Background: Thyroid diseases are among the leading endocrine disorders affecting a large proportion of people worldwide and show geographical variation in incidence and histopathological pattern related to age, sex, d...Background: Thyroid diseases are among the leading endocrine disorders affecting a large proportion of people worldwide and show geographical variation in incidence and histopathological pattern related to age, sex, dietary and environmental factors. Histopathological patterns of surgically treated thyroid diseases play an important role in early diagnosis and management of these diseases. There is, however, limited published data regarding histopathological reports on thyroid disease in our local setting. This study aimed to determine the histopathological patterns and highlight early postoperative complications among patients with surgically treated thyroid diseases at Bugando Medical Centre (BMC). Methods: This was a longitudinal study involving all patients with surgically treated thyroid diseases seen at BMC over a period of 6 months from October 2019 to March 2020. Results: A total of 84 patients were studied. Females outnumbered males by a female to male ratio of 11:1. The median age of patients was 44 [IQR, 35 - 54] years old, the youngest was 14 years old and the oldest was 76 years old. Colloid goiter was the most common non-neoplastic lesion accounting for 34 (44.7%) patients. Among the neoplastic lesions, follicular adenoma was the most commonly encountered benign pathologies (n = 16;21.1%), while papillary carcinoma was the most commonly encountered malignancy (n = 4;50%). Following thyroidectomy, 12 (14.3%) patients developed early complications, of which hemorrhage sometimes requiring blood transfusion was the leading intra/postoperative complications accounting for 4 (33.3%) patients. Other complications include temporary recurrent laryngeal nerve palsy 2 (16.7%), surgical site infection 2 (16.7%) and tracheomalacia, bronchospasm, thyroid abscess and respiratory obstruction in 1 (8.3%) patient each, respectively. In this study, malignant thyroid lesion (p Conclusion: This study demonstrated that colloid goiter was the most common non-neoplastic lesion, and on the neoplastic category, follicular adenoma was the most common benign lesion, while papillary carcinoma was the most frequent malignant lesion.展开更多
In this editorial we comment on the article by Pavlidis et al,published in the recent issue of the World Journal of Oncology.We focus on the recent contributions in the management of anaplastic thyroid carcinoma,highl...In this editorial we comment on the article by Pavlidis et al,published in the recent issue of the World Journal of Oncology.We focus on the recent contributions in the management of anaplastic thyroid carcinoma,highlighting the importance of surgery and radiotherapy as first line therapies in its management and the introduction of new systemic therapies beyond chemotherapy,focused on molecular alterations,an essential step in the diagnosis and included in clinical guidelines for the selection of the ideal treatment.In contrast to other neoplasms,immunotherapy,is still beginning in studies of this pathology with encouraging results.Therefore,multimodal management of the pathology together with new drugs seems to be the logical step to increase the survival of this neoplasm.展开更多
Thyroid carcinoma is a complex disease with several types,the most common being well-differentiated and undifferentiated.The latter,“undifferentiated carcinoma”,also known as anaplastic thyroid carcinoma(ATC),is a h...Thyroid carcinoma is a complex disease with several types,the most common being well-differentiated and undifferentiated.The latter,“undifferentiated carcinoma”,also known as anaplastic thyroid carcinoma(ATC),is a highly aggr-essive malignant tumor accounting for less than 0.2%of all thyroid carcinomas and carries a poor prognosis with a median survival of 5 months.BRAF gene mutations are the most common molecular factor associated with this type of thyroid carcinoma.Recent advances in targeted biological agents,immuno-therapy,stem cell therapy,nanotechnology,the dabrafenib/trametinib com-bination therapy,immune checkpoint inhibitors(ICI)and artificial intelligence offer novel treatment options.The combination therapy of dabrafenib and tra-metinib is the current standard treatment for patients with BRAF-V600E gene mutations.Besides,the dabrafenib/trametinib combination therapy,ICI,used alone or in combination with targeted therapies have raised some hopes for improving the prognosis of this deadly disease.Younger age,earlier tumor stage and radiotherapy are all prognostic factors for improved outcomes.Ultimately,therapeutic regimens should be tailored to the individual patient based on surveillance and epidemiological data,and a multidisciplinary approach is ess-ential.展开更多
BACKGROUND Autoimmune hepatitis(AIH)and primary biliary cholangitis(PBC)are two common clinical autoimmune liver diseases,and some patients have both diseases;this feature is called AIH-PBC overlap syndrome.Autoimmune...BACKGROUND Autoimmune hepatitis(AIH)and primary biliary cholangitis(PBC)are two common clinical autoimmune liver diseases,and some patients have both diseases;this feature is called AIH-PBC overlap syndrome.Autoimmune thyroid disease(AITD)is the most frequently overlapping extrahepatic autoimmune disease.Immunoglobulin(IgG)4-related disease is an autoimmune disease recognized in recent years,characterized by elevated serum IgG4 levels and infiltration of IgG4-positive plasma cells in tissues.CASE SUMMARY A 68-year-old female patient was admitted with a history of right upper quadrant pain,anorexia,and jaundice on physical examination.Laboratory examination revealed elevated liver enzymes,multiple positive autoantibodies associated with liver and thyroid disease,and imaging and biopsy suggestive of pancreatitis,hepatitis,and PBC.A diagnosis was made of a rare and complex overlap syndrome of AIH,PBC,AITD,and IgG4-related disease.Laboratory features improved on treatment with ursodeoxycholic acid,methylprednisolone,and azathioprine.CONCLUSION This case highlights the importance of screening patients with autoimmune diseases for related conditions.展开更多
As a common hyperglycemic disease,type 1 diabetes mellitus(T1DM)is a complicated disorder that requires a lifelong insulin supply due to the immunemediated destruction of pancreaticβcells.Although it is an organ-spec...As a common hyperglycemic disease,type 1 diabetes mellitus(T1DM)is a complicated disorder that requires a lifelong insulin supply due to the immunemediated destruction of pancreaticβcells.Although it is an organ-specific autoimmune disorder,T1DM is often associated with multiple other autoimmune disorders.The most prevalent concomitant autoimmune disorder occurring in T1DM is autoimmune thyroid disease(AITD),which mainly exhibits two extremes of phenotypes:hyperthyroidism[Graves'disease(GD)]and hypothyroidism[Hashimoto's thyroiditis,(HT)].However,the presence of comorbid AITD may negatively affect metabolic management in T1DM patients and thereby may increase the risk for potential diabetes-related complications.Thus,routine screening of thyroid function has been recommended when T1DM is diagnosed.Here,first,we summarize current knowledge regarding the etiology and pathogenesis mechanisms of both diseases.Subsequently,an updated review of the association between T1DM and AITD is offered.Finally,we provide a relatively detailed review focusing on the application of thyroid ultrasonography in diagnosing and managing HT and GD,suggesting its critical role in the timely and accurate diagnosis of AITD in T1DM.展开更多
BACKGROUND In recent years,the emergence of multiplex technology that can simultaneously measure multiple anti-islet autoantibodies has become particularly valuable for the staging and early diagnosis of immune-mediat...BACKGROUND In recent years,the emergence of multiplex technology that can simultaneously measure multiple anti-islet autoantibodies has become particularly valuable for the staging and early diagnosis of immune-mediated type 1 diabetes(T1D).While it has been established that 20%-30%of T1D patients suffer from autoimmune thyroid disease(AITD),there is limited available data regarding the presence of anti-islet autoantibodies in AITD patients.Among commercially available anti-islet autoantibodies,glutamic acid decarboxylase 65 autoantibodies(GADAs)are often the first marker measured in general clinical practice.AIM To investigate the frequency of anti-islet autoantibodies in AITD patients.METHODS Our study involved four hundred ninety-five AITD patients,categorized into three distinct groups:AITD with T1D(n=18),AITD with phenotypic type 2 diabetes(T2D)(n=81),and AITD without diabetes(n=396),and the enzyme-linked immunosorbent assay(ELISA)was employed to determine the frequencies of 3 Screen Islet Cell Autoantibody(3 Screen ICA),GADA,insulinoma-associated antigen-2 autoantibodies(IA-2As),and zinc transporter 8 autoantibodies(ZnT8As)within these groups.RESULTS The frequency of 3 Screen ICA in AITD patients with T1D,T2D,and those without diabetes were 88.9%,6.2%,and 5.1%,respectively,with no significant difference seen between the latter two groups.Notably,the frequency of 3 Screen ICA was 11.1%higher in AITD patients with T1D,1.3%higher in AITD patients with T2D,and 1.1%higher in AITD patients without diabetes compared to GADA,respectively.Furthermore,12.5%,20.0%,and 20.0%of the 3 Screen ICA-positive patients were negative for GADA.Additionally,1.3%of the AITD patients who tested negative for 3 Screen ICA in both the AITD with T2D and non-diabetic AITD groups were found to be positive for individual autoantibodies.Among the 3 Screen ICA-positive patients,there was a significantly higher proportion of individuals with multiple autoantibodies in AITD patients with T1D compared to those without diabetes(37.5%vs 5.0%,P<0.05).However,this proportion was similar to that in AITD patients with T2D(20.0%).Nevertheless,there was no significant difference in 3 Screen ICA titers between AITD patients with T1D and those without diabetes(436.8±66.4 vs 308.1±66.4 index).Additionally,no significant difference in 3 Screen ICA titers was observed between Graves’disease and Hashimoto’s thyroiditis in any of the groups.CONCLUSION Our findings reveal that some AITD patients without diabetes exhibit 3 Screen ICA titers comparable to those in AITD patients with T1D.Thus,3 Screen ICA outperforms GADA in identifying latent anti-islet autoantibody-positive individuals among AITD patients.展开更多
Well-differentiated thyroid carcinoma has a favorable prognosis with a 5-year survival rate of over 95%.However,the undifferentiated or anaplastic type accounting for<0.2%,usually in elderly individuals,exhibits a ...Well-differentiated thyroid carcinoma has a favorable prognosis with a 5-year survival rate of over 95%.However,the undifferentiated or anaplastic type accounting for<0.2%,usually in elderly individuals,exhibits a dismal prognosis with rapid growth and disappointing outcomes.It is the most aggressive form of thyroid carcinoma,with a median survival of 5 mo and poor quality of life(airway obstruction,dysphagia,hoarseness,persistent pain).Early diagnosis and staging are crucial.Diagnostic tools include biopsy(fine needle aspiration,core needle,open surgery),high-resolution ultrasound,computed tomography,magnetic resonance imaging,[(18)F]fluoro-D-glucose positron emission tomography/computed tomography,liquid biopsy and microRNAs.The BRAF gene(BRAF-V600E and BRAF wild type)is the most often found molecular factor.Others include the genes RET,KRAS,HRAS,and NRAS.Recent management policy is based on surgery,even debulking,chemotherapy(cisplatin or doxorubicin),radiotherapy(adjuvant or definitive),targeted biological agents and immunotherapy.The last two options constitute novel hopeful management modalities improving the overall survival in these otherwise condemned patients.Anti-programmed death-ligand 1 antibody immunotherapy,stem cell targeted therapies,nanotechnology achievements and artificial intelligence implementation provide novel promising alternatives.Genetic mutations determine molecular pathways,thus indicating novel treatment strategies such as anti-BRAF,anti-vascular endothelial growth factor-A,and anti-epidermal growth factor receptor.Treatment with the combination of the BRAF inhibitor dabrafenib and the MEK inhibitor trametinib has been approved by the Food and Drug Administration in cases with BRAF-V600E gene mutations and is currently the standard care.This neoadjuvant treatment followed by surgery ensures a twoyear overall survival of 80%.Prognostic factors for improved outcomes have been found to be younger age,earlier tumor stage and radiation therapy.A multidisciplinary approach is necessary,and the therapeutic plan should be individu alized based on surveillance and epidemiology end results.展开更多
Background: Hypocalcaemia is a serious complication that may follows thyroid surgeries. So, the purpose of this study was to determine the frequency of postoperative hypocalcaemia after thyroid surgery in Omdurman mil...Background: Hypocalcaemia is a serious complication that may follows thyroid surgeries. So, the purpose of this study was to determine the frequency of postoperative hypocalcaemia after thyroid surgery in Omdurman military hospital (Jan.-July 2018). Materials & Methods: In this retrospective facility based cross sectional study, 124 files were reviewed, the recorded data were age, sex, residence, diagnosis, type of surgery & postoperative calcium level, data were collected by a designed pretested checklist, data were analyzed by SPSS version 20 by using frequencies & cross tabulations, for postoperative hypocalcaemia. Results: Majority of the patients were between 21 - 41 years 49.2%, majority of them were females 83.9%. 97.6% of them underwent total thyroidectomy, 25% of the patients developed postoperative hypocalcaemia, also we found that there was no relation between sex, type of thyroid surgery & development of postoperative hypocalcaemia (P > 0.001). Conclusion: Our research showed that 25% of the patients who underwent thyroid surgery developed postoperative hypocalcaemia.展开更多
The role of vitamin D as an immune modulator has been emphasized in recent years,and low levels of the hormone were observed in several autoimmune diseases including multiple sclerosis and systemic lupus erythematosus...The role of vitamin D as an immune modulator has been emphasized in recent years,and low levels of the hormone were observed in several autoimmune diseases including multiple sclerosis and systemic lupus erythematosus.Vitamin D mediates its effect though binding to vitamin D receptor(VDR),and activation of VDR-responsive genes.While VDR gene polymorphism was found to associate with autoimmune thyroid diseases(AITDs),few studies examined levels of vitamin D in these patients and those that did yielded conflicting results.We therefore undertook to evaluate the levels of vitamin D in patients with AITDs compared to patients with non-AITDs and healthy controls.Serum vitamin D(25-OH)levels were measured in 50 patients with AITDs,42 patients with non-AITDs and 98 healthy subjects,utilizing the LIAISON chemiluminescence immunoassay(DiaSorin,Saluggia,Italy).VitaminD deficiency was designated at levels lower than 10 ng/ml.Antithyroid antibodies,thyroid functions and demographic parameters were evaluated in all patients.The prevalence of vitamin D deficiency was significantly higher in patients with AITDs compared with healthy individuals(72% versus 30.6%;P<0.001),as well as in patients with Hashimoto’s thyroiditis compared to patients with non-AITDs(79% versus 52%;P<0.05).Vitamin D deficiency also correlated to the presence of antithyroid antibodies(P=0.01)and abnormal thyroid function tests(P=0.059).Significantly low levels of vitamin D were documented in patients with AITDs that were related to the presence of anti thyroid antibodies and abnormal thyroid function tests,suggesting the involvement of vitamin D in the pathogenesis of AITDs and the advisability of supplementation.展开更多
Objective This study aimed to determine whether the prevalence of thyroid nodules(TNs)increased due to modern lifestyles or other factors,despite the advances in screening and diagnostic tools.Methods This study inclu...Objective This study aimed to determine whether the prevalence of thyroid nodules(TNs)increased due to modern lifestyles or other factors,despite the advances in screening and diagnostic tools.Methods This study included 3474 pairs of participants,who were matched by gender and age(±3 years)from two cross-sectional sampling surveys:(1)the program on the iodine nutritional status and related health status of residents in Shanghai in 2009;(2)the thyroid disease screening program for adults in Shanghai between 2017 and 2018.The prevalence of TNs and thyroid diseases in 2009 and 2017–2018 were compared,and the potential risk factors of TNs were detected.Results The prevalence of TNs in 2009 was 28.9%:22.5%in males and 34.5%in females.In 2017,this increased to 43.8%:37.9%in males and 49.1%in females.The prevalence of TNs significantly increased from 2009 to 2017(odds ratio,1.486;95%confidence interval,1.238–1.786).In addition,female gender,thyroid disease history,and age were the main risk factors for TNs after adjusting for confounders in the logistic regression across the time period.Conclusion The prevalence of TNs significantly increased across nearly 10 years in Shanghai.展开更多
Thyroid cancer is the most common endocrine malignancy.While there has been no appreciable increase in the observed mortality of well-differentiated thyroid cancer,there has been an overall rise in its incidence world...Thyroid cancer is the most common endocrine malignancy.While there has been no appreciable increase in the observed mortality of well-differentiated thyroid cancer,there has been an overall rise in its incidence worldwide over the last few decades.Patients with papillary thyroid carcinoma(PTC)and clinical evidence of central(cN1)and/or lateral lymph node metastases require total thyroidectomy plus central and/or lateral neck dissection as the initial surgical treatment.Nodal status in PTC patients plays a crucial role in the prognostic evaluation of the recurrence risk.The 2015 guidelines of the American Thyroid Association(ATA)have more accurately determined the indications for therapeutic central and lateral lymph node dissection.However,prophylactic central neck lymph node dissection(pCND)in negative lymph node(cN0)PTC patients is controversial,as the 2009 ATA guidelines recommended that CND“should be considered”routinely in patients who underwent total thyroidectomy for PTC.Although the current guidelines show clear indications for therapeutic CND,the role of pCND in cN0 patients with PTC is still debated.In small solitary papillary carcinoma(T1,T2),pCND is not recommended unless there are high-risk prediction factors for recurrence and diffuse nodal spread(extrathyroid extension,mutation in the BRAF gene).pCND can be considered in cN0 disease with advanced primary tumors(T3 or T4)or clinical lateral neck disease(cN1b)or for staging and treatment planning purposes.The role of the preoperative evaluation is fundamental to minimizing the possible detrimental effect of overtreatment of the types of patients who are associated with low disease-related morbidity and mortality.On the other hand,it determines the choice of appropriate treatment and determines if close monitoring of patients at a higher risk is needed.Thus,pCND is currently recommended for T3 and T4 tumors but not for T1 and T2 tumors without high-risk prediction factors of recurrence.展开更多
AIM:To investigate the choroidal thickness and the microvascular network changes around the macula in thyroid eye disease(TED)patients at different stages and the relationship of those changes with risk factors,serum ...AIM:To investigate the choroidal thickness and the microvascular network changes around the macula in thyroid eye disease(TED)patients at different stages and the relationship of those changes with risk factors,serum antibodies and the severity of TED.METHODS:A total of 85 participants were enrolled.All participants underwent ophthalmology and endocrinology examinations.Subfoveal choroidal thickness(SFCT),superficial(s)and deep(d)foveal avascular zone(FAZ)area,mean(m)and central(c)superficial vascular density(SVD),deep vascular density(DVD)measurements of the enrolled cases were performed with Topcon swept source optical coherence tomography(OCT)/OCT angiography(OCTA)DRI OCT Triton.Multiple linear regression analysis was used to explore the associations between SFCT,FAZ area,SVD,DVD and the relevant factors of TED.RESULTS:Those with active TED patients had higher c-DVD and m-DVD levels(P<0.05),however there is no statistically significant difference in SFCT between active and stable TED patients.Among the serum antibodies,it was observed that s-FAZ and d-FAZ increased,c-SVD and m-SVD decreased in patients with high thyroid stimulating hormone-receptor autoantibodies(TRAB)level,whereas SFCT thickened in patients with high levels of both TRAB and human thyroglobulin(hTG).There was no significant difference in SFCT,FAZ,SVD and DVD measurement at gender,between hyperthyroid and euthyroid patients and among those with or without thyroid papillary carcinoma.CONCLUSION:The results show that both disease activation and serum antibodies differentially affect both superficial and deep retinal vascular density.It has also been shown that high serum antibody levels affect choroidal thickness independent of clinical activity.展开更多
Hepatocrinology explores the intricate relationship between liver function and the endocrine system.Chronic liver diseases such as liver cirrhosis can cause endocrine disorders due to toxin accumulation and protein sy...Hepatocrinology explores the intricate relationship between liver function and the endocrine system.Chronic liver diseases such as liver cirrhosis can cause endocrine disorders due to toxin accumulation and protein synthesis disruption.Despite its importance,assessing endocrine issues in cirrhotic patients is frequently neglected.This article provides a comprehensive review of the epidemiology,pathophysiology,diagnosis,and treatment of endocrine disturbances in liver cirrhosis.The review was conducted using the PubMed/Medline,EMBASE,and Scielo databases,encompassing 172 articles.Liver cirrhosis is associated with endocrine disturbances,including diabetes,hypoglycemia,sarcopenia,thyroid dysfunction,hypogonadotropic hypogonadism,bone disease,adrenal insufficiency,growth hormone dysfunction,and secondary hyperaldosteronism.The optimal tools for diagnosing diabetes and detecting hypoglycemia are the oral glucose tolerance test and continuous glucose monitoring system,respectively.Sarcopenia can be assessed through imaging and functional tests,while other endocrine disorders are evaluated using hormonal assays and imaging studies.Treatment options include metformin,glucagon-like peptide-1 analogs,sodium-glucose co-transporter-2 inhibitors,and insulin,which are effective and safe for diabetes control.Established standards are followed for managing hypoglycemia,and hormone replacement therapy is often necessary for other endocrine dysfunctions.Liver transplantation can address some of these problems.展开更多
To determine the value of dissecting the recurrent laryngeal nerve during thyroid surgery with respect to preventing recurrent laryngeal nerve injury, we retrospectively analyzed clinical data from 5 344 patients unde...To determine the value of dissecting the recurrent laryngeal nerve during thyroid surgery with respect to preventing recurrent laryngeal nerve injury, we retrospectively analyzed clinical data from 5 344 patients undergoing thyroidectomy. Among these cases, 548 underwent dissection of the recurrent laryngeal nerve, while 4 796 did not. There were 12 cases of recurrent laryngeal nerve injury following recurrent laryngeal nerve dissection (injury rate of 2.2%) and 512 cases of recurrenl laryngeal nerve injury in those not undergoing nerve dissection (injury rate of 10.7%). This difference remained statistically significant between the two groups in terms of type of thyroid disease, type of surgery, and number of surgeries. Among the 548 cases undergoing recurrent laryngeal nerve dissection, 128 developed anatomical variations of the recurrent laryngeal nerve (incidence rate of 23.4%), but no recurrent laryngeal nerve injury was found. In addition, the incidence of recurrent laryngeal nerve injury was significantly lower in patients with the infedor parathyroid gland and middle thyroid veins used as landmarks for locating the recurrent laryngeal nerve compared with those with the entry of the recurrent laryngeal nerve into the larynx as a landmark. These findings indicate that anatomical variations of the recurrent laryngeal nerve are common, and that dissecting the recurrent laryngeal nerve during thyroid surgery is an effective means of preventing nerve injury.展开更多
Estrogen receptor(ER) and progesterone receptor (PgR) in core-needle biopsied thyroidtissues of 30 cases of autoimmune thyroid disease and 2 cases of simple gotter were measured usingenzyme-linked histochemical techni...Estrogen receptor(ER) and progesterone receptor (PgR) in core-needle biopsied thyroidtissues of 30 cases of autoimmune thyroid disease and 2 cases of simple gotter were measured usingenzyme-linked histochemical technique. The results showed that the frequences of presence of ER inGraves' disease (GD) and Hashimoto's thyroditis(HT) were 50% (9/18) and 58. 3K (7/12) respectively ; and those of PgR were 11. 1 % (2/18) in GD, 16. 2% (2/7) in HT. Both ER and PgR werenegative in simple gotter. This study demonstrated that the content of ER in thyroid tissues of autoimmune thyroid disease was relatively high, suggesting that estrogen may play a role in the development of the disease.展开更多
Background: Thyroid eye disease represents an organ-specific autoimmune process that is usually associated with thyroid disease. Graves’ disease is the most common thyroid abnormality associated with thyroid eye dise...Background: Thyroid eye disease represents an organ-specific autoimmune process that is usually associated with thyroid disease. Graves’ disease is the most common thyroid abnormality associated with thyroid eye disease. Aim: This study was conducted for the profile of ocular manifestation in Thyroid Eye Disease (TED). Methodology: A cross-sectional study of 117 cases of thyroid dysfunction was carried out at BP Koirala Institute of Health System, out of which 84 (71.79%) cases had ocular manifestation. They were evaluated and analyzed in detail and the characteristics documented included patient’s demography, ocular and systemic history and as well as ocular examination and some of the systemic and laboratory findings. Results: In this study, mean age of presentation of TED was 39.7 years. 59 patients were female and 25 were male. The maximum patients of both sexes were in the fourth decade of their lives. The common lid signs were lid retraction and lid lag. Proptosis was seen in 33.3% of cases out of which 68% had bilateral proptosis. Corneal ulcer was seen in 7.1% and optic neuropathy in 1.2% of cases. In 27.3% of cases there was elevation of IOP. Dry eye was seen in 61.9% of cases and POAG seen in 8.3% of cases. In the study population 75% were hyperthyroiditic, 16.7% were hypothyroiditic and 8.3% were in euthyroid state. Conclusion: Female was more commonly affected. The maximum number of patients of both sexes was in the fourth decade of their lives. Hyperthyroidism patient had greater chance of ocular manifestation.展开更多
<strong>Introduction:</strong> Autoimmune thyroiditis is relatively common in medicine. However, comprehensive studies are few in number, especially in Africa and particularly in Senegal. The aim of this s...<strong>Introduction:</strong> Autoimmune thyroiditis is relatively common in medicine. However, comprehensive studies are few in number, especially in Africa and particularly in Senegal. The aim of this study was therefore to determine the epidemiological, clinical, profile of Autoimmune Thyroid Diseases (OITD). <strong>Materials and Methods: </strong>This was a retrospective descriptive study from 2016 to 2019 of the records of patients who consulted or were hospitalised for autoimmune dysthyroidism in the internal medicine department of the Aristide Le Dantec Hospital. During this period, 1227 new consultations were recorded;they concerned three specialized consultations including endocrinology. The autoimmune origin was confirmed in 159 patients, <em>i.e.</em> in 45.69% of cases the AIDM then 12.96% of all consultations. The autoimmune origin was established on clinical, biological and immunological grounds. The data were collected from the medical records of the patients and recorded on a pre-established individual survey sheet taking into account the objectives of the study. The data collected was entered into the Sphinx V5 software on an established form. The analysis was carried out with the following software: Excel 2010 and Epi info 7.2. <strong>Results:</strong> Among this dysthyroidism, 159 patients had a confirmed autoimmune thyroid disease. On all new consultations, OITD represented 12.96% of internal medicine consultations. The sex ratio M/F was 0.18. The majority of our patients (57.86%) were aged between 25 and 44 years with extremes ranging from 11 to 63 years. In Graves’ disease, the notion of an irritative spine was found in 60.27% of cases. Signs of thyrotoxicosis were present in 92.7% of cases. There was a goiter in 81.1% of cases with a vascular character in 76.47% of cases. Anti-THR antibodies were positive in 96.15% of cases. Complications were noted in 9 patients (6.5%) such as cardiothyreosis in 8 patients (5.7%) and malignant orbitopathy noted in 1 patient (0.8%). In Hashimoto’s thyroiditis, signs of hypometabolism were evident in 87.50% of patients. Anti-TPO antibodies were positive in all patients. All patients had received thyroid hormone supplementation. Thyroid autoimmune disease was associated with other autoimmune diseases in 6.2% of cases. <strong>Conclusion:</strong> Autoimmune thyroiditis is common in our daily practice in Senegal;it is dominated by Grave’s disease. Hypothyroidism was the most common manifestation of Hashimoto’s thyroiditis. The inaccessibility of antithyroid antibody testing is an obstacle to the diagnosis and management of these conditions.展开更多
Objective To investigate the heterogeneity of TSH receptor antibodies ofpatients with autoimmune thyroid disease (AITD). Methods Six patients with heterogeneous TSH receptor antibodies were selected. The EBV-transform...Objective To investigate the heterogeneity of TSH receptor antibodies ofpatients with autoimmune thyroid disease (AITD). Methods Six patients with heterogeneous TSH receptor antibodies were selected. The EBV-transformed B cell clones producing monoclonal anti-thyrotropin receptor antibodies were established from those selected patients. Results 125I-TSHbinding inhibiting immunoglobulin (TBII) values of the 6 patients ranged from 51 % to 89%. Thyroid stimulating antibody (TSAb) existed in patients No. 1,2, 4, 5 and 6 while only patients No. 1,2 and 3 had thyroid stimulation-blocking antibody (TSBAb ). After EBV-transformation of the peripheral B lymphocytes from those patients, we isolated and characterized 5 Bcell clones prepucing the TBII from patient No. 3 and 4 B cell clones prepucing TSAb from patient No. 6. Conclusion Autoantibodies against the us receptor are polyclonal and consist of heterogeneous populations with both stimulatory and inhibitory effects.展开更多
BACKGROUND Vaccines against severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)which were approved for emergency use have been administered on a large scale globally to contain the pandemic coronavirus disease...BACKGROUND Vaccines against severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)which were approved for emergency use have been administered on a large scale globally to contain the pandemic coronavirus disease 2019(COVID-19)and to save lives.Vaccine safety is one of the issues under surveillance and a possible correlation between vaccines and thyroid function has been reported.However,reports of the impact of coronavirus vaccines on those with Graves’disease(GD)are rare.CASE SUMMARY This paper presents two patients with underlying GD in remission,both developed thyrotoxicosis and one developed thyroid storm following the adenovirus-vectored vaccine(Oxford-AstraZeneca,United Kingdom).The objective of this article is to raise awareness regarding a possible association between COVID-19 vaccination and the onset of thyroid dysfunction in patients with underlying GD in remission.CONCLUSION Receiving either the mRNA or an adenovirus-vectored vaccine for SARS-CoV-2could be safe under effective treatment.Vaccine induced thyroid dysfunction has been reported,but the pathophysiology still not well understood.Further investigation is required to evaluate the possible predisposing factors for developing thyrotoxicosis especially in patients with underlying GD.However,early awareness of thyroid dysfunction following vaccination could avoid a lifethreatening event.展开更多
Thyroid stimulating hormone receptor(TSHR) is thought to be a significant candidate for genetic susceptibility to Graves' disease(GD).However,the association between TSHR gene polymorphism and the risk of GD rema...Thyroid stimulating hormone receptor(TSHR) is thought to be a significant candidate for genetic susceptibility to Graves' disease(GD).However,the association between TSHR gene polymorphism and the risk of GD remains controversial.In this study,we investigated the relationship between the two conditions by meta-analysis.We searched all relevant case-control studies in PubMed,Web of Science,CNKI and Wanfang for literature available until May2015,and chose studies on two single nucleotide polymorphisms(SNPs):rs 179247 and rsl2101255,within TSHR intron-1.Bias of heterogeneity test among studies was determined by the fixed or random effect pooled measure,and publication bias was examined by modified Begg's and Egger's test.Eight eligible studies with 15 outcomes were involved in this meta-analysis,including 6,976 GD cases and 7,089 controls from China,Japan,Poland,UK and Brazil.Pooled odds ratios(ORs) for allelic comparisons showed that both TSHR rsl79247A/G and rsl2101255T/C polymorphism had significant association with GD(OR=1.422,95%CI=1.353—1.495,P〈0.001,P_(heterogeneity)=0.448;OR= 1.502,95%CI:1.410-1.600,P〈0.001,P_(heterogeneity)=0.642),and the associations were the same under dominant,recessive and co-dominant models.In subgroup analyses,the conclusions are also consistent with all those in Asian,European and South America subgroups(P〈0.001).Our meta-analysis revealed a significant association between TSHR rsl79247A/G and rsl2101255T/C polymorphism with GD in five different populations from Asia,Europe and South America.Further studies are needed in other ethnic backgrounds to independently confirm our findings.展开更多
文摘Background: Thyroid diseases are among the leading endocrine disorders affecting a large proportion of people worldwide and show geographical variation in incidence and histopathological pattern related to age, sex, dietary and environmental factors. Histopathological patterns of surgically treated thyroid diseases play an important role in early diagnosis and management of these diseases. There is, however, limited published data regarding histopathological reports on thyroid disease in our local setting. This study aimed to determine the histopathological patterns and highlight early postoperative complications among patients with surgically treated thyroid diseases at Bugando Medical Centre (BMC). Methods: This was a longitudinal study involving all patients with surgically treated thyroid diseases seen at BMC over a period of 6 months from October 2019 to March 2020. Results: A total of 84 patients were studied. Females outnumbered males by a female to male ratio of 11:1. The median age of patients was 44 [IQR, 35 - 54] years old, the youngest was 14 years old and the oldest was 76 years old. Colloid goiter was the most common non-neoplastic lesion accounting for 34 (44.7%) patients. Among the neoplastic lesions, follicular adenoma was the most commonly encountered benign pathologies (n = 16;21.1%), while papillary carcinoma was the most commonly encountered malignancy (n = 4;50%). Following thyroidectomy, 12 (14.3%) patients developed early complications, of which hemorrhage sometimes requiring blood transfusion was the leading intra/postoperative complications accounting for 4 (33.3%) patients. Other complications include temporary recurrent laryngeal nerve palsy 2 (16.7%), surgical site infection 2 (16.7%) and tracheomalacia, bronchospasm, thyroid abscess and respiratory obstruction in 1 (8.3%) patient each, respectively. In this study, malignant thyroid lesion (p Conclusion: This study demonstrated that colloid goiter was the most common non-neoplastic lesion, and on the neoplastic category, follicular adenoma was the most common benign lesion, while papillary carcinoma was the most frequent malignant lesion.
文摘In this editorial we comment on the article by Pavlidis et al,published in the recent issue of the World Journal of Oncology.We focus on the recent contributions in the management of anaplastic thyroid carcinoma,highlighting the importance of surgery and radiotherapy as first line therapies in its management and the introduction of new systemic therapies beyond chemotherapy,focused on molecular alterations,an essential step in the diagnosis and included in clinical guidelines for the selection of the ideal treatment.In contrast to other neoplasms,immunotherapy,is still beginning in studies of this pathology with encouraging results.Therefore,multimodal management of the pathology together with new drugs seems to be the logical step to increase the survival of this neoplasm.
文摘Thyroid carcinoma is a complex disease with several types,the most common being well-differentiated and undifferentiated.The latter,“undifferentiated carcinoma”,also known as anaplastic thyroid carcinoma(ATC),is a highly aggr-essive malignant tumor accounting for less than 0.2%of all thyroid carcinomas and carries a poor prognosis with a median survival of 5 months.BRAF gene mutations are the most common molecular factor associated with this type of thyroid carcinoma.Recent advances in targeted biological agents,immuno-therapy,stem cell therapy,nanotechnology,the dabrafenib/trametinib com-bination therapy,immune checkpoint inhibitors(ICI)and artificial intelligence offer novel treatment options.The combination therapy of dabrafenib and tra-metinib is the current standard treatment for patients with BRAF-V600E gene mutations.Besides,the dabrafenib/trametinib combination therapy,ICI,used alone or in combination with targeted therapies have raised some hopes for improving the prognosis of this deadly disease.Younger age,earlier tumor stage and radiotherapy are all prognostic factors for improved outcomes.Ultimately,therapeutic regimens should be tailored to the individual patient based on surveillance and epidemiological data,and a multidisciplinary approach is ess-ential.
基金Supported by National Natural Science Foundation of China,No.82060123National Health Commission of Guizhou Province,No.gzwjk2019-1-082.
文摘BACKGROUND Autoimmune hepatitis(AIH)and primary biliary cholangitis(PBC)are two common clinical autoimmune liver diseases,and some patients have both diseases;this feature is called AIH-PBC overlap syndrome.Autoimmune thyroid disease(AITD)is the most frequently overlapping extrahepatic autoimmune disease.Immunoglobulin(IgG)4-related disease is an autoimmune disease recognized in recent years,characterized by elevated serum IgG4 levels and infiltration of IgG4-positive plasma cells in tissues.CASE SUMMARY A 68-year-old female patient was admitted with a history of right upper quadrant pain,anorexia,and jaundice on physical examination.Laboratory examination revealed elevated liver enzymes,multiple positive autoantibodies associated with liver and thyroid disease,and imaging and biopsy suggestive of pancreatitis,hepatitis,and PBC.A diagnosis was made of a rare and complex overlap syndrome of AIH,PBC,AITD,and IgG4-related disease.Laboratory features improved on treatment with ursodeoxycholic acid,methylprednisolone,and azathioprine.CONCLUSION This case highlights the importance of screening patients with autoimmune diseases for related conditions.
文摘As a common hyperglycemic disease,type 1 diabetes mellitus(T1DM)is a complicated disorder that requires a lifelong insulin supply due to the immunemediated destruction of pancreaticβcells.Although it is an organ-specific autoimmune disorder,T1DM is often associated with multiple other autoimmune disorders.The most prevalent concomitant autoimmune disorder occurring in T1DM is autoimmune thyroid disease(AITD),which mainly exhibits two extremes of phenotypes:hyperthyroidism[Graves'disease(GD)]and hypothyroidism[Hashimoto's thyroiditis,(HT)].However,the presence of comorbid AITD may negatively affect metabolic management in T1DM patients and thereby may increase the risk for potential diabetes-related complications.Thus,routine screening of thyroid function has been recommended when T1DM is diagnosed.Here,first,we summarize current knowledge regarding the etiology and pathogenesis mechanisms of both diseases.Subsequently,an updated review of the association between T1DM and AITD is offered.Finally,we provide a relatively detailed review focusing on the application of thyroid ultrasonography in diagnosing and managing HT and GD,suggesting its critical role in the timely and accurate diagnosis of AITD in T1DM.
文摘BACKGROUND In recent years,the emergence of multiplex technology that can simultaneously measure multiple anti-islet autoantibodies has become particularly valuable for the staging and early diagnosis of immune-mediated type 1 diabetes(T1D).While it has been established that 20%-30%of T1D patients suffer from autoimmune thyroid disease(AITD),there is limited available data regarding the presence of anti-islet autoantibodies in AITD patients.Among commercially available anti-islet autoantibodies,glutamic acid decarboxylase 65 autoantibodies(GADAs)are often the first marker measured in general clinical practice.AIM To investigate the frequency of anti-islet autoantibodies in AITD patients.METHODS Our study involved four hundred ninety-five AITD patients,categorized into three distinct groups:AITD with T1D(n=18),AITD with phenotypic type 2 diabetes(T2D)(n=81),and AITD without diabetes(n=396),and the enzyme-linked immunosorbent assay(ELISA)was employed to determine the frequencies of 3 Screen Islet Cell Autoantibody(3 Screen ICA),GADA,insulinoma-associated antigen-2 autoantibodies(IA-2As),and zinc transporter 8 autoantibodies(ZnT8As)within these groups.RESULTS The frequency of 3 Screen ICA in AITD patients with T1D,T2D,and those without diabetes were 88.9%,6.2%,and 5.1%,respectively,with no significant difference seen between the latter two groups.Notably,the frequency of 3 Screen ICA was 11.1%higher in AITD patients with T1D,1.3%higher in AITD patients with T2D,and 1.1%higher in AITD patients without diabetes compared to GADA,respectively.Furthermore,12.5%,20.0%,and 20.0%of the 3 Screen ICA-positive patients were negative for GADA.Additionally,1.3%of the AITD patients who tested negative for 3 Screen ICA in both the AITD with T2D and non-diabetic AITD groups were found to be positive for individual autoantibodies.Among the 3 Screen ICA-positive patients,there was a significantly higher proportion of individuals with multiple autoantibodies in AITD patients with T1D compared to those without diabetes(37.5%vs 5.0%,P<0.05).However,this proportion was similar to that in AITD patients with T2D(20.0%).Nevertheless,there was no significant difference in 3 Screen ICA titers between AITD patients with T1D and those without diabetes(436.8±66.4 vs 308.1±66.4 index).Additionally,no significant difference in 3 Screen ICA titers was observed between Graves’disease and Hashimoto’s thyroiditis in any of the groups.CONCLUSION Our findings reveal that some AITD patients without diabetes exhibit 3 Screen ICA titers comparable to those in AITD patients with T1D.Thus,3 Screen ICA outperforms GADA in identifying latent anti-islet autoantibody-positive individuals among AITD patients.
文摘Well-differentiated thyroid carcinoma has a favorable prognosis with a 5-year survival rate of over 95%.However,the undifferentiated or anaplastic type accounting for<0.2%,usually in elderly individuals,exhibits a dismal prognosis with rapid growth and disappointing outcomes.It is the most aggressive form of thyroid carcinoma,with a median survival of 5 mo and poor quality of life(airway obstruction,dysphagia,hoarseness,persistent pain).Early diagnosis and staging are crucial.Diagnostic tools include biopsy(fine needle aspiration,core needle,open surgery),high-resolution ultrasound,computed tomography,magnetic resonance imaging,[(18)F]fluoro-D-glucose positron emission tomography/computed tomography,liquid biopsy and microRNAs.The BRAF gene(BRAF-V600E and BRAF wild type)is the most often found molecular factor.Others include the genes RET,KRAS,HRAS,and NRAS.Recent management policy is based on surgery,even debulking,chemotherapy(cisplatin or doxorubicin),radiotherapy(adjuvant or definitive),targeted biological agents and immunotherapy.The last two options constitute novel hopeful management modalities improving the overall survival in these otherwise condemned patients.Anti-programmed death-ligand 1 antibody immunotherapy,stem cell targeted therapies,nanotechnology achievements and artificial intelligence implementation provide novel promising alternatives.Genetic mutations determine molecular pathways,thus indicating novel treatment strategies such as anti-BRAF,anti-vascular endothelial growth factor-A,and anti-epidermal growth factor receptor.Treatment with the combination of the BRAF inhibitor dabrafenib and the MEK inhibitor trametinib has been approved by the Food and Drug Administration in cases with BRAF-V600E gene mutations and is currently the standard care.This neoadjuvant treatment followed by surgery ensures a twoyear overall survival of 80%.Prognostic factors for improved outcomes have been found to be younger age,earlier tumor stage and radiation therapy.A multidisciplinary approach is necessary,and the therapeutic plan should be individu alized based on surveillance and epidemiology end results.
文摘Background: Hypocalcaemia is a serious complication that may follows thyroid surgeries. So, the purpose of this study was to determine the frequency of postoperative hypocalcaemia after thyroid surgery in Omdurman military hospital (Jan.-July 2018). Materials & Methods: In this retrospective facility based cross sectional study, 124 files were reviewed, the recorded data were age, sex, residence, diagnosis, type of surgery & postoperative calcium level, data were collected by a designed pretested checklist, data were analyzed by SPSS version 20 by using frequencies & cross tabulations, for postoperative hypocalcaemia. Results: Majority of the patients were between 21 - 41 years 49.2%, majority of them were females 83.9%. 97.6% of them underwent total thyroidectomy, 25% of the patients developed postoperative hypocalcaemia, also we found that there was no relation between sex, type of thyroid surgery & development of postoperative hypocalcaemia (P > 0.001). Conclusion: Our research showed that 25% of the patients who underwent thyroid surgery developed postoperative hypocalcaemia.
文摘The role of vitamin D as an immune modulator has been emphasized in recent years,and low levels of the hormone were observed in several autoimmune diseases including multiple sclerosis and systemic lupus erythematosus.Vitamin D mediates its effect though binding to vitamin D receptor(VDR),and activation of VDR-responsive genes.While VDR gene polymorphism was found to associate with autoimmune thyroid diseases(AITDs),few studies examined levels of vitamin D in these patients and those that did yielded conflicting results.We therefore undertook to evaluate the levels of vitamin D in patients with AITDs compared to patients with non-AITDs and healthy controls.Serum vitamin D(25-OH)levels were measured in 50 patients with AITDs,42 patients with non-AITDs and 98 healthy subjects,utilizing the LIAISON chemiluminescence immunoassay(DiaSorin,Saluggia,Italy).VitaminD deficiency was designated at levels lower than 10 ng/ml.Antithyroid antibodies,thyroid functions and demographic parameters were evaluated in all patients.The prevalence of vitamin D deficiency was significantly higher in patients with AITDs compared with healthy individuals(72% versus 30.6%;P<0.001),as well as in patients with Hashimoto’s thyroiditis compared to patients with non-AITDs(79% versus 52%;P<0.05).Vitamin D deficiency also correlated to the presence of antithyroid antibodies(P=0.01)and abnormal thyroid function tests(P=0.059).Significantly low levels of vitamin D were documented in patients with AITDs that were related to the presence of anti thyroid antibodies and abnormal thyroid function tests,suggesting the involvement of vitamin D in the pathogenesis of AITDs and the advisability of supplementation.
基金supported by grants from the National Natural Science Foundation of China(No.81602851)Excellent Young Talents of Health System in Shanghai(No.2017YQ043)the Fourth Three Year Public Health Key Disciplines(No.15GWZK0801).
文摘Objective This study aimed to determine whether the prevalence of thyroid nodules(TNs)increased due to modern lifestyles or other factors,despite the advances in screening and diagnostic tools.Methods This study included 3474 pairs of participants,who were matched by gender and age(±3 years)from two cross-sectional sampling surveys:(1)the program on the iodine nutritional status and related health status of residents in Shanghai in 2009;(2)the thyroid disease screening program for adults in Shanghai between 2017 and 2018.The prevalence of TNs and thyroid diseases in 2009 and 2017–2018 were compared,and the potential risk factors of TNs were detected.Results The prevalence of TNs in 2009 was 28.9%:22.5%in males and 34.5%in females.In 2017,this increased to 43.8%:37.9%in males and 49.1%in females.The prevalence of TNs significantly increased from 2009 to 2017(odds ratio,1.486;95%confidence interval,1.238–1.786).In addition,female gender,thyroid disease history,and age were the main risk factors for TNs after adjusting for confounders in the logistic regression across the time period.Conclusion The prevalence of TNs significantly increased across nearly 10 years in Shanghai.
文摘Thyroid cancer is the most common endocrine malignancy.While there has been no appreciable increase in the observed mortality of well-differentiated thyroid cancer,there has been an overall rise in its incidence worldwide over the last few decades.Patients with papillary thyroid carcinoma(PTC)and clinical evidence of central(cN1)and/or lateral lymph node metastases require total thyroidectomy plus central and/or lateral neck dissection as the initial surgical treatment.Nodal status in PTC patients plays a crucial role in the prognostic evaluation of the recurrence risk.The 2015 guidelines of the American Thyroid Association(ATA)have more accurately determined the indications for therapeutic central and lateral lymph node dissection.However,prophylactic central neck lymph node dissection(pCND)in negative lymph node(cN0)PTC patients is controversial,as the 2009 ATA guidelines recommended that CND“should be considered”routinely in patients who underwent total thyroidectomy for PTC.Although the current guidelines show clear indications for therapeutic CND,the role of pCND in cN0 patients with PTC is still debated.In small solitary papillary carcinoma(T1,T2),pCND is not recommended unless there are high-risk prediction factors for recurrence and diffuse nodal spread(extrathyroid extension,mutation in the BRAF gene).pCND can be considered in cN0 disease with advanced primary tumors(T3 or T4)or clinical lateral neck disease(cN1b)or for staging and treatment planning purposes.The role of the preoperative evaluation is fundamental to minimizing the possible detrimental effect of overtreatment of the types of patients who are associated with low disease-related morbidity and mortality.On the other hand,it determines the choice of appropriate treatment and determines if close monitoring of patients at a higher risk is needed.Thus,pCND is currently recommended for T3 and T4 tumors but not for T1 and T2 tumors without high-risk prediction factors of recurrence.
文摘AIM:To investigate the choroidal thickness and the microvascular network changes around the macula in thyroid eye disease(TED)patients at different stages and the relationship of those changes with risk factors,serum antibodies and the severity of TED.METHODS:A total of 85 participants were enrolled.All participants underwent ophthalmology and endocrinology examinations.Subfoveal choroidal thickness(SFCT),superficial(s)and deep(d)foveal avascular zone(FAZ)area,mean(m)and central(c)superficial vascular density(SVD),deep vascular density(DVD)measurements of the enrolled cases were performed with Topcon swept source optical coherence tomography(OCT)/OCT angiography(OCTA)DRI OCT Triton.Multiple linear regression analysis was used to explore the associations between SFCT,FAZ area,SVD,DVD and the relevant factors of TED.RESULTS:Those with active TED patients had higher c-DVD and m-DVD levels(P<0.05),however there is no statistically significant difference in SFCT between active and stable TED patients.Among the serum antibodies,it was observed that s-FAZ and d-FAZ increased,c-SVD and m-SVD decreased in patients with high thyroid stimulating hormone-receptor autoantibodies(TRAB)level,whereas SFCT thickened in patients with high levels of both TRAB and human thyroglobulin(hTG).There was no significant difference in SFCT,FAZ,SVD and DVD measurement at gender,between hyperthyroid and euthyroid patients and among those with or without thyroid papillary carcinoma.CONCLUSION:The results show that both disease activation and serum antibodies differentially affect both superficial and deep retinal vascular density.It has also been shown that high serum antibody levels affect choroidal thickness independent of clinical activity.
文摘Hepatocrinology explores the intricate relationship between liver function and the endocrine system.Chronic liver diseases such as liver cirrhosis can cause endocrine disorders due to toxin accumulation and protein synthesis disruption.Despite its importance,assessing endocrine issues in cirrhotic patients is frequently neglected.This article provides a comprehensive review of the epidemiology,pathophysiology,diagnosis,and treatment of endocrine disturbances in liver cirrhosis.The review was conducted using the PubMed/Medline,EMBASE,and Scielo databases,encompassing 172 articles.Liver cirrhosis is associated with endocrine disturbances,including diabetes,hypoglycemia,sarcopenia,thyroid dysfunction,hypogonadotropic hypogonadism,bone disease,adrenal insufficiency,growth hormone dysfunction,and secondary hyperaldosteronism.The optimal tools for diagnosing diabetes and detecting hypoglycemia are the oral glucose tolerance test and continuous glucose monitoring system,respectively.Sarcopenia can be assessed through imaging and functional tests,while other endocrine disorders are evaluated using hormonal assays and imaging studies.Treatment options include metformin,glucagon-like peptide-1 analogs,sodium-glucose co-transporter-2 inhibitors,and insulin,which are effective and safe for diabetes control.Established standards are followed for managing hypoglycemia,and hormone replacement therapy is often necessary for other endocrine dysfunctions.Liver transplantation can address some of these problems.
基金supported by the National Natural Science Foundation of China, No. 81271088the Natural Science Foundation of Shanghai, No. 11ZR1423600
文摘To determine the value of dissecting the recurrent laryngeal nerve during thyroid surgery with respect to preventing recurrent laryngeal nerve injury, we retrospectively analyzed clinical data from 5 344 patients undergoing thyroidectomy. Among these cases, 548 underwent dissection of the recurrent laryngeal nerve, while 4 796 did not. There were 12 cases of recurrent laryngeal nerve injury following recurrent laryngeal nerve dissection (injury rate of 2.2%) and 512 cases of recurrenl laryngeal nerve injury in those not undergoing nerve dissection (injury rate of 10.7%). This difference remained statistically significant between the two groups in terms of type of thyroid disease, type of surgery, and number of surgeries. Among the 548 cases undergoing recurrent laryngeal nerve dissection, 128 developed anatomical variations of the recurrent laryngeal nerve (incidence rate of 23.4%), but no recurrent laryngeal nerve injury was found. In addition, the incidence of recurrent laryngeal nerve injury was significantly lower in patients with the infedor parathyroid gland and middle thyroid veins used as landmarks for locating the recurrent laryngeal nerve compared with those with the entry of the recurrent laryngeal nerve into the larynx as a landmark. These findings indicate that anatomical variations of the recurrent laryngeal nerve are common, and that dissecting the recurrent laryngeal nerve during thyroid surgery is an effective means of preventing nerve injury.
文摘Estrogen receptor(ER) and progesterone receptor (PgR) in core-needle biopsied thyroidtissues of 30 cases of autoimmune thyroid disease and 2 cases of simple gotter were measured usingenzyme-linked histochemical technique. The results showed that the frequences of presence of ER inGraves' disease (GD) and Hashimoto's thyroditis(HT) were 50% (9/18) and 58. 3K (7/12) respectively ; and those of PgR were 11. 1 % (2/18) in GD, 16. 2% (2/7) in HT. Both ER and PgR werenegative in simple gotter. This study demonstrated that the content of ER in thyroid tissues of autoimmune thyroid disease was relatively high, suggesting that estrogen may play a role in the development of the disease.
文摘Background: Thyroid eye disease represents an organ-specific autoimmune process that is usually associated with thyroid disease. Graves’ disease is the most common thyroid abnormality associated with thyroid eye disease. Aim: This study was conducted for the profile of ocular manifestation in Thyroid Eye Disease (TED). Methodology: A cross-sectional study of 117 cases of thyroid dysfunction was carried out at BP Koirala Institute of Health System, out of which 84 (71.79%) cases had ocular manifestation. They were evaluated and analyzed in detail and the characteristics documented included patient’s demography, ocular and systemic history and as well as ocular examination and some of the systemic and laboratory findings. Results: In this study, mean age of presentation of TED was 39.7 years. 59 patients were female and 25 were male. The maximum patients of both sexes were in the fourth decade of their lives. The common lid signs were lid retraction and lid lag. Proptosis was seen in 33.3% of cases out of which 68% had bilateral proptosis. Corneal ulcer was seen in 7.1% and optic neuropathy in 1.2% of cases. In 27.3% of cases there was elevation of IOP. Dry eye was seen in 61.9% of cases and POAG seen in 8.3% of cases. In the study population 75% were hyperthyroiditic, 16.7% were hypothyroiditic and 8.3% were in euthyroid state. Conclusion: Female was more commonly affected. The maximum number of patients of both sexes was in the fourth decade of their lives. Hyperthyroidism patient had greater chance of ocular manifestation.
文摘<strong>Introduction:</strong> Autoimmune thyroiditis is relatively common in medicine. However, comprehensive studies are few in number, especially in Africa and particularly in Senegal. The aim of this study was therefore to determine the epidemiological, clinical, profile of Autoimmune Thyroid Diseases (OITD). <strong>Materials and Methods: </strong>This was a retrospective descriptive study from 2016 to 2019 of the records of patients who consulted or were hospitalised for autoimmune dysthyroidism in the internal medicine department of the Aristide Le Dantec Hospital. During this period, 1227 new consultations were recorded;they concerned three specialized consultations including endocrinology. The autoimmune origin was confirmed in 159 patients, <em>i.e.</em> in 45.69% of cases the AIDM then 12.96% of all consultations. The autoimmune origin was established on clinical, biological and immunological grounds. The data were collected from the medical records of the patients and recorded on a pre-established individual survey sheet taking into account the objectives of the study. The data collected was entered into the Sphinx V5 software on an established form. The analysis was carried out with the following software: Excel 2010 and Epi info 7.2. <strong>Results:</strong> Among this dysthyroidism, 159 patients had a confirmed autoimmune thyroid disease. On all new consultations, OITD represented 12.96% of internal medicine consultations. The sex ratio M/F was 0.18. The majority of our patients (57.86%) were aged between 25 and 44 years with extremes ranging from 11 to 63 years. In Graves’ disease, the notion of an irritative spine was found in 60.27% of cases. Signs of thyrotoxicosis were present in 92.7% of cases. There was a goiter in 81.1% of cases with a vascular character in 76.47% of cases. Anti-THR antibodies were positive in 96.15% of cases. Complications were noted in 9 patients (6.5%) such as cardiothyreosis in 8 patients (5.7%) and malignant orbitopathy noted in 1 patient (0.8%). In Hashimoto’s thyroiditis, signs of hypometabolism were evident in 87.50% of patients. Anti-TPO antibodies were positive in all patients. All patients had received thyroid hormone supplementation. Thyroid autoimmune disease was associated with other autoimmune diseases in 6.2% of cases. <strong>Conclusion:</strong> Autoimmune thyroiditis is common in our daily practice in Senegal;it is dominated by Grave’s disease. Hypothyroidism was the most common manifestation of Hashimoto’s thyroiditis. The inaccessibility of antithyroid antibody testing is an obstacle to the diagnosis and management of these conditions.
基金Supported by the Foundation of Shanghai Municipal Bureau of Education,China (96B18)
文摘Objective To investigate the heterogeneity of TSH receptor antibodies ofpatients with autoimmune thyroid disease (AITD). Methods Six patients with heterogeneous TSH receptor antibodies were selected. The EBV-transformed B cell clones producing monoclonal anti-thyrotropin receptor antibodies were established from those selected patients. Results 125I-TSHbinding inhibiting immunoglobulin (TBII) values of the 6 patients ranged from 51 % to 89%. Thyroid stimulating antibody (TSAb) existed in patients No. 1,2, 4, 5 and 6 while only patients No. 1,2 and 3 had thyroid stimulation-blocking antibody (TSBAb ). After EBV-transformation of the peripheral B lymphocytes from those patients, we isolated and characterized 5 Bcell clones prepucing the TBII from patient No. 3 and 4 B cell clones prepucing TSAb from patient No. 6. Conclusion Autoantibodies against the us receptor are polyclonal and consist of heterogeneous populations with both stimulatory and inhibitory effects.
文摘BACKGROUND Vaccines against severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)which were approved for emergency use have been administered on a large scale globally to contain the pandemic coronavirus disease 2019(COVID-19)and to save lives.Vaccine safety is one of the issues under surveillance and a possible correlation between vaccines and thyroid function has been reported.However,reports of the impact of coronavirus vaccines on those with Graves’disease(GD)are rare.CASE SUMMARY This paper presents two patients with underlying GD in remission,both developed thyrotoxicosis and one developed thyroid storm following the adenovirus-vectored vaccine(Oxford-AstraZeneca,United Kingdom).The objective of this article is to raise awareness regarding a possible association between COVID-19 vaccination and the onset of thyroid dysfunction in patients with underlying GD in remission.CONCLUSION Receiving either the mRNA or an adenovirus-vectored vaccine for SARS-CoV-2could be safe under effective treatment.Vaccine induced thyroid dysfunction has been reported,but the pathophysiology still not well understood.Further investigation is required to evaluate the possible predisposing factors for developing thyrotoxicosis especially in patients with underlying GD.However,early awareness of thyroid dysfunction following vaccination could avoid a lifethreatening event.
基金supported by grants from the National Natural Science Foundation of China(Grant No.81102032)
文摘Thyroid stimulating hormone receptor(TSHR) is thought to be a significant candidate for genetic susceptibility to Graves' disease(GD).However,the association between TSHR gene polymorphism and the risk of GD remains controversial.In this study,we investigated the relationship between the two conditions by meta-analysis.We searched all relevant case-control studies in PubMed,Web of Science,CNKI and Wanfang for literature available until May2015,and chose studies on two single nucleotide polymorphisms(SNPs):rs 179247 and rsl2101255,within TSHR intron-1.Bias of heterogeneity test among studies was determined by the fixed or random effect pooled measure,and publication bias was examined by modified Begg's and Egger's test.Eight eligible studies with 15 outcomes were involved in this meta-analysis,including 6,976 GD cases and 7,089 controls from China,Japan,Poland,UK and Brazil.Pooled odds ratios(ORs) for allelic comparisons showed that both TSHR rsl79247A/G and rsl2101255T/C polymorphism had significant association with GD(OR=1.422,95%CI=1.353—1.495,P〈0.001,P_(heterogeneity)=0.448;OR= 1.502,95%CI:1.410-1.600,P〈0.001,P_(heterogeneity)=0.642),and the associations were the same under dominant,recessive and co-dominant models.In subgroup analyses,the conclusions are also consistent with all those in Asian,European and South America subgroups(P〈0.001).Our meta-analysis revealed a significant association between TSHR rsl79247A/G and rsl2101255T/C polymorphism with GD in five different populations from Asia,Europe and South America.Further studies are needed in other ethnic backgrounds to independently confirm our findings.