BACKGROUND Vaccines against severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)which were approved for emergency use have been administered on a large scale globally to contain the pandemic coronavirus disease...BACKGROUND Vaccines against severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)which were approved for emergency use have been administered on a large scale globally to contain the pandemic coronavirus disease 2019(COVID-19)and to save lives.Vaccine safety is one of the issues under surveillance and a possible correlation between vaccines and thyroid function has been reported.However,reports of the impact of coronavirus vaccines on those with Graves’disease(GD)are rare.CASE SUMMARY This paper presents two patients with underlying GD in remission,both developed thyrotoxicosis and one developed thyroid storm following the adenovirus-vectored vaccine(Oxford-AstraZeneca,United Kingdom).The objective of this article is to raise awareness regarding a possible association between COVID-19 vaccination and the onset of thyroid dysfunction in patients with underlying GD in remission.CONCLUSION Receiving either the mRNA or an adenovirus-vectored vaccine for SARS-CoV-2could be safe under effective treatment.Vaccine induced thyroid dysfunction has been reported,but the pathophysiology still not well understood.Further investigation is required to evaluate the possible predisposing factors for developing thyrotoxicosis especially in patients with underlying GD.However,early awareness of thyroid dysfunction following vaccination could avoid a lifethreatening event.展开更多
Objective:To investigate the clinical significance of serum thyroid stimulating hormone(TSH) receptor antibody(TRAb) levels in pregnant women with Graves'disease,on neonatal hyperthyroidism. Methods:The clinical d...Objective:To investigate the clinical significance of serum thyroid stimulating hormone(TSH) receptor antibody(TRAb) levels in pregnant women with Graves'disease,on neonatal hyperthyroidism. Methods:The clinical data of 68 pregnant women with Graves' disease and their newborns were retrospectively analyzed.Testing indicators included thyroid function tests and TRAb levels during pregnancy,at delivery,and within 2 weeks after birth.The serum TRAb and T_3,T_4,Free T_3,Free T_4,TSH levels were detected by radio receptor assay(RRA) and electrical chemiluminescence immunoassay(ECLIA),respectively. Results:The results showed that serum TRAb levels of the third trimester of pregnancy was positively correlated with that of the umbilical vein(n = 68,r= 0.8494,P<0.01),and that of the newborns(n = 68, r=0.8286,P<0.01).The incidence of neonatal hyperthyroidism was 11.8%(8/68).The serum TRAb levels in the 8 neonates with hyperthyroidism within 2 weeks after birth were 3 times higher than those in the normal neonates.Of these 8 neonates,2 had 15 times higher serum TRAb levels than those of normal neonates within 2 weeks after birth.The thyroid function and TRAb levels of these 2 neonates were still abnormal 6 months later. Conclusions:The risk of hyperthyroidism in newborn whose mother's TRAb levels were high in the third trimester of pregnancy was increased.This study suggests a significant correlation between TRAb levels in pregnant women with Graves' disease and the severity of neonatal hyperthyroidism.展开更多
Resistance to Thyroid Hormone (RTH) is a rare form of hormone resistance secondary to changes in the genes encoding thyroid hormone receptors. The two subtypes, Pituitary RTH (PRTH) and Generalized RTH (GRTH), cause c...Resistance to Thyroid Hormone (RTH) is a rare form of hormone resistance secondary to changes in the genes encoding thyroid hormone receptors. The two subtypes, Pituitary RTH (PRTH) and Generalized RTH (GRTH), cause clinically distinguishable patient presentations. In PRTH, typically only the pituitary gland is resistant to thyroid hormone (TH) while the rest of the body maintains sensitivity. Selective pituitary resistance to thyroid hormone results in dysregulation of thyroid hormone homeostasis with clinical presentation as either euthyroid or hyperthyroidism. PRTH is characterized by elevated thyroid hormone levels with an elevated or inappropriately normal TSH concentration. Herein we describe a case report of a 70-year-old woman who complained of weight loss of over 35 lbs., palpitations, jitters, hair loss, diarrhea, fatigue, muscle weakness, etc. over 6 months, thus, indicating the presence of iatrogenic hyperthyroidism while receiving levothyroxine 175 ug daily prescribed by her primary care provider because of a reported history of “Graves disease” treated by radioactive iodine ablation of the thyroid several years ago. The daily dose of levothyroxine had been increased gradually at an interval of 3 months over a year because of persistent elevation of serum TSH level. Laboratory tests revealed markedly elevated Free T4, Free T3 and TSH levels, along with low concentrations of all lipid fractions, serum creatinine and urea nitrogen levels, indicating TSH induced hyperthyroidism or PRTH. Further testing documented a mutation of thyroid hormone receptor beta gene 2 confirming presence of PRTH. We believe that the initial diagnosis of Graves Disease was erroneous and I-131 ablation further confounded and missed the diagnosis of PRTH. Thus, the purpose of this report is to report a patient with PRTH and describe potential pitfalls in diagnosis and management of this rare disorder.展开更多
BACKGROUND Hyperthyroidism in pregnancy may pose a great threat to maternal and fetal health.The risk of hyperthyroid heart disease(HHD),even heart failure,is significantly elevated in pregnant women.AIM To investigat...BACKGROUND Hyperthyroidism in pregnancy may pose a great threat to maternal and fetal health.The risk of hyperthyroid heart disease(HHD),even heart failure,is significantly elevated in pregnant women.AIM To investigate the clinical characteristics,prognosis,and therapy of HHD in pregnant women.METHODS We searched the patient registry data at West China Second University Hospital of Sichuan University in Chengdu,China,following the approval by the Ethics Committee.We retrospectively analyzed the clinical characteristics of pregnant women diagnosed with HHD.The medical records of women with HHD during pregnancy from January 2012 to December 2017 were obtained from the electronic medical records system.All the included patients were followed in outpatient clinics and by telephone interviews until October 2018.RESULTS A total of 155 patients were diagnosed with thyrotoxicosis,of whom six were diagnosed with HHD.Three of them had regular antenatal care.Two patients were complicated with acute heart failure attacks,and one of them had a stillbirth.Both of these patients had a long history of Graves’disease with poor treatment compliance.Treatments of precipitating factors such as the control of infection could relieve the symptoms and prolong gestation for a better prognosis.Hyperthyroid heart failure could be controlled with aggressive diuretics and management of the coexisting complications.Intense monitoring and timely anti-heart failure treatment were crucial in patients with severe cardiac damage.Our findings indicated the importance of regular antenatal care and treatment adherence in patients with hyperthyroidism.CONCLUSION The timely and accurate diagnosis of HHD and the implementation of effective management are important for a better prognosis in pregnant women with HHD.Improvement in patients’awareness of thyrotoxicosis is needed.展开更多
AIM: To investigate the correlation between autoimmune thyroid diseases (ATDs) and the prevalence of Cag-A positive strains of Helicobacter pylori (H. pylori) in stool samples. METHODS: We investigated 112 consecutive...AIM: To investigate the correlation between autoimmune thyroid diseases (ATDs) and the prevalence of Cag-A positive strains of Helicobacter pylori (H. pylori) in stool samples. METHODS: We investigated 112 consecutive Caucasian patients (48 females and 4 males with Graves' disease and 54 females and 6 males with Hashimoto' s thyroiditis HT), at their first diagnosis of ATDs. We tested for H. pylori in stool samples using an amplified enzyme immunoassay and Cag-A in serum samples using an enzyme-linked immunoassay method (ELISA). The results were analyzed using the two-sided Fisher' s exact test and the respective odds ratio (OR) was calculated. RESULTS: A marked correlation was found between the presence of H. pylori (P ≤ 0.0001, OR 6.3) and, in particular, Cag-A positive strains (P ≤ 0.005, OR 5.3)in Graves' disease, but not in Hashimoto's thyroiditis, where we found only a correlation with Cag-A strains (P ≤ 0.005, OR 8.73) but not when H. pylori was present. CONCLUSION: The marked correlation between H. pylori and Cag-A, found in ATDs, could be dependent on the different expression of adhesion molecules in the gastric mucosa.展开更多
Graves' disease is an autoimmune disease, which can manifest with a variety of extrathyroidal clinical syndromes like ophthalmopathy, pretibial myxedema(dermopathy), acropathy, cardiomyopathy, and encephalopathy. ...Graves' disease is an autoimmune disease, which can manifest with a variety of extrathyroidal clinical syndromes like ophthalmopathy, pretibial myxedema(dermopathy), acropathy, cardiomyopathy, and encephalopathy. Though quite rare, this disease can also manifest with gastrointestinal symptoms such as dysphagia, heartburn, nausea, vomiting and diarrhea. We report a clinical case of Graves' disease manifesting with dysfunction of the esophagus and heartburn in a 61-year-old man. In the muscular layer of the esophagus we found dystrophic changes led to its atony, which was documented by endoscopy and high-resolution manometry. The pathology features of esophageal symptoms were: focal proliferation of the basal cells, vascular distension, and dystrophy of the epithelial cells. Antithyroid treatment led to decrease of all clinical symptoms after 5 d of Thiamazole administration. Complete restoration of peristalsis in the esophagus, according to manometry, was observed in 1 mo after initiation of treatment.展开更多
Aim: to describe the salient relationships between Graves’ disease (GD) and both Turner syndrome (TS) and Down syndrome (DS). Design: to conduct a secondary analysis of current literature on this topic. Results: 1) t...Aim: to describe the salient relationships between Graves’ disease (GD) and both Turner syndrome (TS) and Down syndrome (DS). Design: to conduct a secondary analysis of current literature on this topic. Results: 1) the prevalences of GD in TS and in DS young patients are 1.7% and 6.5‰, respectively, i.e. higher than that in pediatric general population (around 1‰);2) in both these chromosomopathies GD presentation is often preceded by Hashimoto’s thyroiditis (HT) antecedents;3) in both TS and DS, GD presents with a clinical picture very similar to that observed in GD patients without these chromosomopathies;4) in TS, clinical course of GD under pharmacological therapy is very similar to that observed in non-TS girls;5) in DS, clinical course of GD under pharmacological therapy is less severe than that in non-DS patients. Conclusions: in the children with either TS or DS, GD is characterized by two common epidemiological peculiarities, i.e. increased prevalence rate and elevated frequency of HT antecedents.展开更多
In recent years,hyperthyroid heart disease has become a condition with high incidence rate and high mortality rate.This paper discusses the pathogenesis,treatment,and influencing factors of hyperthyroid heart disease ...In recent years,hyperthyroid heart disease has become a condition with high incidence rate and high mortality rate.This paper discusses the pathogenesis,treatment,and influencing factors of hyperthyroid heart disease from two different angles-traditional Chinese medicine and western medicine-in hope to provide a reference basis for the treatment of hyperthyroid heart disease.展开更多
Cholestatic jaundice and elevated liver enzymes are uncommon, but recognized, manifestations of neonatal thyrotoxicosis. Current guidelines for evaluation of cholestatic jaundice and reviews in Neonatology literature ...Cholestatic jaundice and elevated liver enzymes are uncommon, but recognized, manifestations of neonatal thyrotoxicosis. Current guidelines for evaluation of cholestatic jaundice and reviews in Neonatology literature do not discuss hyperthyroidism in the differential diagnosis of cholestatic jaundice. We report two cases of neonatal thyrotoxicosis secondary to neonatal Graves’ disease that presented with cholestatic jaundice and elevated liver enzymes at birth. Early recognition of thyrotoxicosis as a cause of the hepatic disease in the neonate is crucial to prevent unnecessary diagnostic procedures and to initiate timely treatment.展开更多
Objective To investigate changes in T lymphocyte subsets and NK cells in patients with simple Graves’ disease(GD)and Graves’ disease combined with type 2 diabetes mellitus(GD/T2DM).Methods Fifteen cases of GD/T2DM w...Objective To investigate changes in T lymphocyte subsets and NK cells in patients with simple Graves’ disease(GD)and Graves’ disease combined with type 2 diabetes mellitus(GD/T2DM).Methods Fifteen cases of GD/T2DM were selected from our hospital from November 2001 to November 2004.Before and after therapy thyroid function,thyroglobulin antibody(TGA),thyroid microsomal antibody(TMA)and blood glucose level were measured,and T lymphocyte subsets(CD3,CD4,CD8,CD4/CD8)and NK cells(CD56)were measured by immunofluorescence double labeling monoclonal antibody and flow cytometry,respectively.At the same time,comparison was made with simple GD(15 cases),T2DM(15 cases)and healthy control(20 cases).Results Before therapy,CD4/CD8,CD4 and NK cells in GD/T2DM were less than normal,and there was no significant difference in comparison with simple GD(P<0.05).In T2DM group,only CD4/CD8 and CD4 were less than those of healthy controls(P<0.05).When thyroid function recovered after 1 to 3 months of methimazole treatment in both GD/T2DM and simple GD groups,various indexes recovered,which were more obvious in simple GD.Conclusion Immune hypofunction of GD may be the key to the immune abnormality of GD/T2DM,which is more significant than that of simple GD or T2DM.The recovery of thyroid function and immune abnormality is not consistent,and the recovery of GD is more significant than that of GD/T2DM.展开更多
TSAb and TSBAb both were measured in i63 patients with Graves' disease(GD) and 31 Autoimmune Thyroiditis(AIT) individually and simultaneously. The TSAb activities and positive percentage in active and relapse GD ...TSAb and TSBAb both were measured in i63 patients with Graves' disease(GD) and 31 Autoimmune Thyroiditis(AIT) individually and simultaneously. The TSAb activities and positive percentage in active and relapse GD groups were higher than those in the normal control and euthyroidgroups; no significant difference was found between the active GD and relapse GD groups. TSAb were positive in one of 31 Patients with hypothyroidism due to AIT. TSBAb were positive in GD patients after treatment who became patients with hypothyroidism and patients with bypothyroidism dueto AIT, being 30. 0% and 35.5% respectively. TSAb and TSBAb were measured simultaneously in 35GD patients with different thyroid function status, and 4 PatientS with hypothyroidism due to AIT.We found that two patients with GD who were euthyroid during treatment with ATD and one patient with active GD had TSAb and TSBAb coexisting in circulation. we would postulate that perhaps only one kind of preponderant autoantibody activity could be detected and those nonpreponderant autoantibodies might be very difficultly found, when the patients were in a certain stable thyroid function saute.展开更多
Objective To explore the roles of Fcγ recep tor in the pathogenesis of Graves' disease. Methods Fcγ receptor gene knockout mice(Fcγ R KO m ice) which were rooted in C57BL/6 mice and wild type C57BL/6 mice wer...Objective To explore the roles of Fcγ recep tor in the pathogenesis of Graves' disease. Methods Fcγ receptor gene knockout mice(Fcγ R KO m ice) which were rooted in C57BL/6 mice and wild type C57BL/6 mice were immunized by hTSH receptor expressing cells (DAP3.WT). 1-2×107 DAP3.WT cells were peri toneally injected into mice every two weeks for a total of six times. Two weeks after final immunization, mice were killed for measurement of total thyroxine, T RAb and pathological examination. Results The thyroxine level of the immunized Fcγ recept or gene knockout mice was significantly lower than that of the immunized wild ty pe control mice (2.2±0.31 vs. 3.32± 0.59 g·dL -1, P< 0.05 ),but there was no significant difference between immunized Fcγ R KO mic e and non-immunized wild type control group. The TRAb levels of the immunized F γ R KO mice significantly increased compared to those of the immunized wild type mice (21.75±8.21 vs. 14.11±6.21, P< 0.05). The lymphocyte cel ls infiltration and destruction of thyroid follicles were found in the thyroid gland of the immunized Fcγ R KO mice. Conclusion These results suggest that Fcγ receptor may be involved in the pathogenesis of Graves' disease.展开更多
Objective To construct an animal model of Graves’ disease(GD)by immunizing BALB/c mice with hM12 cells co-expressing major histocompatibility complex(MHC)class II molecules and human thyrotropin receptor(TSHR)molecul...Objective To construct an animal model of Graves’ disease(GD)by immunizing BALB/c mice with hM12 cells co-expressing major histocompatibility complex(MHC)class II molecules and human thyrotropin receptor(TSHR)molecules.Methods BALB/c mice in experimental group(H-2d)were immunized with hM12 cells intraperitoneally every 2 weeks for six times,while mice in control group were immunized with M12 cells.Five weeks later,the thyroids were histologically examined,and serum samples were tested for thyroid-stimulating antibodies(TSAb)and thyroid hormone levels.Results One BALB/c mouse in experimental group developed Graves’-like disease.Total T4 and T3 levels in this mouse were above the upper limit of normal,TSAb activity was displayed in its serum.The thyroid histologically showed the features of thyroid hyperactivity including thyrocyte hypercellularity and colloid ABSorption.None of control mice developed Graves’-like disease.Conclusion An animal model with some characteristics of human Graves’ disease was successfully induced and the model will facilitate studies aimed directly at understanding the pathogenesis of autoimmunity in Graves’ disease.展开更多
目的探讨甲状腺功能与阿尔茨海默病(AD)脑容量变化的关系。方法选择2020年1月至2022年3月在四川大学华西医院龙泉医院神经内科接受诊治的64例AD患者(AD组)和36例轻度认知功能障碍(MCI)患者(MCI组)。另选择同期19例没有认知障碍或精神疾...目的探讨甲状腺功能与阿尔茨海默病(AD)脑容量变化的关系。方法选择2020年1月至2022年3月在四川大学华西医院龙泉医院神经内科接受诊治的64例AD患者(AD组)和36例轻度认知功能障碍(MCI)患者(MCI组)。另选择同期19例没有认知障碍或精神疾病史的健康者作为正常对照组。采用电化学发光法检测游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))、促甲状腺激素(TSH)水平。结果与正常对照组比较,MCI组和AD组患者FT_(3)水平显著降低[2.50(2.28,2.60)ng/L、2.07(1.97,2.30)ng/L vs 2.76(2.55,2.93)ng/L,P<0.05],且AD组显著低于MCI组。AD组患者中脑、脑桥、延髓、左右侧海马体、左右侧杏仁核、左右侧颞叶体积显著低于MCI组(P<0.05,P<0.01)。Spearman相关性分析和多元线性回归分析显示,AD组患者FT_(3)、FT_(4)水平与左右侧海马体和左右侧杏仁核体积呈正相关,TSH水平与左右侧海马体和左右侧杏仁核体积呈负相关(P<0.05,P<0.01);TSH与左侧颞叶体积呈负相关(P<0.05)。结论甲状腺功能失调与脑容量减小有关,可能促进AD患者认知功能障碍和脑萎缩进展。展开更多
文摘BACKGROUND Vaccines against severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)which were approved for emergency use have been administered on a large scale globally to contain the pandemic coronavirus disease 2019(COVID-19)and to save lives.Vaccine safety is one of the issues under surveillance and a possible correlation between vaccines and thyroid function has been reported.However,reports of the impact of coronavirus vaccines on those with Graves’disease(GD)are rare.CASE SUMMARY This paper presents two patients with underlying GD in remission,both developed thyrotoxicosis and one developed thyroid storm following the adenovirus-vectored vaccine(Oxford-AstraZeneca,United Kingdom).The objective of this article is to raise awareness regarding a possible association between COVID-19 vaccination and the onset of thyroid dysfunction in patients with underlying GD in remission.CONCLUSION Receiving either the mRNA or an adenovirus-vectored vaccine for SARS-CoV-2could be safe under effective treatment.Vaccine induced thyroid dysfunction has been reported,but the pathophysiology still not well understood.Further investigation is required to evaluate the possible predisposing factors for developing thyrotoxicosis especially in patients with underlying GD.However,early awareness of thyroid dysfunction following vaccination could avoid a lifethreatening event.
文摘Objective:To investigate the clinical significance of serum thyroid stimulating hormone(TSH) receptor antibody(TRAb) levels in pregnant women with Graves'disease,on neonatal hyperthyroidism. Methods:The clinical data of 68 pregnant women with Graves' disease and their newborns were retrospectively analyzed.Testing indicators included thyroid function tests and TRAb levels during pregnancy,at delivery,and within 2 weeks after birth.The serum TRAb and T_3,T_4,Free T_3,Free T_4,TSH levels were detected by radio receptor assay(RRA) and electrical chemiluminescence immunoassay(ECLIA),respectively. Results:The results showed that serum TRAb levels of the third trimester of pregnancy was positively correlated with that of the umbilical vein(n = 68,r= 0.8494,P<0.01),and that of the newborns(n = 68, r=0.8286,P<0.01).The incidence of neonatal hyperthyroidism was 11.8%(8/68).The serum TRAb levels in the 8 neonates with hyperthyroidism within 2 weeks after birth were 3 times higher than those in the normal neonates.Of these 8 neonates,2 had 15 times higher serum TRAb levels than those of normal neonates within 2 weeks after birth.The thyroid function and TRAb levels of these 2 neonates were still abnormal 6 months later. Conclusions:The risk of hyperthyroidism in newborn whose mother's TRAb levels were high in the third trimester of pregnancy was increased.This study suggests a significant correlation between TRAb levels in pregnant women with Graves' disease and the severity of neonatal hyperthyroidism.
文摘Resistance to Thyroid Hormone (RTH) is a rare form of hormone resistance secondary to changes in the genes encoding thyroid hormone receptors. The two subtypes, Pituitary RTH (PRTH) and Generalized RTH (GRTH), cause clinically distinguishable patient presentations. In PRTH, typically only the pituitary gland is resistant to thyroid hormone (TH) while the rest of the body maintains sensitivity. Selective pituitary resistance to thyroid hormone results in dysregulation of thyroid hormone homeostasis with clinical presentation as either euthyroid or hyperthyroidism. PRTH is characterized by elevated thyroid hormone levels with an elevated or inappropriately normal TSH concentration. Herein we describe a case report of a 70-year-old woman who complained of weight loss of over 35 lbs., palpitations, jitters, hair loss, diarrhea, fatigue, muscle weakness, etc. over 6 months, thus, indicating the presence of iatrogenic hyperthyroidism while receiving levothyroxine 175 ug daily prescribed by her primary care provider because of a reported history of “Graves disease” treated by radioactive iodine ablation of the thyroid several years ago. The daily dose of levothyroxine had been increased gradually at an interval of 3 months over a year because of persistent elevation of serum TSH level. Laboratory tests revealed markedly elevated Free T4, Free T3 and TSH levels, along with low concentrations of all lipid fractions, serum creatinine and urea nitrogen levels, indicating TSH induced hyperthyroidism or PRTH. Further testing documented a mutation of thyroid hormone receptor beta gene 2 confirming presence of PRTH. We believe that the initial diagnosis of Graves Disease was erroneous and I-131 ablation further confounded and missed the diagnosis of PRTH. Thus, the purpose of this report is to report a patient with PRTH and describe potential pitfalls in diagnosis and management of this rare disorder.
基金Supported by Science and Technology Department of Sichuan Province,No.2019YJ0086Clinical Research Fund of West China Second University Hospital of Sichuan University,No.KL024
文摘BACKGROUND Hyperthyroidism in pregnancy may pose a great threat to maternal and fetal health.The risk of hyperthyroid heart disease(HHD),even heart failure,is significantly elevated in pregnant women.AIM To investigate the clinical characteristics,prognosis,and therapy of HHD in pregnant women.METHODS We searched the patient registry data at West China Second University Hospital of Sichuan University in Chengdu,China,following the approval by the Ethics Committee.We retrospectively analyzed the clinical characteristics of pregnant women diagnosed with HHD.The medical records of women with HHD during pregnancy from January 2012 to December 2017 were obtained from the electronic medical records system.All the included patients were followed in outpatient clinics and by telephone interviews until October 2018.RESULTS A total of 155 patients were diagnosed with thyrotoxicosis,of whom six were diagnosed with HHD.Three of them had regular antenatal care.Two patients were complicated with acute heart failure attacks,and one of them had a stillbirth.Both of these patients had a long history of Graves’disease with poor treatment compliance.Treatments of precipitating factors such as the control of infection could relieve the symptoms and prolong gestation for a better prognosis.Hyperthyroid heart failure could be controlled with aggressive diuretics and management of the coexisting complications.Intense monitoring and timely anti-heart failure treatment were crucial in patients with severe cardiac damage.Our findings indicated the importance of regular antenatal care and treatment adherence in patients with hyperthyroidism.CONCLUSION The timely and accurate diagnosis of HHD and the implementation of effective management are important for a better prognosis in pregnant women with HHD.Improvement in patients’awareness of thyrotoxicosis is needed.
文摘AIM: To investigate the correlation between autoimmune thyroid diseases (ATDs) and the prevalence of Cag-A positive strains of Helicobacter pylori (H. pylori) in stool samples. METHODS: We investigated 112 consecutive Caucasian patients (48 females and 4 males with Graves' disease and 54 females and 6 males with Hashimoto' s thyroiditis HT), at their first diagnosis of ATDs. We tested for H. pylori in stool samples using an amplified enzyme immunoassay and Cag-A in serum samples using an enzyme-linked immunoassay method (ELISA). The results were analyzed using the two-sided Fisher' s exact test and the respective odds ratio (OR) was calculated. RESULTS: A marked correlation was found between the presence of H. pylori (P ≤ 0.0001, OR 6.3) and, in particular, Cag-A positive strains (P ≤ 0.005, OR 5.3)in Graves' disease, but not in Hashimoto's thyroiditis, where we found only a correlation with Cag-A strains (P ≤ 0.005, OR 8.73) but not when H. pylori was present. CONCLUSION: The marked correlation between H. pylori and Cag-A, found in ATDs, could be dependent on the different expression of adhesion molecules in the gastric mucosa.
文摘Graves' disease is an autoimmune disease, which can manifest with a variety of extrathyroidal clinical syndromes like ophthalmopathy, pretibial myxedema(dermopathy), acropathy, cardiomyopathy, and encephalopathy. Though quite rare, this disease can also manifest with gastrointestinal symptoms such as dysphagia, heartburn, nausea, vomiting and diarrhea. We report a clinical case of Graves' disease manifesting with dysfunction of the esophagus and heartburn in a 61-year-old man. In the muscular layer of the esophagus we found dystrophic changes led to its atony, which was documented by endoscopy and high-resolution manometry. The pathology features of esophageal symptoms were: focal proliferation of the basal cells, vascular distension, and dystrophy of the epithelial cells. Antithyroid treatment led to decrease of all clinical symptoms after 5 d of Thiamazole administration. Complete restoration of peristalsis in the esophagus, according to manometry, was observed in 1 mo after initiation of treatment.
文摘Aim: to describe the salient relationships between Graves’ disease (GD) and both Turner syndrome (TS) and Down syndrome (DS). Design: to conduct a secondary analysis of current literature on this topic. Results: 1) the prevalences of GD in TS and in DS young patients are 1.7% and 6.5‰, respectively, i.e. higher than that in pediatric general population (around 1‰);2) in both these chromosomopathies GD presentation is often preceded by Hashimoto’s thyroiditis (HT) antecedents;3) in both TS and DS, GD presents with a clinical picture very similar to that observed in GD patients without these chromosomopathies;4) in TS, clinical course of GD under pharmacological therapy is very similar to that observed in non-TS girls;5) in DS, clinical course of GD under pharmacological therapy is less severe than that in non-DS patients. Conclusions: in the children with either TS or DS, GD is characterized by two common epidemiological peculiarities, i.e. increased prevalence rate and elevated frequency of HT antecedents.
文摘In recent years,hyperthyroid heart disease has become a condition with high incidence rate and high mortality rate.This paper discusses the pathogenesis,treatment,and influencing factors of hyperthyroid heart disease from two different angles-traditional Chinese medicine and western medicine-in hope to provide a reference basis for the treatment of hyperthyroid heart disease.
文摘Cholestatic jaundice and elevated liver enzymes are uncommon, but recognized, manifestations of neonatal thyrotoxicosis. Current guidelines for evaluation of cholestatic jaundice and reviews in Neonatology literature do not discuss hyperthyroidism in the differential diagnosis of cholestatic jaundice. We report two cases of neonatal thyrotoxicosis secondary to neonatal Graves’ disease that presented with cholestatic jaundice and elevated liver enzymes at birth. Early recognition of thyrotoxicosis as a cause of the hepatic disease in the neonate is crucial to prevent unnecessary diagnostic procedures and to initiate timely treatment.
基金the Scientific and Technological Development Foundation of Baotou Medical Science in Inner Mongolia [(2001) No.198]
文摘Objective To investigate changes in T lymphocyte subsets and NK cells in patients with simple Graves’ disease(GD)and Graves’ disease combined with type 2 diabetes mellitus(GD/T2DM).Methods Fifteen cases of GD/T2DM were selected from our hospital from November 2001 to November 2004.Before and after therapy thyroid function,thyroglobulin antibody(TGA),thyroid microsomal antibody(TMA)and blood glucose level were measured,and T lymphocyte subsets(CD3,CD4,CD8,CD4/CD8)and NK cells(CD56)were measured by immunofluorescence double labeling monoclonal antibody and flow cytometry,respectively.At the same time,comparison was made with simple GD(15 cases),T2DM(15 cases)and healthy control(20 cases).Results Before therapy,CD4/CD8,CD4 and NK cells in GD/T2DM were less than normal,and there was no significant difference in comparison with simple GD(P<0.05).In T2DM group,only CD4/CD8 and CD4 were less than those of healthy controls(P<0.05).When thyroid function recovered after 1 to 3 months of methimazole treatment in both GD/T2DM and simple GD groups,various indexes recovered,which were more obvious in simple GD.Conclusion Immune hypofunction of GD may be the key to the immune abnormality of GD/T2DM,which is more significant than that of simple GD or T2DM.The recovery of thyroid function and immune abnormality is not consistent,and the recovery of GD is more significant than that of GD/T2DM.
文摘TSAb and TSBAb both were measured in i63 patients with Graves' disease(GD) and 31 Autoimmune Thyroiditis(AIT) individually and simultaneously. The TSAb activities and positive percentage in active and relapse GD groups were higher than those in the normal control and euthyroidgroups; no significant difference was found between the active GD and relapse GD groups. TSAb were positive in one of 31 Patients with hypothyroidism due to AIT. TSBAb were positive in GD patients after treatment who became patients with hypothyroidism and patients with bypothyroidism dueto AIT, being 30. 0% and 35.5% respectively. TSAb and TSBAb were measured simultaneously in 35GD patients with different thyroid function status, and 4 PatientS with hypothyroidism due to AIT.We found that two patients with GD who were euthyroid during treatment with ATD and one patient with active GD had TSAb and TSBAb coexisting in circulation. we would postulate that perhaps only one kind of preponderant autoantibody activity could be detected and those nonpreponderant autoantibodies might be very difficultly found, when the patients were in a certain stable thyroid function saute.
文摘Objective To explore the roles of Fcγ recep tor in the pathogenesis of Graves' disease. Methods Fcγ receptor gene knockout mice(Fcγ R KO m ice) which were rooted in C57BL/6 mice and wild type C57BL/6 mice were immunized by hTSH receptor expressing cells (DAP3.WT). 1-2×107 DAP3.WT cells were peri toneally injected into mice every two weeks for a total of six times. Two weeks after final immunization, mice were killed for measurement of total thyroxine, T RAb and pathological examination. Results The thyroxine level of the immunized Fcγ recept or gene knockout mice was significantly lower than that of the immunized wild ty pe control mice (2.2±0.31 vs. 3.32± 0.59 g·dL -1, P< 0.05 ),but there was no significant difference between immunized Fcγ R KO mic e and non-immunized wild type control group. The TRAb levels of the immunized F γ R KO mice significantly increased compared to those of the immunized wild type mice (21.75±8.21 vs. 14.11±6.21, P< 0.05). The lymphocyte cel ls infiltration and destruction of thyroid follicles were found in the thyroid gland of the immunized Fcγ R KO mice. Conclusion These results suggest that Fcγ receptor may be involved in the pathogenesis of Graves' disease.
基金supported by the National Natural Science Foundation of China(No.30371335)
文摘Objective To construct an animal model of Graves’ disease(GD)by immunizing BALB/c mice with hM12 cells co-expressing major histocompatibility complex(MHC)class II molecules and human thyrotropin receptor(TSHR)molecules.Methods BALB/c mice in experimental group(H-2d)were immunized with hM12 cells intraperitoneally every 2 weeks for six times,while mice in control group were immunized with M12 cells.Five weeks later,the thyroids were histologically examined,and serum samples were tested for thyroid-stimulating antibodies(TSAb)and thyroid hormone levels.Results One BALB/c mouse in experimental group developed Graves’-like disease.Total T4 and T3 levels in this mouse were above the upper limit of normal,TSAb activity was displayed in its serum.The thyroid histologically showed the features of thyroid hyperactivity including thyrocyte hypercellularity and colloid ABSorption.None of control mice developed Graves’-like disease.Conclusion An animal model with some characteristics of human Graves’ disease was successfully induced and the model will facilitate studies aimed directly at understanding the pathogenesis of autoimmunity in Graves’ disease.
文摘目的探讨甲状腺功能与阿尔茨海默病(AD)脑容量变化的关系。方法选择2020年1月至2022年3月在四川大学华西医院龙泉医院神经内科接受诊治的64例AD患者(AD组)和36例轻度认知功能障碍(MCI)患者(MCI组)。另选择同期19例没有认知障碍或精神疾病史的健康者作为正常对照组。采用电化学发光法检测游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))、促甲状腺激素(TSH)水平。结果与正常对照组比较,MCI组和AD组患者FT_(3)水平显著降低[2.50(2.28,2.60)ng/L、2.07(1.97,2.30)ng/L vs 2.76(2.55,2.93)ng/L,P<0.05],且AD组显著低于MCI组。AD组患者中脑、脑桥、延髓、左右侧海马体、左右侧杏仁核、左右侧颞叶体积显著低于MCI组(P<0.05,P<0.01)。Spearman相关性分析和多元线性回归分析显示,AD组患者FT_(3)、FT_(4)水平与左右侧海马体和左右侧杏仁核体积呈正相关,TSH水平与左右侧海马体和左右侧杏仁核体积呈负相关(P<0.05,P<0.01);TSH与左侧颞叶体积呈负相关(P<0.05)。结论甲状腺功能失调与脑容量减小有关,可能促进AD患者认知功能障碍和脑萎缩进展。
