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1.
BMJ Case Rep ; 14(11)2021 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-34753732

RESUMO

Subacute thyroiditis following vaccination is an uncommon presentation of thyrotoxicosis. As the world undertakes its largest immunisation campaign to date in an attempt to protect the population from COVID-19 infections, an increasing number of rare post vaccine side effects are being observed. We report a case of a middle-aged woman who presented with painful thyroid swelling following the second dose of the COVID-19 mRNA vaccine BNT162b2 (Pfizer-BioNTech) with clinical, biochemical and imaging features consistent with destructive thyrotoxicosis. Symptomatic management only was required for the self-limiting episode. Thyroiditis typically has a mild and self-limiting course and thus this observation should not deter people from vaccination, as COVID-19 infection has a far greater morbidity and mortality risk than thyroiditis.


Assuntos
COVID-19 , Tireoidite Subaguda , Tireoidite , Vacinas contra COVID-19 , Feminino , Humanos , Pessoa de Meia-Idade , SARS-CoV-2 , Tireoidite/induzido quimicamente , Tireoidite/diagnóstico , Tireoidite Subaguda/induzido quimicamente , Tireoidite Subaguda/diagnóstico
2.
Endocrine ; 74(2): 205-214, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34467467

RESUMO

PURPOSE: Thyroid dysfunction, including thyroiditis, is well recognized in COVID-19 patients. We evaluated thyroid ultrasonographic features among COVID-19 survivors, which are less well known. METHODS: Adult COVID-19 survivors without known thyroid disorders who attended dedicated COVID-19 clinic underwent thyroid ultrasonography and assessment of thyroid function and autoimmunity. Adults admitted for acute non-thyroidal surgical problems and negative for COVID-19 were recruited as control. SARS-CoV-2 viral load (VL) was presented as the inverse of cycle threshold values from the real-time reverse transcription-polymerase chain reaction of the respiratory specimen on admission. RESULTS: In total, 79 COVID-19 patients and 44 non-COVID-19 controls were included. All abnormal thyroid function tests during acute COVID-19 recovered upon follow-up. Thyroid ultrasonography was performed at a median of 67 days after acute COVID-19. The median thyroid volume was 9.73 mL (IQR: 7.87-13.70). In multivariable linear regression, SARS-CoV-2 VL on presentation (standardized beta -0.206, p = 0.042) inversely correlated with thyroid volume, in addition to body mass index at the time of ultrasonography (p < 0.001). Sex-specific analysis revealed similar results among men but not women. Eleven COVID-19 patients (13.9%) had ultrasonographic changes suggestive of thyroiditis, comparable to non-COVID-19 patients (p = 0.375). None of these 11 patients had isolated low thyroid-stimulating hormone levels suggestive of thyroiditis at initial admission or the time of ultrasonography. CONCLUSIONS: Higher SARS-CoV-2 VL on presentation were associated with smaller thyroid volumes, especially in men. Further research is suggested to investigate this possible direct viral effect of SARS-CoV-2 on the thyroid gland. There was no increased rate of ultrasonographic features suggestive of thyroiditis in COVID-19 survivors.


Assuntos
COVID-19 , Tireoidite , Adulto , Feminino , Humanos , Masculino , SARS-CoV-2 , Sobreviventes , Ultrassonografia , Carga Viral
4.
J R Coll Physicians Edinb ; 51(3): 250-252, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34528612

RESUMO

Thyroiditis can be due to infection/autoimmunity with different clinical presentations. Correctly diagnosing and initiating treatment is a challenge to the treating physician. We present two cases of thyroiditis, who approached the physician for different complaints. The first was a female with a change in voice, foreign body sensation in throat, laryngoscopy showing left vocal cord paralysis, reduced thyroid stimulating hormone. An ultrasound neck was suggestive of thyroiditis, and a contrast enhanced computed tomography scan showed a bulky thyroid with enlarged cervical lymphadenopathy. The second patient was a female with high-grade fever, chills and the inability to take fluids-food. Assessment revealed bilateral enlarged, inflamed tonsils-membranous exudate, tender jugulo-digastric lymphadenopathy and a Technetium-99 thyroid scan suggestive of thyroiditis. Patients were admitted, treated with steroids, antipyretics, antibiotics, cured and discharged. At the three-month follow-up, they were asymptomatic, video laryngoscopy showed normal vocal cords with equal mobility in the first patient and the thyroid profile within normal range for both patients. These cases highlight that thyroiditis can co-exist with benign vocal cord palsy or occasionally also with inflammations of local tissues, such as the tonsils.


Assuntos
Tireoidite , Paralisia das Pregas Vocais , Feminino , Humanos , Laringoscopia , Ultrassonografia
5.
Zhonghua Yi Xue Za Zhi ; 101(32): 2537-2543, 2021 Aug 24.
Artigo em Chinês | MEDLINE | ID: mdl-34407580

RESUMO

Objective: To compare the diagnostic performance of thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb) and high-resolution ultrasound (HRUS) in euthyroid Hashimoto's thyroiditis (HT). Methods: From January 2016 to January 2019, patients with complete data of preoperative thyroid function, TPOAb, TgAb and HRUS who had undergone thyroid surgery treatment at the First Affiliated Hospital with Nanjing Medical University were reviewed. The diagnostic value of different diagnostic methods was compared using histopathology (HP) examination result as the gold standard. Results: The data of 792 patients (217 males and 575 females) was retrospectively collected. The M(Q1,Q3)of patients' age was 41(32,52)years and the range was 16-75 years. With HP as the diagnostic gold standard, TPOAb exhibited similar sensitivity (59.3% vs 61.2%, P=0.752), accuracy (85.0% vs 83.6%, P=0.379), area under the receiver operating characteristic curve (AUC) (0.767 vs 0.764, P=0.886) and higher specificity (94.2% vs 91.6%, P=0.033) when compared with TgAb in diagnosing euthyroid HT. They both exhibited a higher sensitivity (59.3% vs 44.5%, P = 0.002; 61.2% vs 44.5%, P<0.001), accuracy (85.0% vs 79.7%, P = 0.001; 83.6% vs 79.7%, P = 0.013) and AUC (0.767 vs 0.684, P<0.001; 0.764 vs 0.684, P<0.001) than HRUS. Compared with each method alone, the sensitivity and AUC of TPOAb combined with TgAb or HRUS were improved. The combination of three methods showed the greatest sensitivity. Concordance analysis demonstrated that TPOAb and HP had a moderate agreement (Kappa=0.580, 95%CI:0.513-0.647,P<0.001). Conclusions: The combination of thyroid antibodies, TPOAb and TgAb, can improve sensitivity, accuracy and AUC of diagnosis in euthyroid Hashimoto's thyroiditis. The two antibodies combined with HRUS exhibited the highest diagnostic performance. Elevated TPOAb showed moderate diagnostic consistency with histopathologic evidence of HT.


Assuntos
Doença de Hashimoto , Tireoidite , Adolescente , Adulto , Idoso , Autoanticorpos , Feminino , Doença de Hashimoto/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
6.
Endocrine ; 74(2): 215-218, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34363586

RESUMO

PURPOSE: To evaluate the possible association between Covid-19 infection and subacute thyroiditis. METHODS: We reviewed the medical and imaging records of patients referred to our Department's outpatient setting dedicated to 'thyroid emergency' (records with a 'bollino verde'-green sticker, classifed as urgent) from April 2020 to October 2020. This outpatient clinic is devoted to patients requiring evaluation for severe hypothyroidism, thyrotoxicosis and neck discomfort or pain. All patients with a newly-diagnosed subacute thyroiditis were selected. The data of all patients receiving a diagnosis of subacute thyroiditis was collected retrospectively, taking into account the same period of time (April-October) and starting from 2016. RESULTS: During the COVID-19 outbreak in our region (April 2020 to October 2020) 396 patients attended the outpatient emergency clinic. Among them, 10 (2.5%) patients received a diagnosis of subacute thyroiditis. In a single patient, a 44-year-old man, a COVID-19 pulmonary infection had been diagnosed 7 weeks before the diagnosis of subacute thyroiditis. All of the remaining patients were and remain COVID-19 free as confirmed by telephone interview. The percentage of patients who received a diagnosis of subacute thyroiditis in the same period starting from 2016 was very similar (2.9%, 2.9%, 2.6% and 3.0% in 2016, 2017, 2018 and 2019, respectively). CONCLUSIONS: Our data do not show an increase in the incidence of subacute thyroiditis in the Brescia area, a region with the highest prevalence of COVID-19 in Italy during the period of the pandemic outbreak.


Assuntos
COVID-19 , Tireoidite Subaguda , Tireoidite , Adulto , Humanos , Incidência , Masculino , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , Tireoidite Subaguda/epidemiologia
7.
Front Immunol ; 12: 606056, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34220792

RESUMO

Context: Immune-related adverse events frequently take place after initiation of immune checkpoint inhibitors (ICI) therapy. The thyroid gland is the endocrine organ most commonly affected by ICI therapy, the pathological mechanism is still poorly understood. Case Description: A 60-year old Upper Austrian male melanoma patient under pembrolizumab therapy received thyroidectomy because of a suspicious FDG avid thyroid nodule. Histopathology showed a pattern comparable with thyroiditis de Quervain. The inflammatory process consisted predominantly of T lymphocytes with a dominance of CD4+ T helper cells. In addition CD68+ histiocytes co-expressing PD-L1 were observed. Conclusion: Clusters of perifollicular histiocytes expressing PD-L1 were observed in this case of pembrolizumab induced thyroiditis - probably induced by the former ICI therapy. This finding might indicate the initial target for the breakdown of self tolerance. In context with other data the immunological process seems to be driven by CD3+ lymphocytes infiltrating the thyroid.


Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Antígeno B7-H1/metabolismo , Linfócitos T CD4-Positivos/imunologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Histiócitos/imunologia , Inibidores de Checkpoint Imunológico/efeitos adversos , Imunoterapia/métodos , Melanoma/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Glândula Tireoide/patologia , Tireoidite/diagnóstico , Anticorpos Monoclonais Humanizados/uso terapêutico , Movimento Celular , Humanos , Inibidores de Checkpoint Imunológico/uso terapêutico , Masculino , Melanoma/complicações , Melanoma/diagnóstico , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/diagnóstico , Glândula Tireoide/imunologia , Tireoidectomia , Tireoidite/etiologia
8.
BMJ Case Rep ; 14(7)2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34266818

RESUMO

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a potentially life-threatening adverse drug reaction with a mortality rate of 10%. Interstitial nephritis, pneumonitis, myocarditis, meningitis, thyroiditis and pancreatitis are major causes of morbidity and mortality in this syndrome. Cessation of offending medication is paramount. There is paucity in high quality prospective studies guiding the treatment of DRESS, and there are no published therapeutic clinical trials in the treatment of corticosteroid refractory hypersensitivity myocarditis. The authors present a unique case of ciprofloxacin-induced DRESS with concurrent thyroiditis and refractory eosinophilic myocarditis that required mepolizumab and multiple immunosuppressants for successful treatment.


Assuntos
Síndrome de Hipersensibilidade a Medicamentos , Miocardite , Tireoidite , Anticorpos Monoclonais Humanizados/efeitos adversos , Humanos , Miocardite/induzido quimicamente , Miocardite/tratamento farmacológico , Estudos Prospectivos
9.
Orphanet J Rare Dis ; 16(1): 324, 2021 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-34289855

RESUMO

PURPOSE: This study aimed to clarify the clinical features of and evaluate the treatment efficacy for IgG4-related thyroiditis. METHODS: Fourteen IgG4-related thyroiditis patients and 42 randomly matched IgG4-related disease (IgG4-RD) patients without thyroiditis in a prospective cohort at the Peking Union Medical College Hospital (PUMCH) were enrolled from 2011 to 2019. Patient demographics, clinical characteristics, laboratory parameters and treatment efficacy were analysed. RESULTS: The prevalence of IgG4-related thyroiditis in our cohort was 2.0%. The average patient age was 42.8 ± 14.9 years, and the male: female ratio was 1:1. Goiter (14, 100.0%), hard thyroid (14, 100.0%) and neck compression (5, 35.7%) were the most prevalent onset symptoms observed. IgG4-related thyroiditis was characterized by asymmetric diffuse thyroid enlargement on ultrasound. Thirteen (92.9%) patients had hypothyroidism, and all patients had significantly elevated circulating thyroid antibodies. Compared with patients without thyroiditis, patients with IgG4-related thyroiditis had less submandibular gland involvement and lacrimal gland involvement and lower serum IgG4 and T-IgE levels (P = 0.019, P = 0.022, P = 0.004, and P = 0.006, respectively) and more single-organ involvement (P = 0.011). After treatment, the symptoms were relieved, while the size of the thyroid gland did not change significantly, and levothyroxine as a supplemental therapy was still needed. CONCLUSIONS: IgG4-related thyroiditis is a distinct subtype of IgG4-RD characterized by positive circulating thyroid antibodies and a high rate of hypothyroidism. Although compression symptoms could be relieved with treatment, the thyroid size did not change significantly, and the damage to thyroid function was often irreversible.


Assuntos
Doença Relacionada a Imunoglobulina G4 , Tireoidite , Adulto , Feminino , Humanos , Imunoglobulina G , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
11.
BMJ Case Rep ; 14(6)2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34083194

RESUMO

A 76-year-old man with hypogammaglobulinemia on monthly intravenous immunoglobulin infusions presented to the hospital with fever, cough, and shortness of breath and was diagnosed with COVID-19 pneumonia requiring intensive care unit admission but not intubation. He was treated with convalescent plasma, remdesivir and corticosteroids. Sixteen days into his hospitalisation he began to report weakness without sensory symptoms and was found on biopsy to have a necrotising myopathy.


Assuntos
COVID-19 , Doenças Musculares , Tireoidite , Idoso , COVID-19/terapia , Humanos , Imunização Passiva , Masculino , SARS-CoV-2
12.
J Laryngol Otol ; 135(7): 640-643, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34120661

RESUMO

OBJECTIVE: To evaluate the circumstances in which recurrent laryngeal nerve palsy occurs after thyroid surgery. METHODS: This study assessed 1026 patients who underwent surgery for benign thyroid disease over a seven-year period in a retrospective, single-centre study. RESULTS: With a total of 1835 recurrent laryngeal nerves at risk, there were 38 cases (2.07 per cent) of transient recurrent laryngeal nerve palsy and 8 (0.44 per cent) of permanent recurrent laryngeal nerve palsy. No explanation was found for 10 of the 46 cases of recurrent laryngeal nerve palsy. Among the 38 other cases, the probable causes included poor identification of the recurrent laryngeal nerve during surgery, involuntary resection of the nerve and several other factors. CONCLUSION: Apart from accidental resection of the recurrent laryngeal nerve during thyroid surgery, the causes of post-operative recurrent laryngeal nerve palsy are often unclear and likely multifactorial. Poor identification of the recurrent laryngeal nerve during surgery is still the main cause of post-operative recurrent laryngeal nerve palsy, even when intra-operative neuromonitoring is used.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia , Paralisia das Pregas Vocais/epidemiologia , Adenoma/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Bócio Nodular/cirurgia , Doença de Graves/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos do Nervo Laríngeo Recorrente/epidemiologia , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/cirurgia , Tireoidite/cirurgia , Adulto Jovem
13.
J Med Life ; 14(2): 127-130, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34104234

RESUMO

Vitiligo, the discoloration of the skin, has different autoimmune mechanisms reflected by many biomarkers as shown by skin histology, staining for CD4 and CD8 T lymphocytes, chemokine ligand 9 or circulating cytokines such as interleukin (IL)-1 beta, interferon (IFN)-gamma, transforming growth factor (TGF)-beta, antibodies, markers of oxidative stress, chemokines, and others. In this narrative review, we aim to overview vitiligo in relationship with chronic autoimmune thyroiditis. Regarding vitiligo, more than 50 different genetic loci have been associated with this disease, and the heritability is high. There is a 20% risk of an environmental connection which may also act as a trigger; moreover, the association with human leukocyte antigen (HLA) expression is well recognized. The specific lesions display CD8+ tissue-resident memory T cells as continuous key activators of melanocytes. The association with chronic thyroiditis is based on common autoimmune background and excessive reactive oxygen species that destroy melanocytes and thyrocytes (oxidative stress hypothesis) with thyroxine and melanin as target molecules, thus sharing a common origin: tyrosine. Moreover, common epigenetic anomalies or mutations of the Forkhead transcription factor D3 (FOXD3) have been described. Since vitiligo affects up to 1-2% of the population worldwide and 34% of patients have positive thyroid antibodies, apart from common autoimmunity background and oxidative stress toxicity, the association is clinically relevant for different practitioners.


Assuntos
Tireoidite Autoimune/complicações , Vitiligo/complicações , Animais , Doença de Hashimoto/complicações , Humanos , Tireoidite/complicações
14.
Niger J Clin Pract ; 24(6): 905-910, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34121740

RESUMO

Background: Hashimoto's thyroiditis (HT) is one of the commonest endocrine disorders, globally. Often, HT presents a protean range of associated autoimmune features (AAI) such as vitiligo, rheumatoid arthritis, pernicious anemia, skin allergy/atopy, thrombocytopenia, Addison's disease, type 1 diabetes, celiac disease, eosinophilia, etc., The usual treatment of HT is symptomatic with no curative option. In this context, we report our experience on the impact of surgical thyroidectomy on remission of AAI in HT. Aims: To report our experience on the impact of surgical thyroidectomy on remission of AAI in patients with HT. Material and Methods: This is a retrospective study conducted in the Endocrine Surgery department of a tertiary care hospital. A total of 61 patients with HT and various AAI combinations were included in this study. All the clinicoinvestigative and operative data were systematically analyzed. The most frequent indication for surgery was nodular goiter followed by associated malignancy, persistent goiter, and painful thyroiditis. Others were cosmetic/pressure symptoms and not AAI per se. The mean follow-up after surgery was 55.6 ± 11.8 months. Results: The gender ratio was 5.8:1 in favor of women and the mean age was 41.5 ± 5.4 years. The mean preoperative and postoperative serum anti-thyroperoxidase antibody (Anti-TPO Ab) levels were 339 ± 98.2 and 58.75 ± 25 IU/L at the last follow-up visit. A total of 60% AAI manifestations had resolution or significant alleviation. The major improvements in AAI were skin allergy, eosinophilia, rheumatoid arthritis, vitiligo, thrombocytopenia, celiac disease symptomatic episodes; but, type 1 diabetes and Addison's disease showed static response. Conclusions: Surgical total thyroidectomy and anti-TPO Ab-related autoimmunity appear to play a beneficial role and definitive role in the remission of AAI in HT.


Assuntos
Doença de Hashimoto , Tireoidite , Adulto , Feminino , Doença de Hashimoto/epidemiologia , Doença de Hashimoto/cirurgia , Humanos , Pessoa de Meia-Idade , Dor , Estudos Retrospectivos , Tireoidectomia
17.
Probl Endokrinol (Mosk) ; 67(2): 10-19, 2021 04 09.
Artigo em Russo | MEDLINE | ID: mdl-34004099

RESUMO

BACKGROUND: The level of iodine consumption by the population largery determines the spectrum of thyroid pathology. To date, in the Russian Federation, iodine-deficiency disorders (IDD) occupy a leading position in the structure of all thyroid diseases. Chronic ID leads to adverse health consequences and significant economic costs for their elimination on a national scale. However, the spectrum of thyroid pathology is not limited to the problem of ID, and the study of other thyroid diseases is also of interest. AIMS: to assess the dynamics of prevalence and incidence of IDD and other thyroid diseases in the entire population of the RF for the period 2009-2018, using official state statistics. MATERIALS AND METHODS: the main epidemiological indicators (incidence and prevalence) of thyroid diseases in the entire population of the RF were analyzed using official state statistics. The analyzed period is 2009-2018. There was no medical intervention. To assess the dynamics of prevalence and incidence, a linear regression models were constructed, the slope of the trend line was calculated. RESULTS: the data were analyzed in accordance with the structure of diseases presented in the statistical reporting: goiter, thyroiditis, hypothyroidism, thyrotoxicosis, congenital iodine deficiency syndrome. For the ten-year period 2009-2018 there is a statistically significant increase in the prevalence of various forms of goiter, thyrotoxicosis, congenital iodine deficiency syndrome in the entire population of the Russian Federation. During the observation period, an increase in the incidence of thyrotoxicosis was revealed. With regard to the incidence of congenital iodine deficiency syndrome, only an upward trend was revealed. Despite the fact that during the observation period the number of new cases of various forms of goiter decreased, the prevalence of goiter among the population of the Russian Federation remains high: 1.2% of the population by January 1, 2019. with the growth of autoimmune pathology, improvement of the level of diagnosis, and also, in some cases, with overdiagnosis (for example, when diagnosing autoimmune thyroiditis in individuals with asymptomatic carriage of antithyroid antibodies). The current approaches to iodine prophylaxis are not effective enough. CONCLUSIONS: the results of the analysis indicate mainly an increase in the high prevalence of thyroid pathology among the population of the RF against the background of regional events. The problem of ID remains unresolved, which dictates the need to introduce universal mandatory salt iodization in the territory of the RF.


Assuntos
Hipotireoidismo Congênito , Bócio , Tireoidite , Humanos , Federação Russa/epidemiologia
18.
Sci Transl Med ; 13(593)2021 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-33980577

RESUMO

Immune-related adverse events induced by anti-programmed cell death-1 antibodies (PD-1-Ab), including destructive thyroiditis (thyroid-irAE), are thought to be caused by activated T cells. However, the T cell subsets that are directly responsible for damaging self-organs remain unclear. To clarify which T cell subsets are involved in the development of thyroid-irAE, a mouse model of thyroid-irAE was analyzed. PD-1-Ab administration 2.5 months after immunization with thyroglobulin caused destructive thyroiditis. Thyroiditis was completely prevented by previous depletion of CD4+ T cells and partially prevented by depleting CD8+ T cells. The frequencies of central and effector memory CD4+ T cell subsets and the secretion of interferon-γ after stimulation with thyroglobulin were increased in the cervical lymph nodes of mice with thyroid-irAE compared with controls. Histopathological analysis revealed infiltration of CD4+ T cells expressing granzyme B in thyroid glands and major histocompatibility complex class II expression on thyrocytes in mice with thyroid-irAE. Adoptive transfer of CD4+ T cells from cervical lymph nodes in mice with thyroid-irAE caused destruction of thyroid follicular architecture in the irradiated recipient mice. Flow cytometric analyses showed that the frequencies of central and effector memory CD4+ T cells expressing the cytotoxic marker CD27 were higher in peripheral blood mononuclear cells collected from patients with thyroid-irAE induced by PD-1-Ab versus those without. These data suggest a critical role for cytotoxic memory CD4+ T cells activated by PD-1-Ab in the pathogenesis of thyroid-irAE.


Assuntos
Tireoidite Autoimune , Tireoidite , Animais , Autoanticorpos , Linfócitos T CD4-Positivos , Linfócitos T CD8-Positivos , Humanos , Leucócitos Mononucleares , Camundongos , Tireoglobulina
19.
Probl Endokrinol (Mosk) ; 67(2): 20-27, 2021 02 09.
Artigo em Russo | MEDLINE | ID: mdl-34004100

RESUMO

The exponential rise in the use of immune checkpoint inhibitors (Ipilimumab, Nivolumab, Pembrolizumab, Atezolizumab, Durvalumab, and Avelumab) as the new standard for cancer treatment increase the incidence the immune-related adverse events due to immune activation. Endocrine immune-related adverse events are the third most commonly reported. Thyroid gland is most susceptible to autoimmune dysfunctions from immune checkpoint inhibitors and associated with the use of anti-PD-1 monoclonal antibodies. Hypophysitis develops more often during therapy with anti-CTLA-4 monoclonal antibodies. But such immune-related adverse events as diabetes mellitus, hypoparathyroidism are rare (about 1% of cases).We present a clinical case of the patient with skin melanoma who was prescribed therapy with immune checkpoints inhibitors (Pembrolizumab). Immune-related adverse events developed with damage to the endocrine organs after 3 Pembrolizumab injections. Of greatest interest is the development of two endocrine immune-related adverse events at once: destructive thyroiditis (with a short phase of thyrotoxicosis and subsequent persistent hypothyroidism) and diabetes mellitus. We tried to reflect the chronology of diseases and their features as fully as possible for endocrinologists, oncologists, therapists, family doctors and other medical doctors of related specialties.


Assuntos
Diabetes Mellitus , Melanoma , Tireoidite , Anticorpos Monoclonais Humanizados , Humanos , Melanoma/tratamento farmacológico , Nivolumabe , Tireoidite/induzido quimicamente
20.
Probl Endokrinol (Mosk) ; 67(2): 57-83, 2021 04 12.
Artigo em Russo | MEDLINE | ID: mdl-34004104

RESUMO

Acute and chronic thyroid diseases are the most frequently detected disorders being second only to diabetes mellitus.The World Health Organization points out that thyroid diseases' incidence tends to grow every year. The present paper consists of clinical practice guidelines that consider etiology, clinical course, diagnostics and treatment of acute and chronic inflammatory thyroid diseases (except those of autoimmune type).The clinical practice guidelines provide an important working tool for clinicians including specialty physicians and medical experts. Containing structured and concise information on the specific nosology, diagnostic methods and treatment tips these guidelines allow medical specialists to quickly resolve difficulties and choose the most efficient and personalized treatment (following strict principles of evidence-based medicine at the same time).The clinical practice guidelines were drawn up by highly-skilled professional team of specialty physicians approved by the Expert Council of Russian Federation's Health Department. These guidelines contain the most complete and up-to-date information required to diagnose acute and chronic thyroiditis, provide patient care and treatment.The working group publishes the present paper in the professional journal dealing with endocrinology topics to improve healthcare quality and refine treatment of acute and chronic thyroiditis (autoimmune thyroiditis excluded). It is advisable to acquaint as many endocrinology and general (family) medicine specialists as possible with the full text of these clinical guidelines.


Assuntos
Doença de Hashimoto , Tireoidite Autoimune , Tireoidite , Doença Crônica , Medicina Baseada em Evidências , Humanos , Guias de Prática Clínica como Assunto , Tireoidite Autoimune/diagnóstico
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