[The volumes of the thyroid gland in adults].
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Adult↗
Biomedical subjects
Z Límanová
Publications and source records attributed to Z Límanová.
[Contemporary theories concerning chronic lymphocytic thyroiditis].
Review of contemporary theories and hypothesis concerning chronic lymphycytic thyroiditis is presented. The origin of the disease depends on various factors: genetics, immunological conditions, cytokins, iodine supply, hormones, TSH and its receptors, apoptosis activation and inhibition. The environmental conditions include goitrogens, selenium, polutants and other still unknown factors. Whether the disease will be accompanied with goiter, nodules or thyroid atrophy with functional disorder is still not evident.
Hashimoto Disease↗
Screening for associated autoimmunity in type 1 diabetes mellitus with respect to diabetes control.
As an autoimmune disease, type 1 diabetes mellitus (DM) can be associated with other autoimmune disorders. The aim of this study was to detect subclinically associated autoimmune thyroid disease, coeliac disease, and Addison's disease. The presence of autoantibodies was evaluated with special regard to the control of diabetes and to the clinical status of the patient. Fifty-one type 1 diabetic patients (22 men, 29 women, mean age 37+/-11 years, mean duration of diabetes 16+/-13 years) were included into this study. Specific antibodies to islet antigens--glutamic acid decarboxylase (GAD65), protein thyrosine phosphatase IA-2alpha, and to thyroid autoantigens--thyroid microsomal peroxidase (TPO) and thyroglobulin (TG) and also thyroid stimulating hormone (TSH) were measured by RIA. Autoantigens of the small intestine--tissue transglutaminase autoantibodies (ATTG), IgA and IgG antibodies to gliadin (AGA-IgA, AGA-IgG) were evaluated by ELISA. Endomysial autoantibodies (EMA) and adrenal cortex antibodies (ACA) were detected by indirect immunofluorescence microscopy. Eleven new cases of thyreopathy (22 % of patients) were detected by the assessment of thyroid autoantibodies and TSH. Two new cases of thyreotoxicosis were diagnosed during the study. Coeliac disease was diagnosed in at least two cases. Addison's disease was not diagnosed, although the ACA were positive in two patients. No influence of single or combined autoantibody positivity on the control of diabetes was found if normal organ function was preserved. In both patients with thyreotoxicosis the control of diabetes was worsened and improved after treatment. The screening of autoantibodies in type 1 diabetic patients could reveal subclinical cases of AITD or coeliac disease. Subclinical forms of these disorders have no influence on diabetes control. However, impaired organ function may be associated with the worsened control of diabetes as we demonstrated on two newly diagnosed cases of thyreotoxicosis. We suggest the need for the follow-up of patients with positive autoantibodies because further deterioration of the respective organs can be expected.
Addison Disease↗
[Thyroid diseases in oncological patients].
The authors review the most common situation concerning oncological patients with concomitant thyroid disease. In case of unknown origin of metastasis and nodular goitre the ultrasound examination with fine needle aspiration biopsy confirms or excludes the thyroid origin. The euthyroid sick syndrome is often diagnosed in oncological patient as a consequence of oncological disease and it doesn't mean hypothyroidism. If oncological patients prove to have a thyroid functional failure the endocrinologist must correct the function as fast as possible to enable oncological treatment. There is no evidence that chemotherapy can influence the thyroid function, but radiotherapy can cause thyroiditis with later hypofunction. The interferon therapy causes thyroid dysfunction in 10% of patients and the recommendation to examine not only TSH and FT4 but also thyroid antibodies is warranted. Lymphoma of the thyroid gland occurs most often on the basis of lymphocytic thyroiditis and lymphocytic thyroiditis may be a risk factor for papillary carcinoma of the thyroid as well. Women with breast carcinoma were proved to have lymphocytic thyroiditis with minor thyroid hypofunction more often than the corresponding group of women with colon cancer or control group of healthy women. In case of renal tumor (Grawitz), breast or lung carcinoma the thyroid can be attacked with metastasis, and ultrasound with fine needle biopsy can reliably differentiate between primary or secondary thyroid involvements. The thyroid can be involved in some diseases: multiple endocrine neoplasia, Carney, Cowden and Gardner's syndromes.
Humans↗
Serum levels of antibodies to thyroid peroxidase correlate with quantitative descriptors of thyroid ultrasound images in patients with breast cancer.
The aim of the study was to compare the structural changes in ultrasound image of the thyroid tissue in 12 women with breast cancer (BC) and 8 women with colorectal cancer (CC). MATLAB software was used to analyse the digitised images. As quantitative descriptors of thyroid ultrasound images (QDTI) were used raw grey scale values of individual image pixels (RAW) and the optimal one-dimensional discriminative texture features (F2, F6, F7). The possible relations between QDTI and thyroid laboratory parameters were tested. In the BC group serum levels of antibodies to thyroid peroxidase negatively correlated with feature RAW (multiple regression, beta coefficient -0.75, p=0.004) and positively with feature F2 (multiple regression, beta coefficient 1.44, p=0.04). In the BC group RAW negatively correlated with serum levels of tumour marker CA 15-3 (Pearson's correlation coefficient, r=-0.714, p=0.00917). No such correlations were found in CC group. The correlations between QDTI and serum levels of antibodies to thyroid peroxidase in patients with BC show that the positivity of antibodies to thyroid peroxidase is probably accompanied with structural changes in the thyroid tissue.
Aged↗
Autoimmune thyroid diseases in women with breast cancer and colorectal cancer.
The aim of the study was to compare the prevalence of autoimmune thyroid diseases in three groups of women (66 with breast cancer (CaB), 68 with colorectal cancer (CaC) and 49 without oncological diseases as a control group). Serum levels of thyroid-stimulating hormone (TSH), free thyroxin (fT4), antibodies to thyroglobulin (TGB-ab) and thyroperoxidase (TPO-ab) and tumor markers CEA, CA 15-3 and CA 19-9 were investigated in all subjects by using the chemiluminiscence method. In contrast to Graves' disease (no observed case), autoimmune thyroiditis was diagnosed in 24.2 % women with CaB (4.5 % euthyroid and 19.7 % with subclinical or overt hypothyroidism), compared to 16.7 % in women with CaC (2.0 % euthyroid and 14.7 % with subclinical or overt hypothyroidism) and 16.2 % controls (4.0 % euthyroid and 12.2 % with subclinical or overt hypothyroidism). Serum levels of TGB-ab were higher in the group with breast cancer as compared to those with colorectal cancer and the control group (medians: 35.80 vs. 31.75 vs. 27.70, p<0.001). Similarly, the percentage of positive TGB-ab and TPO-ab serum levels was higher in women with breast cancer as compared to those with colorectal cancer and the control group. The results of the study support the controversial theory that there is an increased prevalence of autoimmune thyroiditis in women with breast cancer.
Aged↗
IgA and IgG antigliadin, IgA anti-tissue transglutaminase and antiendomysial antibodies in patients with autoimmune thyroid diseases and their relationship to thyroidal replacement therapy.
Celiac disease is a chronic illness of the small bowel caused by gliadin intolerance in genetically predisposed subjects. The aim of this study was to investigate serum levels of IgA and IgG antigliadin antibodies, IgA antiendomysial antibodies, and IgA anti-tissue transglutaminase antibodies in 169 patients with autoimmune thyroid diseases, i.e. chronic thyroiditis and Graves' disease. Antiendomysial antibodies were positive in 2 out of 169 persons (1.18%), IgA antigliadin antibodies in 15.98%, IgG antigliadin antibodies in 51.48%, and IgA anti-tissue transglutaminase in 14.79%. The prevalence of positivity was higher compared to the 1312 control blood donors described in our previous study (Vancíková et al. 2002) (p<0.05). Patients with chronic thyroiditis treated with a high replacement dosage of levothyroxin (125-200 microg daily) had higher serum levels of IgA antigliadin antibodies in comparison with patients treated with a lower dosage (50-100 microg daily) (medians: 13.00 vs. 19.69, p=0.033). We found a negative correlation of IgA anti-tissue transglutaminase antibodies and total calcium serum levels (r = -0.480, p=0.0236, n=22). We can conclude that in persons with autoimmune thyropathy there is a high prevalence of positive antigliadin, anti-tissue transglutaminase and antiendomysial antibodies. Latent celiac disease may lead to impaired resorption of therapeutically administered levothyroxine, calcium, or other substances.
Adolescent↗
[Subclinical hypothyroidism with emphasis on the cardiovascular system].
Subclinical hypothyroidism is comparatively frequent disorder with incidence between 3 to 7% in the general population; in females over 60 it can exceed 10%. There is no unequivocal view on the clinical significance of the syndrome; however, it may correspond with increased risk of atherosclerosis and its complications. Especially in elderly women, screening for subclinical hypothyroidism is recommended with possible hormone replacement according to given criteria. Decision about the therapy of subclinical hypothyroidism should be done together with cardiologist, psychiatrist or neurologist in order to correct possible clinical impacts and prevent further manifestations.
Arteriosclerosis↗
The serologic screening for celiac disease in the general population (blood donors) and in some high-risk groups of adults (patients with autoimmune diseases, osteoporosis and infertility) in the Czech republic.
The prevalence of celiac disease (CD) was determined in healthy blood donors and in high-risk groups of adults (a total of 1835 adults--randomly selected 1312 healthy blood donors, 102 patients with primary osteoporosis, 58 patients with autoimmune diseases and 365 infertile women). It was calculated on the basis of a two-step serologic screening method--in the first step IgA and IgG antigliadin antibodies (AGA) and IgA anti-gamma-glutamyltransferase ('transglutaminase') antibodies (ATG) were estimated, in the second step sera positive for IgA AGA and/or IgA ATG were examined for antiendomysial IgA (AEA) antibodies. Immunoenzymic assay (ELISA) was used for determining of AGA and ATG antibodies; immunofluorescence method, performed on human umbilical cord tissue, was used for assaying of AEA antibodies. Total serum IgA level in only IgG AGA positive subjects was measured by routine turbidimetric method. 0.45% of healthy blood donors, 0.98% of osteoporotic patients, 2.7% of patients suffering from autoimmune disease and 1.13% of women with infertility considered as immunologically mediated were found to be positive in both steps of serologic screening (AGA and/or ATG and antiendomysium positive). The presumed high prevalence of seropositivity for CD in apparently healthy Czech adult population was confirmed. In the high-risk groups, the prevalence of seropositivity for CD was approximately 2-4 times higher than in healthy blood donors. The real prevalence of CD in the tested groups, however, can be estimated after performing small intestinal biopsy in the seropositive patients.
Adolescent↗
[Editorial referring to (in general) to the article: Hauer D. et al: Thyroid disease in pregnant women and its development after childbirth].
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Female↗
[Myopathy syndrome in undiagnosed hypothyroidism].
This article describes three cases of undiagnosed hypothyroidism in a developed stage which manifest themselves with myopathic syndrome (myalgia, muscular fatigue, and higher serum levels of creatine kinase, aminotranferases, and lactate dehydrogenase) without the "classic" symptoms of hypothyroidism. In addition, two of the three patients were receiving hypolipidemic drugs for secondary hyperlipoproteinemia, which could have affected the development of the myopathy. Emphasis is placed on the description of atypical symptoms of hypothyroidism and the necessity of endocrinological examination in each case of myopathy with indefinite etiology.
Female↗
[Do we know when to examine the thyroid gland?].
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Humans↗
The evaluation of thyroid and islet autoantibodies in type 1 diabetes mellitus.
Type 1 diabetes mellitus is an autoimmune disease in which the presence of different autoantigens can often be found. The aim of our study was to evaluate the prevalence of antibodies against insulin (IA) and autoantibodies against glutamic acid decarboxylase (anti-GAD), tyrosine phosphatase IA-2 (anti-IA-2), thyroid microsomal peroxidase (anti-TPO) and thyroglobulin (anti-TG) in 55 randomly selected Type 1 diabetic patients (34 males, 21 females). Mean age of these patients was 39 +/- 12 yrs, mean duration of diabetes 18 +/- 13 yrs. Positivity of anti-GAD was found in 29 (58%) patients, anti-IA-2 in 13 (25%) patients, IA in 46 (85%) patients, anti-TPO in 10 (21%) and anti-TG in 11 (23%) patients. Simultaneous positivity of thyroid and islet autoantibodies was found in 6 (11%) patients whereas the positivity at least one of them was in 38 (69%) patients. No relationship between glycated hemoglobin and autoantibody concentration was found in the whole group of patients. The autoimmune thyroid disease was newly detected in 4 patients from high concentration of thyroid autoantibodies together with impaired TSH and T4 values and ultrasonography finding. No clinical evidence of thyroid disease was previously found in these patients. Positivity of anti-GAD or anti-IA-2 was found in almost 65% and of any thyroid autoantibody in almost 30% of our patients. Four patients with autoimmune thyroid disease were newly identified. We conclude that the evaluation of thyroid autoantibodies in Type 1 diabetic patients may improve the diagnosis of thyroid disease in very early stage and thus prevent consequent complications.
Adult↗
[Frequent incidence of thyropathies in women with breast carcinoma].
In a group of 82 women with breast cancer selected at random 10 had treatment on account of thyroid disease. In 43 women the authors found a positive titre of antibodies against thyroid antigens, indicating autoimmune affection of thyroid tissue. Although none of the patients reported thyroid complaints a total of 11 women of the group (13.4%) had TSH values in the pathological range. Based on slightly elevated TSH levels and/or a positive TRH test the authors diagnosed 11 new cases of subclinical hypothyroidism and in two women subclinical thyrotoxicosis. They did not prove a relationship between thyroid disorder and chemotherapy or hormonal treatment. From the small number of 10 women treated by external radiation thyroid pathology was proved in 3. The finding that 25.6% women with breast cancer had beyond doubt a thyroid disorder, though subclinical, and another 26.8% are candidates of thyroid disease with a positive antibodies supports the hypothesis of a relationship of certain types of thyroid disease and (some types) of breast cancer. The influence of functional thyroid disease on the prognosis of breast cancer, in particular with regard to the autoimmune character of the diagnosed thyropathies will call for further detailed investigations.
Adult↗
[Thyroid gland function in women with breast carcinoma].
Data in the literature concerning thyroid disease in women after treatment of breast cancer differ. The authors examined therefore the thyroid function (thyroid stimulating hormone, thyroxine, triiodothyronine, antibodies against thyroid peroxidase and against thyroglobulin) in a random sample of 76 women after ablation of the breast on account of carcinoma. A deviation in some of the investigated indicators was found in 46,7% of the examined women. A total of 10,5% women had an elevated level of thyroid stimulating hormone, in 18,4% both antibodies were positive, in another 11,8% antibodies against thyroglobulin only were positive and in 9,2% antibodies against thyroid peroxidase were positive. In none of the women the thyroxine level was beyond the physiological, i.e. normal range, the triiodothyronine level was elevated in 5,2%. Newly diagnosed subclinical hypothyroidism in 10,5% of the group supports the hypothesis of a more frequent thyroid abnormality in women treated on account of breast cancer. The cause and sequelae of this finding will be investigated.
Aged↗
[Pitfalls in cytologic diagnosis of thyroid disease associated with pregnancy].
The activation of the hypothalamo-pituitary thyroidal axis during pregnancy and puerperal period may provoke an unusual morphological response that is hard to distinguish from malignancy. Moreover, autoimmune thyroiditis (postpartum thyroiditis--PPT) becomes manifest or aggravated in some predisposed women prone to contract thyroiditis with the termination of the physiological gestation immunosuppression. In five cytologically investigated women (some of whom were examined repeatedly) during the postpartum period less typical goitre and lymphoplasmacytic thyroiditis were observed. In two of them, a tumour was diagnosed (borderline oncocytic lesion and medullary carcinoma). Evaluating the dynamics of the process in the patients investigated repeatedly and the histological findings in others we conclude: 1) given thorough clinical observation and favorable development of the cytology picture the less typical lesions may be treated conservatively. 2) The diagnostic features of malignancy are maintained in the puerperal period. Taking into account the age distribution of thyroid malignancies this risk should be taken into account in the puerperal period too.
Adult↗
[Thyropathies].
This text presents a very brief historical overview of the globally significant discoveries in thyroidology. Three areas of thyroidological research are mentioned: questions of autoimmunity, iodine deficiency and the tumorigenesis of the thyroid glands. The following text refers to the colleagues and pupils of Professor Charvát who concentrated on thyroid gland research at the Third Medical Clinic. The contribution of the radioisotopic laboratory which-as part of the hospital-facilitated not only prompt diagnosis of the thyroid diseases of both in- and out-patients, but also provided the basis for extensive cooperation and research between specialists at the clinic, i.e. between obesitologists, cardiologists, haematologists, osteologists and paediatricians.
Humans↗
[Differential diagnosis of goiter using thin-needle biopsy-- differences between the pediatric and adult population].
The authors give an account of their experience with needle biopsy of the thyroid gland and differences in the frequency of different findings in the thyroid gland of adults and children. From the total number of 2260 punctures in adults and 274 punctures in children and adolescents they found in adults most frequently tissue without marked pathological changes (so-called standard finding), in 46%. In children the most frequent finding was lymphocytic thyroiditis, in 44.8%, in adults in 13%. Carcinomas were diagnosed in adults in 7.3% and in 1.8% children (= in 5 children). In four adolescents aged 19-23 years who observed a resistance in the thyroid gland at least from the age of 18 onwards and in a 22-year-old girl who had irradiation therapy on account of a Hodgkin lymphoma at the age of 19 years a thyroid carcinoma was diagnosed. The authors discuss also other less frequent thyroid findings. They draw attention to the diagnostic value of thyroid thin-needle puncture and consider this examination an essential diagnostic procedure in all obscure resistances in the thyroid area not only in adults but also in children.
Adolescent↗