Impact of thyroid autoimmunity on pregnancy outcomes in euthyroid women following fresh/frozen-thawed embryo transfer.

OBJECTIVE: To investigate whether thyroid autoimmunity (TAI) is associated with assisted reproductive technology (ART) outcomes in euthyroid women undergoing fresh embryo transfer (ET) and frozen-thawed embryo transfer (FET). DESIGN: A retrospective cohort study. Pregnancy and neonatal outcome after fresh ET or FET were compared between the positive and negative thyroid autoimmune antibody groups. PATIENTS: A total of 5439 euthyroid women who started their ART cycle at our centre between 2015 and 2019 were included. RESULTS: The thyroid antibody positive group had a greater mean age than the thyroid antibody negative group (32(29,35) vs. 31(28,34), p < .001). Women with positive thyroid antibody presented with a higher prevalence of diminished ovarian reserve (DOR) (9.1% vs. 7.1%, p = .026) and lower number of oocyte retrieved (9(5,15) vs. 10(6,15), p = .020), but difference was not significant after adjusting for age. The pregnancy rate, live birth rate, pregnancy loss rate, preterm delivery rate and low birthweight rate between the thyroid antibody positive and thyroid antibody negative groups were comparable both in fresh ET cycles and FET cycles. Subanalysis of the treatment outcomes when using a stricter threshold of TSH of 2.5 mIU/L showed no difference to that achieved when using an upper limit of 4.78 mIU/L. CONCLUSIONS: The present study reveals that patients with anti-thyroid peroxidase antibodies (TPOAbs) and/or antithyroglobulin antibodies (TgAbs) showed no significant differences in pregnancy outcomes following fresh ET and FET when compared with patients with negative thyroid antibodies.

On the Centennial of Vitamin D-Vitamin D, Inflammation, and Autoimmune Thyroiditis: A Web of Links and Implications.

The 100th anniversary of the discovery of vitamin D3 (VitD3) coincides with significant recent advances in understanding its mechanism of action along with accumulating knowledge concerning its genomic and nongenomic activities. A close relationship between VitD3 and the immune system, including both types of immunity, innate and adaptive, has been newly identified, while low levels of VitD3 have been implicated in the development of autoimmune thyroiditis (AIT). Active 1,25(OH)2 D3 is generated in immune cells via 1-α-hydroxylase, subsequently interacting with the VitD3 receptor to promote transcriptional and epigenomic responses in the same or adjacent cells. Despite considerable progress in deciphering the role of VitD3 in autoimmunity, its exact pathogenetic involvement remains to be elucidated. Finally, in the era of coronavirus disease 2019 (COVID-19), brief mention is made of the possible links between VitD3 deficiency and risks for severe COVID-19 disease. This review aims to commemorate the centennial of the discovery of VitD3 by updating our understanding of this important nutrient and by drawing up a framework of guidance for VitD3 supplementation, while emphasizing the necessity for personalized treatment in patients with autoimmune thyroid disease. A tailored approach based on the specific mechanisms underlying VitD3 deficiency in different diseases is recommended.

Orthostatic Myoclonic Jerks in a Case of Hashimoto's Encephalopathy.

Hashimoto's encephalopathy (HE) is an uncommon syndrome with the characteristic triad of positive antithyroid antibodies (most commonly antibodies to thyroid peroxidase), response to steroids, and clinical picture presenting either as stroke-like pattern of focal neurological deficit or slowly progressive cognitive impairment. Myoclonus or tremors, seizures, and psychosis are other associated features which can be seen in HE. Herein, we report a girl with an uncommon presentation of orthostatic axial and myoclonic jerks in bilateral lower limbs in a case of HE.

Rapid cycling bipolar disorder is associated with antithyroid antibodies, instead of thyroid dysfunction.

BACKGROUND: Conclusions regarding the association between antithyroid antibodies or thyroid dysfunction and rapid cycling bipolar disorder (RCBD) have been conflicting. Previous studies suggest that the impact of antithyroid antibodies on mental wellbeing seems to be independent of thyroid function. Here, we investigated their independent association with RCBD in a large, well-defined population of bipolar disorder (BD). METHODS: Fast serum levels of free thyroxine (FT4), free triiodothyronine (FT3), thyroid Stimulating Hormone (TSH), TPO-abs and Tg-abs were simultaneously measured in 352 patients with BD. Clinical features of BD were collected through semi-structural interview conducted by trained interviewers with background of psychiatric education. RESULTS: Neither hypothyroidism nor hyperthyroidism was significantly associated with RCBD. Both TPO-abs and Tg-abs were significantly related to RCBD, even after controlling for gender, age, marriage status, education, antidepressants treatment, comorbidity of thyroid diseases, and thyroid function (serum levels of FT3, FT4 and TSH). Although TPO-abs and Tg-abs were highly correlated with each other, binary logistic regression with forward LR selected TPO-abs, instead of Tg-abs, to be associated with RCBD. TPO-abs was significantly, independently of Tg-abs, associated with hyperthyroidism, while Tg-abs was marginally significantly related to hypothyroidism at the presence of TPO-abs. CONCLUSION: TPO-abs might be treated as a biomarker of RCBD. Further exploring the underlying mechanism might help understand the nature of RCBD and find out new treatment target for it.

Is There Any Association Between Psoriasis and Hashimoto's Thyroiditis?

Background The association between psoriasis and Hashimoto's thyroiditis has been evaluated in many retrospectives and prospective studies with varying numbers of patients and study designs. A positive association had been found certain studies, while no clear association in others. Objective The objective of this study was to evaluate the prevalence of Hashimoto's thyroiditis in patients with psoriasis in comparison with healthy matched control from the same geographical region. Methods A case-control study was conducted from October 2017 to October 2018 in Faiha Specialized Diabetes, Endocrine, and Metabolism Center (FDEMC). Fifty-six psoriatic patients were compared with 54 healthy, gender, age and body mass index-matched controls. All participants had thyroid evaluation in the form of measurement of thyroid-stimulating hormone (TSH), free thyroxine (FT4), antithyroid peroxidase antibody (TPO Ab), and antithyroglobulin antibody (Tg Ab). Thyroid ultrasound examination was performed looking for volume, hypo-echogenicity, pseudo-nodularity, and increased vascularity. Assessment of psoriasis severity was conducted using the Psoriasis Area and Severity Index (PASI) score. Results Significantly higher prevalence of TPO Ab, Tg Ab, hypo-echogenicity, pseudo-nodularity, and increased vascularity was found in patients with psoriasis. The prevalence in psoriasis versus control was for TPO Ab (25.0% vs 9.3%, p = 0.02), Tg Ab (30.4% vs 11.1%, p = 0.01), hypo-echogenicity (30.4% vs 9.3%, p = 0.02), pseudo-nodularity (16.1% vs 0%, p = 0.002), and increased vascularity (35.7% vs 5.6%, p = 0.001). Patients with psoriasis with age of onset at diagnosis ≥40 years old and obesity were significantly more likely to have positive TPO Ab with a prevalence of (42.1% and 40.7%, respectively). There were no significant differences in the prevalence of hypothyroidism and subclinical hypothyroidism between psoriasis and control. In patients with psoriasis, psoriasis types, severity, duration, age, gender, smoking status, type 2 diabetes, and personal and family history of autoimmune diseases did not correlate with thyroid autoimmunity. Conclusions This study demonstrates a clear association between psoriasis and Hashimoto's thyroiditis in the form of a significantly higher prevalence of TPO Ab, Tg Ab, hypo-echogenicity, pseudo-nodularity, and increased vascularity. Hence, thyroid evaluation by anti-thyroid antibodies, particularly TPO Ab, and ultrasound should be included in the care of psoriasis patients.

Isolated effect of maternal thyroid-stimulating hormone, free thyroxine and antithyroid peroxidase antibodies in early pregnancy on gestational diabetes mellitus: a birth cohort study in China.

This article aims to understand the isolated effect of maternal thyroid-stimulating hormone (TSH), free thyroxine (FT4) and antithyroid peroxidase antibodies (TPOAb) in early pregnancy on gestational diabetes mellitus (GDM). Based on a birth cohort, pregnant women presented to maternity hospitals for the first antenatal care from Nov 2008 to Oct 2010 were invited to participate in the study. A self-administered questionnaire was asked to complete to collect data on socio-economic variables, previous adverse pregnancy outcomes, method of conception, previous endocrinic and metabolic diseases, and pregnancy-related anxiety in 1st trimester of the index pregnancy. Pre-pregnancy BMI was measured. Serum samples were collected, and TSH, FT4 and TPOAb were assayed. GDM was confirmed from medical records screened on 24-28 gestational weeks by using oral glucose tolerance test (OGTT). The prevalence of isolated subclinical hypothyroidism, hypothyroidemia and positive TPOAb in early pregnancy was 2.0%, 2.0% and 12.8%. Prevalence of GDM in women with the isolated sub-clinical hypothyroidism, hypothyroxinemia and positive TPOAb was 2.9%, 2.8% and 3.1%, respectively, which were all higher than that detected in euthyroidism women (1.2%). Women with isolated positive TPOAb had significantly higher TSH and lower FT4 level compared with euthyroidism women. It was found that isolated positive TPOAb in early pregnancy increased the risk of GDM, adjusted RR and 95%CI being 2.541(1.037-6.226). No significant relationships were identified between isolated sub-clinical hypothyroidism or hypothyroxinemia with GDM. In conclusion, isolated thyroid autoimmunity, represented by positive TPOAb, in early pregnancy were associated with GDM independent of TSH and FT4.

Technetium-99m Thyroid Scintigraphy and Human Leukocyte Antigen - B35 in Sub-Acute Thyroiditis.

INTRODUCTION: Sub-acute thyroiditis possibly caused by a viral infection of thyroid gland is associated with a surge in thyroxine levels of the patient. Women in the younger age group are affected more than men. Markedly decreased radioactive iodine thyroid uptakes in a setting of thyrotoxicosis associated with elevated thyroxine levels and reduced thyroid stimulating hormone levels usually clinches the diagnosis. Patients mostly require symptomatic treatment with non-steroidal anti-inflammatory drugs. Sub-acute thyroiditis is a self-limiting disorder with most of the patients making a complete recovery in a span of three to six months. Being geographically and ethnically different the present studies was undertaken with an objective of understanding the clinical, laboratory and thyroid uptake profiles in patients of SAT during its natural history and also find the extent of genetic influences through its association with HLA B35. MATERIALS AND METHODS: 32 patients in the age group of 20-59 years diagnosed to have sub-acute thyroiditis were studied. 18 patients out of 32 were subjected to HLA B35 testing. Other laboratory parameters that included hormonal profile and radioactive thyroid uptakes were performed. RESULTS: Most of the patients were females and in their fourth decade of life. Thyroid stimulating hormone levels were decreased in 32 (100%). A majority of patients had normal anti TPO levels. All the patients had grossly decreased Tc-99m thyroid uptake levels at presentation. HLA B35 test done in 18 patients was reported positive in 10 (55.56%) patients. CONCLUSION: The present study is unique in having used serial Tc-99m thyroid scintigraphy in patients of SAT. A positive HLA B 35 is associated in a majority of patients conferring genetic susceptibility.

Practice Variance in Thyroid Screening of Youth with Type 1 Diabetes Mellitus.

BACKGROUND: Variance between current American Diabetes Association (ADA) and International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines and in clinical practice exists for the use of thyroid antibody and thyroid function screening in pediatric patients with new-onset type 1 diabetes (T1D). METHODS: North American Pediatric Endocrine Society (PES) members were surveyed regarding their thyroid screening practices of euthyroid youth with T1D. An institutional analysis of the ability of antithyroid peroxidase (aTPO) and antithyroglobulin antibodies (aTG) to predict the subsequent use of levothyroxine was performed. RESULTS: Forty-eight percent of 374 survey respondents tested both aTPO and aTG at diagnosis of T1D, but 35% performed no baseline antibody testing. If antibodies were positive, 89% of the respondents would perform annual thyroid function testing, but if antibodies were negative, 62% would follow thyroid function annually and 29% biannually. Institutionally, aTPO had significantly greater sensitivity (p = 0.04) but lower specificity (p = 0.008) than aTG for predicting the use of levothyroxine. CONCLUSIONS: Variance exists among North American PES members regarding thyroid disease screening for pediatric patients diagnosed with T1D, and this appears to reflect differences between ADA and ISPAD guidelines. A prospective multicenter observational study which shares electronic medical record data and compares aTPO and TSH as primary screening tests may allow for more uniform guidelines and address the possibility of using TSH alone.

Sarcoidosis and Thyroid Autoimmunity.

Most of the studies have shown a higher risk for subclinical and clinical hypothyroidism, antithyroid autoantibodies [overall antithyroid peroxidase antibodies (TPOAb)], and in general, thyroid autoimmunity, overall in the female gender in patients with sarcoidosis (S). A significantly higher prevalence of clinical hypothyroidism and Graves' disease was also described in female S patients with respect to controls. Gallium-67 (Ga-67) scyntigraphy in S patients, in the case of thyroid uptake, suggests the presence of aggressive autoimmune thyroiditis and hypothyroidism. For this reason, ultrasonography and thyroid function should be done in the case of Ga-67 thyroid uptake. In conclusion, thyroid function, TPOAb measurement, and ultrasonography should be done to assess the clinical profile in female S patients, and the ones at high risk (female individuals, with TPOAb positivity, and hypoechoic and small thyroid) should have periodically thyroid function evaluations and suitable treatments.

Role of oxidative stress and autoimmunity in onset and progression of vitiligo.

Vitiligo is an acquired depigmentation disorder characterized by the loss of functional melanocytes from the epidermis. Two major theories of vitiligo pathogenesis include autoimmunity and oxidative stress-mediated toxicity in melanocytes. The present study aimed to evaluate both the hypotheses in vitiligo patients and to investigate their role in the disease onset and progression. Antimelanocyte antibody levels and lipid peroxidation (LPO) levels were evaluated in 427 patients and 440 controls; antithyroid peroxidase (TPO) antibody levels were estimated in 102 patients and 72 controls. Patients showed a significant increase in LPO and antimelanocyte antibody levels compared to controls. Antimelanocyte antibody and LPO levels were higher in active vitiligo compared to stable. Only 9.8% of patients showed the presence of anti-TPO antibodies in their circulation. Oxidative stress may be the initial triggering event to precipitate vitiligo in Gujarat population, which is exacerbated by contributing autoimmune factors together with oxidative stress.

Steroid-responsive encephalopathy in autoimmune thyroiditis: Clinical spectrum and MRI observations in three cases.

Hashimoto's encephalopathy (H.E.) is probably of autoimmune etiology, and manifests with seizures, stroke-like episodes, cognitive decline, neuropsychiatric symptoms, myoclonus. It is presumed to be autoimmune in origin with high serum titers of antithyroid peroxidase antibodies (anti-TPA). Thyroid function might often be normal. The diagnosis is arrived at by excluding other toxic, metabolic and infectious causes of encephalopathies, supportive clinical profile, elevated thyroid antibodies and optimum steroid response. We present the characteristic phenotypic manifestations, magnetic resonance imaging and electroechography observations and response to immunomodulation with follow-up in three cases of H.E. All the three cases manifested with subacute to chronic progressive encephalopathy, cerebellar dysfunction, seizures, behavioral abnormalities and oculomotor disturbances and had evidence of hypothyroidism, elevated titers of anti-TPA and positive thyroid anti-microsomal antibodies. Atypical and uncommon presentations are known. This report emphasizes that a high index of suspicion is often required in cases with "investigation negative encephalopathy" for early diagnosis of H.E.