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.

Isolated primary amyloidosis of the inferior rectus muscle mimicking Graves’ orbitopathy / Amiloidose primária isolada do músculo reto inferior simulando orbitopatia de Graves

ABSTRACT The diagnosis of Graves’ orbitopathy is usually straightforward. However, orbital diseases that mimick some clinical signs of Graves’ orbitopathy may cause diagnostic confusion, particularly when associated to some form of thyroid dysfunction. This report describes the rare occurrence of localized inferior rectus muscle amyloidosis in a patient with autoimmune hypothyroidism, who was misdiagnosed as Graves’ orbitopathy. A 48-year-old man complained of painless progressive proptosis on the left side and intermittent vertical diplopia for 6 months. The diagnosis of Graves’ orbitopathy was entertained after magnetic resonance imaging revealing a markedly enlarged, tendon-sparing inferior rectus enlargement on the left side, and an autoimmune hypothyroidism was disclosed on systemic medical workup. After no clinical improvement with treatment, the patient was referred to an ophthalmologist and further investigation was performed. The presence of calcification in the inferior rectus muscle on computed tomography, associated with the clinical findings led to a diagnostic biopsy, which revealed amyloid deposition. This report emphasizes that a careful evaluation of atypical forms of Graves’ orbitopathy may be crucial and should include, yet with rare occurrence, amyloidosis in its differential diagnosis.

RESUMO O diagnóstico de orbitopatia de Graves usualmente é fácil de ser estabelecido. No entanto, doenças da órbita que simulam alguns sinais clínicos da orbitopatia de Graves podem levar à confusão diagnóstica, particularmente quando associada à alguma forma de disfunção tireoidiana. Relatamos a ocorrência rara de amiloidose localizada no músculo reto inferior em paciente com hipotireoidismo autoimune, que recebeu inicialmente o diagnóstico errôneo de orbitopatia de Graves. Paciente masculino, 48 anos, com queixa de proptose progressiva e indolor do lado esquerdo e diplopia vertical intermitente há 6 meses. O diagnóstico de orbitopatia de Graves foi considerado após a realização de ressonância magnética, que revelou aumento importante do músculo reto inferior esquerdo, sem acometimento do tendão, e uma propedêutica sistêmica detectou hipotireoidismo autoimune. Como não houve melhora com o tratamento clínico, o paciente foi encaminhado a um oftalmologista, que realizou nova investigação. A presença de calcificação no músculo reto inferior na tomografia computadorizada, associada aos achados clínicos, levou a uma biópsia da lesão, que demonstrou a deposição de material amiloide. Este relato enfatiza como uma avaliação minuciosa das formas atípicas de orbitopatia de Graves é essencial e deve incluir a ocorrência, embora rara, de amiloidose no diagnóstico diferencial da orbitopatia de Graves.

Publicaciones de artículos originales de autores cubanos sobre algunas afecciones endocrinas en la mujer de edad mediana / Publication of original papers on some endocrine illnesses in middle-aged women by Cuban authors

Introducción: en la posmenopausia se incrementa la morbilidad por afecciones endocrinas, cuya frecuencia varía en las diferentes regiones del mundo y que desconocemos en nuestro medio. Objetivo: identificar la frecuencia que en artículos originales autores cubanos hacen referencia sobre afecciones endocrinas frecuentes en la edad mediana de la mujer cubana, y reportar los artículos útiles. Métodos: estudio infométrico referido a las publicaciones de autores cubanos recuperados de las bases de datos (Lilacs, Medicc Review, Esbco, PubMed, Cochrane Library, Scielo Cuba y Cumed), repositorios de tesis, eventos médicos nacionales, relacionados con la osteoporosis posmenopausia, la diabetes mellitus tipo 2, el nódulo del tiroides, el hipo e hipertiroidismo y la tiroiditis autoinmune. Se incluyeron los artículos originales reportados entre 1995-2012, accesibles, con referencia a mujeres con edades 40-59 años, y en los que se especificara la metodología utilizada para establecer los diagnósticos de referencia. Resultados: se identificaron 7 703 trabajos que incluían al menos uno de los descriptores definidos. El 2,4 por ciento de los reportes de autores cubanos fueron útiles, y en todos se identificó una alta frecuencia de las afecciones referidas. La dificultad en el acceso virtual e impreso fue la principal causa de no utilidad de los artículos. Conclusiones: se evidencia la poca frecuencia o visibilidad de la morbilidad por afecciones endocrinas en la mujer de edad mediana(AU)

Introduction: in the postmenopausal period, morbidity from endocrine illnesses increases and their frequency varies in different parts of the world, but knowledge about this topic is limited in our country. Objective: to determine the frequency of reference to common endocrine illnesses affecting Cuban middle-aged women in original papers by Cuban authors and to report on useful articles. Methods: informative study of the publication of Cuban papers retrieved in Lilacs, Medicc Review, Esbco, PubMed, Cochrane Library, Scielo Cuba and Cumed databases, thesis repositories and national medical events, which cover postmenopausal osteoporosis, type 2 diabetes mellitus, thyroid modes, hypo and hyperthyroidism and autoimmune thyroiditis. It included accessible original papers from the 1995 to 2012 period, making reference to 40-59 years-old women and specifying the used methodology to make diagnoses. Results: there were found 7 703 papers that comprised at least one of the defined subject headings. In the group, 2.4 percent of reports by Cuban authors were useful and all identified high frequency of the above-mentioned illnesses. The extent of difficulties in having access, either digital or printed, to these articles was the main cause of classifying them as useless. Conclusions: low frequency of visibility of morbidity from endocrine illnesses in the Cuban middle-aged women was demonstrated(AU)

Encefalopatía respondedora a corticoides asociada a tiroiditis autoinmune (SREAT). Una causa no habitual de compromiso de conciencia en pediatría, reporte de 2 casos / Steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT): an unusual cause of encephalopathy in children, report of two cases

Introduction: steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT) is a rare condition in children. The pathogenesis and etiology of SREAT has not yet been clearly identified. Clinical features include acute or subacute encephalopathy with neuropsychiatric symptoms, associated with abnormally elevated thyroid antibodies (TA) and symptoms improvement with corticosteroid treatment. Methods and Patients: we present 2 clinical cases; the first a 6 years 8 months male with cephalic myoclonic seizures and behavioral changes, the second a 12 years 10 months female with 4 hospitalizations for encephatlopathy, dystonia and psychomotor agitation. In both patients thyroid function tests and TA were compatible with Hashimoto’s thyroiditis, this associated with neuropsychiatric symptoms did raise the diagnosis of SREAT. Glucocorticoid therapy was started, the first case showed remission of seizures and behavioral improvement, however the second patient had insufficient response, so second line therapy with intravenous immunoglobulin was introduced with good response. This therapy was supplemented by additional long-term glucocorticoids use but when suspended both patients presented relapsing symptoms. Conclusions: Although SREAT is rarely suspected at presentation, it is necessary to consider this diagnosis in patients with encephalopathy, neuropsychiatric symptoms and elevated TA. Further studies are required to elucidate the pathophysiology of this disease and follow-up work to assess comorbidities and long-term complications in pediatric patients.

Ocular surface and salivary gland involvement in patients with autoimmune thyroid disease

Purpose: Many reports have indicated an association between thyroid dieases and primary Sjõgren’s syndrome (pSS). The aim of our study was to evaluate the outcomes of the tests used for dry eye diagnosis and salivary gland involvement in patients with autoimmune thyroiditis. Methods: Forty-two patients (group 1) with autoimmune thyroid disease and 30 controls (group 2) were selected. Tear film break up time, Schirmer I test, Schirmer II test, ocular staining with 1% rose Bengal and salivary gland cintilography were performed in both groups. Results: Regarding the ocular surface damage observed by Rose Bengal test there was no difference between groups (p=0.77). For tear film break up time the groups did not differ statistically (p=0.46). There was no statistical difference between groups 1 and control in scintigraphy of the salivary gland (p=0.99). A statistical difference between the patients with thyroid disease and the control group was seem only in the Schirmer II test (p=0.0009). Conclusions: No patients fulfilled all criteria for Sjõgren’s syndrome. It is possible that it could be underestimated.

Objetivo: Muitos trabalhos mostraram uma associação entre doenças da tireoide e síndrome de Sjõgren primária (pSS) . O objetivo do nosso estudo foi avaliar os resultados dos testes utilizados para o diagnóstico de olho seco e envolvimento das glândulas salivares em pacientes com tireoidite autoimune. Métodos: Quarenta e dois pacientes (grupo 1) com doença autoimune da tireoide e 30 controles (grupo 2 ) foram selecionados. Nos dois grupos foi realizada a mesma sequência de exames: tempo de ruptura do filme lacrimal, teste de Schimer I, teste de Schirmer II, avaliação da córnea e conjuntiva com corante de Rosa Bengala. Também foi realizado cintilografia da glândula salivar para avaliar seu envolvimento. Resultados: Em relação aos danos na superfície ocular observado pelo teste rosa bengala não houve diferença entre os grupos (p=0,77), o mesmo ocorrendo no tempo de ruptura do filme lacrimal (p=0,46) e na cintilografia da glândula salivar (p=0,99). Apenas no teste de Schirmer II houve diferença estatística significante (p=0,0009). Conclusão: Nenhum paciente cumpriu todos os critérios para a síndrome de Sjõgren. É possível que este resultado esteja subestimado.

Thyroid autoimmunity in patients with hyperprolactinemia: an observational study / Autoimunidade tireoidiana em pacientes com hiperprolactinemia: um estudo observacional

Objective : To establish whether there is a relationship between hyperprolactinemia and primary thyroid disorders, focusing on patients with autoimmune features. Materials and methods : The medical records of 100 patients with hyperprolactinemia (HPRL) were retrospectively examined. Records of thyroid ultrasonography (USG), basal serum levels of thyroid stimulating hormone, circulating free thyroxine, free triiodothyronine, antithyroglobulin (anti-Tg), and antithyroperoxidase (anti-TPO) antibodies were analyzed. In 100 control subjects, matched by age and gender with HPRL patients, thyroid USG, thyroid function tests (TFTs), and autoantibody panel were obtained. Results : The median PRL in patients was 93 ng/mL (range: 37-470). Twenty-five patients (25%) and 22 controls (22%) had positive anti-Tg and/or anti-TPO titers (P = 0.739). The median serum PRL was 98 (37-470) ng/mL in patients with positive thyroid autoantibodies, and 92 (40-470) ng/mL in patients who were negative (P = 0.975). Among the individuals with autoantibody positivity TFTs abnormalities were more frequent in HPRL patients (60%, out of 25 patients, 14 with subclinical hypothyroidism and one with hyperthyroidism) than in controls (9.1%, out of 22 patients, 2 with subclinical hyperthyroidism) (P < 0.001). Twenty-seven patients with HPRL and 31 controls had goiter (27 vs. 31%, P = 0.437). Forty-six patients (46%) and 50 (50%) controls had one or more of the features of thyroid disorder, which were goiter, positive thyroid autoantibody, and thyroid function abnormality (P = 0.888). Conclusion : HPRL may be associated with more severe thyroid dysfunction in patients with thyroid autoimmunity. .

Objetivo : Verificar se existe uma relação entre a hiperprolactinemia e distúrbios primários da tireoide, focando em pacientes com características autoimunes. Materiais e métodos : Os prontuários de 100 pacientes com hiperprolactinemia (HPRL) foram examinados retrospectivamente. Foram analisados registros de ultrassonografia da tireoide (USG), níveis séricos basais de hormônio tireoestimulante, tiroxina livre, triiodotironina livre e anticorpos antitireoglobulina (anti-Tg) e antitireoperoxidase (anti-TPO). Foram obtidos de 100 controles, pareados por idade e sexo com pacientes com HPRL, USG, testes de função da tireoide (TFTs) e painel de autoanticorpos. Resultados : A média de PRL em pacientes foi de 93 ng/mL (variação: 37-470). Vinte e cinco pacientes (25%) e 22 controles (22%) foram positivos para títulos de anti-Tg e/ou anti-TPO (P = 0,739). A mediana de PRL sérica foi de 98 (37-470) ng/mL em pacientes positivos para autoanticorpos tiroidianos e 92 (40-470) ng/mL em pacientes negativos (P = 0,975). Entre os indivíduos positivos para autoanticorpos, as anormalidades da TFTs foram mais frequentes em pacientes HPRL (60%; de 25 pacientes, 14 com hipotireoidismo subclínico e um com hipertireoidismo) do que nos controles (9,1%; de 22 pacientes, 2 com hipertireoidismo subclínico) (P < 0,001). Vinte e sete pacientes com HPRL e 31 controles apresentavam bócio (27 contra 31%; P = 0,437). Quarenta e seis pacientes (46%) e 50 (50%) controles tiveram uma ou mais das características de problemas de tireoide, como bócio, autoanticorpos antitireoide e anormalidades da função tiroidiana (P = 0,888). Conclusão : A HPRL pode estar associada à disfunção da tireoide mais grave em pacientes com autoimunidade contra a tireoide. .

Autoantibodies against thyroid hormones and their influence on thyroxine determination with chemiluminescence immunoassay in dogs

Autoantibodies against thyroxin (T4AA) and triiodothyronine (T3AA) are present in dogs with autoimmune thyroiditis and have been reported to interfere with immunoassays. The objectives of this study were to determine the frequency of autoantibodies and to determine whether interference occurs by T4AA, using a non-immunological method (high performance liquid chromatography, HPLC) for thyroxin (T4) measurement. Based on clinical symptoms, T4 and thyroid stimulating hormone (TSH) concentration, 1,339 dogs were divided into six groups: Group 1: hypothyroid (n = 149); Group 2: subclinical thyroiditis (n = 110); Group 3: suspicious for non thyroidal illness (n = 691); Group 4: biochemical euthyroid (n = 138); Group 5: hypothyroid dogs under substitution therapy (n = 141); Group 6: healthy dogs (n = 110). The incidence of T4AA and T3AA, determined using radiometric assay, was low (0.5% and 3.8%) and higher in hypothyroid dogs compared to dogs suspicious for hypothyroidism (Group 2-4) (p<0.05). T4AA was not detected in dogs with normal T4 and elevated TSH. T4 concentrations of T4AA positive samples determined using HPLC were comparable to results obtained by chemiluminescence immunoassay. These findings indicate that the probability of interference of T4AA leading to falsely elevated T4 concentration in the T4 assay seems to be low.

A iodúria de pacientes portadores de tireopatias autoimunes em Santo André, SP, é comparável à dos indivíduos normais e estável nos últimos dez anos / Urinary iodine in patients with auto-immune thyroid disorders in Santo André, SP, is comparable to normal controls and has been steady for the last 10 years

OBJETIVO: Avaliar se o aumento de iodo na dieta seria o fator desencadeante de tireopatias autoimunes na cidade de Santo André, SP. MÉTODOS: Determinou-se a iodúria em amostra isolada de 58 pacientes, divididos em quatro grupos e de 13 indivíduos normais (controles). RESULTADOS: Iodúria: grupo 1 - hipertireoidismo = 203,5 ± 152,71 µg/L (média ± DP); grupo 2 hipotireoidismo = 258,31 ± 148,2 µg/L; grupo 3 - tireodite crônica autoimune = 244,29 ± 191,6 µg/L; grupo 4 - amiodarona = 1.157,5 ± 261,8 µg/L; grupo 5 - controles = 262,31 ± 146,2 µg/L. Comparadas as médias da iodúria entre os cinco grupos, dos grupos 1, 2, 3 e 5 não apresentaram diferenças significantes (p > 0,05) e todos diferiram do grupo 4 (p < 0,05). A iodúria dos grupos 1, 2, 3 e 5, obtida em 2002 e 2003, não diferiram dos valores determinados em 1994 em escolares em Santo André. CONCLUSÃO: Este estudo evidencia que o iodo não deve ser considerado o agente responsável pelas tireopatias autoimunes em Santo André, e outros fatores ambientais devem ser investigados.

OBJECTIVE: Evaluate whether the increase of iodine in the diet would be the triggering factor for auto-immune thyropathies in the city of Santo André, SP. METHODS: Urinary iodine was determined in samples isolated from 58 patients, divided in 4 Groups, and in 13 normal individuals (controls). RESULTS: Urinary Iodine: Group 1 - hyperthyroidism = 203.5±152.71 µg/ L(mean±sd); Group 2 - hypothyroidism = 258.31±148,2 µg/L; Group 3 - chronic auto-immune thyroiditis = 244.29±191.6 µg/L; group 4 (Amiodarone) = 1157.5±261.8 µg/L; Group 5 - Controls = 262.31±146.2 µg/L. On comparing the means of urinary iodine among the groups, the means for groups 1, 2, 3, and 5 did not present significant differences (p>0.05), and all differed from group 4 (p<0.05). Urinary iodine obtained in groups 1, 2, 3 and 5, obtained in 2002-03, is not different from the values determined in students in 1994 in Santo André. CONCLUSION: This study shows evidence that iodine should not be considered as the responsible agent for auto-immune thyropathies in Santo André, and other environmental factors should be investigated.

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

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

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

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.

Tiroiditis de Hashimoto en niños y adolescentes con bocio / Hashimoto´s thyroiditis in children and adolescents with goiter

Se denomina bocio al aumento de tamaño de la glándula tiroidea, que da lugar a un abultamiento en la región anterior del cuello, el agrandamiento de los lóbulos laterales de la tiroides debe ser superior al tamaño de la falange distal del dedo pulgar del paciente. La tiroiditis de Hashimoto es la inflamación crónica de la tiroides de origen autoinmunitario; cursa con bocio y puede provocar hipotiroidismo existe un hipotiroidismo, este se desarrolla en forma paulatina. El tratamiento del paciente hipotiroideo consiste en la administración de levotiroxina.

Morphological evaluation of non neoplastic lesions of the thyroid gland

This study was conducted to see the frequency of non neoplastic lesions of thyroid glands in patients who underwent thyroid surgery at Mayo hospital, Lahore. It was a descriptive cross sectional study. It was a retrospective and prospective study commencing from Ist July 1999 to 30th June 2002 and was conducted at Pathology Department King Edward Medical University, Lahore. All thyroid samples submitted and reported at the Department of Pathology, King Edward Medical University, Lahore during a three year period commencing from Ist July 1999 to 30th June 2002 were included in this study. Out of the total number of 1136 thyroid surgical specimens, 855 specimens [75.26%] were shown to comprise of non-neoplastic lesions and were more common in females [77.2%] as compared to males [22.8%] giving a male to female ratio of 1:3.4. Regarding non neoplastic lesions maximum comprised of diffuse[74%] and multi nodular goiters [16%]. Others consisted of inflammatory conditions [5%], hyperplastic nodules[4%] and simple colloid filled cysts 1%. Inflammatory conditions included Hashimotos' thyroiditis [67.3%] deQuervain's thyroiditis [granulomatous thyroiditis] [16.3%], Lymphocytic thyroiditis [11.7%], and Riedel's thyroiditis[4.7%]. Non neoplastic thyroid lesions are more common than neoplastic lesions, especially in females. The frequency of diffuse colloid goiter was very high, while among inflammatory lesions Hashimotos' thyroiditis was the commonest lesion. Most of the cases of hypothyroidism were associated with iodine deficiency

An unusual presentation of primary lymphoma of the thyroid in a young male patient.

Primary lymphoma of the thyroid gland is a rare disease that is strongly associated with chronic lymphocytic thyroiditis. We report an unusual case of 20-year-old male who presented with thyroid swelling and was diagnosed on cytology as lymphocytic thyroidtis. However, histopathologicalfindings revealed non-Hodgkin's lymphoma that was further classified as B-cell type on immunohistochemical stains. In cytology, lymphomas must be considered as a differential diagnosis in case of Hashimoto's/lymphocytic thyroiditis, subacute thyroiditis and small cell carcinoma.

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.

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.

Hypothyroidism due to Hashimoto thyroiditis post struma ovarii excision

Struma ovarii is a rare ovarian teratoma that may produce hyperthyroidism. The association with Hashimoto thyroiditis HT, however is rare and has been reported in only one case. We report a case of HT following the resection of struma ovarii tumor, after which the patient became frankly, hypothyroid with elevated thyroid stimulating hormone and low thyroxin levels. Her thyroid peroxidase antibodies were positive. She improved after initiation of levothyroxine replacement therapy. We believe her euthyroid status preoperatively was due to thyroid hormone secretion by struma ovarii itself

Valor de la determinación de anticuerpos antitiroideos plasmáticos para el diagnóstico de tiroiditis crónica autoinmune / Value of the determination of plasmatic antithyroid antibodies for the diagnosis of chronic autoimmune thyroiditis

Se valoró la eficacia de los métodos de detección de anticuerpos humorales empleados en el Instituto Nacional de Endocrinología para el diagnóstico de TCA. Se estudió un grupo de 100 pacientes con bocio y la sospecha clínica de que padecieran de TCA. A cada uno se le realizó una biopsia con aguja fina (BAF), que se tomó como la regla de oro del diagnóstico, determinación de anticuerpos plasmáticos antitiroglobulina por el método del TRC y antimicrosomales (AMS), para hacer una validación estadística de ambos métodos; sensibilidad, especificidad, valor predictivo para casos positivos, valor predictivo para casos negativos y el índice general de eficacia diagnóstica. Se hallaron 70 pacientes con resultados positivos de TCA por la BAF y 30, negativos. La sensibilidad de ambos métodos de detección de anticuerpos humorales fue pobre (45,7 (por ciento) para el AMS y 30 (por ciento) para el TRC). Aún aplicados los dos al mismo paciente no sobrepasó del 60 (por ciento). La especificidad fue mucho mejor para ambos métodos (73,3 (por ciento) para la AMS, 90 (por ciento) para el TRC y 70 (por ciento) para ambos métodos juntos). El valor predictivo para casos positivos fue bueno (80 (por ciento) para AMS, 87,5 (por ciento) para TRC y 82,3 (por ciento) para los métodos de conjunto) y el predictivo para casos negativos fue 36,3, 35,5 y 42,9 (por ciento), respectivamente. La eficacia general fue tan solo del 54 (por ciento) para el TRC, 48 (por ciento) para AMS y 63 (por ciento) para ambos métodos de conjunto. Se concluyó que estos métodos son útiles para reafirmar el diagnóstico cuando resultan positivos, pero de poca utilidad para asegurar que no se trata de esta afección cuando resultan negativos(AU)

The effectiveness of the humoral antibody detection methods used in the diagnosis of chronic autoimmune thyroiditis (CAT) in the National Institute of Endocrinology was assessed. A group of 100 patients with goitier and presenting with clinical suspicion of CAT was studied. A fine needle biopsy was performed on each of the patients, which was taken as the golden rule of the diagnosis and also the determination of plasmatic antithyroglobulin antibodies by the TCR method and the determination of antimicrosomal antibodies were made for statistically validating both methods, taking sensitivity, specificity, predictive value for positive cases, predictive value for negative cases and general index of diagnostic efficacy into consideration. Seventy patients were found positive and 30 negative for CAT by the FNB. The sensitivity of both methods of humoral antibodies was poor: 45.7 percent for AMS and 30 percent for TRC. Even the joint application of both methods to the same patient did not exceed 60 percent. Specificity was a much better indicator in both methods (73.3 percent for AMS, 90 percent for TRC and 70 percent for both applied together). The predictive value for positive cases was good (80 percent for AMS; 87.5 percent for TRC and 82.3 percent for both) and the predictive value for negative cases was 36.3, 35.5 and 42.9 percent respectively. The general efficacy was only 54 percent for TRC, 48 percent for AMS and 63 percent for both methods together. It was concluded that these procedures are useful to confirm the diagnosis when cases are positive, but they are rather useless to assure the non-existence of this affection when cases are negative(AU)