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The Journal of Clinical Endocrinology... Aug 2021Autoimmune/inflammatory syndrome induced by adjuvants (ASIA syndrome) can be seen as a postvaccination phenomenon that occurs after exposure to adjuvants in vaccines...
CONTEXT
Autoimmune/inflammatory syndrome induced by adjuvants (ASIA syndrome) can be seen as a postvaccination phenomenon that occurs after exposure to adjuvants in vaccines that increase the immune responses. There are very limited data regarding ASIA syndrome following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines.
OBJECTIVES
This work aims to report cases of subacute thyroiditis related to the SARS-CoV-2 vaccine.
METHODS
We describe the clinical, laboratory, and imaging features of 3 cases of subacute thyroiditis after inactivated SARS-CoV-2 vaccine (CoronaVac®). Three female healthcare workers have applied to our clinic with anterior neck pain and fatigue 4 to 7 days after SARS-CoV-2 vaccination. Two of them were in the breastfeeding period. They were negative for thyroid antibodies, and there was no previous history of thyroid disease, upper respiratory tract infection, or COVID-19. Laboratory test results and imaging findings were consistent with subacute thyroiditis.
RESULTS
SARS-CoV-2 vaccination can lead to subacute thyroiditis as a phenomenon of ASIA syndrome. Subacute thyroiditis may develop within a few days after the SARS-CoV-2 vaccination. Being in the postpartum period may be a facilitating factor for the development of ASIA syndrome after the SARS-CoV-2 vaccination.
CONCLUSIONS
This is the first report of subacute thyroiditis as a phenomenon of ASIA syndrome after inactivated COVID-19 vaccination. Clinicians should be aware that subacute thyroiditis may develop as a manifestation of ASIA syndrome after the inactive SARS-CoV-2 vaccine.
Topics: Adult; COVID-19; COVID-19 Vaccines; Female; Health Personnel; Humans; Prognosis; SARS-CoV-2; Thyroiditis, Subacute
PubMed: 34043800
DOI: 10.1210/clinem/dgab373 -
Endokrynologia Polska 2021Selenium (Se) supplements are commonly prescribed to autoimmune thyroiditis (AIT) patients by European endocrinologists, despite the lack of official guidelines. The... (Review)
Review
Selenium (Se) supplements are commonly prescribed to autoimmune thyroiditis (AIT) patients by European endocrinologists, despite the lack of official guidelines. The majority of Europe is depleted of natural Se sources, and the daily population intake does not comply with recommended values. Optimal individual plasma Se concentration is reached when the selenoproteins (selenoprotein P, glutathione peroxidase) are fully saturated. However, Se intake has to be regulated because both Se shortage and overdose negatively impact health. In the case of AIT, Se may alleviate symptoms or prevent progression to hypothyroidism and postpartum hypothyroidism. Se supplementation in euthyroid, subclinical, or overt hypothyroid AIT patients decreased thyroid autoantibodies, lowered or maintained the TSH level, decreased the fT4/fT3 ratio, reduced the body's oxidative stress and inflammatory status, and amended quality of life and thyroid ultrasound structure and volume. In pregnant females, adequate Se intake protected them against miscarriages, preeclampsia/hypertension, preterm birth, small-for-gestational-age infants' birth, and improved child's neuropsychological development. In the elderly population, adequate Se supplementation decreased cardiovascular diseases and hypertension risk, but prolonged intake of excessive doses increased the all-cause mortality rate. Routine Se supplementation implementation requires from researchers and clinicians consideration of specific populational differences in natural Se and iodine supply, the patient's clinical situation (supplementation simultaneously or before levothyroxine treatment, AIT/non-AIT hypothyroidism), individual response to supplementation (Se and selenoprotein P assessment), predisposition (genetic testing), the status of other trace elements, and the interplay between those micronutrients. Moreover, the safety of commercially available Se formulations, doses, and duration of treatment should be determined. Proper guidelines are warranted to standardise the medical approach to Se supplementation. This article presents a comprehensive review of recent randomised-controlled trials, meta-analyses, and clinical trials concerning the risks and benefits of Se supplementation in different clinical settings and specific populations with particular emphasis on AIT in a practical manner.
Topics: Aged; Child; Dietary Supplements; Female; Hashimoto Disease; Humans; Hypertension; Hypothyroidism; Infant, Newborn; Pregnancy; Premature Birth; Quality of Life; Selenium; Selenoprotein P; Thyroiditis, Autoimmune
PubMed: 33970480
DOI: 10.5603/EP.a2021.0017 -
Endocrine May 2021The world is dealing with the Covid-19 pandemic due to the coronavirus SARS-CoV-2. Amongst the extra-pulmonary manifestations presented by Covid-19 patients, thyroiditis... (Review)
Review
The world is dealing with the Covid-19 pandemic due to the coronavirus SARS-CoV-2. Amongst the extra-pulmonary manifestations presented by Covid-19 patients, thyroiditis form part of the spectrum of visceral involvement linked to SARS-CoV-2. In this review, we will describe the various documented clinical forms of thyroiditis (inflammatory thyroiditis, subacute or de Quervain's thyroiditis, chronic lymphocytic thyroiditis or Hashimoto's disease, painless (silent) postpartum thyroiditis) to facilitate their diagnosis in more or less symptomatic Covid-19 patients and to provide guidance for patient treatment.
Topics: COVID-19; Female; Humans; Pandemics; SARS-CoV-2; Thyroiditis; Thyroiditis, Subacute
PubMed: 33774779
DOI: 10.1007/s12020-021-02689-y -
The Quarterly Journal of Nuclear... Jun 2021Hyperthyroidism is a clinical condition characterized by inappropriately high synthesis and secretion of thyroid hormones by the thyroid gland. It has multiple... (Review)
Review
Hyperthyroidism is a clinical condition characterized by inappropriately high synthesis and secretion of thyroid hormones by the thyroid gland. It has multiple aetiologies, manifestations and potential therapies. Graves' disease is the most common form of hyperthyroidism, due to the production of autoantibodies against thyrotropin receptor, capable of over-stimulating thyroid function. A reliable diagnosis of hyperthyroidism can be established on clinical grounds, followed by the evaluation of serum thyroid function tests (thyrotropin first and then free thyroxine, adding the measurement of free triiodothyronine in selected specific situations). The recent guidelines of both the American and European Thyroid Associations have strongly recommended the measurement of thyrotropin receptor autoantibodies for the accurate diagnosis and management of Graves' disease. If autoantibody test is negative, a radioiodine uptake should be performed. Considering the most recent laboratory improvements, binding assays can be considered the best first solution for the measurement of thyrotropin receptor autoantibodies in diagnosis and management of overt cases of Graves' disease. In fact, they have a satisfactory clinical sensitivity and specificity (97.4% and 99.2%, respectively) being performed in clinical laboratories on automated platforms together with the other thyroid function tests. In this setting, the bioassays should be reserved for fine and complex diagnoses and for particular clinical conditions where it is essential to document the transition from stimulating to blocking activity or vice versa (e.g. pregnancy and post-partum, related thyroid eye disease, Hashimoto's thyroiditis with extrathyroidal manifestations, unusual cases after LT4 therapy for hypothyroidism or after antithyroid drug treatment for Graves' disease). Undoubtedly, technological advances will help improve laboratory diagnostics of hyperthyroidism. Nevertheless, despite future progress, the dialogue between clinicians and laboratory will continue to be crucial for an adequate knowledge and interpretation of the laboratory tests and, therefore, for an accurate diagnosis and correct management of the patient.
Topics: Animals; Antithyroid Agents; Autoantibodies; Biosensing Techniques; Cell Line; Humans; Hyperthyroidism; Iodine Radioisotopes; Protein Binding; Receptors, Thyrotropin; Sensitivity and Specificity; Thyroid Gland
PubMed: 33565846
DOI: 10.23736/S1824-4785.21.03344-6 -
Endocrine Journal Mar 2021Postpartum thyroiditis (PPT) is characterized by mild thyrotoxicosis occurring within one year of parturition commonly followed by transient hypothyroidism. Having...
Postpartum thyroiditis (PPT) is characterized by mild thyrotoxicosis occurring within one year of parturition commonly followed by transient hypothyroidism. Having genetic background of autoimmune thyroid disorders is a risk factor for it because the immune reactivation during postpartum period is a trigger for PPT. Pandemic of COVID-19: caused by SARS-CoV-2 infection is a global health problem, and occurrence of Graves' disease and Hashimoto's thyroiditis after the viral infection have been reported but occurrence of PPT with COVID-19 has never been reported. A 29-year-old woman developed general fatigue four and a half months after parturition, and was diagnosed as having PPT: one month before, she had COVID-19. Hereafter, we define the date of delivery as Day 0 to make timeline clear. SARS-CoV-2 infection was diagnosed by PCR on Day 103, its disappearance from the upper airway confirmed on Day 124, and the thyroiditis diagnosed on Day 136. She had been euthyroid on Day 0 and 95, but thyrotoxic on Day 136. Serum thyroglobulin (Tg) concentration was normal in the presence of anti-Tg antibody, other thyroid-related autoantibodies were negative, and by ultrasonography, the thyroid gland was normal in size and no evidence of increased vascularity. Thyroid function returned to normal by Day 172 without any specific drug therapy. In conclusion, although a clear causal relationship could not be found, we documented the world's first case of PPT developed following COVID-19.
Topics: Adult; Autoantibodies; COVID-19; Female; Humans; Postpartum Thyroiditis; Recovery of Function; Remission, Spontaneous; SARS-CoV-2; Thyroglobulin
PubMed: 33177251
DOI: 10.1507/endocrj.EJ20-0553 -
Nutrients Sep 2020Vitamin D is a steroid hormone traditionally connected to phosphocalcium metabolism. The discovery of pleiotropic expression of its receptor and of the enzymes involved... (Review)
Review
Vitamin D is a steroid hormone traditionally connected to phosphocalcium metabolism. The discovery of pleiotropic expression of its receptor and of the enzymes involved in its metabolism has led to the exploration of the other roles of this vitamin. The influence of vitamin D on autoimmune disease-namely, on autoimmune thyroid disease-has been widely studied. Most of the existing data support a relationship between vitamin D deficiency and a greater tendency for development and/or higher titers of antibodies linked to Hashimoto's thyroiditis, Graves' disease, and/or postpartum thyroiditis. However, there have also been some reports contradicting such relationships, thus making it difficult to establish a unanimous conclusion. Even if the existence of an association between vitamin D and autoimmune thyroid disease is assumed, it is still unclear whether it reflects a pathological mechanism, a causal relationship, or a consequence of the autoimmune process. The relationship between vitamin D's polymorphisms and this group of diseases has also been the subject of study, often with divergent results. This text presents a review of the recent literature on the relationship between vitamin D and autoimmune thyroid disease, providing an analysis of the likely involved mechanisms. Our thesis is that, due to its immunoregulatory role, vitamin D plays a minor role in conjunction with myriad other factors. In some cases, a vicious cycle is generated, thus contributing to the deficiency and aggravating the autoimmune process.
Topics: Graves Disease; Humans; Thyroiditis, Autoimmune; Vitamin D; Vitamin D Deficiency; Vitamins
PubMed: 32933065
DOI: 10.3390/nu12092791 -
Thyroid Research 2020Levothyroxine (LT) pseudomalabsorption due to medication non-adherence results in significant costs for Health Service. High dose LT or LT/paracetamol absorption test is...
BACKGROUND
Levothyroxine (LT) pseudomalabsorption due to medication non-adherence results in significant costs for Health Service. High dose LT or LT/paracetamol absorption test is used in such cases. Hence, establishment of an optimal test protocol and timing of sample collection is of utmost importance.
CASE PRESENTATION
A 34-year old woman was admitted to our Department because of severe hypothyroidism [on admission thyrotropin (TSH) > 100 μIU/ml, free thyroxine (FT) 0.13 ng/dl (ref. range 0.93-1.7)] despite apparently taking 1000 μg of LT a day. Autoimmune hypothyroidism had been diagnosed 4 years before during post-partum thyroiditis. Subsequently, it was not possible to control her hypothyroidism despite several admissions to two University Hospitals and despite vehement denial of compliance problems. There was no evidence of coeliac disease or other malabsorption problems, though gluten-free and lactose-free diet was empirically instigated without success. A combined paracetamol (1000 mg)/LT (1000 μg) absorption test was performed in one of these Hospitals. This showed good paracetamol absorption (from < 2 μg/ml to 14.11 μg/ml at 120 min), with inadequate LT absorption (FT increase from 5.95 pmol/l to 9.92 pmol/l at 0 and 120 min respectively). About 2 years prior to admission to our Department the patient was treated with escalating doses of levothyroxine [up to 3000 μg of T and 40 μg of triiodothyronine (T) daily] without significant impact on TSH (still > 75 μIU/ml, and FT still below reference range).After admission to our Department we performed a 2500 μg LT absorption test with controlled ingestion of crushed tablets, strict patient monitoring and sampling at 30 min intervals. We observed a quick and striking increase in FT from 0.13 to 0.46, 1.78, 3.05 and 3.81 ng/dl, at 0, 30, 60, 90 and 120 min, respectively. Her TSH concentration decreased to 13.77 μIU/ml within 4 days. When informed, that we had managed to "overcome" her absorption problems, she discharged herself against medical advice and declined psychiatric consultation.
CONCLUSIONS
Adequate patient supervision and frequent sampling (e.g. every 30 min for 210 min) is the key for successful implementation of LT absorption test. Paracetamol coadministration appears superfluous in such cases.
PubMed: 32467734
DOI: 10.1186/s13044-020-00079-6 -
Frontiers in Endocrinology 2020Postpartum thyroiditis (PPT) has a prevalence of 1-22%, with an ~50% rate of evolution into permanent hypothyroidism (PH). PPT risk is assessed by measuring serum...
Postpartum thyroiditis (PPT) has a prevalence of 1-22%, with an ~50% rate of evolution into permanent hypothyroidism (PH). PPT risk is assessed by measuring serum thyroid antibodies during gestation, as 1/3-1/2 of Ab+ve pregnant women will develop PPT. Family and personal history positive for autoimmune non-thyroid diseases (AINTDT), and consumption of swordfish increases while consumption of small oily fish decreases the risk of PPT. Monitoring thyroid function in a very high-risk subgroup avoids the costs of the Ab-based universal screening. We aimed at identifying such subgroup in 412 women followed from week 7-11 of gestation to month 12 postpartum. At study entry, we measured serum TPOAb, TgAb, TSH, FT4, FT3, and evaluated seafood consumption, familial history for thyroid diseases and AINTD, and personal history for AINTD. We measured TSH, FT4, FT3 at 1.5, 3, 6, and 12 months postpartum. PPT occurred in 63 women (15.3%), and PH in 34/63 (54%). Based on positivity/negativity for the three histories, women were classified into 8 categories, with PPT rates of 3.8-100%. Seafood consumption allowed further separation of subgroups having different PPT risks. We considered 11 possible strategies, termed [a] through [k]. Strategy [a] consisted in omitting gestational screening, while performing universal postpartum monitoring with TSH and one thyroid hormone; strategy [k] consisted in selective gestational screening with TPOAb and TgAb, based on history and fish consumption, and selective postpartum monitoring in TPOAb and/or TgAb+ve women. The 100% sensitivity, specificity and diagnostic accuracy of strategy [a] were counterbalanced by the highest costs (Euro 32,960 or 523 per each PPT caught). The corresponding numbers for strategy [k] were 78, 95, 93%, and Euro 8,920 or 182/PPT caught. These savings stem from gestational screening being done in 186 women, and postpartum monitoring done in 65/186 women. One gestational screning-free strategy was the cheapest (Euro 2,080 or 83/PPT caught), because based on postpartum monitoring of only 26 women, but had the lowest sensitivity (40%). Identification of pregnant women having different risks for PPT is feasible, with the costless evaluation of history and seafood consumption driving gestational screening of thyroid antibody status and postpartum monitoring of thyroid function.
Topics: Adolescent; Adult; Autoantibodies; Biomarkers; Cohort Studies; Female; Follow-Up Studies; Humans; Hypothyroidism; Postpartum Thyroiditis; Pregnancy; Prenatal Diagnosis; Prognosis; Thyroiditis, Autoimmune; Young Adult
PubMed: 32362873
DOI: 10.3389/fendo.2020.00220 -
Cureus Feb 2020Background Thyroid disorder is common among pregnant women. Hashimoto thyroiditis is the most common etiology of hypothyroidism among pregnant women. Many studies showed...
Background Thyroid disorder is common among pregnant women. Hashimoto thyroiditis is the most common etiology of hypothyroidism among pregnant women. Many studies showed that hypothyroidism during pregnancy has been associated with negative outcomes for the mother and for child as well including miscarriage, intrauterine growth retardation, preterm delivery and cognitive impairment in the offspring. Objectives To assess the adverse maternal and neonatal outcome among hypothyroidism obese pregnant women. Methods This is a retrospective study conducted among obese pregnant women diagnosed with hypothyroidism attending King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia between January 1, 2013, and December 31, 2018. For analysis, we used (1) descriptive statistics, (2) Chi-square test, Pearson correlation, independent t-test, and one-way ANOVA to test the difference in thyroid stimulating hormone (TSH) levels and adverse pregnancy outcomes. A p-value of <0.05 is used to calculate statistical significance. Results A total of 9095 pregnant women had delivered in the last five years, 65 of these pregnant women had been diagnosed with hypothyroidism and 57 were enrolled in our study. Out of 65, 44 (77.2%) were Saudi, and 13 (22.8%) non-Saudis. Mean age at the time of delivery was 32.9 ± 5.6 years, while BMI means were 35.7 ± 4.6. A total of 35 (61.4%) were from class 1, 14 (26.2%) were from class 2 and eight (12.3%) were from class 3. Out of 57, 16 (28.1%) developed undesired antepartum outcomes, while 14 (21.5%) had postpartum outcomes. Preterm labor, gestational diabetes mellitus, and urinary tract infections were significantly associated with abnormal TSH levels (P < 0.05). Conclusion As demonstrated earlier, hypothyroidism during pregnancy leads to unfavorable outcomes. Therefore, screening for thyroid function tests in prenatal and antenatal periods is vital to avoid potential adverse outcomes.
PubMed: 32190490
DOI: 10.7759/cureus.6938