Prevalence of autoimmune thyroiditis in patients with type 1 diabetes: a long-term follow-up study

황금빛,윤종서,박규정,이해상,황진순 대한소아내분비학회 2018 Annals of Pediatirc Endocrinology & Metabolism Vol.23 No.1

Purpose: Type 1 diabetes mellitus (DM) is associated with autoimmune diseases such as thyroiditis. Therefore, we aimed to investigate the prevalence of autoimmune thyroiditis in patients with type 1 DM. Methods: A total of 102 patients who were diagnosed and followed up (mean age, 8.1±4.0 years) in Ajou University Hospital were enrolled in this study. All the patients were evaluated for beta cell autoimmunity, including insulin autoantibody, glutamic acid decarboxylase antibodies (GADA), and islet cell antibody. Moreover, autoantibodies to thyroid peroxidase and thyroglobulin were assessed at initial diagnosis and annually thereafter. Results: The mean patient age (49 men and 53 women) was 19.2±4.8 years. The prevalence of at least one thyroid antibody was 30.4%. Patients with thyroid antibodies had a significantly higher frequency of GADA at the time of the diagnosis. Autoimmune thyroiditis was more prevalent in the older age group. GADA was a significant risk factor for development of thyroid autoantibodies after diagnosis of type 1 DM (odds ratio, 4.45; 95% confidence interval, 1.399–14.153). Conclusion: In patients with type 1 DM, the prevalence of autoimmune thyroiditis was higher than in the general population. Moreover, GADA positivity at diagnosis was associated with thyroid autoimmunity.

급성 신손상으로 발현된 미세 변화 신증에 동반된 자가면역 갑상선염

김지수,박치영,신석표,임영민,고은정,김형종 영남대학교 의과대학 2014 Yeungnam University Journal of Medicine Vol.31 No.2

Autoimmune thyroiditis is the most common cause of hypothyroidism in the world. It is characterized clinically by gradual thyroid failure, goiter formation, or both, because of the autoimmune-mediated destruction of the thyroid gland. Renal involvement presenting proteinuria in autoimmune thyroiditis is not uncommon, occurring in 10% to 30% of the cases. Glomerulonephropathy associated with autoimmune thyroiditis, however, is a rare disease. Most reports of autoimmune thyroiditis with glomerulonephropathy have demonstrated a mixed pathological morphology and have been predominantly associated with membranous glomerulopathy. The case of minimal-change disease associated with thyroiditis presenting acute kidney injury is a rare disease that has not been reported in South Korea. Reported herein is the case of a 16-year-old man diagnosed with Hashimoto’s thyroiditis, with minimal-change disease presenting acute kidney injury. He revealed hypothyroidism, proteinuria, and impaired renal function. Renal biopsy showed minimal-change disease and minimal tubular atrophy. The patient was treated with thyroid hormone, and his renal function and proteinuria improved. Therefore, for patients with autoimmune thyroiditis presenting unexplained proteinuria, glomerulonephropathy should be ruled out. Conversely, for patients with glomerulonephropathy and persistent proteinuria despite proper treatment, thyroid function and antibody tests should be performed.

The effect of gene therapy using CTLA4Ig/silica-nanoparticles on canine experimental autoimmune thyroiditis

Choi, Eun Wha,Shin, Il Seob,Lee, Chang Woo,Youn, Hwa Young John Wiley Sons, Ltd. 2008 The journal of gene medicine Vol.10 No.7

<B>Background</B><P>The present study aimed to determine the effect of canine CTLA4Ig on canine autoimmune thyroiditis. In a previous study, we established a canine model of autoimmune thyroiditis by immunizing normal dogs with bovine thyroglobulin. An in vitro study using recombinant CTLA4Ig revealed that this protein can inhibit the expression of Th1-type cytokines and the pro-inflammatory cytokines tested.</P><B>Methods</B><P>As a result of the in vitro study, we constructed therapeutic CTLA4Ig/silica-nanoparticles and applied them to the treatment of experimentally induced canine autoimmune thyroiditis.</P><B>Results</B><P>Gene therapy resulted in significant reductions in anti-canine-thyroglobulin autoantibody titer, anti-T4 antibody titer and T-cell proliferation against thyroglobulin and in the mRNA expressions of interleukin-18 in fresh peripheral blood mononuclear cells (PBMC) from all dogs. There was also a significant reduction compared to day 0 in tumor necrosis factor-α and interferon-γ levels in the supernatant from cultured PBMC.</P><B>Conclusions</B><P>The CTLA4Ig-induced suppression of Th1 cytokines is relatively more significant than it appears because autoimmune thyroiditis is a Th1-polarized disease. Thus, CTLA4Ig can improve Th1/Th2 cytokine balance in autoimmune thyroiditis by downregulating Th1 cytokines. Copyright © 2008 John Wiley & Sons, Ltd.</P>

갑상선기능항진증에서 갑상선 자가항체의 해석

백한상 ( Han-sang Baek ),임동준 ( Dong-jun Lim ) 대한내과학회 2023 대한내과학회지 Vol.98 No.3

Thyrotoxicosis is a clinical state with a variety of various etiologies that results from excess thyroid hormones, including hyperthyroidism and thyroiditis. Graves' disease (GD) is a well-known autoimmune thyroid disease that causes hyperthyroidism, and its pathogenesis is mainly driven by the thyroid-stimulating hormone receptor antibody (TSHRAb), which is highly specific for GD. Measuring the TSHRAb is a fast and accurate diagnostic tool for GD and has been used to monitor disease activity and the treatment response. However, conventional TSH-binding inhibitory immunoglobulin (TBII) does not differentiate between stimulating, blocking, or neutral antibodies. In contrast, thyroid stimulatory immunoglobulin bioassays differentiate between stimulating and blocking antibodies and have comparably high sensitivity and specificity to TBII for GD. We also discuss the role of thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) in thyrotoxicosis, although they are less specific than TSHRAb for GD. TPOAb is associated with autoimmune thyroiditis, while TgAb appears with TPOAb in patients with autoimmune thyroid disease. In addition, TPOAb or TgAb may be associated with a low recurrence of GD after discontinuing anti-thyroid drugs. Clinicians should interpret thyroid autoantibodies in the context of the patient's clinical presentation and consider their implications to manage and monitor thyrotoxicosis. (Korean J Med 2023;98:132-136)

Usefulness of SPECT/CT in Parathyroid Lesion Detection in Patients with Thyroid Parenchymal 99mTc-Sestamibi Retention

황상현,이유미,윤미진,윤정현,이정원,조아서 대한핵의학회 2017 핵의학 분자영상 Vol.51 No.1

Purpose Parathyroid adenoma detection with dual-phase 99mTc-sestamibi (MIBI) scintigraphy depends on differential MIBI washout from thyroid. However, autoimmune thyroid disease (AITD) may cause MIBI to be retained in the thyroid gland and reduce parathyroid detection.We evaluated the impact of AITD on MIBI thyroid retention and additional benefit of SPECT/CT in these patients. Methods Dual phase planar MIBI and SPECT/CT was performed on 82 patients. SPECT/CTwas performed immediately after delayed planar scan. Thyroid density (Hounsfield unit, CT-HU) and size were measured on CT component of SPECT/CT. MIBI uptake in early scans and retention in delayed scans were visually graded and correlated with clinical factors and CT findings. Finally, planar and SPECT/CT findings were compared for parathyroid lesion visualization according to thyroid MIBI retention. Results In early scan, multivariate analysis showed only thyroid size predicted early uptake. In delayed scan, multivariate analysis showed higher visual grade in early scan, lower CTHU or AITD were significant predictors for delayed thyroid parenchymal retention. Overall, ten more parathyroid lesions were visualized on SPECT/CT compared to planar scans (57 vs. 47, p = 0.002). SPECT/CT was especially more useful in patients with thyroidal MIBI retention, as eight out of the ten additional lesions detected were found in patients with thyroid MIBI retention. Conclusion AITD is an important factor for MIBI thyroid parenchymal retention on delayed scans, and may impede parathyroid lesion detection. Patients with MIBI retention in the thyroid parenchyma on delayed scans are likely to benefit from an additional SPECT/CT.

An overview of the pathogenic mechanisms of autoimmune thyroid disorders

박근용 고신대학교(의대) 고신대학교 의과대학 학술지 2014 고신대학교 의과대학 학술지 Vol.29 No.2

Objectives, recent epidemiologic studies in humans suggest an increased prevalence of thyroiditis associated with the excessive administration of iodine. More than three times of recommended daily intake of iodine was observed among people in North America. These people generally presented higher level of anti-thyroglobulin antibody, anti-thyroperoxidase antibody, serum thyroid-stimulating hormone and exacerbation of lymphocytic infiltration in thyroid, which indicated the overconsumption of iodine could induce hypothyroidism and enhance the autoimmune response. However, the precise mechanism of excessive iodine intake induced autoimmune thyroid disease remains largely unknown. Over half a century has elapsed since the 1956 identification of thyroglobulin antibodies and the devising of the first experimental model of autoimmune thyroiditis. Since then an incredible amount of experimental work has led to an ever deeper understanding of the nature of thyroid auto-antigens, the main immune mechanisms responsible for Hashimoto's thyroiditis and graves’ disease, their genetics, and therir environmental risk factor. Yet, in the majority of genetically predisposed people the individual trigger of thyroid autoimmunity remains obscure. Similarly, effective prevention strategies still remain to be established and, hopefully, will be the target of future studies.

Thyroid dysfunction and subfertility

Cho, Moon Kyoung The Korean Society for Reproductive Medicine 2015 Clinical and Experimental Reproductive Medicine Vol.42 No.4

The thyroid hormones act on nearly every cell in the body. Moreover, the thyroid gland continuously interacts with the ovaries, and the thyroid hormones are involved in almost all phases of reproduction. Thyroid dysfunctions are relatively common among women of reproductive age, and can affect fertility in various ways, resulting in anovulatory cycles, high prolactin levels, and sex hormone imbalances. Undiagnosed and untreated thyroid disease can be a cause of subfertility. Subclinical hypothyroidism (SCH), also known as mild thyroid failure, is diagnosed when peripheral thyroid hormone levels are within the normal reference laboratory range, but serum thyroid-stimulating hormone levels are mildly elevated. Thyroid autoimmunity (TAI) is characterized by the presence of anti-thyroid antibodies, which include anti-thyroperoxidase and anti-thyroglobulin antibodies. SCH and TAI may remain latent, asymptomatic, or even undiagnosed for an extended period. It has also been demonstrated that controlled ovarian hyperstimulation has a significant impact on thyroid function, particularly in women with TAI. In the current review, we describe the interactions between thyroid dysfunctions and subfertility, as well as the proper work-up and management of thyroid dysfunctions in subfertile women.

자가 면역성 갑상선염 환자에서 발생한 쇼그렌 증후군과 원위 세뇨관 산증 1예

안혜림 ( Hye Rim An ),배성창 ( Sung Chang Bae ),이기병 ( Ki Byung Lee ),이용규 ( Yong Kyu Lee ),김좌경 ( Jwa Kyung Kim ),박형천 ( Hyeong Cheon Park ),하성규 ( Sung Kyu Ha ),이정은 ( Jung Eun Lee ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.1

A 52-year old woman, who had hypothyroidism associated with autoimmune thyroiditis for 5 years, was hospitalized for tingling sensation and muscle weakness of both lower extremities. Her initial laboratory findings showed severe hypokalemia, metabolic acidosis, and high titer of thyroid autoimmune antibodies. She was diagnosed of distal renal tubular acidosis by bicarbonate loading test (FEHCO3-<3.0%) and renal calcifications on pre-enhanced CT scan. Since she had other symptoms of xerostomia and xerophthalmia, primary Sjogren`s syndrome was diagnosed by Schirmer test, salivary scan, and serologic findings. She was treated with potassium citrate, potassium chloride, and hydroxychlorquine. Four months later, she has remained well with those treatments. There were only a few case reports about distal renal tubular acidosis associated with Sjogren`s syndrome and autoimmune thyroiditis. In Korea, there has not been any report of such cases. Therefore, we report a case of distal renal tubular acidosis and Sjogren`s syndrome in a patient with autoimmune thyroiditis.

페그인터페론 치료 중 발생한 자가면역성 갑상선염 1예

노정민,유정선,이윤범,안혜림,최홍규,정교태,박종숙,이관식,김경래 대한내분비학회 2010 Endocrinology and metabolism Vol.25 No.1

Combination treatment with pegylated interferon and ribavirin has been established as a standard therapy for chronic hepatitis C. Although interferon therapy is relatively safe, an important side effect is the induction of autoantibodies and autoimmune disease, especially autoimmune thyroid disease. Interferon associated autoimmune thyroid disease can consist of autoimmune hypothyroidism, Graves’ disease, and destructive thyroiditis. Thyroid disease may lead to dose reduction or discontinuation of therapy. To the best of our knowledge, there are no case reports of pegylated interferon induced autoimmune hypothyroidism in Korea. We report here a case of a 26-year-old woman who developed hypothyroidism during antiviral therapy for chronic hepatitis C with pegylated interferon.

하시모토 갑상선염을 주소로 내원한 노인에서 발생한 갑상선 MALT 림프종(MALToma) 1예

남주영,김똘미,박종숙,김철식,박진아,조민호,이성주,안철우,차봉수,임승길,김경래,이현철,양석우,홍순원,양우익 대한임상노인의학회 2004 대한임상노인의학회지 Vol.5 No.2

갑상선의 MALT 림프종의 대부분은 하시모토 갑상선염과 동반되고 갑상선 자가항체의 자극으로 인한 림프구의 증식과정에서의 변화가 그 병인으로 생각되어 왔는데 본 증례의 경우에서처럼 갑상선 자가항체가 검출되지 않거나 증가되지 않은 경우 조직학적 소견도 반응성 증식이 심하여 기존의 검사법으로는 확진이 어려우며 진단을 위해 분자생물학적 기법이 필요했고 자가항체 이외의 새로운 기전에 관한 연구가 필요하다고 생각되어 문헌고찰과 함께 보고하는 바이다. We report the case of 72-year-old woman with mucosa-associated lymphoid tissue (MALT-lymphoma or maltoma) and antibody negative Hashimoto’s thyroiditis. She noted a painless, growing mass in her neck and denied any signs or symptoms of abnormal thyroid function. Her thyroid function test showed no abnormality and thyroid autoimmune antibodies were not detected. The patient underwent a hemithyroidectomy for a growing mass. Histological examination showed diffuse follicular proliferation of small lymphocytes and suggestive of Hashimoto’s thyroiditis. To confirm maltoma, PCR (polymerize chain reaction) was performed and it revealed a clonally rearrangement of the Ig heavy chain gene. We conclude that other factor rather than antigenic stimulation may contribute to unusual histology and development of thyroid maltoma from antibody negative Hashimoto’s thyroiditis.