As tireoidites auto-imunes são afecções endocrinológicas relativamente comuns. Há uma noção entre os clínicos de que a incidência das mesmas tem aumentado nos últimos anos. Este aumento foi documentado em algumas regiões no mundo, mas ainda há controvérsias se o mesmo ocorre no nosso país. Apesar de ser alvo de intensos e exaustivos estudos, a fisiopatologia das tireoidites auto-imunes bem como a identidade do fator desencadeante inicial da auto-imunidade permanecem obscuros e fatores genéticos, ambientais, medicamentosos e nutricionais (por exemplo, iodo) têm sido responsabilizados como causas do incremento da freqüência da auto-imunidade tireoidiana. O Iodo tem sido implicado, como responsável pelo aumento de incidência em diferentes populações após sua introdução para prevenção de bócio endêmico. Na literatura as tireoidites são definidas e classificadas de diferentes formas e há diversidade de metodologias para avaliação de material cirúrgico e de necropsias o que dificulta o estudo comparativo em diferentes séries. Para verificar se houve incremento da freqüência de tireoidites em nossa área estudamos retrospectivamente os laudos de 5 anos de necropsias realizadas no SVO da FMUSP e comparamos com levantamento anterior realizado na mesma instituição. Os infiltrados linfocitários foram marcados para CD4, CD8, CD20 e CD68. A participação da apoptose foi analisada pela técnica do TUNEL e marcação de caspase 3. Camundongos NOD (Não Obesos Diabéticos) foram submetidos à sobrecarga oral de iodo por 60 e 90 dias com o objetivo de avaliar o papel do iodo nas alterações histolopatológicas da tireóide e para criar um modelo experimental para o estudo da fisiopatologia da tireoidite autoimune.. Resultados: A freqüência de tireoidite em nosso estudo de necropsias aumentou 58 vezes em relação ao estudo anterior (2,3% e 0,04%, respectivamente). À imunohistoquímica, os casos classificados inicialmente como tireoidite linfocítica e tireoidite de Hashimoto mostraram padrão semelhante de infiltrados sugerindo serem as duas condições estágios evolutivos da mesma doença. A apoptose foi marcante nos casos estudados demonstrando ter papel importante na fisiopatologia da tireoidite auto-imune. Nos camundongos NOD o iodo antecipou e aumentou a prevalência de tireoidites. Nas duas tireóides estudadas à microscopia eletrônica encontramos lesões mitocondriais e do retículo endoplasmático rugoso que não foram vistas em nossos controles. Conclusão: Temos um incremento real da prevalência de tireoidites em necropsias realizadas em nossa instituição. O padrão histopatológico das tireoidites auto-imunes estudadas sugere que a tireoidite dita linfocítica poderia corresponder à fase inicial do processo auto-imune que levaria à tireoidite de Hashimoto. O iodo foi o fator desencadeante e que aumentou e antecipou a incidência de tireoidite em nosso estudo experimental. / Autoimmune thyroiditis are relatively common endocrine diseases. There is a common perception among clinicians that its incidence has been increasing in recent years. Such an increase has been documented in a number of regions worldwide; it remains controversial, however, whether the frequency of thyroiditis is increasing in our country. Despite of being a subject of intense and exhaustive studies, the pathophysiology of auto-immune thyroiditis as well as the identity of the factor that triggers the initial autoimmunity have remained undetermined and genetics, environmental factors, drugs and, nutrition (e.g., iodine) have been implicated in the increase of frequency of thyroid autoimmunity. The iodine has been hold responsible for the increase in the incidence of autoimmune thyroiditis in different populations after its introduction in iodine-defficient regions as a prophylaxis for endemic goiter. There is a myriad of different definitions and classifications for thyroiditis. There is also a great diversity in methods used in the assessment of surgical specimens and necropsy materials. Such a diversity of classification systems and study protocols creates a barrier for comparison of data from different series/studies. In order to verify whether an increase in frequency of thyroids is occurring in our population we retrospectively analyzed the report of necropsies performed in a period of five years in the service of death verification of University of Sao Paulo School of Medicine and compared to a published study performed previously at the same institution. Lymphocytic infiltrations were labeled with antiserum against CD4, CD8, CD20 e CD68. The involvement of apoptosis was assessed by TUNEL and caspase 3 labeling. NOD (Non Obese Diabetic) mice were exposed with high dose oral iodine for 60 or 90 days in order to evaluate the role of iodine in the genesis of histopathological derangements of thyroid and to create an experimental model for the study of autoimmune thyroiditis. Results: In this study, we found a 58-fold increase in the frequency of thyroiditis in comparison to the study performed previously (2,3% e 0,04%, respectively). Cases categorized initially as lymphocytic thyroiditis showed a cell infiltrate that labeled by immunohistochemistry in a similar way as the infiltrates of cases classified as Hashimotos thyroiditis which suggests that these entities might be different stages of a same disease. All cases displayed strong labeling for apoptosis markers demonstrating its important role in the pathophysiology of autoimmune thyroiditis. Iodine anticipated and increased the frequency of thyroiditis in NOD mice. In both thyroids studied with electron microscopy, we found mitochondrial and rough endoplasmic reticulum lesions that were not seen on control thyroids. Conclusion: there is an actual increase in thyroiditis prevalence in necropsies performed at our institution. The histological pattern of autoimmune thyroiditis we studied suggests that the sol called lymphocytic thyroiditis might be the initial stage of an autoimmune process that would eventually lead to Hashimotos thyroiditis. The iodine was the triggering factor which increased and anticipated the incidence of thyroiditis in our experimental study.

Autoimmune diseases are endemic, but the disease mechanisms are poorly understood. A way to better understand these are to find disease-regulating genes. However, this is difficult as the diseases are complex, with several genes as well as environmental factors influencing the development of disease. A way to facilitate the search for genes responsible for the diseases is to use comparative genomic studies. Animal models are relatively easy to analyze since control of environment and breeding are obtained. The University of California at Davies – line 200 (UCD-200) chickens have a hereditary disease that is similar to systemic sclerosis. Using a backcross between UCD-200 chickens and red junglefowl (RJF) chickens we identified three loci linked to the disease. The loci contained immune-regulatory genes suggested to be involved in systemic sclerosis in humans, as well as a previously unidentified linkage between systemic sclerosis in UCD-200 chickens and IGFBP3. The Dark brown (Db) gene enhances red pheomelanin and restricts expression of eumelanin in chickens. The Db phenotype is regulated by an 8 kb deletion upstream of SOX10. Pigmentation studies are potentially useful when trying to identify pathogenic mechanisms and candidate genes in vitiligo The Obese strain (OS) of chickens spontaneously develops an autoimmune thyroiditis which closely resembles human Hashimoto’s thyroiditis. By using an intercross between OS chickens and RJF chickens, we found several disease phenotypes that can be used in an ongoing linkage analysis with the goal to find candidate genes for autoimmune disease. An important phenotype to record and add to the linkage analysis is autoantibodies against thyroid peroxidase, since this phenotype is a key feature in Hashimoto’s thyroiditis. Previous attempts to measure these titres in OS chickens have failed, hence an assay was developed for this purpose.

Ziel dieser Arbeit war es, in Querschnitts- und prospektiven Longitudinalstudien die Diagnostik diabetes-assoziierter Autoimmunerkrankungen (Autoimmun-Thyreoiditis und Zöliakie, primäre Komorbiditäten) sowie diagnostische Verfahren zur Früherkennung von sekundären Spätkomplikationen (Retinopathie und Nephropathie, sekundäre Komorbiditäten) bei Kindern und Jugendlichen mit Typ 1 Diabetes zu evaluieren. Mit Hilfe eines Screenings spezifischer Antikörper (EmA, IgA-Gliadin-, IgA-tTG-Antikörper) konnte eine höhere als bisher berichtete Zöliakie-Prävalenz bei zwei Prozent der asymptomatischen Kinder mit Typ 1 Diabetes festgestellt werden. Eine Autoimmun-Thyreoiditis wurde durch Untersuchungen von Schilddrüsen-spezifischen Antikörpern (Anti-TPO, Anti-TG) bei bis zu 20 Prozent der Kinder und Jugendlichen diagnostiziert. Mädchen hatten signifikant häufiger Schilddrüsen-Antikörper als Jungen. Mit zunehmendem Alter der Patienten stieg die Prävalenz der Antikörper. Die Anwesenheit positiver Schilddrüsen-Antikörper war mit höheren TSH-Werten assoziiert. Sehr hohe Schilddrüsen-Antikörper (Anti-TPO, Anti-TG) waren prädiktiv für die spätere Entwicklung einer subklinischen Hypothyreose. Hinsichtlich der sekundären Komorbiditäten konnte anhand von Messungen der glomerulären (Alb, Tf, IgG) und tubulären Marker (NAG, alpha1-MG) nachgewiesen werden, dass bei Patienten mit Diabetes nicht nur eine glomeruläre, sondern auch eine tubuläre renale Dysfunktion vorliegen kann. Eine erhöhte NAG-Urinausscheidung war prädiktiv für die Entwicklung einer Mikroalbuminurie. Für die Retinopathieentwicklung war die Stoffwechseleinstellung (HbA1c) von wesentlicher Bedeutung, insbesondere während der ersten Diabetesjahre. In der Pubertät kam es zu einer Beschleunigung der Retinopathieentwicklung. Weitere Risikofaktoren für sekundäre Spätkomplikationen insbesondere Retinopathie waren Blutdruck, Lipidstoffwechsel (Triglyzeride, HDL-Cholesterin) und Gesamtrenin. Für die Prognose und Prävention primärer und sekundärer Komorbiditäten bei Kindern mit einem Typ 1 Diabetes als chronische Grunderkrankung ist ein frühzeitiges und regelmäßiges Screening von wesentlicher Bedeutung. / The aim of this study was the evaluation of diagnostic procedures for the early detection of diabetes-associated autoimmune diseases (autoimmune thyroiditis and coeliac disease, primary co-morbidity) as well as of diabetes-specific late complications (retinopathy and nephropathy, secondary co-morbidity) in children and adolescents with type 1 diabetes. The prevalence of coeliac disease among asymptomatic children with type 1 diabetes was 2 percent based on a screening for specific autoantibodies (EMA, IgA-gliadin-, IgA-tTG-antibodies) being higher than reported previously. Autoimmune thyroiditis was diagnosed in up to 20 percent of children and adolescents according to screening procedures for thyroid-specific antibodies (anti-TPO, anti-TG). Girls had more frequently thyroid antibodies than boys. The prevalence of thyroid antibodies increased with increasing age of patients. The presence of thyroid antibodies was associated with higher TSH values, while very high values of thyroid antibodies were predictive for the development of a subclinical hypothyroidism. Studies concerning the prevalence of secondary co-morbidity in young patients with type 1 diabetes revealed that not only glomerular, but also tubular renal dysfunction may occur in these patients. These studies based on the measurement of urinary excretion of glomerular (Alb, Tf, IgG) and tubular (NAG, alpha1-MG) markers. Elevated urinary excretion of NAG was predictive for the development of microalbuminuria. Glycaemic control (HbA1c), particularly during the first years of diabetes, constituted a significant parameter for the development of retinopathy, while puberty may accelerate the development of this late complication. Arterial blood pressure, lipid profile (triglycerides, HDL-cholesterol) and total renin had been found to be additional risk factors for the development of late complications, particularly retinopathy. An early and regularly performed screening is recommended for the prognosis and prevention of primary and secondary co-morbidity in children with type 1 diabetes.

INTRODUÇÂO: A tireoidite crônica autoimune (TCA) é a principal causa de hipotireoidismo adquirido, o qual requer tratamento contínuo com levotiroxina (LT4). Até o momento, não há terapia capaz de regenerar o tecido tireóideo lesado e melhorar sua função. Como a terapia com Laser de baixa intensidade (LILT) foi eficaz em outras doenças autoimunes, bem como na regeneração de vários tecidos, o objetivo deste estudo foi avaliar a eficácia do Laser de baixa intensidade no tratamento de pacientes com hipotireoidismo decorrente de tireoidite crônica autoimune utilizando-se os seguintes parâmetros de resposta: a) o mapeamento dúplex-Doppler colorido da tireoide; b) a função tireóidea estimada pela dose de LT4 necessária para manter as concentrações séricas de T3 total, T4 total, T4 livre e TSH normais; c) as concentrações séricas de anticorpos antiperoxidase tireóidea (TPOAb) e antitireoglobulina (TgAb). MÉTODOS: Trata-se de ensaio clínico randomizado, placebo-controlado, conduzido no Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, de março de 2006 a março de 2009, no qual foram incluídos 43 pacientes com hipotireoidismo causado por TCA. Todos eles apresentavam altas concentrações séricas de TPOAb e/ou TgAb e padrão ultrassonográfico compatível com TCA. Os pacientes foram randomizados em grupo L (submetido à LILT, n = 23) e P (submetido ao placebo, n = 20). Os limites da tireoide foram demarcados com o auxílio da ultrassonografia. Pacientes do grupo L submeteram-se à LILT (830 nm) e os do grupo P à função placebo do mesmo equipamento. Ambos os grupos foram submetidos, no total, à 10 sessões, duas vezes por semana, com a mesma técnica. Realizou-se pré e 30 dias pós-intervenção: o estudo ultrassonográfico (US) pelo modo-B, que incluiu o histograma computadorizado de escala de cinzas para estimar quantitativamente o índice de ecogenicidade; o US-Doppler colorido de amplitude atribuindo-se valores de 0 a 4 para os padrões de vascularização e o US-Doppler pulsado para estimar a velocidade de pico sistólico e o índice de resistividade das artérias tireóideas superiores e inferiores. Após o segundo US, os pacientes descontinuaram a LT4, a qual foi reintroduzida para os pacientes que apresentaram hipotireoidismo, em dose suficiente para obter normalização hormonal. Realizaram-se determinações séricas de T3 total, T4 total, T4 livre, TSH, TPOAb e TgAb pré-intervenção e no 1º, 2º, 3º, 6º e 9º meses pós-suspensão de LT4. RESULTADOS: No US modo-B pós-intervenção, verificou-se aumento estatisticamente significativo do índice de ecogenicidade no grupo L (1,24 ± 0,11) comparado ao P (0,98 ± 0,07; P < 0,001), assim como a proporção de pacientes com volume normal foi estatisticamente maior no grupo L (P = 0,005). O US-Doppler colorido de amplitude mostrou que o valor do padrão de vascularização foi estatisticamente maior no grupo P (2,3 ± 0,27) do que no L (1,87 ± 0,36; P = 0,033). Observou-se redução da dose de LT4 no grupo L (38,59 ± 20,22 g/dia) comparada à do P (106,88 ± 22,9 g/dia; p < 0,001). TPOAb foi menor no grupo L (681,91 ± 317,44 U/mL) do que no P (1176,40 ± 551,9 U/mL; p = 0,043). Não houve redução de TgAb e efeitos adversos. CONCLUSÕES: A LILT foi eficaz no tratamento da TCA, uma vez que no grupo L verificou-se: a) melhora da ecogenicidade, do volume e do padrão de vascularização da glândula tireoide no mapeamento dúplex-Doppler colorido; b) melhora da função da glândula tireoide, evidenciada pela redução da dose de LT4 necessária para tratar o hipotireoidismo c) modulação parcial da autoimunidade, demonstrada por meio da redução das concentrações séricas de TPOAb / INTRODUCTION: A chronic autoimmune thyroiditis (CAT) is the main cause of acquired hypothyroidism which requires continuous treatment with levothyroxine (LT4). So far there has been no such therapy which can make the damaged thyroid tissue regenerate, improving its function. As the low-intensity Laser therapy (LILT) was effective in other autoimmune diseases, as well as in regenerating several tissues, the objective of this study was to evaluate the efficacy of LILT in patients with hypothyroidism caused by CAT by utilizing the following response parameters: A) Color Doppler ultrasonography of thyroid; B) The thyroid function estimated by the dose of LT4 in order to keep the serum concentrations of normal T3, T4, free T4 (fT4) and TSH; C) The serum concentrations of thyroid peroxidase (TPOAb) and thyroglobulin antibodies (TgAb). METHODS: This is a placebo-controlled randomized clinical essay guided at the Institute of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo from March 2006 to March 2009, made up of 43 patients with hypothyroidism caused by CAT. All the patients showed high serum concentrations of TPOAb and/or TgAb and ultrasound pattern compatible with CAT. The patients were randomized in L group (submitted to LILT, n = 23) and P group (submitted to placebo, n = 20). The limits of thyroid were marked off with the help of ultrasonography. The patients in L group were submitted to LILT (830 nm) and the patients in P group were submitted to the placebo function of the same equipment. Both groups were submitted a total of 10 sessions, twice a week, using the same technique. Pre- and 30 days post-intervention were applied: ultrasonographic study (US) by B-mode, which included the grey scale computerized histogram to quantitatively estimate the index of echogenicity; the amplitude color Doppler US with values given from 0 to 4 for the vascularization patterns and the pulsed Doppler US to estimate the systolic peak velocity and the index of resistivity of superior and inferior thyroid arteries. After the second US the patients discontinued the LT4, which was later re-introduced in the patients having hypothyroidism in a certain amount so as to be sufficient to obtain hormonal normalization. Serum determinations of total T3, total T4, fT4, TSH, TPOAb and TgAb pre-intervention were accomplished and also in the 1st, 2nd, 3rd, 6th and 9th month post-suspension of LT4. RESULTS: In post-intervention B-mode US a significant increase in the index of echogenicity in L group (1.24 ± 0.11) was statistically observed compared with the P group (0.98 ± 0.07; P < 0.001), as well as the proportion of patients with normal volume was shown statistically higher in L group (P = 0.005). The amplitude color Doppler US showed the standard value of vascularization was statistically greater in P group (2.3 ± 0.27) than in L group (1.87 ± 0.36; P = 0.033). Pulsed Doppler US showed an increase in the systolic peak velocity of the inferior thyroid arteries in L group (34.47 ± 4.81 cm/s) in relation to P group (26.12 ± 4.29 cm/s; P = 0.016). A reduction in the dose of LT4 in L group (38.59 ± 20.22 g/day) was observed compared with the one in P group (106.88 ± 22.9 g/day; p < 0.001). TPOAb was smaller in L-group (681.91 ± 317.44 U/mL) than in P-group (1176.40 ± 551.9 U/mL; p = 0.043). There was no reduction of TgAb and adverse effects. CONCLUSIONS: LILT was effective in the treatment of CAT, once L group showed: A) amelioration of echogenicity, of volume and of vascularization of the thyroid gland in the color Doppler ultrasonography; B) improvement of thyroid function, featured through the reduction in the necessary dose of LT4 to treat the hypothyroidism; C) partial modulation of autoimmunity demonstrated by reduction of TPOAb serum concentrations

INTRODUÇÂO: A tireoidite crônica autoimune (TCA) é a principal causa de hipotireoidismo adquirido, o qual requer tratamento contínuo com levotiroxina (LT4). Até o momento, não há terapia capaz de regenerar o tecido tireóideo lesado e melhorar sua função. Como a terapia com Laser de baixa intensidade (LILT) foi eficaz em outras doenças autoimunes, bem como na regeneração de vários tecidos, o objetivo deste estudo foi avaliar a eficácia do Laser de baixa intensidade no tratamento de pacientes com hipotireoidismo decorrente de tireoidite crônica autoimune utilizando-se os seguintes parâmetros de resposta: a) o mapeamento dúplex-Doppler colorido da tireoide; b) a função tireóidea estimada pela dose de LT4 necessária para manter as concentrações séricas de T3 total, T4 total, T4 livre e TSH normais; c) as concentrações séricas de anticorpos antiperoxidase tireóidea (TPOAb) e antitireoglobulina (TgAb). MÉTODOS: Trata-se de ensaio clínico randomizado, placebo-controlado, conduzido no Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, de março de 2006 a março de 2009, no qual foram incluídos 43 pacientes com hipotireoidismo causado por TCA. Todos eles apresentavam altas concentrações séricas de TPOAb e/ou TgAb e padrão ultrassonográfico compatível com TCA. Os pacientes foram randomizados em grupo L (submetido à LILT, n = 23) e P (submetido ao placebo, n = 20). Os limites da tireoide foram demarcados com o auxílio da ultrassonografia. Pacientes do grupo L submeteram-se à LILT (830 nm) e os do grupo P à função placebo do mesmo equipamento. Ambos os grupos foram submetidos, no total, à 10 sessões, duas vezes por semana, com a mesma técnica. Realizou-se pré e 30 dias pós-intervenção: o estudo ultrassonográfico (US) pelo modo-B, que incluiu o histograma computadorizado de escala de cinzas para estimar quantitativamente o índice de ecogenicidade; o US-Doppler colorido de amplitude atribuindo-se valores de 0 a 4 para os padrões de vascularização e o US-Doppler pulsado para estimar a velocidade de pico sistólico e o índice de resistividade das artérias tireóideas superiores e inferiores. Após o segundo US, os pacientes descontinuaram a LT4, a qual foi reintroduzida para os pacientes que apresentaram hipotireoidismo, em dose suficiente para obter normalização hormonal. Realizaram-se determinações séricas de T3 total, T4 total, T4 livre, TSH, TPOAb e TgAb pré-intervenção e no 1º, 2º, 3º, 6º e 9º meses pós-suspensão de LT4. RESULTADOS: No US modo-B pós-intervenção, verificou-se aumento estatisticamente significativo do índice de ecogenicidade no grupo L (1,24 ± 0,11) comparado ao P (0,98 ± 0,07; P < 0,001), assim como a proporção de pacientes com volume normal foi estatisticamente maior no grupo L (P = 0,005). O US-Doppler colorido de amplitude mostrou que o valor do padrão de vascularização foi estatisticamente maior no grupo P (2,3 ± 0,27) do que no L (1,87 ± 0,36; P = 0,033). Observou-se redução da dose de LT4 no grupo L (38,59 ± 20,22 g/dia) comparada à do P (106,88 ± 22,9 g/dia; p < 0,001). TPOAb foi menor no grupo L (681,91 ± 317,44 U/mL) do que no P (1176,40 ± 551,9 U/mL; p = 0,043). Não houve redução de TgAb e efeitos adversos. CONCLUSÕES: A LILT foi eficaz no tratamento da TCA, uma vez que no grupo L verificou-se: a) melhora da ecogenicidade, do volume e do padrão de vascularização da glândula tireoide no mapeamento dúplex-Doppler colorido; b) melhora da função da glândula tireoide, evidenciada pela redução da dose de LT4 necessária para tratar o hipotireoidismo c) modulação parcial da autoimunidade, demonstrada por meio da redução das concentrações séricas de TPOAb / INTRODUCTION: A chronic autoimmune thyroiditis (CAT) is the main cause of acquired hypothyroidism which requires continuous treatment with levothyroxine (LT4). So far there has been no such therapy which can make the damaged thyroid tissue regenerate, improving its function. As the low-intensity Laser therapy (LILT) was effective in other autoimmune diseases, as well as in regenerating several tissues, the objective of this study was to evaluate the efficacy of LILT in patients with hypothyroidism caused by CAT by utilizing the following response parameters: A) Color Doppler ultrasonography of thyroid; B) The thyroid function estimated by the dose of LT4 in order to keep the serum concentrations of normal T3, T4, free T4 (fT4) and TSH; C) The serum concentrations of thyroid peroxidase (TPOAb) and thyroglobulin antibodies (TgAb). METHODS: This is a placebo-controlled randomized clinical essay guided at the Institute of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo from March 2006 to March 2009, made up of 43 patients with hypothyroidism caused by CAT. All the patients showed high serum concentrations of TPOAb and/or TgAb and ultrasound pattern compatible with CAT. The patients were randomized in L group (submitted to LILT, n = 23) and P group (submitted to placebo, n = 20). The limits of thyroid were marked off with the help of ultrasonography. The patients in L group were submitted to LILT (830 nm) and the patients in P group were submitted to the placebo function of the same equipment. Both groups were submitted a total of 10 sessions, twice a week, using the same technique. Pre- and 30 days post-intervention were applied: ultrasonographic study (US) by B-mode, which included the grey scale computerized histogram to quantitatively estimate the index of echogenicity; the amplitude color Doppler US with values given from 0 to 4 for the vascularization patterns and the pulsed Doppler US to estimate the systolic peak velocity and the index of resistivity of superior and inferior thyroid arteries. After the second US the patients discontinued the LT4, which was later re-introduced in the patients having hypothyroidism in a certain amount so as to be sufficient to obtain hormonal normalization. Serum determinations of total T3, total T4, fT4, TSH, TPOAb and TgAb pre-intervention were accomplished and also in the 1st, 2nd, 3rd, 6th and 9th month post-suspension of LT4. RESULTS: In post-intervention B-mode US a significant increase in the index of echogenicity in L group (1.24 ± 0.11) was statistically observed compared with the P group (0.98 ± 0.07; P < 0.001), as well as the proportion of patients with normal volume was shown statistically higher in L group (P = 0.005). The amplitude color Doppler US showed the standard value of vascularization was statistically greater in P group (2.3 ± 0.27) than in L group (1.87 ± 0.36; P = 0.033). Pulsed Doppler US showed an increase in the systolic peak velocity of the inferior thyroid arteries in L group (34.47 ± 4.81 cm/s) in relation to P group (26.12 ± 4.29 cm/s; P = 0.016). A reduction in the dose of LT4 in L group (38.59 ± 20.22 g/day) was observed compared with the one in P group (106.88 ± 22.9 g/day; p < 0.001). TPOAb was smaller in L-group (681.91 ± 317.44 U/mL) than in P-group (1176.40 ± 551.9 U/mL; p = 0.043). There was no reduction of TgAb and adverse effects. CONCLUSIONS: LILT was effective in the treatment of CAT, once L group showed: A) amelioration of echogenicity, of volume and of vascularization of the thyroid gland in the color Doppler ultrasonography; B) improvement of thyroid function, featured through the reduction in the necessary dose of LT4 to treat the hypothyroidism; C) partial modulation of autoimmunity demonstrated by reduction of TPOAb serum concentrations

No description available.

Introduktion. Autoimmun tyreoidit (AITD) är en kronisk autoimmun sjukdom där immunförsvarets antikroppar (ab) attackerar tyreoideaproteinerna tyreoideaperoxidas (TPO) och/eller tyreoglobulin (TG). Studier visar att selentillskott hos patienter med AITD kan minska tyreoideaantikroppar, storleken och antalet noduler hos en förstorad tyreoidea. Syftet med detta arbete var att undersöka hur selentillskott påverkar serumnivåer av TPOab, samt tyreoideahormonnivåer vid AITD.   Metod. Arbetet är en litteraturstudie och därför har metoden varit att samla relevant litteratur genom PubMed med sökningar som ”selenium autoimmune thyroiditis”, ”selenium thyroid” och ”autoimmune thyroiditis”. Bland sökresultaten valdes nio artiklar ut baserat på studiekvalitet, publikationsår och relevans. Bland artiklarna granskades och sammanställdes uppmätta nivåer av TPOab samt tyreoideahormonnivåer, vilka valdes som indikation på effekt utav selentillskott. Resultat. Resultaten var inkonsekventa. Majoriteten av studierna (7 av 9) tydde på att oral administrering av selentillskott effektivt minskade serumkoncentrationerna av TPOab hos patienter med AITD i alla åldersgrupper. De studier som resulterade i störst minskning av TPOab pågick i 3-12 månader. Utav de 9 studerade artiklarna var det endast en studie som inte rapporterade någon som helst positiv klinisk effekt hos patienterna. Två av studierna visade att selen förhindrar vidare försämring av tyreoideans ekogenitet, vilket tyder på att selen kan hejda inflammationsprocessen men ej reversera tyreoideaskadorna den orsakat. Majoriteten av studierna (7 av 9) visade att selentillskott ej ger några signifikanta förändringar i tyreoideahormonerna: TSH, fT4 och fT3. Diskussion. Varför AITD-patienter svarar olika på selenadministrering är ännu okänt, men kan misstänkas bero på selenbehandlingens varaktighet, patienternas intratyroidnivåer av selen vid studiens början, förekomst av jodbrist, samt patienternas ålder och sjukdomsprogression. Slutsats. Att ha adekvata fysiologiska nivåer av selen är av stor vikt för att bevara tyreoideans hälsa och förebygga tyreoidearelaterade sjukdomar. Majoriteten utav de granskade studierna visar att tillskott av selen kan minska antalet TPOab. Selentillskott kan även ha immunrelaterade fördelar men verkar inte påverka nivån tyreoideahormonnivåer. Inga negativa effekter påvisades vid intag av selentillskott vilket gör dess administrering säker. Fler studier behöver dock göras för att fastställa effektiviteten av selentillskott vid AITD. / Introduction. Autoimmune thyroiditis (AITD) is a chronic autoimmune disease in which the immune system's antibodies (ab) attack the thyroid proteins thyroid peroxidase (TPO) and/or thyroglobulin (TG). Studies show that selenium supplementation in patients with AITD can reduce thyroid antibodies and the size and number of nodules in an enlarged thyroid. The purpose of this study was to investigate how selenium supplementation affects the serum levels of thyroid peroxidase antibodies (TPOab) and thyroid hormone levels in autoimmune thyroiditis. Method. This is a literature study and therefore the method has been to gather relevant literature through searches on PubMed such as "selenium autoimmune thyroiditis", "selenium thyroid" and "autoimmune thyroiditis". Among the search results, nine articles were selected based on quality, publication year and relevance. Among the articles, measured levels of TPOab and thyroid hormone levels were examined and compiled, and were chosen as an indication of the effect of selenium supplementation. Results. The results were inconsistent. The majority of the studies (7 of 9) suggest that oral administration of selenium supplements effectively reduced serum concentrations of TPOab in patients with AITD in all age groups. The studies that resulted in the largest decrease in TPOab lasted for 3-12 months. Out of the 9 examined studies, only one study did not report any positive clinical effect in patients. Two of the studies showed that the selenium prevents further impairment of thyroid echogenicity, suggesting that selenium can inhibit the inflammatory process but not reverse the pre-existing thyroid damage it’s caused. The majority of studies (7 out of 9) show that selenium supplementation does not produce significant changes in the thyroid hormones: TSH, fT4 and fT3. Discussion. Why AITD-patients respond differently to selenium administration is still unknown, but it may be due to the duration of selenium treatment, the patients' intrathyroid levels of selenium at the onset of the study, the presence of iodine deficiency, as well as the age and disease progression of the patients. Conclusion. Having adequate physiological levels of selenium is of great importance in preserving thyroid health and preventing thyroid-related diseases. The majority of the studies show that selenium supplementation can reduce the number of TPOab. Selenium supplementation may also have immune related benefits but does not appear to affect the thyroid hormone levels. No adverse effects were observed during selenium supplementation, which makes its administration safe. However, more studies are needed to determine the effectiveness of selenium supplementation for AITD.