جستجوی مقالات مرتبط با کلیدواژه "بیماری گریوز" در نشریات گروه "پزشکی"

Graves' disease is the most common cause of hyperthyroidism in all age groups, although due to the decrease in the incidence of classic hyperthyroid symptoms and Graves' disease and uncommon symptoms in the elderly, timely diagnosis and treatment of the disease are often complicated. For this reason, mortality and morbidity rate increases in the aged groups. This article discusses a case report of an elderly patient who went to the emergency room with progressive dysphagia of solids and liquids and was admitted to the gastroenterology department. In the subsequent follow-ups, the response to the treatment was visible in the patient, and the patient's dysphagia was resolved mainly, which shows the high importance of thyroid tests in the el. Timely diagnosis in this age group will reduce mortality.

The presence of the antibodies against the main thyroid antigens, which include thyroid peroxidase (TPO) or microsomal antigen, thyroglobulin (Tg) as well as thyrotropin receptor or Thyroid Stimulating Hormone Receptor (TSH-R), is a hallmark and symbol of the autoimmune thyroid diseases (AITDs) as one of the most common autoimmune diseases (AD) around the world. The prevalence of the thyroid peroxidase antibodies (anti-TPO antibody) and the thyroglobulin antibodies (anti-Tg antibody) is considerably higher in patients suffering from Graves’ disease (GD) and Hashimotochr('39')s thyroiditis (HT, chronic autoimmune thyroiditis, autoimmune hypothyroidism). While the TSH receptor antibodies (TRAbs) are common in the patients suffering from GD, they are relatively rare and infrequent in HT patients. This fact may indicate that TRAbs are more specific than other antibodies. In fact, TRAbs as one of the most important autoantibodies against the different thyroid antigens, are a set of the heterogeneous group of antibodies that based on the function, fall into three categories, including TSHR-stimulating antibodies (TSAbs), TSHR-blocking antibodies (TBAbs), and the neutral antibodies (no effect on receptor). TSAbs and TBAbs result in overproduction and reduction of intracellular cAMP respectively. Therefore the induction of the relevant signaling pathways can be the cause of different clinical symptoms in the form of hyperthyroidism or hypothyroidism consecutively. The extra-thyroidal effects of TRAbs as the extra-thyroid GD manifestations, such as ophthalmopathy and dermopathy, often have an effect on the eyes as well as the skin with the relatively well-known immunological mechanisms of the antibodies functions. Hashimoto encephalopathy is an extra-thyroidal effects of anti-TPO that provokes the central nervous system. On the other hand, anti-TPO like anti-Tg can affect the reproductive organs of women and lead to infertility by an unknown mechanism. Moreover, the circulating antibodies against the thyroid antigens can also be detected in other autoimmune diseases such as rheumatoid arthritis (RA), type I diabetes (T1DM) and celiac disease (CD). In this review article, the most important types of thyroid autoantibodies, their essential immunological processes in AITD as well as the main and important clinical extra-thyroidal manifestations of them have been discussed and reviewed.

Thyroid Stimulating Hormone Receptor (TSH-R) autoantibodies are the main cause of Graveschr('39') disease and its external thyroid manifestations such as ophtalmopathy and dermatopathy. These antibodies are functionally different and are commonly called TSH receptor antibodies (TRAbs). In fact, TRAbs are a set of autoantibodies including TSHR-stimulating antibodies (TSAbs), TSHR- blocking antibodies (TBAbs), and neutral antibodies. The measurement of TRAbs is clinically important and various commercial tests with high sensitivity and specificity are available for diagnostic purposes. If the diagnostic purpose of the TRAbs assay is the non-functional evaluation of autoantibodies, competitive binding immunoassays are used.  These methods are based on the ability of TRAbs in patient’s sample to compete and prevent ligand binding (TSH or anti-TSHR monoclonal antibodies) to the receptor. TSAbs and TBAbs appear to have common overlapping epitopes of the TSH-binding site which hinders them to be differentiated by competitive TRAbs assays. On the other hand, if the diagnostic purpose is to evaluate antibody function and differentiate between TSAbs and TBAbs, cell-based bioassays are used. The basis of these methods are the use of living cells to evaluate the function of autoantibodies and distinguish TSAbs and TBAbs based on the increase and decrease of the intracellular Cyclic adenosine monophosphate (cAMP). Since TSAbs and TBAbs have different pathogenic roles with different clinical symptoms and require different treatment protocols, differential diagnosis of TSAbs and TBAbs is of great clinical importance. In this review, different generations of competitive binding immunoassays and cell-based bioassays in the order of evolution, have been discussed.

One of the major concern of the administration of radioiodine is its complications. Pancras has sodium iodine symporter and may concentrate radioiodine. This study compared glucose tolerance in Graves disease patients on continuous treatment with antithyroid drugs, with those who received radioiodine.

In this study, 132 patients with Grave's disease who relapsed after drug therapy were randomly selected on by the patient preference for long-term treatment with either methimazole or radioactive iodine. In each group, fasting blood sugar, glucose tolerance test, and lipid profiles, TSH, insulin, HOMA-IR and HOMA-B were measured.

The two groups showed no significant difference in age sex, BMI and BP. Median FBS and HOMA-IR in the radioactive iodine group were higher than in the methimazole group (94 mg/dl vs. 90 mg/dl, P=0.019) and 1.5(1.2-2.3) vs. 1.3(0.8-2.1, P=0.045, respectively, but after adjustment there was no difference between the two groups; no significant difference was seen in HOMA-B, median two-hour blood glucose and serum insulin levels, between the two groups.

Results indicate no relationship between radioactive iodine treatment and glucose intolerance.