypertropia with restriction of the right inferior rectus, mild exophthalmos, non-tender diffuse enlargement of the thyroid, normal thyroid function tests, anti-thyroglobulin, and anti-microsomal antibodies indicated an association of autoimmune thyroiditis and ocular myasthenia. The ptosis was remedied with pyridostigmine and short-course oral prednisolone, but the hypertropia persisted.

Pulmonary veno-occlusive disease in a patient with a history of Hashimoto's thyroiditis.

Pulmonary veno-occlusive disease (PVOD), a rapidly progressive and fatal disorder, is a rare cause of pulmonary hypertension. We report the occurrence of PVOD in a female patient with Hasimoto's thyroiditis. This report emphasises that PVOD can co-exist with Hashimoto's thyroiditis and a high index of clinical suspicion is required to confirm the diagnosis of PVOD.

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.

Eosinophilic Fasciitis Associated with Autoimmune Thyroiditis

Eosinophilic fasciitis (EF) is scleroderma-like disease without Raynaud's phenomenon or visceral involvement. It is characterized by painful swelling of the extremities, accompanied by rapid weight gain, fever and myalgia. The acute state of disease is associated with significant peripheral blood eosinophilia, an elevated erythrocyte sedimentation rate and hypergammaglobulinemia. EF is also frequently associated with hematological abnormalities, including malignant lymphoproliferative diseases, but rarely associated with autoimmune thyroiditis. In the present study we report a case of eosinophilic fasciitis associated with autoimmune thyroiditis.