Total and "activated" peripheral blood T lymphocytes in patients with thyroid disorders

Role of lipid peroxidation and oxidative stress in the association between thyroid diseases and breast cancer

Evidence is accumulating for a role of the thyroid in the natural history of breast cancer, although no plausible mechanism has been advanced to explain this association. We believe that the thyroid disease-breast cancer relationship provides a unique opportunity to find out the causes of breast cancer. Both diseases are female predominant, with specifically identified biological pathways and genetic and environmental determinants, and seeing them in concert provides an opportunity to identify the most relevant mechanistic pathways. In this communication, we advance a plausible mechanism to explain the thyroid disease-breast cancer relationship. We specifically propose that the reduction in risk associated with hyperthyroidism or increased levels of thyroid hormones, or iodine, may derive from the pro-oxidant properties of these compounds, i.e., from its ability to generate oxidative stress-induced apoptosis. Conversely, the increased risk from hypothyroidism may derive from its ability to inhibit this stress-mediated apoptotic process.

Effects of thyroid hormones on apoptotic cell death of human lymphocytes

Apoptosis plays a critical role in the development and homeostasis of tissues, especially those with high cell turnover such as the lymphoid system. We have examined the effects of thyroid hormones, TSH and TRH, on apoptosis of human T lymphocytes. We found that T lymphocytes cultured with T3 and T4, but not TSH nor TRH, in vitro showed enhanced apoptosis, evidenced by DNA ladder formation and characteristic morphological changes. In addition, prolonged cultivation with thyroid hormones of the lymphocytes further enhanced the extent of apoptosis. We also found that treatment with thyroid hormones of T lymphocytes induced reduction of mitochondrial transmembrane potential (delta psi) and production of reactive oxygen species, both of which are intimately associated with apoptotic cell death. In addition, cellular expression of antiapoptotic Bcl-2 protein was clearly reduced by the treatment of lymphocytes with thyroid hormones in vitro. Thus, T lymphocytes treated with thyroid hormones accompany reduction of Bcl-2 protein expression, production of reactive oxygen species, and reduction of mitochondrial delta psi, resulting in apoptotic lymphocyte death. Moreover, we found that lymphocytes in patients with Graves' disease showed enhanced apoptosis compared with those in normal individuals. These results suggest that thyroid hormones have the potential to induce apoptotic cell death of human lymphocytes in vivo and in vitro.

Total skin electron beam and total nodal irradiation of cutaneous T-cell lymphoma

Nineteen patients with cutaneous T-cell lymphoma (CTCL) limited to the skin and/or lymph nodes were treated at Hahnemann University with a combination of total skin electron beam and total nodal irradiation (TSEB + TNI). The patients were classified as Stage Ib (1 patient), Stage IIa (8 patients), Stage IIb (5 patients), and Stage IVa (5 patients). Treatment resulted in a complete response in 100% (14/14) of patients with Stage Ib, IIa, and IIb disease, and a CR in 60% (3/5) of patients with Stage IVa disease. The Stage Ib and IIa patients had an overall survival of 100% and a disease-free survival of 44% at 6 years. Four of the five patients with Stage IIb CTCL relapsed within 3 months after completing TSEB + TNI with an overall survival in the group of 40% at 5 years. The Stage IVa patients all relapsed within 7 months and died of their disease within 50 months of completing treatment. The acute effects of TSEB + TNI were well tolerated, but three patients developed second malignancy (lung, kidney and skin) and one patient developed myelodysplasia, possibly the result of radiotherapy.

Clinical and immunological studies on patients with Graves' disease preoperatively treated with corticosteroids and iodides

The purpose of this study was to evaluate the acute effects of corticosteroid and iodide preoperative therapy in patients with Graves' disease in terms of thyroid function and immunological parameters. The above combination was prescribed for 4 patients who had experienced severe side effects from antithyroid drugs (ATD) in order to reduce the possibility of post-thyroidectomy thyroid storm. Corticosteroids were employed daily for four days, and iodides were given daily for two weeks prior to thyroidectomy. The free T3 values decreased rapidly to euthyroid levels following the administration of both drugs, although the free T4 values were still much higher than normal in 3 of the 4 patients at the time of surgery. By comparison, 3 of 8 patients treated with ATD also had thyroid hormone levels above normal. Studies of lymphocyte subsets revealed that the percentage of helper T cells was significantly less in the corticosteroid-iodide treatment group than in the control and ATD groups. It is thus possible that postoperative thyroid storm might be prevented through corticosteroid-iodide therapy by virtue of the reduction of free T3 values to within the normal range by the time of surgery. The acute suppression of helper T cells was another results of this form of therapy observed.

Graves' disease with thyrotoxicosis following subacute thyroiditis

Two patients are described who manifested the sequential occurrence of Graves' disease and subacute thyroiditis. The literature on this very unusual event is reviewed and speculation is offered on a possible mechanism linking thyroiditis to activation of Graves' disease in susceptible persons.

Cell-mediated immunity of Yersinia enterocolitica serotype 3 in patients with thyroid diseases

The cellular immunity to Yersinia enterocolitica serotype 3 and crude human thyroid extract in 64 patients with thyroid diseases and 25 controls was studied by the leucocyte migration test. In the patient group as a whole and in patients with Graves' disease and nontoxic diffuse goitre a significantly reduced leucocyte migration towards Yersinia was found when compared with the controls. In controls the migration index was not related to the presence or titre of circulating yersinia antibodies, whereas the migration index of patients with yersinia antibodies was lower than the migration index of patients without yersinia antibodies as well as that of the controls. The leucocyte migration inhibition in two patients with recent yersinosis was normal during the recovery phase. In the presence of thyroid extract leucocyte migration inhibition differed only significantly in Graves' disease. However, a significantly positive correlation between inhibition of migration by thyroid extract and by Yersinia was found, while no correlation could be demonstrated in the controls. The cell-mediated immunity towards Yersinia in thyroid diseases thus demonstrated adds further evidence to the association between Yersinia and thyroid disease.