MyMedR

Fulltext A woman with fever and neck pain

Teng CL

Malays Fam Physician, 2009;4(1):40.

PMID: 25606159

Matched MeSH terms: Thyroiditis, Subacute*

Fulltext Typhoid thyroiditis

Jasmi AY, Rohaizak, Meah FA, Sulaiman BT

Med J Malaysia, 1998 Mar;53(1):109-11.

PMID: 10968149

Acute suppurative thyroiditis in a 62 year old lady with enteric fever is reported. Plain radiography of the neck showed a distinct localised abscess cavity with air fluid level. A rare causative agent Salmonella typhi was isolated. Needle aspiration and antibiotics resulted in complete recovery.

Matched MeSH terms: Thyroiditis, Suppurative/etiology*

Fulltext Idiopathic portal hypertension associated with autoimmune thyroiditis

Azian M, Goh KL

Med J Malaysia, 1993 Dec;48(4):443-5.

PMID: 8183170

We report a case of idiopathic portal hypertension (IPH) in association with autoimmune thyroiditis occurring in a 39 year old woman. Ultrasonography revealed a normal liver echotexture. Spleno-portogram confirmed portal hypertension and liver biopsy showed features in keeping with IPH. She was also found to be biochemically hypothyroid with markedly elevated thyroid autoantibodies. These findings may suggest an autoimmune link in the pathogenesis of IPH.

Matched MeSH terms: Thyroiditis, Autoimmune/complications*

Fulltext Painful thyroiditis in postpartum period

Sakinah SO, Sharifah NA, Yusoff K

Med J Malaysia, 1993 Mar;48(1):83-5.

PMID: 8341177

Destructive thyroiditis commonly occurs during the postpartum period, with a prevalence rate of 5% to 16%, and is mainly due to postpartum autoimmune thyroiditis (PPT) and, very rarely, to subacute thyroiditis. The thyroiditis is similar to Hashimoto's thyroiditis and is generally painless in nature, although cases with painful thyroiditis have been described. We report a case of painful destructive thyroiditis occurring during the postpartum period, which was clinically and biochemically indistinguishable from the variant of painful PPT or subacute thyroiditis. Fine needle aspiration cytology showed multi-nucleated giant cells diagnostic of subacute thyroiditis.

Matched MeSH terms: Thyroiditis, Autoimmune/diagnosis*; Thyroiditis, Autoimmune/pathology; Thyroiditis, Autoimmune/physiopathology

Autoimmune antithyroid antibodies with special reference to their presence in human patients in Singapore

STEIN J, STEIN B, YU M, CHEE M, CHEW BK

Med J Malaysia, 1963 Dec;18:116-21.

PMID: 14117279

Matched MeSH terms: Thyroiditis*; Thyroiditis, Autoimmune*

Treatment of chronic urticaria with thyroxine in an euthyroid patient with thyroglobulin and microsomal antibodies

Koh CK, Hew FL, Chiu CL

Ann Acad Med Singap, 2000 Jul;29(4):528-30.

PMID: 11056786

INTRODUCTION: The association of chronic urticaria and thyroid autoimmunity is not well recognised and the potential use of thyroxine in the treatment of chronic urticaria in patients with thyroid autoimmunity is even less well known.

CLINICAL PICTURE: We report a case of chronic urticaria in an euthyroid patient with evidence of significantly elevated levels of thyroglobulin and microsomal antibodies.

TREATMENT AND OUTCOME: Treatment with thyroxine has brought about clinical remission of the chronic urticaria but no change in the thyroid antibody levels could be demonstrated.

CONCLUSION: Patients with chronic urticaria should be screened for evidence of thyroid autoimmunity. A closely monitored trial of thyroxine therapy for those who have thyroid autoimmunity can be rewarding.

Matched MeSH terms: Thyroiditis, Autoimmune/blood; Thyroiditis, Autoimmune/complications*; Thyroiditis, Autoimmune/drug therapy*; Thyroiditis, Autoimmune/immunology

Fulltext Autoimmune thyroid disease in a cohort of Malaysian SLE patients: frequency, clinical and immunological associations

Ong SG, Choy CH

Lupus, 2016 Jan;25(1):67-74.

PMID: 26113361 DOI: 10.1177/0961203315593164

Autoimmune thyroid disease (ATD) has been associated with other systemic autoimmune diseases. To date, there is limited data on thyroid disorders and autoimmune thyroid disease in Malaysia. The frequency of ATD among 189 systemic lupus erythematosus (SLE) patients was 6.3%, with 2.6% in the hyperthyroid group and 3.7% in the hypothyroid group. Hypothyroidism developed at a much younger mean age (24.3 years), suggesting that SLE might be a predisposing factor for the development of Hashimoto's thyroiditis. There was a higher rate of thyroid peroxidase antibody (TPO) positivity compared with anti-thyroglobulin antibody (Tg) in the hyperthyroid subgroup. This study also demonstrated a greater proportion of ATD patients who demonstrated high titres (≥ 1:6400) of TPO compared with high titres of Tg. Although there was an association between ATD and the presence of anti-Ro/SSA and/or anti-La/SSB antibodies, the absence of sicca symptoms and negative Schirmer's tests suggest a lack of association with secondary Sjogren's syndrome. A novel association between ATD and antiphospholipid syndrome (APS) was detected in our cohort. Hence we propose that patients affected by APS be routinely screened for ATD.

Matched MeSH terms: Thyroiditis, Autoimmune*

Fulltext Clinical Practice Guideline: Management of Thyroid Disorders

Citation: Clinical Practice Guideline: Management of Thyroid Disorders. Putrajaya: Ministry of Health, Malaysia; 2019

Quick reference: http://www.acadmed.org.my/view_file.cfm?fileid=968

Keywords: CPG

Matched MeSH terms: Thyroiditis

Fulltext A case of prolonged fever and a diagnosis obscured by an opaque sinus

Velayudhan M, Lee CW

Med J Malaysia, 2014 Jun;69(3):140-1.

PMID: 25326357 MyJurnal

Prolonged fever in patients can be a diagnostic challenge. Clinicians generally consider infectious diseases, malignant diseases and collagen vascular diseases as possible causes of pyrexia of unknown origin (PUO). Even after extensive evaluation as many as 15 percent of patients with prolonged fever may remain undiagnosed. This case report describes subacute thyroiditis as a cause of prolonged fever and documents how that diagnosis was finally made after 40 days of fever.

Matched MeSH terms: Thyroiditis, Subacute

High prevalence of thyroid function test abnormalities in chronic schizophrenia

Othman SS, Abdul Kadir K, Hassan J, Hong GK, Singh BB, Raman N

Aust N Z J Psychiatry, 1994 Dec;28(4):620-4.

PMID: 7794205

The thyroid status of 249 patients with chronic schizophrenia (males = 136, females = 113) with a median age of 36 years (range: 16 to 58 years) and a median duration of hospitalisation of 10 years (range: 1 to 30 years) was assessed. Thyroid antibodies (TAb) were found in 51 patients (20%). In female patients, 32 (28%) were TAb positive compared to 13% (n = 152, p = 0.01) in healthy female blood donors. In male patients, the prevalence of TAb was 14% compared to 7% (n = 449, p = 0.01) in healthy male blood donors. Of the 183 patients who had thyroid hormone measurements, 60% had normal test, 5% had elevated TSH and 17% had low TSH. The T4, FT41 and FT31 were significantly lower in those with low or high TSH (p < 0.001) compared to those with normal TSH. Of the 143 patients with normal TSH, 33 (23%) had low T3. In conclusion, there is a spectrum of thyroid function test abnormalities in chronic schizophrenia; this may be related to an abnormality in the central regulation of the hypothalamo-pituitary thyroid axis as well as at the peripheral level. However the association between chronic schizophrenia and the presence of thyroid antibodies, and the clinical relevance of these biochemical abnormalities, are still not clear.

Matched MeSH terms: Thyroiditis, Autoimmune/diagnosis; Thyroiditis, Autoimmune/physiopathology; Thyroiditis, Autoimmune/psychology

Usefulness and limitations of thyrotropin measurements as a first-line test for follow-up of Graves' patients

Ng ML, Tan TT, Roslan BA, Rajna A, Khalid BA

Ann Acad Med Singap, 1993 Jul;22(4):569-72.

PMID: 7504901

We evaluated the usefulness of sensitive thyrotrophin hormone (TSH) measurements in determining the thyroid status in the follow-up of Graves' patients undergoing medical treatment with thionamides. Out of a total of 186 serum samples tested, TSH levels were suppressed in 123 (66.1%), normal in 32 (17.2%) and elevated in 31 (16.7%) cases. Total T4, or T3 or both were elevated only in 97 (74.8%) cases of TSH-suppressed patients, indicating that TSH is less discriminatory as a first-line test for patients under treatment due to the hypothalamic-pituitary lag period. No comparisons with free T4 or free T3 were done in this study. Both total T4 (120 +/- 28 nmol/l) and TBII (23 +/- 21%) levels were significantly greater (p < 0.02) in the euthyroid group with suppressed TSH. This may suggest that persistence of a thyrotoxic state may still be present.

Matched MeSH terms: Thyroiditis, Autoimmune/diagnosis; Thyroiditis, Autoimmune/drug therapy; Thyroiditis, Autoimmune/immunology

Fulltext Association of Immunoglobulin G abnormalities in diseases: a mini review

Foong, Audrey Kow Siew, Nuha Fahimah Binti Wan Zahidi, Chau, Ling Tham

Life Sciences, Medicine and Biomedicine, 2018;2(1):24-39.

MyJurnal

Immunoglobulins are antibodies that play important roles in preserving our immune system. They have the ability to initiate humoral responses and remove antigen from the body. Out of the five major isotypes of immunoglobulins, IgG are most abundantly found in human serum. Abnormalities – deficiency or elevation in the level of IgG are found to be associated to the occurrence of several autoimmune diseases. These may include rheumatoid arthritis, Crohn’s disease, Mikulicz’s disease, Kuttner’s tumour and Hashimoto’s thyroiditis. Apart from autoimmune diseases, IgG has been found to play a role in initiating anaphylaxis, a severe and life threatening form of allergy and lately it has been discovered in cases of dengue virus infection too. It is important to acknowledge the roles of IgG on diseases especially subclass IgG4 which the elevation has been tied to numerous diseases such as Kuttner’s tumour and Hashimoto’s thyroiditis hence termed IgG4-related diseases. In addition, the roles of IgG in anaphylaxis are of importance, too, as IgG has been used in allergy immunotherapy. Hence, this review is a mini compilation of effects of IgG abnormalities based on their subclasses. Hopefully it will provide insightful understanding on the development of diagnostic and therapeutic courses for the aforementioned IgG abnormalities in the future.

Matched MeSH terms: Thyroiditis

Fulltext Hashimoto's thyroiditis: a rare cause for rhinosinusitis

Jeevanan J, Gendeh BS, Satpal S

Med J Malaysia, 2004 Aug;59(3):428-30.

PMID: 15727394

Rhinosinusitis is a common disorder with various etiological factors. In our clinical practice allergy seems to be a predominant cause followed by other less common causes like infection, drugs and aspirin hypersensitivity. We present a case of chronic rhinosinusitis secondary to hypothyroidism. Although hormonal causes like hypothyroidism have been proven to cause nasal congestion and rhinosinusitis, this is the first reported case of chronic rhinosinusitis in Hashimoto's thyroiditis in our center. This is a diagnosis of exclusion for chronic rhinosinusitis not responding to optimal medical therapy.

Matched MeSH terms: Thyroiditis, Autoimmune/complications*

Thyroid autoantibodies and associated complications during pregnancy

Nor Azlin MI, Bakin YD, Mustafa N, Wahab NA, Johari MJ, Kamarudin NA, et al.

J Obstet Gynaecol, 2010;30(7):675-8.

PMID: 20925608 DOI: 10.3109/01443615.2010.503908

This study was undertaken to determine the presence of thyroid autoantibodies and associated pregnancy complications from 49 pregnant women with thyroid disease. There were 31 (63%) women with Graves' disease (GD) and 18 (37%) with primary hypothyroidism (PHT). A total of 26 (53.1%) women, 19 (61%) with GD and seven (39%) with PHT, had positive antibodies. Six had thyroid peroxidase antibodies (TPO), one with thyroglobulin antibody (TG) and eight had TSH receptor antibodies (TR). Two had a mixture of antibodies involving TG/TPO (one GD vs one PHT), four with TG/TPO/TR (all had GD) and five with TPO/TR (four with GD vs one with PHT). There were associations in women with positive thyroid antibodies and pre-eclampsia (15.4%), abruptio placenta (4%), caesarean deliveries (31%), postpartum thyroiditis (19.2%) and abnormal neonatal thyroid function (15.4%). Women with positive thyroid antibodies in pregnancy need close care during and after pregnancy, as they can develop complications affecting both mother and fetus.

Matched MeSH terms: Thyroiditis/immunology; Thyroiditis/epidemiology

Racial disparity in the prevalence of thyroid disorder during pregnancy

Sakinah SO, Khalid BA, Aishah AB

Ann Acad Med Singap, 1993 Jul;22(4):563-6.

PMID: 8257059

A study to determine the prevalence of goitre and abnormal thyroid status during pregnancy in Malaysian women was conducted. Two hundred and three women (Malay = 85, Chinese = 47 and Indian = 71) in the third trimester and with no known thyroid disease were studied. There was a marked racial disparity in the prevalence of goitre: Indian 61%, Malay 28% and Chinese 29% (p = 0.001). The serum thyrotropic hormone (TSH) was significantly higher in Indians (median: 1.36 uIU/ml) compared to Malays (1.14 uIU/ml, p = 0.009). The serum albumin was also significantly lower in Indians (mean +/- sd; 36.12 +/- 3.9 mmol/l) compared to Malays (39.3 +/- 4.8 mmol/l) or Chinese (39.1 +/- 5.2) (p < 0.001). Thyroid antibody was detected in 14.6% of these women with no significant racial difference in its prevalence. Three women were found to be thyrotoxic but none were hypothyroid. This study found a high prevalence of goitre among the pregnant Indian women, probably related to the protein malnutrition state. The high prevalence of positive thyroid antibody in our population indicates that a high percentage of women are at risk of developing postpartum thyroiditis.

Matched MeSH terms: Thyroiditis, Autoimmune/blood; Thyroiditis, Autoimmune/diagnosis; Thyroiditis, Autoimmune/epidemiology

Salmonella thyroid abscess-two case reports

Khoo KS, Koh PS, Ng KL

Gland Surg, 2020 Dec;9(6):2198-2203.

PMID: 33447571 DOI: 10.21037/gs-20-474

Acute suppurative thyroiditis account for <1% of thyroid diseases and is uncommon because of the gland's encapsulation, iodine-rich environment, good vascular supply and extensive lymphatic drainage. It has been reported in patients with underlying goiters, thyroid cancers and in immuno-compromised patients. The usual causative organisms are Staphylococci spp. and Streptococci spp. Rarer organisms include Klebsiella spp. and Salmonella spp. Due to its rarity (as there have been only 28 cases of Salmonella thyroid abscess being reported in the literature till 2020), only case reports are available to guide management. We report two cases of thyroid abscess due to Salmonella enteritidis in our institution that may herald the re-emergence of this uncommon infection of the thyroid gland and to raise awareness for all clinicians. Both patients presented with neck swelling, dysphagia and sepsis. Surgical intervention was warranted in both patients due to the severity of the disease and failed medical therapy. Recovery was uneventful following adequate surgical intervention and antibiotic therapy according to the culture and sensitivity report of the pathogen. This case report highlights that both patients were immunocompromised, and they contracted Salmonella thyroid abscess without any gastrointestinal involvement. Thus, a high index of suspicion for Salmonella thyroid abscess in immunocompromised patients can expedite the diagnosis and appropriate management can be commenced such as antibiotic therapy, percutaneous aspiration and surgical drainage in the event of failed medical therapy.

Matched MeSH terms: Thyroiditis, Suppurative

Fulltext Subclinical hypothyroidism among patients with depressive disorders

Siti Yazmin Zahari Sham, Nor Aini Umar, Zarida Hambali, Rosdinom Razali, Mohd Rizal Abdul Manaf

Malaysian Journal of Medicine and Health Sciences, 2014;10(2):71-78.

MyJurnal

Subclinical hypothyroidism (SHT) is a biochemical diagnosis, defined as an elevated Thyroid Stimulating Hormone (TSH) with normal free thyroxine (FT4). It affects 4-10% of the adult population and is more prevalent in elderly women. Its commonest cause is autoimmune thyroiditis, detected by anti- thyroid peroxidase antibody (TPO-Ab). About 2-5% of SHT patients progress to overt hypothyroidism annually. The SHT prevalence among depressed patients ranges between 3% and 17%. This study aimed to determine the prevalence of SHT and TPO-Ab positivity among patients diagnosed with depressive disorders. It was a cross-sectional study carried out in the Universiti Kebangsaan Malaysia Medical Centre over a 12 months period. Serum TSH, FT4 and TPO-Ab were measured. Results showed that 82% of depressed patients were euthyroid, 4% had SHT, 11% had subclinical hyperthyroidism and 2% had discordant thyroid function. TPO-Ab positivity among the subjects was 7%, one of whom had SHT. In conclusion, the prevalence of SHT and TPO-Ab positivity in the study population, at 4% and 7%, respectively, were comparable to previous findings.

Matched MeSH terms: Thyroiditis, Autoimmune

Fulltext Acute suppurative thyroiditis presenting as a painless thyroid swelling

Keah SH, Leong CK

Malays Fam Physician, 2006;1(2):54-57.

PMID: 27570587 MyJurnal

Acute suppurative thyroiditis is a rare disorder. We saw a 24 year old man with this condition that present atypically. The patient had a non-tender thyroid enlargement associated with fever and leukocytosis. FNA cytology clinched the diagnosis. The abscess was associated with Klebsiella pneumoniae septicemia and required surgical drainage after failing antibiotic therapy.

Matched MeSH terms: Thyroiditis, Suppurative

Fulltext Autoimmune Thyroiditis as Initial Presentation of Systemic Lupus Erythematosus Complicated by Massive Ascites: A Case Report

Abdullah NRA, Akbar RZA

J ASEAN Fed Endocr Soc, 2017;32(1):50-53.

PMID: 33442085 DOI: 10.15605/jafes.032.01.09

Autoimmune thyroiditis in the course of other autoimmune diseases such as systemic lupus erythematosus (SLE) is common because these disorders are attributed to the production of autoantibodies against various autoantigens. Beyond this association, autoimmune thyroiditis can occur before, during or after the development of SLE. In this report, we describe a female who presented with facial puffiness, lethargy and progressive abdominal distension. She was diagnosed with autoimmune thyroiditis followed by the diagnosis of SLE complicated by a massive ascites, a rare form of lupus peritonitis, which is sterile ascites that results from severe serositis. Her presentation was complex and posed a diagnostic challenge and dilemma to the physicians involved in her care.

Matched MeSH terms: Thyroiditis, Autoimmune

Fulltext Autoimmune polyglandular syndrome presenting with jaundice and thrombocytopenia

Norasyikin AW, Rozita M, Mohd Johan MJ, Suehazlyn Z

Med Princ Pract, 2014;23(4):387-9.

PMID: 24401542 DOI: 10.1159/000357645

OBJECTIVE: To report an uncommon presentation of a rare case of autoimmune polyglandular syndrome type IIIb in an elderly woman.
CLINICAL PRESENTATION AND INTERVENTION: A 62-year-old woman presented with anaemic symptoms and jaundice. Blood tests showed macrocytic anaemia due to vitamin B12 deficiency with Coombs negative haemolysis. A thyroid function test was consistent with hypothyroidism. Autoimmune antibody assays were positive for anti-parietal cell, anti-intrinsic factor and anti-thyroid peroxidase antibodies. A final diagnosis of autoimmune thyroiditis with pernicious anaemia, which constituted autoimmune polyglandular syndrome type IIIb, was made and the patient was treated with L-thyroxine, vitamin B12 injection and a blood transfusion. She was discharged uneventfully after a week of hospitalization.
CONCLUSION: This case showed that the presence of one autoimmune endocrine disease should prompt clinicians to look for other coexisting autoimmune diseases which may be asymptomatic despite positive autoantibodies.

Matched MeSH terms: Thyroiditis, Autoimmune

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