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Molinaro et al., Pisa, Italy, and Minsk, Belarus, studied
thyroid function (FT3, FT4, and
TSH) and prevalence of anti-thyroglobulin antibodies (AbTg) and of anti-thyroperoxidase
antibodies (AbTPO) in 287 randomly children (0-9 years) living in Hoiniki
Village being 9.2% of children contaminated by the Chernobyl radioactive
fall-out and in a control group of 208 children randomly selected from
a group of 5273 children of the same age, living in Braslav, who were not
contaminated. The prevalence of positive AbTg and/or AbTPO was significantly
higher in the contaminated children i.e. 19.1% versus 3.8%. Despite the
increased prevalence of thyroid autoantibodies there was no increased thyroid
dysfunction in the contaminated children. However, it should be taken into
account that follow-up after the accident was relatively short (7 years).
(Comment: Hypothyroidism after the Chernobyl accident in the Gomel area
of Belarus has been documented with a highest prevalence in 1995 of 30.2
x 10-4. See Sasakawa Memorial Health Foundation. Sasakawa Foundation, Japan:
A report on the 1995 Chernobyl Sasakawa Project Workshop; 1995.)
Olivieri et al., Rome, Italy, studied the prevalence of TPOAb in 62 pregnant women at risk for gestational diabetes mellitus (GDM). Risk factors were obesity, familial and personal history for GDM, and maternal age. Glucose tolerance was found to be abnormal in 15/62 women. Euthyroidism was found in all 62 women and TPOAb prevalence was similar to that observed in healthy pregnant controls (14.5% vs 12.5%). However, when 62 GDM risk women were grouped on the basis of family history of diabetes (IDDM or NIDDM) an increased prevalence of TPOAb was found (35%). When a positive family history for diabetes was combined with a positive history for thyroid dysfunction TPOAb prevalence was even higher (66%). The authors suggest screening for TPOAb especially in women who are at increased risk of GDM. Mariotti et al., Cagliari, Italy and London, UK, studied the prevalence of thyroid autoantibodies (ATA), islet cell autoantibodies (ICA) and goiter rate in 7576 school children. They found that ATA and goiter prevalence did not show a sex difference in prepubertal children, while a clear age-dependent increase of both goiter and ATA prevalence was observed in females as compared to males beyond the age of 11-12 years. Between 12 and 14 years goiter rate increased from 30-35% in females and from 20-24% in males. In this age period ATA increased from 4.2-5% in females but did not vary significantly in males (2.0 à 3%). The prevalence of ICA was not different in the age groups or between the sexes. (Comment: No information was given regarding the iodine intake in these children, but looking at the goiter rate, it seems that iodine intake was probably marginal.) Beressi et al., Paris, Lille, Limoges, Bobigny, Kremlin-Bicêtre, France; Algiers, Algeria; Oxford, UK, studied vertical transmission of autoimmune thyroid diseases in multiplex families. Families were all caucasian but from different origin: France (n = 68), Algeria (n = 14), and Egypt (n = 10). Of these families 41% were Graves' disease only, 27% Hashimoto thyroiditis only, and 30% both. Vertical transmission (1 or 2 parents affected) of disease was observed in 59% of families. Horizontal transmission (at least 2 affected siblings) was observed in 50% of families. Among 260 affected subjects 82% were women. Presence of other autoimmune disease was rare (9 patients in 92 families). (Comment: This is an interesting study, showing clustering of autoimmune thyroid disease in caucasian families.) Bocale et al., Rome, Italy, compared the diagnostic accuracy of autoimmune thyroiditis by ultrasonography and fine needle aspiration retrospectively in a group of 204 patients (177 females) in the age between 12 and 62 years. Four groups were delineated: group I: 6.9% of patients with an enlarged and diffusely hypoechogenic thyroid gland in all of whom chronic autoimmune thyroiditis (CAT) was confirmed by cytology; group II: 9.8% of patients with a sonographic pattern of multiple focal hypoechogenicities and positive cytology for CAT; group III: 72% of patients with hypoechogenic thyroid gland with single or multiple nodules and scattered hyperechogenic areas. In 57.1% CAT was cytologically confirmed; Group IV: 11.3% of patients with isoechogenic ultrasound but numerous hyperechogenic spots and strings in a small thyroid gland. In 45.5% CAT was cytologically confirmed while cytology was inadequate in 54.5%. The authors conclude that ultrasonography is a useful technique for the diagnosis of CAT, but can only serve as a complimentary test in addition to cytology and serum antithyroid antibody measurement. (Comment: I personally feel that the diagnosis of autoimmune thyroiditis should primarily be based on the presence of circulating thyroid antibodies and not on the echogenic pattern of ultrasound.) Weissel et al., Vienna, Austria, investigated thyroid function and thyroid autoimmunity in 55 patients (42 females) suffering from myasthenia gravis (MG). They found in no instance thyroid dysfunction but in 5% of patients positive antibodies against Tg, in 16% against thyroid microsomes, and in 7% against TSH-receptor. The authors conclude that thyroid dysfunction in patients with MG is rare, however, that there is a relative increased frequency of thyroid autoantibodies, suggesting a link between autoimmune thyroid disease and MG. (Comment: Kiesling et al., Neurology 31:771-774, 1981, also found an increased frequency of thyroid dysfunction in 104 patients with MG. Thyrotoxicosis was found in 5.7%, thyroid autonomy in 10%, hypothyroidism in 1.9%, and subclinical hypothyroidism in 3.4%.) Smyth et al., Dublin, Ireland, investigated the prognostic significance of the presence of TPO antibodies in the outcome of breast cancer. They found positive antibodies in 41% of breast cancer patients versus 19.2% in controls. The presence of TPO antibodies was associated with improved outcome following therapy in breast cancer in 143 patients available for follow-up, only if thyroid volume varied between 9.4 and 18.8 ml. At 5 years disease, free survival was 65% compared to 36% in TPO negative breast cancer patients, and for the same period overall survival was respectively 93 and 54%. No such associations were found in TPO positive patients when thyroid volume was beyond the above mentioned range. (Comment: The mechanistic and clinical significance of these findings is not known, but further studies are welcome.) Marino et al., Cagliari, Italy, investigated the prevalence of circulating anti-cardiolipin (aCL) with a recent more specific ELISA and compared the results to those obtained with a less specific first generation ELISA in 31 patients with Graves' disease and 31 patients with Hashimoto's disease. The first generation ELISA found an increased prevalence of aCL in Graves' disease but not in Hashimoto's disease. With the more specific ELISA no differences with controls were found in either patients groups. |
