Exploring the relationship between Hashimoto's thyroiditis and male fertility:A meta-analytic and meta-regression perspective on hormonal and seminal factors

Objective:To explore the relationship between Hashimoto's autoimmune hypothyroidism(HT)and male fertility,focusing on hormonal and seminal factors.Methods:A systematic literature search was conducted across databases such as PubMed,Web of Science,EMBASE,Scopus,Cochrane,and Google Scholar,covering studies published from January 2000 to March 2024.Studies investigating the impact of HT on semen quality parameters and reproductive hormones were included.Pooled effect estimates were calculated using standard mean difference(SMD)and 95%confidence intervals(CI).Results:A total of 8 studies with 8965 participants were included.HT significantly affected semen quality and reproductive hormone levels.Specifically,there was a notable decrease in progressive morphology(SMD=-0.78;95%CI:-1.40 to-0.17;P=0.01)and sperm motility(SMD=-1.151;95%CI:-1.876 to-0.425;P=0.002).In addition,there were no significant changes in reproductive hormones,although there were elevated levels of luteinizing hormone(SMD=0.437;95%CI:0.000 to 0.874;P=0.050)and follicle-stimulating hormone(SMD=0.293;95%CI:-0.171 to 0.758;P=0.216),with a slight impact on testosterone levels(SMD=-1.143;95%CI:-2.487 to 0.200;P=0.095).Conclusions:This systematic review and meta-analysis provides robust evidence of the detrimental effects of HT on semen quality and reproductive hormones,underscoring the necessity for thorough evaluation and management of thyroid function in male infertility assessments.

Ultrafast pulse wave velocity technique for evaluating changes of carotid artery elasticity in Hashimoto thyroiditis patients with euthyroidism

Objective To explore the value of ultrafast pulse wave velocity(UFPWV)technique for evaluating changes of carotid artery elasticity in Hashimoto thyroiditis(HT)patients with euthyroidism.Methods Conventional ultrasound and UFPWV for carotid artery were prospectively performed in 91 HT patients with euthyroidism(HT group)and 81 healthy subjects(control group).Clinical data and ultrasonic parameters were compared between groups.Spearman correlation analysis was performed to observe the correlations of carotid pulse wave velocity in end of systole(PWV-ES)with clinical indexes and other ultrasonic parameters in HT group.Multiple stepwise linear regression analysis was used to screen the independent impact factors of increased carotid PWV-ES in HT group.Results Significant differences of thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TgAb),total cholesterol(TC),low density lipoprotein and neutrophil-lymphocyte ratio(NLR)were found between groups(all P<0.05).The carotid PWV-ES in HT group was significantly higher than that in control group(P<0.05),while no significant difference of carotid artery intima-media thickness(CIMT)nor carotid pulse wave velocity in beginning of systole(PWV-BS)was found between groups(both P>0.05).Carotid PWV-ES in HT group was positively correlated with patients'age,body mass index,TPOAb,TC,triglyceride,NLR and CIMT(r=0.217—0.707,all P<0.05).Patients'age,TPOAb and NLR were all independent impact factors of increased carotid PWV-ES in HT patients with euthyroidism(all P<0.05).Conclusion UFPWV technique could be used to evaluate changes of carotid artery elasticity in HT patients with euthyroidism,among which PWV-ES was relatively sensitive.

Vitamin D, selenium in type 2 diabetes and Hashimoto's thyroiditis: Is it effective?

The study by Feng et al,explores treatment approaches for these coexisting conditions.It emphasizes the potential advantages of selenium and vitamin D supplementation but also raises methodological and patient selection concerns.Findings indicate a complex interplay between interventions and disease markers,prompting the need for further research.Despite limitations,the study offers valuable insights into managing the intricate relationship between type 2 diabetes mellitus and Hashimoto's thyroiditis.The authors'contributions shed light on potential treatment avenues,although careful consideration of study design and patient characteristics is warranted for future investigations in this domain.

Vitamin D and selenium for type 2 diabetes mellitus with Hashimoto’s thyroiditis:Dosage and duration insights

This letter discusses the publication by Feng et al.Iodine,selenium,and vitamin D are closely associated with thyroid hormone production in humans;however,the efficacy of selenium and vitamin D supplementation for type 2 diabetes mellitus(T2DM)patients with Hashimoto’s thyroiditis(HT)remains controversial.In the retrospective study we discuss herein,the authors highlighted significant improvements in thyroid function,thyroid antibodies,blood glucose,and blood lipid in T2DM patients with HT following addition of vitamin D and selenium to their antidiabetic regimens,underscoring the value of these supplements.Our team is currently engaged in research exploring the relationship between micronutrients and HT,and we have obtained invaluable insights from the aforementioned study.Based on this research and current literature,we recommend a regimen of 4000 IU/day of vitamin D and 100-200μg/day of selenium for over three months to six months for patients with HT,particularly for those with concurrent T2DM.

儿童Hashimoto脑病临床特征分析与随访研究

目的探讨儿童Hashimoto脑病(HE)的临床特点。方法回顾分析4例HE患儿的临床资料。结果 4例患儿均为学龄期,3例为女童,既往均体健。临床主要表现为痫性发作3例,精神症状2例,意识障碍2例,卒中样表现、记忆力下降及睡眠减少各1例。4例患儿脑电图背景活动均减慢,3例头颅MRI异常;4例患儿血清甲状腺抗体均明显升高,其中2例临床症状消失后甲状腺抗体恢复正常,另外2例明显降低,但未完全恢复正常;4例患儿中仅1例甲状腺功能异常。4例均对糖皮质激素治疗反应良好,其中1例自行停药后复发,继续原药治疗仍有效。结论儿童HE极少见,当出现其他疾病难以解释的痫性发作、精神异常、认知损害、运动障碍、意识障碍等时,应考虑到HE,血清甲状腺抗体增高为诊断必要条件。

Hashimoto病患者血清中抗人促甲状腺激素自身抗体的检测

应用^(125)Ⅰ标记的人促甲状腺激素(hTSH)作为示踪配体,对29名正常人和18名Hashi-moto病(HTD)患者血清中抗hTSH自身抗体(TSHab)病行了检测;29名正常人TSHab指数(TSHabI)为0.85±0.22:而18名HTD患者TSHabI为1.37±0.39(x±s,P<0.01)。SPA菌体结合沉淀试验表明:这种与hTSH结合的抗体属于IgG成份。TSHab的存在提示:HTD的兔疫学发病及其转归可能涉及垂体和独特型、抗独特型反应机制。

Coexistence of papillary thyroid microcarcinoma and mucosa-associated lymphoid tissue lymphoma in a context of Hashimoto's thyroiditis

Papillary thyroid cancer(PTC)represents 80%-85%of thyroid cancer and its prevalence has been rising in the last decades.Primary thyroid lymphoma(PTL)accounts for 3%of extranodal lymphomas and about 5%of thyroid malignancies,having a prevalence of one or two cases per million people.Mucosa-Associated Lymphoid Tissue lymphoma represents approximately30%of PTL.Both entities have an indolent course and a very good prognosis.Diagnosis is made by ultrasound and fine needle aspiration(FNA)or surgery specimen pathology.They have also been associated with Hashimoto’s thyroiditis(HT),but pathogenesis and its links remains to be known.Treatment remains controversial and surgery is generally accepted in cases of disease limited to thyroid,as the present.Patients with thyroid nodules should be observed and followed.If there is an enlargement by ultrasound or clinical symptoms,FNA should be performed promptly.Patients with HT deserve additional surveillance,since this condition is associated with both PTC and PTL.In this case,the management with surgery and radioactive iodine ablation therapy was effective for both entities.Patients with thyroid nodules should be properly evaluated with ultrasound and thyroid function tests.If there is an enlargement of the neck,reported by symptoms or ultrasound,it requires further investigation.HT is associated to both PTC and PTL so if the enlargement of the nodules is on this context additional tests such as FNA should be performed.In this case,the patient was managed with surgery and radioactive iodine ablation therapy and it was effective for both entities.

Hashimoto甲状腺炎的CT诊断

目的：探讨Ｈａｓｈｉｍｏｔｏ甲状腺炎的ＣＴ表现特点。材料与方法：Ｈａｓｈｉｍｏｔｏ甲状腺炎２２例：其中手术病理证实１５例；活检病理证实４例；经临床及同位素放免测定诊断３例。扫描层厚、层距各５～１０ｍｍ。结果：Ｈａｓｈｉｍｏｔｏ甲状腺炎ＣＴ扫描甲状腺实质内多无结节或低密度病灶以及钙化灶，甲状腺两叶多为对称性弥漫性肿大，腺叶增大相对不明显，边缘清楚。结论：ＣＴ对Ｈａｓｈｉｍｏｔｏ甲状腺炎的诊断。

Ascher syndrome: a rare case of blepharochalasis combined with double lip and Hashimoto’s thyroiditis

Dear Editor,I am Dr. Yao Fu, from the Department of Ophthalmology,Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. I write to present a rare case of Ascher syndrome.Ascher syndrome was described first in 1920, presenting as a combination of blepharochalasis, double lip, and non-toxic goitre(1)It is considered to be a rare, sporadic.

Coeliac disease in Dutch patients with Hashimoto’s thyroiditis and vice versa

AIM: To define the association between Hashimoto’s thyroiditis and coeliac disease in Dutch patients. METHODS: A total of 104 consecutive patients with Hashimoto’s thyroiditis underwent coeliac serological tests (antigliadins, transglutaminase and endomysium antibodies) and HLA-DQ typing. Small intestinal biopsy was performed when any of coeliac serological tests was positive. On the other hand, 184 patients with coeliac disease were subjected to thyroid biochemical (thyroid stimulating hormone and free thyroxine) and thyroid serological tests (thyroglobulin and thyroid peroxidase antibodies). RESULTS: Of 104 patients with Hashimoto’s thyroiditis, sixteen (15%) were positive for coeliac serology and five patients with documented villous atrophy were diagnosed with coeliac disease (4.8%; 95% CI 0.7-8.9). HLA-DQ2 (and/or -DQ8) was present in all the five and 53 patients with Hashimoto’s thyroiditis (50%; 95% CI 43-62). Of 184 patients with coeliac disease, 39 (21%) were positive for thyroid serology. Based on thyroid biochemistry, the 39 patients were subclassified into euthyroidism in ten (5%; 95% CI 2-9), subclinicalhypothyroidism in seven (3.8%; 95% CI 1.8-7.6), and overt hypothyroidism (Hashimoto’s thyroiditis) in 22 (12%; 95% CI 8-16). Moreover, four patients with coeliac disease had Graves’ disease (2%; 95% CI 0.8-5) and one patient had post-partum thyroiditis. CONCLUSION: The data from a Dutch population confirm the association between Hashimoto’s thyroiditis and coeliac disease. Screening patients with Hashimoto’s thyroiditis for coeliac disease and vice versa is recom- mended.

Hashimoto's encephalopathy presenting as acute cognitive decline in an elderly male

Hashimoto’s encephalopathy(HE)is a rare form of reversible encephalopathy characterized by the presence of anti-thyroid antibodies in serum and/or cerebrospinal fl uid.The syndrome is more common in women and the presentation varies considerably.Here,we report a case of an elderly male with a history of Hashimoto’s thyroiditis,presenting with acute cognitive decline.A diagnosis of HE was established based on the presence of antithyroid antibodies in the serum,diffuse electroencephalography changes and lack of an alternative explanation.The patient promptly responded to steroids and was discharged on the 8th day of admission.We suggest that an assessment of thyroid antibodies should be included in anyone presenting with acute cognitive decline in the absence of alternative explanation.

抗LGi1抗体阳性边缘系统脑炎叠加Hashimoto脑炎临床特点分析并文献复习(附1例报告)

目的总结抗LGi1抗体阳性边缘系统脑炎的临床与影像学特点,加深对于本病的认识。方法报告于2013年11月25日就诊于北京积水潭医院神经内科门诊后收住院确诊的1例抗LGi1抗体阳性边缘系统脑炎患者的整个临床发病及诊治转归过程,对于患者的临床资料、影像学、电生理资料进行分析总结。结果患者为中年女性,亚急性起病,主要临床表现包括极其频繁发作的面部肩部不适及面部抽动、频率稍低的发作性幻嗅、逐渐出现的记忆力下降、精神淡漠等认知及精神障碍;头部MRI在T2及Flair序列上见到了双侧颞叶内侧、海马区的高信号病灶,脑电图见到多导广泛的高幅慢波及棘慢或尖慢综合波等癫痫样放电;血及脑脊液LGi1抗体均阳性,同时血甲状腺抗过氧化物酶抗体及甲状腺抗球蛋白抗体均明显增高,提示叠加了Hashimoto脑炎,此外尚合并部分其他自身抗体的阳性;在接受了大剂量甲基强的松龙冲击并逐渐减量的治疗方案后,患者病情迅速缓解好转,随访1 y未再复发。结论抗LGi1抗体阳性边缘系统脑炎作为一种罕见的以损伤边缘系统为主的自身免疫性脑炎,在边缘系统脑炎基本表现的基础上,有其特殊的临床变现。同时还可以合并其他自身免疫相关脑炎及自身抗体阳性,尽早明确诊断并给予一线的免疫治疗可明显改善患者预后。

Presence of thyroid-associated ophthalmopathy in Hashimoto's thyroiditis

·AIM: To determine the prevalence of ophthalmopathy in Hashimoto’s patients and to make a comparison in subgroups of patients·METHODS: The study involved 110 Hashimoto’s thyroiditis patients and 50 control subjects attending to the endocrinology department of the hospital. Subgroup classification of patients was made as euthyroid,subclinic and clinic in Hashimato’s thyroiditis. All patients were evaluated by a single experienced ophthalmologist for the prevalence and characteristics of eye signs.·RESULTS:Theoverallprevalencesofeyechanges were22.7%(25 patients) in patients and 4%(2 persons) in control subjects respectively(P =0.002). In patients the most common symptom was retrobulbar eye pain with or without any eye movement. Thirteen patients had significant upper eyelid retraction(11.8%). Six patients had eye muscle dysfunction as reduced eye movements in up gaze. In control patients one person had proptosis and another had lid retraction. The clinical activity score and classification of the ophthalmopathy did not show any significant differences among subgroups.·CONCLUSION:Theeyesignsweremostlymild(22.7%)and the most common eye sign was the presence of upper eyelid retraction(11.8%). Additionally six patients had eye muscle dysfunction as reduced eye movements in up gaze. Therefore we recommend to make a routine ophthalmic examination in Hashimoto’s thyroiditis patients in order not to omit the associated ophthalmopathy.

Pituitary-Thyroid Dysfunction in a Hashimoto’s Encephalopathy Patient

The pathogenesis of Hashimoto’s encephalopathy has not been clearly elucidated and involvement of autoimmune damage has been proposed. We report a 23-year-old man who was emergently hospitalized for paroxysmal syncope and involuntary tremor with normal physical examination except for low heart rate. The patient was characterized by neurological symptoms, mild hypothyroidism, enlarged pituitary gland and extremely elevated thyrotropin, which all were reversed with levothyroxine alone. The case indicated that the pituitary-thyroid dysfunction may play a role in the pathogenesis of Hashimoto’s encephalopathy, hence, evaluation of pituitary gland should be recommended in diagnosis and treatment of Hashimoto’s encephalopathy.

Hashimoto’s Thyroiditis and Encephalopathy

Although very rare, the literature describes cases of Hashimoto encephalopathy attesting to its occurrence. Affected patients present with seizures, stroke-like episodes, transient focal and global neurological deficits, and a variety of neuropsychiatric disturbance from dementia to hallucinations and psychosis. The encephalopathy evolves with concomitantly elevated anti-thyroid peroxidase antibodies, independent from hormonal thyroid function setting it apart from thyrotoxicosis and myxedema. A new patient reported with Hashimoto’s encephalopathy, in whom neurocognitive impairment and stroke-like onset of hemiparesis and hemiparkinsonism correlated with brain magnetic resonance imaging fused with positron emission tomography.

Hashimoto Encephalopathy: Impact of Concussion

Patients with Hashimoto encephalitis may present with seizures, stroke-like episodes, transient focal and global neurological deficits, and a variety of neuropsychiatric disturbances. The encephalopathy evolves with elevated anti-thyroid peroxidase antibodies, independent of hormonal thyroid function. A teenager experienced repeated concussions antedating onset of Hashimoto encephalopathy. Neuroradiological studies showed overlapping areas of altered brain metabolism and vascular perfusion in the hippocampus, deemed most vulnerable in autoimmune encephalopathy. Concussive brain injury may be a contributing factor in the development of encephalopathy due to its capacity to alter the blood-brain barrier.

Convulsive Seizures Revealing Hashimoto’s Encephalopathy

Introduction: Hashimoto encephalopathy (HE) is an autoimmune disease with different neurological and psychiatric characteristics. It is associated with increased thyroperoxidase autoantibodies. The diagnosis of HE is clinical and involves the detection of serum thyroperoxidase (TPO) antibodies and the exclusion of other etiologies. A clinical response to corticosteroid therapy supports the diagnosis. We report a case of HE revealed by convulsive seizures and cognitive and behavioral disorders. Observation: She is a 7-year-old child followed in a neurology unit for convulsive seizures for one year. Clinical examination performed in the endocrinology unit later found tachycardia without goiter, behavioral disorders, difficulties to concentrate as well as psychomotor agitation. Biological work up revealed subclinical hypothyroidism, positive anti-TPO antibodies with normal thyroid ultrasound and brain MRI. The cerebrospinal fluid was clear, normotensive and absence of pleocytosis. The sleep-wake electroencephalogram was well organized for her age with a paroxysmal discharge in the left parieto-temporal region. Based on these clinical, biological and morphological data, the diagnosis of HE was retained. Corticosteroid therapy with prednisone at 1 mg/kg/day was initiated for 6 weeks while reducing the dose progressively. There was a good clinical and biological progress under treatment. Conclusion: Hashimoto’s encephalopathy is a rare, but probably unrecognized entity. Over the past decades, knowledge about thyroid, brain, immunity interactions has increased. This indicates the importance of a multidisciplinary approach of endocrinologists, neurologists, psychiatrists and pediatricians for early recognition and treatment.

Evaluation of Serum Trace Elements and Vitamin Levels in Hashimoto’s Thyroiditis: Single Centre Experience from Turkey

Aim: To determine levels of serum trace elements and vitamins, and to find out possible correlations between these elements and vitamins with thyroid function tests and thyroid autoantibody levels in patients having Hashimoto’s thyroiditis (HT). Methods: The study included 51 premenauposal women with untreated HT, aged 18 to 56 years without any known chronic diseases or chronic medicine usage, and 27 healthy premenauposal women aged 19 to 42 years old. Trace elements (selenium, zinc, copper, iron levels) and vitamins [A, E, B12, 25-OH-D, 1,25(OH)2D and folic acid levels] were evaluated in patient and control groups. Results: Consequently, serum trace elements and vitamin B12 levels did not significantly differ in patients with HT and control group. Thyroid functioning tests and autoantibody levels did not show any correlation with the levels of trace elements, vitamin A, vitamin E and 25-OH vitamin D. A correlation was detected between vitamin B12 and Anti thyroid peroxidase levels. Conclusion: The negative correlation between vitamin B12 and Anti thyroid peroxidase levels may demonstrate the necessity to screen the patients with HT for atrophic gastritis. We believe that more comprehensive studies with larger sample sizes are needed in which patients are randomized according to their nutritional status.

Hashimoto’s Disease: Associated Thyroid Gland Disorders, Pharmacological, and Nutritional Interventions

Hashimoto’s disease is a condition that occurs when an affected person’s immune system attacks their thyroid gland and produces an immune response that results in low levels of thyroid hormones in the blood. These hormones are important in maintaining the body’s metabolic processes and the lack of thyroid hormones causes the symptoms of Hashimoto’s disease that include weight gain, paleness, coldness, birth defect, infertility, menorrhagia, and even death in rare cases of uncontrolled hypothyroidism. The disease requires a blood test to determine the levels of circulating thyroid hormones in the blood or the presence of specific antibodies. Thyroid hormone replacement is used to raise the levels of thyroid hormones in the body, if the hormone test shows that they are deficient. People who are middle aged, female, and have or are predisposed to an autoimmune disorder are most at risk for developing the disease. In recent times, the notion that the antidote for managing Hashimoto’s disease may be found in common food and supplements has grown among endocrinologists and caregivers. This review is intended to investigate the various aspects of the disease that include its pathogenesis, associated disorders, pharmacological and nutritional interventions.