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Hypothyroidism
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
I he common causes of hypothyroidism are: Chronic autoimmune thyroiditis (Hashimoto's thyroiditis).Post surgical resection or radio-iodine therapy for hyperthyroidism.Secondary to anti-thyroid drugs, e.g. carbimazole, etc. Other causes include: Diet with endemic goitre.Developmental abnormalities, e.g. agenesis and maldevelopment.Dyshormonogenesis.Hypopituitarism.
Special Groups
Published in Vineet Relhan, Vijay Kumar Garg, Sneha Ghunawat, Khushbu Mahajan, Comprehensive Textbook on Vitiligo, 2020
Sandipan Dhar, Sahana M. Srinivas
Diagnosis of vitiligo is based on clinical appearance. The classical presence of depigmented macules, repigmented macules within the depigmented macules, characteristic distribution, poliosis, leukotrichia, and Koebner phenomenon points to the diagnosis of vitiligo. Investigations are not required to confirm vitiligo, however in cases where there is doubt, Woods lamp examination can be performed. Woods lamp examination shows accentuation of the vitiligo lesions. Differential diagnosis of childhood vitiligo is summarized in Table 15.2.2 [2,13,17,25]. Children with nonsegmental vitiligo can be routinely screened for diabetes and thyroid abnormalities to rule out associated autoimmune disorders, especially if there is an alteration in normal growth velocity [2]. Annual assessment of thyroid function is recommended. T3, T4, and TSH levels, antithyroglobulin antibody, and antithyroperoxidase antibody (anti-TPO) can be done to rule out autoimmune thyroiditis. Other tests that can be done are complete blood count and fasting blood sugar. Screening for other autoantibodies to rule out lupus, rheumatoid arthritis, and inflammatory bowel disease can be performed only if symptoms are present [26].
Medical Management of Thyroid Disorders
Published in Madan Laxman Kapre, Thyroid Surgery, 2020
Himanshu Patil, Shailesh Pitale
Loss of functional thyroid tissue Chronic autoimmune thyroiditisReversible autoimmune hypothyroidismSurgery and irradiationInfiltrative and infectious diseasesSub-acute thyroiditisThyroid dysgenesis
Gluten-free diet attenuates the impact of exogenous vitamin D on thyroid autoimmunity in young women with autoimmune thyroiditis: a pilot study
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2022
Robert Krysiak, Karolina Kowalcze, Bogusław Okopień
Autoimmune (Hashimoto’s thyroiditis) is the most common thyroid disease, the major cause of thyroid hypofunction in developed countries and one of the most common human disorders worldwide [1,2]. The disease is associated with antibody-mediated cytotoxicity and apoptosis, which leads to the progressive loss of follicular cells, the consequence of which is replacement of the thyroid tissue by lymphoid lymphocytic infiltrate, fibrotic reaction and hypothyroidism [3]. Although highly prevalent, autoimmune thyroiditis still remains a poorly understood and understudied disorder of unknown pathogenesis, awaiting prevention strategies and new modes of treatment. There are some arguments suggesting, however, that the risk of autoimmune thyroiditis and its severity may be affected by vitamin D status and gluten intake.
Physical health status in first-degree relatives of patients with bipolar disorder, a systematic review
Published in Nordic Journal of Psychiatry, 2022
Louise Holm Madsen, Kimie Stefanie Ormstrup Sletved, Lars Vedel Kessing, Maj Vinberg
Among the 30 autoimmune diseases investigated no increased risk of autoimmune thyroiditis among first-degree relatives of bipolar probands was found [22]. Contrary, a higher prevalence of autoimmune thyroiditis in offspring of bipolar parents, particularly female offspring was revealed in another study [23]. However, the latter study included offspring only. In contrast, the other study included both siblings and parents [22]. Hereby the age group of the two studies also differs (the offspring in the study by Hillegers were aged between 12 and 21, and the study by Eaton included parents or siblings to cases with age 14 to over 45 yrs.) Both studies have limitations, one study is a register study, with a small number of cases (n = 23) followed for a 29 year follow period, so the participants may not have lived through the age of onset for the autoimmune diseases [22]. The study by Hillegers [23], did no test of thyroperoxidase antibodies level in the parents of offspring. Parental autoimmune thyroiditis could explain the higher prevalence of autoimmune thyroiditis in offspring of patients with BD [23]. Based on the present findings, first-degree relatives of patients with bipolar disorder may not be vulnerable to autoimmune diseases in general, Still, they may have increased rates of autoimmune thyroiditis and pernicious anaemia.
Clinically relevant thyroid disorders and inflammatory bowel disease are inversely related: a retrospective case-control study
Published in Scandinavian Journal of Gastroenterology, 2021
Maria Pina Dore, Giuseppe Fanciulli, Alessandra Manca, Valentina Cocco, Alessandra Nieddu, Michele Murgia, Giovanni Mario Pes
In agreement with these results, in our IBD cohort there were 132 patients under azathioprine treatment and 22 under anti‒TNFα infusion. Both immunosuppressive treatments may have inhibited the occurrence of autoimmune thyroiditis, the major cause of hypothyroidism. Even those studies that highlighted a positive association of IBD with increased extra-intestinal autoimmunity, compared to non-IBD, emphasized that this phenomenon is limited to rheumatoid arthritis (both in UC and CD) and dermatological disorders, excluding other common autoimmune diseases such as autoimmune thyroiditis [33]. These data were confirmed in a large study carried out in Israel on 12,967 subjects with IBD showing a significantly increased prevalence of several autoimmune diseases but with the remarkable exception of TDs [34]. In general, studies reporting a positive relationship between IBD and autoimmune TD explain the association by the existence of shared genetic susceptibility loci. However, this explanation is unsatisfactory as IBD, strictly speaking, is not an autoimmune disease, although various immune mechanisms, as well as a hyper-reactivity against intestinal bacteria, may contribute to its pathogenesis [5,6].