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Nicolescu CR, Bazus L, Stephan JL. Severe Acquired Hypothyroidism and Van Wyk-Grumbach Syndrome in Two Children. Case Rep Pediatr 2024; 2024:8919177. [PMID: 39015673 PMCID: PMC11251785 DOI: 10.1155/2024/8919177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/18/2024] [Indexed: 07/18/2024] Open
Abstract
The primary manifestations of chronic hypothyroidism in children include growth arrest, delayed skeletal maturity, and delayed puberty. In 1960, Van Wyk and Grumbach reported three girls with hypothyroidism and a combination of incomplete isosexual precocious puberty (early breast development, menstruation, and absence of pubic hair), galactorrhea, delayed bone age, and pituitary enlargement. All abnormalities regressed after appropriate thyroid hormone replacement therapy. Over the years, an increasing number of reported cases has allowed for a more precise understanding of the clinical, biochemical, and radiological phenotypes of the Van Wyk-Grumbach syndrome (VWGS). These varying clinical manifestations are thought to result from a unique pathophysiological process where the thyroid-stimulating hormone (TSH) is a key element. We describe the cases of two patients (a boy and a girl) with severe autoimmune thyroiditis and VWGS. The clinical, biochemical, and radiological imaging characteristics were similar in both patients and included growth failure, absence of clinical goiter, markedly elevated TSH concentrations >100 mIU/L, undetectable free thyroxine levels, "normal" thyroglobulin levels, high follicle-stimulating hormone (FSH) and prolactin levels, prepubertal levels of luteinizing hormone (LH), delayed bone age, and hyperplasia of the pituitary gland. The two patients displayed differences, especially in the absence of clinical pubertal development, moderate anemia, abnormal renal function, and moderate goiter detected via ultrasonography (in the female patient). Thyroxine replacement therapy reversed the VWGS phenotype and hypothyroidism, with satisfactory growth velocity, strictly normal thyroid function, and normal pituitary size detected via magnetic resonance imaging at the 6-month follow-up visit.
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Affiliation(s)
- Corina Ramona Nicolescu
- Department of Pediatric Endocrinology and DiabetesCentre Hospitalier Universitaire Saint-Etienne, Avenue Albert Raimond, Saint-Priest en Jarez 42270, France
| | - Lucie Bazus
- Department of Pediatric Endocrinology and DiabetesCentre Hospitalier Universitaire Saint-Etienne, Avenue Albert Raimond, Saint-Priest en Jarez 42270, France
| | - Jean-Louis Stephan
- Department of PediatricsCentre Hospitalier Universitaire Saint-Etienne, Avenue Albert Raimond, Saint-Priest en Jarez 42270, France
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Corica D, Abbate T, Kucharska AM, Wojcik M, Vierucci F, Valenzise M, Li Pomi A, Pepe G, Tuli G, Pyrzak B, Aversa T, Wasniewska M. Growth impairment in children with atrophic autoimmune thyroiditis and pituitary hyperplasia. Ital J Pediatr 2024; 50:83. [PMID: 38650008 PMCID: PMC11036550 DOI: 10.1186/s13052-024-01641-w] [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: 07/17/2023] [Accepted: 04/04/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Atrophic autoimmune thyroiditis (AAT) is a rare phenotype of autoimmune thyroiditis (AT) in pediatric age. AAT occurs without thyroid enlargement leading to a delay in its diagnosis. Growth impairment is infrequent in autoimmune thyroiditis, if timely diagnosed. Prolonged severe hypothyroidism is a rare cause of pituitary hyperplasia (PH) in childhood. Loss of thyroxine negative feedback causes a TRH-dependent hyperplasia of pituitary thyrotroph cells resulting in adenohypophysis enlargement. A transdifferentiation of pituitary somatotroph cells into thyrotroph cells could explain growth failure in those patients. METHODS Twelve patients were retrospectively evaluated at five Italian and Polish Centres of Pediatric Endocrinology for height growth impairment. In all Centres, patients underwent routine clinical, biochemical and radiological evaluations. RESULTS At the time of first assessment, the 75% of patients presented height growth arrest, while the remaining ones showed growth impairment. The study of thyroid function documented a condition of hypothyroidism, due to AT, in the entire cohort, although all patients had no thyroid enlargement. Thyroid ultrasound showed frankly atrophic or normal gland without goiter. Cerebral MRI documented symmetrical enlargement of the adenohypophysis in all patients and a homogeneous enhancement of the gland after the administration of Gadolinium-DPTA. Replacement therapy with levothyroxine was started and patients underwent close follow-up every 3 months. During the 12 months of follow-up, an improvement in terms of height growth has been observed in 88% of patients who continued the follow-up. Laboratory findings showed normalization of thyroid function and the control brain MRI documented complete regression of PH to a volume within the normal range for age and sex. CONCLUSIONS This is the largest pediatric cohort with severe autoimmune primary hypothyroidism without goiter, but with pituitary hyperplasia in which significant growth impairment was the most evident presenting sign. AAT phenotype might be correlated with this specific clinical presentation. In youths with growth impairment, hypothyroidism should always be excluded even in the absence of clear clinical signs of dysthyroidism.
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Affiliation(s)
- Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy.
| | - Tiziana Abbate
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | | | - Malgorzata Wojcik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, Kraków, Poland
| | | | - Mariella Valenzise
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Alessandra Li Pomi
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Giorgia Pepe
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Gerdi Tuli
- Department of Public Health and Paediatric Sciences, Paediatric Endocrinology, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Beata Pyrzak
- Department of Pediatrics and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, Unit of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
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Wakatsuki R, Shimizu M, Shimbo A, Adachi E, Kanamori T, Yamazaki S, Udagawa T, Takasawa K, Kashimada K, Morio T, Mori M. Atrophic autoimmune thyroiditis complicated with systemic lupus erythematosus. Mod Rheumatol Case Rep 2023; 7:65-67. [PMID: 35801853 DOI: 10.1093/mrcr/rxac057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/23/2022] [Accepted: 07/01/2022] [Indexed: 01/07/2023]
Abstract
Atrophic autoimmune thyroiditis (AAT) is a type of autoimmune thyroiditis that causes hypothyroidism without thyroid enlargement. AAT is distinguished from Hashimoto's disease (HD) by the absence of thyroid enlargement. AAT is rare in children and clinically characterised by severe primary hypothyroidism. Autoimmune thyroiditis, especially HD, is commonly complicated with systemic lupus erythematosus (SLE). Here, we reported the patient with AAT as the initial presentation of SLE complicated with generalised myxoedema, whose presentation was a diagnostic challenge. This patient illustrates the importance of the early recognition of an atypical presentation of SLE patients with autoimmune thyroiditis. It is possible that similar cases have existed in the past but have been overlooked as HD. A large-scale study is necessary to clarify the reality of AAT in SLE.
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Affiliation(s)
- Ryosuke Wakatsuki
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaki Shimizu
- Department of Child Health and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Asami Shimbo
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eriko Adachi
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toru Kanamori
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Susumu Yamazaki
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomohiro Udagawa
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kei Takasawa
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenichi Kashimada
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomohiro Morio
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaaki Mori
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Rotondi M, Bendotti G, Croce L, Molteni M, Carbone A, Magri F, Pearce EN, Chiovato L. A unique presentation of Graves' disease in a pregnant woman with severe hypothyroidism. Gynecol Endocrinol 2022; 38:697-701. [PMID: 35723545 DOI: 10.1080/09513590.2022.2087216] [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] [Indexed: 10/18/2022] Open
Abstract
BackgroundGraves' disease occurrence during pregnancy is not a frequent event, showing an incidence of 0.2-0.4% in unselected pregnant women. Depending on their functional properties, TSH-receptor antibodies can induce hypothyroidism or hyperthyroidism. Recognizing the signs of altered thyroid function is essential to prevent possible complications on the fetus.Materials and methodsThe case of a pregnant woman without previous history of thyroid disease presenting with severe overt hypothyroidism during the first trimester is reported. Levothyroxine therapy was started and 6 weeks later overt hyperthyroidism was observed. TRAb were detected at high titers. Levothyroxine was withdrawn and low dose methimazole was started. Serial obstetric ultrasound scans were negative for indirect signs of fetal thyroid dysfunctions and no fetal goiter was visualized throughout pregnancy. Spontaneous delivery occurred without complications at 39 weeks of gestation. In the post-partum, severe overt hypothyroidism recurred, thus methimazole was discontinued and levothyroxine was restarted. TRAb persisted at high levels. The infant experienced a transient thyrotoxicosis, which fully resolved in three months with normalization of thyroid function and negativization of TRAb levels.ResultsThe present case report allows us to overview the challenges related to the management of hypo and hyperthyroidism in patients with high TRAb levels, requiring strict monitoring aimed at early detection of both maternal and fetal consequences.ConclusionsThis case underlines the importance of close follow-up and the need of collaboration in a multidisciplinary team when Graves's disease is diagnosed in a pregnant woman to prevent adverse neonatal outcomes.
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Affiliation(s)
- Mario Rotondi
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Giulia Bendotti
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Laura Croce
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Martina Molteni
- Unit of Internal Medicine, Medical-Oncologic Department, ASST Lodi, Lodi, Italy
| | - Andrea Carbone
- Unit of Internal Medicine, Medical-Oncologic Department, ASST Lodi, Lodi, Italy
| | - Flavia Magri
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Elizabeth N Pearce
- Section of Endocrinology Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA, USA
| | - Luca Chiovato
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
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Giannone M, Dalla Costa M, Sabbadin C, Garelli S, Salvà M, Masiero S, Plebani M, Faggian D, Gallo N, Presotto F, Bertazza L, Nacamulli D, Censi S, Mian C, Betterle C. TSH-receptor autoantibodies in patients with chronic thyroiditis and hypothyroidism. Clin Chem Lab Med 2022; 60:1020-1030. [PMID: 35511904 DOI: 10.1515/cclm-2022-0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/15/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The reported prevalence of TSH-receptor (TSHR) autoantibodies (TRAb) in patients with chronic thyroiditis (CT) range from 0 to 48%. The objective was to study the prevalence of TRAb in patients with CT and hypothyroidism and to correlate it with gender, age, thyroid dimensions, TSH levels, and autoimmune diseases. METHODS The study comprised 245 patients with CT and hypothyroidism (median age 42 years, 193 females, 52 males) and 123 Italian healthy subjects matched for sex and age as controls. TRAb were tested with ELISA using a >2.5 IU/L cut off for positivity. TSHR blocking (TBAb) and TSHR stimulating autoantibodies (TSAb) were measured in 12 TRAb-positive patients using bioassays with Chinese hamster ovary (CHO) cells expressing wild-type or R255D-mutated TSHR. RESULTS TRAb positivity was found in 32/245 (13.1%) patients and significantly correlated (p<0.05) with TSH levels. TRAb positivity was significantly higher in males vs. females (p=0.034), in females 16-45 years of age vs. >45 years of age (p<0.05) and in patients with reduced vs. normal/increased thyroid dimensions (p<0.05). Linear regression analysis showed a correlation between TRAb concentrations with age (p<0.05) and TRAb concentrations with TSH (p<0.01). In bioassay with TSHR-R255D all 12 patients tested were TBAb-positive while 33% were also TSAb-positive suggesting the presence of a mixture of TRAbs with different biological activities in some patients. CONCLUSIONS TRAb have been found in patients with CT and hypothyroidism. A mixture of TBAb and TSAb was found in some patients and this may contribute to the pathogenesis of thyroid dysfunction during the course of the disease.
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Affiliation(s)
- Mariella Giannone
- Gynecological Clinic, Dipartimento di Salute della Donna e del Bambino, Università Padova, Padova, Italy.,Endocrine Unit, Department of Medicine, Università di Padova, Padova, Italy
| | - Miriam Dalla Costa
- Endocrine Unit, Department of Medicine, Università di Padova, Padova, Italy
| | - Chiara Sabbadin
- Endocrine Unit, Department of Medicine, Università di Padova, Padova, Italy
| | - Silvia Garelli
- Endocrine Unit, Department of Medicine, Università di Padova, Padova, Italy.,Department of Medicine, Ospedale dell'Angelo, Mestre-Venezia, Italy
| | - Monica Salvà
- Endocrine Unit, Department of Medicine, Università di Padova, Padova, Italy
| | - Stefano Masiero
- Endocrine Unit, Department of Medicine, Università di Padova, Padova, Italy
| | - Mario Plebani
- Unit of Laboratory Medicine, Department of Medicine, Università di Padova, Padova, Italy
| | - Diego Faggian
- Unit of Laboratory Medicine, Department of Medicine, Università di Padova, Padova, Italy
| | - Nicoletta Gallo
- Unit of Laboratory Medicine, Department of Medicine, Università di Padova, Padova, Italy
| | - Fabio Presotto
- Department of Medicine, Ospedale dell'Angelo, Mestre-Venezia, Italy
| | - Loris Bertazza
- Endocrine Unit, Department of Medicine, Università di Padova, Padova, Italy
| | - Davide Nacamulli
- Endocrine Unit, Department of Medicine, Università di Padova, Padova, Italy
| | - Simona Censi
- Endocrine Unit, Department of Medicine, Università di Padova, Padova, Italy
| | - Caterina Mian
- Endocrine Unit, Department of Medicine, Università di Padova, Padova, Italy
| | - Corrado Betterle
- Endocrine Unit, Department of Medicine, Università di Padova, Padova, Italy
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Nagasaki K, Nakamura A, Yamauchi T, Kamasaki H, Hara Y, Kanno J, Koyama S, Ohtsu Y, Takahashi I, Suzuki S, Kashimada K, Tajima T. Investigation of TSH receptor blocking antibodies in childhood-onset atrophic autoimmune thyroiditis. Clin Pediatr Endocrinol 2021; 30:79-84. [PMID: 33867667 PMCID: PMC8022035 DOI: 10.1297/cpe.30.79] [Citation(s) in RCA: 2] [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: 09/08/2020] [Accepted: 12/25/2020] [Indexed: 11/17/2022] Open
Abstract
Atrophic autoimmune thyroiditis (AAT) is a type of autoimmune hypothyroidism without
goiter. TSH receptor-blocking antibodies (TSBAb) are involved in its etiology in adults.
Reportedly, this disease is extremely rare in children. In this study, we aimed to
investigate the prevalence of TSBAb during AAT onset in children using a commercially
available cell-based bioassay TSAb kit. We conducted a multicenter retrospective
observational study. We collected data of patients with AAT who were < 15 yr old,
enrolled in a collaborative research group, and diagnosed since July 2003. AAT was defined
as acquired autoimmune hypothyroidism without thyroid enlargement. Eighteen patients
(including 15 females) whose TSH receptor antibody (TRAb) or TSBAb levels were measured
within a year from the initial visit were included. The median age at diagnosis was 9.3
years, and the estimated time between onset and diagnosis was 2.6 yr. The positive rate
for either TSBAb or TRAb was 38.8% (95% confidence interval: 18.3–59.5%). There were no
significant differences in age, the estimated time between onset and diagnosis, and FT4
levels at diagnosis between the TSBAb-positive and -negative groups. Unlike previous
reports, we showed that the prevalence of TSBAb-positivity in childhood-onset AATs is not
rare, as in adults.
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Affiliation(s)
- Keisuke Nagasaki
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medicine and Dental Science, Niigata, Japan
| | - Akie Nakamura
- Department of Pediatrics, Hokkaido University School of Medicine, Hokkaido, Japan
| | - Takeru Yamauchi
- Department of Pediatrics, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Hotaka Kamasaki
- Department of Pediatrics, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Yosuke Hara
- Department of Pediatrics, Shinshu University School of Medicine, Nagano, Japan
| | - Junko Kanno
- Department of Pediatrics, Tohoku University School of Medicine, Miyagi, Japan
| | - Satomi Koyama
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Yoshiaki Ohtsu
- Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Ikuko Takahashi
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | - Shigeru Suzuki
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Kenichi Kashimada
- Department of Pediatrics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshihiro Tajima
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan
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Napolitano G, Bucci I, Di Dalmazi G, Giuliani C. Non-Conventional Clinical Uses of TSH Receptor Antibodies: The Case of Chronic Autoimmune Thyroiditis. Front Endocrinol (Lausanne) 2021; 12:769084. [PMID: 34803929 PMCID: PMC8602826 DOI: 10.3389/fendo.2021.769084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/11/2021] [Indexed: 01/21/2023] Open
Abstract
Anti TSH receptor antibodies (TSHrAb) are a family of antibodies with different activity, some of them stimulating thyroid function (TSAb), others with blocking properties (TBAb), it is a common finding that antibodies with different function might coexist in the same patient and can modulate the function of the thyroid. However, most of the labs routinely detect all antibodies binding to the TSH receptor (TRAb, i.e. TSH-receptor antibodies detected by binding assay without definition of functional property). Classical use of TSHr-Ab assay is in Graves' disease where they are tested for diagnostic and prognostic issues; however, they can be used in specific settings of chronic autoimmune thyroiditis (CAT) as well. Aim of the present paper is to highlight these conditions where detection of TSHr-Ab can be of clinical relevance. Prevalence of TSHrAb is different in in the 2 main form of CAT, i.e. classical Hashimoto's thyroiditis and in atrophic thyroiditis, where TBAb play a major role. Simultaneous presence of both TSAb and TBAb in the serum of the same patient might have clinical implication and cause the shift from hyperthyroidism to hypothyroidism and vice versa. Evaluation of TRAb is recommended in case of patients with Thyroid Associated Orbitopathy not associated with hyperthyroidism. At present, however, the most relevant recommendation for the use of TRAb assay is in patients with CAT secondary to a known agent; in particular, after treatment with alemtuzumab for multiple sclerosis. In conclusion, the routine use of anti-TSH receptor antibodies (either TRAb or TSAb/TBAb) assay cannot be suggested at the present for diagnosis/follow up of patients affected by CAT; there are, however, several conditions where their detection can be clinically relevant.
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Affiliation(s)
- Giorgio Napolitano
- Department of Medicine and Sciences of Aging, Unit of Endocrinology, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), University “G. d’Annunzio” of Chieti‐Pescara, Chieti, Italy
- *Correspondence: Giorgio Napolitano,
| | - Ines Bucci
- Department of Medicine and Sciences of Aging, Unit of Endocrinology, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), University “G. d’Annunzio” of Chieti‐Pescara, Chieti, Italy
| | - Giulia Di Dalmazi
- Department of Medicine and Sciences of Aging, Unit of Endocrinology, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), University “G. d’Annunzio” of Chieti‐Pescara, Chieti, Italy
| | - Cesidio Giuliani
- Department of Medicine and Sciences of Aging, Unit of Endocrinology, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), University “G. d’Annunzio” of Chieti‐Pescara, Chieti, Italy
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Kucharska AM, Witkowska-Sȩdek E, Labochka D, Rumińska M. Clinical and Biochemical Characteristics of Severe Hypothyroidism Due to Autoimmune Thyroiditis in Children. Front Endocrinol (Lausanne) 2020; 11:364. [PMID: 32733376 PMCID: PMC7360718 DOI: 10.3389/fendo.2020.00364] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/11/2020] [Indexed: 01/04/2023] Open
Abstract
Introduction: In the majority of countries, autoimmune thyroiditis is the main cause of acquired hypothyroidism in children. Typically, the natural course of the disease is initially insidious and the diagnosis is incidental. There are some children who develop severe hypothyroidism without a proper diagnosis. The aim of the study was to analyze the clinical and biochemical profiles of children with severe primary hypothyroidism due to autoimmune thyroiditis. Materials and Methods: We analyzed the records of 354 patients diagnosed between 2009 and 2019 with autoimmune thyroiditis. Only patients with TSH above 100 μIU/mL, associated with decreased free thyroxine and the presence of antithyroid antibodies, were enrolled in the study. The analysis encompassed clinical symptoms, thyroid and biochemical status, bone age, and imaging. Results: Twenty-six children were enrolled in the study. The mean age at diagnosis was 10.26 ± 3.3 years, with a female preponderance of 1.8:1. The most frequent symptom was growth impairment (77%) and weight gain (58%). Goiters were present in 42% of patients. Less common findings were pituitary hypertrophy (four patients) and hypertrichosis (three patients). Median values at the time of diagnosis were TSH 454.3 uIU/ml (295.0-879.4), anti-TPO antibodies 1,090 IU/ml, and anti-Tg antibodies 195 IU/ml. Anti-TSHR ab were evaluated only in six out of the 26 patients. The characteristic biochemical profile was correlated with the grade of hypothyroidism, and the strongest correlations were found with CBC parameters, lipid profile, aminotransferases, and creatine. Conclusion: In children with severe hypothyroidism, the most sensitive symptoms are growth arrest and weight gain despite the fact that, in some children, the auxological parameters at presentation could be within normal values for the population. The specific biochemical profile closely correlates to the severity of thyroid hormone deficiency and involves mostly erythropoiesis, liver function, and kidney function. Pituitary enlargement should be considered in each child with severe hypothyroidism. It is necessary to conduct prospective studies evaluating the actual frequency of anti-TSHR antibodies and pituitary enlargement in children with extremely high TSH, especially those presenting without goiters.
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Abstract
Autoantibodies (Ab) against the thyroid-stimulating hormone receptor (TSHR) are frequently found in autoimmune thyroid disease (AITD). Autoantibodies to the TSHR (anti-TSHR-Ab) may mimic or block the action of TSH or be functionally neutral. Measurement of anti-TSHR-Ab can be done either via competitive-binding immunoassays or with functional cell-based bioassays. Antibody-binding assays do not assess anti-TSHR-Ab functionality, but rather measure the concentration of total anti-TSHR binding activity. In contrast, functional cell-based bioassays indicate whether anti-TSHR-Ab have stimulatory or blocking activity. Historically bioassays for anti-TSHR-Ab were research tools and were used to study the pathophysiology of Graves' disease and Hashimoto's thyroiditis. In the past, bioassays for anti-TSHR-Abs were laborious and time-consuming and varied widely in performance from laboratory to laboratory. Recent advances in the development of cell-based assays, including the application of molecular engineering, have led to significant improvements that have enabled bioassays to be employed routinely in clinical laboratories. The prevalence and functional significance of TSHR blocking autoantibodies (TBAb) in autoimmune hypothyroidism has been less well investigated compared to TSHR stimulating Ab. There is an increasing body of data, however, that demonstrate the clinical utility and relevance of TBAb, and thus the importance of TBAb bioassays, in the diagnosis and management of patients with AITD. In the present review, we summarize the different methods used to measure TBAb, and discuss their prevalence and clinical relevance.
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Affiliation(s)
- Tanja Diana
- Molecular Thyroid Research Laboratory, Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
| | - Paul D. Olivo
- Department of Molecular Microbiology, Washington University Medical School, St. Louis, Missouri, USA
| | - George J. Kahaly
- Molecular Thyroid Research Laboratory, Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
- Correspondence Prof. George J. Kahaly JGU Medical CenterLangenbeckstraße 155131 MainzGermany+49-6131-17-2290+49-6131-17-3460
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10
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Pomahacova R, Zamboryova J, Paterova P, Fiklik K, Cerna Z, Lad V, Skalicka E, Huml M, Sykora J. Autoimmune disease, familial clustering and thyroid carcinoma coexistent with autoimmune thyroiditis in children and adolescence: A cross-sectional study from the Czech Republic. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 162:289-293. [PMID: 29936527 DOI: 10.5507/bp.2018.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The prevalence of autoimmune thyroiditis (AIT), as the most common autoimmune disease (AD) and papillary thyroid cancer (PTC) is steadily rising in children. The aim of this study was to determine the coexistence of other AD and thyroid carcinoma (TC) in AIT. METHODS The cross-sectional study conducted at a tertiary center comprised AIT children (< 19 years). Data on age/sex, thyroid function and ultrasound, autoantibodies, associated AD, familial occurence of AD and the occurence of TC for each child were collected. RESULTS In total, 231 eligible patients (77% females) were included. The most common onset (66%) was during adolescence. At onset, hypothyroidism was detected in 59.3%; hashitoxicosis in 1.3%. The positivity of both autoantibodies was present in 60.6%, the negativity was in 3,5%. We confirmed a high frequency (44.6%) of AD with AIT predominance in parents and/or grandparents of patients and in siblings (7.4%). 15.2% had at least 1 comorbid AD, of which type 1 diabetes mellitus was the most common (8.5%). Over a period of 7 years TC was diagnosed in 16 patients (mean age 13.5 years) with predominance of PTC in 15 (94%) patients. AIT had concurrently 69% patients. 56% of patients had metastases (89% in AIT subjects). An invasive PTC was present in 44% (86% in AIT subjects). CONCLUSIONS The prevalence rate of AD in AIT and first-degree relatives is high, and several new associations have been reported. Providers should be aware of comorbidities and TC in AIT as this would help in early diagnoses and timely interventions.
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Affiliation(s)
- Renata Pomahacova
- Department of Paediatrics, Charles University in Prague, Faculty of Medicine in Pilsen, Czech Republic
| | - Jana Zamboryova
- Department of Paediatrics, Charles University in Prague, Faculty of Medicine in Pilsen, Czech Republic
| | - Petra Paterova
- Department of Paediatrics, Charles University in Prague, Faculty of Medicine in Pilsen, Czech Republic
| | - Karel Fiklik
- Department of Paediatrics, Charles University in Prague, Faculty of Medicine in Pilsen, Czech Republic
| | - Zdenka Cerna
- Department of Paediatrics, Charles University in Prague, Faculty of Medicine in Pilsen, Czech Republic
| | - Vaclav Lad
- Department of Paediatrics, Charles University in Prague, Faculty of Medicine in Pilsen, Czech Republic
| | - Eva Skalicka
- Department of Paediatrics, Charles University in Prague, Faculty of Medicine in Pilsen, Czech Republic
| | - Michal Huml
- Department of Paediatrics, Charles University in Prague, Faculty of Medicine in Pilsen, Czech Republic
| | - Josef Sykora
- Department of Paediatrics, Charles University in Prague, Faculty of Medicine in Pilsen, Czech Republic
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11
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Stożek K, Bossowski A, Ziora K, Bossowska A, Mrugacz M, Noczyńska A, Walczak M, Petriczko E, Pyrżak B, Kucharska A, Szalecki M, Diana T, Kahaly GJ. Functional TSH receptor antibodies in children with autoimmune thyroid diseases. Autoimmunity 2018; 51:62-68. [DOI: 10.1080/08916934.2018.1431776] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Karolina Stożek
- Department of Pediatric Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Bialystok, Poland
| | - Artur Bossowski
- Department of Pediatric Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Bialystok, Poland
| | - Katarzyna Ziora
- Department of Pediatric Nephrology and Endocrinology, Silesian Medical University, Zabrze, Poland
| | - Anna Bossowska
- Division of Cardiology, Internal Affairs Ministry Hospital in Bialystok, Białystok, Poland
| | - Małgorzata Mrugacz
- Department of Ophthalmology and Visual Rehabilitation, Medical University of Bialystok, Białystok, Poland
| | - Anna Noczyńska
- Department of Endocrinology and Diabetology for Children and Adolescents, Wroclaw Medical University, Wrocław, Poland
| | - Mieczysław Walczak
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - Elżbieta Petriczko
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - Beata Pyrżak
- Department of Pediatrics and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Kucharska
- Department of Pediatrics and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Mieczysław Szalecki
- Department of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw, Poland
- Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Tanja Diana
- Molecular Thyroid Research Laboratory, Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
| | - George J. Kahaly
- Molecular Thyroid Research Laboratory, Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
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12
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Park KY. An overview of the pathogenic mechanisms of autoimmune thyroid disorders. KOSIN MEDICAL JOURNAL 2014. [DOI: 10.7180/kmj.2014.29.2.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
<title>Abstract Objectives, recent epidemiologic studies in humans suggest an increased prevalence of thyroiditis associated with the excessive administration of iodine. More than three times of recommended daily intake of iodine was observed among people in North America. These people generally presented higher level of anti-thyroglobulin antibody, anti-thyroperoxidase antibody, serum thyroid-stimulating hormone and exacerbation of lymphocytic infiltration in thyroid, which indicated the overconsumption of iodine could induce hypothyroidism and enhance the autoimmune response. However, the precise mechanism of excessive iodine intake induced autoimmune thyroid disease remains largely unknown.</p><p>Over half a century has elapsed since the 1956 identification of thyroglobulin antibodies and the devising of the first experimental model of autoimmune thyroiditis. Since then an incredible amount of experimental work has led to an ever deeper understanding of the nature of thyroid auto-antigens, the main immune mechanisms responsible for Hashimoto's thyroiditis and graves’ disease, their genetics, and therir environmental risk factor. Yet, in the majority of genetically predisposed people the individual trigger of thyroid autoimmunity remains obscure. Similarly, effective prevention strategies still remain to be established and, hopefully, will be the target of future studies.</p>
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13
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Lee HJ, Kim JK. Nongoitrous autoimmune thyroiditis with facial palsy. Ann Pediatr Endocrinol Metab 2013; 18:214-7. [PMID: 24904880 PMCID: PMC4027082 DOI: 10.6065/apem.2013.18.4.214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 11/07/2013] [Accepted: 12/23/2013] [Indexed: 11/20/2022] Open
Abstract
We report a case of severe hypothyroidism with nongoitrous, autoimmune thyroiditis and pituitary hyperplasia in a 13-year-old boy, who presented with sudden palsy on the left side of his face. Prednisolone and antiviral medication was administered. However, the facial palsy did not improve completely. The medications were replaced with thyroxine, and the facial palsy recovered. Endocrinological testing showed severe hypothyroidism as follows: thyroid stimulating hormone (TSH) level >100 µIU/mL, T4 of 1.04 µg/dL, T3 of 0.31 ng/mL, and free T4 of 0.07 ng/dL. Level of serum antithyroid peroxidase antibodies was 1,933.39 IU/mL, and that of antithyroglobulin antibodies was 848.16 IU/mL. Level of TSH receptor antibodies was >40 IU/L. Bioassay result for TSH receptor stimulating antibodies was negative. Thyroid sonography revealed no increase in the size or vascularity of the bilateral gland. Thyroid scintigraphy with 99mTc showed decreased uptake, and magnetic resonance imaging demonstrated an enlarged pituitary gland.
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Affiliation(s)
- Hyung Jik Lee
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jin Kyung Kim
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea
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14
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Li Y, Kim J, Diana T, Klasen R, Olivo PD, Kahaly GJ. A novel bioassay for anti-thyrotrophin receptor autoantibodies detects both thyroid-blocking and stimulating activity. Clin Exp Immunol 2013; 173:390-7. [PMID: 23647395 PMCID: PMC3949626 DOI: 10.1111/cei.12129] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2013] [Indexed: 12/23/2022] Open
Abstract
Autoantibodies to the thyrotrophin (TSH) receptor (anti-TSHR) are unique, in that they are involved directly in the pathophysiology of certain autoimmune thyroid diseases (AITD). Thyroid-stimulating antibodies (TSAb) act as agonists that activate the thyroid gland and cause Graves' disease. Other anti-TSHR antibodies block TSH and can cause hypothyroidism. Thyroid-blocking antibodies (TBAb) have not been studied as extensively as TSAb. We developed a TBAb bioassay based on a cell line that expresses a chimeric TSHR. The 50% inhibitory concentration of the chimeric Chinese hamster ovary (CHO)-Luc cells was more than five-fold lower compared with the wild-type CHO-Luc cells. We tested the performance of this bioassay using a thyroid-blocking monoclonal antibody K1-70, established an assay cut-off and detected TBAb in 15 of 50 (30%) patients with AITD. Interestingly, the assay detects both TSAb and TBAb and measures the net activity of a mixture of both types of antibodies. There was a high correlation (R(2) 0·9, P < 0·0001) between the results of the TSAb assay and the negative percentage inhibition of the TBAb assay. The TBAb bioassay was approximately 20-fold more sensitive than a commercially available TSHR binding assay (TRAb). In contrast to TRAb, sera with high levels of TBAb activity were able to be diluted several hundred-fold and still exhibit blocking activity above the cut-off level. Thus, this TBAb bioassay provides a useful tool for measuring the activity of anti-TSHR antibodies and may help clinicians to characterize the diverse clinical presentations of patients with AITD.
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Affiliation(s)
- Y Li
- Diagnostic Hybrids Inc.Athens, Ohio, USA
| | - J Kim
- Diagnostic Hybrids Inc.Athens, Ohio, USA
| | - T Diana
- Molecular Thyroid Research Laboratory, Department of Medicine I, Gutenberg University Medical CenterMainz, Germany
| | - R Klasen
- Diagnostic Hybrids Inc.Athens, Ohio, USA
| | - P D Olivo
- Diagnostic Hybrids Inc.Athens, Ohio, USA
| | - G J Kahaly
- Molecular Thyroid Research Laboratory, Department of Medicine I, Gutenberg University Medical CenterMainz, Germany
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15
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Abstract
Autoimmune thyroiditis (AIT) is the most common thyroid disorder in the pediatric age range. The disease results from an as yet poorly characterized defect or defects in immunoregulation and a cascade of events progressing from lymphocyte infiltration of the thyroid, to T-cell- and cytokine-mediated thyroid follicular cell injury, and apoptotic cell death. Approximately 70% of disease risk has been attributed to genetic background with environmental factors being important in triggering disease in susceptible individuals. The contribution of individual genes is small and probably polymorphisms in multiple genes play a role. Some immuno susceptibility genes affect immune recognition or response in general, while others are thyroid-specific. Environmental agents may act through an epigenetic mechanism. Antibodies (Abs) to a variety of thyroid-specific antigens are detectable in a majority of patients, but the role of Abs in mediating cell injury and death is unclear and only thyrotropin (TSH) receptor Abs significantly affect thyroid function by interfering with (or stimulating) the action of TSH. Nonetheless, thyroid peroxidase (TPO) Abs and thyroglobulin (Tg) Abs, present in a majority of patients, are valuable diagnostically as markers of underlying autoimmune thyroid destruction. TSH receptor blocking Abs are found in ~18% of children and adolescents with severe hypothyroidism and, when persistent, may identify an adolescent likely to have a baby with TSH receptor blocking Ab-induced congenital hypothyroidism. AIT may coexist with other organ-specific autoimmune diseases. Although the most common age at presentation is adolescence, the disease may occur rarely in children <1 year of life.
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Affiliation(s)
- Rosalind S. Brown
- Division of Endocrinology, Children’s Hospital Boston and Department of Pediatrics, Harvard Medical School, Boston, USA
,* Address for Correspondence: Rosalind S. Brown MD, Division of Endocrinology, Children’s Hospital Boston and Department of Pediatrics, Harvard Medical School, Boston, USA Phone: +617-355-7476 E-mail:
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16
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Lytton SD, Li Y, Olivo PD, Kohn LD, Kahaly GJ. Novel chimeric thyroid-stimulating hormone-receptor bioassay for thyroid-stimulating immunoglobulins. Clin Exp Immunol 2011; 162:438-46. [PMID: 21070207 DOI: 10.1111/j.1365-2249.2010.04266.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Thyroid-stimulating immunoglobulins (TSI) are a functional biomarker of Graves' disease (GD). To develop a novel TSI bioassay, a cell line (MC4-CHO-Luc) was bio-engineered to constitutively express a chimeric TSH receptor (TSHR) and constructed with a cyclic adenosine monophosphate (cAMP)-dependent luciferase reporter gene that enables TSI quantification. Data presented as percentage of specimen-to-reference ratio (SRR%) were obtained from 271 patients with various autoimmune and thyroid diseases and 180 controls. Sensitivity of 96% and specificity of 99% for untreated GD were attained by receiver operating characteristic analysis, area under the curve 0·989, 95% confidence interval 0·969-0·999, P = 0·0001. Precision testing of manufactured reagents of high, medium, low and negative SRR% gave a percentage of coefficient-of-variation of 11·5%, 12·8%, 14·5% and 15·7%, respectively. There was no observed interference by haemoglobin, lipids and bilirubin and no non-specific stimulation by various hormones at and above physiological concentrations. TSI levels from GD patients without (SRR% 406 ± 134, mean ± standard deviation) or under anti-thyroid treatment (173 ± 147) were higher (P < 0·0001) compared with TSI levels of patients with Hashimoto's thyroiditis (51 ± 37), autoimmune diseases without GD (24 ± 10), thyroid nodules (30 ± 26) and controls (35 ± 18). The bioassay showed greater sensitivity when compared with anti-TSHR binding assays. In conclusion, the TSI-Mc4 bioassay measures the functional biomarker accurately in GD with a standardized protocol and could improve substantially the diagnosis of autoimmune diseases involving TSHR autoantibodies.
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Affiliation(s)
- S D Lytton
- Department of Medicine I, Gutenberg University Medical Center, Mainz, Germany
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17
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Gregoric E, Gregoric JA, Guarneri F, Benvenga S. Injections of Clostridium botulinum neurotoxin A may cause thyroid complications in predisposed persons based on molecular mimicry with thyroid autoantigens. Endocrine 2011; 39:41-7. [PMID: 21061092 DOI: 10.1007/s12020-010-9410-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 10/04/2010] [Indexed: 12/21/2022]
Abstract
A woman with Hashimoto's thyroiditis, under replacement L-T4, repeatedly experienced, over a 10-year period, elevations of serum TSH after eyelid injections of Clostridium botulinum neurotoxin A (Btx). We hypothesized a link between Btx injections and TSH elevations via molecular mimicry, and aimed to verify our hypothesis. Using an in silico approach, we searched first for amino acid sequence homology between Btx and thyroid autoantigens, and next for HLA binding motifs within homologous segments. We found that (i) Btx and thyroid autoantigens share amino acid sequence homology; (ii) some homologous regions contain epitopes of both Btx and thyroid autoantigens; (iii) some of such regions contain HLA-DR3 and/or HLA-DR7 binding motifs, which predominate over other HLA-DRs. This is relevant because the patient's HLA-DR haplotype was DR3/DR7. In conclusion, clinical and bioinformatics data suggest a possible pathogenetic link between Btx and autoimmune thyroid diseases. Considering the wide and increasing medical and dermocosmetic use of Btx, and the frequently subclinical course of autoimmune thyroid diseases, we think that thyroid "complications" may pass frequently undetected in Btx-treated persons.
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Affiliation(s)
- Edvina Gregoric
- Department of Nuclear Medicine, Hospital Izola, Izola, Slovenia
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18
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Inamo Y. A 5-year-old boy with atrophic autoimmune thyroiditis caused by thyroid-stimulation blocking antibodies. J Pediatr Endocrinol Metab 2011; 24:591-4. [PMID: 21932608 DOI: 10.1515/jpem.2011.193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 5-year-old boy was presented for a growth disturbance, which was initially noted at 3 years of age. Endocrinological testing identified severe hypothyroidism, defined by the following levels: TSH 990.5 microU/mL, F-T3 0.26 pg/mL, and F-T4 0.09 ng/dL. Serum anti-thyroid peroxidase (TPO) antibodies were 158 IU/mL and serum thyroid-stimulation blocking antibodies (TSBab) levels were 82.1 IU/mL (normal range < 45.6). Thyroid scintigraphy with 99mTc showed markedly decreased uptake, and magnetic resonance imaging (MRI) revealed pituitary hyperplasia. He was diagnosed with atrophic autoimmune thyroiditis. His thyroid function and pituitary size normalized following thyroid hormone replacement therapy. We report a rare case of a young boy with atrophic thyroiditis caused by TSBab.
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Affiliation(s)
- Yasuji Inamo
- Department of General Pediatrics, Nihon University, Nerima-Hikarigaoka Hospital, Nerima-ku, Tokyo, Japan.
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19
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Current world literature. Curr Opin Rheumatol 2010; 23:125-30. [PMID: 21124095 DOI: 10.1097/bor.0b013e3283422cce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Lytton SD, Kahaly GJ. Bioassays for TSH-receptor autoantibodies: an update. Autoimmun Rev 2010; 10:116-22. [PMID: 20807591 DOI: 10.1016/j.autrev.2010.08.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2010] [Indexed: 10/19/2022]
Abstract
Immunoglobulins in patients with Graves' disease (GD) that modulate the thyroid stimulating hormone receptor (TSH-R) do so via stimulating cAMP dependent signals (TSI), blocking TSH or inhibition of TSH-receptor activation (TBI) or inducing apoptotic signals. These functional immunoglobulins represent powerful biomarkers of anti-self reactivity in the thyroid and systemic tissues that harbor TSH-R expressing target cells. TSI on thyrocytes induce hyperthyroidism, and TSI on TSH-R fibroblasts of orbital muscles, skin and heart provoke the release of cytokines and antigen-specific T-cell responses leading to systemic inflammation. Bioassays of anti-TSH-R autoantibodies provide decisive information on GD activity. This review examines the past and present bioassays in GD. The critical goal of cell-based anti-TSH-R autoantibody bioassays, to identify the pathogenic immunoglobulins in GD under robust and standardized conditions suitable for routine clinical laboratory practice, is discussed.
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Affiliation(s)
- Simon D Lytton
- Thyroid Research Laboratory, Department of Medicine I, Gutenberg University Medical Center, Mainz 55101, Germany.
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