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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.

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.

Objectives. To assess autoimmune thyroiditis prevalence in subclinical and clinical psoriatic arthritis (PsA). Materials and methods. 45 female adult Egyptian patients with psoriatic disease were classified into 3 equal groups: PsA, subclinical PsA, and psoriasis. A full assessment was done including Health Assessment Questionnaire, Psoriasis Area Severity Index (PASI), Leeds Enthesitis Index (LEI), PsA disease activity score (DAPSA), MAdrid Sonographic Enthesitis Index (MASEI), thyroid hormones (TSH, FT4, and FT3), thyroglobulin and thyroid peroxidase antibodies (Tg and TPO Abs), and thyroid ultrasound. Results. Thyroid abnormalities prevalence was: 33.3% with subclinical hypothyroidism, 80% with positive TPO Ab, and 46.7% with positive Tg Ab in PsA group, 26.7% with subclinical hypothyroidism, 60% with positive TPO Ab, and 33.3% with positive Tg Ab in subclinical PsA group and none in psoriasis group. PsA patients had higher TPO Ab levels compared to psoriasis patients with high statistical significant difference and lower FT3 levels compared to psoriasis patients with statistical significant difference. In subclinical PsA group, MASEI was positively correlated with TPO Ab with high statistical significance and with FT3 and Tg Ab with statistical significance, FT4 was negatively correlated with LEI with high statistical significance, and FT4 was correlated with PASI with statistical significance. In PsA group, TPO Ab was correlated with DAPSA with statistical significance. Conclusions. Autoimmune thyroiditis is more common in PsA than subclinical PsA patients. PsA patients are advised to be tested for TPO and Tg Abs. Musculoskeletal ultrasound is a screening tool to detect enthesitis in psoriasis patients.

Background: Sclerosing mucoepidermoid carcinoma of the thyroid gland was first reported in 1991. This type of a tumor may develop in connection with Hashimoto's thyroiditis. There are two variants of mucoepidermoid carcinoma of the thyroid gland: the normal and sclerosing types. Sclerosing mucoepidermoid carcinoma of the thyroid gland has recently been recognized by the World Health Organization as a separate disease. Сlinical case description: We present a clinical case of a 51-year-old woman who was observed for 2 years for autoimmune thyroiditis with nodulation. The patient had no symptoms or signs of compression. The level of thyroid–stimulating hormone was 15.8 (range 0.4–4.0), the level of antibodies to peroxidase was 150 IU/ml. Thyroid scintigraphy revealed a dominant cold node (1.5×2 cm) in the right lobe of the gland. During the control ultrasound examination of the neck, negative dynamics was observed, then a fine needle aspiration biopsy of the thyroid node was performed. A follicular tumor was found against the background of Hashimoto's thyroiditis, which was the reason for a timely treatment. In the described case, the patient underwent a total thyroidectomy without neck lymph node dissection, no postoperative radiotherapy or other auxiliary treatments were performed. A full-body scintigraphy showed no recurrence of the disease in 10 months after the initial treatment. Conclusion: Given the rarity of the disease and the impossibility to differentiate it from other thyroid tumor’s, a more thorough examination of the nearby lymphatic collectors is necessary to exclude metastatic lesions, and in the presence of altered lymph nodes, additional diagnosis by fine-needle aspiration biopsy with subsequent determination of the scope of surgical treatment and postoperative management of this category of patients is indicated.

Autoimmune polyglandular syndromes (APS) are a heterogeneous group of clinical conditions characterized by functional impairment of multiple endocrine glands due to loss of central or peripheral immune tolerance. These syndromes are also often accompanied by autoimmune damage to non-endocrine organs. Taking into account the wide range of components and variants of the disease, APS is usually divided into a rare juvenile type (APS 1) and a more common adult type (APS 2–4). APS type 1 is caused by a monogenic mutation, while APS types 2–4 have a polygenic mode of inheritance. One subtype of adult APS (APS 3D) is characterized by a combination of autoimmune thyroid disease and autoimmune rheumatic disease. This review considers the available literature data on combinations that meet the above criteria. Many studies have noted a significantly higher prevalence of rheumatic diseases in patients with autoimmune thyroid disease compared with the control group. Also, as in a number of rheumatic diseases, a more frequent occurrence of autoimmune thyroiditis, primary hypothyroidism and Graves' disease was noted.

Abstract Background Recent studies have reported associations between body mass index (BMI) and various autoimmune disorders. However, it is still uncertain whether there exists a direct cause-and-effect relationship between BMI and autoimmune thyroiditis (AIT). The aim of our study is to investigate the causal association between BMI and AIT. Methods We conducted a two-sample summary data Mendelian randomization (MR) analysis using genome-wide association studies (GWAS) summary statistics data related to BMI as exposure, and GWAS summary statistic data sets for AIT as the outcome. Robustly associated single-nucleotide polymorphisms (SNPs) for BMI were selected as instrumental variables (IVs). We used the inverse variance weighted (IVW) method as the primary method and performed other MR methods such as MR-Egger regression, weighted median, simple mode, and weighted mode analyses for further validation. The slope of MR-Egger regression was used to correct for pleiotropy and provide estimates of causality. The p-value for the intercept in MR-Egger was utilized to detect any directional pleiotropic effects. Heterogeneity and sensitivity analyses were performed to assess the robustness of our findings. Results Seventy-eight SNPs were selected from GWAS on BMI as the IVs. Our MR analysis using the IVW method showed a potential causal association between BMI and AIT (OR = 3.071, 95% CI 1.324–7.118). Findings from other MR methods are non-significant, although the direction of effect is consistent. There was no evidence that the result was affected by genetic pleiotropy (MR-Egger regression intercept = 0.01, SE = 0.00025, p = 0.719). Heterogeneity and sensitivity analyses revealed no significant heterogeneity among SNPs, and no single SNP drove the observed associations. Conclusion Our findings suggest a potential causal association between BMI and AIT, which may provide a basis for further investigation into the relationship between BMI and AIT. Further studies are required as only the IVW method shows significant results, and the case sample size is small.

Introduction:Although more common in adults, autoimmune thyroiditis (AT) is one of the most common thyroid diseases in children and adolescents. Salivary gland involvement has been described in many studies of patients with AT. Several inflammatory scores are used to assess the inflammatory status of patients with systemic autoimmune diseases. We aimed to sonographically evaluate the parotid and submandibular salivary glands with inflammatory parameters in patients with AT in our study.Methods:Our study population consisted of 37 consecutive pediatric AT patients and 29 healthy control subjects. Ultrasonographic and laboratory evaluations of the study population were performed. Jamovi and MedCalc software were used to analyze the data.Results:The volume of the thyroid gland in the patients was significantly higher than that in the control group (p=0.030), while there was no difference in the volume of the salivary glands. Multiple logistic regression analysis was planned to assess the predictability of salivary gland involvement in patients with the disease. Both systemic immune-inflammation index (SII) and pan-immune inflammation value (PIV) were found to be predictors of salivary gland involvement in AT patients.Conclusion:We found that both SII and PIV inflammatory markers are predictive of salivary gland parenchymal changes in patients with AT, and SII is likely to be more valuable than PIV at this time.

A review of data on the possible causes of an increase rheumatoid factor (RF), antibodies against cyclic citrullinated peptide (ACCP) and antibodies to modified citrullinated vimentin (AMCV) in patients without rheumatoid arthritis (RA) is presented. The possibility of hyperproduction of these autoantibodies before the development of the clinical picture of RA was indicated. It is indicated that ACCP and IgA RF have the greatest prognostic value in terms of the subsequent development of RA. These antibodies are recommended to be additionally determined in diagnostically difficult cases. Data on the sensitivity and specificity of detection of RF, ACCP and AMCV in the diagnosis of RA are summarized. The results of detection of the discussed antibodies in various rheumatic (other than RA) and non-rheumatic diseases are presented in detail. Particular attention is paid to diseases in which increased synthesis of RF, ACCP and AMCV may not be accompanied by clear clinical symptoms (Sjögren’s disease, autoimmune thyroiditis, some chronic infections, silicosis, monoclonal gammopathy, etc.). Recommendations are given for examining patients with “accidentally” identified increase in RF or ACCP.

The article presents a description of a patient with chronic HCV infection and multiple extrahepatic manifestations, which manifested in dynamics and were recorded with a different sequence during 15 years of follow-up. In the patient we observed, the most frequently recorded extrahepatic manifestations were verified: porphyria cutanea tarda, mixed cryoglobulenemia, and utoimmune thyroiditis. Chronic HCV infection is often diagnosed in the presence of psoriasis was assessed as a paraneoplastic disease.

Summary: Anemia is a global public health problem that needs to be identified. When determining the algorithms for examination and treatment of anemic syndrome, it is necessary to carefully study the risk factors for its development, taking into account comorbidity. Carrying out of diagnostic search in several directions will allow to specify mechanisms of development of an anemic syndrome which at a combination worsen a clinical condition. Special attention should be paid to patients with manifestations of anemic syndrome on the background of endocrine pathology, namely autoimmune thyroiditis in hypothyroidism, as the incidence rate among women of childbearing age has increased significantly, which determines the direction of research and aim of this publication. The article presents a clinical case of observation and treatment of a patient with chronic autoimmune thyroiditis in a state of hypothyroidism and adenomyosis, accompanied by abnormal uterine bleeding, which was complicated by iron deficiency anemia. Because the patient initially considered uterine bleeding to be the main problem, she was observed by a gynecologist; at the same time changes of indicators of the general analysis of blood in favor of anemia are established. Treatment of endometriosis and the appointment of iron supplements led to improvement with the normalization of laboratory parameters. For 6 months the patient did not consult a doctor, no laboratory control was performed. If she felt worse, the patient consulted a family doctor. Careful examination with the involvement of an endocrinologist allowed to diagnose chronic autoimmune thyroiditis in a state of hypothyroidism and prescribe adequate therapy, which helped to normalize the patient's condition. Conclusion. Manifestations of anemic syndrome require determining the causes of its occurrence with the development of algorithms for examination and monitoring of treatment. The general practice physician should be the main coordinator in studying the causes of anemia and the management of patients in the outpatient phase with the involvement of physicians of other specialties.

Abstract Autoimmune polyglandular syndrome type 2 (APS II) is a rare autoimmune disease that affects many endocrine glands. We present a case of a 32‐year‐old man with Addison's disease, autoimmune thyroiditis, and pernicious anemia. Multi‐line and timely management are crucial for each association.

One of the most important pathogenetic mechanisms of autoimmune thyroiditis (AIT) is the violation of immunological tolerance and the development of the autoimmune process, the markers of which are various biologically active substances, in particular, matrix metalloproteinases (MMP) of the extracellular matrix (ECM). MMPs play a crucial role in the development of pathological processes in these diseases, contributing­ to matrix degradation due to imbalance between the activity of enzymes and their inhibitors. The aim of the work was to study the activity of key metalloproteinases and the level of α2-macroglobulin in patients with autoimmune thyroiditis. The diagnosis of AIT was established based on the study of data on anamnesis, thyroid status, the results of ultrasound of TG, and the presence of antibodies to the thyroid-stimulating hormone receptor (TSH) in blood plasma. Patients were enrolled in 2 groups: group 1 – 74 patients with a manifest form of the disease; group 2 – 96 patients with a subclinical form of the disease. The study of matrix metalloprotein activity in the examined patients showed a statistically significant (P = 0.015) increase in MMP-3 and MMP-7 activity in patients with AIT compared to the corresponding parameters in persons of the control group. Thus, levels of MMP-3 and 7 were in the group of patients, respectively 56 (51.0; 59.0) and 4.6 (4.3; 5.2) ng/ml, in control 23.0 (16.0; 26.0) and 3.6 (3.4; 4.1) ng/ml, respectively.

Aim. Primary hyperparathyroidism (PHPT) often coexists with thyroid diseases. Current guidelines advise preoperative ultrasound (US) examination of the thyroid gland for thyroid nodular disease or concomitant malignancy but not evaluation for autoimmune thyroiditis (AIT). The impact of autoimmune thyroiditis on the clinical presentation and intraoperative course of PHPT is not clear. Material and methods. We retrospectively assessed the medical records of 21 patients with PHPT who underwent parathyroidectomy. Clinical, biochemical, ultrasonographic and intraoperative data were evaluated. Results. There was a longer duration of parathyroidectomy in patients with AIT than in those without (113.3 min vs. 93.9 min, P=0.03). A lower rate of kidney stones was noted in patients with autoimmune thyroiditis (44.4% vs. 0%, P=0.03). Patients with AIT were more symptomatic, but this was not significant. There was no difference between the two groups in the prevalence of osteoporosis or thyroid nodular disease. Conclusions. A significantly longer duration of parathyroidectomy was seen in PHPT patients with AIT. Patients with PHPT undergoing surgery should be investigated for autoimmune thyroiditis, as this may affect surgical planning.

ABSTRACT Objectives: To assess serum anti-Müllerian hormone (AMH) levels as an ovarian reserve marker in adolescent girls with autoimmune thyroiditis (AIT) and explore the relationship of this marker with autoimmunity and thyroid function biomarkers. Subjects and methods: This study included 96 adolescent girls with newly diagnosed AIT and 96 healthy, age- and sex-matched controls. All participants were evaluated with detailed history taking and physical examination, thyroid ultrasound, and measurement of levels of thyroid-stimulating hormone (TSH), free thyroxin (FT4), free triiodothyronine (FT3), antithyroid peroxidase antibodies (TPOAb), antithyroglobulin antibody (TGAb), estradiol, total testosterone, and anti-Müllerian hormone (AMH) levels. The LH/FSH ratio was also calculated. Among 96 patients evaluated, 78 were overtly hypothyroid and 18 were euthyroid. AMH levels were significantly lower in participants with overt hypothyroidism and euthyroidism compared with controls. Results: Serum levels of AMH correlated negatively with age, body mass index (BMI) standard deviation score (SDS), and TPOAb, TGAb, and TSH levels but positively with FT4 levels. In multivariate analysis, AMH levels correlated significantly with age (odds ratio [OR] = 1.65, 95% confidence interval [CI] 1.18-2.32, p = 0.05), BMI SDS (OR = 2.3, 95% CI, 2.23-3.50, p = 0.01), TSH (OR = 2.43, 95% CI 1.5-2.8, p = 0.01), and TPOAb (OR = 4.1, 95% CI 3.26-8.75, p = 0.001). Conclusions: Ovarian reserve of adolescent girls with AIT, as measured by serum AMH levels, is affected by thyroid autoimmunity and hypothyroidism, indicating a possible need for ovarian reserve monitoring in these patients.

Introduction. Nodular goiters are clinically recognizable enlargements of the thyroid gland characterized by structural and/or functional transformation of one or several areas within the normal thyroid tissue. In the absence of thyroid dysfunction, autoimmune thyroid disease, thyroiditis, and thyroid malignancy, they constitute an entity described as simple nodular goiter. The objective of the study was to determine the scope of surgery in patients with unilateral nodular goiter with autoimmune thyroiditis (NGAIT) with compression syndrome and predict the long-term results of surgical treatment, based on the study of proliferation of apoptosis and autoimmune disorders. Materials and methods. Long-term results of hemithyroidectomy were analysed in 101 women aged between 23-72 years, with unilateral NGAIT. We analysed the volume of the gland lobe and the echo structure variant before surgery, blood levels of thyroid-stimulating hormone (TSH), free thyroxine and triiodothyronine, thyroid peroxidase antibodies (TPOab), apoptosis and proliferation indicators showing satisfactory or unsatisfactory treatment results. Results. In 75 patients, three years after hemithyroidectomy, no thyroid dysfunction was detected. At ultrasound, in the remaining thyroid the signs of autoimmune thyroiditis (AIT) did not progress. Twenty-six patients showed an increase in the remaining thyroid gland and progression of the autoimmune disease, with hypothyroidism. Conclusions. Hemithyroidectomy can be performed in patients with NGAIT and compression syndrome in conditions of preserved gland function, activation of proliferation and apoptosis, and pseudo micronodular parenchymal echo structure.

Sclerosing lichen (SL) of the external genitalia is a chronic slowly progressive disease with pronounced focal atrophy of the skin of the perineum and visible mucous membranes of the vulva and has two main peaks of clinical manifestations: childhood and perimenopausal age. It is associated with an increased risk of developing vulvar cancer, even though it is not a malignancy in itself. The true precursor of SL-associated cancer is intraepithelial vulvar neoplasia (VIN). The diagnosis is usually clinical, but in some cases a biopsy may be performed, especially to rule out VIN or cancer. In this study, 180 patients with SL vulva were examined on the basis of two clinical bases (National Cancer Institute, MC "Verum"). After examining the patients, the diagnosis was made on the basis of examination, complaints, advanced biochemical blood test, detailed blood test, hormonal examination and ultrasound. In most cases, the diagnosis of SL vulva is clinical. As a result of a number of examinations of patients of reproductive age in patients with SL vulva, it was found that SL vulva is a consequence of thyroid disease (82.2%) of different types compared with patients in the control group (32.7%). The diagnosis of SL vulva was established in young patients mainly with AIT (48.6%) and with AIT accompanied by hypothyroidism or nodular thyroid disease (27%). When comparing the diagnostic findings of thyroid disease in patients with SL vulva and the control group, no significant differences were found. Therefore, timely detection of latent forms of AIT, hypothyroidism, nodular goiter, adequate treatment of thyroid dysfunction will allow to normalize changes in the reproductive system and prevent the formation of pathological lesions of the reproductive organs of women.

Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis, is a necrotizing vasculitis of small and medium-sized blood vessels characterized by diffuse inflammation of vascular structures and perivascular and extravascular granulomatosis. In its systemic form, GPA predominantly affects the ear, nose and throat, with lung and kidney involvement with typically rapidly progressive necrotizing glomerulonephritis with extracapillary crescents, while the absence of kidney damage at the time of diagnosis is defined as a limited form of GPA with a more favorable prognosis (1, 2). Antineutrophil cytoplasmic antibodies (c-ANCA) with specificity for proteinase 3 (PR3) represent a biochemical diagnostic criterion. They are detected in 90% of generalized forms and in about 50% of limited forms of granulomatosis with polyangiitis (1, 2). In the absence of treatment, GPA is a disease of progressive evolution. Systemic corticosteroid therapy and immunosuppressive therapy significantly changed the prognostic aspect of the disease. Only a few sporadic observations have been published on endocrine disorders associated with GPA. We present a case of a man, 39 years old, with Wegener's granulomatosis who developed autoimmune thyroiditis 8 years after the initial diagnosis.

Hashimoto thyroiditis (HT) is a thyroid-specific autoimmune disorder, triggering hypothyroidism in a population with an adequate dietary intake. Despite the current conventional treatment focuses on the permanent replacement of levothyroxine (LT4) deficiency, it appears that thyroid autoimmunity remains the cause of persistent symptoms in patients with HT, even when they achieve to be euthyroid from a biochemical standpoint. Photobiomodulation (PBM) showed to be an effective therapy in the management of autoimmune diseases, but with limited evidence. Hence, our study was conducted to appraise the efficacy of PBM therapy with supplements in restoring thyroid gland homeostasis in patients with HT compared with supplements alone. Seventy-four female subjects aged between 20 and 50 years old were recruited and divided equally into two groups: PBM and supplements group (group 1); and supplements alone group (group 2). The PBM dosimetry and treatment protocols were as follows: wavelength, 820 nm; power output, 200 mW; continuous emission mode; irradiating time, 20 s per point; fluence, 32 J/cm2 per point; treatment frequency, twice a week (excluding weekends); and treatment duration, three consecutive weeks. Whereas, the supplements protocol for both groups was the same, as follows: subjects with a serum level of vitamin D3 p < 0.05). Our results, for the first time, demonstrated an efficacy of PBM delivered at a lower fluence with supplements in restoring thyroid function, anthropometric parameters and lifestyle factors in patients with HT. Hence, extensive studies with a longer follow-up period are warranted.

Abstract Background Juvenile dermatomyositis is an inflammatory disease of muscles, skin, and blood vessels of unknown cause affecting all age and ethnic groups, with a reported incidence of 1.9–4.1 per million. It manifests with weakness in axial and proximal muscles and typical skin lesions. Historically, the Bohan and Peter classification schema has been used to diagnose juvenile dermatomyositis. Case presentation We report an 8-year-old African female child, who presented with features of juvenile dermatomyositis and a rare association with subclinical autoimmune thyroiditis. This case illustrates the typical presentation, diagnosis, and treatment outcomes of this highly misdiagnosed condition. Conclusion Due to the limited resources and knowledge about this under-reported disease in resource-constrained settings, the characteristic manifestations of juvenile dermatomyositis can be easily missed and thus requires a high index of suspicion for earlier diagnosis and management.

Chemical environmental factors trophic for the endocrine system and its organs produce negative influence on it that becomes apparent through growing incidence and pathomorphism of endocrine diseases. Our test group was made up of 102 children with diagnosed autoimmune thyroiditis (AIT) who were chronically exposed to metals (lead, manganese, nickel, chromium, and zinc) being components in emissions from metallurgic enterprises in Perm region. Our reference group included 46 children with AIT who lived beyond zones influenced by the aforementioned enterprises in areas with the sanitary-hygienic situation being relatively favorable. We comparatively analyzed the results of clinical and ultrasound examinations that focused on evaluating children’s thyroidal and immune state. A growth in incidence with thyroiditis amounted to 63.6 % on the test territory over 10 years and it was 1.6 times higher than on average in the region (40.8 %); there was no growth in the indicator detected on the reference territory. Concentrations of chromium, nickel, lead, zinc, and manganese higher than regional background level were 1.7–5.5 times more frequently detected in blood of children from the test group against the reference one. A number of AIT cases was higher among exposed boys (by 2.0 times, p = 0.070); exposed children also had higher Ig A, M, and G contents in blood serum (by up to 2.9 times, p = 0.015–0.056), higher TSH levels (by 2.0 times, p = 0.096), and lower free T4 contents (by 5.4 times, p = 0.057). Diffuse damage to the thyroid gland was by 1.3 times more frequent under exposure to adverse factors created by metallurgic production; AIT combined with other diseases was also more frequent (p = 0.041). Rates and growth in incidence of thyroid gland diseases and thyroiditis are by 1.3–2.3 times higher among children and teenagers living on territories where metallurgic enterprises are located against the same indicators on territories where sanitary-hygienic situation is relatively favorable. We detected less apparent gender-related differences in AIT frequency, a greater number of improper thyroidal state, elevated risks of diffuse changes in the thyroid gland and activation of humoral immune response that was by 2.2–3.4 times more frequent together with concomitant damage to other systems under elevated contents of metals in blood.

Autoimmune thyroiditis is very rare etiology of primary hypothyroidism in infancy. Hypothyroidism has a wide range of clinical presentation, from subclinical hypothyroidism to overt type. It is unclear what pathological mechanisms connect thyroid function and erythropoiesis or how thyroid disease can contribute to anemia. We report a 12-month-old infant who presented with anemia associated with early onset of overt autoimmune thyroiditis. The peculiarity of our case enables us to draw attention of physician to consider acquired hypothyroidism in the differential diagnosis of unexplained anemia even if the neonatal screening is normal and congenital hypothyroidism is a remote possibility.

Selenium is one of the most important micronutrients affecting the human body. It plays a crucial role in the thyroid gland, where its concentration is the highest. This element has the ability to remove reactive oxygen species and deiodinate thyroid hormones. Balanced diet and supplements are basic for achieving proper concentration of selenium in human organism. Recently a number of studies have been conducted focusing on the effect of selenium on autoimmune thyroiditis - Hashimoto’s disease. In our study the oral supply of selenium was used, and then the levels of selected parameters were measured. It has been proved that Selenium lowers levels of antithyroglobulin and anti-thyroid peroxidase antibodies. Moreover the concentration of Thyroid Stimulating Hormone is also lowered by this micronutrient. In this review we draw attention to possible resources of delivery of this element to organisms and the impact it has on the course of the above-mentioned diseases. We come to conclusion that there is a strong correlation between Selenium and the functioning of thyroid gland. Doctor’s awareness and cooperation with the patient in order to establish proper doses of micro- and macronutrients which are taken with basic medications is very important for the therapeutic process. This article is a review of current medical knowledge about Selenium affecting a thyroid gland based on available publications in Pubmed and Google Scholar databases.

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a sensory and motor demyelinating polyneuropathy that occurs with autoimmune mechanisms, affects the spinal roots, plexuses, and peripheral nerves, and presents with attacks or progressivity. Proximal and/or distal strength loss and mild atrophy in the upper and lower extremities and sensory complaints, such as numbness, pain, and burning, are observed. Cranial nerve involvement rarely accompanies typical findings. Facial nerve involvement is the most common; however, trigeminal, oculomotor, hypoglossus, and abducens nerve involvements are reported. Multifocal acquired demyelinating sensory and motor neuropathy (MADSAM) is an atypical variant of CIDP, characterized by asymmetrical motor and sensory losses and conduction blocks in the electromyography. Hashimoto’s thyroiditis is an autoimmune disease diagnosed with high serum thyroid antibody concentrations. Coexistence with neurological autoimmune diseases such as multiple sclerosis, myasthenia gravis, and multifocal motor neuropathy was reported. Moreover, few studies showed the coexistence of Hashimato’s thyroiditis and CIDP in the literature. Presented herein is a case of MADSAM with cranial nerve involvement and Hashimato’s thyroiditis.

Abstract Rheumatic manifestations can reveal hypothyroidism, such as arthritis and nonspecific musculoskeletal symptoms. We report herein the case of an acute polyarthritis revealing Hashimoto's thyroiditis (HT). Hormone replacement therapy leads to the resolution of arthritis related to HT, suggesting the role of thyroid hormone in the pathogenesis of arthritis.

Metformin decreases elevated prolactin levels, which are frequently found in patients with thyroid disorders. The aim of this study was to investigate whether thyroid autoimmunity modulates the impact of metformin on lactotrope secretory function. This study compared two matched groups of young women with prediabetes and mild-to-moderate prolactin excess: 28 subjects with coexisting euthyroid autoimmune thyroiditis (group 1) and 28 individuals without thyroid disorders (group 2), treated for six months with metformin (3 g daily). Thyroid antibody titers, glucose homeostasis markers, prolactin, thyrotropin, free thyroid hormones, FSH, LH, ACTH, IGF-1 and hsCRP were assessed at the beginning and at the end of the study. At entry, the study groups differed in antibody titers and hsCRP levels. Although the improvement in glucose homeostasis and the decrease in hsCRP levels were observed in both study groups, they were more pronounced in group 2. Only in group 2 did metformin reduce circulating prolactin levels (both total and monomeric). Prolactin-lowering properties of metformin positively correlated with baseline prolactin levels, baseline antibody titers (in group 1) and with the degree of reduction in hsCRP levels. The obtained results suggest that autoimmune thyroiditis may attenuate the impact of metformin on lactotrope secretory function.

The article presents an analysis of resources about the course of thyroid pathology, specifically hypothyroidism, during pregnancy. This problem is of current interest, because hypothyroidism can cause infertility or miscarriage. This applies not only to overt but also to the subclinical one. The physiological changes that occur in the thyroid gland during pregnancy are described. Attention is drawn to the signs that can be mistaken for pathological. In addition, the reference values of hormonal thyroid parameters during pregnancy differ significantly from those in non-pregnant women. This should also be taken into account in the diagnosis of appropriate disorders. The presented resources data are illustrated by two clinical cases. The first case history demonstrates the deterioration of the autoimmune process on the background of the pregnancy. Interesting is the fact that this effect was delayed, ie during pregnancy, compensatory mechanisms created a proper supply of the body of a woman and two fetuses with thyroid hormones. At the same time, during lactation period there was a pronounced decompensation of the patient's condition, which was manifested by activation of autoimmune aggression against thyroid tissue with increasing titer of antithyroid antibodies, the development of overt hypothyroidism and deepening structural changes in the thyroid gland. The need for further follow-up of postpartum women with autoimmune thyroiditis is emphasized, even if no thyroid dysfunction has been reported throughout pregnancy. The second clinical case illustrates the importance of following the recommendations of the European and American thyroid associations regarding the level of thyroid-stimulating hormone (TSH) during pregnancy. When planning the first pregnancy of this patient, the doctor did not pay attention to the fact that TSH level, being within normal values for non-pregnant women, did not meet international guidelines for planning a pregnancy and its first trimester. This had extremely adverse consequences in the form of two miscarriages. The prescription of an appropriate hormone replacement therapy and careful monitoring of the patient both at the planning stage and throughout the pregnancy, led to the birth of a healthy baby. Thus, compliance with the principles of management and use of the proposed treatment regimens for pregnant women with thyroid pathology will ensure the normal course of pregnancy and the birth of a healthy child.

Introduction. The main treatment of autoimmune thyroiditis (AIT) is conservative. However, there are patients with AIT in whom surgical treatment is mandatory. The growing experience and reports of surgical intervention with newer indications challenges this traditional view of AIT. The objective of the study was to determine the choice of surgery volume in patients with nodular goiter and AIT, taking into account the activity of apoptosis, index of proliferative activity and polymorphisms of cytotoxic T-lymphocyte antigen-4 (CTLA-4) gene. Material and methods. 95 patients with nodular goiter and autoimmune thyroiditis (NGAIT) were included in the study. We determined the activity of the apoptosis index of proliferative activity and gene polymorphism of CTLA-4. Results. The correlation analysis of markers used to optimize surgical treatment, namely the choice of the surgery volume in patients with NGAIT, showed that the studied tests are objective and reliable for the long-term results of surgical treatment: the volume of the thyroid gland not affected by the nodes less than 10 cm3, the level of antibodies to thyroid peroxidase (TPO Ab) 43%, IIRC Bcl-2 50%; AA and AG-genotype of the CTLA-4 gene. Conclusions. The study allowed to determine new criteria for selecting the volume of surgery in patients with NGAIT.

Aim. To determine the features of visualization of papillar thyroid cancer (PTC) in presence of autoimmune thyroiditis (AIT) according to sonoelastography data. Materials and methods. 155 patients were examined (75 PTC, 30 AIT, 20 PTC in presence of AIT and 30 with diffuse parenchymal changes) and 30 patients of the control group. Among patients with PTC 68 (90.7%) were represented by female (mean age 46.713.12 years) and 7 (9.3%) by male (average age 48.14.05 years) patients, PTC in presence of AIT by 19 female (average age 46.916.98 years) and 1 male (22 years) patients. Ultrasound investigation was performed with devices Toshiba Aplio-400 and Toshiba Aplio-500 (Japan) by the standard method and using elastography. A surface transducer with a frequency of 1014 MHz was used. An analysis of the thyroid ultrasound image was performed in correspondence with TI-RADS. For a qualitative assessment of the elastographic picture of thyroid foci, the TsukubaUeno assessment visual standardized system was implemented. Results. According to the TI-RADS scale, most nodular formations are assigned to category 4. With TPC with an unchanged thyroid gland, category 4 was determined in 52 patients (69.3%), and with PR in presence of AIT 15 patients (75%). When determining the qualitative criteria for Tsukuba Ueno, the majority of tumors were assigned to types 3b and 4: cancers in presence of AIT 95% and cancers with no changes to thyroid gland 81.3%. Sonoelastographic criteria for thyroid parenchyma with AIT with a high degree of confidence are significantly higher than in the control group (p0.000). In a comparative analysis of thyroid sonoelastography in PTC with unchanged parenchyma and AIT, changes according to compression elastography are statistically unreliable. In shear wave elastography, sonoelastographic criteria for PTC are significantly higher in patients with AIT (p0.02 when measured in kPa, p0.01 when measured in m/s). Conclusion. Sonoelastography data can be used as additional criteria in the differential diagnosis of focal thyroid formations.

ABSTRACT Objective: The prevalence of autoimmune thyroiditis (AT) in papillary thyroid carcinoma (PTC) is still controversial. The aim of this study was to investigate the frequency of coexistence of PTC with AT versus that of the coexistence of benign nodules with AT. Materials and methods: This was a cross-sectional retrospective study including patients operated on for thyroid nodules from January 2011, to April 2021. The frequency of papillary carcinomas cooccurring with AT was compared to that of benign nodules cooccurring with AT, which was assessed based on cytopathological diagnosis after thyroidectomy. Results: The study included 668 cases of benign nodules and 420 cases with PTC. No statistically significant difference was observed between cases of benign and PTC nodules regarding the presence of AT (25% vs. 28%, respectively, p = 0.177). The size of the PTC compared to that of the benign predominant nodules was significantly smaller both in the absence (0.96 ± 1.09 cm vs. 2.19 ± 1.06 cm, p < 0.05) and in the presence (0.77 ± 0.76 cm vs. 1.67 ± 1.08 cm, p < 0.01) of AT. In the binary logistic regression analysis of the PTC, the only variable associated with AT was multifocality (odds ratio: 1.750, 95% confidence intervals: 1.131-2.706, p = 0.013). The incidences of lymph node involvement and advanced stage PTC were very low both in the presence and absence of AT. Conclusion: The nodules present with PTC were not more likely to coexist with AT than benign nodules were. The small incidence of advanced PTC indicates a significant improvement in early-stage diagnosis.

Objective To investigate the significance of macrophage polarization imbalance and metabolic pathway changes in the occurrence and development of autoimmune thyroiditis (AIT). Methods Four weeks old NOD.H-2h4 female mice were randomly divided into control group and AIT group(0.05% sodium iodide water). Hematoxylin-eosin(HE) staining was used to observe the lymphocyte infiltration in thyroid tissue. TgAb was measured by ELISA technology. The ratio of M1 type and M2 type macrophages in thyroid tissue was analyzed by immunofluorescence. Seahorse was used to analyze the energy metabolism of cells, and the extracellular acidification rate (ECAR) and oxygen consumption rate (OCR) were measured. Results The thyroid tissue of mice in AIT group had obvious lymphocyte infiltration, and the incidence of AIT was significantly higher than the control group(P＜0.05). Compared with the control group, the ratio of M1 and M2 macrophages in the thyroid tissue of mice in the AIT group increased, while the proportion of M2 type macrophages decreased (P＜0.05); the ECAR and OCR values of mice in the high iodine drinking water group were significantly higher than those of the control group (P＜0.05). Conclusions The changes of macrophage metabolism and polarization imbalance affect the occurrence and development of AIT.

Objective To investigate the inhibitory effect of α-lipoic acid on inflammation in autoimmune thyroiditis (AIT) mice and its effect on lymphocyte subsets. Methods Eighty NOD.H-2h 4 female rats were randomly divided into a control group and the AIT group which was given 50 mg/L sodium iodide orally; Low- and high-dose α-lipoic acid intervention group was injected intraperitoneally with 0.1 and 0.4 g/L α-lipoic acid daily. Twenty animals in each group were continued to be intervened for 8 weeks. After 8 weeks of intervention, HE staining was used to observe lymphocyte infiltration; flow cytometry was used to detect Th17, Treg, CD4+, CD8+ T cells and CD4+/CD8+ levels; and Western blot method was used to determine p38MAPK and NF-κB protein level. Results The incidence of thyroid inflammation in AIT group was as high as 85%. The incidence of thyroiditis, the degree of thyroid inflammation, and the proportion of Th17 cells in the AIT+low/high-dose alpha-lipoic acid group were significantly lower than those in the AIT group (P＜0.05), and the proportion of Treg, CD4+, CD8+, and CD4+/CD8+ cells were significant higher than that in the AIT group (P＜0.05).The AIT+low/high-dose α-lipoic acid group had significantly lower relative protein expression than those in the AIT group (P＜0.05). Conclusions α-lipoic acid can reduce the expression of inflammatory cytokines in autoimmune thyroid mice, improve the proportion of lymphocyte subsets, thereby suppressing the inflammatory response and improving the symptoms of AIT.

Autoimmune thyroiditis is an organ-specific autoimmune disease caused by the activation of self-reactive CD4+ T cells. Regulatory T (Treg) cells are a population of T cells that play a central role in immunological tolerance by suppressing selfreactive cells. CD4+ Tregs are divided into thymic (tTreg) and peripheral (pTreg). tTregs perform their functions through cytokine-independent mechanisms, pTregs – through IL-10, TGF-β and IL-35. Tregs perform a protective function against AIT. Studies of Treg level in AIT show different results, in most cases Treg level is increased, and their function is impaired. Treg function in AIT is affected by many factors, such as the level of thyroglobulin, vitamin D etc. Apart from the Treg level itself, the Th17/Treg ratio is also crucial in AIT. Activation of Tregs and modification of the Th17/Treg ratio can be used in AIT treatment.

Introduction. In recent years, there has been an increase in the prevalence of gastroesophageal reflux disease and autoimmune thyroiditis in young people. This is associated with a hereditary predisposition, viral diseases, which are often recorded in children's and adolescent groups, the unreasonable use of a large number of drugs, as well as the influence of various negative environmental factors, instability of the autonomic nervous system, eating disorders, the presence of bad habits, chronic stress and others. The aim of the work was to investigate the state of total antioxidant status and the content of biomarkers of the second phase of detoxification of xenobiotics - manganese superoxide dismutase and glutathione peroxidase in young people with gastroesophageal reflux disease and autoimmune thyroiditis. Materials and methods. To achieve this goal, 120 patients with a combined course of gastroesophageal reflux disease (GERD) and autoimmune thyroiditis (AIT) were examined, which made up the main group and two comparison groups: with isolated GERD (45 people) and AIT (42 patients). All patients were students of various universities and were between the ages of 18 and 25. Duration of the disease did not exceed 3 years. The total antioxidant status as an indicator of the first phase of defense and the levels of mitochondrial manganese superoxide dismutase and glutathione peroxidase – the second phase of antioxidant defense was determined. Results. The study showed that in all surveyed groups there was a decrease of total antioxidant status, which characterizes the first phase of the antioxidant defense system. Changes in the first phase of antioxidant defense affect the indicators of the second level of the system, which became the basis for studying the activity of mitochondrial manganese superoxide dismutase. Thus, the value of this indicator in all examined individuals exceeded the norm, which confirmed the inclusion of the second controlling phase of antioxidant system into the pathological process. At the same time, an increase inhibition of the glutathione defense link, the second phase of xenobiotic detoxification, were diagnosed. Conclusions. Negative changes occur in the enzyme system of the first line of antioxidant system in patients with GERD and AIT which may be the result of an unfavorable autoimmune background. Control over the work of antioxidant system moves to the second phase of the system, manifested by an increase in the content of mitochondrial manganese superoxide dismutase and inhibition of the activity of glutathione peroxidase in patients with a combination of GERD and AIT.

Aim. The aim of this study was to evaluate the features and frequency of combinations various forms of thyroid cancer (TC) with background pathology of the thyroid parenchyma. Patients and methods. This was a retrospective study of 424 histological preparations of patients with TC who had undergone thyroidectomy over an 12-year period (between 2008 and 2019). Was determined of morphological variant of the TС, which appeared of combinations of with and without other pathology of the thyroid parenchyma. All statistical calculations were performed using Statistica 6.0. Copy right © Stat Soft, Inc. 1984-2001, Serial number 31415926535897. Statistical data processing was performed using Pearson χ2 test and Fisher’s exact test. Results. Of the 424 studied histological preparations of the thyroid gland, 178 were diagnosed with papillary carcinoma (PC), 161 had follicular carcinoma (FC), 50 had medullary carcinoma (MK), 25 had Gyurtle cell carcinoma (G-CLA), and 10 was poorly differentiated carcinoma (NDC). It has been shown that a large number of thyroid cancer develops against the background of benign thyroid pathology, most often against the background of colloid goiter (38%), autoimmune thyroiditis (29.5%) and follicular adenoma (26%), very few against of diffuse toxic goiter. (1.4%). Follicular adenoma of the thyroid gland is significantly more common in follicular carcinoma than in papillary and medullary carcinomas. As an independent disease, the studied carcinomas occurred in 35.8% of cases, and most often of them – follicular and medullary. Papillary thyroid cancer was most common against the background of autoimmune thyroiditis (47%) and colloid goiter (42%), less often with follicular adenoma (22%) and only in three cases with diffuse toxic goiter and only in combination with another background pathology. Follicular thyroid cancer with an equally high frequency occurred against the background of colloidal goiter and follicular adenoma (36 % and 35 %, respectively), significantly less frequently against the background of autoimmune thyroiditis (2.5 %) and diffuse toxic goiter (1.4 %). Gürtle cell carcinoma was most often found against the background of autoimmune thyroiditis and colloid goiter (48%), less with follicular adenoma (24 % of cases) and mainly with autoimmune thyroiditis and colloid goiter medullary cancer was detected with the same frequency with colloid goiter and autoimmune thyroiditis (28 %), and twice less often with follicular adenoma (14 %) and never with diffuse toxic goiter. Conclusions. The found high frequency and variety of pathological changes in the thyroid tissue against the background of various forms of cancer requires optimizing differential diagnosis, surgical tactics and strategy of postoperative treatment of this pathology.

Vitiligo is a common polygenic autoimmune disease in which the foci of depigmentation are formed on the skin and/or mucous membranes as a result of the death of melanocytes. There are several hypotheses for the pathogenesis of the disease, the leading role among them is played the autoimmune hypothesis. This review summarizes the available literature data on the prevalence and structure of comorbid endocrine autoimmune pathology in vitiligo patients. In most studies conducted in Europe, America and Asia the prevalence of autoimmune thyroid diseases (including autoimmune thyroiditis and Graves disease), diabetes mellitus and autoimmune adrenal insufficiency was higher in vitiligo patients than in the general population. The results of some studies indicate a frequent association of vitiligo with autoimmune polyglandular syndromes. In the structure of comorbid pathology the highest prevalence was in autoimmune thyroid diseases. A number of studies have established a higher prevalence of autoimmune endocrine diseases in women, as well as in nonsegmental vitiligo patients and in cases of family history of vitiligo and/or other autoimmune diseases. In addition, it was shown that the prevalence of endocrine diseases increases with increasing area of depigmentation. The data obtained justify the advisability of conducting a timely examination of vitiligo patients with the aim of early detection of comorbid diseases and the appointment of appropriate treatment. Further studies are needed to investigate the effect of the identified associations on the course of vitiligo and comorbid endocrinopathies, as well as the effectiveness of therapy and the quality of life of patients.

Recent studies have shown that papillary thyroid cancer (PTC) associated with autoimmune thyroiditis (AIT) has a higher percentage of malignant nodes. However, it has not been studied how AIT affects the development and course of PTC. The aim was to determine the incidence of autoimmune thyroiditis in papillary thyroid cancer and study the frequency of its metastasis. Materials and methods. A retrospective analysis of 63 case histories of patients diagnosed with PTC who received treatment in the Surgery Department of “VIZUS” LLC from January 2018 to December 2019 was performed. The mean age of the patients was 53.1 ± 10.4 years. There were 56 (88.9 %) women and 7 (11.1 %) men among the patients. All the patients underwent surgical treatment. An inclusion criterion for the main group was pathohistologically confirmed PTC and AIT – 33 patients (52.4 %). The comparison group included patients with PTC without AIT – 30 (47.6 %). Results. Hypothyroidism was detected in 5 (15.2 %) persons of the main group, and the other patients were diagnosed with euthyroidism – 28 (84.8 %). All the comparison group patients - 30 (100 %) were in a state of euthyroidism. Elevation of antibodies to thyroperoxidase (AT-TPO) was found in 14 (42.4 %) persons in the main group, while no increase in this indicator was found among the comparison group patients. The specific to AIT changes in the ultrasonographic characteristics of the thyroid parenchyma were detected in 13 patients (39.4 %) of the main group and in 9 (30.0 %) patients of the comparison group, P = 0.3714. Following the cytological examination results of thyroid nodule aspirates, follicular neoplasia was detected in 6 (18.2 %) patients of the main group and in 2 (6.7 %) of the comparison group, P = 0.0473. The pathohistological examination revealed a combination of PTC with AIT in 33 (52.4 %) patients. Cancer metastasis to the regional lymph nodes was observed in 14 (42.4 %) patients with AIT and 10 (33.3 %) patients of the comparison group, P < 0.0356. Conclusions. The results of ultrasound, fine-needle aspiration biopsy and measurement of serum thyroid hormone levels are not sufficiently informative to diagnose AIT. The specific to AIT changes in the thyroid parenchyma impede the diagnosis of malignancies. The metastasis frequency in PTC with coexistent AIT is higher than without it.

Aim. The aim of this study was to evaluate the frequency of combinations of Hashimoto’s thyroiditis (HT) with other underlying pathology of the thyroid parenchyma in various forms of thyroid cancer (TC). Patients and methods. This was a retrospective study of 424 histological preparations of patients with TC who had undergone thyroidectomy over an 12-year period (between 2008 and 2019). Was determined of morphological variant of the TС, which appeared of combinations of HT with and without other pathology of the thyroid parenchyma. All statistical calculations are made using Statistics 6.0 Copyright © StatSoft, Inc. 1984-2001, Serial number 31415926535897. Statistical analysis was performed using chi-square test and Fisher’s exact criterion. Results. It was shown that thyroid cancer, as an independent disease, occurred in 35.8% of ТС (152 cases). However, it was found that Gyurtle- cellular ТС, as an independent disease, on the background of intact thyroid parenchyma was observed significantly less often (РF 2-4 = 0,04; РF 3-4 = 0,021), than follicular ТС and medullary ТС, and papillary ТС – much less common than follicular ТС (Рχ1-2 = 0,003). HT as a background pathology, in a separate form was detected in 58 cases (13.7%) of the ТС, and in combination with other pathology of the thyroid gland in 67 cases (15.8%). Thus, in general, HT is 29.5% (125 cases), the last 147 cases of the thyroid gland were combined with other background pathology of the thyroid gland. The most common background thyroid diseases at which ТС was detected in combination with НТ were colloid goiter and follicular adenoma, as well as their combinations. In total, НТ was found in papillary ТС in 47% of cases, in medullary ТС – in 30%, in Gyurtle- cellular – in 56% and in poorly differentiated ТС – in 40%. It was shown, that in combination with follicular carcinoma, НT is detected significantly less frequently than in all other studied forms of ТC (in pure form – 2.5%, all in all – 5.5%). Conclusions. Such a frequent combination of thyroid cancer with other thyroid diseases can significantly complicate preoperative diagnosis and requires special attention when choosing treatment tactics.

The prevalence of hypothyroidism in the population is high. The frequency of manifest hypothyroidism in the world, according to various data, is 0.2–2.0%, subclinical one – up to 10% for women and up to 3% for men, and in the older age group (over 70 years) reaches 14%, with the majority of cases of hypothyroidism accounted for primary hypothyroidism. Thus, a doctor of any specialty in his practice is likely to meet a patient with hypothyroidism: both with the established diagnosis, and face the need for differential diagnosis of various pathological conditions with hypothyroidism. This article presents a classification of hypothyroidism based on etiological aspects, describes the clinical picture of the disease, pays special attention to the so-called «masks» of hypothyroidism, which, in our view, can be useful for a doctor of any specialty, provides available methods for diagnosing this syndrome (special attention is paid to laboratory methods), as well as the goals and principles of treatment, highlights the need to monitor laboratory indicators in dynamics against the background of treatment. In addition, the features of correction of hypothyroidism during pregnancy are given. The article presents the peculiarities of selecting drug doses depending on the patient’s age and comorbidity. The distinctive feature and the purpose of this article, from our point of view, is its potential benefits not only for endocrinologists, but also for other health professionals.

The article presents the issues of epidemiology, classification, and clinic of hypothyroidism. The frequency of hypothyroidism increases significantly with age. The most common form is primary hypothyroidism, caused by a pathological process in the thyroid gland itself. Secondary hypothyroidism or tertiary hypothyroidism is caused by insufficient secretion of thyroid- stimulating hormone (TSH), or thyrotropin-releasing hormone. The article deals with the main causes of primary and secondary hypothyroidism. The most common cause of primary hypothyroidism is autoimmune thyroiditis, which can develop both separately and simultaneously with other autoimmune diseases, as part of polyglandular syndrome. Special attention should be paid to the change of thyroid status as a result of adverse side reactions when using a range of drugs. The questions about the mechanisms of thyroid insufficiency development as a result of unfavorable side reactions when using a number of drugs (lithium preparations, iodine-containing compounds, tyrosine kinase inhibitors, etc.) have been raised. Undiagnosed hypothyroidism is a risk factor for the progression of already existing cardiovascular diseases. The severity of clinical manifestations is determined by the severity of thyroid hormone deficiency. There are no significant clinical differences between the pronounced forms of primary and secondary hypothyroidism. Depending on the degree of lesion, secondary hypothyroidism may be complicated by other manifestations of hypothalamic-pituitary disorders, as well as the latter may include a decrease in the secretion of antidiuretic hormone at a certain stage of their development. Diagnostic difficulties are discussed, as hypothyroidism disrupts the functioning of most organs and systems of the body (musculoskeletal, cardiovascular, urinary, gastrointestinal, central and peripheral nervous systems) and can be masked by various diseases. The final diagnosis of hypothyroidism is clarified by a number of laboratory and instrumental studies. Substitution therapy with levothyroxine is used to treat hypothyroidism of any etiology.

Dermatitis herpetiformis is a rare, chronic, autoimmune blistering disease with hypersensitivity to gluten with the presence of intense pruritus. Symptoms of the disease are symmetrical, polymorphic skin lesions in a typical location. It is thought that dermatitis herpetiformis is a specific skin manifestation of celiac disease, with frequent asymptomatic gluten enteropathy. Both diseases are characterized by the same tissue compatibility antigens, the presence of circulating IgA antibodies against endomysium and transglutaminases, and clinical remission on a gluten-free diet. Non-adherence to this diet predisposes to the development of some tumours, autoimmune and thyroid gland diseases. The diagnosis of dermatitis herpetiformis is based on the findings of the characteristic IgA deposits in the skin papilla in the direct immunofluorescence test. Specific serum antibodies are used as an aid in the diagnosis and for monitoring the compliance with gluten free diet.

Objective: To analyse the detailed cytomorphological spectrum in Hashimoto thyroiditis (HT), cytological grading and its significance with the hormonal and antibody status Methods: This is both a prospective and retrospective study of 102 cases of HT in a tertiary care institute of the eastern part of India. Detailed cytological parameters were observed, graded and correlated with the serological parameters. Results: The majority of patients were females with a younger age group (21–30 years) and diffuse thyromegaly was the common presentation. A good number of cases showed neutrophilic infiltration, background colloid and follicular hyperplasia. Among the cytological parameters, Hurthle cell change was correlated with hypothyroidism (P < 0.05) but there was no significant correlation with the anti-TPO antibody. Statistical correlation of different cytological grades with the anti-TPO antibody was significant (P < 0.05), however the thyroid hormone profile with cytological grade and TPO level were not significant (P > 0.05). Conclusion: A younger age of presentation in a coastal area with iodine sufficiency and supplementation needs further epidemiological studies. Fine-needle aspiration cytology is superior to other sophisticated methods in diagnosing HT, even in seronegative cases. A good number of cases displaying folliculolysis by neutrophils needs to be corroborated by larger studies. One should be vigilant while examining slides to rule out associated malignancy.

Hypothyroidism is the most common endocrine disease after diabetes mellitus. Its frequency depends on age, sex and iodine intake. The highest prevalence of hypothyroidism is observed in older women. Chronic autoimmune thyroiditis is the most common cause of this condition. The peculiarity of hypothyroidism is an erased clinical picture, diversity and nonspecific symptoms. This makes it difficult to diagnose the disease, leads to an erroneous diagnosis and later detection of thyroid insufficiency. This article discusses the various «masks» of hypothyroidism and peculiarities of clinical manifestations. The main «masks» are: cardiological, dermatological, urological, gastroenterological, endocrine and reproductive system disorders, neurological, psychiatric, hematological, rheumatological. Free thyroxine and thyroid-stimulating hormone are used to diagnose hypothyroidism, as well as antibody titer to thyroid peroxidase and thyroglobulin to detect chronic autoimmune thyroiditis. Levothyroxine preparations are used as a substitution therapy. The dose of the drug depends on the age of the patient and the presence of cardiovascular disease. Patients under 50 years of age without a severe concomitant cardiovascular disease are given 1.6 µg of levothyroxine per kg of body weight. In persons over 50 years of age with cardiovascular diseases, the drug dose is prescribed at the rate of 0.9 µg per kg of body weight. The therapy starts with small doses, slowly increasing it under the control of electrocardiography. At occurrence or strengthening of symptoms of angina a dose of levothyroxine is reduced to the previous one and the cardiovascular therapy is corrected. Evaluation of the effectiveness of the treatment is carried out on the level of thyroid hormone.

Introduction: The mechanisms by which hepatitis C virus (HCV) infection induces autoimmune thyroiditis (AIT) have been studied, and it was suggested that inflammatory cytokines during HCV infection would change the thyroperoxidase (TPO) signaling cascade and thyroglobulin (Tg) determining autoimmune thyroid disease. Objective: To show the signaling pathway, of TPO and Tg, and their potential targets mediated HCV in individuals with hepatitis C. Methods: The mapping of the signaling pathway was based on a review study approach and performed using the automatic annotation server of the Kyoto and Genome Encyclopedia (KEGG). PathVisio is free software for analysis and design of open source routes, and was used for the graphic representation of the signaling pathway. Results: The contigs were extracted from the KEGG database and their mapped transcription represents the signaling pathway of the main biomolecules that triggers the AIT. The action of HCV, or its treatment can trigger AIT that is characterized by the presence of autoantibodies against TPO and Tg. In AIT, autoreactive CD4 + T lymphocytes recruit B cells and CD8 + T cells in the thyroid. The progression of the disease leads to the death of thyroid cells and hypothyroidism. Conclusion: HCV or its treatment activates several signaling pathways with thyroid cells damage resulting in AIT and secondary hypothyroidism to cellular apoptosis.

Craniofrontonasal syndrome (CFNS), also known as craniofrontonasal dysplasia, is an X-linked inherited developmental malformation caused by mutations in the ephrin B1 (EFNB1) gene. The main phenotypic features of the syndrome are coronal synostosis, hypertelorism, bifid nasal tip, dry and curly hair, and longitudinal splitting of nails. A 9-year-and-11-month-old girl with CFNS was admitted due to polyuria, polydipsia, fatigue, and abdominal pain. On physical examination, she had the classical phenotypical features of CFNS. Genetic tests revealed a c.429_430insT (p.Gly144TrpfsTer31) heterozygote variant in the EFNB1 coding region. The patient was diagnosed with type 1 diabetes mellitus (T1DM) and autoimmune thyroiditis based on laboratory findings and symptoms. The mother of the patient, who had the same CFNS phenotype and EFNB1 variant, was screened for autoimmune diseases and was also with autoimmune thyroiditis. This is the first report describing the association of CFNS with T1DM and autoimmune thyroiditis in patients with EFNB1 mutation.

There are data indicating the coexistence of papillary thyroid carcinoma and autoimmune thyroiditis (AIT) in children. The aim of the study was elastographic evaluation of thyroid nodules in children and adolescents with AIT and nodular goiter in relation to cytological and/or histopathological diagnosis. We examined 215 children (57 boys and 158 girls) with 261 thyroid nodules (143 non-AIT and 118 AIT). All study participants underwent a conventional ultrasound examination with elastography followed by fine needle aspiration biopsy (FNAB). Abnormal Strain Ratio (SR ≥ 5) was observed in 36 non-AIT nodules and 15 AIT nodules. Papillary thyroid carcinoma was diagnosed in 5 patients (2% of all investigated nodules). SR of malignant thyroid nodules was statistically higher in comparison to SR of benign nodules both in the group of non-AIT (6 ± 4 vs. 3.67 ± 2.62, p = 0.024) and AIT nodules (6.3 ± 0.01 vs. 2.92 ± 1.89, p = 0.047). Comparison of non-AIT and AIT benign nodules revealed that SR was higher in non-AIT nodules (3.67 ± 2.62 vs. 2.92 ± 1.89, p = 0.01). We observed a strong positive correlation (R = 1) between TSH concentration and SR ratio in the group of all malignant thyroid nodules. Autoimmune inflammatory process of the thyroid gland does not limit the use of elastography in the diagnosis of thyroid nodules in children.

Introduction. The implications of oxidative stress and inflammation are unanimously accepted in thyroid disease. Objective. The aim of our study was to find correlations between serum antioxidant markers: glutathione peroxidase-3 (GPx-3), thioredoxin (Trx), total antioxidant capacity (TAC), inflammatory marker IL-8 and thyroid hormones, TSH and anti-thyroperoxidase antibodies (ATPO antibodies). Patients with different thyroid disorders were compared. Materials and methods. The study included 57 patients (men and women), divided into three groups: 26 patients with hyperthyroidism, 19 patients with hypothyroidism and 12 patients with autoimmune thyroiditis. The control group was represented by 33 healthy subjects. All the participants provided the informed consent for this study. Results. Our results showed that the patients with autoimmune thyroiditis had the highest level of Il-8 and the lowest TAC. Both Trx and GPx-3 were negatively correlated with TAC and IL-8 was positively correlated with the free T4 level, the ATPO antibodies titers, GPx-3 activity and negatively with serum TAC values. Conclusions. Systemic oxidative stress and inflammation are present in thyroid disorders, act in cluster and potentiate each other.The presence of autoimmune antibodies worsens the biological picture.

Introduction: In childhood, thrombocytopenia caused by transient antibody-mediated thrombocyte destruction is most frequently diagnosed as immune thrombocytopenic purpura (ITP). We report the case of a girl with ITP associated with autoimmune thyroiditis.

Background Autoimmune thyroiditis may manifest as overt hypothyroidism, subclinical hypothyroidism, euthyroidism, or hyperthyroidism in children. Although there is no consensus on treating euthyroidism and autoimmune thyroiditis in children, some studies have demonstrated the efficacy of levothyroxine in reducing thyroid volume, improving thyroid function, and stabilizing the immunological process. Objective To determine the effect of levothyroxine on thyroid gland volume changes, thyroid function, and thyroid antibodies in euthyroid children with autoimmune thyroiditis. Methods We performed a literature search of electronic databases (the Cochrane Library, MEDLINE, EBSCO, ProQuest, clinicaltrials.gov, and other sources, as well as a non-electronic search (searching journals and conference proceedings by hand) to identify studies of euthyroid children with autoimmune thyroiditis published by August 2018. Only English-language articles were included in the search (electronic and non-electronic). Randomized controlled trials that compared levothyroxine with a control (placebo or no treatment) in euthyroid children with autoimmune thyroiditis were selected. The outcome measures were thyroid volume changes, thyroid function, and thyroid antibody levels in euthyroid children with autoimmune thyroiditis. Two authors independently extracted the data, assessed the risk of bias, and analyzed the pooled data from the included studies using a random effects model. The same authors performed a sensitivity analysis. Results We identified 57 studies. Of these, three studies, involving 97 subjects (51 subjects in an intervention group and 46 subjects in the control group) were selected for inclusion in a systematic review/meta-analysis. The meta-analysis revealed a significant difference in mean thyroid volume changes between the two groups (-1.10 SDs; 95%CI -1.56 to -0.64; P

Introduction. Autoimmune thyroiditis is one of the most important problems of modern endocrinology, with inadequately studied etiological and pathogenic mechanisms of development. It is characterized by the lack of objective and reliable diagnostic methods, effective treatment methods, uncertain therapy or indications for the choice of treatment methods. The aim of the study. Determination of markers for prediction of clinical course and choice of surgery’ volume in patients with nodular goiter and autoimmune thyroiditis, taking into account the oxidative, autoimmune and apoptotic processes. Material and methods. A total of 95 patients who were operated for a nodular endemic goiter on the background of autoimmune thyroiditis were examined. The status of pro- and antioxidant systems, the activity of proinflammatory cytokines, hormonal function of thyroid gland, the level of antibodies to thyroperoxidase, thyroglobulin antibodies and ultrasound structural changes in the thyroid gland have been evaluated in all patients, before and after surgery. Results. In patients with nodular endemic goiter and autoimmune thyroiditis, in the remote period after surgical treatment, there is a significant increase in the peroxide oxidation index and a decrease in the activity of antioxidant defense systems, against the suppression of apoptotic processes and the activation of pro-inflammatory cytokines. These processes lead to functional failure, hyperplasia and the progression of structural thyroid abnormalities, with progression of the functional incapacity of the thyroid gland and inadequate long-term outcome of treatment. Conclusions. The study allowed to clarify the indications and contraindications of different methods of treatment in patients with NGAIT, taking into account the parameters of severity of peroxide oxidation processes, the activity of apoptosis and functional capacity of the gland.

Background: The prevalence of autoimmune thyroiditis (AIT), as the most common autoimmune disease (AD) and papillary thyroid cancer (PTC) is steadily rising in children. The aim of this study was to determine the coexistence of other AD and thyroid carcinoma (TC) in AIT. Methods: The cross-sectional study conducted at a tertiary center comprised AIT children (< 19 years). Data on age/sex, thyroid function and ultrasound, autoantibodies, associated AD, familial occurence of AD and the occurence of TC for each child were collected. Results: In total, 231 eligible patients (77% females) were included. The most common onset (66%) was during adolescence. At onset, hypothyroidism was detected in 59.3%; hashitoxicosis in 1.3%. The positivity of both autoantibodies was present in 60.6%, the negativity was in 3,5%. We confirmed a high frequency (44.6%) of AD with AIT predominance in parents and/or grandparents of patients and in siblings (7.4%). 15.2% had at least 1 comorbid AD, of which type 1 diabetes mellitus was the most common (8.5%). Over a period of 7 years TC was diagnosed in 16 patients (mean age 13.5 years) with predominance of PTC in 15 (94%) patients. AIT had concurrently 69% patients. 56% of patients had metastases (89% in AIT subjects). An invasive PTC was present in 44% (86% in AIT subjects). Conclusions: The prevalence rate of AD in AIT and first-degree relatives is high, and several new associations have been reported. Providers should be aware of comorbidities and TC in AIT as this would help in early diagnoses and timely interventions.