1,720,981 research outputs found
Reversible normalisation of serum TSH levels in patients with autoimmune atrophic gastritis who received L-T4 in tablet form after switching to an oral liquid formulation: A case series
Full text linkBackground: L-thyroxine (L-T4) malabsorption is a potential concern in patients with autoimmune atrophic gastritis. Methods: We evaluated five patients with autoimmune gastritis, who showed high serum thyrotropin (TSH) levels (in the hypothyroid range) while in therapy with L-T4 in tablet. All patients were switched to receive an oral L-T4 liquid formulation maintaining the same dosage. Results: In all patients who received L-T4 in tablet form after switching to an oral liquid formulation with the same L-T4 dosage, TSH circulating levels were normalized. In four patients who were switched back again to receive L-T4 in tablets, maintaining the dosage, TSH levels worsened again reaching levels in the hypothyroid range. Conclusions: The fact that the change from tablets to liquid oral formulation normalised serum TSH levels, and that switching back to tablets caused thyrotropin levels to worsen, leads us to believe that absorption of L-T4 is greater with oral liquid formulations in these patients. These results suggest that the L-T4 oral liquid formulation could circumvent the pH alteration resulting from atrophic gastritis
Th1 chemokines in autoimmune endocrine disorders
Full text linkCONTEXT:
The chemokine receptor (CXCR)3 and its chemokines CXCL10, CXCL9 and CXCL11 are implicated in the pathogenesis of autoimmune diseases. Here, we review these chemokines in "autoimmune thyroiditis" (AT), "Graves' disease" (GD), "thyroid eye disease (TED), "Type 1 diabetes" (T1D), "Addison's disease" (AAD).
EVIDENCE ACQUISITION:
A PubMed revision of the literature was conducted searching for the above mentioned chemokines in combitation with AT, GD, TED, T1D, AAD.
EVIDENCE SYNTHESIS:
Thyroid follicular cells in AT and GD, retroorbital cells in TED (fibroblasts, preadipocytes, myoblasts), β cells and islets in T1D, and adrenal cells in AAD, respond to IFN-γ stimulation producing large amounts of these chemokines. Furthermore, lymphocytes and PBMC are in part responsible for the secreted Th1 chemokines. In AT, GD, TED, T1D, AAD circulating levels of these chemokines have been shown to be high. Furthermore these chemokines have been associated with the early phases of the autoimmune response in all the above mentioned disorders. High levels of these chemokines have been associated also with the "active phase" of the disease in GD, and also in TED. Other studies have shown an association with the severity of hypothyroidism in AD, of hyperthyroidism in GD, with severity of TED, or with fulminant T1D.
CONCLUSION:
The above mentioned data have shown the importance of the Th1 immune response in different endocrine autoimmune diseases, and many studies have suggested that CXCR3, and its chemokines, might be considered potential targets of new drugs for the treatment of these disorders
Patients with lactose intolerance absorb liquid levothyroxine better than tablet levothyroxine
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The association of other autoimmune diseases in patients with Graves’ disease (with or without ophthalmopathy): Review of the literature and report of a large series
Full text linkGraves’ disease (GD) and autoimmune thyroiditis (AT) are the two main clinical presentations of AITD, and their clinical hallmarks are thyrotoxicosis and hypothyroidism, respectively. GD, and AT, can be associated with other organ specific, or systemic autoimmune diseases in the same patient. However discordant results have been reported in the literature about the possible associations. Here, we review the association of GD and other autoimmune syndromes. Furthermore, we report the results of our prospective study that investigated the prevalence of other autoimmune disorders in 3209 GD patients (984 with Graves’ ophthalmopathy), with respect to 1069 healthy controls, or 1069 patients with AT, or 1069 with multinodular goiter (matched by age, gender, coming from the same area, with a similar iodine intake). On the whole, 16.7% of GD patients had another associated autoimmune disease; and the most frequently observed were: vitiligo (2.6%), chronic autoimmune gastritis (2.4%), rheumatoid arthritis (1.9%), polymyalgia rheumatica (1.3%), multiple sclerosis (0.3%), celiac disease (1.1%), diabetes (type 1) (0.9%), systemic lupus erythematosus and sarcoidosis (<0.1%), Sjogren disease (0.8%). Moreover, 1.5% patients with GD had three associated autoimmune disorders. Interestingly, patients with Graves’ ophthalmopathy (GO) had another autoimmmune disorder more frequently (18.9%), with respect to GD patients without GO (15.6%). However the pattern of the associated autoimmune disorders in GD was not significantly different from that observed in AT patients. In conclusion, we suggest GD patients who are still sick, or who develop new unspecific symptoms (even if during an appropriate treatment of hyperthyroidism) should be appropriately screened for the presence of other autoimmune disorders
The association of other autoimmune diseases in patients with autoimmune thyroiditis: Review of the literature and report of a large series of patients
Full text linkWe have evaluated prospectively the prevalence of other autoimmune disorders in outpatient clinic in 3069 consecutive patients with diagnosed chronic autoimmune thyroiditis (AT), with respect to two age- and sex-matched control groups: a) a control group of 1023 subjects, extracted from a random sample of the general population without thyroid disorders; b) 1023 patients with non-toxic multinodular goiter extracted from the same random sample of the general population, with similar iodine intake. The results of our study demonstrate a significant increase of the prevalence of autoimmune disorders in AT patients (with respect to both controls), for the following diseases: chronic autoimmune gastritis (CAG), vitiligo (Vit), rheumatoid arthritis, polymialgia rheumatica (Polym), celiac disease, diabetes, sjogren disease, multiple sclerosis, systemic lupus erythematosus, sarcoidosis, alopecia, psoriathic arthritis, systemic sclerosis, and HCV-related cryoglobulinemia. While the statistical analysis reached near the significance for Addison's disease and ulcerative colitis. Interestingly, the association of three autoimmune disorders was observed almost exclusively in AT patients, and the most frequent associations were AT+CAG+Vit and AT+CAG+Polym. We suggest that patients with AT who remain unwell, or who develop new not specific symptoms (despite adequate treatment) should be screened for other autoimmune disorders, avoiding the delay in the diagnosis of these disorders
Increased incidence of autoimmune thyroid disorders in patients with psoriatic arthritis: a longitudinal follow-up study
Full text linkContrasting results have been reported about the prevalence of thyroid autoimmunity (AT) and dysfunction (TD) in patients with psoriatic arthritis (PsA). In this study, we pointed to evaluate the incidence of new cases of clinical and subclinical TD in a broad group of patients with PsA versus a control group, matched by age and gender belonging to the same geographic area. PsA patients with TD were excluded firstly, and new cases of thyroid disorders were evaluated in 97 PsA patients and 97 matched controls, who had comparable iodine intake (median follow-up of 74 months in PsA versus 92 in controls). A raised rate of new cases of hypothyroidism, TD, positive antithyroid peroxidase (AbTPO) antibodies, and appearance of a small hypoechoic thyroid pattern in PsA, especially in female gender, compared to controls has been evidenced. Risk factors in female gender for the development of TD are thyroid-stimulating hormone (TSH) within the normal range but at the higher limit, positive AbTPO, and small thyroid volume. To sum up, thyroid function follow-up and suitable treatments should be performed regularly in female patients at high risk (TSH within the normal range but at the higher limit, positive AbTPO, hypoechoic and small thyroid)
Advancements in the treatment of hypothyroidism with L-T4 liquid formulation or soft gel capsule: an update
Full text linkINTRODUCTION: The most recent advance concerning levothyroxine (L-T4) therapy is the development of novel oral formulations: the liquid preparation, and the soft gel capsule.
AREAS COVERED: This review evaluates the most recent clinical studies about these new formulations. The liquid formulation has been shown to overcome: the food and beverages intereference with L-T4 tablets absorption, caused by food or coffee at breakfast; malabsorption induced by the increased gastric pH, resulting from atrophic gastritis, or due to proton-pump inhibitors; and malabsorption after bariatric surgery. The use of liquid L-T4 has been studied also in pregnancy, newborns and infants, suggesting a better bioequivalence than tablets. Finally, liquid L-T4 is more active than tablets in the control of thyroid-stimulating hormone (TSH) in hypothyroid patients without malabsorption, drug interference, or gastric disorders, leading to a hypothesized higher absorption of liquid L-T4 also in these patients. Few studies have evaluated soft gel L-T4 with promising results in patients with malabsorption related to coffee or gastritis.
EXPERT OPINION: Liquid L-T4 (and soft gel capsules) are more active than the tablet L-T4 in the control of TSH in hypothyroid patients with gastric disorders, malabsorption, or drug interference, but also in patients without absorption disorders
CXCL10 in psoriasis
Full text linkChemokine (C-X-C motif) ligand (CXCL)10 is involved in the pathogenesis of psoriasis. It has been demonstrated that chemokine (C-X-C motif) receptors (CXCR)3 and CXCL10 were detected in keratinocytes and the dermal infiltrate obtained from active psoriatic plaques and that successful treatment of active plaques decreased the expression of CXCL10. Elevated CXCL10 serum levels have been shown in patients with psoriasis, with a type 1 T helper cells immune predominance at the beginning of the disease, while a decline of this chemokine has been evidenced later, in long lasting psoriasis. Circulating CXCL10 is significantly higher in patients with psoriasis in the presence of autoimmune thyroiditis. It has been hypothesized that CXCL10 could be a good marker to monitor the activity or progression of psoriasis. Efforts have been made to modulate or inhibit the CXCR3/CXCL10 axis in psoriasis to modify the course of the disease
TSH Normalization in Bariatric Surgery Patients After the Switch from l-Thyroxine in Tablet to an Oral Liquid Formulation
Full text linkObjective: Drug malabsorption is one of the potential troubles after bariatric surgery. Evidence for diminished levothyroxine (L-T4) absorption has been reported in patients after bariatric surgery. Methods: This study reports 17 cases of hypothyroid patients [who were well replaced with thyroxine tablets (for >1 year) to euthyroid thyrotropin (TSH) levels before surgery (13 Roux-en-Y gastric bypasses (RYGB); 4 biliary pancreatic diversions (BPD))]. From 3 to 8 months after surgery, these patients had elevated TSH levels. Patients were then switched from oral tablets to a liquid L-T4 formulation (with the same dosage, 30 min before breakfast). Results: Two–three months after the switch, TSH was significantly reduced both in patients treated with RYGB, as in those treated with BPD, while FT4 and FT3 levels were not significantly changed (RYGB group, TSH μIU/mL: 7.58 ± 3.07 vs 3.808 ± 1.83, P < 0.001; BPD group, TSH μIU/mL: 8.82 ± 2.76 vs 3.12 ± 1.33, P < 0.01). Conclusions: These results first show that liquid L-T4 could prevent the problem of malabsorption in patients with BPD and confirm those of previous studies in patients submitted to RYGB, suggesting that the L-T4 oral liquid formulation could circumvent malabsorption after bariatric surgery
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