Toll-like receptor 7 and tumor necrosis factor alpha polymorphisms in Egyptian patients with autoimmune thyroid diseases.

Hashimoto's thyroiditis (HT) and Graves' disease (GD) susceptibility depends on a complex interaction between environmental and genetic factors. Genes for tumor necrosis factor alpha (TNF-α) and toll-like receptors (TLRs) have been incorporated into the pathophysiology of autoimmune disorders. Our aim is to assess the association between TLR7 (rs179009) and TNF-α (rs1800629) polymorphisms and susceptibility to autoimmune thyroid disorders. One-hundred ninety-nine individuals, divided into 68 HT patients in group I, 57 GD patients in group II, and 74 age- and gender-matched healthy subjects in group III, underwent laboratory investigations, including the detection of TLR7 and TNF-α polymorphisms using real-time PCR technique. TLR7 (rs179009) genotypes, A/G and G/G, were significantly more prevalent in HT patients (group I) compared to normal controls. Meanwhile, TNF-α (rs1800629) genotypes in GD patients (group II) showed a six fold increase in the risk of the disease in the G/A and A/A genotypes. Our findings propose the fact that the polymorphisms of TLR7 (rs179009) play a role in the susceptibility and the development of Hashimoto's thyroiditis, whereas TNF-α (rs1800629) polymorphisms play a role in the susceptibility and development of Graves' disease.

Do Brassica Vegetables Affect Thyroid Function?-A Comprehensive Systematic Review.

Brassica vegetables are widely consumed all over the world, especially in North America, Asia, and Europe. They are a rich source of sulfur compounds, such as glucosinolates (GLSs) and isothiocyanates (ITCs), which provide health benefits but are also suspected of having a goitrogenic effect. Adhering to PRISMA guidelines, we conducted a systematic review to assess the impact of dietary interventions on thyroid function, in terms of the potential risk for people with thyroid dysfunctions. We analyzed the results of 123 articles of in vitro, animal, and human studies, describing the impact of brassica plants and extracts on thyroid mass and histology, blood levels of TSH, T3, T4, iodine uptake, and the effect on thyroid cancer cells. We also presented the mechanisms of the goitrogenic potential of GLSs and ITCs, the limitations of the studies included, as well as further research directions. The vast majority of the results cast doubt on previous assumptions claiming that brassica plants have antithyroid effects in humans. Instead, they indicate that including brassica vegetables in the daily diet, particularly when accompanied by adequate iodine intake, poses no adverse effects on thyroid function.

The Role of the Immune System in the Course of Hashimoto's Thyroiditis: The Current State of Knowledge.

The process of thyroid autoimmunization develops against the background of genetic predispositions associated with class II human leukocyte antigens (HLA-DR), as well as cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), protein tyrosine phosphatase non-receptor type 22 (PTPN22), and forkhead transcription box protein P3 (FOXP3). Environmental factors, such as vitamin D deficiency, Zn, Se, and Mg, as well as infections, chronic stress, pregnancy, smoking, alcohol, medications, intestinal dysbiosis, and malnutrition, also play an important role. The first stage of autoimmunization involves the accumulation of macrophages and dendritic cells, as well as plasma cells. In the second stage, the mutual interactions of individual cells in the immune system lead to a decrease in the level of CD8+ in favor of CD4+, which intensifies the synthesis of T lymphocyte derivatives, especially Th1, Th17, Tfh, and Tc, reducing the level of Treg. Consequently, the number of the anti-inflammatory cytokines IL10 and IL2 decreases, and the synthesis of the pro-inflammatory cytokines IL-2, Il-12, Il-17, IL-21, IL-22, IFN-γ, and TNF-α increases. The latter two especially trigger the pyroptosis process involving the inflammasome. Activation of the inflammasome by IL-ß and IL-18 produced by macrophages is one of the mechanisms of pyroptosis in the course of Hashimoto's thyroiditis, involving Gram-negative bacteria and NLRC4. In the next step, the apoptosis of thyroid cells is initiated by the intensification of perforin, granzyme, and proteoglycan synthesis by Tc and NK cells. The current findings raise many possibilities regarding interventions related to the inhibition of pro-inflammatory cytokines and the stimulation of anti-inflammatory cytokines produced by both T and B lymphocytes. Furthermore, since there is currently no effective method for treating thyroid autoimmunity, a summary of the review may provide answers regarding the treatment of not only Hashimoto's thyroiditis, but also other autoimmune diseases associated with autoimmunity.

Hashimoto Thyroiditis and Mortality in Patients with Differentiated Thyroid Cancer: The National Epidemiologic Survey of Thyroid Cancer in Korea and Meta-Analysis.

BACKGRUOUND: Many studies have shown that Hashimoto's thyroiditis (HT) acts as a protective factor in differentiated thyroid cancer (DTC), but little is known about its effects on mortality. Therefore, this study was performed to reveal the prognosis of HT on mortality in patients with DTC. METHODS: This study included two types of research. RESULTS: retrospective cohort study using the National Epidemiologic Survey of Thyroid cancer (NEST) in Korea and meta-analysis study with the NEST data and eight selected studies. RESULTS: Of the 4,398 patients with DTC in NEST, 341 patients (7.8%) died during the median follow-up period of 15 years (interquartile range, 12.3 to 15.6). Of these, 91 deaths (2.1%) were related to DTC. HT was associated with a smaller tumor size and less aggressive DTC. In Cox regression analysis after adjusting for age and sex, patients with HT showed a significantly lower risk of all-cause death (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.52 to 0.96) and DTC-related death (HR, 0.33; 95% CI, 0.14 to 0.77). The analysis with inverse probability of treatment weight data adjusted for age, sex, and year of thyroid cancer registration showed similar association. The meta-analysis showed that patients with HT showed a lower risk of all-cause mortality (risk ratio [RR], 0.24; 95% CI, 0.13 to 0.47) and thyroid cancer-related mortality (RR, 0.23; 95% CI, 0.13 to 0.40) in comparison with patients without HT. CONCLUSION: This study showed that DTC co-presenting with HT is associated with a low risk of advanced DTC and presents a low risk for all-cause and DTC-related death.

Is Every Thyroid Antibody a Bad Sign?: The Complex Relationship of Antithyroid Antibodies and Obsessive-compulsive Symptoms.

Objective: : Several immunological factors are emphasized in the etiology of autoimmune thyroid diseases and obsessivecompulsive disorder. Obsessive-compulsive symptoms (OCS) are commonly seen in patients with autoimmune thyroid diseases. This study aims to evaluate the relationship between OCS and antithyroid antibodies. Methods: : The study included 145 patients with Hashimoto thyroiditis or Graves' disease and 42 healthy controls. Thyroid function tests and serum thyroid autobody levels (anti-thyroglobulin [TG], anti-thyroid peroxidase [TPO], and anti-thyroid stimulating hormone [TSH]) of the patients were measured. The socio-demographic data and OCS of the participants were evaluated with Dimensional OCS (DOCS). Results: : DOCS scores were higher in patients than in the control group. There was not found a significant relationship between free T3, free T4, and TSH levels and DOCS scores. Anti-TG positivity in females was associated with lower DOCS scores. Anti-TPO positivity in males had a positive correlation with DOCS scores. There was no correlation between sex and the presence of anti-TSH in terms of OCS severity. Univariate analysis found the highest OCS scores in anti-TPO positive, anti-TG, and anti-TSH negative patients. The group with the lowest OCS scores was found to be anti-TG positive, anti-TPO, and anti-TSH negative patients. Conclusion: : OCS severity could be affected by different thyroid autoantibody profiles in patients with autoimmune thyroid diseases. While anti-TG serves a protective role against OCS in females, the presence of anti-TPO may worsen the OCS in men. Additionally, the co-existence of different antithyroid antibodies may affect the severity of OCS differently according to sex.

Surgical management of papillary thyroid carcinoma coexisting with Hashimoto's disease: a single-center retrospective cohort study.

Background: The mechanism and impact of Hashimoto's disease (HT) in patients with papillary thyroid carcinoma (PTC) remains a subject of ongoing debate. The optimal extent of thyroid resection is also controversial in cases of low-risk PTC. Objective: To investigate the clinical outcomes and prognoses associated with different extents of surgical resection in patients diagnosed with PTC coexisting with HT. Methods: We retrospectively analyzed data on the clinical features and treatment outcomes of patients with PTC concomitant with HT who underwent lobectomy with isthmusectomy and those who underwent total thyroidectomy at Peking University International Hospital between December 2014 and August 2023. Results: Twenty-one patients in group A underwent lobectomy with isthmusectomy and prophylactic central neck dissection, whereas twenty patients in group B underwent total thyroidectomy with prophylactic central lymph node (LN) dissection, except one who did not undergo LN dissection. Group A demonstrated shorter surgery time (105.75 min ± 29.35 vs. 158.81 min ± 42.01, p = 0.000), higher parathyroid hormone (PTH) levels on postoperative day 1 [26.96 pg/ml (20.25, 35.45) vs. 9.01 pg/ml (2.48, 10.93), p = 0.000] and a shorter postoperative hospital stay [2.95 d (2.0, 4.0) vs. 4.02 d (3.0, 5.0), p = 0.008] than those of group B, with statistically significant differences. Both groups exhibited similar recovery patterns in terms of PTH [32.10 pg/ml (22.05, 46.50) vs. 20.47 pg/ml (9.43, 34.03), p = 0.192] and serum calcium (2.37 mmol/L ± 0.06 vs. 2.29 mmol/L ± 0.19, p = 0.409) after 1 montsh following the surgery. According to the Kaplan-Meier curves, no significant difference in the 5-year disease-free survival rates were observed between patients in group A (100%) and group B (97.1%) (Log rank test: p = 0.420, Breslow test: p = 0.420). Conclusion: Lobectomy with isthmusectomy and prophylactic central neck dissection is a safe and feasible treatment option for patients with low-risk PTC coexisting with HT. Clinical trial registration: http://www.chictr.org.cn, identifier ChiCTR2300079115.

Evaluation of ovarian reserve in women with thyroid autoimmunity.

OBJECTIVE: To compare the ovarian reserve of women of reproductive age with and without thyroid autoimmunity (TAI). METHODS: We performed a retrospective analysis of medical records from an assisted reproduction clinic from February 2017 to December 2021. Women aged between18 and 47 years with data on antithyroperoxidase and antithyroglobulin (anti-Tg) antibodies and assessment of ovarian reserve by anti-müllerian hormone (AMH) and antral follicle count (AFC) were included. Among the 188 participants included, 63 were diagnosed with TAI, and 125 had both antibodies negative. AMH and AFC were compared between groups. Subanalysis based on age, types of antibodies, and thyroid function markers were performed. In addition, bivariate analysis and regression models were used. RESULTS: Overall, there was no difference in the median levels of AMH or AFC between the two groups. However, in the subgroup analysis by age, we observed a trend towards lower median levels of AMH in women over 39 years with TAI (0.9 ng/mL vs. 1.5 ng/mL, p=0.08). In a subanalysis according to antibodies, we found a significantly lower median AFC in the group with anti-Tg than in the group without this antibody (8.0 follicles vs. 11.5 follicles, p=0.036). We also found a significantly higher prevalence of anti-Tg in patients with low ovarian reserve compared to those with normal reserve (60.7% vs. 39.3%, p=0.038). CONCLUSIONS: The ovarian reserve of women with TAI appears to be insidiously compromised over the years, with a decreased ovarian reserve in women with anti-Tg.

A Silent Cause of Shock: Autoimmune Polyglandular Syndromes.

Addison's disease is a rare, autoimmune condition leading to destruction of the adrenal gland. Autoimmune conditions are known to commonly co-occur. When Addison's disease presents in the setting of autoimmune thyroid disease and/or type 1 diabetes, this condition is termed autoimmune polyendocrine syndrome type II, a rare endocrinopathy found in roughly 1.4-4.5 per 100,000 individuals. Here, we describe a clinical case presenting with hypotension refractory to fluid resuscitation and electrolyte derangements later diagnosed as autoimmune polyendocrine syndrome type II. LEARNING POINTS: Primary adrenal insufficiency may present clinically as shock refractory to fluid resuscitation.Autoimmune polyglandular syndrome type 2 is a rare autoimmune condition occurring in 1.5-4.5 per 100,000 individuals.The presence of an underlying autoimmune condition should raise suspicion for multiple concurrent autoimmune conditions.

Thyroid Disorders.

This article includes a review of information primary care physicians need to know direct their evaluation and treatment of thyroid disorders that include sick euthyroid, hyperthyroidism, hypothyroidism, and subclinical thyroid disorders.

Utilizing Immunoglobulin G4 Immunohistochemistry for Risk Stratification in Patients with Papillary Thyroid Carcinoma Associated with Hashimoto Thyroiditis.

BACKGRUOUND: Hashimoto thyroiditis (HT) is suspected to correlate with papillary thyroid carcinoma (PTC) development. While some HT cases exhibit histologic features of immunoglobulin G4 (IgG4)-related disease, the relationship of HT with PTC progression remains unestablished. METHODS: This cross-sectional study included 426 adult patients with PTC (≥1 cm) undergoing thyroidectomy at an academic thyroid center. HT was identified based on its typical histologic features. IgG4 and IgG immunohistochemistry were performed. Wholeslide images of immunostained slides were digitalized. Positive plasma cells per 2 mm2 were counted using QuPath and a pre-trained deep learning model. The primary outcome was tumor structural recurrence post-surgery. RESULTS: Among the 426 PTC patients, 79 were diagnosed with HT. With a 40% IgG4 positive/IgG plasma cell ratio as the threshold for diagnosing IgG4-related disease, a cutoff value of >150 IgG4 positive plasma cells per 2 mm2 was established. According to this criterion, 53% (43/79) of HT patients were classified as IgG4-related. The IgG4-related HT subgroup presented a more advanced cancer stage than the IgG4-non-related HT group (P=0.038). The median observation period was 109 months (range, 6 to 142). Initial assessment revealed 43 recurrence cases. Recurrence-free survival periods showed significant (P=0.023) differences, with patients with IgG4 non-related HT showing the longest period, followed by patients without HT and those with IgG4-related HT. CONCLUSION: This study effectively stratified recurrence risk in PTC patients based on HT status and IgG4-related subtypes. These findings may contribute to better-informed treatment decisions and patient care strategies.

Higher Levels of Plasma Fetuin-A, Nrf2, and Cytokeratin 18 in Patients with Hashimoto's Disease.

Objectives: Fetuin-A is a protein that exhibits proatherogenic, pro-inflammatory, and anti-inflammatory effects with increased insulin resistance and adipocyte dysfunction. The nuclear factor erythroid 2-related factor (Nrf2) is a transcription factor that is crucial for protecting cells against oxidative damage. As a cell death product, cytokeratin 18 (CK18) levels increase during necrosis and apoptosis of both normal and tumor cells. We analyzed the plasma levels of three biomarkers based on the hypothesis that they might be related to some pathophysiological pathways in Hashimoto's disease. Methods: We compared 34 female patients with overt hypothyroidism due to Hashimoto's disease (Group 1) with 34 age-matched healthy females (Group 2). For comparison, plasma levels of thyroid-stimulating hormone (TSH), fetuin-A, Nrf2, and CK18 were measured in all participants. Results: In group 1, the mean TSH levels (31.4±15.3) were significantly higher than those in group 2 (2.6±1.0) (p<0.001). The levels of mean fetuin-A (606.7±34.2) and Nrf2 (1.3±0.6) were found to be significantly higher in group 1 than in group 2 (440.0±34.2 vs. 0.7±0.2) (p<0.001 for both). CK18 levels in group 1 (0.36±0.13) were also significantly higher than in group 2 (0.26±0.16) (p=0.020). A significant correlation was observed between TSH levels and fetuin-A (r=0.401, p=0.001). Conclusion: Increased levels of fetuin-A, Nrf2, and CK18 may be a consequence or cause of the pathophysiological pathways of Hashimoto's disease. The clinical significance of increased levels of these biomarkers requires further investigation.

[Epidemiological, Clinical And Evolutionary Characteristics Of Autoimmune Dysthyroidism In The National University Center Hubert Koutoukou Maga (CNHU-HKM) Of Cotonou]. / Caracteristiques Epidemio-Cliniques Et Evolutives Des Dysthyroïdies Auto-Immunes Au Centre National Hospitalier Universitaire Hubert Koutougou Maga (CNHU-HKM) De Cotonou.

OBJECTIVE: To study the epidemiological, clinical and evolutionary characteristics of autoimmune dysthyroidism in the endocrinology-diabetes department of the CNHU-HKM. MATERIAL AND METHOD: This was a descriptive and analytical cross-sectional study of patients seen for thyroid pathology in the endocrinology diabetology department over a 10-year period. Patients with at least one abnormal TSH and positive anti-thyroid antibodies were included. RESULTS: Over the study period, we recorded 2883 consultants, 347 of them having thyroid diseases, including 69 cases of autoimmune dysthyroidism divided into 54 cases of Graves' disease and 15 cases of Hashimoto's disease. Autoimmune dysthyroidism represented 2.39% of consultations and 19.89% of thyroid disorders. Graves' disease and Hashimoto's disease accounted for 1.87% (54 cases) and 0.52% (15 cases) of consultations respectively. Autoimmune dysthyroidism was more frequent in the 30-40 and 40-50 age groups. The most frequent symptoms of Graves' disease were asthenia (94.4%), weight loss (87.0%) and tachycardia (85.2%). In Hashimoto's disease, the main symptoms were asthenia (86.66%), goiter (66.6%) and weight gain (60%). High initial R-TSH antibody levels and iatrogenic hypothyroidism were found to be factors associated with extended follow-up of Graves' disease beyond 18 months. CONCLUSION: Autoimmune dysthyroidism is a frequent condition, with Graves' disease predominating. Their evolution under therapy is influenced by clinical, biological and ultrasonographic factors.

OBJECTIF: Etudier les caractéristiques épidémio cliniques et évolutives des dysthyroïdies auto immunes dans le service d'endocrinologie diabétologie du CNHU-HKM. MATÉRIEL ET MÉTHODE D'ÉTUDE: Il s'agit d'une étude transversale descriptive et analytique ayant porté sur les patients reçus en consultation pour une pathologie thyroïdienne dans le service d'endocrinologie diabétologie sur une période de 10 ans. Ont été inclus les patients ayant au moins une TSH anormale et les anticorps anti thyroïdiens positifs. RÉSULTATS: Sur la période d'étude, nous avons enregistré 2883 consultants, 347 avaient une pathologie thyroïdienne, dont 69 cas de dysthyroïdie auto-immune répartis en 54 cas de maladie de Basedow et 15 cas de maladie de Hashimoto. Les dysthyroïdies auto immunes représentaient donc 2,39 % des consultations et 19,89% des thyroïdopathies. Les fréquences de la maladie de Basedow et de la maladie de Hashimoto étaient respectivement de 1,87% (54 cas) et 0,52% (15 cas) parmi les consultations. Les dysthyroïdies auto immunes étaient plus fréquentes dans les tranches d'âge de 30 à 40 et 40 à 50 ans. Les manifestations les plus fréquentes de la maladie de Basedow étaient l'asthénie (94,4%), l'amaigrissement (87,0%) et la tachycardie (85,2%) . Quant à la maladie de Hashimoto les principales manifestations étaient représentées par une asthénie (86,66%), un goitre (66,6%) et une prise de poids (60%). Le titre initial élevé des anticorps anti R-TSH, l'hypothyroïdie iatrogène ont été retrouvés comme des facteurs associés au suivi prolongé de la maladie de Basedow au-delà de 18 mois. CONCLUSION: Les dysthyroïdies auto-immunes sont des affections fréquentes dominées par la maladie de Basedow. Leur évolution sous traitement est influencée par des facteurs cliniques, biologiques et échographiques.

Seasonality of Hashimoto Thyroiditis: Infodemiology Study of Google Trends Data.

BACKGROUND: Hashimoto thyroiditis (HT) is an autoimmune thyroid disease and the leading cause of hypothyroidism in areas with sufficient iodine intake. The quality-of-life impact and financial burden of hypothyroidism and HT highlight the need for additional research investigating the disease etiology with the aim of revealing potential modifiable risk factors. OBJECTIVE: Implementation of measures against such risk factors, once identified, has the potential to lessen the financial burden while also improving the quality of life of many individuals. Therefore, we aimed to examine the potential seasonality of HT in Europe using the Google Trends data to explore whether there is a seasonal characteristic of Google searches regarding HT, examine the potential impact of the countries' geographic location on the potential seasonality, and identify potential modifiable risk factors for HT, thereby inspiring future research on the topic. METHODS: Monthly Google Trends data on the search topic "Hashimoto thyroiditis" were retrieved in a 17-year time frame from January 2004 to December 2020 for 36 European countries. A cosinor model analysis was conducted to evaluate potential seasonality. Simple linear regression was used to estimate the potential effect of latitude and longitude on seasonal amplitude and phase of the model outputs. RESULTS: Of 36 included European countries, significant seasonality was observed in 30 (83%) countries. Most phase peaks occurred in spring (14/30, 46.7%) and winter (8/30, 26.7%). A statistically significant effect was observed regarding the effect of geographical latitude on cosinor model amplitude (y = -3.23 + 0.13 x; R2=0.29; P=.002). Seasonal increases in HT search volume may therefore be a consequence of an increased incidence or higher disease activity. It is particularly interesting that in most countries, a seasonal peak occurred in spring and winter months; when viewed in the context of the statistically significant impact of geographical latitude on seasonality amplitude, this may indicate the potential role of vitamin D levels in the seasonality of HT. CONCLUSIONS: Significant seasonality of HT Google Trends search volume was observed in our study, with seasonal peaks in most countries occurring in spring and winter and with a significant impact of latitude on seasonality amplitude. Further studies on the topic of seasonality in HT and factors impacting it are required.

Sindrome poliglandular autoinmune tipo iii-c asociado con vitiligo; reporte de caso en honduras / Polyglandular autoimmune syndrome type iii-c associated with vitiligo; case report in Honduras

Los síndromes poliglandulares autoinmunes son una serie de anomalías funcionales que causan desregulación inmunitaria y afectan a múltiples glándulas endocrinas del organismo. Las patologías crónicas en un paciente adulto no siempre son independientes una de otra, sino más bien, múltiples presentaciones clínicas con un origen en común. Presentamos el caso de una paciente femenina de tercera edad, con antecedentes de vitÍligo, alopecia, hipertensión arterial y diabetes mellitus tipo 2, acude a consulta por presentar astenia, adinamia y somnolencia de aproximadamente 10 meses de evolución, al examen físico biotipo pícnico, mixedema, piel seca más bocio, laboratorio reporta TSH (12 UI/ml), T4 libre (0.2 ng/dl), Anti TPO 168.70 UI/ml, USG que determina bocio tiroideo y patrón micro nodular, se hace el diagnóstico de tiroiditis de Hashimoto. Es así que el análisis de los antecedentes patológicos junto al padecimiento actual, nos permitieron diagnosticar un síndrome poli glandular autoinmune tipo III-C.

Polyglandular autoimmune syndromes (PAS) are a series of functional anomalies that can cause immunitary deregulation affecting multiple endocrine glands. Chronic pathologies in adult patients are not always independent from one another, but rather, are unique defects with multiple clinical presentations.We report an elderly female patient with a history of vitiligo, alopecia, hypertension and type 2 diabetes mellitus who came into a consultation for asthenia, adynamia and drowsiness for approximately 10 months. The physical exam showed a pyknic biotype, myxedema, dry skin and goiter.Test results show TSH (12 lU/ml), free T4 (0. 2 ng/dl), Anti TPO 168.70 lU/ml, USG reported thyroid goiter and a micro nodular pattern where the diagnosis of Hashimoto's thyroiditis is made. This study demonstrated that, through understanding the pathological history alongside the current disease, we can diagnose a polyglandular autoimmune syndrome type III-C.

Cardiovascular risk in hashimoto thyroiditis patients according to their thyroid state: a cross-sectional study / Riesgo cardiovascular en pacientes con tiroiditis hashimoto según su estada tiroidea: un estudio transversal

Objetivo: investigar la asociación entre los factores de riesgo cardiovascular y el nivel de riesgo cardiovascular con el estado tiroideo de pacientes con Tiroiditis de Hashimoto. Métodos y técnicas: treinta y ocho adultos con tiroiditis de Hashimoto participaron en este estudio descriptivo transversal. Los factores de riesgo cardiovascular considerados incluyeron edad, sexo, presión arterial, índice de masa corporal, glucemia, perfil lipídico, comorbilidades cardiovasculares, Proteína C Reactiva y Eritrosedimentación. Se utilizó la calculadora de riesgo cardiovascular de Framingham. La muestra se clasificó según el estado tiroideo en eutiroidismo (n = 15), hipotiroidismo clínico (n = 9) e hipotiroidismo subclínico (n = 13) e incluyó la presencia de anticuerpos antitiroideos. Se utilizó la prueba exacta de Fisher para determinar la asociación entre las variables estudiadas. Resultados: el 100 % de la muestra fue de sexo femenino; con una edad media entre 39-59 años. La categoría con bajo riesgo fue la mayor muestra (n = 30), equivalente al 78,9 %; riesgo moderado, no se obtuvo ningún paciente; alto riesgo (n = 8) constituyó el 21,1 %. Se encontró significancia estadística entre la edad y el nivel de riesgo cardiovascular en pacientes con hipotiroidismo clínico (p < 1), score in patients with clinical hypothyroidism was found (p < 1), IC 95 %. El nivel de glucosa en el hipotiroidismo subclínico y el hipotiroidismo clínico tuvo significancia estadística. Del mismo modo, se demostró que la presencia de antitiroglobulina (antiTg) está estrechamente relacionada con el nivel de riesgo cardiovascular en pacientes con hipotiroidismo subclínico. Conclusión: la edad, la glucemia, los anti-Tg, el antecedente de diabetes mellitus, la dislipemia y haber padecido algún accidente cerebrovascular se ha relacionado con un aumento del riesgo de desarrollar un evento cardiovascular hasta en 10 años en función de su perfil tiroideo. No se encontró evidencia de una relación directa entre la puntuación de riesgo cardiovascular y el estado de la tiroides en los participantes de este estudio.

Aims: To investigate the association between cardiovascular risk factors and cardiovascular risk score with the thyroid status of patients with Hashimoto's Thyroiditis. Methods: Thirty-eight consenting adults with Hashimoto's Thyroiditis participated in this cross-sectional study. The cardiovascular risk factors considered included age, sex, blood pressure, body mass index, fast blood glucose, lipid profile, cardiovascular comorbidities, C reactive protein, and erythrocyte sedimentation rate. The Framingham CV risk score was performed. The sample was classified into euthyroid (n = 15), clinical hypothyroidism (n = 9), and subclinical hypothyroidism (n = 13), and included the presence of antithyroid antibodies. Fisher's exact test was used to determine the association between the variables studied. Results: 100% of the sample were women; a mean age between 39-59 years old. The category with low risk was the largest (n = 30), equivalent to 78.9%; moderate risk, no patient was obtained; high risk (n = 8) constituted 21.1%. Statistical significance between age and CV risk score in patients with clinical hypothyroidism was found (p < 1), 95% CI. The glucose level in the subclinical hypothyroidism and clinical hypothyroidism had statistical significance. The presence of anti-Thyroglobulin (antiTg) was shown to be closely related to the level of CV risk in patients with subclinical hypothyroidism. Conclusion: Age, glycemia, anti-Tg, history of DM, dyslipidemia, or cerebrovascular accidents have been linked to raising the risk of developing CVD in up to 10 years depending on their thyroid profile. No evidence of a direct relationship between CV risk score and thyroid state was found in the participants of this study.

Debut con síntomas psicóticos de encefalopatía de Hashimoto: reporte de caso / Debut with psychotic symptoms of Hashimoto encephalopathy: a case report

La encefalopatía de Hashimoto es una enfermedad rara reportada por primera vez en 1966 con una prevalencia de 2,1/1000 habitantes. Se presenta el caso de una mujer de 42 años, sin antecedentes médicos de importancia, quien inició un cuadro de manera súbita con alteración de conciencia, alucinaciones visuales y delusiones. En los exámenes de laboratorio se tuvo anticuerpos antiperoxidasa tiroidea mayor a 600 U/ml, tiroxina 0,93, hormona estimulante de la tiroides 1,60 U/ml, resonancia magnética con lesiones focales subcorticales bilaterales de aspecto desmielinizante inespecífico, electroencefalograma sin particularidades. Se realizó el diagnóstico de encefalopatía de Hashimoto y el cuadro remitió luego del tratamiento con corticoides. El artículo resalta la importancia de realizar una evaluación integral de los pacientes con sintomatología psiquiátrica atípica y ahondar en el diagnóstico de exclusión.

Hashimoto's encephalopathy is a rare disease, first reported in 1966, with a prevalence of 2.1 in 1000 inhabitants. We present the case of a 42- year- old woman, with no relevant medical history, who suddenly started having symptoms of altered consciousness, visual hallucinations and de-lusions. Laboratory tests showed anti- thyroperoxidase antibodies greater than 600 U/ml, thy-roxin 0.93 U/ml, and thyroid stimulating hormone 1.60 U/ml. Magnetic resonance imaging showed bilateral subcortical focal lesions with a nonspecific demyelinating appearance. The electroencephalogram was nonspecific. The diagnosis of Hashimoto encephalopathy was made, and symptoms remitted after treatment with steroids. This article highlights the importance of conducting a comprehensive evaluation of patients with atypical psychiatric symptoms and a thorough differential diagnosis.

Vitamin D in patients with Hashimoto's disease: a systematic review and meta-analysis

One of the most common thyroid dysfunctions is Hashimoto's disease (HD), characterized by the production of specific antibodies against thyroid gland antigens (Anti-Tg and Anti-TPO). Recent studies have suggested that vitamin D supplementation, associated with levothyroxine, may contribute to the control of this autoimmune disease. However, secondary studies on this topic, such as systematic reviews and meta-analyses, are still scarce. Thus, the present study aimed to evaluate the efficacy and safety of vitamin D in patients with HD through a systematic review with meta-analysis. Randomized clinical trials were selected on the Pubmed, Scopus, and Web of Science databases. Studies comparing groups of HD patients supplemented with vitamin D and non-supplemented HD patients were included. The following outcomes were considered: TSH, T3, T4, Anti-Tg, Anti-TPO, and adverse drug reactions. The risk of bias was performed according to the Cochrane recommendations (RoB v. 2.0), and the quality of evidence was evaluated by the GRADE system. A total of 766 studies were identified in the databases, of which 7 met the eligibility criteria. None of the studies indicated the occurrence of adverse reactions with vitamin D supplementation in any administered dosage. Supplemented patients had a significant reduction in serum TSH levels compared to the control group (mean difference = -0.180 (95% CI [-0.316 to -0.045]), p = 0.009), suggesting that thyroid function was more controlled in the intervention group. However, for the other outcomes, no statistically significant differences were observed between the groups. Additionally, most of included articles (n=5/7) had some concerns or high risk of bias, and the quality of evidence revealed a moderate confidence for almost all outcomes; so the results must be interpreted with caution. Thus, more consistent, and robust clinical trials need to be carried out to confirm the efficacy of vitamin D supplementation in patients with HD.

Encefalopatía asociada a enfermedad tiroidea autoinmune: reporte de caso y revisión de la literatura / Encephalopathy associated with autoimmune thyroid disease: Case report and literature review

RESUMEN INTRODUCCIÓN: La encefalopatía asociada a enfermedad tiroidea autoinmune se caracteriza por un inicio insidioso de síntomas neuropsiquiátricos que incluyen alteración de la función cognoscitiva, cambios del comportamiento, crisis convulsivas y trastornos del movimiento. REPORTE DE CASO: Hombre de 69 años con antecedente de hipotiroidismo primario que consultó por dos semanas de alteración de la memoria, confusión y trastorno del lenguaje, asociados a hiperreflexia y temblor generalizado. Los estudios mostraron nivel de hormona tiroidea y títulos de anticuerpos antitiroideos elevados, líquido cefalorraquídeo con aumento de proteínas y anticuerpos antineuronales negativos, neuroimagen normal y electroencefalograma con alteraciónes inespecíficas. Posterior a descartar otras etiologías, se hizo el diagnóstico de encefalopatía asociada a enfermedad tiroidea autoinmune y se inició manejo con esteroides, con los que presentó una mejoría clínica significativa. DISCUSIÓN: La encefalopatía asociada a enfermedad tiroidea autoinmune es un trastorno complejo que requiere un diagnóstico oportuno y rápido. En todos los pacientes con síntomas neuropsiquiátricos agudos o subagudos, y sin causa clara, es pertinente solicitar un perfil de anticuerpos antitiroideos independiente de la función tiroidea basal.

ABSTRACT INTRODUCTION: Thyroid autoimmune disease-associated encephalopathy is characterized by an insidious onset of neuropsychiatric symptoms which may include impaired cognitive function, behavioral changes, seizures, and movement disorders. CASE REPORT: A 69-year-old man with a history of primary hypothyroidism who consulted for two weeks of memory impairment, confusion, and language disorder, associated with hyperreflexia and generalized tremor. Studies showed elevated thyroid hormone levels and antithyroid antibody titers, cerebrospinal fluid with increased protein and negative antineuronal antibodies, normal neuroimaging, and electroencephalogram with nonspecific abnormalities. After ruling out other etiologies, a diagnosis of encephalopathy associated with autoimmune thyroid disease was made and management with steroids was started, with which he presented significant clinical improvement. DISCUSSION: Encephalopathy associated with autoimmune thyroid disease is a complex disorder that requires timely and rapid diagnosis. In all patients with acute or subacute neuropsychiatric symptoms, and without a clear cause, it is pertinent to request an antithyroid antibody profile independent of baseline thyroid function

Linfoma del tejido linfoide asociado a las mucosas en paciente con tiroiditis de Hashimoto / Mucosa-associated lymphoid tissue lymphoma in a patient with Hashimoto's thyroiditis

RESUMEN El linfoma del tejido linfoide asociado a las mucosas es una variedad poco común y recientemente descubierta del linfoma no Hodgkin. Suele presentarse en la sexta década de la vida, con un predominio del sexo femenino y en sitios como el tracto digestivo, pulmón, riñón, hígado, piel, y solo en el 2 % de los casos, en la glándula tiroides, donde en muchas ocasiones se asocia a la tiroiditis autoinmune de Hashimoto. Su evolución es favorable cuando se diagnostica en estadios iniciales de la enfermedad. Se presenta una paciente de 22 años, con una historia de trastornos endocrinos, perceptibles desde la adolescencia, a quien se le diagnosticó una tiroiditis de Hashimoto, sobre la que subyacía un linfoma del tejido linfoide asociado a las mucosas, y que evolucionó satisfactoriamente luego del tratamiento quirúrgico.

ABSTRACT Mucosa-associated lymphoid tissue lymphoma is a rare and recently discovered variant of non-Hodgkin's lymphoma. It usually occurs in the sixth decade of life, with a predominance of females and may be observed in sites such as the digestive tract, lung, kidney, liver, skin, and only in 2% of cases, in the thyroid gland, where in many occasions it is associated with Hashimoto's autoimmune thyroiditis. Its evolution is favorable when it is diagnosed in the initial stages of the disease. We present a 22-year-old female patient with a history of perceptible endocrine disorders since adolescence, who was diagnosed with Hashimoto's thyroiditis, underlying mucosa-associated lymphoid tissue lymphoma, and who evolved satisfactorily after surgical treatment.

Prevalence of Hashimoto's thyroiditis in psoriasis patients

SUMMARY OBJECTIVE: To study the prevalence of Hashimoto's Thyroiditis in a sample of psoriasis patients. METHODS: Cross-sectional observational study of 120 individuals (60 with psoriasis and 60 control subjects) paired by gender and age for thyroid function (thyroid stimulating hormone, free T4), antithyroperoxidase and antithyroglobulin tests and physical examination. Psoriasis Area and Severity Index and Nail Psoriasis Severity Index were evaluated simultaneously. Epidemiological, clinical and treatment data was collected from medical records. Patients with documented hypothyroidism and/or goiter associated with positive antithyroperoxidase antibody were considered to have Hashimoto's Thyroiditis. RESULTS: The prevalence of Hashimoto's Thyroiditis in the group with psoriasis was 21.6%; in the control group, it was 4/60 (6.6%) with p=0.03 (OR=3.8; 95%CI 1.18-12.6). In the group of patients with psoriasis, Hashimoto's Thyroiditis was more common in women (p=0.002) and less common in those who had polyarticular arthropathic psoriasis (p=0.05) and plaque psoriasis (p=0.005). A logistic regression showed that the only independent variable associated with Hashimoto's thyroiditis was plaque psoriasis. CONCLUSIONS: There is a high prevalence of Hashimoto's Thyroiditis in psoriatic patients, especially in women. Hashimoto's Thyroiditis is less common in patients with the plaque form of psoriasis.