Hello. A 50 year old woman had muscle aches and heightened tremors (she had essential tremors prior to this also) for the past 12 months, due to which she underwent several tests. Her T3 and T4 came out to be very high and her TSH was low. She also has a slightly raised ESR and ALP. The same lab tests have been repeated several times over the past year. There are no other symptoms. Her iodine uptake scan of the thyroid showed a diffusely enlarged, hyperactive thyroid with slightly more activity on the right side. Her anti-thyroid microsomal antibodies came out to be very high (99 mIU/L). The normal is reported to be below 25 mIU/L. The lab concludes that antibodies at this level are unlikely to be associated with autoimmune thyroid disease. The patient is currently on carbimazole and is reporting an improvement of the symptoms. In your opinion, is this autoimmune thyroiditis that has been having the hyperthyroid state for the past 12 months, or should anything else be on the differential list too? What should the next investigative or management step be?
The Results show that she is Hyperthyroid. The +ve Antibody test suggests that it is due to Autoimmune thyroiditis. I am not sure why the lab say that it is not due to AIT.
The Iodine scan too confirms this
Carbimazole has little place in the management of AIT as there is NO excess of thyroid hormones being produced . Beta Blockers will control her symptoms and the disease will subside in due course
Recently role ofPD1and its ligands PD-L1 andPDL2andtheor polymerismshave been foundto beassociatedwith variousautoimmune diseases,so why dont you chgeck forthePD1.3 polymorphismswhich hasbeen foundto becommon in RHEUMATOIDARTHRIitis,Ankylosing spoondylitis,MULTIPLESCLEROSIS,aswell asotherautoimmune diseasesandcheck fortheanti phospho lipidantibodieswhich might beabnormal aswell likeantinuclear ,antiphospholipidantibodyasthere isacrossincrease in theseconditions.-attaching references
http://www.ncbi.nlm.nih.gov/pubmed/10485649
http://www.ncbi.nlm.nih.gov/pubmed/15188352
http://www.ncbi.nlm.nih.gov/pubmed/14730631
She has clinical and biological thyrotoxicosis, due to autoimmune thyroiditis (Hashimoto with antiimicrosomal antibodies and enlarged hyperactive thyroid on radioiodine scan : it is a not infrequent opening presentation of the illness, and in the future it's possible she 'll become hypothyroid. So it would be useful not to extend too long the antithyroid therapy, and regularly check the thyroid function. Sometimes Grave's disease can present with antimicrosome antibodies and anti TSH receptors antibodies have yo be looked for.
- Badges
- Science topic
- Similar topics
- Biological Science
- Biochemistry
- Biomolecules
- Nucleic Acids
- RNA
- Small RNA
- microRNA