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Laron Z, Shulman L, Hampe C, Blumenfeld O. Hypothesis: Viral infections of pregnant women may be early triggers of childhood type 1 diabetes and other autoimmune disease. J Autoimmun 2023; 135:102977. [PMID: 36621175 DOI: 10.1016/j.jaut.2022.102977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/06/2022] [Accepted: 12/06/2022] [Indexed: 01/09/2023]
Abstract
Children and adolescents with early onset autoimmune diseases have a different seasonality of month of birth than the general population. This pattern is consistent with an infection during pregnancy affecting the fetus or an infection immediately after birth that act as early triggers of the autoimmune diseases. We present data supporting the use of Rotavirus vaccinations in the reduction of incidence of childhood T1D and propose further investigations into whether other anti-virus vaccinations may reduce the burden of other autoimmune diseases such as multiple sclerosis, atopic dermatitis, psoriasis and subtypes of rheumatoid arthritis, Hashimoto thyroiditis.
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Affiliation(s)
- Zvi Laron
- Schneider Children's Medical Center, Israel.
| | - Lester Shulman
- Central Virology Laboratory, Public Health Services MOH, Israel
| | | | - Orit Blumenfeld
- Israel Center for Disease Control, Ministry of Health, Israel
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Lui DTW, Tsoi KH, Lee CH, Cheung CYY, Fong CHY, Lee ACH, Tam AR, Pang P, Ho TY, Law CY, Lam CW, To KKW, Chow WS, Woo YC, Hung IFN, Tan KCB, Lam KSL. A prospective follow-up on thyroid function, thyroid autoimmunity and long COVID among 250 COVID-19 survivors. Endocrine 2023; 80:380-391. [PMID: 36596904 PMCID: PMC9810240 DOI: 10.1007/s12020-022-03281-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/01/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE We evaluated the evolution of thyroid function and autoimmunity among COVID-19 survivors over 6 months in relation to interferon beta-1b treatment and long COVID. METHODS We included COVID-19 survivors managed in a major COVID-19 centre between July 2020 and May 2021 who were reassessed three and/or six months after acute COVID-19. Thyroid function tests (TFTs) and anti-thyroid antibody titres were measured at acute COVID-19, 3-month and 6-month. RESULTS 250 COVID-19 survivors were included (mean age 52.7 years, 50.4% men). Persistent thyroid function abnormalities were more likely in those with abnormal TFTs in acute COVID-19 (P < 0.001). Among 51 patients with abnormal TFTs in acute COVID-19, 82.4% resolved upon follow-up. Of 199 patients with normal TFTs in acute COVID-19, only 4.5% had incident abnormal TFTs, more likely in interferon-treated patients (P = 0.044) and none clinically overt. Among 129 patients with complete 6-month follow-up for anti-thyroid antibody titres, there was no significant change overall, except for modest increase in anti-thyroid antibody titres among the 84 interferon-treated patients (P < 0.05 at both 3 months and 6 months). Long COVID occurred in 19.5% and 10.4% at 3 and 6 months respectively, where TFTs and anti-thyroid antibody titres were not predictive of its occurrence. CONCLUSION Over 6 months, most abnormal TFTs in acute COVID-19 resolved, with no significant incident thyroid dysfunction. SARS-CoV-2 infection did not lead to change in thyroid autoimmunity, while interferon treatment was associated with modest increase in anti-thyroid antibody titres. Thyroid function and anti-thyroid antibodies did not play a significant role in long COVID.
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Affiliation(s)
- David Tak Wai Lui
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Kimberly Hang Tsoi
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Chi Ho Lee
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Chloe Yu Yan Cheung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Carol Ho Yi Fong
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Alan Chun Hong Lee
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Anthony Raymond Tam
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Polly Pang
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Tip Yin Ho
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Chun Yiu Law
- Division of Chemical Pathology, Queen Mary Hospital, Hong Kong, China
| | - Ching Wan Lam
- Department of Pathology, The University of Hong Kong, Hong Kong, China
| | - Kelvin Kai Wang To
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Wing Sun Chow
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Yu Cho Woo
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Ivan Fan Ngai Hung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Kathryn Choon Beng Tan
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Karen Siu Ling Lam
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
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Ramos-Leví AM, Collado G, Marazuela M. Seasonality of month of birth in patients with autoimmune endocrine diseases: A systematic review. ENDOCRINOL DIAB NUTR 2022; 69:779-790. [PMID: 36526353 DOI: 10.1016/j.endien.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/26/2021] [Indexed: 06/17/2023]
Abstract
BACKGROUND Exposure to seasonal environmental factors during gestation or early in the postnatal period could influence the development of autoimmunity, determining a seasonality in the month of birth (MOB). There are studies evaluating this potential seasonality in patients with type 1 diabetes (T1D), autoimmune thyroid diseases (AITD), and Addison's disease (ADD), but results have been controversial. METHODS Systematic review according to PRISMA guidelines, using PubMed, Web of Science and WorldCat databases (2005-2020) of studies that explored the association between the seasonality of the MOB and T1D, AITD and ADD. Information on sex and age, location, methodology and internal quality, seasonal patterns, hypotheses and other factors proposed to explain seasonality were extracted. Differences in season and month of birth were further discussed. RESULTS The initial search retrieved 300 articles, and after further screening, 11 articles fulfilled inclusion criteria and were finally selected and reviewed. 73% found a seasonal pattern and 64% showed birth peaks in spring and/or summer. Hashimoto's thyroiditis and women exhibited a higher seasonality. Ultraviolet radiation, Vitamin D levels and viral infections were identified as influencing factors. CONCLUSIONS The effect of certain seasonal factors during foetal development, reflected by the seasonal differences in the MOB, could contribute to the development of endocrine autoimmune diseases in predisposed patients. Further research is needed to elucidate the mechanisms underlying the observed seasonality.
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Affiliation(s)
- Ana M Ramos-Leví
- Department of Endocrinology and Nutrition, Hospital Universitario La Princesa, Instituto de Investigación Princesa, Universidad Autónoma, C/ Diego de León 62, 28006 Madrid, Spain.
| | - Gloria Collado
- Department of Endocrinology and Nutrition, Hospital Universitario La Princesa, Instituto de Investigación Princesa, Universidad Autónoma, C/ Diego de León 62, 28006 Madrid, Spain
| | - Monica Marazuela
- Department of Endocrinology and Nutrition, Hospital Universitario La Princesa, Instituto de Investigación Princesa, Universidad Autónoma, C/ Diego de León 62, 28006 Madrid, Spain
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Skov J, Kuja-Halkola R, Magnusson PKE, Gudbjörnsdottir S, Kämpe O, Bensing S. Shared etiology of type 1 diabetes and Hashimoto's thyroiditis: a population-based twin study. Eur J Endocrinol 2022; 186:677-685. [PMID: 36321757 PMCID: PMC9175555 DOI: 10.1530/eje-22-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Type 1 diabetes and Hashimoto's thyroiditis frequently cluster in individuals and in families, indicating shared origins. The objective of this study was to investigate familial co-aggregation of these diseases and to quantify shared genetic and environmental factors. DESIGN This study is a twin cohort study. METHODS National health registers were used to identify cases among 110 814 Swedish twins. Co-aggregation was calculated as risk ratios for type 1 diabetes among co-twins of individuals with Hashimoto's thyroiditis, and vice-versa. Variance explained by genetics (i.e. heritability), and the proportions thereof shared between the diseases, was estimated by contrasting associations in monozygotic and dizygotic twins using structural equation models. RESULTS Individuals with one disease were at a high risk for the other disease (adjusted risk ratio: 11.4 (95% CI: 8.5-15.3)). Co-aggregation was more common in monozygotic than in dizygotic pairs, with adjusted risk ratios of 7.0 (95% CI: 3.2-15.1) and 1.7 (95% CI: 0.7-4.1), respectively. Genetic effects shared across diseases accounted for 11% of the variance for type 1 diabetes and 9% of the variance for Hashimoto's thyroiditis, while environmental factors unique to individual twins, but shared across diseases, accounted for 10% of the variance for type 1 diabetes and 18% of the variance for Hashimoto's thyroiditis. CONCLUSIONS Both genes and environment unique to individual twins contribute to considerable etiologic overlap between type 1 diabetes and Hashimoto's thyroiditis. These findings add to the current knowledge on the mechanisms behind autoimmune disease clustering and could guide future research aimed at identifying pathophysiological mechanisms and intervention targets.
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Affiliation(s)
- Jakob Skov
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Karlstad Central Hospital, Karlstad, Sweden
- Correspondence should be addressed to J Skov;
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Soffia Gudbjörnsdottir
- Institute of Medicine, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
- National Diabetes Register, Centre of Registers, Gothenburg, Sweden
| | - Olle Kämpe
- Center for Molecular Medicine, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
- K.G. Jebsen Center for Autoimmune Diseases, University of Bergen, Bergen, Norway
| | - Sophie Bensing
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
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Davis GE, Davis MJ, Lowell WE. The effect of ultraviolet radiation on the incidence and severity of major mental illness using birth month, birth year, and sunspot data. Heliyon 2022; 8:e09197. [PMID: 35368522 PMCID: PMC8969152 DOI: 10.1016/j.heliyon.2022.e09197] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/06/2021] [Accepted: 03/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background and objectives The evaluation of the severity of patients afflicted with major mental illness (MMI) has been problematic because of confounding variables and genetic variability. There have been multiple studies that suggest several human diseases, especially schizophrenia, are predisposed to be born in certain months or seasons. This observation implied an epigenetic effect of sunlight, likely ultraviolet radiation (UVR), which is damaging to DNA, especially in an embryo. This paper outlines a method to evaluate the severity of schizophrenia (SZ), bipolar disorder (BPD), and schizoaffective disorder (SZ-AFF) using the month/year of birth of those affected compared to the month/year of birth of the general population (GP). Relevance Our previous research found that more intense UVR (equal to or greater than 90 sunspot number (SSN)) had a negative effect on the average human lifespan. Also, human birth rates vary in frequency by month of birth reflecting variables like availability of food, sunlight, and other unknown epigenetic factors. We wanted to see if the patient month of birth varied from the average birth months of the general population and if UVR has an epigenetic effect promoting these diseases. Methods We obtained the month and year of birth of 1,233 patients admitted over a 15-year period to Maine's largest state psychiatric hospital and counted the months of birth for each diagnosis of SZ, BPD, and SZ-AFF, and compared these results to the general population's birth months of 4,265,555 persons from U. S. Census Year 2006. The number of patients in each month was normalized to August and compared with the normalized birth months of the general population (GP). Plots of the normalized months were considered rates of change (e.g., derivatives) and their respective integrals gave domains of each mental illness relative to the GP. Normalizing the GP to unity was then related to the factor 1.28, e.g., 28% more entropy, deduced from the Sun's fractal dimension imprinted on biological organisms. Results The percent of patients meeting our criterion for severity: SZ = 27%; BPD = 26%; SZ-AFF = 100%. Conclusions High UVR intensity or a rapid increase in UVR in early gestation are likely epigenetic triggers of major mental illness. BPD is more epigenetically affected than SZ or SZ-AFF disorders. We found that 52% of 1,233 patients comprised the core function of a tertiary-care psychiatric hospital. Also, mental illness exacerbated when the median SSN doubled. This work also validates the Kraeplinian dichotomy. What is new in this research This paper offers a new paradigm for evaluating the severity of MMI and supports significant epigenetic effects from UVR.
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Affiliation(s)
- George E Davis
- Riverview Psychiatric Center, 250 Arsenal Street, State House Station #11, Augusta, Maine, 04333-0011, USA
| | - Matthew J Davis
- Riverview Psychiatric Center, 250 Arsenal Street, State House Station #11, Augusta, Maine, 04333-0011, USA
| | - Walter E Lowell
- Riverview Psychiatric Center, 250 Arsenal Street, State House Station #11, Augusta, Maine, 04333-0011, USA
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Seasonality of month of birth in patients with autoimmune endocrine diseases: A systematic review. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Dave I, Estroff B, Gergely T, Rostad CA, Ponder LA, McCracken C, Prahalad S. Impact of the Season of Birth on the Development of Juvenile Idiopathic Arthritis in the United States: A Nationwide Registry-based Study. J Rheumatol 2021; 48:1856-1862. [PMID: 34329181 DOI: 10.3899/jrheum.201238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Autoimmune disorders result from the interplay of genetic and environmental factors. Many autoimmune disorders are associated with specific seasons of birth, implicating a role for environmental determinants in their etiopathology. We investigated if there is an association between the season of birth and the development of juvenile idiopathic arthritis ( JIA). METHODS Birth data from 10,913 children with JIA enrolled at 62 Childhood Arthritis and Rheumatology Research Alliance Registry sites was compared with 109,066,226 US births from the same period using a chi‑square goodness-of-fit test. Season of birth of the JIA cohort was compared to the US population estimate using a 2-sided 1-sample test for a binomial proportion and corrected for multiple comparisons. Secondary analysis was performed for JIA categories, age of onset, and month of birth. RESULTS A greater proportion of children with JIA were born in winter (January-March) compared to the US general population (25.72% vs 24.08%; corrected P < 0.0001). This observation was also true after stratifying for age of onset (≤ or > 6 yrs). When analyzed by the month of birth, a greater proportion of children with JIA were born in January compared to the US population (9.44% vs 8.13%; corrected P < 0.0001). CONCLUSION Relative to the general population, children with JIA are more often born in the winter, and specifically in the month of January. These observations support the hypothesis that seasonal variations in exposures during the gestational and/or early postnatal periods may contribute to development of JIA.
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Affiliation(s)
- Ishaan Dave
- SP is supported in part by a grant from The Marcus Foundation Inc., Atlanta, and also serves on a Macrophage Activation Syndrome Advisory Committee for Novartis pharmaceuticals. I. Dave, MSPH, B. Estroff, MD, T. Gergely, BS, C. McCracken, PhD, Department of Pediatrics, Emory University School of Medicine; C.A. Rostad, MD, Department of Pediatrics, Division of Infectious diseases, Emory University School of Medicine, and Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta; L.A. Ponder, BS, Department of Human Genetics, Emory University School of Medicine; S. Prahalad, MD, MSc, Department of Pediatrics, Department of Human Genetics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA. I. Dave and B. Estroff contributed equally. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Prahalad, Marcus Professor and Chief of Pediatric Rheumatology, Emory University School of Medicine, 1760 Haygood Drive NE, Atlanta, GA 30322 USA. . Accepted for publication June 7, 2021
| | - Brandon Estroff
- SP is supported in part by a grant from The Marcus Foundation Inc., Atlanta, and also serves on a Macrophage Activation Syndrome Advisory Committee for Novartis pharmaceuticals. I. Dave, MSPH, B. Estroff, MD, T. Gergely, BS, C. McCracken, PhD, Department of Pediatrics, Emory University School of Medicine; C.A. Rostad, MD, Department of Pediatrics, Division of Infectious diseases, Emory University School of Medicine, and Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta; L.A. Ponder, BS, Department of Human Genetics, Emory University School of Medicine; S. Prahalad, MD, MSc, Department of Pediatrics, Department of Human Genetics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA. I. Dave and B. Estroff contributed equally. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Prahalad, Marcus Professor and Chief of Pediatric Rheumatology, Emory University School of Medicine, 1760 Haygood Drive NE, Atlanta, GA 30322 USA. . Accepted for publication June 7, 2021
| | - Talia Gergely
- SP is supported in part by a grant from The Marcus Foundation Inc., Atlanta, and also serves on a Macrophage Activation Syndrome Advisory Committee for Novartis pharmaceuticals. I. Dave, MSPH, B. Estroff, MD, T. Gergely, BS, C. McCracken, PhD, Department of Pediatrics, Emory University School of Medicine; C.A. Rostad, MD, Department of Pediatrics, Division of Infectious diseases, Emory University School of Medicine, and Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta; L.A. Ponder, BS, Department of Human Genetics, Emory University School of Medicine; S. Prahalad, MD, MSc, Department of Pediatrics, Department of Human Genetics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA. I. Dave and B. Estroff contributed equally. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Prahalad, Marcus Professor and Chief of Pediatric Rheumatology, Emory University School of Medicine, 1760 Haygood Drive NE, Atlanta, GA 30322 USA. . Accepted for publication June 7, 2021
| | - Christina A Rostad
- SP is supported in part by a grant from The Marcus Foundation Inc., Atlanta, and also serves on a Macrophage Activation Syndrome Advisory Committee for Novartis pharmaceuticals. I. Dave, MSPH, B. Estroff, MD, T. Gergely, BS, C. McCracken, PhD, Department of Pediatrics, Emory University School of Medicine; C.A. Rostad, MD, Department of Pediatrics, Division of Infectious diseases, Emory University School of Medicine, and Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta; L.A. Ponder, BS, Department of Human Genetics, Emory University School of Medicine; S. Prahalad, MD, MSc, Department of Pediatrics, Department of Human Genetics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA. I. Dave and B. Estroff contributed equally. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Prahalad, Marcus Professor and Chief of Pediatric Rheumatology, Emory University School of Medicine, 1760 Haygood Drive NE, Atlanta, GA 30322 USA. . Accepted for publication June 7, 2021
| | - Lori A Ponder
- SP is supported in part by a grant from The Marcus Foundation Inc., Atlanta, and also serves on a Macrophage Activation Syndrome Advisory Committee for Novartis pharmaceuticals. I. Dave, MSPH, B. Estroff, MD, T. Gergely, BS, C. McCracken, PhD, Department of Pediatrics, Emory University School of Medicine; C.A. Rostad, MD, Department of Pediatrics, Division of Infectious diseases, Emory University School of Medicine, and Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta; L.A. Ponder, BS, Department of Human Genetics, Emory University School of Medicine; S. Prahalad, MD, MSc, Department of Pediatrics, Department of Human Genetics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA. I. Dave and B. Estroff contributed equally. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Prahalad, Marcus Professor and Chief of Pediatric Rheumatology, Emory University School of Medicine, 1760 Haygood Drive NE, Atlanta, GA 30322 USA. . Accepted for publication June 7, 2021
| | - Courtney McCracken
- SP is supported in part by a grant from The Marcus Foundation Inc., Atlanta, and also serves on a Macrophage Activation Syndrome Advisory Committee for Novartis pharmaceuticals. I. Dave, MSPH, B. Estroff, MD, T. Gergely, BS, C. McCracken, PhD, Department of Pediatrics, Emory University School of Medicine; C.A. Rostad, MD, Department of Pediatrics, Division of Infectious diseases, Emory University School of Medicine, and Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta; L.A. Ponder, BS, Department of Human Genetics, Emory University School of Medicine; S. Prahalad, MD, MSc, Department of Pediatrics, Department of Human Genetics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA. I. Dave and B. Estroff contributed equally. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Prahalad, Marcus Professor and Chief of Pediatric Rheumatology, Emory University School of Medicine, 1760 Haygood Drive NE, Atlanta, GA 30322 USA. . Accepted for publication June 7, 2021
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Abstract
It is 70 years since Noel Rose embarked on his pioneering studies that lead to the discovery of autoimmune thyroiditis and the elucidation of Hashimoto's thyroiditis. This short review to honour his passing focuses on the developments in our understanding of the causes and pathogenesis of HT over the last five years. Recent genetic studies have reported heritability estimates for HT and associated diseases for the first time, and emphasised the complexity of the genetic factors involved, including monogenic forms of HT. Environmental factors continue to be elucidated, especially as a side effect of drugs which modulate the immune system therapeutically. Regarding pathogenetic mechanisms, multiple cytokine networks have been identified which involve the thyroid cells in a circuit of escalating proinflammatory effects, such as the expression of inflammasome components, and an array of different defects in T regulatory cells may underlie the loss of self-tolerance to thyroid autoantigens. Finally, a number of studies have revealed fresh insights into disease associations with HT which may have both pathological and clinical significance, the most intriguing of which is a possible direct role of the autoimmune process itself in causing some of the persistent symptoms reported by a minority of patients with levothyroxine-treated HT.
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Affiliation(s)
- A P Weetman
- Department of Oncology and Metabolism, Faculty of Medicine, Dentistry and Health, University of Sheffield, The Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
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Vieira IH, Rodrigues D, Paiva I. Vitamin D and Autoimmune Thyroid Disease-Cause, Consequence, or a Vicious Cycle? Nutrients 2020; 12:E2791. [PMID: 32933065 PMCID: PMC7551884 DOI: 10.3390/nu12092791] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 12/13/2022] Open
Abstract
Vitamin D is a steroid hormone traditionally connected to phosphocalcium metabolism. The discovery of pleiotropic expression of its receptor and of the enzymes involved in its metabolism has led to the exploration of the other roles of this vitamin. The influence of vitamin D on autoimmune disease-namely, on autoimmune thyroid disease-has been widely studied. Most of the existing data support a relationship between vitamin D deficiency and a greater tendency for development and/or higher titers of antibodies linked to Hashimoto's thyroiditis, Graves' disease, and/or postpartum thyroiditis. However, there have also been some reports contradicting such relationships, thus making it difficult to establish a unanimous conclusion. Even if the existence of an association between vitamin D and autoimmune thyroid disease is assumed, it is still unclear whether it reflects a pathological mechanism, a causal relationship, or a consequence of the autoimmune process. The relationship between vitamin D's polymorphisms and this group of diseases has also been the subject of study, often with divergent results. This text presents a review of the recent literature on the relationship between vitamin D and autoimmune thyroid disease, providing an analysis of the likely involved mechanisms. Our thesis is that, due to its immunoregulatory role, vitamin D plays a minor role in conjunction with myriad other factors. In some cases, a vicious cycle is generated, thus contributing to the deficiency and aggravating the autoimmune process.
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Affiliation(s)
- Inês Henriques Vieira
- Endocrinology Department of Coimbra Hospital and University Centre, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal; (D.R.); (I.P.)
| | - Dírcea Rodrigues
- Endocrinology Department of Coimbra Hospital and University Centre, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal; (D.R.); (I.P.)
- Faculty of Medicine of the University of Coimbra, R. Larga 2, 3000-370 Coimbra, Portugal
| | - Isabel Paiva
- Endocrinology Department of Coimbra Hospital and University Centre, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal; (D.R.); (I.P.)
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Skov J, Sundström A, Ludvigsson JF, Kämpe O, Bensing S. Sex-Specific Risk of Cardiovascular Disease in Autoimmune Addison Disease-A Population-Based Cohort Study. J Clin Endocrinol Metab 2019; 104:2031-2040. [PMID: 30608542 PMCID: PMC6469226 DOI: 10.1210/jc.2018-02298] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 12/28/2018] [Indexed: 12/03/2022]
Abstract
CONTEXT Little is known of cardiovascular disease (CVD) in autoimmune Addison disease (AAD). Inadequate glucocorticoid replacement might potentially increase CVD risk. OBJECTIVE To examine CVD in AAD in subgroups of ischemic heart disease (IHD) and cerebrovascular disease (CeVD) and investigate the effects of glucocorticoid and mineralocorticoid dosing. DESIGN, SETTING, AND PATIENTS In this cohort-control study, we used Swedish health registries from 1964 to 2013 to identify 1500 subjects with AAD and 13,758 matched controls. Incident CVD was analyzed from 2006 to 2013. Adjusted hazard ratios (aHRs) were calculated using Cox proportional hazard models. Glucocorticoid and mineralocorticoid doses were stratified to examine dose-related risks. RESULTS During 8807 person-years (PY), 94 events of first CVD (10.7/1000 PY) in patients with AAD occurred compared with 563 events during 80,163 PY (7.0/1000 PY) in controls. IHD was significantly more common in women (aHR, 2.15; 95% CI, 1.49 to 3.10) but not men (aHR, 1.16; 95% CI, 0.75 to 1.78) with AAD compared with controls. No increase in CeVD risk was detected (aHR, 0.88; 95% CI, 0.56 to 1.37, women; aHR, 0.88; 95% CI 0.53 to 1.50, men). CVD was associated with greater glucocorticoid and mineralocorticoid replacement doses in women but not men. CONCLUSION The risk of IHD but not CeVD is increased in AAD, especially in women. The risk of CVD independently correlated with greater glucocorticoid and mineralocorticoid replacement doses in women. Our data suggest that close monitoring and early treatment of risk factors for CVD, among women in particular, might be warranted.
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Affiliation(s)
- Jakob Skov
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anders Sundström
- Centre for Pharmacoepidemiology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Olle Kämpe
- Center for Molecular Medicine, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- K.G. Jebsen Center for Autoimmune Diseases, University of Bergen, Bergen, Norway
| | - Sophie Bensing
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
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Kyrgios I, Giza S, Tsinopoulou VR, Maggana I, Haidich AB, Galli-Tsinopoulou A. Seasonality of month of birth in children and adolescents with autoimmune thyroiditis: a continuing conundrum. J Pediatr Endocrinol Metab 2018; 31:1123-1131. [PMID: 30226206 DOI: 10.1515/jpem-2018-0051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 08/13/2018] [Indexed: 12/17/2022]
Abstract
Background The aim of this study was to analyze the seasonal birth month pattern in young patients with autoimmune thyroiditis and compare it with youth controls. Methods Medical records of a total of 298 children and adolescents of Greek origin, with a diagnosis of Hashimoto thyroiditis (HT) before the age of 21 years that were born from 1987 to 2010 were retrospectively reviewed. In addition, 298 consecutive subjects that were born from 1988 to 2012 and evaluated in a tertiary unit for any reason, served as controls, provided that they had no personal or family history of thyroid or any other autoimmune disease. Results Significant differences were found between children and adolescents with HT and healthy controls in the yearly pattern of month of birth distribution (p=0.029). During month-by-month analysis, it was shown that the highest and lowest predispositions to HT were among those born in spring (March) (odds ratio [OR] 2.34, p=0.005), and autumn (November) (OR 0.49, p=0.035), respectively. A binary logistic regression model also revealed that season of birth and sex were the only factors that remained related to HT disease, even after adjustment for confounding factors such as year of birth and age (p<0.001, Nagelkerke r-square 0.151). Conclusions This study suggests that the effect of certain seasonal factors during fetal development, reflected by the seasonal differences in birth pattern, in children and adolescents with autoimmune thyroiditis could contribute to long-term programming of an autoimmune response against the thyroid gland. Further studies are needed to demonstrate a clear cause and effect relationship between month of birth and HT.
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Affiliation(s)
- Ioannis Kyrgios
- 4th Department of Pediatrics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Styliani Giza
- 4th Department of Pediatrics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Vasiliki Rengina Tsinopoulou
- 4th Department of Pediatrics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Ioanna Maggana
- 4th Department of Pediatrics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Laboratory of Hygiene and Epidemiology, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, University Campus, Thessaloniki, Greece
| | - Assimina Galli-Tsinopoulou
- 4th Department of Pediatrics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
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Mel'nichenko GA, Larina II. Syndrome of thyrotoxicosis. Differential diagnosis and treatment. TERAPEVT ARKH 2018; 90:4-23. [DOI: 10.26442/terarkh201890104-13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Since the middle of the twentieth century, there has been a significant change in methods of the diagnosis and treatment of thyroid diseases with thyrotoxicosis syndrome. Previously doctors did not have trouble just with diagnosing diseases that occur with a typical clinical presentation (the Merzeburg triad, a multinodal goiter with fibrillation) because of no possible to determine thyroid hormones. Then in the early 70s years the appearance of immunological methods for estimating hormones in the blood has led to significant changes in our understanding of the variants of thyroid pathology with thyrotoxicosis (TT). Today, the diagnosis of the fact of thyrotoxicosis as a whole is not difficult (except for the confusion of preanalytical errors), but differential diagnosis within the declared syndrome remains extremely relevant to this day. Unfortunately, in the minds of many doctors, these diseases are sometimes perceived as a whole, and in the conditions of the "century of speeds", a modern doctor, extremely limited in time, often unjustifiably prescribes thyreostatic therapy, treatment with radioactive iodine or even surgical intervention after detecting thyrotoxicosis. The old truth "remember that a patient with thyrotoxicosis is a person with a sick heart..." has not lost relevance today. It is very important for the practicing physician be able to navigate in the spectrum of pathologies manifested by the thyrotoxicosis pattern because of the influence of excess thyroid hormones on the cardiovascular system and the hemostasis system. Hereinafter we tried to show diagnostic aspects focusing on differences in pathologies with TT syndrome in a lot of thyroid diseases and even nonthyroid diseases.
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Sivalingam S, Thvilum M, Brix TH, Hegedüs L, Brandt F. No link between season of birth and subsequent development of Graves' disease or toxic nodular goitre: a nationwide Danish register-based study. Endocr Connect 2018; 7:EC-18-0185. [PMID: 30139815 PMCID: PMC6198190 DOI: 10.1530/ec-18-0185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/31/2018] [Accepted: 08/23/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Season of birth, an exogenous indicator of early life environment, has been linked with a higher risk of adverse health outcomes such as autoimmune thyroiditis, multiple sclerosis and schizophrenia later in life. Whether the development and cause of hyperthyroidism is influenced by season of birth is unclarified. We aimed, at a nationwide level, to investigate whether season of birth influences the risk of hyperthyroidism due to Graves' disease (GD) and/or toxic nodular goitre (TNG). METHOD Register-based nationwide cohort study. By record-linkage between Danish health registers, 36,087 and 20,537 patients with GD and TNG, respectively, were identified. Each case was matched with four controls without thyroid disease, according to age and sex. Differences in month-of-birth across the year were evaluated by the Walter-Elwood test. Hazard ratios, for the risk of GD and TNG in individuals born in a certain month or season of the year, were calculated using Cox regression models. RESULTS Neither for GD nor for TNG could we demonstrate a significant difference in birth rate across months or seasons of the year (Walter-Elwood's test; X2 = 5.92 and X2 = 1.27, p = 0.052 and p=0.53, respectively). CONCLUSION Irrespective of its cause, our findings do not support the hypothesis that season of birth is significantly related to the development of hyperthyroidism.
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Affiliation(s)
- Suvanjaa Sivalingam
- S Sivalingam, Department of Internal Medicine, Hospital of Southern Jutland, Sønderborg, Denmark
| | - Marianne Thvilum
- M Thvilum, Department of Endocrinology and Metabolism, Odense University Hospital, Odense, 5000, Denmark
| | - Thomas Heiberg Brix
- T Brix, Department of Endocrinology and Metabolism, Odense University Hospital, Odense C, 5000, Denmark
| | - Laszlo Hegedüs
- L Hegedüs, Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Frans Brandt
- F Brandt, Department of Internal Medicine, Hospital of Southern Jutland, Sønderborg, Denmark
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