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Petranović Ovčariček P, Görges R, Giovanella L. Autoimmune Thyroid Diseases. Semin Nucl Med 2024; 54:219-236. [PMID: 38044176 DOI: 10.1053/j.semnuclmed.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/02/2023] [Accepted: 11/11/2023] [Indexed: 12/05/2023]
Abstract
Autoimmune thyroid diseases (AITDs) include a wide spectrum of thyroid diseases affecting more commonly women than men. The most frequent forms are Graves' Disease (GD) and Hashimoto's thyroiditis / Autoimmune Thyroiditis (AIT), but there are also other immunogenic destructive forms of thyroiditis, that is, silent and postpartum thyroiditis. In the last decade, AITDs and other inflammatory thyroid diseases related to anti-tumor molecular drugs are more frequently seen due to the widespread use of tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICPIs). Autoimmune thyroiditis related to SARS-CoV-2 infection has been a novel entity in recent years. Graves' Disease and AIT may shift from hyperthyroidism to hypothyroidism, which may complicate the differential diagnosis and further treatment strategy. Moreover, all AITDs may manifest with thyrotoxicosis (a clinical condition marked with high serum levels of thyroid hormones) which has to be distinguished from hyperthyroidism (increased thyroid hormone production and secretion as a result of hyperfunctioning thyroid gland) due to different therapeutic approaches. Nuclear medicine techniques, such as radioiodine uptake (RAIU) and thyroid scintigraphy, using 99mTc- pertechnetate (Na[99mTc]TcO4) or 123-Iodine (Na[123I]I), have a crucial role in the differential diagnosis. Measurement of thyroid antibodies, e.g. thyroid peroxidase antibodies (TPO) and thyrotropin receptor antibodies (TRAb), as well as thyroid ultrasound, are complementary methods in the evaluation of thyroid disorders.
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Affiliation(s)
- Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia.
| | - Rainer Görges
- Department of Nuclear Medicine, University Hospital of Essen, Essen, Germany
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Clinic for Nuclear Medicine, University Hospital and University of Zürich, Zürich, Switzerland
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2
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Stancu AM, Alexandrescu D, Badiu C. Effects of block-replace regimen in patients with autoimmune hypothyroidism converted to Graves' disease. Hormones (Athens) 2024; 23:107-111. [PMID: 37831339 DOI: 10.1007/s42000-023-00496-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/04/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE We present two cases of autoimmune hypothyroidism converted to Graves' disease (GD) and their medical management. METHODS We tested thyroid function and thyroid antibodies and performed an ophthalmologic examination and neck ultrasound in two patients with autoimmune hypothyroidism converted to GD during a follow-up of several years. CASE REPORTS The first case is a 33 year-old woman with hypothyroidism due to Hashimoto's thyroiditis (HT). She developed signs and symptoms of hyperthyroidism after 7 years of treatment with the same dose of levothyroxine (LT4). Even when LT4 therapy was discontinued, she remained thyrotoxic, with mild Graves' ophthalmopathy (GO) and very high thyroid-stimulating hormone receptor antibodies (TRAb > 40 IU/L, reference range: <1.75 IU/L). Antithyroid medication was started on a titration regimen, without achievement of euthyroidism. She was switched to a block and replace regimen, using 20 mg of methimazole (MMI) and 75 mcg of LT4 daily, with normalization of thyroid hormones and improvement of GO without steroids. The second case is a 57 year-old man with a 2-year positive medical history of HT and 6 months of LT4 treatment. He developed hyperthyroidism and moderate-severe GO. Despite stopping LT4 and initiating antithyroid medication in a titration regimen, he did not achieve euthyroidism and had active GO. Pulse glucocorticoid therapy and switching to a block-replace regimen was required to achieve euthyroidism and reduce ocular proptosis and diplopia. CONCLUSION Spontaneous autoimmune conversion of hypothyroidism to hyperthyroidism can occur at any time: it is important to promptly identify these cases so as to manage them effectively.
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Affiliation(s)
- Ana-Maria Stancu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
- "C.I.Parhon" National Institute of Endocrinology, Bd. Aviatorilor, no. 34-36, sector 1, 011863, Bucharest, Romania.
| | - Daniela Alexandrescu
- "C.I.Parhon" National Institute of Endocrinology, Bd. Aviatorilor, no. 34-36, sector 1, 011863, Bucharest, Romania
| | - Corin Badiu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- "C.I.Parhon" National Institute of Endocrinology, Bd. Aviatorilor, no. 34-36, sector 1, 011863, Bucharest, Romania
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3
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Alnahdi H. The Thyroid Swing: A Patient's Journey From Hypothyroidism to Hyperthyroidism. Cureus 2024; 16:e52598. [PMID: 38374853 PMCID: PMC10875210 DOI: 10.7759/cureus.52598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2024] [Indexed: 02/21/2024] Open
Abstract
The flip from hyperthyroidism (HT), as observed in Graves' disease (GD) cases, to hypothyroidism associated with Hashimoto's disease (HD) has been widely recognized and documented. However, the converse is infrequently observed. The observed phenomenon is likely attributed to the major role played by thyroid-stimulating hormone receptor antibodies (TRAbs) in this alternating disease pattern and a substantial reduction in thyroid tissue mass that could be stimulated by these antibodies. Therefore, here we present a case of one middle-aged individual experiencing this transitional switch from hypothyroidism to GD. A 42-year-old male patient diagnosed with HD-related hypothyroidism for two years has remained stable with levothyroxine medication since diagnosis. However, his symptoms of thyrotoxicosis, such as anxiety, weight loss, and palpitations, had appeared during his follow-up time at the clinic. Physical examination revealed mild exophthalmos, which confirmed HT by thyroid function test results. The possibility of levothyroxine-induced HT was initially considered, although the observed symptoms failed to ameliorate despite the reduction and discontinuation of levothyroxine. The diagnosis of GD was confirmed after subsequent examination, and a follow-up was carried out. This particular case study underscores a distinctive correlation that carries substantial implications for the diagnosis and treatment of GD. The consideration of this shift is warranted in cases where HT continues to exist despite the reduction or cessation of levothyroxine treatment. The diagnosis is established through antibody titers and a radioiodine uptake scan. Treatment choice is based on the illness's stage and the patient's and care provider's preferences. In the initial phase, anti-thyroid medications may be employed. It is imperative to conduct regular follow-ups on these patients due to the potential transient nature of this clinical condition.
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Affiliation(s)
- Haifa Alnahdi
- Department of Internal Medicine, Endocrinology and Metabolism, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
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4
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Guo M, Li Q, Liu X, Wang Y, Yang Q, Li R, Zhao Y, Li C, Sheng S, Ma H, Li Z, Gao R. Mapping the path towards novel treatment strategies: a bibliometric analysis of Hashimoto's thyroiditis research from 1990 to 2023. Front Endocrinol (Lausanne) 2023; 14:1277739. [PMID: 38027117 PMCID: PMC10667915 DOI: 10.3389/fendo.2023.1277739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background Hashimoto's thyroiditis (HT), a common form of thyroid autoimmunity, is strongly associated with deteriorating clinical status and impaired quality of life. The escalating global prevalence, coupled with the complexity of disease mechanisms, necessitates a comprehensive, bibliometric analysis to elucidate the trajectory, hotspots, and future trends in HT research. Objective This study aims to illuminate the development, hotspots, and future directions in HT research through systematic analysis of publications, institutions, authors, journals, references, and keywords. Particular emphasis is placed on novel treatment strategies for HT and its complications, highlighting the potential role of genetic profiling and immunomodulatory therapies. Methods We retrieved 8,726 relevant documents from the Web of Science Core Collection database spanning from 1 January 1990 to 7 March 2023. Following the selection of document type, 7,624 articles were included for bibliometric analysis using CiteSpace, VOSviewer, and R software. Results The temporal evolution of HT research is categorized into three distinct phases: exploration (1990-1999), rapid development (1999-2000), and steady growth (2000-present). Notably, the United States, China, Italy, and Japan collectively contributed over half (54.77%) of global publications. Among the top 10 research institutions, four were from Italy (4/10), followed by China (2/10) and the United States (2/10). Recent hotspots, such as the roles of gut microbiota, genetic profiling, and nutritional factors in HT management, the diagnostic dilemmas between HT and Grave's disease, as well as the challenges in managing HT complicated by papillary thyroid carcinoma and type 1 diabetes mellitus, are discussed. Conclusion Although North America and Europe have a considerable academic impact, institutions from emerging countries like China are demonstrating promising potential in HT research. Future studies are anticipated to delve deeper into the differential diagnosis of HT and Grave's disease, the intricate relationship between gut microbiota and HT pathogenesis, clinical management of HT with papillary thyroid carcinoma or type 1 diabetes, and the beneficial effects of dietary modifications and micronutrients supplementation in HT. Furthermore, the advent of genetic profiling and advanced immunotherapies for managing HT offers promising avenues for future research.
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Affiliation(s)
- Manping Guo
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Postdoctoral Research Station, China Academy of Chinese Medical Sciences, Beijing, China
- Postdoctoral Works Station, Yabao Pharmaceutical Group Co., Ltd., Yuncheng, Shanxi, China
| | - Qingna Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, National Medical Products Administration, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Xingfang Liu
- Research Department, Swiss University of Traditional Chinese Medicine, Bad Zurzach, Switzerland
| | - Yiming Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qiaoning Yang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, National Medical Products Administration, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Rui Li
- Evidence Based Medicine Center, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan, China
| | - Yang Zhao
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, National Medical Products Administration, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Chenfei Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, National Medical Products Administration, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Song Sheng
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hangkun Ma
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhenghong Li
- Research Department, Swiss University of Traditional Chinese Medicine, Bad Zurzach, Switzerland
| | - Rui Gao
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, National Medical Products Administration, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
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Daramjav N, Takagi J, Iwayama H, Uchino K, Inukai D, Otake K, Ogawa T, Takami A. Autoimmune Thyroiditis Shifting from Hashimoto's Thyroiditis to Graves' Disease. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040757. [PMID: 37109715 PMCID: PMC10141468 DOI: 10.3390/medicina59040757] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
In 15-20% of cases, Graves' disease (GD) shifts to Hashimoto's thyroiditis (HT), while the shift from HT to GD is rare. We present a case of a patient in whom HT shifted to GD, along with a literature review. A 50-year-old woman with myxedema was diagnosed with Hashimoto's disease due to hypothyroidism and the presence of antibodies against thyroid peroxidase (TPOAb) and thyroglobulin (TgAb); she also had thyroid stimulating antibodies (TSAb) without any signs of GD. Although thyroid hormone replacement therapy improved her thyroid function, 2 months later, hyperthyroidism appeared and did not improve after discontinuation of the replacement therapy. The patient was diagnosed with GD, which improved with antithyroid agent administration. To date, only 50 cases regarding conversion from HT to GD have been reported. The median age is 44 years (range, 23-82 years), and the median time of conversion is 7 years (range, 0.1-27 years). The male-to-female ratio of HT conversion to GD is 1:9, closer to that of regular GD (1:10) than that of general HT (1:18). All patients received thyroid hormone replacement therapy for hypothyroidism due to HT. Continuous evaluation of TSAb levels is recommended in HT, particularly in cases of TSAb-positive and those under replacement, since it may help predict conversion to GD. Evaluating the clinical characteristics of patients with HT preceding GD is crucial to ensure appropriate treatment and reduce the risk of adverse events.
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Affiliation(s)
- Narantsatsral Daramjav
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Aichi Medical University School of Medicine, Nagakute 480-1195, Aichi, Japan
| | - Junko Takagi
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Aichi Medical University School of Medicine, Nagakute 480-1195, Aichi, Japan
| | - Hideyuki Iwayama
- Department of Pediatrics, Aichi Medical University School of Medicine, Nagakute 480-1195, Aichi, Japan
| | - Kaori Uchino
- Department of Internal Medicine, Division of Hematology, Aichi Medical University School of Medicine, Nagakute 480-1195, Aichi, Japan
| | - Daisuke Inukai
- Department of Otorhinolaryngology Head and Neck Surgery, Aichi Medical University School of Medicine, Nagakute 480-1195, Aichi, Japan
| | - Kazuo Otake
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Aichi Medical University School of Medicine, Nagakute 480-1195, Aichi, Japan
| | - Tetsuya Ogawa
- Department of Otorhinolaryngology Head and Neck Surgery, Aichi Medical University School of Medicine, Nagakute 480-1195, Aichi, Japan
| | - Akiyoshi Takami
- Department of Internal Medicine, Division of Hematology, Aichi Medical University School of Medicine, Nagakute 480-1195, Aichi, Japan
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6
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Nozue T, Tada H, Murakami M, Michishita I. A case of hyperchylomicronemia associated with GPIHBP1 autoantibodies and fluctuating thyroid autoimmune disease. J Clin Lipidol 2023; 17:68-72. [PMID: 36402671 DOI: 10.1016/j.jacl.2022.10.005] [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: 08/08/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
Recent studies have reported that patients with autoimmune hyperchylomicronemia caused by glycosylphosphatidylinositol-anchored high-density lipoprotein binding protein 1 (GPIHBP1) autoantibodies are associated with rheumatoid arthritis, systemic lupus erythematosus, Sjogren's syndrome, Hashimoto's thyroiditis, Basedow's disease, and immune thrombocytopenia. We report a rare case of hyperchylomicronemia due to GPIHBP1 autoantibodies and fluctuating thyroid autoimmune disease. A 28-year-old woman, diagnosed with Hashimoto's thyroiditis at 26 years of age, started taking 50 µg/day of levothyroxine sodium. She had an episode of acute pancreatitis at 27 years of age; her serum triglyceride (TG) level was 1291 mg/dL at that time. The patient was referred to our hospital because her hyperchylomicronemia (hypertriglyceridemia) did not improve on treatment with pemafibrate and eicosapentaenoic acid (EPA). Serum total cholesterol and TG levels were 237 mg/dL and 2535 mg/dL, respectively, while plasma pre-heparin lipoprotein lipase (LPL) mass was 15 ng/mL (26.5-105.5 ng/mL). We diagnosed her as Basedow's disease based on autoimmune antibodies and ultrasound examination. Targeted exome sequencing revealed no pathogenic variants in the LPL or GPIHBP1 genes. The serum GPIHBP1 autoantibody level was 686.0 U/mL (<58.4 U/mL) and GPIHBP1 mass was 301.9 pg/mL (570.6-1625.6 pg/mL). The patient showed hyperchylomicronemia during periods of hypothyroidism and hyperthyroidism, whereas GPIHBP1 autoantibodies were positive during episode of hyperchylomicronemia but negative during periods of normal TG levels. Based on these findings, the patient was diagnosed with hyperchylomicronemia due to GPIHBP1 autoantibodies and treated with rituximab. GPIHBP1 autoantibodies remained undetectable and TG levels were controlled at approximately 200 mg/dL.
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Affiliation(s)
- Tsuyoshi Nozue
- Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
| | - Hayato Tada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Masami Murakami
- Department of Clinical Laboratory Medicine, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Ichiro Michishita
- Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
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7
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Patel P, Prater J, Baloch Z, Mayrin JV. Spectrum of thyroid disease in a single patient: A case of papillary thyroid carcinoma in a patient with Graves' disease and Hashimoto's thyroiditis. Clin Case Rep 2022; 10:e06361. [PMID: 36188051 PMCID: PMC9513194 DOI: 10.1002/ccr3.6361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/27/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022] Open
Abstract
A 65‐year‐old man with a history of Hashimoto's thyroiditi on Levothyroxine developed Graves' disease with ocular symptoms and was treated with teprotumumab without improvement. Total thyroidectomy was performed to control hyperthyroidism. Surgical pathology revealed multifocal papillary thyroid carcinoma. Rarely, a spectrum of thyroid disorders is seen in a single patient.
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Affiliation(s)
- Pooja Patel
- Department of Internal Medicine Rutgers University New Jersey Medical School Newark New Jersey USA
| | - Janna Prater
- Department of Endocrinology Einstein Medical Center Philadelphia Pennsylvania USA
| | - Zubair Baloch
- Department of Pathology University of Pennsylvania Philadelphia Pennsylvania USA
| | - Jane V. Mayrin
- Department of Endocrinology Einstein Medical Center Philadelphia Pennsylvania USA
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Shrestha A, Adhikari N, Devkota S, Chowdhury T, Shiferaw-Deribe Z, Gousy N, Adhikari S. Fluctuating Hyperthyroidism and Hypothyroidism in Graves’ Disease: The Swinging Between Two Clinical Entities. Cureus 2022; 14:e27715. [PMID: 36081960 PMCID: PMC9440987 DOI: 10.7759/cureus.27715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 11/05/2022] Open
Abstract
Autoimmune thyroid disorders are frequently encountered in clinical practice and consist of a spectrum ranging from Graves’ hyperthyroidism to Hashimoto's hypothyroidism. Generally, patients with autoimmune thyroid disorders will lean towards one end of the spectrum or the other, with fluctuations between hyper- and hypothyroidism rarely seen. This is especially the case when persistent hyperthyroidism occurs after a prolonged period of hypothyroidism. Here, we present a case of a young female patient initially presenting with Graves’ disease with a previous history of hypothyroidism.
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Jadhav R, Alberawi M, Gupta K. Graves' disease: A rare fate of Hashimoto's thyroiditis. World J Nucl Med 2021; 20:102-104. [PMID: 33850498 PMCID: PMC8034799 DOI: 10.4103/wjnm.wjnm_34_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/07/2020] [Accepted: 05/26/2020] [Indexed: 12/02/2022] Open
Abstract
Hashimoto's thyroiditis is a known autoimmune disorder that leads to chronic inflammation of the thyroid gland, with a gradual decline in function and eventual hypothyroidism. Conversion of Hashimoto's thyroiditis to Graves' disease is unusual clinically and has been occasionally reported in the literature. Awareness of such a rare phenomenon is important for the physicians evaluating patients with autoimmune thyroid disorders. Close investigation of the patient's symptoms and biochemical status is crucial in the implementation of appropriate treatment.
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Affiliation(s)
- Rahul Jadhav
- Rush University Medical Center, Chicago, IL, USA
| | - Mohammad Alberawi
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Khushboo Gupta
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA
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10
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Sukik A, Mohamed S, Habib MB, Sardar S, Tanous B, Tahtouh R, Mohamed MFH. The Unusual Late-Onset Graves' Disease following Hashimoto's Related Hypothyroidism: A Case Report and Literature Review. Case Rep Endocrinol 2020; 2020:5647273. [PMID: 33489388 PMCID: PMC7787859 DOI: 10.1155/2020/5647273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 11/09/2020] [Accepted: 11/23/2020] [Indexed: 11/26/2022] Open
Abstract
Background. The shift of Graves' disease (GD) to Hashimoto's disease- (HD-) related hypothyroidism is well established. However, the opposite is rare. This is likely to the loss of critical thyroid mass available for stimulation by thyroid hormone receptor stimulating antibody, making this shift unusual. Herein, we report a young lady with a late shift from HD into GD and present a scoping literature review. Case presentation. We report a twenty-five-year-old lady with a sixteen-year-history of Hashimoto's-related hypothyroidism stable on levothyroxine. While following in the clinic, she started developing thyrotoxic symptoms in the form of anxiety, weight loss, and palpitation. Physical examination was remarkable for mild exophthalmos. The thyroid function test confirmed hyperthyroidism. Levothyroxine-induced hyperthyroidism was initially suspected; however, the symptoms did not improve despite reducing and stopping levothyroxine. Subsequent workup confirmed the diagnosis of GD. Discussion and Conclusion. This case highlights a unique association that has significant diagnostic and management implications. This shift should be considered when hyperthyroidism persists despite reducing or stopping levothyroxine. The diagnosis is made utilizing antibody titers and radioiodine update scan. While the management depends on the disease's stage and the treating physician preference, antithyroid agents can be used initially. Following up these patients is essential as the shift can be transient.
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Affiliation(s)
- Aseel Sukik
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Sara Mohamed
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Mhd-Baraa Habib
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Sundus Sardar
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Bashar Tanous
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Raad Tahtouh
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
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11
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Panfilova EA, Kruk LP, Isaeva MP, Osmanova PO, Bostanova FA, Troshina EA. [The development of Graves' disease after long-term hypothyroidism due to Hashimoto's disease]. ACTA ACUST UNITED AC 2020; 66:24-30. [PMID: 33369370 DOI: 10.14341/probl12420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/26/2020] [Accepted: 10/05/2020] [Indexed: 11/06/2022]
Abstract
The main autoimmune thyroid diseases are Hashimoto's thyroiditis (HT) and Graves' disease (GD). Despite the significant differences in a pathogenesis and a clinical picture between HT and GD, the literature describes the cases of the conversion of one autoimmune disease to another, which, according to one version, is associated with a change in the balance between the levels of a stimulating and blocking antibodies to the thyroid-stimulating hormone receptor. At the same time, there are more frequent observations of the transition of GD to HT, and much less often describe, on the contrary, the development of GD against the background of HT. The article presents a clinical case of the conversion of HT to GD. A detailed algorithm of the conservative management according to the «block-replace» scheme is described, indicating the results of laboratory and instrumental examination. At the time of describing the clinical case, the result of the treatment can be considered successful. The predictors such as a low level of the thyroid-stimulating hormone receptor and thyroid volume before discontinuation of the thyrostatic therapy suggest a low risk of the recrudescence of GD.According to the authors, the phenomenon of the conversion of one autoimmune thyroid disease to another, in addition to the scientific interest, is important for the practitioners, since a timely change in the diagnostic paradigm can significantly change the treatment strategy and the favorably affect the prognosis of disease, preventing the development of complications.
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Affiliation(s)
| | | | | | | | - F A Bostanova
- Russian Medical Academy of Continuous Professional Education
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12
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Zhang QY, Liu W, Li L, Du WH, Zuo CL, Ye XP, Zhou Z, Yuan FF, Ma YR, Sun F, Yu SS, Xie HJ, Zhang CR, Ying YX, Yuan GY, Gao GQ, Liang J, Zhao SX, Song HD. Response Letter to the Editor: "Genetic Study in a Large Cohort Supported Different Pathogenesis of Graves' Disease and Hashimoto's Hypothyroidism". J Clin Endocrinol Metab 2020; 105:5872091. [PMID: 32671382 DOI: 10.1210/clinem/dgaa457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/10/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Qian-Yue Zhang
- The Core Laboratory in Medical Center of Clinical Research, Department of Molecular Diagnostic and Endocrinology, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
| | - Wei Liu
- The Core Laboratory in Medical Center of Clinical Research, Department of Molecular Diagnostic and Endocrinology, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu Li
- The Core Laboratory in Medical Center of Clinical Research, Department of Molecular Diagnostic and Endocrinology, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
| | - Wen-Hua Du
- Department of Endocrinology, Linyi People's Hospital, Linyi, Shandong Province, China
| | - Chun-Lin Zuo
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Province, China
| | - Xiao-Ping Ye
- The Core Laboratory in Medical Center of Clinical Research, Department of Molecular Diagnostic and Endocrinology, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
| | - Zheng Zhou
- The Core Laboratory in Medical Center of Clinical Research, Department of Molecular Diagnostic and Endocrinology, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
| | - Fei-Fei Yuan
- The Core Laboratory in Medical Center of Clinical Research, Department of Molecular Diagnostic and Endocrinology, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
| | - Yu-Ru Ma
- The Core Laboratory in Medical Center of Clinical Research, Department of Molecular Diagnostic and Endocrinology, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
| | - Feng Sun
- The Core Laboratory in Medical Center of Clinical Research, Department of Molecular Diagnostic and Endocrinology, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
| | - Sha-Sha Yu
- The Core Laboratory in Medical Center of Clinical Research, Department of Molecular Diagnostic and Endocrinology, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
| | - Hui-Jun Xie
- The Core Laboratory in Medical Center of Clinical Research, Department of Molecular Diagnostic and Endocrinology, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
| | - Chang-Run Zhang
- The Core Laboratory in Medical Center of Clinical Research, Department of Molecular Diagnostic and Endocrinology, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
| | - Ying-Xia Ying
- The Core Laboratory in Medical Center of Clinical Research, Department of Molecular Diagnostic and Endocrinology, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
| | - Guo-Yue Yuan
- Department of Endocrinology, The Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Guan-Qi Gao
- Department of Endocrinology, Linyi People's Hospital, Linyi, Shandong Province, China
| | - Jun Liang
- Department of Endocrinology, The Central Hospital of Xuzhou Affiliated to Xuzhou Medical College, Xuzhou, Jiangsu Province, China
| | - Shuang-Xia Zhao
- The Core Laboratory in Medical Center of Clinical Research, Department of Molecular Diagnostic and Endocrinology, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
| | - Huai-Dong Song
- The Core Laboratory in Medical Center of Clinical Research, Department of Molecular Diagnostic and Endocrinology, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University (SJTU) School of Medicine, Shanghai, China
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Horiya M, Anno T, Kawasaki F, Iwamoto Y, Irie S, Monobe Y, Tomoda K, Kaku K, Nakanishi S, Kaneto H. Basedow's disease with associated features of Hashimoto's thyroiditis based on histopathological findings. BMC Endocr Disord 2020; 20:120. [PMID: 32758269 PMCID: PMC7405338 DOI: 10.1186/s12902-020-00602-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 07/30/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Basedow's disease and Hashimoto's thyroiditis are autoimmune thyroid disorders and usually diagnosed with elevation of serum autoimmune antibodies. Thyrotropin receptor antibodies (TRAb) and/or thyroid-stimulating antibody (TSAb) are usually used for diagnosis of Basedow's disease, and thyroid peroxidase antibodies (TPOAb) and/or thyroglobulin antibodies (TgAb) are for diagnosis of Hashimoto's thyroiditis. However, it is difficult to diagnose a subject as Basedow's disease with associated features of Hashimoto's thyroiditis only with elevation of such autoimmune antibodies. CASE PRESENTATION A 44-year-old woman with 5-year history of Basedow's disease underwent a total thyroidectomy. She did not have a goiter. TRAb, TSAb, TPOAg and TgAb were all positive before a total thyroidectomy. In histopathological macroscopic examination, diffuse hyperplasia of the thyroid gland was observed. Furthermore, in histopathological microscopic examination, both characteristics of Basedow's disease and Hashimoto's thyroiditis were observed. After a total thyroidectomy, titers of all thyroid-associated autoimmune antibodies were markedly reduced. CONCLUSION Herein, we report a subject with Basedow's disease without a goiter whose TPOAb and TgAb were relatively high at the onset of Basedow's disease. In addition, interestingly, the histopathological findings of this subject showed direct signs of Basedow's disease and Hashimoto's thyroiditis in the same thyroid gland. Considering from such findings, she seemed to have Basedow's disease with associated features of Hashimoto's thyroiditis. In conclusion, we should bear in mind the possibility of Basedow's disease with associated features of Hashimoto's thyroiditis in subjects with Basedow's disease, particularly when TPOAb and TgAb as well as TRAb and TSAb are positive.
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Affiliation(s)
- Megumi Horiya
- Department of General Internal Medicine 1, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama, 700-8505, Japan
| | - Takatoshi Anno
- Department of General Internal Medicine 1, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama, 700-8505, Japan.
| | - Fumiko Kawasaki
- Department of General Internal Medicine 1, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama, 700-8505, Japan
| | - Yuichiro Iwamoto
- Department of General Internal Medicine 1, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama, 700-8505, Japan
| | - Shintaro Irie
- Department of General Internal Medicine 1, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama, 700-8505, Japan
| | - Yasumasa Monobe
- Department of Pathology, Kawasaki Medical School, Okayama, 700-8505, Japan
| | - Koichi Tomoda
- Department of General Internal Medicine 1, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama, 700-8505, Japan
| | - Kohei Kaku
- Department of General Internal Medicine 1, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama, 700-8505, Japan
| | - Shuhei Nakanishi
- Department of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, Kurashiki, 701-0192, Japan
| | - Hideaki Kaneto
- Department of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, Kurashiki, 701-0192, Japan
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14
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Rotondi M, Virili C, Pinto S, Coperchini F, Croce L, Brusca N, Centanni M, Chiovato L. The clinical phenotype of Graves' disease occurring as an isolated condition or in association with other autoimmune diseases. J Endocrinol Invest 2020; 43:157-162. [PMID: 31407208 DOI: 10.1007/s40618-019-01094-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/31/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Graves' disease (GD) can present as an isolated disease (iGD) or in association with other autoimmune diseases (aGD). The aim of this study, performed in two Endocrine referral centers settled in different geographical areas of Italy, was to compare the anthropometric, clinical, and biochemical phenotype of iGD patients with that of the aGD ones. METHODS Clinical history, physical examination data, serum levels of TSH, FT4, FT3, thyroglobulin (TgAb), thyroid-peroxidase (TPOAb) and TSH-receptor (TRAb) antibody, presence of Graves' orbitopathy (GO), and thyroid ultrasound examination at disease diagnosis were recorded. RESULTS 68 aGD and 136 iGD patients were consecutively recruited. At diagnosis, aGD and iGD patients did not differ for F/M ratio, age at presentation, thyroid function parameters, serum levels of TRAb, TgAb, TPOAb, presence of GO, and thyroid volume. The serum levels of TRAb were strongly correlated with the circulating concentrations of both FT3 (ρ = 0.667; p < 0.0001) and FT4 (ρ = 0.628; p < 0.001) in iGD patient, but not in the aGD ones (FT3: ρ = 0.231; p = 0.058; FT4: ρ = 0.096; p = 0.435). Compared with iGD patients, the aGD ones displayed a higher rate of transition from the previous hypothyroidism to hyperthyroidism (χ2 = 6.375; p = 0.012). CONCLUSION Despite similar anthropometric, clinical, and biochemical features at diagnosis, aGD patients display a higher rate of transition from a thyroid functional status to the other as compared with iGD patients.
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Affiliation(s)
- M Rotondi
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Via S. Maugeri 4, 27100, Pavia, Italy
| | - C Virili
- Endocrinology Unit, Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | - S Pinto
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Via S. Maugeri 4, 27100, Pavia, Italy
| | - F Coperchini
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Via S. Maugeri 4, 27100, Pavia, Italy
| | - L Croce
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Via S. Maugeri 4, 27100, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - N Brusca
- Department of Medical and Surgical Sciences and Biotechnology, Sapienza University of Rome, Rome, Italy
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - M Centanni
- Endocrinology Unit, Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | - L Chiovato
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Via S. Maugeri 4, 27100, Pavia, Italy.
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.
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15
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Fathima N, Narne P, Ishaq M. Association and gene-gene interaction analyses for polymorphic variants in CTLA-4 and FOXP3 genes: role in susceptibility to autoimmune thyroid disease. Endocrine 2019; 64:591-604. [PMID: 30771152 DOI: 10.1007/s12020-019-01859-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/05/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Polymorphic variants of cytotoxic T-lymphocyte antigen-4 (CTLA-4) and forkhead box protein P3 (FOXP3) genes are implicated in dysregulated immune homeostasis and autoimmune disorders. We analyzed the association between CTLA-4 rs231775 and FOXP3 rs3761548, rs3761549 polymorphisms and predisposition to autoimmune thyroid disease (AITD), inclusive of Hashimoto's thyroiditis (HT) and Graves' disease (GD) in South-Indian population. METHODS A total of 355 AITD subjects (comprising 275 HT and 80 GD) and 285 randomly selected age- and sex-matched control subjects were genotyped for the aforementioned polymorphisms by PCR-RFLP method. RESULTS The rs231775 "G" allele was preponderant in HT and GD subjects when compared with controls and exerted a dominant influence on the susceptibility to HT (p = 0.009) and GD (p = 0.02), respectively. There was no allelic association of rs3761548 and rs3761549 polymorphisms with AITD susceptibility, albeit a significant difference in genotype distribution with respect to rs3761549. Haplotype analysis revealed an increased frequency of rs3761548 "C"-rs3761549 "T" in HT and GD subjects, thereby associating it with disease predisposition (p = 0.03). Epistatic interaction analysis by multifactor dimensionality reduction approach revealed redundancy between CTLA-4 and FOXP3 genes in influencing the susceptibility to AITD. CONCLUSIONS The genetic variation in CTLA-4 gene with reference to rs231775 polymorphism contributes to an increased predisposition to HT and GD. Also, in conjunction with FOXP3 gene variants it seems to influence the susceptibility to HT and GD respectively. The significance of these findings in combination with antithyroid antibody screening could plausibly contribute towards meticulous case-finding for effective treatment of HT and GD.
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Affiliation(s)
- Nusrath Fathima
- Department of Genetics, Osmania University, Hyderabad, Telangana, India
| | - Parimala Narne
- Department of Biotechnology and Bioinformatics, University of Hyderabad, Hyderabad, Telangana, India.
| | - Mohammed Ishaq
- Department of Genetics, Osmania University, Hyderabad, Telangana, India.
- Salar-E-Millat, Research Centre for Cellular and Molecular Medicine, Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, Telangana, India.
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16
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Ekpebegh C, Elmezughi K, Mtingi L. Graves' disease following hypothyroidism due to Hashimoto's thyroiditis in a black South African lady: a case report. Pan Afr Med J 2019; 32:186. [PMID: 31312298 PMCID: PMC6620106 DOI: 10.11604/pamj.2019.32.186.18713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/10/2019] [Indexed: 11/11/2022] Open
Abstract
Graves' disease and Hashimoto's thyroiditis are autoimmune thyroid disorders with distinct pathological and histopathological features. The conversion from Hashimoto's thyroiditis to Graves' disease has been rarely reported throughout the world with no reports in the African race to our knowledge. We here report an African lady who was initially diagnosed with primary hypothyroidism following Hashimoto's disease but later became thyrotoxic due to Graves' disease.
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Affiliation(s)
- Chukwuma Ekpebegh
- Department of Internal Medicine, Walter Sisulu University, Mthatha, South Africa
| | - Khaled Elmezughi
- Department of Internal Medicine, Walter Sisulu University, Mthatha, South Africa
| | - Lungiswa Mtingi
- Department of Internal Medicine, Walter Sisulu University, Mthatha, South Africa
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17
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Gonzalez-Aguilera B, Betea D, Lutteri L, Cavalier E, Geenen V, Beckers A, Valdes-Socin H. Conversion to Graves disease from Hashimoto thyroiditis: a study of 24 patients. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 62:609-614. [PMID: 30624501 PMCID: PMC10118676 DOI: 10.20945/2359-3997000000086] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 10/19/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The conversion of Hashimoto's thyroiditis (HT) to hyperthyroidism due to thyrotropin receptor antibodies is intriguing and considered rare. The contribution of TSH receptor blocking antibodies (TRAb), which may be stimulators (TSAb) or blockers (TBAb), is suspected. We describe clinical and biological variables in a series of patients switching from Hashimoto's thyroiditis to Grave's disease. SUBJECTS AND METHODS Retrospective case study of 24 patients with Hashimoto's thyroiditis followed during 48 ± 36 months that developed later Graves' disease (GD). These variables were analysed in the hypo and hyperthyroid phase: age, sex, initial TSH, free triiodothyronine (fT3), free thyroxine (fT4), anti-TPO, TBII antibodies, parietal cell autoantibodies, time between hypo and hyperthyroidism, thyroid volume and levothyroxine doses (LT). RESULTS In HT, mean TSH was 9.4 ± 26.1 UI/L and levothyroxine treatment was 66.2 ± 30.8 µg/day. The switch to GD was observed 38 ± 45 months after HT diagnosis. As expected, we found significant differences on TSH, FT3, FT4 and TBAb levels. Three out of 14 patients had parietal cell autoantibodies. In two of these three cases there was an Helicobacter pylori infection. There were no significant differences between HT and GD groups with respect to thyroid volume. CONCLUSIONS To our knowledge, large series documenting the conversion of HT to GD are scarce. Although rare, this phenomenon should not be misdiagnosed. Suspicion should be raised whenever thyroxine posology must be tapered down during the follow-up of HT patients. Further immunological and genetic studies are needed to explain this unusual autoimmune change.
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Affiliation(s)
- Beatriz Gonzalez-Aguilera
- Department of Endocrinology, University Hospital Juan Ramón Jiménez (Huelva), Quirónsalud Hospital Group, Sevilla, Spain
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18
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Cui Z, Wang Z, Liu X, Cai Y, Xu X, Yang T. Establishment of clinical diagnosis model of Graves' disease and Hashimoto's thyroiditis. J Transl Med 2019; 17:11. [PMID: 30616573 PMCID: PMC6322254 DOI: 10.1186/s12967-018-1765-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/31/2018] [Indexed: 11/25/2022] Open
Abstract
Background A clinical diagnosis model include thyroid functions, thyroid antibodies and radioactive iodine uptake (RAIU) of patients with hyperthyroidism were established and as new evaluation indicators for the differentiation of the Graves’ disease (GD) and Hashimoto’s thyroiditis (HT). Methods Clinical data of patients with newly diagnosed hyperthyroidism including gender, age, thyroid function, thyroid antibodies (FT3, FT4, TSH, TPOAb, TGAb, TRAb), RAIU (2 h, 6 h, 24 h) were collected. A stepwise regression analysis was performed to establish a model based on these variables. Results Model 1 was subjected to stepwise regression analysis. After screening, the variables that entered the model included FT3, TGAb, TPOAb, TRAb, 2-h RAIU, 24-h RAIU and gender, in which the variables FT3, TGAb, TRAb, 2-h RAIU, 24-h RAIU, and gender were significantly different. Model 2 without RAIU was also subjected to stepwise regression analysis. After screening, the variables that entered the model included FT4, TGAb, TPOAb, TRAb and gender were statistical significant. The larger value of each variable in the two models indicated the higher probability to diagnose GD. The area under the receiver operating characteristic (ROC) curve of model 1 was 0.843 (95% CI 0.779–0.894), and the area under the ROC curve of model 2 was 0.806 (95% CI 0.685–0.824), which showed good differential diagnostic value. Conclusions GD and HT diagnosis model was established according to the variables including gender, FT3, TGAb, TRAb, the 2-h RAIU, the 24-h RAIU in the model 1, and the variables FT4, TGAb, TPOAb, TRAb and gender in the model 2 that did not include RAIU. These models had high value to differentiate GD and HT for patients with early hyperthyroidism.
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Affiliation(s)
- Zhaohui Cui
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China.,Department of Endocrinology, The Affiliated Huaian NO.1 People's Hospital of Nanjing Medical University, Huai'an, 223300, People's Republic of China
| | - Zhixiao Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Xiaoyun Liu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Yun Cai
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Xinyu Xu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Tao Yang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China.
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19
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Ravera S, Carrasco N, Gelernter J, Polimanti R. Phenomic Impact of Genetically-Determined Euthyroid Function and Molecular Differences between Thyroid Disorders. J Clin Med 2018; 7:E296. [PMID: 30248900 PMCID: PMC6210201 DOI: 10.3390/jcm7100296] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/11/2018] [Accepted: 09/18/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The thyroid plays a key role in development and homeostasis, but it has been difficult to establish causality with diseases and phenotypic traits because of several potential confounders. METHODS To determine the causal effect of euthyroid function, we conducted a two-sample Mendelian randomization study of euthyroid thyrotropin (TSH) and free thyroxine (FT4) levels with respect to 2419 traits assessed in 337,199 individuals from UK Biobank. Additionally, we investigated the molecular differences between hypothyroidism and hyperthyroidism using genome-wide data. RESULTS After multiple testing correction, sixteen traits appear to be affected by genetically-determined euthyroid TSH, including multiple thyroid-related traits, e.g., hypothyroidism (p = 2.39 × 10-17), height (p = 2.76 × 10-10), body fat distribution (impedance of whole body, p = 4.43 × 10-8), pulse rate (p = 2.84 × 10-8), female infertility (p = 4.91 × 10-6), and hearing aid use (p = 7.10 × 10-5). Moreover, we found a consistent genetic correlation between hypothyroidism and hyperthyroidism (rg = 0.45, p = 5.45 × 10-6) with several immune pathways shared between these diseases. Two molecular pathways survived multiple testing correction for specificity to hyperthyroidism, JAK/STAT signaling (p = 1.02 × 10-6) and Rac guanyl-nucleotide exchange factor activity (p = 4.39 × 10-6). CONCLUSION Our data shed new light on the inter-individual variability of euthyroid function and the molecular mechanisms of the two thyroid disorders investigated.
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Affiliation(s)
- Silvia Ravera
- Department of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT 06510, USA.
| | - Nancy Carrasco
- Department of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT 06510, USA.
| | - Joel Gelernter
- Department of Psychiatry, Yale School of Medicine and VA CT Healthcare Center, West Haven, CT 06516, USA.
- Departments of Genetics and Neuroscience, Yale University School of Medicine, New Haven, CT 06510, USA.
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine and VA CT Healthcare Center, West Haven, CT 06516, USA.
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20
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Wong M, Inder WJ. Alternating hyperthyroidism and hypothyroidism in Graves' disease. Clin Case Rep 2018; 6:1684-1688. [PMID: 30214742 PMCID: PMC6132101 DOI: 10.1002/ccr3.1700] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/24/2018] [Accepted: 06/10/2018] [Indexed: 12/17/2022] Open
Abstract
Spontaneously oscillating thyroid function in Graves' disease is a rare phenomenon. Switching between TSH receptor stimulating antibodies (TSAb) and TSH receptor blocking antibodies (TBAb) most likely accounts for presentations of alternating hyperthyroidism and hypothyroidism. To achieve stability of thyroid function, definitive therapy is recommended to remove the pathological thyroid.
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Affiliation(s)
- Mimi Wong
- Department of Diabetes and EndocrinologyPrincess Alexandra HospitalBrisbaneQLDAustralia
| | - Warrick J. Inder
- Department of Diabetes and EndocrinologyPrincess Alexandra HospitalBrisbaneQLDAustralia
- Faculty of MedicineThe University of QueenslandBrisbaneQLDAustralia
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21
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Shrestha S, Parks CG, Goldner WS, Kamel F, Umbach DM, Ward MH, Lerro CC, Koutros S, Hofmann JN, Beane Freeman LE, Sandler DP. Pesticide Use and Incident Hypothyroidism in Pesticide Applicators in the Agricultural Health Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2018; 126:97008. [PMID: 30256155 PMCID: PMC6375417 DOI: 10.1289/ehp3194] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 08/15/2018] [Accepted: 08/21/2018] [Indexed: 05/25/2023]
Abstract
BACKGROUND Though evidence suggests that some pesticides may have thyroid-disrupting properties, prospective studies of associations between specific pesticides and incident thyroid disease are limited. OBJECTIVE We evaluated associations between use of specific pesticides and incident hypothyroidism in private pesticide applicators in the Agricultural Health Study (AHS). METHODS Self-reported incident hypothyroidism ([Formula: see text] cases) was studied in relation to ever-use and intensity-weighted cumulative days of pesticide use at study enrollment. We estimated adjusted hazard ratios (HRs) and 95% confidence intervals (CI) using Cox proportional hazards models applied to 35,150 male and female applicators followed over 20 y. All models were stratified by state and education to meet proportional hazards assumptions ([Formula: see text] for age x covariate interactions). Models of pesticides that did not meet proportional hazards assumptions were stratified by median attained age (62 y). RESULTS Hypothyroidism risk was significantly increased with ever- vs. never-use of four organochlorine insecticides (aldrin, heptachlor, and lindane among participants with attained age [Formula: see text]; chlordane in all participants), four organophosphate insecticides (coumaphos in those [Formula: see text]; diazinon, dichlorvos, and malathion in all participants) and three herbicides (dicamba, glyphosate, and 2,4-D in all participants). HRs ranged from 1.21; 95% CI: 1.04, 1.41 (chlordane) to 1.54; 95% CI: 1.23, 19.4 (lindane in those [Formula: see text]). Hypothyroidism risk was greatest among those with higher intensity-weighted lifetime days of using chlordane, lindane, coumaphos (over age 62), diazinon, permethrin, and 2,4-D. CONCLUSIONS Our findings support associations between exposure to several pesticides and increased hypothyroidism risk. These findings are generally consistent with prior analyses of prevalent hypothyroidism in the AHS. https://doi.org/10.1289/EHP3194.
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Affiliation(s)
- Srishti Shrestha
- 1 Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS) , Research Triangle Park, North Carolina, USA
| | - Christine G Parks
- 1 Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS) , Research Triangle Park, North Carolina, USA
| | - Whitney S Goldner
- 2 Department of Internal Medicine, Division of Diabetes, Endocrinology, and Metabolism, University of Nebraska Medical Center , Omaha, Nebraska, USA
| | - Freya Kamel
- 1 Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS) , Research Triangle Park, North Carolina, USA
| | - David M Umbach
- 3 Biostatistics and Computational Biology Branch, NIEHS , Research Triangle Park, North Carolina, USA
| | - Mary H Ward
- 4 Occupational and Environmental Epidemiology Branch, National Cancer Institute , Rockville, Maryland, USA
| | - Catherine C Lerro
- 4 Occupational and Environmental Epidemiology Branch, National Cancer Institute , Rockville, Maryland, USA
| | - Stella Koutros
- 4 Occupational and Environmental Epidemiology Branch, National Cancer Institute , Rockville, Maryland, USA
| | - Jonathan N Hofmann
- 4 Occupational and Environmental Epidemiology Branch, National Cancer Institute , Rockville, Maryland, USA
| | - Laura E Beane Freeman
- 4 Occupational and Environmental Epidemiology Branch, National Cancer Institute , Rockville, Maryland, USA
| | - Dale P Sandler
- 1 Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS) , Research Triangle Park, North Carolina, USA
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22
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Ahmad E, Hafeez K, Arshad MF, Isuga J, Vrettos A. Hypothyroidism conversion to hyperthyroidism: it's never too late. Endocrinol Diabetes Metab Case Rep 2018; 2018:EDM180047. [PMID: 30083349 PMCID: PMC6075370 DOI: 10.1530/edm-18-0047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 07/16/2018] [Indexed: 11/08/2022] Open
Abstract
Primary hypothyroidism is a common endocrine condition, most commonly caused by autoimmune thyroiditis (Hashimoto’s disease) while Graves’ disease is the most common cause of hyperthyroidism. Hypothyroidism is usually a permanent condition in most patients requiring lifelong levothyroxine treatment. Transformation from Hashimoto’s disease to Graves’ disease is considered rare but recently been increasingly recognised. We describe a case of a 61-year-old lady who was diagnosed with hypothyroidism approximately three decades ago and treated with levothyroxine replacement therapy. Approximately 27 years after the initial diagnosis of hypothyroidism, she started to become biochemically and clinically hyperthyroid. This was initially managed with gradual reduction in the dose of levothyroxine, followed by complete cessation of the medication, but she remained hyperthyroid, ultimately requiring anti-thyroid treatment with Carbimazole. This case highlights that there should be a high index of suspicion for a possible conversion of hypothyroidism to hyperthyroidism, even many years after the initial diagnosis of hypothyroidism. To our knowledge, this case illustrates the longest reported time interval between the diagnosis of hypothyroidism until the conversion to hyperthyroidism.
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Affiliation(s)
- Ehtasham Ahmad
- Endocrinology and Diabetes, Queen Elizabeth the Queen Mother Hospital, Margate, UK
| | - Kashif Hafeez
- Endocrinology and Diabetes, Tunbridge Wells Hospital, Tunbridge Wells, UK
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Lewandowski K, Dąbrowska K, Makarewicz J, Lewiński A. Pendulum swings from hypo- to hyperthyroidism: thyrotoxicosis after severe hypothyroidism following neck irradiation in a patient with a history of Hodgkin's lymphoma. Thyroid Res 2016; 9:1. [PMID: 26779284 PMCID: PMC4714489 DOI: 10.1186/s13044-016-0030-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/06/2016] [Indexed: 12/31/2022] Open
Abstract
Background A change in a thyrometabolic state from severe hypothyroidism to thyrotoxicosis is very uncommon, but possible in some circumstances. Case presentation A 27-year old female presented with clinical and biochemical thyrotoxicosis with a previous history chemo- and radiotherapy (including the neck region) for a Hodgkin’s lymphoma (at the age of 18). At the age of 20 this was followed by severe hypothyrodism [TSH > 100 μIU/mL (reference range: 0.27–4.2)]. She was stated on L-thyroxine, but the dose was later reduced and subsequently discontinued. She had significantly elevated titres of both anti-thyroid peroxidase antibodies and anti-TSH-receptor antibodies throughout the course of disease. Thyroid scintigraphy revealed a normal and homogenous iodine uptake. Conclusions We suspect that a gradual switch from thyroid-blocking to thyroid-stimulating antibodies resulted in development of an overt thyrotoxicosis, possibly with a contributory effect of neck irradiation on her autoimmune status.
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Affiliation(s)
- Krzysztof Lewandowski
- Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland ; Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
| | - Katarzyna Dąbrowska
- Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland
| | - Jacek Makarewicz
- Department of Nuclear Medicine and Oncological Endocrinology, Zgierz District Hospital, Zgierz, Poland
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland ; Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
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