Iodine 131 Treatment in Graves’ Disease in a West African Country: Preliminary Study about 25 Cases in Senegal

Introduction: Graves’ disease is the most common cause of hyperthyroidism. Its treatment uses synthetic antithyroid drugs but the use of aggressive radical therapy such as surgery or non-aggressive therapy such as iodine-131 is not uncommon. Treatment of Graves’ disease with radioactive iodine or iratherapy is a simple, inexpensive, well-tolerated treatment. It was introduced in Senegal in 2016. We report through this work the preliminary assessment of the only nuclear medicine service in Senegal in the management of Graves’ disease by iodine-131. Patients and Methods: Retrospective study of the first cases of Graves’ disease treated with iratherapy in Senegal. Socio-demographic, clinical, paraclinical, therapeutic and evolutionary aspects were studied. Radiation protection rules have been implemented and contraception has been effective for six months in women of childbearing age. Results: 25 patients were collected with a mean age of 45 years, twenty women (80%), a family goiter in 24% and a psycho-affective context in 64% of cases. Thyrotoxicosis syndrome was associated with goiter in 68% of patients and exophthalmos in 64%. Thyroid ultrasound performed in 20 patients showed vascular goiter in 80% and thyroid scintigraphy in 3 patients, homogeneous and diffuse hyperfixation. TRAK dosed in 8 patients was still positive. All patients had received first-line medical treatment. The average duration of this treatment was more than 18 months in 92%. The empirically used iodine-131 activity averaged 15.35 mCi. Oral corticosteroid therapy was prescribed in 7 patients for the prevention of malignant orbitopathy. No early side effects were noted. The remission rate at 3 months was 52% and at 6 months was 88% to 92%. Conclusion: The effectiveness of radioactive iodine, in particular ablative doses in the treatment of hyperthyroidism, is no longer to be demonstrated. Taking into account our socioeconomic context, iratherapy should be a treatment of choice for hyperthyroidism with a good quality/price ratio and excellent tolerance.

Postpartum quality of life and mental health in women with heart disease:Integrated clinical communication and treatment

BACKGROUND Postpartum quality of life(QoL)in women with heart disease has been neglected.AIM To improve clinical communication and treatment,we integrated medical data and subjective characteristics to study postpartum QoL concerns.METHODS The study assessed QoL 6 wk after birth using the 12-Item Short-Form Health Survey.The Edinburgh Postnatal Depression Scale,Cardiac Anxiety Questionnaire,European Heart Failure Self-Care Behavior Scale,and a self-designed questionnaire based on earlier research were also used to assess patient characteristics.Patient data were collected.Prediction models were created using multiple linear regression.RESULTS This retrospective study examined postpartum QoL in 105 cardiac patients.Postpartum QoL scores were lower(90.69±13.82)than those of women without heart disease,with physical component scores(41.09±9.91)lower than mental component scores(49.60±14.87).Postpartum depression(33.3%),moderate anxiety(37.14%),pregnancy concerns(57.14%),offspring heart problems(57.14%),and life expectancy worries(48.6%)were all prevalent.No previous cardiac surgery,multiparity,higher sadness and cardiac anxiety,and fear of unfavorable pregnancy outcomes were strongly related to lower QoL(R^(2)=0.525).CONCLUSION Postpartum QoL is linked to physical and mental health in women with heart disease.Our study emphasizes the need for healthcare workers to recognize the unique characteristics of these women while developing and implementing comprehensive management approaches during their maternity care.

Thyrotoxicosis in patients with a history of Graves'disease after SARS-CoV-2 vaccination(adenovirus vector vaccine):Two case reports

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.

Multifocal papillary thyroid cancer in Graves’ disease: A case report

BACKGROUND Thyroid cancer is not commonly observed in patients with Graves’disease(GD).The presence of thyroid nodules in GD is not uncommon.However,a link bet-ween these two entities has been reported.Herein,we report the case of a patient with GD and thyroid cancer in Saudi Arabia,which has not been reported previously in our region.CASE SUMMARY A 26-year-old male patient with GD,receiving carbimazole for 2 years,presented to our hospital.His hyperthyroidism was controlled clinically and biochemically.On clinical examination,he was found to have a left-sided thyroid nodule.Ultra-sound revealed a 2.6 cm hypoechoic nodule with high vascularity.He was then referred for fine needle aspiration which showed that the nodule was highly suspicious for malignancy.The patient underwent total thyroidectomy and was diagnosed with multifocal classical micropapillary thyroid cancer.Post thyroid-ectomy he received radioactive iodine ablation along with levothyroxine replace-ment therapy.CONCLUSION Careful preoperative assessment and thyroid gland ultrasound might assist in screening and diagnosing thyroid cancer in patients with GD.

TPOAb阴性的产后甲状腺炎合并产后Graves病一例并文献复习

目的:总结甲状腺过氧化物酶抗体(TPOAb)阴性的产后甲状腺炎(PPT)合并产后Graves病(PPGD)的特点,提高对该病的认识。方法:收集2021年广西医科大学第一附属医院诊治的1例产后甲状腺炎合并产后Graves病(GD)患者的临床资料并回顾相关文献。结果:患者产后4个月余出现高代谢表现,无GD特征性体征,实验室检查显示游离的三碘甲状腺原氨酸(FT3)、游离的甲状腺素(FT4)明显升高,促甲状腺激素(TSH)降低,促甲状腺素受体抗体(TRAb)阳性,TPOAb阴性,ATD治疗后高代谢症状迅速改善,治疗3个月内甲状腺功能检查骤降甚至出现甲状腺功能减退,超声检查提示PPT合并GD可能性大,行甲状腺细针穿刺确诊为产后甲状腺炎合并PPGD。结论:产后1年内出现的甲状腺毒症,应首先考虑PPT,同时也要考虑PPGD所致的可能;必要时可行甲状腺细针穿刺活检,避免误诊、漏诊。

Graves′病新型疗法的研究进展

Graves′病是一种自身免疫性疾病,其特征是存在刺激促甲状腺激素受体的自身抗体,导致甲状腺肿大及循环甲状腺激素过多。目前临床治疗Graves′病的主要方式包括抗甲状腺药物、放射性碘和甲状腺切除术,但药物治疗存在不良反应大、治疗周期长、复发率高等不足,而放射性碘和甲状腺切除术治疗患者无法避免地需要行终生甲状腺激素替代治疗,因此急需寻找新的治疗方案。目前正在研究的Graves′病的新型疗法包括生物制剂、小分子和肽免疫调节,这些疗法有望在不需要持续治疗的情况下成功使患者甲状腺功能趋于正常化。

夏枯草制剂治疗Graves病的有效性与安全性的系统评价

目的系统评价口服夏枯草制剂联合西医治疗Graves病的疗效及安全性,以期为Graves病的临床诊治提供循证医学证据。方法文章全面系统检索中文学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库(WanfangData)、维普中文期刊全文数据库(VIP)四大中文数据库和PubMed、Embase、CochraneLibrary三大英文数据库,检索时间均从建库至2022年08月。采用Cochrane系统偏倚风险评估工具对纳入研究进行质量评估,并用RevMan 5.4.1软件对结局指标进行Meta分析。结果最终纳入8项随机对照试验,共784例患者。试验组均为口服夏枯草制剂联合西医治疗,对照组均为西医治疗。Meta分析结果表明,口服夏枯草制剂联合西医治疗在甲状腺功能及自身抗体的改善、缩小甲状腺腺体等方面的临床治疗总有效率高于对照组(RR=1.13,95%CI[1.10,1.26],P<0.00001),并且能够显著改善甲状腺肿的临床症状(MD=-0.39,95%CI[-0.67,-0.11],P=0.006),降低血清FT3水平(MD=-1.76,95%CI[-3.10,-0.43],P=0.01)及血清FT4水平(MD=-3.89,95%CI[-6.79,-1.00],P=0.008),提高血清促甲状腺激素(TSH)水平(MD=0.45,95%CI[0.05,0.86],P=0.03),改善甲状腺肿大情况(MD=-0.39,95%CI[-0.67,-0.11],P=0.006),缩小甲状腺左叶前后径(MD=-0.31,95%CI[-0.57,-0.06],P=0.02)、左叶左右径(MD=-0.24,95%CI[-0.32,-0.16],P<0.00001)、右叶前后径(MD=-0.30,95%CI[-0.47,-0.13],P=0.0004)、右叶左右径(MD=-0.21,95%CI[-0.33,-0.10],P=0.0004)。结论夏枯草制剂联合西医治疗对比单用西医治疗Graves病在整体疗效、改善甲状腺肿的临床症状、甲状腺激素水平,缩小甲状腺腺体有明显的优势,且较安全,但仍需后续大样本、高质量文献的支持。

外周血CD4^(+)T、CD8^(+)T细胞及免疫活化分子CD38、IL-2R表达水平在Graves眼病患者中的临床意义

目的研究Graves眼病(GO)患者外周血CD4^(+)T、CD8^(+)T细胞及免疫活化分子CD38、IL-2R水平的临床意义。方法选取2022年1月至2023年1月我院收治的80例Graves病(GD)患者为GD组,65例GO患者为GO组,根据CAS评分将GO组患者分为活动期组(26例)和非活动期组(39例),另选50例体检中心健康者为对照组。比较各组血清甲状腺功能、甲状腺相关抗体及外周血各细胞因子水平,分析GO患者外周血各细胞因子水平与甲状腺功能、甲状腺相关抗体、CAS评分的相关性,并分析外周血各细胞因子对GO疾病活动性的预测价值。结果GO组FT3、FT4低于GD组,高于对照组,GD组高于对照组(P<0.05);GO组TSH高于GD组,低于对照组,GD组低于对照组(P<0.05);GO组、GD组TGAb、TPOAb、TRAb、CD4^(+)T高于对照组(P<0.05);GO组、GD组CD8^(+)T低于对照组(P<0.05);GO组CD4^(+)/CD8^(+)T、CD4^(+)CD38^(+)T、CD8^(+)CD38^(+)T、IL-2R高于GD组和对照组,GD组高于对照组(P<0.05)。GO患者活动期组CD4^(+)/CD8^(+)T、CD4^(+)CD38^(+)T、CD8^(+)CD38^(+)T、IL-2R高于非活动期组(P<0.05)。CD4^(+)/CD8^(+)T、CD8^(+)CD38^(+)T与CAS评分呈正相关(P<0.05);CD4^(+)CD38^(+)T与TRAb、CAS评分呈正相关(P<0.05);IL-2R与FT4、TRAb、TPOAb、CAS评分呈正相关(P<0.05)。CD4^(+)/CD8^(+)T、CD4^(+)CD38^(+)T、CD8^(+)CD38^(+)T、IL-2R联合检测预测GO患者疾病活动性的AUC值为0.930,高于外周血四者单独检测(AUC=0.736、0.749、0.668、0.699,P<0.05)。结论外周血CD4^(+)/CD8^(+)T、CD4^(+)CD38^(+)T、CD8^(+)CD38^(+)T、IL-2R联合预测GO活动性的临床价值更高。

与Graves’Disease发病机制相关的基因研究

背景Graves’Disease(GD)是一种常见的自身免疫性疾病,但其发病机制尚不明确。目的通过对公共基因芯片数据的分析,找出与GD发病可能相关的基因。方法在GEO数据库和ArrayExpress数据库中检索“Graves’Disease”,得到GSE71956和E-MEXP-2612(截至2019-04-02)。利用R语言的“Limma”包对基因芯片的原始数据进行标准化处理并找出差异基因。差异基因共包括对照CD4细胞与GD患者CD4细胞的对比(C-GD CD4)、对照CD8细胞与GD患者CD8细胞的对比(C-GD CD8)、对照者甲状腺组织与短病程GD患者甲状腺组织的对比(C-S)、对照者甲状腺组织与长病程GD患者甲状腺组织的对比(C-L)、短病程GD患者甲状腺组织与长病程GD患者甲状腺组织的对比(S-L)。再对差异基因进行多重比较及功能注释分析。结果维恩图显示,KLF9、RGS1基因同时存在于C-GD CD4、C-GD CD8与C-L差异基因中。氨基酸和类固醇代谢基因可能与GD的发病相关。FMO2、CALHM6和C7基因同时存在于C-S、C-L、S-L差异基因中。长病程和短病程GD患者甲状腺组织CALHM6基因表达水平高于对照者,长病程GD患者CALHM6基因表达水平高于短病程GD患者;长病程和短病程GD患者甲状腺组织FMO2和C7基因表达水平低于对照者,长病程GD患者FMO2和C7基因表达水平低于短病程GD患者(P<0.05)。结论GD的发病可能与KLF9、RGS1的异常表达及氨基酸和类固醇代谢有关,FMO2、CALHM6、C7基因可能与GD的病程相关。

Role of color Doppler in differentiation of Graves' disease and thyroiditis in thyrotoxicosis

AIM:To evaluate the role of thyroid blood flow assessment by color-flow Doppler ultrasonography in the differential diagnosis of thyrotoxicosis and compare it to technetium pertechnetate thyroid scanning. METHODS:Twenty-six patients with thyrotoxicosis were included in the study. Clinical history was taken and physical examination and thyroid function tests were performed for all patients. Thyroid autoantibodies were measured. The thyroid glands of all patients were evaluated by gray scale ultrasonography for size, shape and echotexture. Color-flow Doppler ultrasonography of the thyroid tissue was performed and spectral flow analysis of both inferior thyroid arteries was assessed. Technetium99 pertechnetate scanning of the thyroid gland was done for all patients. According to thyroid scintigraphy, the patients were divided into two groups:18 cases with Graves' disease and 8 cases with Hashimoto's thyroiditis. All patients had suppressed thyrotropin. The diagnosis of Graves' disease and Hashimoto's thyroiditis was supported by the clinical picture and follow up of patients. RESULTS:Peak systolic velocities of the inferior thyroid arteries were significantly higher in patients with Graves' disease than in patients with thyroiditis (P = 0.004 in the right inferior thyroid artery and P = 0.001 in left inferior thyroid artery). Color-flow Doppler ultrasonography parameters demonstrated a sensitivity of 88.9% and a specificity of 87.5% in the differential diagnosis of thyrotoxicosis. CONCLUSION:Color Doppler flow of the inferior thyroid artery can be used in the differential diagnosis of thyrotoxicosis, especially when there is a contraindication of thyroid scintigraphy by radioactive material in some patients.

Graves’ Disease as a Late Manifestation of Immune Reconstitution Syndrome after Highly Active Antiretroviral Therapy in an HIV-1 Infected Patient

Context: Highly active antiretroviral therapy (HAART) inhibits the HIV replication and consequently increases CD4 levels and decreases viral load. This immune system improvement can trigger various immunological phenomena, entity called Immune Reconstitution Syndrome (IRS). Graves’ disease is a late Immune Reconstitution consequence. Patient: We report the case of a 48 years old man with HIV infection who developed Graves’ disease three years after he was on effective HAART because of the Immune Reconstitution Syndrome. At presentation he had a very low CD4 T-cell count (17 cells/μL). When he started HAART he presented a lipodystrophy syndrome. HAART was changed because of the persistent low CD4-T cells count (less than 100 cell/μL). Afterwards serum lipid levels began to decrease and that was the first manifestation of Graves’ disease, which was diagnosed when CD4 T-cells increased up to 343 cell/μL. Our patient developed Graves’ disease 36 months after initiating effective HAART with protease inhibitors which was coincident with viral suppression and a rise of CD4 T cells. Conclusion: The most immunosuppressed patients with a CD4 T cell count less than 100 cells/μL are at greatest risk for the development of Immune Reconstitution Syndrome after HAART initiation. We conclude that clinicians will have to consider the importance of the early diagnosis of thyroid disease to bring an adequate treatment.

Association of Polymorphisms of rs179247 and rs12101255 in Thyroid Stimulating Hormone Receptor Intron 1 with an Increased Risk of Graves' Disease:A Meta-analysis

The polymorphisms of thyroid stimulating hormone receptor(TSHR) intron 1 rs179247 and rs12101255 have been found to be associated with Graves' disease(GD) in genetic studies. In the present study, we conducted a meta-analysis to examine this association. Two reviewers systematically searched eligible studies in Pub Med, Web of Science, Embase and China Biomedical Literature Database(CBM). A meta-analysis on the association between GD and TSHR intron 1 rs179247 or rs12101255 was performed. The odd ratios(OR) were estimated with 95% confidence interval(CI). Meta package in R was used for the analyses. Seven articles(13 studies) published between 2009 and 2014, involving 5754 GD patients and 5768 controls, were analyzed. The polymorphism of rs179247 was found to be associated with an increased GD risk in the allele analysis(A vs. G: OR=1.40, 95% CI=1.33–1.48) and all genetic models(AA vs. GG: OR=1.94, 95% CI=1.73–2.19; AA+AG vs. GG: OR=1.57, 95% CI=1.41–1.74; AA vs. AG+GG: OR=1.54, 95% CI=1.43–1.66). The site rs12101255 also conferred a risk of GD in the allele analysis(T vs. C: OR=1.50, 95% CI=1.40–1.60) and all genetic models(TT vs. CC: OR=2.22, 95% CI=1.92–2.57; TT+TC vs. CC: OR=1.66, 95% CI=1.50–1.83; TT vs. TC+CC: OR=1.74, 95% CI=1.53–1.98). Analysis of the relationship between rs179247 and Graves' ophthalmopathy(GO) showed no statistically significant correlation(A vs. G: OR=1.02, 95% CI=0.97–1.07). Publication bias was not significant. In conclusion, GD is associated with polymorphisms of TSHR intron 1 rs179247 and rs12101255. There is no association between rs179247 SNPs and GO.

Autoimmune thyroid diseases and Helicobacter pylori: The correlation is present only in Graves's disease

AIM: To investigate the correlation between autoimmune thyroid diseases (ATDs) and the prevalence of Cag-A positive strains of Helicobacter pylori (H. pylori) in stool samples. METHODS: We investigated 112 consecutive Caucasian patients (48 females and 4 males with Graves' disease and 54 females and 6 males with Hashimoto' s thyroiditis HT), at their first diagnosis of ATDs. We tested for H. pylori in stool samples using an amplified enzyme immunoassay and Cag-A in serum samples using an enzyme-linked immunoassay method (ELISA). The results were analyzed using the two-sided Fisher' s exact test and the respective odds ratio (OR) was calculated. RESULTS: A marked correlation was found between the presence of H. pylori (P ≤ 0.0001, OR 6.3) and, in particular, Cag-A positive strains (P ≤ 0.005, OR 5.3)in Graves' disease, but not in Hashimoto's thyroiditis, where we found only a correlation with Cag-A strains (P ≤ 0.005, OR 8.73) but not when H. pylori was present. CONCLUSION: The marked correlation between H. pylori and Cag-A, found in ATDs, could be dependent on the different expression of adhesion molecules in the gastric mucosa.

Case report of Graves' disease manifesting with odynophagia and heartburn

Graves' disease is an autoimmune disease, which can manifest with a variety of extrathyroidal clinical syndromes like ophthalmopathy, pretibial myxedema(dermopathy), acropathy, cardiomyopathy, and encephalopathy. Though quite rare, this disease can also manifest with gastrointestinal symptoms such as dysphagia, heartburn, nausea, vomiting and diarrhea. We report a clinical case of Graves' disease manifesting with dysfunction of the esophagus and heartburn in a 61-year-old man. In the muscular layer of the esophagus we found dystrophic changes led to its atony, which was documented by endoscopy and high-resolution manometry. The pathology features of esophageal symptoms were: focal proliferation of the basal cells, vascular distension, and dystrophy of the epithelial cells. Antithyroid treatment led to decrease of all clinical symptoms after 5 d of Thiamazole administration. Complete restoration of peristalsis in the esophagus, according to manometry, was observed in 1 mo after initiation of treatment.

Diagnosing Graves’ Disease and Non-Graves Hyperthyroidism Using TSH Receptor Antibody Test versus Non-TSH Receptor Antibody Test Methods of Diagnosis

Background: Differentiating Graves hyperthyroidism from the other causes of hyperthyroidism, using serum TRAb testing is essential step for diagnosis. Objectives: To study importance of TRAb in the diagnosis of Graves’ disease, distinguishing it from thyroiditis, and comparing it with clinical features and other tests such as TPOAb, US thyroid and thyroid scintiscan. Methods: A cross-sectional study was conducted on 120 patients attending endocrine clinicErbil city. Patients were studied on clinical feature basis and investigated with serum TRAb, TPOAb, TSH, Free T4, and Ultrasound examination of thyroid gland. Fisher exact test and Chi Square test of independence, Correlation coefficient and t-test of independence were used. Results: Fifty-two patients were found to have Graves’ disease;There was significant correlation between TRAb positivity and diagnosis of Graves’ disease p 0.05. Conclusion: A positive correlation was found between TRAb titer and positivity and no significant relation between TPOAb levels between Graves’ disease patients compared with thyroiditis patients, respectively.

Resistance to Anti-Thyroid Drugs in Graves’ Disease: Clinical-Biological Characteristics and Alternative Therapy in Tropical Area

Background: Resistance to anti-thyroid drugs (ATDs) is a rare entity recently described. We report two African observations in the treatment of Graves’ disease. Case 1: A 19-year-old Senegalese woman presented on admission with thyrotoxicosis syndrome associated with diffuse goitre and Grave’s orbitopathy. TSH levels were low (0.005 mIU/ml;N = 0.27 - 4.20) and fT4 elevated (60 pmol/L;N = 12 - 22]. Combination therapy with propranolol (40 mg/day) and carbimazole (starting dose of 45 mg/day and increased to 60 mg/day) was initiated. In view of the persistence of symptoms despite good therapeutic compliance, carbimazole was replaced by methimazole with an initial starting dose of 40 mg/day, followed by 60 mg/day. Despite the change in therapy, clinical symptoms of thyrotoxicosis persisted, and fT4 levels remained elevated. The patient was diagnosed with resistance to ATDs in Graves’ disease. Total thyroidectomy following 10 days of preoperative preparation with 1% Lugol’s solution was performed successfully. Case 2: A 22-year-old woman was referred for continued management of Graves’ disease with elevated thyroid-stimulating hormone receptor antibody (TRAb) levels (34 UI/mL;N < 1.75). Treatment included propranolol (80 mg/day) and carbimazole at an unusual dose of 80 mg/day. Combined therapy was clinically and biologically ineffective, with an fT4 level of 100 pmol/L [N: 12 - 22]. Upon admission, methimazole (40 mg/day) followed by propylthiouracil (800 mg/day) replaced carbimazole. Despite good patient compliance, the patient’s symptoms remained unaltered and fT4 levels elevated. A total robot thyroidectomy using the right axillary approach was performed successfully after 10 days of preoperative preparation, including prednisone (40 mg/day) combined with 1% Lugol’s solution. Conclusion: Resistance to ATDs complicates the management of Graves’ disease. Total thyroidectomy following preoperative preparation with Lugol’s solution and/or corticosteroids was shown to be successful.

Association between TSHR gene polymorphism and the risk of Graves' disease:a meta-analysis

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.

Influence of serum levels of TSH receptor antibody in pregnant women with Graves disease on neonatal hyperthyroidism

Objective:To investigate the clinical significance of serum thyroid stimulating hormone(TSH) receptor antibody(TRAb) levels in pregnant women with Graves'disease,on neonatal hyperthyroidism. Methods:The clinical data of 68 pregnant women with Graves' disease and their newborns were retrospectively analyzed.Testing indicators included thyroid function tests and TRAb levels during pregnancy,at delivery,and within 2 weeks after birth.The serum TRAb and T_3,T_4,Free T_3,Free T_4,TSH levels were detected by radio receptor assay(RRA) and electrical chemiluminescence immunoassay(ECLIA),respectively. Results:The results showed that serum TRAb levels of the third trimester of pregnancy was positively correlated with that of the umbilical vein(n = 68,r= 0.8494,P<0.01),and that of the newborns(n = 68, r=0.8286,P<0.01).The incidence of neonatal hyperthyroidism was 11.8%(8/68).The serum TRAb levels in the 8 neonates with hyperthyroidism within 2 weeks after birth were 3 times higher than those in the normal neonates.Of these 8 neonates,2 had 15 times higher serum TRAb levels than those of normal neonates within 2 weeks after birth.The thyroid function and TRAb levels of these 2 neonates were still abnormal 6 months later. Conclusions:The risk of hyperthyroidism in newborn whose mother's TRAb levels were high in the third trimester of pregnancy was increased.This study suggests a significant correlation between TRAb levels in pregnant women with Graves' disease and the severity of neonatal hyperthyroidism.

Clinical significance of serum levels of thyroid stimulating hormone receptor antibody in pregnant women with Graves' disease

Objective:To investigate the clinical significance of serum thyroid stimulating hormone(TSH) receptor antibody (TRAb) levels and the antithyroid drug(ATDs) use in pregnant women with Graves' disease in their neonatal thyroid function. Methods:The serum TRAb and T3,T4,FT3,FT4,TSH levels in 68 pregnant women with Graves' disease and their newborns were detected by radio receptor assay(RRA) and electrical chemiluminescence immunoassay (ECLIA),respectively.Based on the maternal serum TRAb levels and the use of antithyroid drugs during pregancy, the newborns were divided into different groups.The incidence of neonatal thyroid dysfunction and its risk factors were analyzed. Results:The results showed the incidence of abnormal thyroid function of newborns was 29.4%(20/68).The proportion of neonatal thyroid dysfunction in women with high TRAb levels in the third trimester of pregnancy were significantly higher than these with normal TRAb(P<0.01).In 23 newborns whose mothers were normal in serum TRAb levels and took no ATDs during pregnancy,only one case had thyroid dysfunction within two weeks after birth,while in other 45 newborns whose mothers had a high level of serum TRAb and/or took ATDs during pregnancy, 19 developed thyroid dysfunction within two weeks after birth. Conclusion:Neonatal thyroid function depends on the balance between the transplacental TRAb and ATDs. TRAb measurement in pregnant women with Graves' disease is of significance in evaluation of neonatal thyroid function. Elevated level of serum TRAb in the third trimester of pregnancy is a risk factor for neonatal thyroid dysfunction.

Graves’ Disease in Senegal: Clinical and Evolutionary Aspects

Objectives: To assess the clinical particularities and management of Graves’ disease at the Medical Clinic II of the Abass Ndao Hospital Centre in Dakar. Patients and methods: This was a retrospective, descriptive study on records of patients monitored for Graves' disease from 1 January 2010 to 31 December 2014 (5 years). Socio-demographic, clinical treatment and changing parameters were evaluated. Outcomes: 878 patients were included and among them 542 had been monitored for at least 18 months. The sex ratio (M/F) was 0.2 and the average age was 34.8 ± 12 years. The average consultation period was 10.7 ± 2 months. Free T4 at diagnosis was > 80 pmol/l (36.6%). Prolonged medical treatment was reported in 96.7% of patients. The average dose for initial therapy with Carbimazole was 37 ± 9 mg/day. Beta-blockers were used in 64% and anxiolytics in 40.5% of cases. The average period for administering the maintenance dose was 5.6 months. Patients’ attendance and compliance stood at 17.7% and 53.1% respectively. Complications, mainly cardiothyreosis, were found in 13% of cases. Goitre regression was found in 13.9% of cases and that of exophthalmos stood at 19.5%. Among our patients, 38.2% were lost to follow-up. The remission rate was 36.5% and thyroidectomy involved 14.5% of patients. Only stage of goiter (p = 0.007) and initial free T4 value (p = 0.003) were statistically associated with remission. Conclusion: Graves’ disease management raises follow-up problems. Indeed, the medical treatment is long while the number of patients lost to follow-up is high. As the only radical alternative available is surgery, it is therefore essential to promote the development of radioactive iodine therapy to expand the therapeutic choice.