In Graves' disease, thyroid autoantibodies and ultrasound features correlate with distinctive histological features

Are sonographic characteristics of Hashimoto's thyroiditis related with immunologic parameters? A cross-sectional study

BACKGROUND

The clinical, laboratory, and imaging characteristics of Hashimoto's thyroiditis are widely recognized. However, there is a dearth of information concerning the relationship between these aspects. The primary objective of this study was to investigate the correlation between sonographic features and immunologic parameters in individuals with Hashimoto's thyroiditis.

METHODS

This cross-sectional study enrolled a cohort of 100 consecutive patients diagnosed with Hashimoto's thyroiditis. Ultrasonography was performed to classify thyroid gland characteristics, including parenchymal heterogeneity (mild/moderate-to-high), extent of fibrosis (none-to-mild/moderate-to-high), and volume (atrophic/non-atrophic). As for immunologic parameters, thyroid autoantibodies (TOA; anti-TPO and anti-Tg), along with IG (immunoglobulin) G4 levels and lymphocyte subsets, were assessed.

RESULTS

Of the 100 patients evaluated, 88 were female (88%) and 12 were male (12%). IgG4/IgG ratio and weekly levothyroxine (LT4) dose were significantly higher in the group with moderate-to-high heterogeneity than the group with mild parenchymal heterogeneity (p = 0.043 and p < 0.001, respectively). Compared to the group with none-to-mild fibrosis, the anti-TPO, IgG4, IgG4/IgG ratio and LT4 dose were significantly higher in the moderate-to-high fibrosis group. Anti-TPO and IgG levels were significantly lower in the atrophic thyroid group compared to the non-atrophic thyroid group. Although not reaching statistical significance, the proportion of plasma cells in the moderate/high fibrosis group was higher than in the non-fibrosis/mild fibrosis group. There was a moderate positive correlation between fibrosis with Anti-TPO, and a low positive correlation between anti-Tg, IgG4 levels with IgG4/IgG ratio.

CONCLUSION

TOA, Ig G4 levels and severity of hypothyroidism were associated with ultrasonographic features such as parenchymal heterogeneity and fibrosis in Hashimoto's thyroiditis.

Association of autoimmune thyroid disease with type 1 diabetes mellitus and its ultrasonic diagnosis and management

As a common hyperglycemic disease, type 1 diabetes mellitus (T1DM) is a complicated disorder that requires a lifelong insulin supply due to the immune-mediated destruction of pancreatic β cells. 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 hypo-thyroidism [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.