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Thyroid disease and hyperparathyroidism (HPT) are among the most common endocrine disorders. Thyroid hormones play an important role in bone and calcium metabolism. The rate of HPT is greater in patients with thyroid disease than in the general medical population. Simultaneous occurrence of hyperthyroidism and hyperparathyroidism in the same patient is a rare combination. The clinical manifestations of hyperthyroidism may overshadow the more subtle and varied symptoms and signs of primary hyperparathyroidism. It poses difficult diagnostic and therapeutic problems. Both diseases, however, may have a profound influence on calcium metabolism. The resulting disturbances in thyrotoxicosis may simulate hyperparathyroidism. Contrariwise, the diagnosis of an associated parathyroid adenoma may be missed, or unnecessarily delayed because hypercalcemia is known to occur in hyperthyroidism. The coexistence of thyroiditis and thyroid nodules with parathyroid disorders is also known. Graves' disease (GD) and primary hyperparathyroidism (PHPT) are two common endocrine disorders. However the co- occurrence of hyperthyroidism and primary hyperparathyroidism (PHPT) is rare. However, the link between the two disorders remains unclarified. Hypercalcemia in Graves' hyperthyroidism should warrant a thorough investigation for concomitant primary hyperparathyroidism. Concomitant thyroid nodular disease and hyperparathyroidism (PHPT) disease has been also documented. PHPT is also reported in patients with thyroid malignancy. We hereby report a rare case of a patient who presented with coexistence of Hyperparathyroidism and Multinodular Goiter with Hashimotos Thyroiditis and Hyperthyroidism. [ABSTRACT FROM AUTHOR]

Steroid-responsive encephalopathy, also known as Hashimoto's encephalopathy, is an uncommon autoimmune neuroendocrine disorder linked to thyroiditis. It presents a variable range of clinical symptoms, making it challenging to diagnose. SREAT (steroid-responsive encephalopathy associated with autoimmune thyroiditis) is considered a diagnosis of exclusion. Diagnosing SREAT poses a challenge as its symptoms can overlap with those of acute conditions such as encephalitis and meningitis, as well as various autoimmune disorders and issues related to substance toxicity and abuse, all of which must be ruled out prior to establishing a definitive diagnosis and starting treatment. However, high anti-TPO antibodies (anti-thyroid peroxidase) in serum and rarely in the CSF favor the diagnosis of the condition. Although rare, Hashimoto's encephalopathy should be considered when managing cases of unexplained encephalopathy. Treatment of choice in these sets of patients includes high-dose corticosteroid therapy. We present a case of Hashimoto's encephalopathy in a middle-aged woman who arrived at our emergency department with altered mental status and facio-brachial seizures. After excluding various potential causes of acute encephalopathy, a diagnosis of SREAT was made. Testing of serum and cerebrospinal fluid (CSF) indicated the presence of anti-thyroid peroxidase (anti-TPO) antibodies, which is uncommon in CSF. Following intravenous steroid therapy, the patient experienced substantial improvement, reinforcing the diagnosis., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Surapaneni et al.)

The present study focus on the complications which are related to thyroid patients which may cause mortality in developing countries like India due to the lack of perfect nutrition and proper iodine levels in gestational period and in normal conditions. so we are planning to study the incidence and prevalance of complications in thyroid patients at tertiary care teaching hospital. Methods-retrospective and prospective study on thyroid conditions like - Hypothyroidism, Hyperthyroidism Multi nodular goiter, Solitary thyroid nodule, Goiter these problems leads to severe complications like - Metabolic disorder, Immune disorders, Dermatological problems, Fetal related problems and psychological problems are estimated by these study. This article mostly covers the complications of thyroid diseases. This article provides maximum incidence rate of thyroid complications between males and females in percentages and also involves prevalence rate too. We were noticed in that majorly females miscarriage in case of males infertility and other complication includes like diabetes, hypertension and cvs dysfunctions so that there was need of further study on large population. [ABSTRACT FROM AUTHOR]

Primary thyroid lymphoma (PTL) is a rare disease characterized by the appearance of a rapidly growing solid mass in the cervical region. A major risk factor is chronic autoimmune thyroiditis with lymphocytes infiltrating the thyroid gland. The lymphoproliferative disease is seen more frequently in the females. PTL usually develops in the sixth and seventh decades of life. We present a case of a 66-year-old woman with diffuse primary B-cell thyroid lymphoma with no prior evidence of underlying autoimmune thyroid pathology. The initial localization of the lymphoproliferative disease was in the thyroid gland, but the involvement of regional cervical lymph nodes was also found at the time of diagnosis. After histological verification with immunohistochemistry and staging by imaging, chemotherapy was initiated according to the R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin hydrochloride, Oncovin ® (vincristine), prednisone) protocol. An excellent therapeutic response was achieved with lymphoma remission after six cycles under the mentioned protocol. Thyroid autoantibodies became positive 18 months after rituximab treatment, possibly reflecting the transient suppressive effects of the immunotherapy. The patient was subsequently kept followed up by a multidisciplinary team in the light of possible lymphoma recurrence and/or development of thyroid dysfunction. This case report demonstrates possible challenges for the diagnosis, treatment, and follow-up of this rare thyroid lesion. At the time of diagnosis, the clinical presentation of the disease, the ultrasound image, and the cytological result may be similar to other low-grade thyroid carcinomas or secondary metastatic involvement of the gland. The initial lack of underlying thyroid autoimmunity makes this distinction even more challenging. Furthermore, despite the rapid resolution, regular long-term monitoring for recurrence is required., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Hristozov et al.)

We report a female case who developed hypothyroid in the course of multibacillary multidrug therapy regimen for leprosy. The evaluation was made to rule out the possible cause of rifampicin induced hypothyroidism in Hashimoto′s thyroiditis.

Abstract: Background: A Thyroidectomy Difficulty Scale (TDS) was previously developed that identified more difficult operations, which correlated with longer operative times and higher complication rates. The purpose of this study was to identify preoperative variables predictive of a more difficult thyroidectomy using the TDS. Methods: A four item, 20-point TDS, was used to score the difficulty of thyroid operations. Patient and disease factors were recorded for each patient. Difficult thyroidectomy and non-difficult thyroidectomy (NDT) patients were compared. A final multivariate logistic regression model was constructed with significant (P < 0.05) variables from a univariate analysis. Results: A total of 189 patients were scored using TDS. Of them, 69 (36.5%) suffered from hyperthyroidism, 42 (22.2%) from Hashimotos, 34 (18.0%) from thyroid cancer, and 36 (19.0%) from multinodular goiter. Among hyperthyroid patients, the DT group had a greater number preoperatively treated with Lugols potassium iodide (81.6% DT versus 58.1% NDT, P = 0.032), presence of ophthalmopathy (31.6% DT versus 9.7% NDT, P = 0.028), and presence of (>4 IU/mL) antithyroglobulin antibodies (34.2% DT versus 12.9% NDT, P = 0.05). Using multivariate analysis, hyperthyroidism (odds ratio [OR], 4.35, 95% confidence interval [CI], 1.23–15.36, P = 0.02), presence of antithyroglobulin antibody (OR, 3.51, 95% CI, 1.28–9.66, P = 0.015), and high (>150 ng/mL) thyroglobulin (OR, 2.61, 95% CI, 1.06–6.42, P = 0.037) were independently associated with DT. Conclusions: Using TDS, we demonstrated that a diagnosis of hyperthyroidism, preoperative elevation of serum thyroglobulin, and antithyroglobulin antibodies are associated with DT. This tool can assist surgeons in counseling patients regarding personalized operative risk and improve OR scheduling. [Copyright &y& Elsevier]

Hashimoto's thyroiditis (HT), also known as chronic lymphocytic thyroiditis is one of the most frequent types of infl ammation of the thyroid gland. The prevalence of the overt HT is about 2% but it is believed that Hashimoto thyroiditis is more frequent than expected. Hashimoto's thyroiditis is characterized by dysfunction of the immune system, which leads to impaired tolerance of own tissues and increased production of autoantibodies against the thyroid cells. Thyroid peroxidase antibodies (anti-TPO), thyroglobulin antibodies (anti-Tg) and/or TSH receptors antibodies are the principal markers of the disease. The essential element of the treatment of HT is the supplementation of L-thyroxine. In Hashimoto's disease, like in many other autoimmune diseases, researchers attempted to support pharmacological treatment by adequate nutrition. The aim of this paper was to review the existing literature on the levels of antioxidants (vitamin A, C, E, selenium, zinc) and vitamin D in patients with HT, as well as the infl uence of the nutritional supplementation of the above mentioned elements on the metabolism of the thyroid gland hormones and the level of anti-thyroid peroxidase (anti-TPO) antibodies. [ABSTRACT FROM AUTHOR]

Thyroiditis-inflammation of thyroid gland includes a group of individual disorders having many different clinical presentations, aetiopathogenesis and histology. Sometimes they are overlapping on their presentations. Objectives: To see the clinical biochemical profile and to observe a short term outcome of the patients presented with different types of thyroiditis. Materials & methods: 50 cases with clinical suspicion of thyroiditis were randomly selected. Clinical history, Physical examination and serum T3, T4, TSH was done in every patient and FNAC of thyroid gland & TMab (Thyroid microsomal antibody) was estimated in some. They were followed up at three monthly intervals with the measurement of TSH. Results: Cases were subdivided in to 3 groups. Among them subacute thyroiditis were 19 (38%), 26 (52%) were Hashimoto's thyroiditis and 5(10%) were silent thyroiditis. The subacute group presented with features of hyperthyroidism, negligible RAIU (radioactive iodine uptake) and FNAC ( Fine Needle Aspiration Cytology) showed granulomatous thyroiditis. During follow up (57%) became hypothyroid at 3 months, (26%) euthyroid and (15%) in thyrotoxic state. After 9 months (87%) was hypothyroid and (5.26%) thyrotoxic. At 12 months (94%) was euthyroid and one thyrotoxic. Hashimoto's group presented in hypothyroid state, RAIU test were variable. FNAC showed lymphocytic infiltration in all patients. They were found 100% hypothyroid after 1 year. Silent Thyroiditis group were in hyperthyroid state with negligible RAIU. After 12 month (60%) became euthyroid and (40%) remain hypothyroid. Conclusion: Thyroiditis has both thyrotoxic and hypothyroid phase but they are self limiting. So before giving specific therapy, thyroiditis must be excluded. [ABSTRACT FROM AUTHOR]

Hashimoto's thyroiditis (HT) is associated with HLA, but the associated allele is still controversial. We hypothesized that specific HLA-DR pocket-sequence variants are associated with HT and that similar variants in the murine l-E locus (homologous to HLA-DR) predispose to experimental autoimmune thyroiditis (EAT), a classical mouse model of HT. Therefore, we sequenced the polymorphic exon 2 of the HLA-DR gene in 94 HT patients and 149 controls. In addition, we sequenced exon 2 of the l-E gene in 22 strains of mice, 12 susceptible to EAT and 10 resistant. Using logistic regression analysis, we identified a pocket amino acid signature, Tyr-26, Tyr-30, Gln-70, Lys-71,strongly associated with HT (P = 6.18 × 10-5. OR = 3.73). Lys-71 showed the strongest association (P = 1.7 × 108, OR = 2.98). This association was seen across HLA-DR types. The 5-aa haplotype Tyr-26, Tyr-30, Gln-70, Lys-71, Arg-74 also was associated with HT (P = 3.66 × 10-4). In mice, the I-E pocket amino acids Val-28, Phe-86, and Asn-88 were strongly associated with EAT. Structural modeling studies demonstrated that pocket P4 was critical for the development of HT, and pockets P1 and P4 influenced susceptibility to EAT. Surprisingly, the structures of the HT- and EAT-susceptible pockets were different. We conclude that specific MHC II pocket amino acid signatures determine susceptibility to HT and EAT by causing structural changes in peptide-binding pockets that may influence peptide binding, selectivity, and presentation. Because the HT- and EAT-associated pockets are structurally different, it is likely that distinct antigenic peptides are associated with HT and EAT. [ABSTRACT FROM AUTHOR]

Mosaicism in Turner syndrome (TS) is a 20%-30% occurrence, with 45, X plus at least another cell line. The haploinsufficiency of the X chromosome is usually responsible for the higher risk of autoimmunity in TS, exhibiting mainly as thyroiditis, type 1 diabetes, etc. Though Hashimoto's thyroiditis is commonly seen in patients with TS, the concurrence of encephalopathy in these patients is significantly rare and has not been reported. We present a case of a young female with mosaic TS who presented with altered mental status. The initial workup was negative for stroke and pulmonary embolism and cerebrospinal fluid (CSF) analysis did not show any infectious etiology. Thyroid peroxidase (TPO) antibodies (Abs) and thyroglobulin Abs were elevated. As the patient's mental status deteriorated, there was a concern for Hashimoto's encephalopathy (HE), hence the patient was started on high-dose IV steroids. Within 24 hours, the patient responded to the IV steroids and an improvement in mentation was noted. HE is a rare immune-mediated disorder, characterized by impaired brain function. The onset of which can be rapid or slowly developing over the course of many years but responds effectively to steroids. Turner syndrome is associated with a high incidence of autoimmune disorders, thus in the setting of a negative workup for more obvious causes, HE should be a consideration when encountered in a clinical scenario., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Chelikani et al.)

Hashimoto's encephalopathy (HE), also known as steroid-responsive encephalopathy, is associated with autoimmune-mediated thyroiditis. Onset is typically gradual often with evolution over the course of months. Characteristic symptoms include impaired concentration and memory, delusions, hallucinations, personality changes, incoordination, tremor, hemiparesis, seizures, and speech difficulties. Diagnosis is predicated upon discovery of elevated anti-thyroid antibodies, specifically anti-thyroid peroxidase (TPO) or anti-M antibodies. Some patients may also present with subclinical hypothyroidism but many are euthyroid. Of note, neither thyroid function tests or antibody titers correlate with disease severity. Other common laboratory findings include elevations in sedimentation rate, liver enzymes, and cerebrospinal fluid (CSF) protein. Radiological work-up, including cerebral angiography, is often normal. Successful treatment includes administration of steroids and/or intravenous immunoglobulin (IVIg) or plasmapheresis. We describe a case of a 74-year-old male who presented for evaluation of abrupt onset confusion ultimately determined to be a consequence of autoimmune-mediated thyroiditis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Kondramashin et al.)

Acute suppurative thyroiditis (AST) is serious and rare infection of the thyroid gland, often it can progress to thyroid abscess. Both anatomical defects and underlying thyroid disorders are attributed to etiopathogenesis of the disease. Bacteria usually reach the gland either by lymphatic spread or via hematogenous routes. If untreated it has fatal outcome and had serious complications. The mainstay of treatment is usually a combination of intravenous antibiotics and drainage, and sometimes surgery., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Mishra et al.)

SLE (systemic lupus erythematosus) can be associated with other autoimmune disorders with overlapping clinical symptoms. We present a case of a 22-year-old male with recurring exertional dyspnea, chest pain, dry cough and chills, which on further testing revealed large pericardial effusion and bilateral pleural effusions along with laboratory abnormalities consistent with a diagnosis of overlap of SLE with serositis and Hashimoto's thyroiditis. SLE patients with underlying hypothyroidism are slow to respond to standard therapy unless the underlying hypothyroidism is adequately treated., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Kammari et al.)