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Summary: A retrospective analysis was conducted using data from the NHANES. Bone mineral density (BMD) was compared in different thyroid-specific autoantibodies groups. Strengths of associations were calculated by using binary logistic regression models. Higher titers of thyroid-specific autoantibodies (TgAb and/or TPOAb) may lead to decreased BMD. Higher prevalence of TgAb and TPOAb significantly associated with fractures in females but not in males. Purpose: Hashimoto's thyroiditis is characterized by elevated thyroid-specific autoantibodies. It is currently believed that osteoporosis is not only a disease with abnormal mineral metabolism but also with immune abnormalities. This study investigated the relationship between thyroid-specific autoantibodies and osteoporosis, including the bone mineral density (BMD) values and fractures. Methods: A retrospective analysis was conducted using data from the National Health and Nutrition Examination Survey (2007–2010). BMD was compared in different thyroid-specific autoantibodies groups. The associations between thyroid-specific autoantibodies and fractures were explored. Strengths of associations were calculated by binary logistic regression models. Candidate variables for binary logistic regression model were selected after screened in univariate analysis (variables with P < 0.05). Results: A total of 3865 study participants were included in this analysis; 224 participants were TgAb positive and 356 were TPOAb positive. A total of 392 participants reported hip, spine or wrist fractures. Participants with higher prevalence of TgAb or TPOAb had lower BMD. In females, significant cigarettes use, higher prevalence of TgAb and TPOAb, and the BMD of the total femur and femoral neck were significantly associated with fractures. Higher prevalence of TPOAb was particularly associated with a higher possibility of hip or spine fractures. In males, significant cigarettes use, 25OHD3, the BMD values of the total femur, femoral neck and total spine were significantly associated with fractures. Conclusion: Higher prevalence of thyroid-specific autoantibodies may lead to decreased BMD. In females, higher prevalence of TgAb and TPOAb significantly associated with fractures and TPOAb especially relating to the fractures of hip and spine. Males patients with vitamin D deficiency or insufficiency associated a higher possibility of fractures. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) has been a great concern since 2019. Patients with myasthenia gravis (MG) may be at higher risk of COVID-19 and a more severe disease course. We examined the associations between COVID-19 and MG. Methods: This single-center retrospective cohort study involved 134 patients who were diagnosed with MG from June 2020 to November 2022 and followed up until April 2023. They were divided into a COVID-19 group and non-COVID-19 group. Logistic regression analysis was used to detect factors potentially associating COVID-19 with MG. Results: Of the 134 patients with MG, 108 (80.6%) had COVID-19. A higher number of comorbidities was significantly associated with an increased risk of COVID-19 (p = 0.040). A total of 103 patients (95.4%) had mild/moderate COVID-19 symptoms, and 4 patients (3.7%) were severe/critical symptoms (including 2 deaths). Higher age (p = 0.036), use of rituximab (p = 0.037), tumors other than thymoma (p = 0.031), Hashimoto's thyroiditis (p = 0.011), more comorbidities (p = 0.002), and a higher baseline MG activities of daily living (MG-ADL) score (p = 0.006) were risk factors for severe COVID-19 symptoms. The MG-ADL score increased by ≥ 2 points in 16 (15.7%) patients. Dry cough and/or expectoration (p = 0.011), use of oral corticosteroids (p = 0.033), and use of more than one kind of immunosuppressant (p = 0.017) were associated with the increase of the post-COVID-19 MG-ADL score. Conclusion: Most patients with MG have a mild course of COVID-19. However, patients with older age, many comorbidities, a high MG-ADL score, and use of a variety of immunosuppressants during COVID-19 may be more prone to severe symptoms. [ABSTRACT FROM AUTHOR]

Background Unexplained infertility (UEI) is a complex pathological condition that involves environmental and genetic factors. Hashimoto's thyroiditis (HT) is the most common autoimmune disease in reproductive-age women. Circular RNAs (circRNAs) play a biological role in autoimmunity by regulating gene transcription. A previous study found upregulation of hsa_circ_0089172 in HT. We aimed in the current research to investigate the relative expression level of hsa_circ_0089172 in patients with HT and to assess its correlation with UEI among Egyptian women. Methods: Among 60 women with HT (35 fertile and 25 women with UEI) and 60 healthy subjects as the control group. all subjects were investigated in clinical, laboratory, and radiological. Hsa-circ-0089172 was examined by RT-PCR. Results: There were significantly higher values of hsa_circ_0089172 in UEI group (3.4±0.26) compared to fertile group (2.34±0.33) and control group (0.91±0.216), P <0. 001. Interestingly we observed that anti-TPO and anti TG values were the independent factors associated with hsa_circ_0089172 in the prediction of UEI. hsa_circ_0089172 exposed a significant predictive value of HT, with an AUC of 0.990 (C. I=0.973-1.000), sensitivity of 91.7%, and specificity of 87.1%. Regarding the prediction of UEI among women with HT, the AUC of hsa_circ_0089172 was 0.994(C.I=0.981-1.000), a sensitivity of 94.9%, and a specificity of 89. 3%, P <0 .001 Conclusions: hsa_circ_0089172 level was upregulated in HT patients, particularly patients with UEI. Moreover, it was positively correlated with TSH, anti-TPO, and anti-TG [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) has been considered a T cell-mediated autoimmune demyelinating disorder. Nuclear factor κB (NF-κB) is one of the master transcription factors that regulate the activity of inflammatory cells the present study aimed to investigate the NFKB/P65 mRNA levels in patients with MS and to assess its role in the prediction of Hashimoto' thyroiditis (HT). Methods: 50 patients with clinically definite relapsing-remitting multiple sclerosis (according to the McDonald criteria 2017) compared to 50 healthy age and sex-matched controls. Thyroid serum antibodies, IgG index (IgG), and oligoclonal band (OCB) were assessed. The relative expression of NFKB/P65 mRNA was measured using real-time quantitative PCR. Results: there were significantly higher values of NFKB/P65 mRNA levels in patients with HT (2.4±0.54) compared to other patients without HT (1.3±1.45) and control group (0.8±0.17), p <0 .001. Significant associations were confirmed between NFKB/P65 mRNA correlated to thyroid autoimmunity and MS manifestations, p <0. 001. Linear regression revealed that only FT4 and TSH were independent variables correlated with NFKB/P65 mRNA, p < 0.001. Regarding prediction of MS, ROC curve revealed that the sensitivity of NFKB/P65 mRNA was 96 %, and specificity was 88% at cutoff 0.98 with (95% CI = 0.909-0.999). Concerning HT prediction, the cutoff 1.42 with (95% CI = 0.843-1.000)with a sensitivity of 93.8 % and, a specificity of 87.4%. Conclusions: NFKB/P65 mRNA increased in patients with MS more specifically in HT. Thus, NFKB/P65 mRNA could be used as noninvasive prediction markers of MS and HT. [ABSTRACT FROM AUTHOR]

Helicobacter pylori (HP) is an infection related to metabolic and autoimmune disease Hashimoto thyroiditis (HT). HP-modified microRNA (miRNA) expression leads to various disorders. We aimed to evaluate circulatory miR-146a-5p and miR-155-5p expression in HT and to investigate their correlations with the clinical profile of HT and HP infection. Methods: We enrolled 100 subjects; 50 participants as healthy control and 50 patients with HT. The diagnosis of HP-infection by-HP antigen in stool and antibodies against cytotoxic-associated gene A (Cag-A). We tested serum antibodies against thyroid antigens. We used Quantitative real-time RT-PCR for the assessment of serum miR-146a-5p and miR-155-5p. Results: Among 100 studied participants, patients inf*. Concerning had significantly higher values of miR-146a-5p (3.94±0.8), compared to HT patients without HP infection (1.84±0.3) and control group (0.98±0.1), p value<0.001*. Concerning miR-155-5p, there were statistically significant higher values in HP infection (3.61±2.2) compared to HT patients without HP infection (1.91±1.1) and control group (0.90±0.35), p value<0.001*. There were significantly positive correlations with nausea, vomiting, heartburn, anti-TPO, anti-TG, TSH, HP antigen, and Cag-A. On the opposing, they were negatively correlated with FT3 and FT4. linear regression analyses revealed that the only variables independently associated with miR-146a-5p were anti-TPO and FT4. Whereas the only variables independent associated with miR-155-5p were anti-TPO and FT3, p value<0.001*. Conclusion: miR-146a-5p and miR-155-5p overexpressed in patients with HT, more specifically in patients infected by HP and they were significantly correlated to gastrointestinal symptoms thyroid dysfunction, and autoimmunity. [ABSTRACT FROM AUTHOR]

Aim: Patients' death or adverse events appear to be associated with poor healthcare decision‐making. This might be due to an inability to have an adequate representation of the problem or of the connections among problem‐related elements. Changing how a problem is formulated can reduce biases in clinical reasoning. The purpose of this article is to explore the possible contributions of psychoneuroendocrinoimmunology (PNEI) and psychology of reasoning and decision‐making (PRDM) to support a new nursing theoretical frame. Design: Discursive paper. Method: This article discusses the main assumptions about nursing and nurses' ability to face patient's problems, suggesting a new approach that integrates knowledge from PNEI and PRDM. While PNEI explains the complexity of systems, highlighting the importance of systems connections in affecting health, PRDM underlines the importance of the informative context in creating a mental representation of the problem. Furthermore, PRDM suggests the need to pay attention to information that is not immediately explicit and its connections. Conclusion: Nursing recognizes the patient–nurse relationship as the axiom that governs care. The integration of PNEI and PRDM in nursing theoretics allows the expansion of the axiom by providing essential elements to read a new type of relationship: the relationship among information. PNEI explains the relationships between biological systems and the psyche and between the whole individual and the environment; PRDM provides tools for the nurse's analytical thinking system to correctly process information and its connections. Impact on Nursing Practice: A theoretical renewal is mandatory to improve nursing reasoning and nursing priority identification. Integrating PNEI and PRDM into nursing theoretics will modify the way professionals approach patients, reducing cognitive biases and medical errors. No Patient or Public Contribution: There was no patient or public involvement in the design or writing of this discursive article. [ABSTRACT FROM AUTHOR]

Immune Thrombocytopenic Purpura (ITP), an autoimmune disease, is characterised by isolated thrombocytopenia, with or without bleeding. Thyroid autoimmune illness can coexist with ITP. The specific clinical characteristics are still unknown. The length of ITP or the patients’ response to treatment is not related to their thyroid condition. In patients with ITP, thyroid impairment is more common. In the present case report, a 60-year-old female patient, a known case of asthma, presented to the hospital with complaints of swelling in the neck along with transient episodes of breathlessness for 3-4 years. On local examination, a butterfly-shaped mass was seen in the neck, which moved upwards on deglutination but did not move on protrusion of the tongue. Pemberton’s sign was also positive. On palpation, the thyroid measured around 8×6 cm in size, thyroid lobes were bosselated, consistency was firm, and no bruit was heard on auscultation. Based on routine laboratory findings, she was found to have refractory thrombocytopenia with a normal thyroid profile. Further investigations revealed that the patient had positive antithyroid stimulating hormone antibodies, and Fine Needle Aspiration Cytology (FNAC) showed colloid nodular goitre with haemorrhagic cystic changes. A bone marrow biopsy was performed in view of refractory thrombocytopenia, which was suggestive of ITP. The patient was advised to take tablet eltrombopag, after which the platelet counts improved drastically. Subsequently, the patient was advised to undergo thyroidectomy, but this could not be done due to haemodynamic instability. [ABSTRACT FROM AUTHOR]

Background and Objectives: Hashimoto's thyroiditis (HT) is an autoimmune disease, characterized by abnormal elevation in thyroid peroxidase antibody and/or thyroglobulin antibody. In recent decades, HT disease has become more and more widespread. Patients always report multiple symptoms, even though their thyroid hormone levels are kept in normal ranges. However, no treatment exists to effectively reduce the levels of thyroid antibodies. Our study aims to determine whether calorie-restricted diet is helpful in improving health of HT patients. Methods and Study Design: This is a 3-month randomized controlled trial. HT patients will be randomized into a calorie-restricted (CR) group or a calorie-unrestricted control group. All the participants will be instructed to consume a diet that includes a combination of 45-55% calories from carbohydrates, 20-30% from fats, and 15- 25% from proteins, according to current Chinese Dietary Guidelines. Participants in CR group need to limit their calories intake equal to their basal energy expenditure, which means that their daily caloric intake will be limited by about 20-30%. Results: The study population is planned to be 66 HT patients aged 18 to 65 years. The primary outcome is change of thyroid antibody levels from baseline. Secondary outcomes include the changes of nonhypothyroid symptoms scores, thyroid function indexes, morphology of thyroid, T lymphocyte subpopulations, inflammatory biomarkers and lipids from baseline to 12 weeks. Conclusions: This trial will have implications for nutrition treatment policy in regard to thyroid antibodies control, immune dysfunction and related nonhypothyroid symptoms improvement among HT patients. [ABSTRACT FROM AUTHOR]

Background Hashimoto's thyroiditis (HT) is an autoimmune disease that is frequently associated with other autoimmune conditions. Objective To perform serological screening for rheumatoid arthritis (RA) in patients with HT. Methods Our study included 88 consecutive serum specimens of patients with confirmed HT and 88 sex- and age-matched healthy subjects. All study participants were tested for anti-cyclic citrullinated peptides antibodies (CCP-Ab) and rheumatoid factor (RF). CCP-Ab and RF were performed using ELISA commercial kits. Statistical analysis was conducted using Epi Info, version 3. Results Out of 88 patients with HT, 15 (17.0%) had CCP-Ab or RF. The frequency of serological markers of RA was significantly higher in patients than in control individuals (17.0% vs 4.5%; P =.007). RF was more frequent in patients than in the control group, and the difference was statistically significant (13.6% vs 3.4%; P =.01). Isolated RF-IgM was absent in all controls and present in 6 patients with HT (6.8% vs 0%; P =.02). Out of 14 male patients, 3 (21.4%) had antibodies of RA. There was no significant difference in age between patients with CCP-Ab or RF and those without. Conclusion A high frequency of serological markers of RA was highlighted in patients with HT. [ABSTRACT FROM AUTHOR]

To present a novel association of multiple autoimmune syndrome (MAS) in a patient with sclerouveitis and alkaptonuria. A 68-year-old female with alkaptonuria, Hashimoto's thyroiditis, and familial autoimmunity presented with decreased VA, red eye, foreign body sensation, and ocular pain. Ophthalmological examination: OD conjunctival hyperemia, ochronosis, a reddish-violet scleral nodule, keratic precipitates, 2+ cells in the anterior chamber, 0.5+ vitreous cells, and mild vitreous haze. The patient was diagnosed with anterior uveitis and anterior nodular scleritis. Due to the associated sicca symptoms, a salivary gland biopsy was ordered, confirming Sjögren's syndrome. Then, MAS was diagnosed, and immunomodulatory medications were started; however, as she was refractory to more than two of them, it was suggested to start biological treatment. We present a novel MAS-type 2 pattern consisting of Hashimoto's thyroiditis, sclerouveitis, and Sjögren's syndrome. Its diagnosis and management represent a challenge, so a multidisciplinary approach should be provided. [ABSTRACT FROM AUTHOR]

Purpose: Struma ovarii is a highly specialized teratoma consisting primarily of mature thyroid tissue. However, malignant struma ovarii coexisting with thyroid carcinoma, not to mention autoimmune disease, is uncommon. Malignant struma ovarii complicated with papillary thyroid carcinoma, Hashimoto's thyroiditis and polycystic ovarian syndrome has never been reported in literature. Patients and Methods: A 32-year-old female was admitted to our hospital due to a history of abdominal distension and menolipsis over the past half a year. Physical examination touched a 6 × 6 cm mass with a clear boundary, normal movement, and no pressing pain in the right adnexal area, Imaging revealed a cystic solid mass of 6 × 7 cm in the right ovary and the level of tumor markers including CA125, CA199, CA153, CEA, AFP were normal, but with low TSH and increased TPOAb, TGAb, TRAb. Laparoscopic right ovary tumor resection was performed, followed by comprehensive staging surgery, as well as thyroidectomy after pathologic diagnosis. The patient was diagnosed with a combination of follicular thyroid cancer from struma ovarii, papillary thyroid carcinoma and Hashimoto's thyroiditis, along with polycystic ovarian syndrome. Immunohistochemical staining showed positivity for Ag, CK-pan, CK7, PAX8 and TTF-1 in the right ovarian mass, and the left thyroid was positive for the BRAF V600E mutation. Results: The patient underwent thyroxine suppression therapy and radioactive iodine 131I therapy after operation. Serum thyroglobulin was undetectable, and no signs of recurrence or metastasis were detected in the imaging examination at the 2-year follow-up. Conclusion: Malignant struma ovarii coexisting with thyroid carcinoma is rare. No report has been identified in literature review on the rare malignant struma ovarii coexisting with thyroid carcinoma, Hashimoto's thyroiditis and polycystic ovarian syndrome. Our case can offer experience of diagnosis and treatment to some extent for such rare case. Therefore, it is essential to consider the association between ovarian tumors and the endocrine system. This case is valuable in understanding the diagnosis and management of such an unusual complicated disease. [ABSTRACT FROM AUTHOR]

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Aim: This study aimed to evaluate the effect of anxiety level, dental fear, anxiety on oral health quality of life oral, and dental health in Hashimoto's thyroiditis patients. Materials and methods: Ninety adult individuals were included from Gaziantep University Faculty of Dentistry. All participants were asked about demographic parameters (age, gender), socio-economic status (education, marital status), and oral hygiene habits. The Oral Health Impact Profile-14 (OHIP-14) and oral health-related quality of life - United Kingdom (OHRQoL-UK) questionnaires were used to asses the effect of individuals' oral health on their quality of life. Dental anxiety levels were evaluation with the Modified Dental Anxiety Scale (MDAS). Statistical analysis was performed using IBM SPSS Statistics 22.0. Result: There were no significant differences for Sociodemographic data, dental habits, age, marital status, educational status, smoking, frequency of brushing tooth, frequency of visiting the dental clinic in OHIP-14, OHRQoL, and MDAS survey scores (p > 0.005). However, there was a statistically moderate positive correlation between the total OHIP-14 scores and the MDAS scores (r = 0.309; p < 0.003). Additionally, a moderate negative correlation was showed between the total OHRQoL and the MDAS scale (r = 0.307; p < 0.003). Conclusion: In conclusion, this study showed that patients' quality of life regarding oral and dental health was low, regardless of individual factors. It was found that dental anxiety was lower in patients with HT, and a significant correlation betwen the quality of life and anxiety level was observed. [ABSTRACT FROM AUTHOR]

Hashimoto's thyroiditis (HT) is not only the most frequent autoimmune thyroid disease (AITD), but it also has a significant impact on patients' health-related quality of life (HRQoL), and it has been variably associated with differentiated thyroid carcinoma. Even though its pathogenesis is still incompletely understood, oxidative stress is believed to play an important role. Hypothyroidism related to later stages of HT can be treated with levothyroxine substitution therapy; various approaches such as selenium supplementation and iodine-restricted diets have been proposed as disease-modifying treatments for earlier stages, and even thyroidectomy has been suggested for refractory cases of painful HT. Nevertheless, many patients still report suboptimal HRQoL, highlighting an unmet medical need in this area. The concepts and approaches of traditional Chinese medicine (TCM) in treating HT are not broadly known in the West. Here, we provide an overview of TCM for HT, including combinations of TCM with selenium. We encompass evidence from clinical trials and other studies related to complex TCM prescriptions, single herbs used in TCM, and phytochemicals; wherever possible, we delineate the probable underlying molecular mechanisms. The findings show that the main active components of TCM for HT have commonly known or presumed antioxidant and anti-inflammatory activities, which may account for their potential utility in HT. Further exploring the practices of TCM for HT and combining them with evidence- and mechanism-based approaches according to Western standards may help to identify new strategies to alter the clinical course of the disease and/or to treat patients' symptoms better and improve their HRQoL. [ABSTRACT FROM AUTHOR]

Background. Limb loss inevitably leads to changes in the physical, social, and mental domains that trigger a cascade of events: a more sedentary lifestyle, decreased ability to self-care, and increased use of health services. In addition, limb loss can negatively affect metabolic regulation and contribute to an increased risk of obesity and all associated metabolic consequences. The aim of the study was to justify the role of doctors of therapeutic specialties in the multidisciplinary team of the rehabilitation center based on the study of patients’ concomitant diseases. Materials and methods. The study included 379 patients from the Charitable Organiza- tion “Charity Fund “Superhumans”. They had an amputation and received a prosthesis and/or underwent rehabilitation from July 2023 to March 2024. Among participants, there were 9 women and 370 men, with an average age of 37.22 ± 9.74 years. Results. The role of doctors of therapeutic specialties in the multidisciplinary team of the rehabilitation center is substantiated based on the study of concomitant diseases of patients who have undergone amputation of one or more limbs. The study identified the following comorbidities: overweight (193 cases, 50.9 %), hypertension (108 cases, 28.5 %), liver damage of viral and non-viral origin (71 cases, 18.7 %), dys- lipidemia (44 cases, 11.6 %), chronic gastritis (19 cases, 5.0 %), gastroesophageal reflux disease (15 cases, 4.0 %), rhythm distur- bances (mainly sinus tachycardia or bradycardia) (14 cases, 3.7 %), chronic pancreatitis (11 cases, 2.9 %), duodenal ulcer (10 cases, 2.6 %), chronic cholecystitis (9 cases, 2.4 %), urolithiasis (4 cases, 1.1 %), chronic cystitis (4 cases, 1.1 %), chronic pyelonephritis (3 cases, 0.8 %), atrioventricular block (3 cases, 0.8 %), chronic obstructive pulmonary disease (2 cases, 0.5 %), bronchial asthma (2 cases, 0.5 %), autoimmune thyroiditis (2 cases, 0.5 %), nodular goiter (1 case, 0.3 %). Conclusions. Based on data obtained, the risks of progression of metabolic disorders and comorbidities in patients with limb amputations were determined. [ABSTRACT FROM AUTHOR]

Background. Autoimmune thyroid diseases (AITDs), which include diffuse toxic goiter (DTG), or Graves’ disease, and autoimmune thyroiditis (AIT), are the most common organ-specific autoimmune diseases. Since recently the population of Ukraine is in a state of chronic stress associated with military operations on the territory of our country, it is important to clarify the nature of stress impact on cellular immunity in patients with autoimmune thyroid pathology. The purpose of the study was to establish the features of the cellular link of the immune response to stress in patients with autoimmune thyroiditis and diffuse toxic goiter. Materials and methods. Sixty patients with AITDs were examined in the clinic of V. Danilevsky Institute for Endocrine Pathology Problems of the National Academy of Medical Sciences of Ukraine, 32 patients with AIT and 28 with DTG. In 24 cases, AITDs were newly diagnosed during the armed conflict (12 patients with DTG and 12 patients with AIT), and in 36 cases, the disease had a long course (16 patients with DTG and 20 patients with AIT, the manifestation took place until 2022). The relative (%) levels of CD3, CD4, CD8, CD16 and CD22 were determined in order to characterize immune homeostasis in patients with AITDs. Immunoregulatory indices were calculated as integral criteria of regulatory and effector links of immunity: suppression — CD4/CD8 as one of the key indicators of immune status, as well as indices of B cell help — CD4/CD16 and CD8/CD16. Results. The presence of DTG newly diagnosed in wartime is accompanied by a significant decrease in CD3 compared to the long-term course (55.67 ± 1.08 vs. 59.12 ± 1.14, P < 0.05). At the same time, in the group of patients with AIT newly diagnosed during military operations, a decrease in CD3 was less pronounced than on the background of DTG (58.30 ± 2.12 vs. 55.67±1.08). The wartime factor contributes to a more pronounced decrease in CD3 against the background of DTG versus AIT (55.67 ± 1.08 vs. 58.30 ± 2.12). Against the background of DTG and AIT in sub- groups with newly diagnosed disease, CD4 levels were higher than in the long-term course (36.33 ± 1.47 vs. 38.87 ± 1.12 in DTG and 35.35 ± 1.08 vs. 36.33 ± 1.47 in AIT). CD16 was lower in patients with DTG when the disease was detected during military operations and probably differed from the group with a long course of the disease (16.58 ± 0.94 vs. 18.68 ± 0.82, Р < 0.05). CD22 level was significantly lower in patients with DTG newly diagnosed during the war than at the long course (20.00 ± 1.01 vs. 23.19 ± 1.09, P < 0.05). The groups of patients with AIT or DTG newly diagnosed during the war had no significant difference in the levels of CD22 but on the background of AIT, the indicators were higher than in DTG (22.53 ± 1.41 vs. 20.00 ± 1.01). At the same time, with a long course of AIT and DTG, CD22 levels were higher in the DTG group (21.65 ± 1.58 vs. 23.19 ± 1.09). Conclusions. In patients with DTG and AIT, indicators of the cellular immune response have a multidirectional orientation, which depends, among other things, on the time of the disease and the stress that caused it. Immunoregulatory indices of suppression and B cell help significantly differ depending on the type of autoimmune disease and the time of its manifestation. [ABSTRACT FROM AUTHOR]

Background: Lichen planus (LP) is a complex condition with numerous and polymorphic clinical manifestations. Although oral lichen planus (OLP) usually appears as isolated cases in the population, there have been reports of this condition manifesting among members of the same family. Therefore, genetic factors represent a potential etiologic factor, as demonstrated in several studies. Aim of the study: To present the clinical-evolutionary characteristics and treatment response in a series of 8 different cases of OLP from 4 different families. Results: All patients included in the study were women, with a mean age of 44.87 years, non-smokers, and had associated general conditions such as psoriasis, autoimmune thyroiditis, or hepatitis C. The most common clinical form was the atrophic-keratotic type, involving 2-3 topographical areas, and the majority of patients reported painful symptoms. In half of the patients, we observed a good progression and significant remission. Discussion: A possible factor associated with the pathogenesis of OLP is genetics. Familial LP appears at younger ages and can manifest with widespread lesions. The study of familial OLP cases reveals certain clinical-evolutionary characteristics, which are sometimes atypical. Conclusion: Studying familial OLP cases is necessary to better understand the specific manifestation patterns and to assess treatment response. Additionally, these cases may have a higher potential for malignant transformation. [ABSTRACT FROM AUTHOR]

Background and Purpose: Sex and age show a dimorphism role in the pathogenesis, lymph node metastasis, and prognostic outcomes of papillary thyroid carcinoma. This investigation endeavors to elucidate the mechanisms underlying these disparities. Methods: The clinicopathological characteristics and risk factors of lymph node metastasis were explored by analyzing the 2261 patients. The gene expression information of 497 samples from The Cancer Genome Atlas Thyroid Cancer database was used to explore the differentially expressed genes in different phenotypes. What's more, the single-cell RNA sequencing data obtained from the Gene Expression Omnibus database was used to explore the gene expression in specific cells. Results: Multivariate logistic regression analysis showed that in male patients, a larger tumor size, extrathyroidal extension, younger age, and the presence of calcification emerged as significant predictors for lymph node metastasis (LNM)(p < 0.05). Conversely, female patients exhibited a different profile, with larger tumor size, extrathyroidal extension, younger age, calcification, and bilateral tumors being identified as key risk factors (p < 0.05). Further stratification by age demonstrated distinct patterns: among the younger cohort, a larger tumor size, extrathyroidal extension, male gender, calcification, multifocality, and the presence of Hashimoto's thyroiditis held statistical significance (p < 0.05). In contrast, the older subgroup was characterized by a larger tumor size, extrathyroidal extension, male gender, calcification, bilateral tumors, and unclear margins as salient indicators of risk (p < 0.05). In the bulk gene analysis, there were two sex-age-related differentially expressed genes with a contrary trend in tissue sources and LNM status: TCL1A and CR2. The analysis of single-cell RNA sequencing showed that the infiltration of TCL1A- and CR2-related B cells varied in different clinical subtypes. Conclusion: Lymph node metastasis of papillary thyroid carcinoma in different sexes and ages may have distinct patterns, and the ages-sex-related B cell infiltration might explain the dimorphism biological behavior. [ABSTRACT FROM AUTHOR]

Immunoinflammatory response can participate in the development of cancer. To investigate the relationship between pretreatment systemic immune inflammatory response index (SII), systemic inflammatory response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR) and lymph node metastasis in patients with papillary thyroid carcinoma (PTC). Methods: A retrospective analysis was performed on 547 PTC patients treated in Meizhou People's Hospital from January 2018 to December 2021. Clinicopathological data were collected, including gender, age, Hashimoto's thyroiditis, maximum tumor diameter, extra-membrane infiltration, disease stage, BRAF V600E mutation, pretreatment inflammatory index levels, and lymph node metastasis. The optimal cutoff values of SII, SIRI, NLR, PLR and LMR were calculated by receiver operating characteristic (ROC) curve, and the relationship between inflammatory indexes and other clinicopathological features and lymph node metastasis was analyzed. Results: There were 303 (55.4%) PTC patients with lymph node metastasis. The levels of SII, SIRI, NLR, and PLR in patients with lymph node metastasis were significantly higher than those in patients without lymph node metastasis, while the levels of LMR were significantly lower than those in patients without lymph node metastasis (all p< 0.05). When lymph node metastasis was taken as the endpoint, the critical value of SII was 625.375, the SIRI cutoff value was 0.705, the NLR cutoff value was 1.915 (all area under the ROC curve > 0.6). The results of regression logistic analysis showed that age < 55 years old (OR: 1.626, 95% CI: 1.009– 2.623, p=0.046), maximum tumor diameter > 1cm (OR: 2.681, 95% CI: 1.819– 3.952, p< 0.001), BRAF V600E mutation (OR: 2.709, 95% CI: 1.542– 4.759, p=0.001), SII positive (≥ 625.375/< 625.375, OR: 2.663, 95% CI: 1.560– 4.546, p< 0.001), and NLR positive (≥ 1.915/< 1.915, OR: 1.808, 95% CI: 1.118– 2.923, p=0.016) were independent risk factors for lymph node metastasis of PTC. Conclusion: Age < 55 years old, maximum tumor diameter > 1cm, BRAF V600E mutation, SII positive, and NLR positive were independent risk factors for lymph node metastasis in PTC. [ABSTRACT FROM AUTHOR]

Autoimmune thyroiditis (AIT), also known as Hashimoto’s thyroiditis (HT), is an autoimmune disease that is characterised by elevated thyroid-specific antibody titres. The incidence of AIT is increasing year over year, making it urgent to establish a suitable animal model for this condition, in order to better explore its pathogenesis and potential pharmaceutical mechanisms for treatment. Owing to a lack of basic research on this disease, problems such as disparate modelling methods with unclear and varying success rates make it difficult for researchers to obtain effective information on AIT in the short term. This report summarises and analyzes the current literature on AIT and combines actual operability to explain the selection and specific implementation processes behind the uses of different modelling approaches, to provide a better overall understanding of autoimmune thyroid diseases.

ObjectiveThis study aims to analyze the causal relationship between autoimmune thyroiditis (AIT) and inflammatory bowel disease (IBD) using bidirectional Mendelian randomization (MR).MethodsSingle nucleotide polymorphisms were obtained from FinnGen. Exposure-outcome causality was assessed using inverse variance weighted, MR-Egger, and weighted median. MR-Egger intercept, Cochran’s Q, and leave-one-out sensitivity analysis were used to evaluate horizontal pleiotropy, heterogeneity, and robustness, respectively.ResultsForward analysis revealed no significant association between AIT and the risk of ulcerative colitis (UC) (odds ratio [OR] 1.008, 95% confidence interval [CI] 0.986 to 1.03, p = 0.460) or Crohn’s disease (CD) (OR 0.972, 95% CI 0.935 to 1.010, p = 0.143). Reverse analysis showed that UC (OR 0.961, 95% CI 0.783 to 1.180, p = 0.707) was not associated with AIT risk, while CD (OR 2.371, 95% CI 1.526 to 3.683, p < 0.001) was linked to an increased risk of AIT. Intercept analysis and Cochran’s Q test indicated no horizontal pleiotropy or heterogeneity. Sensitivity analysis confirmed the robustness of the MR results.ConclusionThis MR analysis suggests that CD, but not UC, is a risk factor for AIT, whereas AIT is not associated with the risk of IBD. Proactive prevention and treatment of CD can help mitigate the risk of AIT.

Objective: The mainstay therapy of hypothyroidism is levothyroxine (LT4). In most cases lifelong treatment is warranted, therefore, choosing adequate doses are of paramount significance. The purpose of this study was to assess several factors that have been proposed to influence LT4 therapy including etiology of hypothyroidism, gender, age, bodyweight, BMI, concomitant drug use, disease severity and time since diagnosis in patients with stable, adequately controlled hypothyroidism. Methods: In this cross-sectional study we analysed past medical history, anthropometric data and biochemical parameters reflecting thyroid function of patients with chronic hypothyroidism who were adequately treated (TSH levels in normal range) with LT4 for at least 6 months. Potential predictors of LT4 requirement were evaluated using uni- and multivariate linear modelling. Results: 191 individuals were enrolled in this study, who were divided into autoimmune (n = 147) and post-surgery (n = 44) groups. Mean age, time since diagnosis and LT4 dose (1.3 versus 1.1 mcg/kgBW) were significantly lower in the autoimmune group. In the post-surgery group age was the only significant (p = 0.016) predictor of LT4 dose. In the autoimmune group BMI (p = 0.001), time since diagnosis (p = 0.023), as well as their interaction (p = 0.012) turned out to be significant predictors of LT4 requirement. Conclusions: Our results implicate the necessity of differentiating between etiologies of hypothyroidism when starting or changing thyroxine replacement therapy. Patient in both groups required significantly lower doses of LT4 replacement, than previous reports suggest, to maintain stable euthyroidism. Distinctly different factors predicted hormone requirement in the two study groups.

The article explores the causal relationship between chronic spontaneous urticaria (CSU) and thyroid function indicators in different ethnic groups using Mendelian randomization analysis. The study found a genetic susceptibility to thyroid dysfunction associated with CSU in Europeans but not in Asians, with no evidence of reverse causation. The research suggests new avenues for investigating the link between thyroid autoimmunity and CSU, highlighting the need for future studies with larger and more diverse cohorts to refine our understanding of these mechanisms. [Extracted from the article]

The article discusses the successful treatment of a patient with pemphigus foliaceus and psoriatic arthritis using upadacitinib, a Janus kinase (JAK) inhibitor. The patient had refractory pemphigus foliaceus and psoriatic arthritis, which were treated with upadacitinib after previous unsuccessful treatments. Upadacitinib showed effectiveness in treating both disorders without aggravating other comorbidities, allowing the discontinuation of oral steroids. Larger randomized clinical trials are needed to further explore the safety and effectiveness of JAK inhibitors in treating pemphigus foliaceus and other immunobullous disorders. [Extracted from the article]

The article "Commentary: Meta-analysis of the effect and clinical significance of Delphian lymph node metastasis in papillary thyroid cancer" by Shanshan Wu critiques a study by Chen et al. on Delphian lymph node metastasis in papillary thyroid cancer. Wu identifies data entry errors and issues with forest plots in Chen's analysis, suggesting modifications for accuracy. The reanalysis shows that male papillary thyroid carcinoma patients are more likely to have Delphian lymph node metastasis, supporting the need for tailored management strategies based on gender disparities in cancer incidence and prognosis. The study emphasizes the importance of assessing Delphian lymph nodes in thyroid cancer patients for personalized treatment planning. [Extracted from the article]

The article discusses a case study of a 33-year-old male with Hashimoto's Thyroiditis who presented with acute cerebral infarction and reversible posterior encephalopathy syndrome. The patient had a history of hyperthyroidism and diabetes, and imaging showed brain abnormalities consistent with both conditions. Treatment included antiplatelet therapy, glycemic control, and thyroid regulation, leading to gradual improvement. The case highlights the importance of early recognition and intervention in patients with neurological deficits and thyroid dysfunction. [Extracted from the article]

Ross syndrome is a rare clinical entity that manifests classically with a triad of segmental anhidrosis, tonic pupil, and hyporeflexia. Here, we present a case of Ross syndrome in a university-going female in her early twenties with a history of hypothyroidism for 5 years. She has complained of insidious onset and progressive anhidrosis on the right side of her body for 7 years. On evaluation, we found her to have autoimmune thyroiditis with elevated serum antithyroid peroxidase antibody. The antinuclear antibody titer was also raised significantly, suggesting a possible autoimmune etiology. In our case, we reiterate the need for autoimmune testing in cases of Ross syndrome and further research on the effectiveness of immunomodulators for treatment. [ABSTRACT FROM AUTHOR]

Problem: Research has suggested a link between recurrent pregnancy loss (RPL) and cell‐mediated immunity dysregulation. We aimed to determine if a history of RPL is associated with diagnosis of a cell‐mediated autoimmune condition (AIC). Method of Study: A retrospective cohort study was conducted using the TriNetX research network. The RPL group had ≥3 spontaneous or missed abortions. Controls had at least one pregnancy but no diagnosis of RPL. Propensity score matching was used for age, race, and ethnicity. Z‐test and relative risk analysis investigated the relationship between RPL and subsequent AIC diagnoses. Results: One hundred twenty‐eight thousand three hundred seventy‐six patients were included in each cohort. RPL was associated with an increased risk for an AIC composite (RR 1.60, 95% CI [1.51, 1.69]), Crohn's disease, Graves' disease, Hashimoto's thyroiditis, multiple sclerosis, rheumatoid arthritis, Sjogren's syndrome, systemic lupus erythematosus, and ulcerative colitis, but not psoriatic arthritis. Conclusions: Using a large research database of patients with RPL, we were able to demonstrate that an antecedent diagnosis of RPL is associated with increased risk of subsequent diagnosis of an AIC, often between 1 and 10 years after RPL. [ABSTRACT FROM AUTHOR]

Rituximab was first used as a treatment for B-cell malign lymphoma, and it is currently used in the treatment of rheumatoid arthritis. On the other hand, an association between rheumatoid arthritis with another autoimmune disease Hashimoto's thyroiditis is a condition that can be expected. Thirty-four-year-old female patient with rheumatoid arthritis received disease-modifying agents in various combinations for 9 years. Due to unresponsiveness to treatment, the biological agent rituximab was initiated. The patient also had euthyroided Hashimoto's thyroiditis and nodular goiter for 15 years. At the time of the diagnosis of Hashimoto thyroiditis, anti-thyroid peroxidase (anti-TPO): 45 IU/mL (0-35), anti-thyroglobulin (anti-Tg) >3000 IU/mL (0-115) but after 4 cycles of treatment with rituximab anti-TPO: 7.38 U/mL (0-35), anti-Tg <10 U/mL (0-115). According to the literature; in patients treated with rituximab for thyroid MALT lymphoma, rheumatoid arthritis, and Grave's disease, few have been reported to have declined levels of thyroid autoantibodies. The levothyroxine replacement dose decreased in some of these patients. The decline in thyroid antibodies with the treatment of rituximab reveals the hope that Hashimoto's thyroiditis may be treatable. To understand the effect of rituximab treatment on the pathogenesis of Hashimoto's disease further studies involving a large series is required. [ABSTRACT FROM AUTHOR]

Abstract Despite treatment with levothyroxine, hypothyroidism and autoimmune thyroiditis (AIT) may be associated with reduced quality of life (QoL), an enigmatic condition referred to as "syndrome T". Peripheral neuropathy, described in untreated thyroid disease, could be a contributing mechanism. We analysed autonomic and somatosensory function in 29 patients with AIT and treated hypothyroidism and 27 healthy volunteers. They underwent heart rate variability (HRV) analysis and quantitative sensory testing (n = 28), comprising 13 parameters of small and large nerve fibre function and pain thresholds. Autonomic cardiovascular function was assessed in rest, deep respiration and orthostasis. Additionally, biomarkers for autoimmunity and thyroid function were measured. Anxiety, depression and QoL were assessed using validated questionnaires. 36% of the patients showed at least one sign of somatosensory small or large fibre dysfunction. 57% presented with mild hyperalgesia to at least one stimulus. Several markers of autonomic function and some detection thresholds were related to the antibody titres. Anxiety, depression scores and QoL correlated to antibody titres and HRV measures. Autonomic and somatosensory dysfunction indicate that in treated hypothyroidism and AIT a subgroup of patients suffers from neuropathic symptoms leading to impaired QoL. Additionally, mild hyperalgesia as a possible sensitisation phenomenon should be considered a target for symptomatic treatment.

While subclinical or overt hypothyroidism are common in Down syndrome (DS); Graves’ disease (GD) is rare (ranges 0.6–3%). We aimed to evaluate the clinical features, course, and treatment of GD in children with DS and compare them with those without DS. Among 161 children with GD, 13 (8 female, 5 male) had DS (8%). Data were collected retrospectively from patients’ medical records. The mean age at diagnosis was 10.6 ± 4.5 years, with a female-to-male ratio 1.6:1. The main symptoms were weight loss (n = 6), increased irritability (n = 3), and increased sweating (n = 3). None had orbitopathy. Seven of 11 patients with a thyroid ultrasound at diagnosis had a goitre. On admission, all had thyroid-stimulating hormone (TSH)

Diseases of the thyroid gland occupy one of the central places in clinical endocrinology. The main components for the synthesis of thyroid hormones are iodine and the amino acid tyrosine. Studies conducted in the 21st century indicate a certain effect on the metabolism and function of the thyroid gland and other microelements and vitamins. We searched the PubMed and Scopus information databases for publications devoted to the study of the influence of trace elements selenium, zinc, vitamins A, C, E on the physiology and pathology of the thyroid gland, including sources up to 29.02.2024. Adequate intake of selenium, zinc, along with two other important microelements (iodine and iron), as well as vitamins A, C, E, contributes to normal metabolism of the thyroid gland. Maintaining a physiological balance of micronutrients and vitamins through a sensible diet or taking nutraceuticals is essential to preventing thyroid disease and maintaining overall health. Basal analysis of microelements and vitamins seems appropriate for better selection of patients in need of replacement therapy using nutraceuticals

Abstract Background Atrophic autoimmune thyroiditis (AAT) is a rare phenotype of autoimmune thyroiditis (AT) in pediatric age. AAT occurs without thyroid enlargement leading to a delay in its diagnosis. Growth impairment is infrequent in autoimmune thyroiditis, if timely diagnosed. Prolonged severe hypothyroidism is a rare cause of pituitary hyperplasia (PH) in childhood. Loss of thyroxine negative feedback causes a TRH-dependent hyperplasia of pituitary thyrotroph cells resulting in adenohypophysis enlargement. A transdifferentiation of pituitary somatotroph cells into thyrotroph cells could explain growth failure in those patients. Methods Twelve patients were retrospectively evaluated at five Italian and Polish Centres of Pediatric Endocrinology for height growth impairment. In all Centres, patients underwent routine clinical, biochemical and radiological evaluations. Results At the time of first assessment, the 75% of patients presented height growth arrest, while the remaining ones showed growth impairment. The study of thyroid function documented a condition of hypothyroidism, due to AT, in the entire cohort, although all patients had no thyroid enlargement. Thyroid ultrasound showed frankly atrophic or normal gland without goiter. Cerebral MRI documented symmetrical enlargement of the adenohypophysis in all patients and a homogeneous enhancement of the gland after the administration of Gadolinium-DPTA. Replacement therapy with levothyroxine was started and patients underwent close follow-up every 3 months. During the 12 months of follow-up, an improvement in terms of height growth has been observed in 88% of patients who continued the follow-up. Laboratory findings showed normalization of thyroid function and the control brain MRI documented complete regression of PH to a volume within the normal range for age and sex. Conclusions This is the largest pediatric cohort with severe autoimmune primary hypothyroidism without goiter, but with pituitary hyperplasia in which significant growth impairment was the most evident presenting sign. AAT phenotype might be correlated with this specific clinical presentation. In youths with growth impairment, hypothyroidism should always be excluded even in the absence of clear clinical signs of dysthyroidism.

Abstract Background Autoimmune hepatitis (AIH) is an organ specific autoimmune disease, which can manifest at any age of life. there is a high prevalence of extrahepatic autoimmune diseases in patients with AIH. Autoimmune thyroid diseases (ATDs) are the most frequent extrahepatic autoimmune disorders among patients with AIH. Aim of work is to detect the frequency of ATDs among Egyptian children with AIH. Methods This research is a cross-sectional study conducted on 58 children with AIH aged ≤ 18 years. All patients were tested for free triiodothyronine (FT3), free tetraiodothyronine (FT4), thyroid stimulating hormone (TSH), anti-thyroid peroxidase (anti-TPO) and antithyroglobulin (anti-TG). Thyroid ultrasound (US) and thyroid scan were performed for patients with abnormal thyroid profile, borderline values, positive anti-TPO or anti-TG. Results The mean ± standard deviation (SD) for the age of the patients was 11.3 ± 4.5 years. Out of 58 patients of AIH, 28 patients (48.3%) had associated other autoimmune diseases. Autoimmune thyroiditis was the most common associated autoimmune disease being present in 10 patients (17.2%). The thyroid status of AIT patients showed that 6 patients (60%) were euthyroid, 3 patients (30%) had subclinical hypothyroidism and only one patient (10%) was hyperthyroid. Conclusion Autoimmune hepatitis in Egyptian children is commonly associated with other autoimmune diseases. Autoimmune thyroiditis is the most common to be associated with AIH in pediatric patients. As it is not usually clinically manifesting, regular screening for AIT in children with AIH is mandatory.

The aim of the study was to examine the involvement of tissue-specific and non-specific autoantibodies, matrix metalloproteinase-3 and neuron-specific enolase (NSE) enzymes in the development and exacerbation of autoimmune thyroiditis. Materials and methods. The study enrolled 170 patients with autoimmune thyroiditis (64 males and 106 females aged 18 to 64 years) to comprehensively examine their humoral immune response indicators (IgA, M, G), organ-specific (Ab-TG, Ab-TPO) and organ-non-specific antibodies (Ab-DNA), metalloproteinase-3 and NSE activity. The control group consisted of 65 individuals without thyroid pathologies or other autoimmune diseases, aged 20 to 65 years (26 males and 39 females). Results. The study has demonstrated changes in the levels of organ-specific and organ-nonspecific antibodies and statistically significantly increased metalloproteinase-3 activity in patients with autoimmune thyroiditis. Positive correlations have been found between elevated levels of IgG, Ab-TG, Ab-TPO, Ab-dsDNA and NSE activity. Negative correlations have been observed between NSE activity and IgA concentrations. Conclusions. Elevated titers of anti-DNA autoantibodies may indicate an aggravation of the autoimmune process due to cellular structure damage, resulting in gland dysfunction. The findings also suggest that metalloproteinase-3, a marker predicting thyroid tissue damage, may negatively impact the immune response induction, ultimately affecting the activity of neuron-specific enolase. The data have shown that studying biochemical indicators such as antinuclear antibodies (ANA), anti-DNA antibodies, metalloproteinase-3 and neurodegenerative indicators could provide informative markers to determine the nature of the disease development and worsening.

Excessive iodine intake can induce autoimmune thyroiditis (AIT), and the methylation of programmed death receptor 2 (PD-L2) may be involved in the development of iodine-induced AIT. Here, we investigated the immune role of methylation of the susceptibility gene PD-L2 in the occurrence of iodine-induced AIT using the DNA methyltransferase inhibitor Decitabine (Dec) in an experimental autoimmune thyroiditis (EAT) rat model. After injecting Dec intraperitoneally into EAT rats, we performed arsenic-cerium catalytic spectrophotometry, pathological hematoxylin and eosin staining, enzyme-linked immunosorbent assay, quantitative methylation-specific polymerase chain reaction (qMSP), and quantitative real-time polymerase chain reaction (qPCR) to determine the relevant indices. The results showed that compared with the control group, the urinary iodine, thyroid lymphocyte infiltration, thyroglobulin antibody (TgAb), interferon (IFN-γ), and interleukin (IL-23) levels of the EAT rats were significantly increased. The PD-L2 methylation levels were significantly decreased in EAT rats compared to control rats, and the mRNA expression of the PD-L2 was significantly increased. Following Dec intervention, the methylation level of the PD-L2 in rats increased and interferon and interleukin-23 levels decreased, albeit not significantly. However, the mRNA expression of PD-L2 decreased significantly after Dec intervention, and the thyroid function of EAT rats also showed a gradual improvement trend. In summary, hypomethylation of PD-L2 is closely related to the development of iodine-induced AIT. Pro-inflammatory cellular factors are also involved in iodine-induced AIT progression. Although Dec shows promise in the treatment of AIT, further evaluation of its safety is necessary.

Autoimmune thyroid disorders, including Hashimoto's thyroiditis and Grave's disease, represent complex conditions characterized by dysregulation of the immune system targeting the thyroid gland. Understanding the molecular and immunological mechanisms underlying the transition from Hashimoto's thyroiditis to Grave's disease is essential for unraveling the pathophysiology of these interconnected autoimmune conditions. We propose insights into the intricate interplay of genetic factors, immune responses, and hormonal pathways that drive the progression from hypothyroidism to hyperthyroidism, shedding light on new perspectives for diagnosis, management, and future research directions in autoimmune thyroid disorders. [ABSTRACT FROM AUTHOR]

Background. Primary adrenal insufficiency is an uncommon condition that manifests as nonspecific symptoms such as fatigue, weight loss, salt craving, and hyperpigmentation. Common cardiovascular presentations of AI are hypotension, arrhythmias, and syncope. However, acute heart failure is an uncommon presentation. Case Presentation. Here, a 26‐year‐old man was hospitalized with vasopressor‐resistant cardiogenic shock, which was finally attributed to an adrenal crisis. His past medical history was notable for Hashimoto's disease, controlled with oral levothyroxine. Conclusion. AI should be considered among patients with cardiogenic shock who are unresponsive to conventional inotropes. Additionally, a history of autoimmune diseases may increase the suspicion of AI. Although the presentation of cardiogenic shock in a patient with undiagnosed AI is considered a rarity, delay in prompt treatment can lead to life‐threatening conditions. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to investigate the risk factors for lateral cervical lymph node metastasis in papillary thyroid carcinoma (PTC). Methods: Clinicopathological data (age, gender, Hashimoto's thyroiditis, preoperative circulating tumor cells (CTCs), multifocal, maximum lesion diameter, invaded capsule, T stage, and lymph node metastasis) of 830 PTC patients diagnosed and treated in Meizhou People's Hospital from June 2021 to April 2023 were collected. The related factors of lateral cervical lymph node metastasis were analyzed. Results: There were 334 (40.2%), and 103 (12.4%) PTC patients with central lymph node metastasis, and lateral cervical lymph node metastasis, respectively. Compared with patients without lateral cervical lymph node metastasis, PTC patients with lateral cervical lymph node metastasis had a higher proportion of multifocal, maximum lesion diameter > 1 cm, invaded capsule, T3-T4 stage. Regression logistic analysis showed that male (odds ratio (OR): 2.196, 95% confidence interval (CI): 1.279–3.769, p = 0.004), age < 55 years old (OR: 2.057, 95% CI: 1.062–3.988, p = 0.033), multifocal (OR: 2.759, 95% CI: 1.708–4.458, p < 0.001), maximum lesion diameter > 1 cm (OR: 5.408, 95% CI: 3.233–9.046, p < 0.001), T3-T4 stage (OR: 2.396, 95% CI: 1.241–4.626, p = 0.009), and invaded capsule (OR: 2.051, 95% CI: 1.208–3.480, p = 0.008) were associated with lateral cervical lymph node metastasis. Conclusions: Male, age < 55 years old, multifocal, maximum lesion diameter > 1 cm, T3-T4 stage, and invaded capsule were independent risk factors for lateral cervical lymph node metastasis in PTC. [ABSTRACT FROM AUTHOR]

This article explores the role of T helper cells in autoimmune diseases and the need for more effective treatment strategies. The authors specifically focus on autoreactive CD4+ T helper cells, particularly the T follicular helper subset, which promote the production of autoantibodies. They also discuss the imbalance between pathogenic peripheral T helper cells and tissue-resident Tregs in autoimmune diseases. The article highlights the importance of further research to develop targeted therapies for controlling autoimmune diseases. Additionally, the document provides a summary of various studies and reviews on the role of T helper cells in specific autoimmune diseases, aiming to contribute to the understanding of T cell involvement and potential therapeutic targets. [Extracted from the article]

Background: Identifying the associations between BRAFV600E mutation, the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) and clinicopathological characteristics could assist in making appropriate treatment strategies for pediatric patients with papillary thyroid carcinoma. Objective: To retrospectively assess the associations between BRAFV600E mutation, TI-RADS, and clinicopathological characteristics in pediatric patients with papillary thyroid carcinoma. Materials and methods: Between May 2013 and May 2023, pediatric patients with papillary thyroid carcinoma who underwent thyroidectomy were retrospectively evaluated. Univariate and multivariate logistic regression analyses were performed to determine the associations between BRAFV600E mutation, TI-RADS, and clinicopathological characteristics. The diagnostic performance of TI-RADS to predict BRAFV600E mutation was assessed. Results: The BRAFV600E mutation was found in 59.1% (39/66) of pediatric patients with papillary thyroid carcinoma. Multivariate analyses showed that hypoechoic/very hypoechoic [odds ratio (OR) = 8.48; 95% confidence interval (CI) = 1.48–48.74); P-value = 0.02] and punctate echogenic foci (OR = 24.3; 95% CI = 3.80–155.84; P-value = 0.001) were independent factors associated with BRAFV600E mutation. In addition, BRAFV600E mutation was significantly associated with TI-RADS 5 (OR = 12.61; 95% CI = 1.28–124.49; P-value = 0.03). There were no associations between BRAFV600E mutation and nodule size, composition, shape, margin, cervical lymph node metastasis, or Hashimoto's thyroiditis (P-value > 0.05). Combined with hypoechoic/very hypoechoic and punctate echogenic foci, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 89.7%, 85.2%, 89.7%, 85.2%, and 87.9%, respectively. Conclusions: Hypoechoic/very hypoechoic, punctate echogenic foci, and TI-RADS 5 are independently associated with BRAFV600E mutation in pediatric patients with papillary thyroid carcinoma. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to develop a predictive nomogram for intermediate-risk differentiated thyroid cancer (DTC) patients after fixed 3.7GBq (100mCi) radioiodine remnant ablation (RRA). Methods: Data from 265 patients who underwent total thyroidectomy with central lymph node dissection (CND) and received RRA treatment at a single institution between January 2018 and March 2023 were analyzed. Patients with certain exclusion criteria were excluded. Univariate and multivariate logistic regression analyses were performed to identify risk factors for a non-excellent response (non-ER) to RRA. A nomogram was developed based on the risk factors, and its performance was validated using the Bootstrap method with 1,000 resamplings. A web-based dynamic calculator was developed for convenient application of the nomogram. Results: The study included 265 patients with intermediate-risk DTC. Significant differences were found between the ER group and the non-ER group in terms of CLNM>5, Hashimoto's thyroiditis, sTg level, TgAb level (P < 0.05). CLNM>5 and sTg level were identified as independent risk factors for non-ER in multivariate analysis. The nomogram showed high accuracy, with an area under the curve (AUC) of 0.833 (95% CI = 0.770-0.895). The nomogram's predicted probabilities aligned closely with actual clinical outcomes. Conclusions: This study developed a predictive nomogram for intermediate-risk DTC patients after fixed 3.7GBq (100mCi) RRA. The nomogram incorporates CLNM>5 and sTg levels as risk factors for a non-ER response to RRA. The nomogram and web-based calculator can assist in treatment decision-making and improve the precision of prognosis information. Further research and validation are needed. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the capability of dual-layer detector spectral CT (DLCT) quantitative parameters in conjunction with clinical variables to detect malignant lesions in cytologically indeterminate thyroid nodules (TNs). Materials and methods: Data from 107 patientswith cytologically indeterminate TNs who underwent DLCT scans were retrospectively reviewed and randomly divided into training and validation sets (7:3 ratio). DLCT quantitative parameters (iodine concentration (IC), NICP (IC nodule/IC thyroid parenchyma), NICA (IC nodule/IC ipsilateral carotid artery), attenuation on the slope of spectral HU curve and effective atomic number), along with clinical variables, were compared between benign and malignant cohorts through univariate analysis.Multivariable logistic regression analysis was employed to identify independent predictors which were used to construct the clinical model, DLCT model, and combined model. A nomogram was formulated based on optimal performingmodel, and itsperformance was assessed using receiver operating characteristic curve, calibration curve, and decision curve analysis. The nomogram was subsequently tested in the validation set. Results: Independent predictors associated with malignant TNs with indeterminate cytology included NICP in the arterial phase, Hashimoto’s Thyroiditis (HT), and BRAF V600E (all p < 0.05). The DLCT-clinical nomogram, incorporating the aforementioned variables, exhibited superior performance than the clinical model or DLCT model in both training set (AUC: 0.875 vs 0.792 vs 0.824) and validation set (AUC: 0.874 vs 0.792 vs 0.779). The DLCT-clinical nomogram demonstrated satisfactory calibration and clinical utility in both training set and validation set. Conclusion: The DLCT-clinical nomogram emerges as an effective tool to detect malignant lesions in cytologically indeterminate TNs. [ABSTRACT FROM AUTHOR]

Objectives: Previous studies have indicated a correlation between cytokines and autoimmune diseases. yet the causality remains uncertain. Through Mendelian Randomization (MR) analysis, we aimed to investigate the causal relationships between genetically predicted levels of 91 cytokines and three autoimmune diseases: Multiple Sclerosis (MS), Systemic Lupus Erythematosus (SLE), and Hashimoto’s Thyroiditis (HT). Methods: A bidirectional two-sample MR approach was utilized to assess the causal relationships between cytokines and MS, SLE, and HT. The datasets included 47,429 MS cases and 68,374 controls, 5,201 SLE cases and 9,066 controls, and 16,191 HT cases with 210,612 controls. Data on 91 cytokines comprised 14,824 participants. Causal analyses primarily employed inverse variance weighted, weighted median, and MR-Egger methods, with sensitivity analyses including heterogeneity and pleiotropy assessment. Results: Genetically predicted levels of IL-18 (OR = 0.706; 95% C.I. 0.538– 0.925), ADA (OR = 0.808; 95% C.I. 0.673–0.970), and SCF (OR = 0.898; 95% C.I. 0.816–0.987) were associated with a decreased risk of MS. IL-4 (OR = 1.384; 95% C.I. 1.081–1.771), IL-7 (OR = 1.401; 95% C.I. 1.010–1.943), IL-10RA (OR = 1.266; 95% C.I. 1.004–1.596), CXCL5 (OR = 1.170; 95% C.I. 1.021–1.341), NTN (OR = 1.225; 95% C.I. 1.004–1.496), FGF23 (OR = 0.644; 95% C.I. 0.460–0.902), and MCP4 (OR = 0.665; 95% C.I. 0.476–0.929) were associated with SLE risk. CDCP1 (OR = 1.127; 95% C.I. 1.008–1.261), IL-33 (OR = 0.852; 95% C.I. 0.727– 0.999), and TRAIL (OR = 0.884; 95% C.I. 0.799–0.979) were associated with HT risk. Bidirectional MR results suggest the involvement of CCL19, IL-13, SLAM, ARTN, Eotaxin, IL-22RA1, ADA, and MMP10 in the downstream development of these diseases. Conclusions: Our findings support causal relationships between certain cytokines and the risks of MS, SLE, and HT, identifying potential biomarkers for diagnosis and prevention. Additionally, several cytokines previously unexplored in these autoimmune disease contexts were discovered, laying new groundwork for the study of disease mechanisms and therapeutic potentials. [ABSTRACT FROM AUTHOR]

Objectives: To investigate quality of life using the SF-12 scale in euthyroid Hashimoto's thyroiditis patients on levothyroxine therapy for at least three years. Methods: This prospective case–control study included 44 euthyroid Hashimoto's thyroiditis patients and 44 matched controls, conducted at a university hospital's endocrinology clinic from 6 November to 30 December 2023. Participants completed the SF-12 questionnaire; data were analyzed using Shapiro–Wilk, Student's t-test, Mann–Whitney U, Yates chi-squared, and Spearman's tests. Results: The study involved 88 participants (Hashimoto's group: 35 females, 9 males; control group: 31 females, 13 males), with average ages of 49.50 and 47.43 years old, respectively. Significant differences were observed in TSH, T4 levels, and family history (p < 0.05). The Hashimoto's thyroiditis group showed higher thyroid peroxidase antibodies (95.69 IU/mL) and lower scores on both physical and mental sub-dimensions of SF-12, with a significant difference in physical scores (p < 0.05). Significant correlations were found between age and Anti-TG; Anti-TPO and Anti-TG; BMI and T3; TSH and T4; HDL and triglycerides; MCS-12 and PCS-12; Anti-TPO and T3; cholesterol and T3; and LDL and cholesterol (p < 0.05). Other variables showed no significant correlations (p > 0.05). Conclusions: Our study shows that effective control of hypothyroidism is not sufficient to reduce the negative effects of Hashimoto's thyroiditis on patients' health-related quality of life. Beyond the normalization of hormone levels, comprehensive therapeutic strategies targeting the autoimmune aspects of the disease are essential for the management of Hashimoto's thyroiditis. This study provides a foundation for developing effective therapies that can enhance quality of life for patients with Hashimoto's thyroiditis. [ABSTRACT FROM AUTHOR]