RESUMEN
Hashimoto's thyroiditis manifesting as hypothyroidism has been implicated in glomerular disorders due to autoantibody formation. Here we present the case of a 26-year-old male without any comorbidities presenting with easy fatiguability and weight gain for 2 months. He was found to have a creatinine of 2.1 mg/dL with a history of rhinitis treated with anti-histaminic three days prior to the hospital visit. He had symptoms of intermittent myalgia for the past two weeks. On laboratory evaluation, he was found to have raised CPK, elevated TSH, low normal T4, and positive anti-TPO and anti-Tg antibodies. Neck ultrasound revealed linear echogenic septations in the thyroid gland. Renal biopsy revealed acute tubular injury. Appropriate thyroxine supplementation was started and his creatinine decreased to 1.2 mg/dL after 1 month. It is important that clinicians should be aware of this rare kidney presentation in Hashimoto's thyroiditis.
Asunto(s)
Lesión Renal Aguda , Enfermedad de Hashimoto , Rabdomiólisis , Humanos , Enfermedad de Hashimoto/complicaciones , Enfermedad de Hashimoto/diagnóstico , Masculino , Adulto , Rabdomiólisis/diagnóstico , Rabdomiólisis/etiología , Lesión Renal Aguda/etiología , Lesión Renal Aguda/diagnóstico , Diagnóstico DiferencialRESUMEN
OBJECTIVE: The association between Papillary Thyroid Carcinoma (PTC) and coexistent Hashimoto's Thyroiditis (HT) was controversial. The purpose of this study was to evaluate the presence of HT exerts any influence on the aggressiveness of PTC, and to establish a nomogram for predicting the possibility of aggressiveness in PTC. METHODS: 373 consecutive PTC patients with/without coexistent HT from January 2017 to December 2020 were retrospective reviewed. Patients' clinicopathologic and sonographic characteristics were collected for univariate and multivariate analyses. A nomogram was established based on the risk factors for aggressiveness in PTC. RESULTS: Male (pâ¯=â¯0.001), tumor size >1.0â¯cm (pâ¯=â¯0.046) and lymph node metastasis (pâ¯=â¯0.018) were negatively associated with PTC coexisted with HT, while it was significantly positively associated with the frequence of multifocality (pâ¯=â¯0.010). Univariate and multivariate analyses suggested that age ≥55 years (pâ¯=â¯0.000), male (pâ¯=â¯0.027), HT (pâ¯=â¯0.017), tumor size >1.0â¯cm (pâ¯=â¯0.015), multifocality (pâ¯=â¯0.041), distance to capsular ≤0â¯cm (pâ¯=â¯0.050) and blood flow (Grade I: pâ¯=â¯0.044) were independent risk factors for predicting the aggressiveness in PTC. A nomogram according to these predictors was further developed and validated. The receiver operating characteristic curve (AUCâ¯=â¯0.734 and 0.809 for training and validation cohorts, respectively) and decision curve analyses indicated that the nomogram model was clinically useful. The calibration curve revealed that the nomogram exhibited an excellent consistency. CONCLUSIONS: In this study, the coexistent HT might play a protective role in preventing the proliferation of PTC. Dispensable aggressive treatment may be reduced in PTC by pre-operative identification of sonographic and clinical characteristics and incorporating with the predicted nomogram model.
Asunto(s)
Enfermedad de Hashimoto , Nomogramas , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides , Ultrasonografía , Humanos , Masculino , Enfermedad de Hashimoto/complicaciones , Enfermedad de Hashimoto/diagnóstico por imagen , Enfermedad de Hashimoto/patología , Persona de Mediana Edad , Femenino , Estudios Retrospectivos , Adulto , Cáncer Papilar Tiroideo/diagnóstico por imagen , Cáncer Papilar Tiroideo/patología , Cáncer Papilar Tiroideo/complicaciones , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/complicaciones , Factores de Riesgo , Anciano , Adulto Joven , Metástasis Linfática/diagnóstico por imagenRESUMEN
OBJECTIVE: Papillary thyroid carcinoma, per se, is the most common type of thyroid cancer, and Hashimoto's thyroiditis is the most frequent autoimmune disease of the papillon gland. The liaison between Hashimoto's thyroiditis and thyroid cancers is still an ongoing debate in thyroidology. The aim of the study was to discuss the frequency of the co-occurrence of Hashimoto's thyroiditis and papillary thyroid carcinoma. METHODS: This study is designed as a retrospective analytical cohort study. The institutional database and archive of histopathology scanning identified the patients who had undergone thyroidectomy between January 2022 and January 2016. The Statistical Package for Social Sciences v21.0 program was used for statistical purposes. Descriptive and chi-square tests were applied, and a p<0.05 was considered significant. RESULTS: Of 498 patients who had undergone thyroidectomy for 4 years, 99 (20%) were male and 399 (80%) were female. Of note, papillary thyroid carcinoma was revealed in 160 (32%) patients, and Hashimoto's thyroiditis was recognized in 178 (35.74%) patients. The prevalence of Hashimoto's thyroiditis in cases with papillary thyroid carcinoma was 43.8%, while the prevalence in patients with Hashimoto's thyroiditis was 41.1%. CONCLUSION: A debate still remains on the propriety of these two phenomena. Herewith, we recognized a correlation between the presence of papillary thyroid carcinoma and Hashimoto's thyroiditis. Providers should be vigilant about the coexistence of these phenomena. We might postulate the so-called total thyroidectomy for cases with a cytologic diagnosis of Hashimoto's thyroiditis with a papillary thyroid carcinoma. As a matter of fact, this issue merits further investigation.
Asunto(s)
Enfermedad de Hashimoto , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides , Tiroidectomía , Humanos , Enfermedad de Hashimoto/complicaciones , Enfermedad de Hashimoto/epidemiología , Enfermedad de Hashimoto/patología , Femenino , Masculino , Estudios Retrospectivos , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/complicaciones , Persona de Mediana Edad , Adulto , Cáncer Papilar Tiroideo/patología , Cáncer Papilar Tiroideo/epidemiología , Cáncer Papilar Tiroideo/complicaciones , Prevalencia , Carcinoma Papilar/patología , Carcinoma Papilar/epidemiología , Brasil/epidemiología , Anciano , Adulto Joven , Enfermedades EndémicasRESUMEN
BACKGROUND: Despite the increasing recognition of PD-L1 as predictor of immunotherapeutic response in various malignancies, its role and prognostic significance in thyroid cancer remain underexplored and subject to debate. This study begins to address this gap by comprehensively analyzing PD-L1 expression in papillary thyroid carcinoma (PTC) and investigating its correlation with key clinicopathological variables. METHODS: We conducted immunohistochemistry (IHC) to assess PD-L1 expression in whole-tissue sections from 121 primary papillary thyroid carcinoma (PTC) cases. We then analyzed the correlations between PD-L1 expression and various clinicopathological variables. RESULTS: PD-L1 expression was detected in 33.1% of papillary thyroid carcinomas (PTCs), predominantly exhibiting weak to moderate intensity. Notably, this study found no significant correlation between PD-L1 expression and various clinicopathological variables. The lack of association with traditional factors such as age, sex, histological subtype, and tumor size suggests the complex and multifaceted nature of PD-L1 regulation in PTC. Multivariate logistic regression analysis identified chronic lymphocytic thyroiditis with oncocytic metaplasia as the sole independent predictor of PD-L1 expression (P = 0.014), underlining the potential influence of the tumor microenvironment on immune checkpoint expression in PTC. CONCLUSIONS: Our study underscores the intricate interplay between chronic lymphocytic thyroiditis with oncocytic metaplasia and PD-L1 expression in papillary thyroid carcinoma. The observed link suggests a potential avenue for therapeutic intervention using anti-PD-1/PD-L1 therapies in surgery-refractory PTC. Understanding the dynamics of immune checkpoint regulation in the context of the tumor microenvironment is crucial for devising effective treatment strategies. Future research endeavors should delve deeper into the molecular mechanisms underlying this interaction and explore its implications for patient outcomes. As the field of immunotherapy continues to evolve, our findings contribute valuable insights into the complex immunological landscape of thyroid cancer.
Asunto(s)
Enfermedad de Hashimoto , Neoplasias de la Tiroides , Humanos , Cáncer Papilar Tiroideo/patología , Enfermedad de Hashimoto/complicaciones , Antígeno B7-H1 , Neoplasias de la Tiroides/patología , Metaplasia , Microambiente TumoralAsunto(s)
Enfermedad de Hashimoto , Liquen Escleroso Vulvar , Humanos , Femenino , Prevalencia , Liquen Escleroso Vulvar/patología , Liquen Escleroso Vulvar/complicaciones , Enfermedad de Hashimoto/complicaciones , Enfermedad de Hashimoto/patología , Enfermedad de Hashimoto/epidemiología , Persona de Mediana Edad , Adulto , Anciano , Brasil/epidemiologíaRESUMEN
Previous studies found conflicting results about associations of vitiligo with different autoimmune diseases. To evaluate associations of vitiligo with multiple autoimmune diseases. A cross-sectional study representative of 612,084,148 US patients from the Nationwide Emergency Department Sample (NEDS) 2015-2019 was performed. Vitiligo and autoimmune diseases were identified using International Classification of Diseases-10 codes. The most frequent autoimmune disorders in patients with vitiligo were type 1 diabetes, rheumatoid arthritis, systemic lupus erythematosus (SLE), autoimmune thyroiditis, Addison's disease, and systemic sclerosis (SSc). Vitiligo was associated with any autoimmune disorder (adjusted odds ratio [95% confidence interval] 1.45 [1.32-1.58]). Cutaneous disorders with largest effect-sizes were alopecia areata (186.22 [115.31-300.72]) and SSc (32.13 [25.28-40.82]). Non-cutaneous comorbidities with largest effect-sizes were primary sclerosing cholangitis (43.12 [18.98-97.99]), pernicious anemia (41.26 [31.66-53.78]), Addison's disease (33.85 [26.68-42.9]), and autoimmune thyroiditis (31.65 [26.34-38.02]). Vitiligo is associated with multiple cutaneous and non-cutaneous autoimmune diseases, especially in females and older age.
Asunto(s)
Enfermedad de Addison , Enfermedades Autoinmunes , Enfermedad de Hashimoto , Tiroiditis Autoinmune , Vitíligo , Femenino , Humanos , Vitíligo/epidemiología , Estudios Transversales , Tiroiditis Autoinmune/complicaciones , Tiroiditis Autoinmune/epidemiología , Enfermedad de Addison/complicaciones , Enfermedades Autoinmunes/complicaciones , Enfermedades Autoinmunes/epidemiología , Piel , Enfermedad de Hashimoto/complicacionesRESUMEN
Hashimoto's encephalopathy is a rare disease, first reported in 1966, with a prevalence of 2.1 in 1000 inhabitants. We present the case of a 42- year- old woman, with no relevant medical history, who suddenly started having symptoms of altered consciousness, visual hallucinations and de-lusions. Laboratory tests showed anti- thyroperoxidase antibodies greater than 600 U/ml, thy-roxin 0.93 U/ml, and thyroid stimulating hormone 1.60 U/ml. Magnetic resonance imaging showed bilateral subcortical focal lesions with a nonspecific demyelinating appearance. The electroencephalogram was nonspecific. The diagnosis of Hashimoto encephalopathy was made, and symptoms remitted after treatment with steroids. This article highlights the importance of conducting a comprehensive evaluation of patients with atypical psychiatric symptoms and a thorough differential diagnosis.
La encefalopatía de Hashimoto es una enfermedad rara reportada por primera vez en 1966 con una prevalencia de 2,1/1000 habitantes. Se presenta el caso de una mujer de 42 años, sin antecedentes médicos de importancia, quien inició un cuadro de manera súbita con alteración de conciencia, alucinaciones visuales y delusiones. En los exámenes de laboratorio se tuvo anticuerpos antiperoxidasa tiroidea mayor a 600 U/ml, tiroxina 0,93, hormona estimulante de la tiroides 1,60 U/ml, resonancia magnética con lesiones focales subcorticales bilaterales de aspecto desmielinizante inespecífico, electroencefalograma sin particularidades. Se realizó el diagnóstico de encefalopatía de Hashimoto y el cuadro remitió luego del tratamiento con corticoides. El artículo resalta la importancia de realizar una evaluación integral de los pacientes con sintomatología psiquiátrica atípica y ahondar en el diagnóstico de exclusión.
Asunto(s)
Encefalopatías , Encefalitis , Enfermedad de Hashimoto , Femenino , Humanos , Adulto , Enfermedad de Hashimoto/complicaciones , Enfermedad de Hashimoto/diagnóstico , Encefalopatías/diagnóstico , Encefalopatías/etiología , Encefalitis/diagnóstico , Tirotropina , EsteroidesRESUMEN
La encefalopatía de Hashimoto es una enfermedad rara reportada por primera vez en 1966 con una prevalencia de 2,1/1000 habitantes. Se presenta el caso de una mujer de 42 años, sin antecedentes médicos de importancia, quien inició un cuadro de manera súbita con alteración de conciencia, alucinaciones visuales y delusiones. En los exámenes de laboratorio se tuvo anticuerpos antiperoxidasa tiroidea mayor a 600 U/ml, tiroxina 0,93, hormona estimulante de la tiroides 1,60 U/ml, resonancia magnética con lesiones focales subcorticales bilaterales de aspecto desmielinizante inespecífico, electroencefalograma sin particularidades. Se realizó el diagnóstico de encefalopatía de Hashimoto y el cuadro remitió luego del tratamiento con corticoides. El artículo resalta la importancia de realizar una evaluación integral de los pacientes con sintomatología psiquiátrica atípica y ahondar en el diagnóstico de exclusión.
Hashimoto's encephalopathy is a rare disease, first reported in 1966, with a prevalence of 2.1 in 1000 inhabitants. We present the case of a 42- year- old woman, with no relevant medical history, who suddenly started having symptoms of altered consciousness, visual hallucinations and de-lusions. Laboratory tests showed anti- thyroperoxidase antibodies greater than 600 U/ml, thy-roxin 0.93 U/ml, and thyroid stimulating hormone 1.60 U/ml. Magnetic resonance imaging showed bilateral subcortical focal lesions with a nonspecific demyelinating appearance. The electroencephalogram was nonspecific. The diagnosis of Hashimoto encephalopathy was made, and symptoms remitted after treatment with steroids. This article highlights the importance of conducting a comprehensive evaluation of patients with atypical psychiatric symptoms and a thorough differential diagnosis.
Asunto(s)
Humanos , Femenino , Adulto , Encefalopatías/diagnóstico , Encefalopatías/etiología , Encefalitis/diagnóstico , Enfermedad de Hashimoto/complicaciones , Enfermedad de Hashimoto/diagnóstico , Esteroides , TirotropinaRESUMEN
PURPOSE: Papillary thyroid carcinoma (PTC) is the most frequent subtype of thyroid cancer; Hashimoto's thyroiditis (HT), autoimmune disease, commonly affects the thyroid gland; there is possibly a correlation between both, but the exact mechanisms that involve this relationship are still under debate. Since oxidative stress (OS) and the inflammatory environment participate in the development of several types of cancer, the objective of the present study was to establish the microenvironment and systemic participation of OS and inflammatory markers in patients with PTC and HT. METHODS: Blood and tissue samples were collected from 115 patients: BENIGN (n = 63); PTC (n = 27); HT (n = 15) and PTC + HT (n = 10), and sixty-three were samples from healthy individuals (control group). RESULTS: Superoxide dismutase, Catalase, reduced Glutathione, markers of lipid peroxidation and inflammation were evaluated in blood. Immunohistochemistry was performed on 3-nitrotyrosine, 4-hydroxynonenal, Ki-67 and VEGF. The results indicate that antioxidant enzymes were more active in groups with thyroid disorders compared to control, while the concentration of Reduced glutathione was reduced in BENIGN and PTC groups. When PTC and PTC + HT groups were analyzed, no significant differences were found in relation to the antioxidant defense and inflammatory markers. The ability to contain the induced lipid peroxidation was lower and a high level of malondialdehyde was observed in the PTC group. All immunohistochemical markers had higher scores in the PTC group compared to PTC + HT. CONCLUSION: There was a more pronounced presence of OS and a greater activity of cell proliferation and angiogenesis markers in PTC than in PTC + HT group.
Asunto(s)
Carcinoma Papilar , Enfermedad de Hashimoto , Neoplasias de la Tiroides , Antioxidantes , Carcinoma Papilar/patología , Catalasa , Glutatión , Enfermedad de Hashimoto/complicaciones , Humanos , Antígeno Ki-67 , Malondialdehído , Estrés Oxidativo , Superóxido Dismutasa , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides/patología , Microambiente Tumoral , Factor A de Crecimiento Endotelial Vascular/metabolismoRESUMEN
Objective: The prevalence of autoimmune thyroiditis (AT) in papillary thyroid carcinoma (PTC) is still controversial. The aim of this study was to investigate the frequency of coexistence of PTC with AT versus that of the coexistence of benign nodules with AT. Materials and methods: This was a cross-sectional retrospective study including patients operated on for thyroid nodules from January 2011, to April 2021. The frequency of papillary carcinomas cooccurring with AT was compared to that of benign nodules cooccurring with AT, which was assessed based on cytopathological diagnosis after thyroidectomy. Results: The study included 668 cases of benign nodules and 420 cases with PTC. No statistically significant difference was observed between cases of benign and PTC nodules regarding the presence of AT (25% vs. 28%, respectively, p = 0.177). The size of the PTC compared to that of the benign predominant nodules was significantly smaller both in the absence (0.96 ± 1.09 cm vs. 2.19 ± 1.06 cm, p < 0.05) and in the presence (0.77 ± 0.76 cm vs. 1.67 ± 1.08 cm, p < 0.01) of AT. In the binary logistic regression analysis of the PTC, the only variable associated with AT was multifocality (odds ratio: 1.750, 95% confidence intervals: 1.131-2.706, p = 0.013). The incidences of lymph node involvement and advanced stage PTC were very low both in the presence and absence of AT. Conclusion: The nodules present with PTC were not more likely to coexist with AT than benign nodules were. The small incidence of advanced PTC indicates a significant improvement in early-stage diagnosis.
Asunto(s)
Enfermedad de Hashimoto , Neoplasias de la Tiroides , Nódulo Tiroideo , Tiroiditis Autoinmune , Estudios Transversales , Enfermedad de Hashimoto/complicaciones , Humanos , Estudios Retrospectivos , Cáncer Papilar Tiroideo/cirugía , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/cirugía , Nódulo Tiroideo/complicaciones , Nódulo Tiroideo/epidemiología , Nódulo Tiroideo/cirugía , Tiroidectomía , Tiroiditis Autoinmune/complicaciones , Tiroiditis Autoinmune/epidemiología , Tiroiditis Autoinmune/cirugíaRESUMEN
The development of nephrotic syndrome in concomitance with Hashimoto's thyroiditis is an in frequent association in the pediatric age. OBJECTIVE: To report an infrequent complication of au toimmune thyroiditis, such as the appearance of nephrotic syndrome. CLINICAL CASE: A 10-year-old patient presenting with nephrotic syndrome and goiter. A history of autoimmune thyroiditis and un treated hypothyroidism was detected. Corticosteroid and hormone replacement therapy (levothyro- xine) is started, achieving a good clinical and laboratory response. CONCLUSION: Autoimmune thyroi ditis impacts renal physiology through immunological and non-immunological mechanisms. At the same time, renal repercussions can affect thyroid function. The importance of this communication lies in reporting an infrequent complication of autoimmune thyroiditis, such as the appearance of nephrotic syndrome.
Asunto(s)
Enfermedad de Hashimoto , Hipotiroidismo , Síndrome Nefrótico , Tiroiditis Autoinmune , Humanos , Niño , Tiroiditis Autoinmune/complicaciones , Síndrome Nefrótico/complicaciones , Síndrome Nefrótico/diagnóstico , Enfermedad de Hashimoto/complicaciones , Enfermedad de Hashimoto/diagnóstico , Hipotiroidismo/complicaciones , RiñónRESUMEN
Infectious diseases have long been considered one of the triggers for autoimmune and autoinflammatory diseases. Since the appearance of the new coronavirus in December 2019 in the city of Wuhan, China, there have been many reports suggesting that infection with coronavirus 2 (SARS-CoV-2) precedes the appearance of several autoimmune and autoinflammatory diseases. We describe a case report of a patient who was infected with the SARS-CoV-2 virus and later developed a picture of Hashimoto's thyroiditis.
Asunto(s)
COVID-19 , Enfermedad de Hashimoto , China , Enfermedad de Hashimoto/complicaciones , Humanos , SARS-CoV-2RESUMEN
INTRODUCTION: Hypothyroidism has been associated with dyslipidemia. Its treatment with levothyroxine has shown a positive effect on the lipid profile in adults, however, there is a lack of data on the pediatric popu lation. OBJECTIVE: to evaluate the effect of the thyroid profile normalization on the lipid profile in children with primary hypothyroidism. PATIENTS AND METHOD: Retrospective study in children aged from 6 to 16 years, with diagnosis of primary hypothyroidism due to Hashimoto's thyroiditis, in treatment with levothyroxine, and who had an evaluation of serum lipids before and during their treatment. The lipid profile was evaluated in 2 stages: the first one referred to as "before levothyroxine treatment" (at the diagnosis of primary hypothyroidism) and the second one referred to as " thyroid profile normalization" (when normalization of Thyroid-stimulating hormone [TSH] and free T4 [FT4] was achieved during levothyroxine treatment). Sociodemographic and anthropometric data were recorded. The lipid profile evaluation consisted of the serum determination of total cholesterol (TC), high-density cholesterol (HDL-C), and TG. The phenotype of dyslipidemias was determined according to the Fredrickson's classification. RESULTS: 72 patients were included (61% women; age 11.5 ± 2.9 years), out of which 58.3% (n = 42) presented pre-treatment dyslipidemia. In hypothyroid state, it was evident the correlation of TSH with TC (r = 0.36; p = 0.002), LDL-C (r = 0.46; p = 0.01), and HDL-C (r = -0.33; p = 0.004). The thyroid profile normalization showed the reduction of TC [184 mg/dL (IQR 92-322) vs 147 mg/dL (IQR 92-283); p = 0.05], LDL-C [99 mg/dL (IQR 44-232) vs 82 mg/dL (IQR 41-168); p = 0.02], TG [113 mg/dL (IQR 50-483) vs 88 mg/dL (IQR 16-343); p = 0.03], and the frequency of dyslipidemia [58.3% vs 22.2%; p = 0.001), as well as the TC correction with TG (r = 0.35; p = 0.02) and LDL-C (r = 0.88; p = 0.01). Persistent dyslipidemia was associated with obesity (r = 0.27; p = 0.02), overweight (r = 0.58; p = 0.001), and pre-treatment dyslipidemia (r = 0.53; p = 0.001). CONCLUSIONS: There is an association between TSH, TC, LDL-C, and HDL-C in hypothyroidism. When the thyroid profile was normalized, there was a reduction of TC, TG, LDL- C, and dyslipidemia frequency. Persistent dyslipidemia was associated with obesity, overweight, and pre-treatment dyslipidemia.
Asunto(s)
Hipotiroidismo/sangre , Lípidos/sangre , Tirotropina/sangre , Tiroxina/sangre , Adolescente , Niño , Colesterol/sangre , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Dislipidemias/sangre , Dislipidemias/clasificación , Dislipidemias/complicaciones , Femenino , Enfermedad de Hashimoto/complicaciones , Humanos , Hipotiroidismo/tratamiento farmacológico , Hipotiroidismo/etiología , Masculino , Obesidad Infantil/etiología , Valores de Referencia , Estudios Retrospectivos , Tiroxina/uso terapéutico , Triglicéridos/sangreRESUMEN
OBJECTIVE: To study the prevalence of Hashimoto's Thyroiditis in a sample of psoriasis patients. METHODS: Cross-sectional observational study of 120 individuals (60 with psoriasis and 60 control subjects) paired by gender and age for thyroid function (thyroid stimulating hormone, free T4), antithyroperoxidase and antithyroglobulin tests and physical examination. Psoriasis Area and Severity Index and Nail Psoriasis Severity Index were evaluated simultaneously. Epidemiological, clinical and treatment data was collected from medical records. Patients with documented hypothyroidism and/or goiter associated with positive antithyroperoxidase antibody were considered to have Hashimoto's Thyroiditis. RESULTS: The prevalence of Hashimoto's Thyroiditis in the group with psoriasis was 21.6%; in the control group, it was 4/60 (6.6%) with p=0.03 (OR=3.8; 95%CI 1.18-12.6). In the group of patients with psoriasis, Hashimoto's Thyroiditis was more common in women (p=0.002) and less common in those who had polyarticular arthropathic psoriasis (p=0.05) and plaque psoriasis (p=0.005). A logistic regression showed that the only independent variable associated with Hashimoto's thyroiditis was plaque psoriasis. CONCLUSIONS: There is a high prevalence of Hashimoto's Thyroiditis in psoriatic patients, especially in women. Hashimoto's Thyroiditis is less common in patients with the plaque form of psoriasis.
Asunto(s)
Enfermedad de Hashimoto , Hipotiroidismo , Psoriasis , Estudios Transversales , Femenino , Enfermedad de Hashimoto/complicaciones , Enfermedad de Hashimoto/epidemiología , Humanos , Prevalencia , Psoriasis/complicaciones , Psoriasis/epidemiologíaRESUMEN
SUMMARY OBJECTIVE: To study the prevalence of Hashimoto's Thyroiditis in a sample of psoriasis patients. METHODS: Cross-sectional observational study of 120 individuals (60 with psoriasis and 60 control subjects) paired by gender and age for thyroid function (thyroid stimulating hormone, free T4), antithyroperoxidase and antithyroglobulin tests and physical examination. Psoriasis Area and Severity Index and Nail Psoriasis Severity Index were evaluated simultaneously. Epidemiological, clinical and treatment data was collected from medical records. Patients with documented hypothyroidism and/or goiter associated with positive antithyroperoxidase antibody were considered to have Hashimoto's Thyroiditis. RESULTS: The prevalence of Hashimoto's Thyroiditis in the group with psoriasis was 21.6%; in the control group, it was 4/60 (6.6%) with p=0.03 (OR=3.8; 95%CI 1.18-12.6). In the group of patients with psoriasis, Hashimoto's Thyroiditis was more common in women (p=0.002) and less common in those who had polyarticular arthropathic psoriasis (p=0.05) and plaque psoriasis (p=0.005). A logistic regression showed that the only independent variable associated with Hashimoto's thyroiditis was plaque psoriasis. CONCLUSIONS: There is a high prevalence of Hashimoto's Thyroiditis in psoriatic patients, especially in women. Hashimoto's Thyroiditis is less common in patients with the plaque form of psoriasis.
Asunto(s)
Humanos , Femenino , Psoriasis/complicaciones , Psoriasis/epidemiología , Enfermedad de Hashimoto/complicaciones , Enfermedad de Hashimoto/epidemiología , Hipotiroidismo , Prevalencia , Estudios TransversalesRESUMEN
BACKGROUND: Autoimmune encephalitis occurs as a subacute condition with a strong infectious association in children. In the last 20 years, the frequency of non-infectious cases has increased significantly. CASE REPORT: A previously healthy eight-year-old male child with normal neurodevelopment, without a history of consanguinity, manifested progressive neurological deterioration with autoimmune encephalitis-limbic encephalitis up to hypothalamic dysfunction. CONCLUSION: In the mentioned case, it was documented that an inborn error of the immune system generated a severe neurological clinical picture, with permanent and irreversible damage, secondary to lack of immunological memory in the broad clinical context of a common variable immunodeficiency.
Antecedentes: La encefalitis autoinmune se presenta como un cuadro subagudo con fuerte asociación infecciosa en los niños. En los últimos 20 años, la frecuencia de casos no infecciosos ha aumentado de manera significativa Caso clínico: Niño del sexo masculino de ocho años de edad previamente sano con neurodesarrollo normal, sin antecedente de consanguinidad, en quien se manifestó deterioro neurológico progresivo, desde encefalitis autoinmune-encefalitis límbica hasta disfunción hipotalámica. Conclusión: En el caso referido se documentó un error innato del sistema inmunológico que generó cuadro clínico neurológico severo, con daño permanente e irreversible secundario a falta de memoria inmunológica en el contexto clínico amplio de una inmunodeficiencia común variable.
Asunto(s)
Enfermedades Autoinmunes , Encefalitis , Enfermedad de Hashimoto , Encefalitis Límbica , Niño , Encefalitis/diagnóstico , Encefalitis/etiología , Enfermedad de Hashimoto/complicaciones , Enfermedad de Hashimoto/diagnóstico , Humanos , Encefalitis Límbica/diagnóstico , Encefalitis Límbica/etiología , MasculinoRESUMEN
OBJECTIVE: This study aimed to investigate expressions and clinical significance of IL-17 and TNF-α after surgery in patients with Hashimoto's disease (HD) combined with thyroid cancer (TC). PATIENTS AND METHODS: From June 2010 to October 2012, 38 patients with HD combined with TC admitted to the oncology department of Tongji Hospital were selected as an experimental group, including three males and 35 females, aged 24-78 years. Forty adults undergoing physical examination during the same period were selected as a control group. All patients in the experimental group were given total endoscopic TC resection. Real-time fluorescence quantification (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA) were used to detect the expression levels of serum IL-17 and TNF-α before and 14 days after surgery. Patients with HD combined with TC were divided into high and low expression groups according to the median values of preoperative IL-17 mRNA and TNF-α mRNA. The relationship between IL-17, TNF-α, and prognosis of patients was analyzed through K-M survival curve. RESULTS: The concentrations of IL-17 and TNF-α in serum were also higher than those in control group 14 days after surgery (p < 0.05). qRT-PCT showed that the relative expressions of IL-17 and TNF-α in serum 14 days after surgery were higher than those in control group (p < 0.05). According to the relative expression median of mRNA in IL-17 and TNF-α before surgery, they were divided into high and low expression groups. It was found that the survival rate of high expression groups of IL-17 and TNF-α was lower than that of low expression groups (IL-17, p = 0.028; TNF-α, p = 0.014). CONCLUSIONS: The protein and mRNA of IL-17 and TNF-α in serum of HD patients with TC are higher than those of healthy control group. Expressions of IL-17 and TNF-α can be reduced by surgical resection of focal tissue. IL-17 and TNF-α may be used as potential prognostic indicators of HD patients with TC.
Asunto(s)
Enfermedad de Hashimoto/sangre , Interleucina-17/sangre , Neoplasias de la Tiroides/sangre , Factor de Necrosis Tumoral alfa/sangre , Adenocarcinoma Folicular/sangre , Adenocarcinoma Folicular/cirugía , Adulto , Carcinoma Medular/sangre , Carcinoma Medular/cirugía , Estudios de Casos y Controles , Cartilla de ADN , Ensayo de Inmunoadsorción Enzimática , Femenino , Enfermedad de Hashimoto/complicaciones , Enfermedad de Hashimoto/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Proteínas de Neoplasias/sangre , Pronóstico , ARN Mensajero/sangre , Estudios Retrospectivos , Cáncer Papilar Tiroideo/sangre , Cáncer Papilar Tiroideo/cirugía , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/mortalidad , Neoplasias de la Tiroides/cirugíaRESUMEN
Hypothyroidism caused by Hashimoto's thyroiditis is the most common reason for thyroid dysfunction in children. Our objective was to analyze its impact on final stature in relation to height and pubertal stage at the time of diagnosis in children younger than 18 years with severe autoimmune hypothyroidism. Out of 79 patients, 78.5 % were girls. Those with goiter (56 %) had a better height at diagnosis than those without goiter (mean standard deviation score for height: 0.2 versus -2.42; p < 0.0001). Five girls (6.3 %) had precocious puberty. When considering the final stature of patients (n: 33), among those with short stature at the time of diagnosis, pubertal children had a significantly shorter final stature than prepubertal children (mean standard deviation score for height: -2.82 versus -1.52; p = 0.0311). The late diagnosis of severe hypothyroidism in pediatrics has a negative impact on final stature, especially in those who were pubertal patients at the time of diagnosis.
El hipotiroidismo por tiroiditis de Hashimoto es la causa más frecuente de disfunción tiroidea en niños. Nuestro objetivo fue analizar el impacto en la talla final según la talla y el estadio puberal al momento del diagnóstico en menores de 18 años con hipotiroidismo grave de origen autoinmune. De los 79 pacientes, el 78,5 % fueron mujeres. Los que presentaron bocio (el 56 %) mostraron mejor talla en el diagnóstico que los que no lo tenían (puntaje de desvío estándar de media de talla: 0,2 vs. -2,42; p < 0,0001). Cinco niñas (el 6,3 %) presentaron pubertad precoz. De los pacientes con talla final (n: 33), dentro de los que presentaron talla baja al momento del diagnóstico, los púberes tuvieron una talla final significativamente menor que los prepúberes (puntaje de desvío estándar media: -2,82 vs. -1,52; p = 0,0311). El diagnóstico tardío de hipotiroidismo grave en pediatría tiene un impacto negativo en la talla final, especialmente, en los pacientes puberales al momento del diagnóstico.