Lupus & Thyroid

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The Dangers of "Explaining Away Your Symptoms."
Assess Your Risks -- What are the key risk factors?
Your chance of having a thyroid problem is greater if
any of the following are true for you:


Family history of thyroid disease -- having parents,
grandparents, siblings, and children with thyroid
problems significantly increases your risk of also
having a thyroid problem :

Gender -- women are seven times more likely than men
to develop a thyroid problem.

Age -- the risk of thyroid problems increase with age.
By the age of 60, a woman has a one in five chance of
having a thyroid problem.
 
Hormonal Change -- the post-partum and menopausal
periods seem to be times when women are particularly
vulnerable to the appearance of thyroid problems.

Other Autoimmune Diseases -- if you or family members
of other autoimmune diseases, like lupus, multiple
sclerosis, or rheumatoid arthritis, for example, you
have an increased risk of thyroid problems.
Medications -- the medications cordarone/amiodarone
and lithium have the potential to create thyroid
problems.


Evaluate Your Symptoms -- The next step is to look at
your symptoms. Fill out our Hypothyroidism Risk
Factors and Symptoms Checklist, or our Hyperthyroidism
Risk Factors and Symptoms Checklist. These checklists
are handy tools when talking to your doctor.

You can also perform the "Thyroid Self-Check" at home
to assess whether you have an enlarged thyroid, lump,
or goiter -- another common thyroid disease symptom.

Thyroid Disease Symptoms

Rapid and inappropriate weight gain or loss, despite
diet/exercise
Constipation or diarrhea
Feeling extremely cold or hot
Particularly high or low pulse rate
High or very low cholesterol levels
High or low blood pressure
Fatigue, exhaustion
Insomnia
Hair, skin and nail problems, hair loss
Puffiness, swelling in eyes, face, hands, feet
Pains, aches in joints, hands and feet
Carpal-tunnel syndrome, tendonitis
Irregular menstrual cycles
Infertility, miscarriage
Depression, mood swings
Anxiety, panic attacks
Low sex drive
Sensitive eyes
Heart palpitations
Hand tremors
Hoarse or gravely voice
Neck, throat discomfort, pain, choking feeling

See Your Physician -- If you have any thyroid risk
factors, and more than one or two of the thyroid
symptoms noted in these checklists, and they've gone
on more than a few weeks, you should definitely get
your thyroid tested.

Bring your Risk Factors and
Symptoms Checklist to the doctor for an evaluation,
and request a thyroid test. A Thyroid Stimulating
Hormone (TSH) test is a simple blood test, it's not
particularly expensive -- a TSH blood test typically
runs from around $30 to $100, depending on the lab
where your doctor sends tests.

Understand The Diagnosis and Results -- Be sure that
you get the specific diagnosis and numerical results
of your thyroid test from your doctor.


www.LupusMCTD.com

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ADDTIONAL THYROID INFOMATION:
Overview of Thyroid Disease 
SMILIES ARE FOR MAKING IT EASIER TO LOCATE EACH SEGMENT TO READ~KAtHY

Thyroid Disease
It is common for people to develop thyroid diseases,
such as hyperthyroidism (hyper means "too much") and
hypothyroidism (hypo means "too little.) The two main
types of autoimmune thyroid disease fall into
hyperthyroidism (Grave's disease), and hypothyroidism
(Hashimoto's thyroiditis).

Often thyroid disease occurs by itself. Occasionally
it is also associated with other autoimmune diseases,
such as type 1 diabetes, systemic scleroderma, and
vitiligo, just to name a few. (Also see: Autoimmune
Diseases)


Thyroid screenings uncover the truth behind symptoms.
With an under-active thyroid, everything slows down.
You cannot tolerate cold, your heart rate is slower
and you may suffer constipation, fatigue, depression,
and lack of energy. Dry skin, brittle nails and hair
loss are also common symptoms and it is difficult to
lose weight due to the slow metabolism.


Diagnosis and management of hyperthyroidism and
hypothyroidism. The most common cause of
hyperthyroidism in Australia is Graves disease, caused
by a defect in immunoregulation in genetically
predisposed individuals, leading to production of
thyroid-stimulating antibodies. The most common cause
of hypothyroidism in Australia is autoimmune chronic
lymphocytic thyroiditis, characterised by raised
circulating levels of thyroid peroxidase antibody.
PubMed. Med J Aust. 2004 Feb 16;180(4):186-93.


Evaluation of salivary gland function in women with
autoimmune thyroid diseases. AITD (autoimmune thyroid
diseases ) may be associated with disturbances in
salivary secretion which depends on thyroid hormones
production. It can be suggested that autoimmunological
processes within salivary glands may influence their
function. PubMed. Wiad Lek. 2003;56(9-10):412-8. (Also
see: Sjogren's Syndrome)


Thyroid Disease and Scleroderma
It is common for people with systemic scleroderma to
also have other health problems, and thyroid disease
can often be associated with it.
However, thyroid disease is very common in the general
population, whereas systemic scleroderma is very rare,
and thyroid disease is not considered to be a symptom
of any type of scleroderma.


Association of systemic and thyroid autoimmune
diseases. Systemic and thyroid autoimmune diseases
often overlap with each other. HT (Hashimoto's
thyroiditis) and GD (Graves' disease) may be most
common among MCTD, SSc and SS patients. Therefore it
is clinically important to screen patients with
systemic autoimmune diseases for the co-existence of
thyroid disorders. PubMed. Clin Rheumatol. 2005 Oct
25. (Also see: MCTD, What is Scleroderma? and
Sjogren's Syndrome)


Presence of systemic autoimmune disorders in patients
with autoimmune thyroid diseases (ATD). ANA
(antinuclear antibodies) are detected in 1/3 of
patients with autoimmune thyroid disease (ATD).
Anti-dsDNA, anti-Ro, and aCL can also be found in ANA
positive patients with ATD. SS (Sjogren's Syndrome)
occurs in about 1/10 of ANA positive patients with
ATD. PubMed. Ann Rheum Dis. 2004 Sep;63(9):1159-61.
(Also see: Antibodies, and Sjogren's Syndrome)


Chronic autoimmune thyroiditis and rheumatic
manifestations. Some hypotheses may be proposed,
including a role of autoantibodies characteristics of
autoimmune thyroiditis, a possible overlap between
autoimmune thyroiditis and some autoimmune rheumatic
diseases, and a systemic inflammatory reaction
associated with thyroiditis. PubMed. Joint Bone Spine.
2004 Jul;71(4):275-83.


Serum Endostatin Level in Patients with Systemic
Sclerosis: Relationship to Thyroid Function, Skin
Score and Pulmonary Fibrosis. Hypothyroidism should be
considered as a endostatin-modulating factor in
evaluation of fibrotic activity in the SSc patients.
The role of endostatin in control of angiogenesis in
SSc patients remains unknown. E. J. Kucharz. FRI0333
EULAR 2004. (Also see: Pulmonary Fibrosis)


Graves' Disease or Hyperthyroidism 
Overview of Graves' Disease
Graves' Disease Graves' disease is an autoimmune
disease characterized by hyperthyroidism due to
circulating autoantibodies. In some patients, Graves'
disease represents part of a more extensive autoimmune
process called autoimmune polyglandular syndrome,
which also is associated with pernicious anemia,
vitiligo, diabetes mellitus type 1, autoimmune adrenal
insufficiency, and systemic lupus erythematosus.
eMedicine.Sai-Ching Jim Yeung, MD, PhD. 01/30/02.


Graves' Disease: Don't Let It Go Untreated. Graves'
causes hyperthyroidism. Symptoms include insomnia,
irritability, weight loss without dieting, heat
sensitivity, increased perspiration, fine or brittle
hair, muscular weakness, eye changes, lighter
menstrual flow, rapid heart beat and hand tremors. It
is associated with inflammation of the eyes, swelling
of the tissue around the eyes, and protrusion, or
bulging, of the eyes. Daily News Central. 08/15/05. 
Thyroid radiation may be cancer risk - study. The
Swedish Radiation Protection Authority (SSI) says
doctors are failing to optimise doses of a standard
therapy for Graves disease and are giving a fixed
amount of radioactive iodine-131 which could be
dangerous for patients. IOL. 03/03/04.
Total thyroidectomy for benign thyroid disease. Total
thyroidectomy is the treatment of choice for
multinodular goiter and thyroiditis, when there is
bilateral gland involvement posterior to middle
thyroid veins, and for Grave's disease. PubMed.
Laryngoscope. 2003 Oct;113(10):1820-6.


Grave's disease 1835-2002. The true aetiology of the
disorder was uncovered in the 1950s and 1960s, based
on the search for a novel thyroid stimulator which
turned out to be an immunoglobulin G autoantibody.
Advances should improve treatment options for Graves'
disease in the foreseeable future. PubMed. Horm Res.
2003;59 Suppl 1:114-8. 


Research of Graves' Disease
Treatment of ocular motility disturbances in Graves'
disease with botulinum toxin A. Statistically, the
degree of upgaze increased notably in all three
groups, but mostly in the first group. PubMed. Coll
Antropol. 2005;29 Suppl 1:41-6.


A 36-year retrospective analysis of the efficacy and
safety of radioactive iodine in treating young Graves'
patients. Over time, all but two patients became
hypothyroid. Pregnancies did not result in an unusual
number of congenital anomalies or spontaneous
abortions. Treating young people with Graves' disease
with radioiodine is safe and effective over the long
term. PubMed. J Clin Endocrinol Metab. 2004
Sep;89(9):4229-33. 


Graves' disease in children: Management and review of
20 patients. Because few children achieve remission
with medical therapy, other types of treatment
(surgery or radioiodine) are often required. Although
antithyroid drugs are considered the first choice for
treatment in Europe, some authors advocate radioiodine
as the treatment of choice. PubMed. An Pediatr (Barc).
2004 Aug;61(2):131-6.


The environment and autoimmune thyroid diseases.
Genetic factors play an important role in the
pathogenesis of autoimmune thyroid disease (AITD) and
it has been calculated that 80% of the susceptibility
to develop Graves' disease is attributable to genes.
Further research is warranted into the importance of
fetal microchimerism and of viral infections capable
of mounting an endogenous interferon-alpha response.
PubMed. Eur J Endocrinol. 2004 May;150(5):605-18.
Eye muscle antibodies in Graves' ophthalmopathy:
pathogenic or secondary epiphenomenon? While a
pathogenic role for eye muscle antibodies has not been
excluded, they are most likely secondary to cytotoxic
T cell reactions in GO and, as such, good markers of
this autoimmune disease. PubMed. J Endocrinol Invest.
2004 Mar;27(3):221-9. 



Hyperthyroidism in pregnancy. Graves' disease may
complicate the course of pregnancy; pregnancy on the
other hand may alter the natural course of the
disease. The future mother and her family should be
aware of the potential complications for both mother
and her offspring if proper management guidelines are
not carefully followed. PubMed. Best Pract Res Clin
Endocrinol Metab. 2004 Jun;18(2):267-88.



Surgical treatment of Graves' disease in children.
Considering the aggressiveness of childhood Graves'
disease, subtotal thyroidectomy with thyroid remnant
less than 3 g is the procedure of choice for
preventing recurrent hyperthyroidism. PubMed. Thyroid.
2004 Jun;14(6):447-52. (Also see: Thyroid Disease:
Graves' Disease)


A case of thymic enlargement in hyperthyroidism in a
young woman. Our result raises the speculation that
the thymus is also a target organ of autoimmune attack
as are the orbital and fibroblasts, which lead to
Graves' ophthalmopathy and pretibial dermopathy,
respectively. PubMed. Thyroid. 2004 Apr;14(4):307-10.
Grave's disease and stress. The findings of this study
support that SLEs (Stressful Life Events) may
contribute to the precipitation of GD. We observed
that patients with GD had significantly more negative
events and experienced a greater negative impact from
them prior to the onset of GD. PubMed. Acta Med Port.
2002 Nov-Dec;15(6):423-7.


Antiphospholipid antibody syndrome complicated by
Grave's disease. There is a close relationship between
the cutaneous manifestation of antiphospholipid
antibody syndrome and the activities of Grave's
disease and a possible link of antiphospholipid
antibody syndrome with Grave's disease was suggested
both by the etiology of the disease as well as the
disease activity. PubMed. J Dermatol. 2002
Dec;29(12):776-80. (Also see: Antiphospholipid
Syndrome)


The contribution of immune regulatory and thyroid
specific genes to the etiology of Graves' and
Hashimoto's diseases. The autoimmune thyroid diseases
(AITD) are complex diseases which are caused by an
interaction between susceptibility genes and
environmental triggers. Genetic susceptibility in
combination with external factors (e.g. dietary
iodine) are believed to initiate the autoimmune
response to thyroid antigens. PubMed. Autoimmunity.
2003 Sep-Nov;36(6-7):367-79.


ncrease in serum levels of autoantibodies after
attack of seasonal allergic rhinitis in patients with
Graves' disease. Seasonal allergic rhinitis aggravated
the clinical course of Graves' disease and induced an
increase in serum antithyroid autoantibody
concentrations as well as an increase in
pollen-specific IgE concentration.  PubMed. Int Arch
Allergy Immunol. 2003 Nov;132(3):268-76.


Relationship of stressful life events, anxiety and
depression to hyperthyroidism in an asian population.
In patients with hyperthyroidism, anxiety, depression
and stressful life events were more severe than in
those with normal thyroid function. PubMed. Horm Res.
2003;60(5):247-51.


Optic neuropathy of Graves disease: results of
transantral orbital decompression and long-term
follow-up in 215 patients. Transantral orbital
decompression appeared to be effective in treating
optic neuropathy of Graves disease. Patient
satisfaction was high at 10-year and 20-year
follow-up. PubMed. Am J Ophthalmol. 2003
Sep;136(3):433-41.
Carotid Cavernous Fistula in a Patient with Graves'
Ophthalmopathy. Carotid cavernous fistula can closely
mimic the cardinal signs of Graves' ophthalmopathy, an
inflammatory disorder of the orbit usually associated
with autoimmune thyroid disease. J. Clin. Endocrinol.
Metab. Vol. 88, No. 8 3487-3490. 2003 (Also see:
Thyroid Disease: Grave's)



Long-Term Safety of Orbital Radiotherapy for Graves'
Ophthalmopathy. OR is a safe treatment, not associated
with an increased frequency of cataract, provided a
high voltage apparatus is used. OR should be
restricted to patients older than 35 yr. J. Clin.
Endocrinol. Metab. 2003 88: 3561-3566. 2003 (Also see:
Thyroid Disease: Grave's)


Antibodies: Anti-Ku antibody-positive
scleroderma-dermatomyositis overlap syndrome
developing Graves' disease and immune thrombocytopenic
purpura. Graves' disease (GD) has been reported to be
frequently complicated with other autoimmune diseases.
However, it is rarely complicated with
scleroderma-polymyositis overlap syndrome. PubMed.
Intern Med 2002 Dec;41(12):1199-203 (Also see Overlap
Syndrome)


Gene fault linked to auto-immune disease risk. The
gene, called CTLA4, regulates the body's immune system
and acts as a molecular brake to prevent it from
overreacting and attacking its own cells. They believe
it is one of several genetic variations linked to an
increased susceptibility to type one, or early onset
diabetes, Graves' disease and autoimmune
hypothyroidism, which are disorders of the thyroid
gland. Sci-Tech News ABC News Online 05/01/03.


Immunoglobulins: Researchers Identify Novel Disease
Mechanism Associated with Graves' Disease; Discovery
Holds Promise for Halting Disease Process in Several
Autoimmune Disorders Research identifies an
interaction between immunoglobulins found in Graves'
patients and the insulin-like growth factor receptor
(IGF-1R) as a cause of inflammation and lymphocyte
infiltration. Business Wire 06/06/03.


Carotid Cavernous Fistula in a Patient with Graves’
Ophthalmopathy. The clinical manifestations of carotid
cavernous fistula, an abnormal arteriovenous
connection between the cavernous sinus and the carotid
artery, can closely mimic the cardinal signs of
Graves’ ophthalmopathy, an inflammatory disorder of
the orbit usually associated with autoimmune thyroid
disease. J. Clin. Endocrinol. Metab. Vol. 88, No. 8
3487-3490. 2003.


Long-Term Safety of Orbital Radiotherapy for Graves’
Ophthalmopathy. OR is a safe treatment, not associated
with an increased frequency of cataract, provided a
high voltage apparatus is used. Hypertension,
especially if associated with diabetes, may represent
a relative contraindication, as it may cause
retinopathy. Although no secondary tumors were
detected, due to the long latency of radiation-induced
tumors, OR should be restricted to patients older than
35 yr. J. Clin. Endocrinol. Metab. 2003 88: 3561-3566.
2003.
 
Hashimoto's Thyroiditis or Hypothyroidism 


Overview of Hashimoto's Disease
Hashimoto's Thyroiditis. Hashimoto’s thyroiditis is a
chronic inflammatory autoimmune disease of the thyroid
gland. Johns Hopkins Medical Institutions. 
Research of Hashimoto's Disease
Cellular immune responses in autoimmune thyroid
disease. Thyroid cell destruction in autoimmune
hypothyroidism is dependent on T cell-mediated
cytotoxicity with the likely additional effect of
death receptor-mediated apoptosis. PubMed. Clin
Endocrinol (Oxf). 2004 Oct;61(4):405-13.


Correlation of computerized gray-scale sonographic
findings with thyroid function and thyroid autoimmune
activity in patients with Hashimoto's thyroiditis. Use
of this modality may prove beneficial in the diagnosis
and follow-up of patients with HT. PubMed. J Clin
Ultrasound. 2004 Mar-Apr;32(3):136-40.


Anti-neuronal autoantibody in Hashimoto's
encephalopathy: neuropathological,
immunohistochemical, and biochemical analysis of two
patients. Hashimoto's encephalopathy (HE) is thought
to be caused by disorders of immune mechanisms. Our
results indicate that anti-neuronal autoantibodies may
be associated with the pathogenesis of HE. PubMed. J
Neurol Sci. 2004 Jan 15;217(1):7-12.


Electrophysiological tests of the hearing organ in
Hashimoto's disease. The aim of this study was to
assess peripheral and central parts of the hearing
organ in children with Hashimoto's thyroiditis.
PubMed. J Pediatr Endocrinol Metab. 2004
Jan;17(1):27-32.
Depression linked to an autoimmune thyroid condition
may have poor prognosis Whether depression is linked
to having an under-active thyroid gland has been
debated for many years. Research published in BMC
Psychiatry this week suggests that some patients with
depression may be suffering from a subtle autoimmune
thyroid condition, which could hinder their recovery.
Medical News Today 03/15/04. (Also see: Emotional
Adjustment)
 

Hypothyroidism: When the gland goes haywire. One of
the most common causes of hypothyroidism is
Hashimoto's thyroiditis, an autoimmune disorder in
which white blood cells gradually replace thyroid
tissue, which then comes under attack by immune-system
proteins called antibodies. Sun Star, February 16,
2004. (Also See: Antibodies)


Little gland, big problems. One reason for the
epidemic of undiagnosed hypothyroidism: It looks like
a raft of other conditions like CFS, depression,
Alzheimer's, or just getting older. There are
theories, but no consensus, as to why women are at
greater risk than men of developing hypothyroidism. It
may relate to women's overall higher incidence of
autoimmune conditions. FortWayne.com Knight Ridder
Newspapers. 03/07/03 (Also see: CFS and Fibromyalgia)



Modifications of the immune responsiveness in
patients with autoimmune thyroiditis: evidence for a
systemic immune alteration. Altogether these data
indicated that in the patients with autoimmune thyroid
disease a certain degree of peripheral immune
deficiency was present. PubMed. Curr Pharm Des.
2003;9(24):1946-50. 


Painful Hashimoto's Thyroiditis as an Indication for
Thyroidectomy: Clinical Characteristics and Outcome in
Seven Patients. Thyroid pain and tenderness are rare
and suggest an alternative diagnosis of subacute
granulomatous thyroiditis or other forms of
thyroiditis. Thyroidectomy is an uncommon but
necessary therapy for patients with painful HT not
responding to medical therapy. PubMed. J Clin
Endocrinol Metab. 2003 Jun;88(6):2667-72.
Thyroid Research Articles   
Autoimmune
Dietary Considerations
Cancer and Hashimoto's
Central Nervous System (CNS)
Gastrointestinal
Genetics
Interferon-induced
(Lungs) Pulmonary
Musculoskeletal Involvement
Pregnancy and Postpartum Thyroiditis
Radiotherapy-induced
Sleep Apnea and Hashimoto's
Stress and Thyroid Autoimmunity 


Autoimmune
Thyroid dysfunction and pulmonary hypertension. Our
findings indicate the presence of a frequent
association between hyperthyroidism and pulmonary
hypertension (35% in the largest series of cases)
which decrease after achievement of a euthyroid state.
Several studies suggest a high prevalence of transient
pulmonary hypertension in hypothyroidism (49% in the
largest series of cases), in these cases autoimmunity
plays a key role. PubMed. Recenti Prog Med. 2004
Sep;95(9):443-6. (Also see: Pulmonary Hypertension)


Thyroid autoantibodies in autoimmune diseases. Our
data confirm a high prevalence of silent autoimmune
thyroid diseases in association with systemic
sclerosis and rheumatoid arthritis (p<0.02), but not
with antiphospholipid syndrome. Subclinical thyroid
diseases should be considered when evaluating patients
with autoimmune diseases. PubMed. Medicina (B Aires).
2004;64(3):227-30

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[Adminஐﻬ]

PART#2- sorry it's so long, but it's a wealth of valuable information to us.


The genetics of autoimmune thyroid disease.
Autoimmune thyroid diseases (AITDs), such as Graves'
hyperthyroidism, are common disorders involving
multiple genes and the environment. Some pathogenetic
genes are probably shared between these diseases and
non-endocrine autoimmune diseases, whereas others are
disease specific. PubMed. Trends Endocrinol Metab.
2004 Jul;15(5):234-9.
Early manifestations of gastric autoimmunity in
patients with juvenile autoimmune thyroid diseases.
Our study shows that autoimmune gastritis is an early
event in juvenile AITD with detectable PCA (parietal
cell antibodies). Gastrin plasma level is a reliable
marker of gastric atrophy. PubMed. J Clin Endocrinol
Metab. 2004 Oct;89(10):4944-8.


U.S. Has 30% Increase in Hypertension Over Decade,
Study Says. The growing rate of high blood pressure
threatens to reverse a trend that cut heart disease
deaths in half over the past 50 years, said David
Goff, a professor of public health science at Wake
Forest University School of Medicine in Winston-Salem,
North Carolina. Increases in obesity and diabetes may
contribute to the problem, he said. Bloomberg.com
08/23/04.
 

Diabetes-associated autoimmune disease in children
and juveniles: how important is early recognition?
Celiac disease (CD) and autoimmune thyroiditis (AIT)
are associated with type-1 diabetes. Identified by
screening, the prevalence of CD and AIT is reported to
be up to 10-fold higher in young patients with type-1
diabetes than in healthy children. PubMed. Dtsch Med
Wochenschr. 2004 May 14;129(20):1145-8. (Also see:
Diabetes)
 

Women take heart. Some health conditions that may
increase a woman's risk of heart disease include
autoimmune disorders, infections of the heart muscle
and lining, and kidney failure. Heart disease may be
prevented by not smoking and by controlling high blood
pressure, diabetes, and cholesterol. News 8 Austin.
05/24/04.
Eyes Provide View Of Overall Health. Exams Can Detect
Diabetes, High Blood Pressure. The American Optometric
Association recommends regular eye exams about every
two years until a person reaches 60, then an exam
should be done every year. Anyone at high risk or with
a diagnosed eye disease may need to go more often.
News Channel 10 04/27/04.


High Blood Pressure in Pregnancy - Information
Preeclampsia is a condition that typically starts
after the 20th week of pregnancy and is related to
increased blood pressure and protein in the mother's
urine. Women with diabetes, kidney disease, rheumatoid
arthritis, lupus, or scleroderma are more likely to
develop preeclampsia. Medical News Today , 13 Feb
2004.


Treatment of Minimal Subclinical Thyroid Disease
Currently Not Recommended Due to Insufficient
Evidence. In subclinical hyperthyroidism, antithyroid
therapy is recommended for patients with TSH levels
<1.0 mIU/L due to risk of developing Graves or nodular
thyroid disease, especially in patients over 60 and
those at risk of heart disease, osteopaenia, or
osteoporosis. Doctor's Guide. 02/02/04 JAMA 2004 Jan
14;291:2:228-238.


Celiac disease and autoimmune diseases or systemic
disease. Six cases and a review of the literature. The
link between celiac disease and autoimmune thyroiditis
or insulin-dependent diabetes mellitus seems to be
real but many discrepancies are observed for the other
autoimmune diseases. PubMed. Ann Med Interne (Paris).
2003 Sep;154(4):197-204.


Vitiligo Light Therapy Researchers don't know the
cause of vitiligo, however it sometimes occurs in
conjunction with certain autoimmune conditions, like
thyroid disease. HOI-ABC News 01/16/04. (Also see:
Vitiligo)


Modulation of dendritic cell function and cytokine
production to prevent thyroid autoimmunity.
Understanding autoimmune thyroid diseases provides an
unique perspective on the role of various components
of the immune system in the pathogenesis of organ
specific autoimmune diseases, whether the effector
mechanism involves autoantibodies or T cells. PubMed.
Autoimmunity. 2003 Sep-Nov;36(6-7):389-96.


Association of a rare thyroglobulin gene
microsatellite variant with autoimmune thyroid
disease. Although these findings may represent a
random chance event, in view of previous reports of
linkage and association of this gene region to AITD,
this may be an example of a rare causal variant of a
complex disease. PubMed. J Clin Endocrinol Metab. 2003
Oct;88(10):5039-42.


Myocarditis associated with Hashimoto's disease: a
case report. In contrast to Grave's disease,
Hashimoto's thyroiditis has never been reported in
association with myocarditis as a cause of sudden
death. We conclude that the cardiac immunological and
histological pattern, similar to that found in the
thyroid gland suggests an autoimmune myocarditis.
PubMed. Int J Legal Med. 2003 Oct 1.


Autoimmunity and vitiligo. These observations
support the concept that, at least in some types of
vitiligo, autoimmune mechanisms are operating to
produce the disease. PubMed. Pigment Cell Res. 2003
Oct;16(5):589. (Also see: Diseases Similar to
Scleroderma: Vitiligo)


The Epidemiology and Genetics of Generalized
Vitiligo. Generalized vitiligo, in which white patches
of skin and hair due to melanocyte death, is among the
most common autoimmune diseases, occurring in
approximately 1/200 people worldwide. PubMed. Pigment
Cell Res. 2003 Oct;16(5):589-90. (Also see: Diseases
Similar to Scleroderma: Vitiligo)
ANA Levels: Autoimmune diseases in vitiligo: do
anti-nuclear antibodies decrease thyroid volume? AT
(autoimmune thyroiditis) is the most frequent
autoimmune disease associated with vitiligo. In our
patients, AT presented simultaneously or after the
onset of vitiligo but not before. Elevated ANA levels
were associated with the atrophic variant of AT and
may affect the volume of the thyroid gland. PubMed.
Clin Exp Immunol 2003 Feb;131(2):347-54 (Also see:
Diseases Similar to Scleroderma: Vitiligo)


Dental amalgam as one of the risk factors in
autoimmune diseases. Results imply that, in some
patients with thyroiditis, mercury from dental amalgam
can stimulate the production of antinuclear
antibodies. Dental amalgam may be a risk factor in
some patients with autoimmune disease. PubMed.
Neuroendocrinol Lett 2003 Feb-Apr;24(1/2):65-67. (Also
see: Causes of Scleroderma, Dental Involvement, and
Antibodies) 


Fetal Cells: Postpartum Autoimmune Thyroid Disease:
The Potential Role of Fetal Microchimerism.
Accumulating evidence suggests that fetal immune cells
may be reactive to maternal antigens and, therefore,
have the capacity to trigger graft vs. host reactions.
This would provide a mechanism for the initiation
and/or exacerbation of autoimmune disease. J. Clin.
Endocrinol. & Metab. 2003 Vol. 88, No. 7 2965-2971
(Also see: Fetal Cells in Scleroderma)


Genetics: PDS Is a New Susceptibility Gene to
Autoimmune Thyroid Diseases: Association and Linkage
Study. Autoimmune thyroid disease (AITD), including
Graves’ disease (GD), Hashimoto thyroiditis (HT), and
primary idiopathic myxedema, is caused by multiple
genetic and environmental factors. Genes involved in
immune response and/or thyroid physiology appear to
influence susceptibility to disease. J. Clin.
Endocrinol. & Metab. 2003 Vol. 88, No. 5 2274-2280 
Genetics: Family history of autoimmune thyroid disease
and childhood acute leukemia. The results suggest that
a familial history of autoimmune thyroid disease may
be associated with childhood acute leukemia. PubMed.
Cancer Epidemiol Biomarkers Prev 2003 Jan;12(1):60-3
p27(Kip1) protein expression in Hashimoto's
thyroiditis. These observations suggest that the
regulation of p27(Kip1) expression in epithelial
thyroid cells may play a role in HT pathogenesis.
PubMed. J Clin Pathol. 2003 Aug;56(8):587-91.
Polyglandular Autoimmune Syndromes: Immunogenetics and
Long-Term Follow-Up. In subjects at risk for PAS,
functional screening every 3 years is warranted. If
clinical disease is present, serological measurement
of organ-specific antibodies should follow. J. Clin.
Endocrinol. & Metab. 2003 Vol. 88, No. 7 2983-2992


Cancer and Hashimoto's Thyroiditis
Detection and molecular characterisation of thyroid
cancer precursor lesions in a specific subset of
Hashimoto's thyroiditis. Our findings provide a
well-substantiated morphological and molecular
demonstration that HT may include a spectrum of
different thyroid conditions ranging from chronic
autoimmune thyroiditis to thyroiditis triggered by
specific immune-response to cancer-related antigens.
PubMed. Br J Cancer. 2004 Aug 3.


The incidence of thyroid carcinoma in Hashimoto's
thyroiditis. Our experience and literature review. The
possibility of an immunological and autoimmune
mechanism in the etiopathogenia of papillary
carcinomas stimulating lymphocytic infiltration has
been suggested. We estimate the coexistence of
papillary Ca. and Hashimoto's disease at 36.4% (4 of
11) in our case history. PubMed. An Otorrinolaringol
Ibero Am. 2004;31(3):223-30. 
Central Nervous System (CNS) and Dementia with
Hashimoto's
Progressive dementia caused by Hashimoto's
encephalopathy - report of two cases. In patients with
rapidly progressive dementia or with dementia of
unknown origin, HE should be considered. PubMed. Eur J
Neurol. 2004 Oct;11(10):711-3.


Brain perfusion abnormalities in patients with
euthyroid autoimmune thyroiditis. These results show
the high prevalence of brain perfusion abnormalities
in euthyroid HT. These abnormalities are similar to
those observed in cases of severe Hashimoto's
encephalopathy and may suggest a higher than expected
involvement of CNS in thyroid autoimmune disease.
PubMed. Eur J Nucl Med Mol Imaging. 2004 Jul 31.
Dietary Considerations for Hashimoto's Thyroiditis
Iodine and thyroid autoimmunity. Epidemiological data
from countries with sufficient or high nutritional
iodine intake clearly show that in comparison to
countries with iodine deficiency there is an increase
in the incidence of autoimmune thyroid disease.
PubMed. Z Arztl Fortbild Qualitatssich. 2004 May;98
Suppl 5:73-6.


Iodine: The effect of iodine restriction on thyroid
function in patients with hypothyroidism due to
Hashimoto's thyroiditis. In this study, 78.3% of
patients with hypothyroidism due to Hashimoto's
thyroiditis regained an euthyroid state with iodine
restriction alone. PubMed. Yonsei Med J. 2003 Apr
30;44(2):227-35. 
Gastrointestinal 
Thyroid-intestinal motility interactions summary.
Thyroid diseases may be related to gastrointestinal
motility symptoms. Such symptoms can vary in degree
and, sometimes, are the only clue of a thyroid disease
or, at least, the first. PubMed. Minerva Gastroenterol
Dietol. 2004 Dec;50(4):305-15. (Also see: Scleroderma
Gastrointestinal Involvement)
Genetics
X Chromosome Monosomy: A Common Mechanism for
Autoimmune Diseases. Chromosome instability is common
to women with SSc and AITD (autoimmune thyroid
disease) and haploinsufficiency for X-linked genes may
be a critical factor for the female predominance of
autoimmune diseases. PubMed. J Immunol. 2005 Jul
1;175(1):575-578. (Also see: Causes of Scleroderma:
Genetics)


Rheumatoid arthritis gene link proven. The gene
PTPN22 has been confirmed as one of the factors that
cause rheumatoid arthritis by University of Otago
researchers. PTPN22, is also over-represented in
people with Type 1 diabetes and thyroiditis, providing
extra evidence it is a causal factor in autoimmune
diseases generally. Scoop NZ 07/04/05. (Also see:
Rheumatoid Arthritis and Diabetes) 
Genetic markers in thyroid autoimmune diseases.
Autoimmune disorders of the thyroid such as Graves'
disease and Hashimoto's thyroiditis are the most
common autoimmune diseases in the Western world. The
frequent occurrence of both diseases in members of the
same family indicates the influence of common genetic
factors generally predisposing to thyroid
autoimmunity. PubMed. Z Arztl Fortbild Qualitatssich.
2004 May;98 Suppl 5:13-5.


Interferon-induced Thyroid Disorders
Thyroid autoimmunity and dysfunction associated with
type I interferon therapy. Type I interferons are
currently used for the treatment of chronic viral
hepatitis, multiple sclerosis and several
hematological and solid tumors. Side effects are not
uncommon, and include multiple alterations in thyroid
function, some of which are unrelated to autoimmunity.
PubMed. Clin Exp Med. 2004 Apr;3(4):199-210. (Also
see: Thyroid Disease)


Lungs (Pulmonary)
Airway function and markers of airway inflammation in
patients with treated hypothyroidism. Patients with
treated hypothyroidism report more respiratory
symptoms and have objective evidence of airway
dysfunction and inflammation. PubMed. Thorax. 2005
Mar;60(3):249-53.
Musculoskeletal Involvement
Interrelations Between Fibromyalgia, Thyroid
Autoantibodies, and Depression. Our results suggest an
association between FM and thyroid autoimmunity. J
Rheumatol. OCTOBER 2004;31:2036-40 (Also see:
Fibromyalgia)
Fibromyalgia and Thyroid Dysfunction. The most
frequent thyroid functional disorder found in
fibromyalgia women was SCHT (subclinical
hypothyroidism), more than in healthy population.
Presence of TPO antibodies was the most frequent
related to this disfunction. R. M. Morlà. AB0169 EULAR
2004. (Also see: Fibromyalgia)
Musculoskeletal manifestations in patients with
thyroid disease. These results demonstrate that
musculoskeletal disorders often accompany thyroid
dysfunction. In addition to the well-known observation
that these disorders are common in patients with
hypothyroidism, they are also observed in patients
with thyrotoxicosis. Patients with thyroid dysfunction
should be questioned for musculoskeletal complaints
and referred to a specialist if necessary. PubMed.
Clin Endocrinol (Oxf). 2003 Aug;59(2):162-7.


Pregnancy and Postpartum Thyroiditis (PPT) 
Miscarriages May Be A Symptom Of Greater Health Risk.
Autoimmune Diseases, such as lupus or thyroid
conditions, are associated with RPL (Recurrent
Pregnancy Loss) and infertility. If you have a history
of autoimmune disease and unexplained RPL, ask about
these potentially appropriate tests: ACA/APA, LAC
(Lupus Anti-coagulant).



Screening for thyroid disease in pregnancy.
Postpartum thyroid dysfunction (PPTD) occurs in 5-9%
of women and is associated with antithyroid peroxidase
antibodies (antiTPOAb) in 10% of women in early
pregnancy. Therefore, screening for thyroid
dysfunction in pregnancy should be considered. PubMed.
J Clin Pathol. 2005 May;58(5):449-52.


Postpartum thyroiditis (PPT) is an autoimmune
disorder which is a transient form of Hashimoto's
thyroiditis occurring postpartum as a consequence of
the immunologic flare following the immune suppression
of pregnancy. PubMed. Best Pract Res Clin Endocrinol
Metab. 2004 Jun;18(2):303-16. 


Radiotherapy-induced Thyroid Disorders
Radiotherapy-induced thyroid disorders. Despite their
specific functional consequences, radiotherapy-induced
thyroid abnormalities remain under-estimated and
underreported. PubMed. Cancer Treat Rev. 2004
Jun;30(4):369-84.


Sleep Apnea and Hashimoto's 
Hashimoto thyroiditis and obstructive sleep apnea
syndrome: is there any relation between them? Five
patients with HT showed the characteristics of
obstructive sleep apnea syndrome (one severe, one
moderate and three mild OSAS), whereas no sleep
breathing disturbance was found in the control group.
These findings suggest that sleep related breathing
problems may develop in the patients with autoimmune
thyroiditis even if they are euthyroid. PubMed. Eur J
Med Res. 2004 Dec 22;9(12):570-2. 



Stress and Thyroid Autoimmunity 
Stress and thyroid autoimmunity. Stress affects the
immune system either directly or indirectly through
the nervous and endocrine systems. These immune
modulations may contribute to the development of
autoimmunity as well as the susceptibility to
autoimmune disease in genetically predisposed
individuals. Stress can be one of the environmental
factors for thyroid autoimmunity.

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The thyroid gland is a double-lobed structure located in the neck. Embedded in its rear surface are the four parathyroid glands. Link to graphic showing the location of the thyroid, parathyroids, and other endocrine glands (92K).

The Thyroid Gland
The thyroid gland synthesizes and secretes:
thyroxine (T4) and
calcitonin
T4 and T3
Thyroxine (T4 ) is a derivative of the amino acid tyrosine with four atoms of iodine. In target cells (e.g. liver cells), one atom of iodine is removed from T4 converting it into triiodothyronine (T3). T3 is the active hormone. It has many effects. Among the most prominent of these are:
an increase in metabolic rate (seen by a rise in the uptake of oxygen);
an increase in the rate and strength of the heart beat.
The thyroid cells responsible for the synthesis of T4 take up circulating iodine from the blood. This action, as well as the synthesis of the hormones, is stimulated by the binding of TSH to transmembrane receptors at the cell surface.

Diseases of the thyroid
1. hypothyroid diseases; caused by inadequate production of T3
cretinism: hypothyroidism in infancy and childhood leads to stunted growth and intelligence. Can be corrected by giving thyroxine if started early enough.
myxedema: hypothyroidism in adults leads to lowered metabolic rate and vigor. Corrected by giving thyroxine.
goiter: enlargement of the thyroid gland. Can be caused by:
inadequate iodine in the diet with resulting low levels of T4 and T3;
an autoimmune attack against components of the thyroid gland (called Hashimoto's thyroiditis).

Why should a hypothyroid disease produce an enlarged gland? The activity of the thyroid is under negative feedback control:
the synthesis and release of TRH and TSH is normally inhibited as the levels of T4 and T3 rise in the blood.
When the iodine supply is inadequate, T4 and T3 levels fall
this stimulates the hypothalamus and pituitary to increased TRH and TSH activity respectively. This stimulates the thyroid gland to enlarge (fruitlessly).
The symptoms of hypothyroidism can also result from inherited mutations in the genes encoding:
the receptor for TSH (present on the surface of thyroid cells) or
the receptor for T3 (present in the nucleus of almost all cells)
The T3 receptor is a nuclear protein bound to the thyroid response element in the promoters of the many genes whose expression is influenced by thyroid hormones. When its ligand, T3, binds to it, it becomes a transcription factor turning on the transcription of many genes.

Link to a discussion of the nuclear receptor superfamily — the family of hormone receptors to which the T3 receptor belongs. Includes a stereo view of a similar receptor binding to its response element.

2. hyperthyroid diseases; caused by excessive secretion of thyroid hormones
Graves´ disease. Autoantibodies against the TSH receptor bind to the receptor mimicking the effect of TSH binding. Result: excessive production of thyroid hormones. Graves´ disease is an example of an autoimmune disease.

Osteoporosis. High levels of thyroid hormones suppress the production of TSH through the negative-feedback mechanism mentioned above. The resulting low level of TSH causes an increase in the numbers of bone-reabsorbing osteoclasts resulting in osteoporosis.




3.Calcitonin
Calcitonin is a polypeptide of 32 amino acids. The thyroid cells in which it is synthesized have receptors that bind calcium ions (Ca2+) circulating in the blood. These cells monitor the level of circulating Ca2+. A rise in its level stimulates the cells to release calcitonin.
bone cells respond by removing Ca2+ from the blood and storing it in the bone
kidney cells respond by increasing the excretion of Ca2+
Both types of cells have surface receptors for calcitonin.
Because it promotes the transfer of Ca2+ to bones, calcitonin has been examined as a possible treatment for osteoporosis, a weakening of the bones that is a leading cause of hip and other bone fractures in the elderly. Being a polypeptide, calcitonin cannot be given by mouth (it would be digested), and giving by injection is not appealing. However, inhaling calcitonin appears to be an effective way to get therapeutic levels of the hormone into the blood. A synthetic version of calcitonin (trade name = Miacalcin) is now available as a nasal spray.


4.The Parathyroid Glands
The parathyroid glands are 4 tiny structures embedded in the rear surface of the thyroid gland. They secrete parathyroid hormone (PTH) a polypeptide of 84 amino acids. PTH increases the concentration of Ca2+ in the blood in three ways. PTH promotes
release of Ca2+ from the huge reservoir in the bones. (99% of the calcium in the body is incorporated in our bones.)
reabsorption of Ca2+ from the fluid in the tubules in the kidneys
absorption of Ca2+ from the contents of the intestine (this action is mediated by calcitriol, the active form of vitamin D.)
PTH also regulates the level of phosphate in the blood. Secretion of PTH reduces the efficiency with which phosphate is reclaimed in the proximal tubules of the kidney causing a drop in the phosphate concentration of the blood.

5.Control of the Parathyroids: the calcium receptor
The cells of the parathyroid glands have surface G-protein-coupled receptors that bind Ca2+ (the same type of receptor is found on the calcitonin-secreting cells of the thyroid and on the calcium absorbing cells of the kidneys). Binding of Ca2+ to this receptor depresses the secretion of PTH and thus leads to a lowering of the concentration of Ca2+ in the blood. Two classes of inherited disorders involving mutant genes encoding the Ca2+ receptor occur:
loss-of-function mutations with the mutant receptor always "off". Patients with this disorder have high levels of Ca2+ in their blood and excrete small amounts of Ca2+ in their urine. This causes hyperparathyroidism.
gain-of-function mutations with the mutant receptor always "on" (as though it had bound Ca2+). People with this disorder have low levels of Ca2+ in their blood and excrete large amounts of Ca2+ in their urine. This causes hypoparathyroidism.
Rare autoimmune disorders can mimic one or the other of these inherited disorders. In each case, autoantibodies bind to the receptors.
If these inhibit the receptors, they cause hyperparathyroidism.
If they activate the receptors (like those in Graves' disease), they cause hypoparathyroidism.

6.Hyperparathyroidism
Tumors in the parathyroids elevate the level of PTH causing a rise in the level of blood Ca2+ at the expense of calcium stores in the bones. So much calcium may be withdrawn from the bones that they become brittle and break.

Until recently, treatment has been the removal of most — but not all — of the parathyroid tissue (i.e. the goal is the removal of 3 1/2 glands). Now clinical trials have begun on a drug (designated R-568) that mimics the action of calcium on the parathyroids, resulting in a drop in PTH and blood Ca2+ and sparing the calcium stores in the bone.

7.Hypoparathyroidism
Causes:
accidental removal of or damage to the parathyroids during neck surgery
inherited mutations in the PTH gene
inherited predisposition to an autoimmune attack against the parathyroids (and other glands)
inherited defect in the embryonic development of the parathyroids (DiGeorge syndrome)
Treatment:
give calcium supplements
give calcitriol 1,25[OH]2 vitamin D3
give teriparatide (Forteo®), a synthetic (by recombinant DNA) version of PTH (containing only the 34 amino acids at the N-terminal). For reasons that are not yet clear, this drug — when given in daily injections (because it would be digested if taken by mouth) — promotes strong bones and thus has been approved as a treatment for osteoporosis. While continuous high levels of PTH weaken bones by removing calcium from them, periodic injections of this drug strengthen bone by increasing the number and activity of osteoblasts.

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