Aspiration cytology of Hashimoto's thyroiditis in an endemic area

Fine needle aspiration (FNA) plays a significant role in the diagnosis of thyroid lesions due to its simplicity and low cost. Hashimoto's thyroiditis (HT) is the second most common thyroid lesion next to endemic goitre diagnosed on FNA in iodine (I2) deficient areas. Data on its incidence, prevalence and clinicopathological features in I2 deficient areas is scanty compared to I2 sufficient areas. In the present study the patients presented with HT a decade earlier than reported in I2 sufficient areas. Presentation as a nodular thyroid is common. Diagnosis of HT is likely to be missed in smears showing cytological evidence of hyperplasia or abundant colloid. HT was concurrent in 20 cases of endemic goitre. Careful screening for Hurthle cell change and lymphocytic infiltration into follicular cells should be carried out. In equivocal cases multiple punctures and immunological investigations are helpful. In antibody-negative cases repeat FNA at follow-up is useful. Marked lymphocytic infiltration and Hurthle cell change may indicate a hypothyroid state but hormonal levels are required for clinical management.     

Qualitative aspects of thyroglobulin antibodies in Hashimoto's thyroiditis and Graves' disease

We have tried to characterize the thyroglobulin antibodies (TgAb) involved in Hashimoto''s thyroiditis and Graves'' disease by studying their affinity constants and binding capacities. Two populations of antibodies were found in half of the patients with either disease, TgAb₁ with a high affinity (K₁) but a low binding capacity (B₁) and TgAb₂ with a lower affinity (K₂) but a much higher binding capacity (B₂). The mean affinity constants and binding capacities were similar in the two diseases. In the other half of the patients only one population of antibody was present, with a low affinity constant (K_t) and a very high binding capacity (B_t), thus comparable to TgAb₂. The mean K_t and B_t were similar in the two diseases. From these results it would appear that circulating thyroglobulin antibodies in Hashimoto''s thyroiditis and Graves'' disease are similar in their affinity constants and binding capacities, so that these characteristics do not reflect the different pathogenesis of each condition.     

Altered N-glycan profile of IgG-depleted serum proteins in Hashimoto's thyroiditis

BackgroundHashimoto's thyroiditis (HT) is an autoimmune disease characterized by chronic inflammation of thyroid gland. Although HT is the most common cause of hypothyroidism, the pathogenesis of this disease is not fully understood. Glycosylation of serum proteins was examined in HT only to a limited extent. The study was designed to determine the glycosylation pattern of IgG-depleted sera from HT patients.MethodsSerum N-glycans released by N-glycosidase F (PNGase F) digestion were analyzed by normal-phase high-performance liquid chromatography (NP-HPLC). N-glycan structures in each collected HPLC fraction were determined by liquid chromatography-mass spectrometry (LC-MS) and exoglycosidase digestion. Fucosylation and sialylation was also analyzed by lectin blotting.ResultsThe results showed an increase of monosialylated tri-antennary structure (A3G3S1) and disialylated diantennary N-glycan with antennary fucose (FA2G2S2). Subsequently, we analyzed the serum N-glycan profile by lectin blotting using lectins specific for fucose and sialic acid. We found a significant decrease of Lens culinaris agglutinin (LCA) staining in HT samples, which resulted from the reduction of α1,6-linked core fucose in HT serum. We also observed an increase of Maackia amurensis II lectin (MAL-II) reaction in HT due to the elevated level of α2,3-sialylation in HT sera.ConclusionsThe detected alterations of serum protein sialylation might be caused by chronic inflammation in HT. The obtained results complete our previous IgG N-glycosylation analysis in autoimmune thyroid patients and show that the altered N-glycosylation of serum proteins is characteristic for autoimmunity process in HT.General SignificanceThyroid autoimmunity is accompanied by changes of serum protein sialylation.     

Anterior pituitary cell antibodies detected in Hashimoto's thyroiditis and Graves' disease

An immunofluorescence study using unfixed cryostat sections of rat pituitary glands was carried out on sera from 34 patients with Hashimoto's thyroiditis, 28 patients with Graves' disease, 10 patients with thyroid adenoma and 50 healthy subjects. After absorption of sera with rat liver tissues, 19 of 34 patients retained reactivity to anterior pituitary cell antibodies (PCA, 55.8%). On the other hand, immunofluorescence in anterior pituitary cells was faint and detected in only 2 of 28 patients with Graves' disease (7.1%) after absorption of their sera with rat liver aceton powder. A similar result was also obtained when PCA were compared in the sera of Hashimoto's thyroiditis and Graves' disease with high titers of thyroid microsomal autoantibodies. PCA were detected neither in the sera of patients with thyroid adenoma nor in the healthy subjects. The present study suggests that PCA were considerably more prevalent in Hashimoto's thyroiditis than in Graves' disease.     

甲状腺素钠和地塞米松结合用于桥本甲状腺炎的临床研究

目的观察甲状腺素钠和地塞米松结合用于桥本甲状腺炎的临床效果。方法选取桥本甲状腺炎患者78例,采用简单随机分组法分为实验组和对照组,对照组给予甲状腺素钠治疗,实验组给予甲状腺素钠和地塞米松联合治疗,比较两组患者的临床效果。结果两组患者治疗后的血清游离三碘甲腺原氨酸(FT3)水平无明显变化,与治疗前比较差异无统计学意义(P0.05)。两组治疗后的超敏促甲状腺激素(sTSH)水平低于治疗前,血清游离甲状腺素(FT4)水平高于治疗前,差异均有统计学意义(P0.05)。两组治疗后sTSH、FT4水平比较,差异有统计学意义(P0.05)。结论甲状腺素钠联合地塞米松治疗桥本甲状腺炎的效果显著,值得临床推广应用。     

Expression of hepatocyte growth factor in Hashimoto's thyroiditis with nodular lesions

Hashimoto's thyroiditis (HT) is an autoimmune thyroid disease frequently associated with hyperplastic nodules (HN)s. Hepatocyte growth factor (HGF) is expressed in benign thyroid nodules and over-expressed in malignant thyroid nodules, particularly in papillary thyroid carcinomas. To elucidate the role of HGF in the development of HNs in association with HT we evaluated, by immunohistochemistry, the expression of HGF in both nodular and extranodular tissues, obtained from 30 HTs and 15 goiter samples. Six normal thyroid glands were used as controls. All normal control tissue samples exhibited no evidence of HGF immunoreaction. HNs showed weak to moderate HGF immunoreaction, which was located exclusively in the cytoplasm of stromal cells (fibroblasts and endothelial cells). However, the percentage of positive cases was higher in HNs arisen in the context of HT, compared to HNs not associated with HT (30/30 or 100% vs 4/15 or 40%; p<0.001). HGF immunoreactivity was also detected in all extranodular tissues from HT specimens (30/30 or 100%), but we found some significant differences. In fact, while in HNs observed in the context of HT lesions HGF was expressed only in stromal cells, in the extranodular tissues from the same thyroid gland affected by HT it was also detected in the cytoplasm of the epithelial follicular cells. Furthermore, HTs showed a much higher HGF staining grade in the extranodular tissue compared to HNs. Finally, a clear positive correlation was observed in HT between the proportion of HGF expressing follicular cells and the grade of lymphoid aggregates of the thyroid gland. In conclusion, HGF is much more frequently and highly expressed in thyroid tissue with HT, compared to goiter. In HT glands HGF can be detected in both follicular thyroid cells and stromal cells, while in HNs, either from goiters or associated with HT, its expression is restricted only to the stromal cells. These data indicate that HGF may play a role in cell proliferation processes occurring in thyroid glands affected by HT, probably under the regulation of the lymphoid infiltrate.     

Measurement and regulation of thyroidal status in teleost fish

Summary We have reviewed the stages in teleost thyroid function and its regulation, from the initial biosynthesis of the TH to their eventual interaction with putative receptors.TH biosynthesis depends on an adequate plasma iodide level, determined partly by dietary iodide and partly by active branchial iodide uptake from the water, Pulse-injected radioiodide can be used to evaluate thyroidal iodide uptake, aspects of TH biosynthesis and TH thyroidal secretion. However, owing to variable plasma iodide levels, care is required in interpretating these parameters. TH biosynthesis, thyroglobulin properties and intrathyroidal secretion mechanisms have received limited recent attention. Histological indices of thyroid tissue changes, while useful in many situations, do not always correlate with more direct estimates of thyroidal secretion and can be misleading.Thyroid function is regulated by the hypothalamo-pituitary-thyroid axis, but neither the identities of the hypothalamic factors nor a reliable immunoassay for TSH have been established. Currently, activity of the hypothalamic-pituitary axis is usually determined by pituitary thyrotrope histological appearance or bioassay of pituitary TSH. Plasma free T₄ feeds back at both the pituitary and hypothalamic levels and inhibits TSH release. Thyroidal T₄ secretory activity is presumably adjusted to maintain a constant plasma T₄level according to physiologic state.Plasma T₄ is probably the most commonly used index of thyroidal status. However, (1) T₄ is probably not the active form of TH, (2) the T₄ plasma level may be influenced by the binding properties of plasma proteins, and (3) the T₄ concentration alone makes no provision for the rate of T₄ turnover in plasma. The most practical way to measure thyroidal T₄SR is to determine plasma T₄DR, and assuming steady-state conditions, equate it to T₄SR. The T₄DR is determined from kinetic studies employing^*T₄, which also enable estimates of sizes of vascular and extravascular T₄ pools and their rates of exchange. Excretion of T₄ or its derivatives in urine or bile can be determined also. A high proportion of T₄ is enzymatically monodeiodinated in liver and other tissues, generating T₃ for local (intracellular) and vascular systemic compartments.Bothin vivo andin vitro methods have been used to quantify T₄ deiodinase activity, which is highly responsive to physiologic state and environmental variables. T₃ production is inhibited by a moderate T₃ excess indicating an autoregulatory system, whereby tissue T₃ levels are maintained at a set-point appropriate for a particular physiologic state. The rate of T₃ production provides an informative measure of thyroidal status in a given tissue. However, other pathways also contribute to the maintenance of T₃ homeostasis at a particular set-point. These include the rate of T₃ degradation to 3,3-T₂, the rate of T₄ substrate diversion to rT₃ (an inactive isomer) and by the excretion of parent compounds or conjugates in bile and urine. Potential losses across branchial or integumentary surfaces have yet to be evaluated.The most fundamental measure of thyroidal status is represented by the amount of T₃ saturably bound to receptors/nucleus for the cell type of interest. This is estimated most accurately in double isotope studies in which T₃ contributions from both vascular and intracellular compartments are evaluated. Less satisfactory but meaningful indices of T₃ availability to receptor sites may be obtained from the plasma T₃ (or free T₃) level and from the tissue T₃ level. The former is appropriate if the cell type in question obtains its T₃ primarily from plasma; the latter should be measured if the cell type derives its T₃ mainly through intracellular deiodinase activity. If the proportion of vascular T₃/intracellular T₃ bound to receptors is known, it may indicate the degree of receptor activation. However, even cytosolic T₃ levels may not vary in proportion to nuclear T₃ levels.Differences in thyroidal function between teleosts and homeotherms can be attributed to distinctive strategies in iodide economy and to fundamental differences in control of thyroidal status. Owing to more certain iodide availability (branchial iodide pump and plasma iodide-binding proteins), teleosts are probably more liberal in their iodide use and have less efficient mechanisms for recovery and retention of hormonal iodide than homeotherms. Also, primary control of teleost thyroidal function appears peripheral. It is the finely regulated conversion of T₄ to T₃ in tissues which may largely determine the T₄ secretion rate. Thus, T₄, as a prohormone, may be produced more to satisfy the substrate needs for T₄ conversion rather than to drive T₃ production. Because TH are mainly implicated in tissue- or cell-specific processes involved in development, growth and reproduction in teleosts, it may be advantageous for their thyroidal status to be determined locally through T₄-to-T₃ deiodination. In homeotherms, primary control is mainly central through the hypothalamic-pituitary axis, which regulates thyroidal secretion of T₄ and significant amounts of T₃. The level of T₄ (free T₄) is believed to drive the production of T₃ in most peripheral tissues. Because TH are extensively involved in the systemically integrated adjustment of basal metabolic rate in homeotherms, it may have been advantageous to evolve a system leaning towards central control by the hypothalamus, the brain centre associated with thermoregulation.     

Differentiation of Hashimoto's thyroiditis from thyroid neoplasms in fine needle aspirates

In order to refine the cytodiagnostic criteria for distinguishing Hashimoto's thyroiditis from thyroid neoplasms, aspirates from six cases of Hashimoto's thyroiditis, five Hürthle cell neoplasms and one papillary carcinoma associated with Hashimoto's thyroiditis were reevaluated. Distinguishing characteristics were cell arrangements, nuclear chromatin pattern and nucleolar appearance. Hashimoto's thyroiditis was characterized by flat sheets and clusters of epithelial cells with oncocytic changes or occasionally by cohesive tissue fragments with cells well oriented one to the other. Thyroid neoplasms were characterized by loosely cohesive, syncytial-type tissue fragments with crowded overlapping cells poorly oriented one to the other and/or numerous isolated single cells. The nuclear chromatin of Askanazy cells in Hashimoto's thyroiditis was bland and even while that of neoplastic cells was finely granular, coarsely granular or irregularly clumped. Macronucleoli were present in Hürthle cell tumors but not in the Askanazy cells of Hashimoto's thyroiditis. Epithelial cellularity, lymphoid cellularity, cellular polymorphism and nuclear pleomorphism were not useful criteria for making the differential diagnosis between the two conditions. An admixture of epithelial cells and lymphoid cells indicated Hashimoto's thyroiditis but was not helpful in ruling out an associated neoplasm.     

凋亡相关蛋白Bcl2、Bax在IgG4相关性乔本甲状腺炎中的表达及其临床病理意义

目的探讨IgG4相关性乔本甲状腺炎(Hashimoto's thyroiditis,HT)的临床病理特征,并进一步分析凋亡相关蛋白Bcl2、Bax的表达与其临床、病理特征的相关性。方法用免疫组化检测46例HT和15例滤泡性腺瘤瘤旁甲状腺组织中IgG4+浆细胞、IgG+浆细胞及Bcl2、Bax蛋白的表达,依据IgG4+浆细胞20/HPF及IgG4+/IgG+30%的标准,将HT分为IgG4组和非IgG4组,分析两组间临床病理特征及Bcl2、Bax蛋白分布、表达的差异。结果 46例HT患者中11例为IgG4-HT(占23.9%)。与非IgG4组比较,IgG4组患者更容易出现亚临床甲状腺功能减退(P=0.02)、甲状腺纤维化程度更显著(P=0.006);IgG4-HT甲状腺滤泡上皮中Bax蛋白的表达显著高于非IgG4-HT组(P=0.001),且与甲状腺纤维化的程度呈正相关(r=0.622,P=0.04)。结论 IgG4-HT代表了更具破坏性的一种乔本甲状腺炎亚型,更容易出现甲状腺功能减退;凋亡促进蛋白Bax可能在IgG4-HT的病理进程中发挥了作用。     

Anti-thyroglobulin anti-idiotypic antibodies in sera of patients with Hashimoto's thyroiditis and Graves' disease

The objective of this study was to find naturally occurring anti-idiotypic (anti-Id) antibodies to anti-human thyroglobulin (anti-hTg) idiotype in sera of patients with autoimmune thyroid disease. Sera from patients with Hashimoto's thyroiditis (HT), Graves' disease (GD), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE) and sera from normal subjects were tested for the presence of anti-Id antibodies against mouse anti-hTg monoclonal antibodies (McAb) in indirect ELISA and in indirect solid-phase RIA. Microtitration plates were coated with six McAb, five of them directed against different epitopes on hTg molecule, and then incubated with patients' sera. The bound antibody was detected with either peroxidase or 125I-labeled anti-human IgG. The specific positive reaction was observed in four of 40 patients with HT, in two of 26 patients with GD, in seven of 58 patients with RA, and in none of 20 normal subjects. The detected binding was due to the presence of anti-hTg anti-Id antibodies and not to Tg-anti-Tg circulating immune complexes, as the positive sera did not contain hTg when resolved on SDS-PAGE, nor did they bind to all anti-hTg McAb tested. The binding was dose dependent, and titers of anti-Id antibodies varied from 1:243 to 1:2187. The binding could be inhibited up to 50% by hTg, but not by the thyroid microsomal antigen, indicating that some of those anti-Id might represent the internal image of the antigen. Serum from the patient 3403, showing the strongest reactivity against McAb A-3, was chosen for IgG purification and F(ab')2 fragment isolation. The 3403 F(ab')2 fragment, but not the Fc fragment, was found to react specifically with four mouse anti-hTg McAb but not with the control mouse IgG. Thus, the obtained results permit the conclusion that anti-hTg anti-Id antibodies could occur naturally during the course of thyroid autoimmune disorders.     

Flow cytometry and phytoplankton

Flow cytometry and sorting are now an important technology in aquatic research. Simultaneous measurements of individual particle cell size, fluorescence, and light scatter properties are directly applicable to current topics in aquatic research. Flow sorting may be employed to obtain subsets of cells for analysis by conventional methods. The manner in which rapid, precise measurements of single cells are made is complex, and the application of this technology to aquatic samples is subject to many analytical constraints. Flow cytometric measurements of algal cell size and pigment autofluorescence are relative and are therefore dependent on the optical configuration and variability of the instrument. Specific types of reference materials are used to establish the validity of analyses: 1) instrument standards, 2) fluorescence controls, and 3) internal stain standards. The selection and application of standards and controls are discussed in the context of allometric (cell size versus pigment fluorescence) and ataxonomic (pigment color groups) methods. The widespread acceptance of particular reference materials among research groups will result in comparable data sets describing aquatic particle distributions.     

Hashimoto's thyroiditis with immunoblastic lymphadenopathy and unusual "macaroni cells".

Light and electron microscopic study of the thyroid gland and an enlarged cervical lymph node in a 75-year-old woman with Hashimoto''s thyroiditis disclosed immunoblastic proliferation in the lymph node, marked by collections of striking round cells positive to periodic acid-Schiff (PAS) staining, immunoblasts and plasmacytoid elements in a vascular, fibrous framework. The PAS-positive cells ("macaroni cells") were distended with whorls of angulated tubular material resembling endoplasmic reticulum. Parafollicular-cell hyperplasia and an atypical plasmacytoid focus were noted in the thyroid. Hashimoto''s disease is known to be associated with malignant lymphoma, as are autoimmune and malignant diseases with immunoblastic lymphadenopathy. This is the first report of the association of Hashimoto''s disease and immunoblastic lymphadenopathy. The atypical plasma cells have not previously been described.     

TSH and prolactin secretions in Hashimoto's thyroiditis following withdrawal of thyroid hormone therapy

Changes in the pituitary-thyroid axis in patients with Hashimoto's thyroiditis following withdrawal of thyroid suppressive therapy were analyzed. The group of patients with thyroid adenoma served as control (group I). Patients with Hashimoto's thyroiditis were divided into 2 groups on the basis of serum TSH levels 8 weeks after discontinuing the exogenous thyroid hormone (group II, less than 10 microunits/ml; group III, more than 10 microunits/ml). During treatment with L-T4(200 micrograms/day) or L-T3(50 micrograms/day), there was no significant difference in serum T4-I and T3 levels among the three groups. Following L-T4 withdrawal, basal serum TSH levels were higher at 2 to 8 weeks in groups II and III than in group I. Serum TSH response to TRH was greater at 4 to 8 weeks in groups II and III than in group I. Following L-T3 withdrawal, basal serum TSH levels were higher at 1 and 2 weeks in group II than in group I, while those of group III were consistently higher during the study. Higher TSH responses to TRH were observed at 1 to 8 weeks in groups II and III. Neither basal nor TRH-induced prolactin (PRL) secretion differed significantly among the three groups. We have demonstrated that pituitary TSH secretion in patients with Hashimoto's thyroiditis is affected more by withdrawal of thyroid hormone therapy than in patients with thyroid adenoma. In addition, the present findings suggest a difference between the sensitivity of thyrotrophs and lactotrophs in Hashimoto's thyroiditis after prolonged thyroid therapy is discontinued.