La función tiroidea en pacientes con enfermedades autoinmunes / Thyroid function in patients with autoimmune diseases

Introducción: la aparición de enfermedad tiroidea autoinmune presenta una gran prevalencia en pacientes con diagnósticos de enfermedades autoinmunes. Objetivo: describir las enfermedades tiroideas autoinmunes en pacientes con enfermedades autoinmunes, atendidos en el Hospital Pediátrico William Soler Ledea, del 1ro. de octubre de 2014 al 31 de enero de 2017. Métodos: estudio descriptivo, transversal y prospectivo en 42 pacientes con diagnóstico de enfermedad autoinmune. Se midieron variables demográficas, enfermedad autoinmune (lupus eritematoso sistémico, hepatitis autoinmune, artritis idiopática juvenil y esclerodermia), función tiroidea (eutiroidismo, hipotiroidismo e hipertiroidismo) y anticuerpos antitiroideos (antiperoxidasa y antitiroglobulina). Resultados: las enfermedades autoinmunes, con enfermedad tiroidea, se presentaron en 26,2 por ciento (n= 11): con hipotiroidismo 81,8 por ciento (n= 9) y con hipertiroidismo 18,2 por ciento (n= 2). El hipotiroidismo estuvo presente en adolescentes del sexo femenino (n= 7), el lupus eritematoso sistémico en el 88,9 por ciento (n= 8), seguido de esclerodermia en el 11,1 por ciento (n= 1). El hipertiroidismo solo se diagnosticó en el lupus eritematoso sistémico 100 por ciento (n= 2), ambas en adolescentes del sexo femenino. Solo 3 pacientes tuvieron anticuerpos antitiroideos positivos, solo 2 se correspondieron con enfermedad tiroidea autoinmune: hipotiroidismo con anticuerpos antitiroideos positivos 22,2 por ciento (n= 2, en este caso correspondiente al lupus eritematoso sistémico). Los pacientes sin enfermedad tiroidea (73,8 por ciento; n= 31), a su vez, predominaron en edades de 10-14 años (n= 15; 48,4 por ciento) y en el sexo femenino (n= 22; 71,0 por ciento). Conclusión: el hipotiroidismo es más frecuente en adolescentes femeninas, con diagnóstico de lupus eritematoso sistémico, y con evidencia de anticuerpos antitiroideos positivos(AU)

Introduction: the appearance of autoimmune thyroid disease has high prevalence in patients diagnosed with autoimmune diseases. Objective: to describe the autoimmune thyroid diseases in patients with autoimmune diseases attended at William Soler Ledea Pediatric Hospital from October 1, 2014 to January 31, 2017. Methods: descriptive, cross-sectional and prospective study in 42 patients diagnosed with autoimmune disease. Demographic variables, autoimmune disease (systemic lupus erythematosus, autoimmune hepatitis, juvenile idiopathic arthritis and scleroderma), thyroid function (euthyroidism, hypothyroidism and hyperthyroidism) and antithyroid antibodies (antiperoxidase and antithyroglobulin) were measured. Results: autoimmune diseases with thyroid disease occurred in 26.2 percent (n= 11), with hypothyroidism 81.8 percent (n= 9), and with hyperthyroidism 18.2 percent (n= 2). Hypothyroidism was present in female adolescents (n= 7), systemic erythematosus lupus in 88.9 percent (n= 8) followed by scleroderma in 11.1 percent (n= 1). Hyperthyroidism was only diagnosed 100 percent in systemic erythematosus lupus (n= 2), both in female adolescents. Only 3 patients had positive antithyroid antibodies, only 2 corresponded to autoimmune thyroid disease: hypothyroidism with positive antithyroid antibodies with 22.2 percent (n= 2, in this case corresponding to systemic lupus erythematosus). Patients without thyroid disease (73.8 percent; n= 31) predominated at ages from 10 to 14 years old (n= 15; 48.4 percent) and in females (n= 22; 71.0 percent). Conclusion: hypothyroidism is more frequent in female adolescents, with a diagnosis of systemic erythematosus lupus, and with evidence of positive antithyroid antibodies(AU)

Familial autoimmunity and polyautoimmunity in 60 Brazilian Midwest patients with systemic sclerosis / Autoimunidade familial e poliautoimunidade em 60 pacientes portadores de esclerose sistêmica da região Centro-Oeste do Brasil

ABSTRACT Introduction: Systemic sclerosis (SSc) is a connective tissue disease of unknown etiology, characterized by a triad of vascular injury, autoimmunity and tissue fibrosis. It is known that a positive family history is the greatest risk factor already identified for the development of SSc in a given individual. Preliminary observation of a high prevalence of polyautoimmunity and of familial autoimmunity in SSc patients support the idea that different autoimmune phenotypes may share common susceptibility variants. Objectives: To describe the frequency of familial autoimmunity and polyautoimmunity in 60 SSc patients in the Midwest region of Brazil, as well as to report the main autoimmune diseases observed in this association of comorbidities. Methods: A cross-sectional study with recruitment of 60 consecutive patients selected at the Rheumatology Department, University Hospital, Medicine School, Federal University of Mato Grosso do Sul (FMUFMS), as well as interviews of their relatives during the period from February 2013 to March 2014. Results: A frequency of 43.3% of polyautoimmunity and of 51.7% of familial autoimmunity in SSc patients was found. Patients with the presence of polyautoimmunity and familial autoimmunity presented primarily the diffuse form of SSc, but this indicator did not reach statistical significance. The autoimmune diseases most frequently observed in polyautoimmunity patients were: Hashimoto's thyroiditis (53.8%), Sjögren's syndrome (38.5%), and inflammatory myopathy (11.5%). The main autoimmune diseases observed in SSc patients' relatives were: Hashimoto's thyroiditis (32.3%), rheumatoid arthritis (22.6%), and SLE (22.6%). The presence of more than one autoimmune disease in SSc patients did not correlate with disease severity or activity. Conclusions: From the high prevalence of coexisting autoimmune diseases found in SSc patients, we stress the importance of the concept of shared autoimmunity, in order to promote a continued vigilance and promptly diagnose other possible autoimmune disease in patients, or in their kin.

RESUMO Introdução: A esclerose sistêmica (ES) é uma enfermidade do tecido conjuntivo de etiologia desconhecida, caracterizada pela tríade de injúria vascular, autoimunidade e fibrose tecidual. Sabe-se que uma história familiar positiva representa o maior fator de risco já identificado para o desenvolvimento da ES em um determinado indivíduo. Observação prévia de alta prevalência de poliautoimunidade e de autoimunidade familiar em pacientes com ES reforça a ideia de que fenótipos autoimunes distintos podem dividir variantes comuns de susceptibilidade. Objetivos: Descrever a frequência de autoimunidade familiar e de poliautoimunidade em 60 pacientes com ES da região Centro-Oeste do Brasil, bem como relatar as principais doenças autoimunes observadas nessa associação de comorbidades. Métodos: Estudo transversal com recrutamento de 60 pacientes consecutivos, selecionados no Serviço de Reumatologia do Hospital Universitário da Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul (FMUFMS), bem como entrevista de seus parentes, de fevereiro de 2013 a março de 2014. Resultados: Foi encontrada uma frequência de 43,3% de poliautoimunidade e de 51,7% de autoimunidade familiar nos pacientes com ES. Os pacientes com presença de poliautoimunidade e de autoimunidade familiar eram principalmente da forma difusa de ES, porém esse índice não atingiu significância estatística. As doenças autoimunes mais comumente observadas nos pacientes com poliautoimunidade foram: tireoidite de Hashimoto (53,8%), síndrome de Sjögren (38,5%) e miopatia inflamatória (11,5%). As principais doenças autoimunes observadas nos parentes dos pacientes com ES foram: tireoidite de Hashimoto (32,3%), artrite reumatoide (22,6%) e LES (22,6%). A presença de mais de uma enfermidade autoimune em pacientes com ES não se correlacionou com maior gravidade ou atividade da doença. Conclusões: A partir da alta prevalência encontrada de doenças autoimunes coexistentes em pacientes com ES, salientamos a importância do conceito de autoimunidade compartilhada, de forma a promover uma vigilância constante e diagnosticar prontamente uma possível outra doença autoimune nos pacientes ou em seus parentes.

Prevalence and clinical features of celiac disease in patients with autoimmune thyroiditis: cross-sectional study / Prevalência e características clínicas da doença celíaca em pacientes com tireoidite autoimune: estudo transversal

CONTEXT AND OBJECTIVE: Celiac disease is an autoimmune disorder with an average prevalence of 1% in Europe and the United States. Because of strong European ancestry in southern Brazil, this study aimed to evaluate the seroprevalence of celiac disease among autoimmune thyroiditis patients. DESIGN AND SETTING: Cross-sectional study in a public university hospital. METHODS: This cross-sectional prevalence study included autoimmune thyroiditis patients who were tested for anti-endomysial and anti-transglutaminase antibodies between August 2010 and July 2011. RESULTS: Fifty-three patients with autoimmune thyroiditis were included; 92.5% were women, with mean age of 49.0 ± 13.5 years. Five patients (9.3%) were serologically positive for celiac disease: three of them (5.6%) were reactive for anti-endomysial antibodies and two (3.7%) for anti-transglutaminase. None of them exhibited anemia and one presented diarrhea. Endoscopy was performed on two patients: one with normal histology and the other with lymphocytic infiltrate and villous atrophy. CONCLUSION: The prevalence of celiac disease among patients with autoimmune thyroid disease was 9.3%; one patient complained of diarrhea and none presented anemia. Among at-risk populations, like autoimmune thyroiditis patients, the presence of diarrhea or anemia should not be used as a criterion for indicating celiac disease investigation. This must be done for all autoimmune thyroiditis patients because of its high prevalence. .

CONTEXTO E OBJETIVO: A doença celíaca é uma doença autoimune, com prevalência média de 1% na Europa e nos Estados Unidos. Em função da forte ascendência europeia no sul do Brasil, este estudo objetiva relatar a soroprevalência de doença celíaca em indivíduos com tireoidite autoimune. TIPO DE ESTUDO E LOCAL: Estudo transversal em um hospital público universitário. MÉTODOS: Este estudo transversal de prevalência incluiu pacientes com tireoidite autoimune que foram submetidos a testes de anticorpos antiendomísio e antitransglutaminase entre agosto de 2010 e julho de 2011. RESULTADOS: Foram incluídos 53 pacientes com tireoidite autoimune, 92,5% mulheres, com idade média de 49,0 ± 13,5 anos. Cinco (9,3%) pacientes apresentaram sorologia positiva para doença celíaca, sendo três (5,6%) com anticorpo antiendomísio positivo e dois (3,7%) com antitransglutaminase positivo. Nenhum paciente apresentou anemia e um apresentou diarreia. Apenas dois pacientes realizaram endoscopia: um com histologia normal e outro apresentou infiltrado linfocitário e atrofia vilositária. CONCLUSÕES: A prevalência de doença celíaca entre pacientes com doença autoimune da tireoide foi de 9,3%; um paciente queixou-se de diarreia e ninguém apresentou anemia. Em populações de risco, como é o caso de pacientes com tireoidite autoimune, a presença de diarreia ou anemia não devem ser utilizados como critério para indicar investigação de doença celíaca, que deve ser feita em todos os indivíduos com tireoidite autoimune devido a sua alta prevalência. .

Prevalencia de hipotiroidismo y relación con niveles elevados de anticuerpos antiperoxidasa y yoduria en población de 35 y más años en Armenia. 2009-2010 / Hypothyroidism prevalence and its relationship to high levels of thyroid peroxidase antibodies and urinary iodine in a population aged 35 and over from Armenia, 2009-2010

Objetivos Determinar la frecuencia de hipotiroidismo y su relación con anticuerpos antiperoxidasa y yoduria elevada, con la finalidad de realizar recomendaciones a las autoridades sanitarias sobre el consumo de sal yodada y detección temprana de enfermedad tiroidea. Métodos Participaron 437 personas de la población general de Armenia (Quindío). Se realizaron pruebas ELISA para Tiroxina-L, hormona estimulante de la tiroides, anticuerpos antiperoxidasa y análisis fotocolorimétrico para yoduria. Resultados La prevalencia de hipotiroidismo fue de 18,5 %. Los anticuerpos antiperoxidasa fueron positivos en el 28,9 %, con prevalencia significativamente más alta entre aquellos con hormona estimulante de la tiroides mayor a 10 uUI/ml comparados con valores de 5,1 a 10 uUI/ml (O.R 3,2) y en fumadores (O.R 3,4). La Tiroxina-L fue normal en el 98,2 % de participantes con hormona estimulante de la tiroides mayor a 5 uUI/ml y en el 92 % de aquellos con valores mayores a 10 uUI/ml. El promedio de yoduria fue de 565,1; niveles por encima de 300 µg/l se obtuvieron en un 81,8 % de los participantes. Conclusiones El aumento en la prevalencia de anticuerpos antiperoxidasa positivo a medida que aumentan los valores de hormona estimulante de la tiroides podría evidenciar una elevado riesgo en Armenia de desarrollo de hipotiroidismo de origen autoinmune; a pesar de los elevados niveles de yoduria, no se logró establecer relación con los niveles de anticuerpos antiperoxidasa ni de hormona estimulante de la tiroides.

Objectives Determining the prevalence of hypothyroidism and its interrelationship with peroxidase antibodies and high urinary iodine levels as a means for devising a set of recommendations for health authorities regarding the consumption of iodised salt and the early detection of thyroid disease. Methods 437 people in the municipality of Armenia (Quindío) participated in the study. ELISA tests were performed for free thyroxine, thyroid-stimulating hormone and thyroid peroxidase antibodies; a photocolorimetric analysis was carried out to determine urinary iodine levels. Results Hypothyroidism prevalence was 18.5%. Thyroid peroxidase antibodies were positive in 28.9% of the study population, with significantly higher prevalence amongst those with levels > 10 mIU/mL thyroid-stimulating hormone compared to 5.1 to 10 mIU/mL in those without it (OR 3.2) and smokers (O.R 3,4). Free thyroxine was normal in 98.2% of participants (> 5 mIU/mL thyroid-stimulating hormone levels) and 92% in those in whom > 10 mIU/mL thyroid-stimulating hormone levels were found. The average iodine level was 565.1; levels above 300µg/L were obtained in 81.8% of the participants. Conclusions Increased positive thyroid peroxidase antibody prevalence with increasing thyroid-stimulating hormone values could demonstrate a high risk of developing autoimmune hypothyroidism in Armenia; despite high iodine levels, a relationship with thyroid peroxidase antibodies or thyroid-stimulating hormone levels could not be established.

Tendencia de la nutrición de yodo durante las últimas décadas en escolares chilenos y sus consecuencias / Trend of iodine nutrition in recent decades and its consequences in Chilean schoolchildren

The endemic goiter, nutritional collective problem due to iodine deficience, constitutes a chronic disease with easy prevention and control, nevertheless still it constitutes a serious problem of public world health, being thought that about 650 million persons have goiter, 43 millions suffer from endemic cretinism and 1570 millions are in risk of suffering this disease for living in areas that present a deficit of iodine. Both patterns, deficit and the excess of iodine can conducted to a thyroid disease. The relation between the ingestion of iodine and the risk of disease corresponds to a U curve, where both, the low one and high ingestion of iodine it is associate to high risk of thyroid disease. To have a program of iodine supplementation, it should imply a constant vigilance of iodine nutrition to see its effect on the goiter prevalence in the population, to control his degree of fulfillment, to avoid a possible excess of ingestion of iodine it might help to correct any precocious alteration. Endemic goiter is not longer a problem in Chile. Salt iodination is in agreement with present legislation, but it is very important to have a continuous surveillance of iodine nutrition in Chile to control if salt fortification is appropiate.

Urticaria crónica y autoinmunidad tiroidea utilidad del testintradérmico de suero autólogo / Chronic urticaria and thyroid autoimmunity utility of autologous intradermal serum test

Introducción: La Urticaria Crónica (UC) es una patología de prevalencia creciente. La relación entre UC y autoinmunidad tiroidea tiene una asociación significativa. El test intradérmico de suero autólogo (TISA) es capaz de inducir un test positivoen la piel de pacientes con urticaria. Objetivo: Determinar la prevalencia de la enfermedad tiroidea autoinmune en pacientes que concurren a la consulta por UC. Correlacionar en pacientes con UC y enfermedad tiroidea autoinmune la positividad de TISA. Comparar resultados del TISA en pacientes con UC y controles sanos. Materiales y Métodos: Se estudiaron51 pacientes, 30 con UC y 21 pacientes sanos del grupo control. Edades: entre 22 y 77 años, desde 01/11/07 hasta el30/04/10. Se realizó historia clínica detallada; dosaje de hormonas tiroideas: hormona estimulante de tirotrofina (TSH), tiroxina libre (T4 libre); dosaje de anticuerpos antitiroideos: anticuerpo antiperoxidasa (ATPO), anticuerpo antitiroglobulina (ATG) y test de TISA. Resultados: Entre los pacientes con UC el 80 % (24) correspondieron al sexo femenino, la franja etaria predominantefue de 51 a 59 años. La mayoría de los pacientes fueron eutiroideos (50%), seguidos de hipotiroideos (30%) y porúltimo hipertiroideos (20%). La prevalencia de enfermedad tiroidea autoinmune en pacientes con UC fue de un 17%. El TISAresultó positivo en un 47% (14), de los sujetos con UC. En todos los pacientes con tiroiditis autoinmune el TISA resultó positivo. Sin embargo se encontró TISA positivo en 8 pacientes con disfunción tiroidea sin autoinmunidad y en un paciente del grupo control (sano). Conclusiones: Se objetivó una tendencia a la autoinmunidad en pacientes con UC. Un TISApositivo enpacientes sin autoinmunidad tiroidea, debería contemplar otros posibles autoanticuerpos y otros factores liberadores de histamina.Un TISA negativo es un marcador útil para determinar ausencia de anticuerpos funcionantes circulantes.

Introduction: Chronic urticaria (UC) is a disease of increasing prevalence. The relationship between UC and thyroid autoimmunityhas a significant association. The autologous intradermal serum test (TISA) is capable of inducing a positive test inthe skin of patients with urticaria. The chemical nature of the factors, defined UC as an antibody-mediated autoimmune disease.Objetive: Determine the prevalence of autoimmune thyroid disease in patients attending the consultation by UC.Correlate the TISA positivity in patients with UC and autoimmune thyroid disease. Compare results of the TISA in UC patientsand healthy controls. Material and Methods: 51 patients were studied, 21 and 30 with UC patients healthy control group.Age: between 22 and 77 years, from 01/11/07 to 04/30/10. It made detailed clinical history; dosing of thyroid hormones: thyrotrophin(TSH)- stimulating hormone, thyroxine l free thyroxine (free T4); dosing of antithyroid antibodies: antibody antiperoxidasa(ATPO), antibody antithyroglobulin (IGT) and test of TISA. Results: Among patients with UC 80% (24) werefemale, the predominant age Strip was 51 to 59 years. The majority of patients were eutiroideos (50%), followed by additivehypothyroid (30%) and finally hipertiroideos (20%). The prevalence of autoimmune thyroid disease in patients with UC was17%. The TISA resulted positive in a 47% (14) of the subjects with UC. The TISA was positive in all patients with autoimmunethyroiditis. However found positive TISA in 8 patients with thyroid without autoimmune dysfunction and a patient of(healthy) control group. Coclusions: We find a tendency to Autoimmunity in patients with UC. A positive TISA in patients withoutthyroid Autoimmunity should consider other possible autoantibodies and other histamine releasing factors. A negativeTISA is a marker that is useful to determine lack of circulating funcionantes antibodies.

Thyroid disorders in children and adolescents with type 1 diabetes mettitus in Isfahan, Iran

Studies in different populations have shown great variation in the prevalence of thyroid diseases in patients with type 1 diabetes mellitus [TIDM]. Our aim was to study the prevalence of thyroid disorders such as autoimmunity of thyroid [AIT], thyroid dysfunction, and goiter in children and adolescents with TIDM, compared with age- and sex-matched healthy controls in Isfahan. One hundred patients with TIDM who were referred to Isfahan Endocrine and Metabolism Research Center and 184 healthy schoolchildren matched for age and sex were included. They were examined for goiter by two endocrinologists. Thyroid function test and serum thyroid antibodies [anti-TPO Ab and anti-Tg AbJ were measured. The prevalence of subclinical hypothyroidism was high in both groups [18%]. TIDM patients had lower frequency of goiter [21% vs. 38%, P=0.001], and higher prevalence of positive AIT [22% vs. 8%, P=0.001], anti-TPO Ab positivity [19.3% vs. 5.3%, P=0.000], and anti-Tg Ab [11.1% vs. 6.4%, P=0.1] in comparison with the control group. Being positive for AIT in diabetic patients meant an odds ratio of 5 [Cl 95%: 1.5-15.6] for thyroid dysfunction. There was no association between age, sex, duration of diabetes and HbAic with serum anti-TPO Ab and anti-Tg Ab concentrations in this group. Our results demonstrated the high prevalence of AIT and thyroid dysfunction in patients with TIDM. We suggest regular thyroid function and antibody testing in these patients

Anticuerpos antitiroperoxidasa y antitransglutaminasa en familiares de primer grado de personas con diabetes tipo 1 y su relación con algunas características clínicas, bioquímicas e inmunológicas / Antithyroperoxidase and antitransglutaminase antibodies in first degree relatives of type 1 diabetes persons and its relation to some clinical, biochemical and immunological features

Los anticuerpos antitiroperoxidasa (AcTPO) y antitransglutaminasa (ATGt) son útiles marcadores de enfermedad tiroidea autoinmune y enfermedad celíaca, respectivamente. Su presencia en familiares de primer grado de personas con diabetes tipo 1 no se ha descrito en Cuba. Objetivo: determinar las frecuencias de los AcTPO y ATGt en familiares de primer grado de personas con diabetes tipo 1 y su relación con algunas características clínicas, bioquímicas e inmunológicas. En un grupo de 285 sujetos se realizó la medición del AcTPO y en 262 individuos la de ATGt. Se incluyeron casos entre los 2 y 65 años de edad. Se registraron datos sobre edad, sexo, color de la piel, antecedentes personales, historia familiar de obesidad, diabetes tipo 2, enfermedad tiroidea y enfermedad celíaca. Se interrogaron síntomas y exploraron signos clínicos de enfermedad celíaca y enfermedad tiroidea autoinmune. Se determinó glucemia, insulinemia, AcTPO, ATGt y autoanticuerpos asociados a diabetes tipo 1 (AGAD y AIA-2), así como la resistencia a la insulina mediante el índice HOMA-IR. RESULTADOS: las frecuencias de AcTPO y ATGt positivos fueron 5,3 y 1,9 por ciento, respectivamente. La historia familiar de enfermedad tiroidea, el temblor muscular fino y el exoftalmos se relacionaron con la presencia de AcTPO. Malabsorción intestinal, diarrea persistente, dolor abdominal recurrente y antecedente personal de hepatopatía se asociaron con la presencia de ATGt. Se encontró asociación entre los ATGt y el AIA-2. La resistencia a la insulina no se asoció con la presencia de AcTPO ni de ATGt. En los familiares de primer grado de personas con diabetes tipo 1 las frecuencias de AcTPO y ATGt son bajas. Algunos antecedentes, síntomas y signos vinculados con enfermedad celíaca y enfermedad tiroidea autoinmune pueden ser indicadores prácticos previos a la indicación de estos autoanticuerpos(AU)

The antithyroperoxidase (TPOAb) and antitransglutaminase (tTGAb) antibodies are useful markers of autoimmune thyroid disease and celiac disease, respectively. Its presence in first-degree relatives of type 1 diabetes patients has not been described in Cuba. Objetive: to determine the TPOAb and tTGAb frequencies in first-degree relatives of type 1 diabetes patients and its relation to some clinical, biochemical and immunological features. In a group of 285 subjects we measured TPOAb and in 262 subjects we measured tTGAb. The cases included aged between 2 and 65. Data were registered on age, sex, skin color, personal backgrounds, and a family history of obesity, type 2 diabetes, thyroid disease and celiac disease. Symptoms were look for and clinical signs of celiac disease and autoimmune thyroid disease were explored. Fasting glucose, fasting insulin, TPOAb, tTGAb and type 1 diabetes associated autoantibodies (AGAD and AIA-2) were determined as well as the insulin resistance according the HOMA-IR index. RESULTS: the frequencies of positive TPOAb and tTGAb were of 5,3 and 1,9 percent, respectively. The family history of thyroid disease, slight muscular tremor and exophthalmos are related to presence of TPOAb. Intestinal malabsorption, persistent diarrhea, recurrent abdominal pain and personal background of liver disease were associated with presence of tTGAb. There was an association between tTGAb and AIA-2. Insulin resistance was not associated with the presence of both antibodies. In first-degree relatives of type 1 diabetes patients, frequencies of TPOAb and tTGAb are low. Some backgrounds, symptoms and signs linked to celiac disease and autoimmune thyroid disease may be practical indicators previous to perform these autoantibodies(AU)

Prevalência de disfunção tireoidiana e anticorpos antitireoidianos em pacientes portadores de diabetes melito tipo 1 e em seus familiares de primeiro grau / Prevalence of thyroid dysfunction and antithyroid antibodies in type 1 diabetic mellitus patients and their first degree relatives

O diabetes melito tipo 1 (DM1) freqüentemente encontra-se associado à doença auto-imune da tireóide (DAT). A prevalência de DAT varia de 3 por cento a 50 por cento entre diabéticos, e é maior também entre seus familiares, comparada à população geral. OBJETIVOS: Investigar a prevalência da DAT em pacientes com DM1, avaliar possíveis diferenças de comportamento clínico-evolutivo do DM1 entre diabéticos com e sem DAT e estudar a prevalência de DAT nos familiares dos pacientes diabéticos. MATERIAIS E MÉTODOS: Os prontuários de 124 diabéticos tipo 1 foram revisados e coletados os dados referentes à função e aos anticorpos tireoidianos; pacientes com e sem DAT foram comparados em relação à média de Hb glicosilada, complicações agudas e crônicas, idade ao diagnóstico e tempo de evolução do DM, dose de insulina e outros. Um estudo caso-controle foi realizado com 54 familiares em primeiro grau destes pacientes; foram avaliadas a função tireoidiana e a presença de anticorpos antitireoidianos em 32 familiares de diabéticos sem DAT e 22 familiares de diabéticos com DAT. RESULTADOS: As prevalências de DAT e de disfunção hormonal entre os diabéticos foram de 35,5 por cento e 19,3 por cento, respectivamente. Quanto à avaliação dos parâmetros de evolução do DM1, comportamento clínico e controle metabólico não houve diferenças significantes entre os diabéticos com e sem DAT. Houve maior prevalência de DAT nos familiares de diabéticos com DAT do que no grupo dos familiares dos diabéticos sem DAT, sem diferença significativa quanto à prevalência de disfunção hormonal. CONCLUSÕES: A prevalência de doença auto-imune de tireóide em diabéticos e em seus familiares é elevada, justificando-se, nesses casos, a investigação rotineira da função tireoidiana, particularmente dos familiares de primeiro grau de diabéticos com DAT.

Diabetes Mellius Type 1 (DM1) is frequently associated to Autoimmune Thyroid Disease (AITD). The prevalence of AITD among diabetic patients varies between 3 to 50 percent and the incidence is also big among their family members, when compared to the population in general. OBJECTIVES: To investigate the prevalence of AITD in patients with DM1; to evaluate possible differences concerning the clinical-evolutive behavior of DM1 among diabetic patients with or without AITD and to study the prevalence of AITD among the diabetes patients' relatives. MATERIALS AND METHODS: 124 prontuaries of diabetic patients (type 1) were revised and data was gathered concerning the thyroid function and the anti-thyroid antibodies. Patients with and without AITD were compared in relation to the level of glycosylated hemoglobin, the presence of acute and chronic complications, the age of the patient at the time of the diagnosis, time of evolution of the disease, daily dose of insulin and other factors. A control case study was conducted with 54 first degree relatives of the diabetic patients who took part in the study; the thyroid function as well as the presence of anti-thyroid antibodies were evaluated in 32 of those first degree relatives with AITD, and in 22 of those without AITD. RESULTS: The prevalence of AITD and of hormonal dysfunction among diabetic patients was 35.5 percent and 19.3 percent, respectively. No significant differences were found between groups in respect to clinical outcome or to diabetic chronic complications. However, prevalence of AITD and hormonal dysfunction were found to be higher among first degree relatives of diabetic patients with AITD than among relatives of diabetic patients without AITD. CONCLUSIONS: The prevalence of autoimmune thyroid disease in diabetic patients and in their first degree relatives is high. Thyroid function screening is therefore justified in these cases, especially in first degree relatives of diabetics ...

Prevalência de doenças tireoidianas auto-imunes em pacientes com lúpus eritematoso sistêmico / Prevalence of thyroid autoimmune disease in patients with systemic lupus erythematosus

INTRODUÇÃO: As doenças tireoidianas auto-imunes têm sido associadas com inúmeras desordens reumatológicas, incluindo o lúpus eritematoso sistêmico (LES). OBJETIVO: Avaliar a prevalência de alterações tireoidianas em pacientes com LES. MÉTODOS: Estudo de coorte transversal comparando prevalência de alterações tireoidianas em 106 pacientes com LES e grupo-controle de 102 pacientes. Os pacientes foram submetidos à avaliação clínica e laboratorial, com dosagens de anticorpos anti-TPO e anti-Tg, TSH, T4 livre e T3. RESULTADOS: Detectou-se aumento de prevalência de hipotireoidismo subclínico (11 por cento) e clínico (13 por cento) no grupo de pacientes com LES, comparados a 7 por cento e 1 por cento, respectivamente, no grupo-controle (p < 0,001). Não houve diferença de prevalência de hipertireoidismo entre os grupos comparados. A positividade de anticorpos antitireoidianos foi maior no grupo de LES (23 por cento versus 19 por cento, p = 0,025). O risco relativo de pacientes com LES apresentarem alterações tireoidianas foi de 1,60. CONCLUSÃO: As alterações tireoidianas são mais freqüentes em pacientes com LES que na população geral.

INTRODUCTION: Thyroid autoimmune diseases have been associated with a variety of rheumatologic diseases, including systemic lupus erythematosus (SLE). OBJECTIVE: To estimate the prevalence of thyroid autoimmune diseases in patients with SLE. METHODS: Transversal study to compare the prevalence of thyroid disorders in 106 patients with SLE and a control group of 102 patients. The patients were submitted to a clinical and a laboratorial evaluation; the tests included antiperoxidase and antithyroglobulin antibodies, TSH, free T4 and T3. RESULTS: We detected high prevalence of subclinical hypothyroidism (11 percent) and clinical hypothyroidism (13 percent) in the group of patients with SLE when they were compared to the control group, 7 percent and 1 percent, respectively (p < 0,001). The hyperthyroidism occurred in a same frequency in the two groups. The positivity of antithyroid antibodies was higher in the group with SLE (23 percent versus 19 percent, p = 0,025). The relative risk of the patients with SLE to develop thyroid dysfunctions was 1,6. CONCLUSION: The thyroid disorders were more prevalent in patients with LES than in general population.

Evaluation of the role of ultrasonography in diagnosis of autoimmune thyroiditis in goitrous children.

OBJECTIVES: To evaluate the role of thyroid ultrasound in children with autoimmune thyroiditis diagnosed either on cytopathology or by the presence of thyroid peroxidase antibodies. DESIGN AND SETTINGS: Children presenting for the first time to the Thyroid Clinic at the Institute of Nuclear Medicine and Allied Sciences for the complaint of goiter over a two year period (January 2005-December 2006) were studied. SUBJECTS: 695 school children (244 boys and 451 girls) aged 5-18 year were studied. METHODS: Children were subjected to thyroid ultrasound, cytopathology, thyroid peroxidase antibody and thyroid function tests. RESULTS: Overall, 16% of goitrous children had hypoechogenicity on ultrasound, 15.2% had cytopathological evidence of thyroiditis, 10.6% had positive thyroid peroxidase antibodies and 25.2% had abnormal thyroid function tests. Subjects with hypoechogenicity had higher percentage of thyroiditis on cytopathology (41.4% vs. 10.3%; P<0.01), thyroid peroxidase antibody positivity (30.6% vs. 6.8%; P<0.01) and thyroid dysfunction (46.8% vs. 21.2%; P<0.01) than those with normal echogenicity. CONCLUSION: Thyroid USG has a useful, though limited, role in excluding thyroid disease in children. The sensitivity of echogenicity for the diagnosis of autoimmune thyroiditis in children is less than that reported in adults.

Prevalência de auto-imunidade tireoidiana em um grupo de pacientes com diabetes mellitus tipo 1 em Londrina, PR / Prevalence of thyroid autoimmunity in a group of patients with type 1 diabetes mellitus from Londrina, PR

A auto-imunidade tireoidiana é uma co-morbidade freqüente entre pacientes com diabetes mellitus tipo 1 (DM1). Neste estudo, avaliamos a prevalência da positividade para auto-anticorpos anti-tireoidianos (anti-microssomal, anti-Tg e anti-TPO), bem como características clínicas (idade, sexo, duracão do DM) e laboratoriais (funcão tireoidiana, HbA1) de 101 pacientes (idade média de 20 n 9,6 anos; 62 do sexo feminino) com DM atendidos no HC/UEL. RESULTADOS: A presenca de auto-anticorpos foi detectada em 31 pacientes (30,7 por cento). No grupo com idade <12 anos, a prevalência de anticorpos foi de 15 por cento; entre 12-18 anos, 32 por cento, e >18 anos, 35,7 por cento (p= 0,22). Entre os 31 pacientes com anticorpos positivos, 40 por cento apresentava alguma disfuncão tireoidiana, comparados a apenas 4,4 por cento daqueles sem anticorpos (p<0,001). O TSH médio foi maior no grupo com anticorpos presentes (3,75 vs. 2,32æU/mL; p= 0,01). CONCLUSAO: A prevalência da positividade para anticorpos marcadores de tireoidite auto-imune foi de em 30,7 por cento, compatível com a literatura.

Urinary iodine status and thyroid dysfunction: a Bangladesh perspective.

Iodine deficiency is endemic in Bangladesh. Compulsory iodization of table salt was introduced since 1993 to prevent and improve thyroid disorders in the country. Urinary iodine status, thyroid function and antithyroid antibodies were studied in 397 newly diagnosed thyroid patients and 94 age-sex matched controls. Among thyroid patients, 96 were hyperthyroid, 185 euthyroid and 116 hypothyroid. Mean and median urinary iodine were higher (p=0.075) in thyroid patients (26.13+/-0.91 and 23.03) than controls (22.65+/-1.47 and 18.59); in hyperthyroid and euthyroid than hypothyroid (p=0.020); in multinodular (28.08+/-2.80 and 26.94) and diffuse (27.35+/-1.19 and 26.71) goitre than uninodular (23.91+/-2.37 and 19.14) and nongoitrous (NG, 21.5+/-2.05 and 18.27) (p=0.098) patients but no sex difference (p=0.466). Antimicrosomal (26.7%) and antithyroglobulin (34%) antibodies were more frequently positive among thyroid patients than controls (6.4% and 12.8% respectively) (p=0.00002 and p=0.00005 respectively). Antibody positivity was higher in diffuse (82/228) and multinodular (20/47) goitre than nongoitrous (20/56) and uninodular (13/66) goitre (p=0.046) as well as in hypothyroid (55.2%) and hyperthyroid (36.5%) than euthyroid (19.5%) patients (P<0.001). Urinary iodine correlated neither with antimicrosomal (thyroid patients: p=0.597 and control: p=0.112) nor with antithyroglobulin (thyroid patients: p=0.388 and control: p=0.195) antibody. Thyroid autoimmunity and dysfunction seems common; and interaction of salt iodization with iodine status and thyroid disorders may be important in Bangladesh.

Prevalence of antithyroid microsomal antibody in thyroid patients of endemic goitre area.

The region of greater Mymensingh known for iodine endemicity, recently came under iodine supplementation as a result of mandatory universal iodination of salt program. Autoimmune thyroid diseases (AITD) are among the most common human autoimmune disorders & presence of autoantibodies to the microsomal antigen (AntiMCAb) is a hallmark of disease activity. Both iodine deficiency & iodine supplementation precipitate increase rate of autoimmunity to the thyroid gland. Study was undertaken to determine prevalence of AntiMCAb positive cases among patients with various thyroid diseases. High resolution ultrasound (HRUS), serum thyroid hormone assays & scintiscan were used to classify the thyroid patients into 8 categories. 221 patients were studied during the stipulated period of 3 months. Male patients were 60 & female patients were 161. Age ranged from 11 to 65 years with median age 29.4 years. AntiMCAb test were done with radioimmunoassay (RIA). 126 patients had antimicrosomal antibody (57.01%). All form of hypothyroid (atrophic, goitrous, Hashimoto's) have very high rate of AntiMCAb positive cases. Highest 89.28% were seen in patients showing feature of Hashimoto's thyroiditis or generalized feature of AITD in HRUS with hypothyroidism, followed had 61.29% positive cases, However, antithyroid antibody was found in all form of thyroid disorders. Nodular goiter had 21.73% antiMCAb positive cases. AntiMCAb found positive at the rate of 33.33% in euthyroid patients with HRUS feature of AITD & diffuse euthyroid goiter, 40% in subclinical hypothyroid, 40% in subclinical hyperthyroid. Female rated higher in range of antimicrosomal antibody positivism. 59% of all thyroid patients among female subjects were AntMCAb positive, where as 51.67% male thyroid patients were positive. Highest number of positive cases found in the 30-35 age group. No definite pattern, however, was observed among age distribution. 20 age matched sample from patients unsuspected of thyroid disease shows 10% AntiMCAb positive compared to 73.33% of the same among same age group of thyroid patients. Frank Hashimoto's thyroiditis with positive antiMCAb and hypothyroidism were all detected by HRUS.

Natural course of autoimmune thyroiditis in Thai children.

Forty-seven pediatric patients with autoimmune thyroiditis were followed for an average of 5.18+/-2.89 years. The diagnosis was based on a firm goiter and a positive test for antithyroid antibodies. Initially, 23 patients had euthyroidism, 11 overt hypothyroidism, 6 compensated hypothyroidism and 7 with low TSH. All patients had clinical euthyroidism, except two who had overt hypothyroidism. The thyroid function tests, the size of the thyroid gland and the thyroid antibodies were regularly evaluated. After the follow-up, 26 patients had untreated euthyroidism, 12 with overt hypothyroidism received eltroxin for maintenance of euthyroidism, while 4 had compensated hypothyroidism and 5 low TSH levels. All had clinical euthyroid. The thyroid size was reduced in 12 patients (26%) while 4 (9%) had normal-sized gland. The goiter size in 35 patients (74%) remained unchanged. The antithyroglobulin and antimicrosomal antibody titers fluctuated higher in patients with overt hypothyroidism. Eltroxin was given only to those having overt hypothyroidism with diminished goiter size in 8 patients (73%).

Características clinico-quirúrgicas de la tiroiditis de Hashimoto y su relación con el carcinoma de tiroides / Clinicosurgical characteristics of Hashimoto thyroiditis and relation with the thyroides carcinoma

En una serie de 1364 tiroidectomías fueron hallados 127 pacientes con tiroiditis de Hashimoto (9.3%). Tuvieron un promedio de edad de 44 años y 121 (95.2%) fueron mujeres. La forma de presentación clínica más frecuente fue como bocio nodular o multinodular eutiroideo (88%). Los anticuerpos antitiroideos estuvieron elevados en el 40.7%de aquellos en quienes se determinaron. La tiroiditis de Hashimoto coexistió con carcinoma de tiroides en 17 casos, que significó un 13.4%de los pacientes con tiroiditis y un 10.5%del total de carcinomas de la misma serie. No pudo ser demostrada relación entre ambas patologías. No existió diferencia significativa entre el porcentaje de enfermos con metástasis ganglionares en aquellos carcinomas papilares con y sin tiroiditis, y no se encontró correlación entre la elevación de anticuerpos antitiroideos en pacientes con tiroiditis con y sin carcinoma. La tiroiditis de Hashimoto fue un hallazgo incidental en piezas quirúrgicas de tiroidectomías. Como no pudo ser demostrada mayor ni menor frecuencia de carcinoma de tiroides simultáneo, en presencia de claras indicaciones de tiroidectomía, la coexistencia de tiroiditis no debe modificar la conducta quirúrgica

Tiroiditis de Hashimoto. Estudio de 100 casos

Presentamos 100 casos de tiroiditis de Hashimoto (TH) cuyo diagnóstico se basó en la presencia de bocio y anticuerpos antitiroideos positivos y/o informe de citología del aspirado de tiroides compatible con TH. El promedio de edad fue de 35 años con su mayor incidencia hacia la cuarta década de la vida; la razón mujer a hombre fue 24:1. A 62 pacientes se les realizó aspirado de tiroides; en 54 la citología fue informada como TH. Los anticuerpos antimicrosomales y antitiroglobulina fueron positivos en 83 por ciento y 52 por ciento de los pacientes respectivamente; ambos anticuerpos fueron negativos en 12 pacientes discriminados así: clínico en 57 y subclínico en 23. De los 20 pacientes eutiroideos, seis elevaron la TSH entre uno y medio y tres años después del diagnóstico. Los hallazgos predominantes en los estudios gamagráficos de tiroides con 99mTc fueron: bocio con distribución homogénea y normo o hipercaptación del radiotrazados. Concluimos que la TH no es tan rara en nuestro medio y que se requieren estudios de mayor envergadura para determinar su prevalencia.

Frecuencia de la tiroiditis de hashimoto en un cento de patología

Con el objeto de conocer en forma aproximada la frecuencia de la tiroiditis de Hashimoto en nuestro medio se realizó una revisión de casos diagnosticados desde el punto de vista histológico en el Instituto de Patología del Hospital San Vicente de Paúl, en material tiroideo obtenido principalmente de glándulas extirpadas quirúrgicamente por diferentes motivos y menos frecuentemente en material obtenido por biopsias por Tru-cut o por aspiración. Se documento que la frecuencia global de la tiroiditis de Hashimoto es de 2.4 casos por 10.000. El 34.5 por ciento de los caosos tuvieron patología concomitante siendo el carcinoma el más frecuente. Se demuestra así que esta entidad en nuestro medio es cada vez más frecuente a medida que se empiezan a utilizar otras ayudas diagnósticas