Special Issue:
Challenges and Opportunities in Thyroid Disease
A Comprehensive Analysis of Clinical and Laboratory Characteristics of Thyroid Abnormalities in a Two-Year Outpatient Cross-Sectional Study
Davaasuren Damdindorj
Department of Endocrinology, First Central Hospital of Mongolia
Oyunbileg Bavuu
Department of Endocrinology, School of Medicine, Mongolian National University of Medical Science
Bolormaa Ganbaatar
Mongolia-Japan Teaching Hospital, School of Medicine, Mongolian National University of Medical Science
Sainbileg Sonomtseren
Department of Endocrinology, School of Medicine, Mongolian National University of Medical Science
Bayasgalan Tumenbayar
Department of Endocrinology, School of Medicine, Mongolian National University of Medical Science
Abstract
Background: The prevalence of thyroid disorders, particularly disseminated Graves’ disease and thyroid nodules, is escalating within the general population. Irregular activation of the immune system is a key factor in causing autoimmune thyroid diseases such as Graves’ disease and Hashimoto thyroiditis. However, the development of autoimmune disorders is influenced by a combination of environmental factors such as urbanization, pollution, and iodine intake.
Methods and Results: The study involved 204 patients with thyroid disorders at the department of endocrinology in the outpatient clinic over the past 2 years. The data collection of demographical and clinical information included age, gender, clinical features, laboratory tests, and instrumental analysis. The mean age of participants was 44.35±14.29 years, and females comprised 91.2% of the cases. Among them, 46.1% had thyroid nodules, 36.8% presented with Grave’s disease, 13.2% with Hashimoto’s thyroiditis, and 3.9% with thyroid hyperplasia. The patients with Grave’s disease, the average levels of thyroid antibodies were as follows: anti-thyroid stimulating hormone receptor (Anti-TSHR ) at 21.91±14.02 IU/L, anti-thyroglobulin (Anti-TG) at 265.91±406.03 IU/ml, and anti-thyroid peroxidase (Anti-TPO) at 319.3±327.1 IU/ml, respectively. Additionally, the mean thyroid enlargement was 29.60±16.08 ml. The participants were categorized based on their geographical region, with the distribution as follows: central region 59.3%, northern region 20.1% western region 10.8%, and eastern region 9.8%.
Conclusion: Thyroid disorders are prevalent in our population, with greater incidence in females than males. The majority of cases (46.1%) involved thyroid nodules, with a peak age of above 30 years among participants. The central region, particularly the capital city (Ulaanbaatar), exhibited the highest prevalence at 59.3%, as highlighted by the distribution of thyroid abnormalities.
Mukund Tinguria
Department of Pathology and Laboratory Medicine Brantford General Hospital 200 Terrace Hill Street Brantford, Ontario Postal Code – N3R 1G9 Canada
Abstract
Celiac disease (CD) is an immune mediated disorder characterised by intolerance to glutens in certain grains like whet, barley, and rye. The exposure to gliadin protein component in the susceptible individuals leads to an inflammatory reaction damaging small bowel mucosa with progressive disappearance of intestinal villi. The damaged intestinal mucosa leads to malabsorption. The usual symptoms of celiac disease include diarrhea, steatorrhea, weight loss, fatigue, and abdominal pain. Diagnosis is based on clinical features, duodenal biopsy, elevated levels of anti-gliadin antibodies and response to gluten free diet. Contrary to common belief, celiac disease is a protein systemic disease rather than merely a pure digestive alteration. Celiac disease is closely associated with genes that code HLA -II antigens mainly of DQ2 and DQ8 classes, production of disease specific antibodies (i.e., endomysial antibodies), multiorgan involvement, comorbidity with other autoimmune diseases (shared autoimmunity), familial aggregation, and immune system dysregulation.
The clinical presentation of celiac disease can be variable. In mild form, patients can be almost asymptomatic whereas in the most severe form, the patients are at increased risk of life-threatening complications. Celiac disease has a well-known association with other autoimmune diseases such as autoimmune liver diseases (autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis), diabetes mellitus, autoimmune thyroid diseases, skin diseases such as dermatitis herpetiformis, rheumatoid arthritis, systemic lupus erythematosus, Sjogren’s syndrome, psoriasis, sarcoidosis, immune thrombocytopenic purpura, and pancreatitis. In addition, celiac disease may be associated with rare but potentially serious complications such as, collagenous sprue, ulcerative jejunoileitis, refractory celiac disease (RCD), enteropathy associated T-cell lymphoma, small bowel adenocarcinoma (SBA), hyposplenism, and cavitating mesenteric lymph node syndrome (CMLNS). The present article describes clinicopathologic features of these rare but serious complications of celiac disease.
Gisah Amaral de Carvalho
Federal University of Parana
Beatriz Drobrzenski
Federal University of Parana
Abstract
In recent decades, significant advancements have been made in the methodologies used for evaluating thyroid dysfunctions. These advancements include the development of radioimmunoassays, immunometric assays, and liquid chromatography coupled with mass spectrometry.
The main thyroid function tests include thyroid-stimulating hormone (TSH) and the measurement of triiodothyronine (T3) and thyroxine (T4), including their total and free fractions.
Over time, different generations of TSH tests have been developed, starting from radioimmunoassays to immunometric assays, and more recently, tests utilizing fluorophores and chemiluminescent molecules. The third-generation tests are currently the most widely used due to their high sensitivity and specificity. Thyroid-stimulating hormone is preferred as the initial test for evaluating thyroid function since it has a log-linear relationship with free T4 levels, enabling the identification of subclinical hypothyroidism and subclinical hyperthyroidism.
The reference range for normal TSH levels is typically between 0.45 and 4.5 mIU/L. However, there can be variations in TSH levels based on factors such as sex, age, and ethnicity. Specific reference values may be required for certain populations, such as the elderly, pregnancy, and neonates. In the elderly, an increase in TSH levels is expected. In the neonatal period, TSH levels are high after birth and take a few weeks to normalize. During pregnancy, various physiological changes occur, leading to alterations in thyroid hormones to meet fetal demands.
Laboratory interferences in thyroid hormone assays must be considered to ensure accurate results. Biotin interference can lead to falsely low TSH and falsely high free T3 and T4 levels. Macro-thyrotropin can cause elevated TSH levels with normal thyroid hormone levels. Heterophilic antibodies can also cause false results. Additionally, the evaluation of autoantibodies and markers used in thyroid cancer follow-up needs special attention.
Patients experiencing conditions like trauma, particularly in severe cases, may undergo changes in thyroid hormone levels, even without having a specific thyroid disease, which is called low triiodothyronine syndrome.
In conclusion, it is essential to be aware of potential laboratory interferences and consider individual variations to ensure accurate interpretation and appropriate management of patients.
Ildikó Molnár, PhD
Immunoendocrinology, EndoMed, Bem tér 18/C., H-4026 Debrecen, Hungary
Abstract
Background: Previously, the presence of autoantibodies against type 2 deiodinase cys- and hom-peptides was investigated in Graves’ disease with relation to thyroid function, ophthalmopathy and therapy. The new design was to reveal the relationship among antithyroid antibodies involved in hormone synthesis.
Aim and scope: To demonstrate some regularity between the appearance of peptide autoantibodies and antithyroid antibodies against TSH receptor, thyroid peroxidase and thyroglobulin, the study followed the main path of hormone synthesis and the effect of antithyroid drug treatment. Has any effect of peptide autoantibodies on the titers of other autoantibodies?
Methods: The methods were described in our previous papers detailed. Autoantibodies against type 2 deiodinase peptides were detected with enzyme-linked immunosorbent assay in 78 patients with Graves’ disease and 30 controls. Thyroid hormones (TSH, FT4 and FT3) and antibodies against TSH receptor, thyroid peroxidase and thyroglobulin were measured with chemiluminescence immunoassay.
Results: The frequency of cys-peptide antibodies was greater in the new onset of Graves’ disease. Propylthiouracil treatment was associated with increased occurrence of cys-peptide antibodies (p<0.0069). No dose-dependency in methimazole treatment could be demonstrated for cys-peptide antibody levels. Antibodies against hom-peptide or both peptides demonstrated a strong relationship with the appearance of antithyroid antibodies. No peptide antibodies were associated with anti-thyroglobulin antibody positivity (0 cases out of 11 for hom-peptide, p<0.0071 and 0 cases out of 8 for both peptides, p<0.0251). In contrast, all cases with TSH receptor antibody positivity were positive for peptide antibodies (all cases out of 13 for hom-peptide, p<0.0139 and all cases out of 9 for both peptides, p<0.0470). TSH receptor antibody levels were relevantly decreased, when hom-peptide antibodies were present [24.35(15.68-37.8) vs 11.8(8.16-17.07) IU/l, p<0.0437].
Conclusion: The presence of hom-peptide antibodies was connected to the absence of antibodies against thyroglobulin and smaller anti-thyroid peroxidase antibody positivity. The presence and the high titers of TSH receptor antibodies demonstrated a close relationship with the appearance of hom-peptide antibodies. The relationship among the studied autoantibodies may depend on the alteration of thyroid hormone synthesis and the steric hindrance of targets and antithyroid drug treatment. Autoantibodies against type 2 deiodinase peptides can influence the therapeutical effectiveness.
Bolormaa Ganbaatar
School of Medicine, Mongolian National University of Medical Science
Davaasuren Damdindorj
Department of Endocrinology, First Central Hospital of Mongolia
Punsaldulam Tsogbadrakh
School of Medicine, Mongolian National University of Medical Science
Anujin Rentsentavkhai
School of Medicine, Mongolian National University of Medical Science
Maralmaa Khuder
School of Medicine, Mongolian National University of Medical Science
Oyunbileg Bavuu
Department of Endocrinology, School of Medicine, Mongolian National University of Medical Science
Abstract
Background: Thyroid hormones play a crucial role in metabolism and the proliferation of blood cells. Therefore, thyroid hormones have a direct effect on blood parameters by stimulating erythrocyte precursors and indirect effect by enhancing erythropoietin production. Additionally, it affects red blood cells include mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and red cell distribution width. In this study, we evaluated difference of complete blood count result between the healthy control, Hashimoto thyroiditis and Graves’ disease study groups.
Methods and results: This is a cross-sectional study which included 158 subjects (male 9, female 149), categorized into three groups: control, hypothyroidism (patients with Hashimoto’s thyroiditis), and hyperthyroidism (patient with Graves’ disease).
The analyses showed a significant difference the between the groups in term of mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and red cell distribution width and monocyte (p values < 0.05).
Conclusion: The functional abnormalities of the thyroid gland significantly impact blood cells, and the complete blood cell count results play a critical role in the diagnosis of the condition.
Derick Rodriguez Reyes
University of Puerto Rico Medical Sciences Campus
Isabel Valle Rodriguez
University of Puerto Rico Medical Sciences Campus
Humberto Lugo-Vicente
Edwin Alvarez-Torres
University of Puerto Rico Medical Sciences Campus
Abstract
This comprehensive review of Graves’ Disease (GD) addresses some of the challenges in diagnosing the condition and with the techniques utilized. Focus is given to the relevant clinical manifestations, management options, complications and long-term effects, and future directions in treatment. It highlights the critical role of thyroid function tests (TFTs) in confirming thyrotoxicosis, and the role of thyroid autoantibodies in distinguishing GD from other thyroid disorders. It discusses the role of antithyroid medications, radioactive iodine therapy, and surgical interventions in the management of GD in children. It sheds light on the risks and benefits associated with each approach. The paper also studies the impact of GD on growth, development, and ophthalmic complications in the pediatric population. Promising advancements in treatment such as B-lymphocyte depletion, CD40 blockage, and small molecule TSH-receptor antagonists are also explored. Lastly, the importance of risk factor assessment, screening programs, and increased research are underscored with an attempt to enhance the understanding and management of GD in children.
Hans-Klaus Goischke
Internal Medicine, Rehabilitation, Socialmedicine, D-97769 Bad Brückenau, Hochwaldstr. 2 Germany, Bavaria
Abstract
At present, no cure for multiple sclerosis can be made possible with the pharmaceuticals available, nor can a gradual progression of multiple sclerosis be prevented. In the management of multiple sclerosis, it is therefore necessary to determine existing autoimmune diseases through anamnesis before starting alemtuzumab therapy with disease modifying therapy. With previously existing autoimmune diseases or as prophylaxis, comorbidities can be influenced by vitamin D supplementation. Secured pathophysiological and immunological mechanisms of vitamin D on autoimmunological processes support the daily, individually high-dose oral vitamin D intake. This add-on therapy should positively influence the quality of life of persons with multiple sclerosis in the long term. So that the patients do not reject the highly efficient multiple sclerosis therapy for fear of side effects, this therapy offer is a way of avoiding side effects of alemtuzumab administration, such as alopecia, vitiligo, and thyroid diseases, and of decisively influencing the course of MS. This increases the compliance of the persons with multiple sclerosis in therapy. The pathophysiological mechanisms of alopecia and vitiligo are shown. The immunological mechanisms of vitamin D and its influence on autoimmune diseases are described. The previous use of vitamin D in the therapy of these skin diseases is presented and oral supplementation is put up for discussion. The additional neuroprotective effect is evident. Preventing infection with oral vitamin D supplements, particularly in coronavirus disease 2019, may prevent or mitigate multiple sclerosis exacerbations.
Othmane Benhoummad
Faculty of Medicine and Pharmacy Ibn Zohr University, Agadir, Morocco
Sara Rochd
ENT-HNS Department, Mohammed VI University Hospital Center, Marrakech, Morocco
Mohammed Yafi
ENT-HNS Department, Mohammed VI University Hospital Center, Marrakech, Morocco
Youssef Rochdi
ENT-HNS Department, Mohammed VI University Hospital Center, Marrakech, Morocco
Abdelaziz Raji
ENT-HNS Department, Mohammed VI University Hospital Center, Marrakech, Morocco
Abstract
The extra nodal tuberculosis is a rare disease in Ear, Nose and Throat. The aim of this work is to study the epidemiological, clinical, therapeutic profiles of rare locations of ENT extra nodal tuberculosis.
This is a retrospective study between June 2003 and June 2019, including 29 cases of ENT extra nodal tuberculosis.
There were 6 cases of laryngeal tuberculosis, 5 cases of nasopharyngeal tuberculosis, 5 cases of salivary gland tuberculosis, 3 cases of tonsillar tuberculosis, 1 case of tuberculous retropharyngeal abscess, 3 cases of nasal tuberculosis, 3 cases of tuberculosis of the middle ear, 1 case of thyroid tuberculosis, 1 case of tuberculosis of the bony palate, and 1 case of mandibular tuberculosis.
All ages were affected with a predominance of young adults. The clinical signs, as well as radiological or endoscopic examinations, were not specific. The diagnosis was based on histology and/or bacteriology. Antibacillary therapy was instaured in all cases.
Extra nodal tuberculosis in ENT is rare. It is dominated by the laryngeal location. It must be considered as a differential diagnosis in front of any atypical symptoms, particularly in endemic countries.
