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Francesco Latrofa - One of the best experts on this subject based on the ideXlab platform.
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Subacute Thyroiditis after sars cov 2 infection
The Journal of Clinical Endocrinology and Metabolism, 2020Co-Authors: Alessandro Brancatella, Debora Ricci, Nicola Viola, Daniele Sgro, Ferruccio Santini, Francesco LatrofaAbstract:Context Subacute Thyroiditis (SAT) is a thyroid disease of viral or postviral origin. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that began in Wuhan, China, has spread rapidly worldwide and Italy has been severely affected by this outbreak. Objectives The objective of this work is to report the first case of SAT related to SARS-CoV-2 infection. Methods We describe the clinical, laboratory, and imaging features of an 18-year-old woman who came to our attention for fever, neck pain radiated to the jaw, and palpitations occurring 15 days after a SARS-CoV-2-positive oropharyngeal swab. Coronavirus disease 2019 (COVID-19) had been mild and the patient had completely recovered in a few days. Results At physical examination the patient presented with a slightly increased heart rate and a painful and enlarged thyroid on palpation. At laboratory exams free thyroxine and free triiodothyronine were high, thyrotropin undetectable, and inflammatory markers and white blood cell count elevated. Bilateral and diffuse hypoechoic areas were detected at neck ultrasound. One month earlier, thyroid function and imaging both were normal. We diagnosed SAT and the patient started prednisone. Neck pain and fever recovered within 2 days and the remaining symptoms within 1 week. Thyroid function and inflammatory markers normalized in 40 days. Conclusions We report the first case of SAT after a SARS-CoV-2 infection. We alert clinicians to additional and unreported clinical manifestations associated with COVID-19.
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the detection of serum igms to thyroglobulin in Subacute Thyroiditis suggests a protective role of igms in thyroid autoimmunity
The Journal of Clinical Endocrinology and Metabolism, 2020Co-Authors: Debora Ricci, Paolo Vitti, Alessandro Brancatella, Michele Marino, Mario Rotondi, Luca Chiovato, Francesco LatrofaAbstract:CONTEXT The role of serum immunoglobulin (Ig)Ms in autoimmune thyroid diseases is uncertain. OBJECTIVE We looked for IgMs to thyroglobulin (Tg) in patients with Subacute Thyroiditis (SAT), which is characterized by high serum Tg levels, the possible de novo appearance of IgGs to Tg (TgAb-IgGs), and no autoimmune sequelae. MAIN OUTCOME MEASURES TgAb-IgMs and TgAb-IgGs were detected by binding to Tg using the enzyme-linked immunosorbent assay (ELISA). The upper reference limit of TgAb-IgMs and TgAb-IgGs was established in 40 normal subjects. We looked for TgAb-IgMs in 16 patients with SAT, 11 with Hashimoto's Thyroiditis (HT), and 8 with Graves' disease (GD) who were all positive for TgAb-IgGs. IgM binding to bovine serum albumin (BSA), keyhole limpet hemocyanin (KLH), and glucagon in ELISA was measured. Inhibition of TgAb-IgMs binding to coated Tg was evaluated by preincubating serum samples or IgG-depleted samples with soluble Tg. RESULTS TgAb-IgMs were positive in 10/16 patients with SAT, 2/11 with HT, and 1/8 with GD. TgAb-IgMs were higher in SAT (0.95; 0.42-1.13) (median; 25th-75th percentiles) than in HT (0.47; 0.45-0.51) and GD patients (0.35; 0.33-0.40) (P < .005 for both). IgM binding of SAT sera to BSA, KLH, and glucagon was significantly lower than Tg. Preincubation with soluble Tg reduced the binding of IgMs to coated Tg by 18.2% for serum samples and by 35.0% and 42.1% for 2 IgG-depleted samples. TgAb-IgM levels were inversely, although nonsignificantly, correlated with Tg concentrations. CONCLUSIONS Tg leak associated with thyroid injury induces the production of specific TgAb-IgMs, which, in turn, increases the clearance of Tg and might prevent the establishment of a persistent thyroid autoimmune response.
Alessandro Brancatella - One of the best experts on this subject based on the ideXlab platform.
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Subacute Thyroiditis after sars cov 2 infection
The Journal of Clinical Endocrinology and Metabolism, 2020Co-Authors: Alessandro Brancatella, Debora Ricci, Nicola Viola, Daniele Sgro, Ferruccio Santini, Francesco LatrofaAbstract:Context Subacute Thyroiditis (SAT) is a thyroid disease of viral or postviral origin. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that began in Wuhan, China, has spread rapidly worldwide and Italy has been severely affected by this outbreak. Objectives The objective of this work is to report the first case of SAT related to SARS-CoV-2 infection. Methods We describe the clinical, laboratory, and imaging features of an 18-year-old woman who came to our attention for fever, neck pain radiated to the jaw, and palpitations occurring 15 days after a SARS-CoV-2-positive oropharyngeal swab. Coronavirus disease 2019 (COVID-19) had been mild and the patient had completely recovered in a few days. Results At physical examination the patient presented with a slightly increased heart rate and a painful and enlarged thyroid on palpation. At laboratory exams free thyroxine and free triiodothyronine were high, thyrotropin undetectable, and inflammatory markers and white blood cell count elevated. Bilateral and diffuse hypoechoic areas were detected at neck ultrasound. One month earlier, thyroid function and imaging both were normal. We diagnosed SAT and the patient started prednisone. Neck pain and fever recovered within 2 days and the remaining symptoms within 1 week. Thyroid function and inflammatory markers normalized in 40 days. Conclusions We report the first case of SAT after a SARS-CoV-2 infection. We alert clinicians to additional and unreported clinical manifestations associated with COVID-19.
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the detection of serum igms to thyroglobulin in Subacute Thyroiditis suggests a protective role of igms in thyroid autoimmunity
The Journal of Clinical Endocrinology and Metabolism, 2020Co-Authors: Debora Ricci, Paolo Vitti, Alessandro Brancatella, Michele Marino, Mario Rotondi, Luca Chiovato, Francesco LatrofaAbstract:CONTEXT The role of serum immunoglobulin (Ig)Ms in autoimmune thyroid diseases is uncertain. OBJECTIVE We looked for IgMs to thyroglobulin (Tg) in patients with Subacute Thyroiditis (SAT), which is characterized by high serum Tg levels, the possible de novo appearance of IgGs to Tg (TgAb-IgGs), and no autoimmune sequelae. MAIN OUTCOME MEASURES TgAb-IgMs and TgAb-IgGs were detected by binding to Tg using the enzyme-linked immunosorbent assay (ELISA). The upper reference limit of TgAb-IgMs and TgAb-IgGs was established in 40 normal subjects. We looked for TgAb-IgMs in 16 patients with SAT, 11 with Hashimoto's Thyroiditis (HT), and 8 with Graves' disease (GD) who were all positive for TgAb-IgGs. IgM binding to bovine serum albumin (BSA), keyhole limpet hemocyanin (KLH), and glucagon in ELISA was measured. Inhibition of TgAb-IgMs binding to coated Tg was evaluated by preincubating serum samples or IgG-depleted samples with soluble Tg. RESULTS TgAb-IgMs were positive in 10/16 patients with SAT, 2/11 with HT, and 1/8 with GD. TgAb-IgMs were higher in SAT (0.95; 0.42-1.13) (median; 25th-75th percentiles) than in HT (0.47; 0.45-0.51) and GD patients (0.35; 0.33-0.40) (P < .005 for both). IgM binding of SAT sera to BSA, KLH, and glucagon was significantly lower than Tg. Preincubation with soluble Tg reduced the binding of IgMs to coated Tg by 18.2% for serum samples and by 35.0% and 42.1% for 2 IgG-depleted samples. TgAb-IgM levels were inversely, although nonsignificantly, correlated with Tg concentrations. CONCLUSIONS Tg leak associated with thyroid injury induces the production of specific TgAb-IgMs, which, in turn, increases the clearance of Tg and might prevent the establishment of a persistent thyroid autoimmune response.
Debora Ricci - One of the best experts on this subject based on the ideXlab platform.
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Subacute Thyroiditis after sars cov 2 infection
The Journal of Clinical Endocrinology and Metabolism, 2020Co-Authors: Alessandro Brancatella, Debora Ricci, Nicola Viola, Daniele Sgro, Ferruccio Santini, Francesco LatrofaAbstract:Context Subacute Thyroiditis (SAT) is a thyroid disease of viral or postviral origin. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that began in Wuhan, China, has spread rapidly worldwide and Italy has been severely affected by this outbreak. Objectives The objective of this work is to report the first case of SAT related to SARS-CoV-2 infection. Methods We describe the clinical, laboratory, and imaging features of an 18-year-old woman who came to our attention for fever, neck pain radiated to the jaw, and palpitations occurring 15 days after a SARS-CoV-2-positive oropharyngeal swab. Coronavirus disease 2019 (COVID-19) had been mild and the patient had completely recovered in a few days. Results At physical examination the patient presented with a slightly increased heart rate and a painful and enlarged thyroid on palpation. At laboratory exams free thyroxine and free triiodothyronine were high, thyrotropin undetectable, and inflammatory markers and white blood cell count elevated. Bilateral and diffuse hypoechoic areas were detected at neck ultrasound. One month earlier, thyroid function and imaging both were normal. We diagnosed SAT and the patient started prednisone. Neck pain and fever recovered within 2 days and the remaining symptoms within 1 week. Thyroid function and inflammatory markers normalized in 40 days. Conclusions We report the first case of SAT after a SARS-CoV-2 infection. We alert clinicians to additional and unreported clinical manifestations associated with COVID-19.
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the detection of serum igms to thyroglobulin in Subacute Thyroiditis suggests a protective role of igms in thyroid autoimmunity
The Journal of Clinical Endocrinology and Metabolism, 2020Co-Authors: Debora Ricci, Paolo Vitti, Alessandro Brancatella, Michele Marino, Mario Rotondi, Luca Chiovato, Francesco LatrofaAbstract:CONTEXT The role of serum immunoglobulin (Ig)Ms in autoimmune thyroid diseases is uncertain. OBJECTIVE We looked for IgMs to thyroglobulin (Tg) in patients with Subacute Thyroiditis (SAT), which is characterized by high serum Tg levels, the possible de novo appearance of IgGs to Tg (TgAb-IgGs), and no autoimmune sequelae. MAIN OUTCOME MEASURES TgAb-IgMs and TgAb-IgGs were detected by binding to Tg using the enzyme-linked immunosorbent assay (ELISA). The upper reference limit of TgAb-IgMs and TgAb-IgGs was established in 40 normal subjects. We looked for TgAb-IgMs in 16 patients with SAT, 11 with Hashimoto's Thyroiditis (HT), and 8 with Graves' disease (GD) who were all positive for TgAb-IgGs. IgM binding to bovine serum albumin (BSA), keyhole limpet hemocyanin (KLH), and glucagon in ELISA was measured. Inhibition of TgAb-IgMs binding to coated Tg was evaluated by preincubating serum samples or IgG-depleted samples with soluble Tg. RESULTS TgAb-IgMs were positive in 10/16 patients with SAT, 2/11 with HT, and 1/8 with GD. TgAb-IgMs were higher in SAT (0.95; 0.42-1.13) (median; 25th-75th percentiles) than in HT (0.47; 0.45-0.51) and GD patients (0.35; 0.33-0.40) (P < .005 for both). IgM binding of SAT sera to BSA, KLH, and glucagon was significantly lower than Tg. Preincubation with soluble Tg reduced the binding of IgMs to coated Tg by 18.2% for serum samples and by 35.0% and 42.1% for 2 IgG-depleted samples. TgAb-IgM levels were inversely, although nonsignificantly, correlated with Tg concentrations. CONCLUSIONS Tg leak associated with thyroid injury induces the production of specific TgAb-IgMs, which, in turn, increases the clearance of Tg and might prevent the establishment of a persistent thyroid autoimmune response.
Bernard Rousset - One of the best experts on this subject based on the ideXlab platform.
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sucrose gradient and
2013Co-Authors: Laure Druetta, Karine Croizet, Hubert Bornet, Bernard RoussetAbstract:Analyses of the molecular forms of serum thyroglobulin from patients with Graves ’ disease, Subacute Thyroiditis or differentiated thyroid cancer by velocity sedimentation o
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analyses of the molecular forms of serum thyroglobulin from patients with graves disease Subacute Thyroiditis or differentiated thyroid cancer by velocity sedimentation on sucrose gradient and western blot
European Journal of Endocrinology, 1998Co-Authors: Laure Druetta, Karine Croizet, Hubert Bornet, Bernard RoussetAbstract:Serum thyroglobulin (Tg) concentration increases in diverse thyroid pathophysiological situations. We examined whether Tg molecules appearing in the serum of patients with Graves' disease (GD), Subacute Thyroiditis (ST) or differentiated thyroid cancer (DTC) have distinctive biochemical properties. We used ultracentrifugation on sucrose gradient and Western blot to analyze structural parameters of immunoreactive Tg in complete serum from 40 patients with GD, ST or DTC. Purified human Tg was used as reference. Immunoreactive Tg from ST or DTC sera sedimented in a single, rather symmetrical peak as purified 19S Tg. In GD sera without detectable anti-Tg autoantibodies (TgaAb), about 80% of immunoreactive Tg was recovered in a Tg dimer peak that often split into two components; the remaining Tg immunoreactivity (10-30%) sedimented faster and was polydispersed. In GD sera containing TgaAb, immunoreactive Tg was recovered in a peak sedimenting faster than 19S Tg corresponding to immune complexes identified by protein A adsorption. Using a Western blot procedure, optimized to detect 0.1 ng Tg in serum. a single band of Tg, migrating as the intact Tg subunit, was always found in non-reducing conditions; the intensity of the band correlated with the immunoassayable Tg concentration. In reducing conditions, the Tg band obtained with GD or ST sera was decreased by up to 70% compared with that of purified Tg or serum Tg from patients with DTC. In conclusion, serum Tg from DTC is remarkably homogeneous and in the form of dimers dissociable into uncleaved monomers. In contrast, serum Tg from GD or ST is heterogeneous with respect to its sedimentation properties and/or the structural integrity of its polypeptide chains. These data provide information on the processes whereby Tg is released into the circulation.
Akira Miyauchi - One of the best experts on this subject based on the ideXlab platform.
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initial treatment with 15 mg of prednisolone daily is sufficient for most patients with Subacute Thyroiditis in japan
Thyroid, 2013Co-Authors: Sumihisa Kubota, Nobuyuki Amino, Eijun Nishihara, Takumi Kudo, Mitsuru Ito, Akira MiyauchiAbstract:Background: Oral glucocorticoids are administered in moderate and severe cases of Subacute Thyroiditis (SAT), providing dramatic relief from pain and fever. However, there have been no reports regarding the optimal dose of prednisolone (PSL) for treatment of SAT. In this study, we used 15 mg/day of PSL as the initial dosage and tapered it by 5 mg every 2 weeks. We assessed the effectiveness of this treatment protocol. Methods: We examined 384 consecutive and untreated patients with SAT who visited our thyroid clinic between February 2005 and December 2008. We excluded patients who did not fit our protocol, and the final number of subjects was 219. When patients complained of pain in their neck or C-reactive protein (CRP) was still high, physicians were able to extend the tapering of the dose of PSL or increase it at 2-week intervals. The endpoint of the study was the duration of the PSL medication. We also compared the severity of thyrotoxicosis and rate of hypothyroidism after SAT between the short medic...
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clinical characteristics of 852 patients with Subacute Thyroiditis before treatment
Internal Medicine, 2008Co-Authors: Eijun Nishihara, Nobuyuki Amino, Shuji Fukata, Sumihisa Kubota, Hidemi Ohye, Kazuna Takata, Takeshi Arishima, Takumi Kudo, Mitsuru Ito, Akira MiyauchiAbstract:Objective Subacute Thyroiditis (SAT) is a transient inflammatory disease of the thyroid. We evaluated the clinical characteristics based on laboratory and imaging studies in patients with SAT before treatment. Patients We reviewed the medical records of 852 patients (107 men and 745 women) with SAT who visited our thyroid clinic at Kuma Hospital from 1996 through 2004. Results SAT developed most often in female patients aged 40 to 50 years, with significant seasonal clusters during summer to early autumn. While the rates of any virus infections and diseases did not differ from those in the general population, recurrent episodes of SAT at intervals of 13.6±5.6 years accounted for 1.6% of all cases. At the onset of SAT, 28.2% of patients had temperatures greater than 38°C and typical symptoms associated with thyrotoxicosis developed in more than 60% of patients. Before treatment, most of the abnormal laboratory findings associated with thyrotoxicosis, inflammation, and liver dysfunction reached peak levels within 1 week after onset. Ultrasound examination showed that half of the patients with unilateral thyroid pain presented with bilateral hypoechogenic area in the thyroid and the rate of bilateral hypoechogenic area tended to increase 2 months after onset. Conclusion Laboratory studies of thyroid dysfunction and inflammation related to SAT presented peak levels within 1 week after onset.
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quantitative measurement of thyroid blood flow for differentiation of painless Thyroiditis from graves disease
Clinical Endocrinology, 2007Co-Authors: Hisashi Ota, Nobuyuki Amino, Shuji Fukata, Shinji Morita, Kaoru Kobayashi, Sumihisa Kubota, Naohisa Kamiyama, Akira MiyauchiAbstract:Summary Objective Differentiation between destruction-induced thyrotoxicosis and Graves’ thyrotoxicosis is important for selection of proper therapy. It is, however, often difficult to make this distinction without measurement of radioactive iodine uptake. We investigated the possibility that assessment of thyroid blood flow would allow differentiation between the two entities. Patients and measurements One hundred and fourteen untreated patients with thyrotoxicosis (56 Graves’ disease, 28 painless Thyroiditis, 30 Subacute Thyroiditis) and 25 normal controls were examined. Serum levels of freeT4 (FT4), freeT3 (FT3) and TSH were measured by chemiluminescent immunoassay, and anti-TSH receptor antibodies (TSH-binding inhibitory immunoglobulin, TBII) were measured by enzyme-linked immunosorbent assay. Thyroid volume and blood flow (TBF) were measured quantitatively by ultrasonography. Results TBF was significantly higher in Graves’ disease (mean ± 1SD: 14·9 ± 6·4%, P < 0·0001) than in painless Thyroiditis (0·8 ± 0·5%), Subacute Thyroiditis (0·9 ± 0·7%) and in normal controls (0·8 ± 0·5%). All patients with Graves’ disease had TBF values of more than 4% and all patients with painless Thyroiditis and Subacute Thyroiditis had TBF values less than 4%. TBF values significantly correlated with values of radioactive iodine uptake (RAIU) either at 3 h (r = 0·492, P < 0·01) or 24 h (r = 0·762, P < 0·001) within the Graves’ disease and painless Thyroiditis groups. There was no relationship between TBF values and thyroid volumes or values of TBII in the Graves’ disease group. All patients with Graves’ disease had positive TBII of 15% or more. Three of 28 patients with painless Thyroiditis and one of 30 patients with Subacute Thyroiditis had positive TBII. Conclusion TBF was quantitatively measured by power Doppler ultrasonography and was more effective than TBII for differentiation between destruction-induced thyrotoxicosis (painless or Subacute Thyroiditis) and Graves’ thyrotoxicosis. TBF values of less than 4% in untreated thyrotoxic patients are laboratory signals of destruction-induced thyrotoxicosis and if these are determined, the radioactive iodine uptake test can be omitted for differential diagnosis of these two types of thyrotoxicosis.
