Development of Hyperthyroidism Following Primary Hypothyroidism: A Case Report with Changes in Thyroid-Related Antibodies (original) (raw)
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Thyroid Autoimmunity in an Iodine-Replete Population: A Research Article
Journal of Evidence Based Medicine and Healthcare
In recent times, the incidence and prevalence of thyroid disorders has been increasing in the Indian population. Autoimmune thyroiditis or Hashimoto's thyroiditis is one of the most common causes of thyroid disease. Antithyroid antibodies rarely develop before 20 years of age, but they may be a prelude to the development of subsequent hypothyroidism. It is universally known that iodine deficiency causes hypothyroidism. However, sustained unnecessary iodine supplementation may be harmful. Goitre, thyroid dysfunction (both hypo-and hyperthyroidism) and thyroid autoimmunity have been reported as a result of sustained supplementation in the iodine-replete state. Data on the impact of iodisation on thyroid function in adults is sparse. A study was conducted with an objective to estimate the problem of thyroid autoimmunity in patients who presented to the OPD. PATIENTS AND METHODS Patients who presented to the surgical OPD with clinical features of thyroid disease were included in the study after obtaining informed consent. Demographic details and clinical features of thyroid disease were noted. Thyroid status was estimated with the help of serum levels of thyroid stimulating hormone (TSH), free l-thyroxine (FT4), and free tri-iodothyronine (FT3). Autoantibodies to thyroid peroxidase (Anti-TPO) were estimated. Findings were tabulated and analysed. RESULTS AND CONCLUSION The prevalence of antibody positivity was 69.7% (209 out of the 300 patients) in this study. Among age-groups, the maximum prevalence was found in the third decade of life (75/99 patients, 75.8%). Among those who were antibody-positive, 69.9% were euthyroid, 26.8% were hypothyroid and 3.3% were thyrotoxic. Hypothyroidism (elevated S. TSH) had a significant positive correlation (r = 0.324, p = 0.003) with antibody-positivity (elevated S. AMA).
Subclinical and manifested hypothyroidism as a consequence of thyroid autoimmune disease]
2005
Hronični autoimunski tireoiditis (Hašimotov tireoiditis-HT) se sporo razvija i predstavqa hronično autoimun sko zapaqewe tireoideje. Može da se javi ma u kojem dobu života, ali više boluju osobe ženskog pola, a bolest se ispo qava posle emocionalnog ili fizičkog stresa. Javqa se kod više članova iste porodice i pojava HT najavquje moguće is poqavawe još neke autoimunske bolesti. U revijskom prikazu izneta su dosadašwa saznawa o supkliničkom i manifest nom hipotireoidizmu, kao posledica autoimunske bolesti štitaste žlezde. U dosadašwim istraživawima pokazano je da je učestalost supkliničkog hipotireoidizma kod starih osoba 4,17%, a primarnog 1%. Primenom hipotalamusnog čini oca (thyrotropin releasing hormon-TRH) veoma je korisno odrediti stimulisani odgovor promene koncentracije tireosti mulišućeg hormona (TSH), odnosno veličinu neposredne, brze tireoidne rezerve merewem oslobođenih trijodotironi na (T3) i tiroksina (T4) 60. minuta pomenutog testa. Veličina tireoidne rezerve određuje odgovor organizma kao celine na razne oblike stresa (infekcija, oboqewa pojedinih sistema i slično). Lečewe je supstitucija levogirnim tiroksinom u prosečnim dozama 1,61,8 μg/kg telesne mase. Starijim osobama se daje mawa doza, nekada samo 1 μg na dan, uz obavezan ko ronarni dilatator.
Clinical-Laboratory Evaluation of a Group of Patients with Hashimoto Thyroiditis
Japan Journal of Research, 2020
Chronic lymphocytic thyroiditis (or chronic thyroiditis, or Hashimoto thyroiditis-HT) was first described in 1992 in Germany by the Japanese pathologist Hakuru Hashimoto as a new disease called lymphomatous struma. Today it represents the most frequent cause of hypothyroidism and goiter in the US and in areas of iodine sufficiency. It is the main cause of goiter in children and young adults and of idiopathic mixedema. The most important auto antibodies are antithyroglobulin (Anti-TG), antithyroperoxidase (Anti-TPO) and TSH receptor antibody blocker (TRAB). In the initial phase Anti-TG is markedly elevated while Anti-TPO is only mildly elevated. Anti-TG may disappear, but Anti-TPO continues to be positive for many years. Its pathogenesis has not been fully clarified. The estimate is that the pathogenesis of this immune disease is due genetic factors in 70 to 80% of cases and to environmental factors in 20 to 30% of cases. The study was conducted on 399 patients, 336 women (87.2%) and 63 men (12.8 %), ranging in age from 11 to 95 years. The predominant age ranges were 20 to 70 years for women and 30 to 60 years for men. Blood samples were obtained for the determination of TSH, T4L, T3L, thyroglobulin, and anti-TPO, anti-thyroglobulin and TSH receptor (TRAB) antibodies by chemiluminescence. Anti-TPO and anti-TG autoantibody values were higher in Anti-TPO-positive and AntiTG-negative: Type 1 thyroiditis; and in Anti-TPO-negative and AntiTG-positive: Type 2 thyroiditis; and in Anti-TPO-positive and antiTG-positive: Type 3 thyroiditis; and in Anti-TPO-negative and AntiTG-negative: Type 4 thyroiditis. Autoantibody expression was similar in men and women, with predominance of type 4 > type 3 > type 2> type 1 when considering the oldest age of each sex (95 years for women and 85 years for men). When considering the youngest age studied, the following results were obtained: type 2 > type 4 > type 1> type 3 for women and type 3 > type 1 > type 4 > type 2 for men.
Thyroid Autoimmunity: Role of Anti-thyroid Antibodies in Thyroid and Extra-Thyroidal Diseases
Frontiers in Immunology, 2017
Autoimmune diseases have a high prevalence in the population, and autoimmune thyroid disease (AITD) is one of the most common representatives. Thyroid autoantibodies are not only frequently detected in patients with AITD but also in subjects without manifest thyroid dysfunction. The high prevalence raises questions regarding a potential role in extra-thyroidal diseases. This review summarizes the etiology and mechanism of AITD and addresses prevalence of antibodies against thyroid peroxidase, thyroid-stimulating hormone receptor (TSHR), and anti-thyroglobulin and their action outside the thyroid. The main issues limiting the reliability of the conclusions drawn here include problems with different specificities and sensitivities of the antibody detection assays employed, as well as potential confounding effects of altered thyroid hormone levels, and lack of prospective studies. In addition to the well-known effects of TSHR antibodies on fibroblasts in Graves' disease (GD), studies speculate on a role of anti-thyroid antibodies in cancer. All antibodies may have a tumor-promoting role in breast cancer carcinogenesis despite anti-thyroid peroxidase antibodies having a positive prognostic effect in patients with overt disease. Cross-reactivity with lactoperoxidase leading to induction of chronic inflammation might promote breast cancer, while anti-thyroid antibodies in manifest breast cancer might be an indication for a more active immune system. A better general health condition in older women with anti-thyroid peroxidase antibodies might support this hypothesis. The different actions of the anti-thyroid antibodies correspond to differences in cellular location of the antigens, titers of the circulating antibodies, duration of antibody exposure, and immunological mechanisms in GD and Hashimoto's thyroiditis.
Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2012
Clinical Practice Guidelines are developed to be of assistance to health care professionals by providing guidance and recommendations for particular areas of practice. The Guidelines should not be considered inclusive of all proper approaches or methods, or exclusive of others. The Guidelines cannot guarantee any specific outcome, nor do they establish a standard of care. The Guidelines are not intended to dictate the treatment of a particular patient. Treatment decisions must be made based on the independent judgment of health care providers and each patient's individual circumstances. The Endocrine Society of Sri Lanka makes no warranty, express or implied, regarding the Guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. The Society shall not be liable for direct, indirect, special, incidental, or consequential damages related to the use of the information contained herein. Endocrine Society of Sri Lanka thanks the Abbott Laboratories for the unrestricted grant to develop and publish the Thyroid Guidelines.