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\"Dr. Izabella Wentz, the author of the phenomenal New York Times bestseller Hashimoto's Thyroiditis, returns with a long-awaited, groundbreaking prescription to reverse the symptoms of this serious autoimmune condition that is becoming one of the country's fastest growing diseases. More than thirty-five million Americans currently suffer from Hashimoto's--an autoimmune disease that affects the thyroid gland and causes the body to attack its own cells. To alleviate the symptoms of this debilitating condition--including chronic cough, acid reflux, IBS, allergies, chronic pain, hair loss, brain fog, and forgetfulness--patients are often prescribed synthetic hormones that have numerous life-altering side effects. But there is a better way. Diagnosed with Hashimoto's at twenty-seven, pharmacist Dr. Izabella Wentz knows first-hand the effects of the disease, as well as the value--and limitations--of medication. The key to improved health, she argues, involves lifestyle interventions. In Hashimoto's Protocol, she outlines a proven treatment that has helped thousands heal and many others feel better--in as fast as ninety days. Drawing on her own personal experience as well as her work consulting with thousands of patients, Hashimoto's Protocol offers a practical pathway for healing and reversing the autoimmune damage at the root of the disease. The first step is a quick-start two-week detox that includes foods to eat and inflammatory foods to avoid, advice on supplements to support the liver, and an adrenal recovery plan. Next, readers create a personalized plan with foods, supplements, and other lifestyle interventions tailored to their body's own unique Hashimoto's triggers, which they can identify using self-tests included in the book. Hashimoto's Protocol also features original recipes. Grounded in the latest science, Hashimoto's Protocol is the first book to offer a proven protocol by an acknowledged expert in the field to treat this condition without dangerous hormones--and help sufferers reclaim their lives\"-- Provided by publisher.

Abstract Context Subacute thyroiditis (SAT) is a thyroid disease of viral or postviral origin. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that began in Wuhan, China, has spread rapidly worldwide and Italy has been severely affected by this outbreak. Objectives The objective of this work is to report the first case of SAT related to SARS-CoV-2 infection. Methods We describe the clinical, laboratory, and imaging features of an 18-year-old woman who came to our attention for fever, neck pain radiated to the jaw, and palpitations occurring 15 days after a SARS-CoV-2–positive oropharyngeal swab. Coronavirus disease 2019 (COVID-19) had been mild and the patient had completely recovered in a few days. Results At physical examination the patient presented with a slightly increased heart rate and a painful and enlarged thyroid on palpation. At laboratory exams free thyroxine and free triiodothyronine were high, thyrotropin undetectable, and inflammatory markers and white blood cell count elevated. Bilateral and diffuse hypoechoic areas were detected at neck ultrasound. One month earlier, thyroid function and imaging both were normal. We diagnosed SAT and the patient started prednisone. Neck pain and fever recovered within 2 days and the remaining symptoms within 1 week. Thyroid function and inflammatory markers normalized in 40 days. Conclusions We report the first case of SAT after a SARS-CoV-2 infection. We alert clinicians to additional and unreported clinical manifestations associated with COVID-19.

Abstract Context Riedel thyroiditis (RT) is a rare inflammatory autoimmune disease that is often a clinically diagnostic dilemma because of its insidious presentation and nonspecific symptoms. Objective The aim of the present systematic review and meta-analysis is to clarify the presentation, management, and outcomes of RT. Study Selection A systematic search of PubMed/MEDLINE and Web of Science was conducted to identify relevant reports published up to September 2019. Data Extraction First author, country, patient sex, ethnicity, presentation, biochemical status, duration of symptoms, histology, treatment, follow-up duration, and short- and long-term outcomes. Data Synthesis Data from 212 RT patients were retrieved. The mean age was 47 years with a predominantly female population (81%). Neck swelling (89%), dyspnea (50%), and neck pain (41%) were the most common presenting symptoms. Inflammatory markers were elevated in 70% to 97% and thyroid antibody positivity was present in less than 50%. Up to 82% underwent surgical intervention, with the most common being total thyroidectomy in 34% of individuals. Glucocorticoids were used in 70% of individuals with median duration 3 months. Prognosis was reasonable with 90% having resolution or improvement of symptoms. Conclusions This analysis is the largest and most comprehensive to date of RT and provides clinicians with vital information on the common presentation features that may alert to the diagnosis and highlight management options.

Subacute thyroiditis (SAT) is a thyroid inflammatory disease, whose pathogenesis and determinants of the clinical course were unclear for many decades. The last few years have brought many clinically significant new data on the epidemiology, pathogenesis and management of SAT. Several human leukocyte antigen (HLA) alleles were demonstrated not only to increase the risk of SAT, but also to correlate with SAT clinical course and determine the risk of recurrence. The world-wide epidemic of the coronavirus disease 19 (COVID-19) has provided new observations that the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) can be a potent SAT-triggering factor, and that the clinical course of SAT in patients affected by COVID-19 is different from a typical one. Additionally, many new trends in the clinical course are emerging. In the last years, painless course of SAT is more and more often described, constituting a special challenge in patients hospitalized due to COVID-19. Despite an excellent availability of diagnostic methods, several difficulties in SAT differential diagnosis can be currently encountered and the proper diagnosis and treatment is frequently delayed. False positive diagnoses of SAT in patients with malignancies of poor prognosis constitute a life-threatening problem. Taking into account all the new aspects of SAT pathogenesis and of its clinical course, the new – modified – SAT diagnosis criteria have been proposed.

Background Patients with chronic autoimmune thyroiditis have impaired health-related quality of life. The thyroid gland has a high selenium concentration, and specific selenoprotein enzyme families are crucial to immune function, and catalyze thyroid hormone metabolism and redox processes in thyroid cells. Previous randomized controlled trials have found that selenium supplementation decreases thyroid-disease-specific antibody levels. We hypothesize that selenium might be beneficial in the treatment of chronic autoimmune thyroiditis. Methods/Design The CATALYST trial is an investigator-initiated randomized, blinded, multicentre clinical trial of selenium supplementation versus placebo in patients with chronic autoimmune thyroiditis. Inclusion criteria: age ≥18 years; serum thyroid peroxidase antibody level ≥100 IU/ml within the previous 12 months; treatment with levothyroxine and written informed consent. Exclusion criteria: previous diagnosis of toxic nodular goitre, Graves’ hyperthyroidism, postpartum thyroiditis, Graves’ orbitopathy; previous antithyroid drug treatment, radioiodine therapy or thyroid surgery; immune-modulatory or other medication affecting thyroid function; pregnancy, planned pregnancy or breastfeeding; allergy towards any intervention or placebo component; intake of selenium supplementation >55 μg/day; inability to read or understand Danish or lack of informed consent. The trial will include 2 × 236 participants. The experimental intervention and control groups will receive 200 μg selenium-enriched yeast or matching placebo tablets daily for 12 months. The experimental supplement will be SelenoPrecise ® . The primary outcome is thyroid-related quality of life assessed by the Thyroid Patient-Reported Outcome (ThyPRO) questionnaire. Secondary outcomes include serum thyroid peroxidase antibody concentration; serum triiodothyronine/thyroxine ratio; levothyroxine dosage; adverse reactions and serious adverse reactions and events. Discussion In this pragmatic trial, participating patients follow their usual treatment at their usual hospitals. In order to collect high-quality data on the clinical course and quality of life, and to minimize missing data, an elaborate trial management system has been designed. 12 months intervention duration was selected in consideration of the primary outcome, thyroid-related quality of life. Trial registration ClinicalTrials.gov ID: NCT02013479 .

The world is dealing with the Covid-19 pandemic due to the coronavirus SARS-CoV-2. Amongst the extra-pulmonary manifestations presented by Covid-19 patients, thyroiditis form part of the spectrum of visceral involvement linked to SARS-CoV-2. In this review, we will describe the various documented clinical forms of thyroiditis (inflammatory thyroiditis, subacute or de Quervain’s thyroiditis, chronic lymphocytic thyroiditis or Hashimoto’s disease, painless (silent) postpartum thyroiditis) to facilitate their diagnosis in more or less symptomatic Covid-19 patients and to provide guidance for patient treatment.

ContextThyroid immune-related adverse events (irAEs) in patients treated with programmed death receptor-1 (PD-1) blockade are increasingly recognized as one of the most common adverse effects. Our aim was to determine the incidence and examine the potential mechanisms of anti-PD-1–induced thyroid irAEs.DesignSingle-center, retrospective cohort study.Patients and MeasurementsWe studied 93 patients with advanced cancer (ages 24 to 82 years; 60% males) who received at least one infusion of pembrolizumab. Thyroid test results and thyroid imaging modalities were reviewed. Comprehensive 10-color flow cytometry of peripheral blood was performed.ResultsThirteen (14%) thyroid irAEs were observed. Thyroiditis occurred in seven patients (54%), from which four recovered. New onset of hypothyroidism overt/subclinical developed in three patients. Levothyroxine dosing required doubling in three patients with a known history of hypothyroidism. Thyroperoxidase antibodies were positive in the minority of the patients [4/13 (31%)] and diffuse increased 18fludeoxyglucose uptake of the thyroid gland was observed in the majority [7/11 (64%)] of patients. We observed more circulating CD56+CD16+ natural killer (NK) cells and an elevated HLA-DR surface expression in the inflammatory intermediate CD14+CD16+ monocytes in anti-PD-1–treated patients.ConclusionsThyroid dysfunction is common in cancer patients treated with pembrolizumab. Reversible destructive thyroiditis and overt hypothyroidism are the most common clinical presentations. The mechanism of thyroid destruction appears independent of thyroid autoantibodies and may include T cell, NK cell, and/or monocyte-mediated pathways. Because the thyroid is a frequent target of anti-PD-1 therapies, patients with therapeutically refractory thyroid cancer may be ideal candidates for this treatment.We studied 93 pembrolizumab-treated patients and found that destructive thyroiditis was the most common clinical presentation, possibly triggered by T cell, NK cell, and/or monocyte-mediated pathways.

Riedel thyroiditis (RT) is a rare immune-mediated inflammatory disease that destroys the thyroid parenchyma, replacing it with storiform fibrosis extending to the extrathyroidal tissue. Secondary fibrotic lesions can be associated as parts of the systemic IgG4-related disease. We present the case of a 52-year-old female patient who presented initially with subacute thyroiditis when corticosteroid treatment was initiated. After a year, compressive respiratory symptoms and dysphagia appear, and fine-needle aspiration cytology is performed to rule out malignancy, but without results. Thyroidectomy is performed, and histopathology shows scleroatrophic thyroiditis, with chronic inflammatory infiltrate containing eosinophils extending in the neighboring tissue, rare atrophic follicles, and obliterative vasculitis. Immunohistochemistry proves abundant plasma cells with IgG4 secretion; the macrophage is mainly the M2 subtype. RT is diagnosed, and a CT (computed tomography) scan is performed to detect peritracheal fibrosis and subtle pulmonary modifications. A literature review was performed that situates our findings in the context of the current literature. The last part discusses the immuno-inflammatory mechanisms behind IgG4-related diseases.

Hypothyroidism is often diagnosed, and subsequently treated, due to health-related quality of life (HRQL) issues. However, HRQL following treatment has never previously been assessed in longitudinal descriptive studies using validated instruments. To investigate disease-specific (ThyPRO) and generic (SF-36) HRQL, following levothyroxine therapy in patients with hypothyroidism due to autoimmune thyroiditis. This prospective cohort study was set at endocrine outpatient clinics at two Danish university hospitals. Seventy-eight consecutive patients were enrolled and completed HRQL questionnaires before, six weeks, and six months after initiation of levothyroxine therapy. Normative ThyPRO (n = 739) and SF-36 (n = 6,638) data were available for comparison and changes in HRQL following treatment were estimated and quantified. Prior to treatment, all ThyPRO scales were significantly impacted (p<0.0001), compared to the general population sample. The same was observed for seven of eight SF-36 scales, the exception being Bodily Pain. Tiredness (ThyPRO) and Vitality (SF-36) were the most markedly impacted scales. After six weeks of treatment, nine of thirteen ThyPRO scales had significantly improved. ThyPRO improvements were consistent at six months, where five of eight SF-36 scales had also significantly improved, but deficits persisted for a subset of both ThyPRO and SF-36 scales. In this population of hypothyroid patients, HRQL was widely affected before treatment, with tiredness as the cardinal impairment according to both ThyPRO and SF-36. Many aspects of HRQL improved during the first six months of LT4 therapy, but full recovery was not obtained. Our results may help clinicians inform patients about expected clinical treatment effects.

Cognitive and affective disturbances are frequent extra-thyroidal manifestations of Hashimoto's thyroiditis (HT), even in euthyroid patients, with severe cases progressing to Hashimoto's encephalopathy. The mechanisms underlying these CNS complications are still unclear; however, neuroinflammation-driven by CD4 T cells and Hmgb1-mediated glial activation-is increasingly implicated. To elucidate this link, we explore in an experimental autoimmune thyroiditis (EAT) model whether Hmgb1 amplifies immune pathways to exacerbate cognitive and emotional impairments. In C57BL/6 mice, EAT was induced by multiple injections of pTg. Histopathological analysis and ELISA confirmed the induction of thyroiditis. Exploratory behavior was assessed in an open field test, and associative memory was evaluated using the novel object recognition task, Y-maze, and Morris water maze. PCR was performed to detect inflammatory markers indicative of neuroinflammation. Furthermore, Western blotting was used to assess Hmgb1 release, and immunofluorescence (IF) was employed to examine the cytoplasmic translocation of Hmgb1 in brain sections, as well as the morphology and activation markers of microglia and astrocytes. Mice with EAT, despite preserved systemic thyroid hormone levels, displayed significant deficits in both spatial and recognition memory. Histological and immunofluorescence analyses revealed pronounced activation of microglia in the cortex and hippocampus, accompanied by an increased number of A1-like astrocytes and disrupted polarization of AQP4. Infiltrating CD4 T cells were detected in these regions and were found to secrete IL-17A. Neuroinflammatory changes were associated with elevated Hmgb1 expression and increased numbers of CD68 microglia, as confirmed by co-localization analyses. Pharmacological inhibition of Hmgb1 markedly reduced microglial activation and alleviated cognitive impairments. Our results identify Hmgb1 as a key factor that translates peripheral thyroid autoimmunity into central neuroinflammation. It functions as a driving force behind pathogenic glial and Th17/IL-17A responses, which propagate neurotoxicity and lead to cognitive-affective dysfunction. Targeting Hmgb1 may thus offer a viable therapeutic approach to prevent or treat neurological symptoms associated with HT.