Recent studies have reported that patients with autoimmune hyperchylomicronemia caused by glycosylphosphatidylinositol-anchored high-density lipoprotein binding protein 1 (GPIHBP1) autoantibodies are associated with rheumatoid arthritis, systemic lupus erythematosus, Sjogren\'s syndrome, Hashimoto\'s thyroiditis, Basedow\'s disease, and immune thrombocytopenia. We report a rare case of hyperchylomicronemia due to GPIHBP1 autoantibodies and fluctuating thyroid autoimmune disease. A 28-year-old woman, diagnosed with Hashimoto\'s thyroiditis at 26 years of age, started taking 50 µg/day of levothyroxine sodium. She had an episode of acute pancreatitis at 27 years of age; her serum triglyceride (TG) level was 1291 mg/dL at that time. The patient was referred to our hospital because her hyperchylomicronemia (hypertriglyceridemia) did not improve on treatment with pemafibrate and eicosapentaenoic acid (EPA). Serum total cholesterol and TG levels were 237 mg/dL and 2535 mg/dL, respectively, while plasma pre-heparin lipoprotein lipase (LPL) mass was 15 ng/mL (26.5-105.5 ng/mL). We diagnosed her as Basedow\'s disease based on autoimmune antibodies and ultrasound examination. Targeted exome sequencing revealed no pathogenic variants in the LPL or GPIHBP1 genes. The serum GPIHBP1 autoantibody level was 686.0 U/mL (<58.4 U/mL) and GPIHBP1 mass was 301.9 pg/mL (570.6-1625.6 pg/mL). The patient showed hyperchylomicronemia during periods of hypothyroidism and hyperthyroidism, whereas GPIHBP1 autoantibodies were positive during episode of hyperchylomicronemia but negative during periods of normal TG levels. Based on these findings, the patient was diagnosed with hyperchylomicronemia due to GPIHBP1 autoantibodies and treated with rituximab. GPIHBP1 autoantibodies remained undetectable and TG levels were controlled at approximately 200 mg/dL.

To evaluate the prevalence of autoimmune diseases (AD) associated with type 1 diabetes mellitus (T1DM).
Analytical cross-sectional study, nested in a multicenter prospective cohort of 1121 adults with DM1 with active follow-up in endocrinology clinics. Sociodemographic and clinical variables and the presence of AD were analysed in 2010 and 2020.
In this second analysis, 49,5% were male, mean age was 49.4 ± 12.8 years, median T1DM duration was 27,1 years (20,7-35,1) and mean glycated hemoglobin was 7.66 ± 1.06%. There is an absolute increase of 13% (95% CI 11-15) (p < 0.001) of patients with at least one AE and an absolute increase of 11.6% (95% CI 9.7-13.5) (p < 0.0001) of any type of autoimmune thyroid disease (ATD) after 10 years of follow-up. Likewise, the prevalence of celiac disease, autoimmune gastritis and other AD increased statistically significantly. In the multivariate logistic regression analysis, the factors that were independently associated with the presence of ATD were female gender [OR 2.9 (95% CI 2.3-3.7); p < 0.0001] and the presence of type 1 b diabetes (OR 0.5 [95% CI 0.3-0.9]; p = 0.041).
After 10 years of follow-up, there is a substantial increase in other types of AE in patients with DM1. It seems necessary to carry out a systematic screening of these AD to optimize the follow-up of patients with 1 TDM, mainly of the ATD.

Autoimmune polyglandular syndromes (APS) are rare disorders characterized by auto-destruction of endocrine and non-endocrine organs by organ-specific antibody-directed T-lymphocytic infiltration. This case highlights a 29-year-old Caucasian man with vitiligo found to have significant neurological abnormalities in the setting of newly diagnosed pernicious anemia and thyroid autoimmune disease.

BACKGROUND: This study was to analyze the correlation between abnormal thyroid function detection and thyroid autoimmune disease, so as to provide theoretical guidance for clinical diagnosis of thyroid autoimmune disease.
METHODS: The Chinese databases were searched with a combination of words \"thyroid\", \"thyroid autoimmune disease\", \"thyroid function testing\", \"meta-analysis\". The entire database was searched in English language databases with the search terms \"thyroid\", \"thyroid autoimmune disease\", \"thyroid function test \", \"meta-analysis\". Review manager software was applied for meta-analysis.
RESULTS: A total of 8 articles were finally included. 4 articles reported the T3 level, showing P=0.95, I2=0%, odds ratio (OR) =2.39, 95% confidence interval (CI): 0.79-7.25; 3 articles reported the T4 levels, showing P=0.81, I2=0%, OR =2.16, 95% CI: 0.43-10.71; and 4 articles reported the thyroid stimulating hormone (TSH) level, showing P=0.48, I2=0%, OR =3.20, 95% CI: 1.45-7.07.
CONCLUSIONS: After a systematic review of the literature, a significant difference was found in T3 and TSH levels between patients with autoimmune thyroid disease and those with a healthy thyroid, but the difference in T4 level was not significant.

The novel coronavirus disease COVID-19 is produced by SARS-CoV-2. WHO has declared COVID-19 as a public health emergency, with the most susceptible populations (requiring ventilation) being the elderly, pregnant women and people with associated co-morbidities including heart failure, uncontrolled diabetes, chronic obstructive pulmonary disease, asthma and cancer. However, such general guidance does not provide information regarding COVID-19 risks in patients with suffering from pre-existing thyroid problems, and furthermore, we do not know whether patients with COVID-19 (symptomatic or without symptoms), who have not previously had thyroid issues develop endocrine thyroid dysfunction after infection. The European Society for Endocrinology recently published a statement on COVID-19 and endocrine diseases (Endocrine, 2020); however, thyroid diseases were not mentioned specifically. We have therefore reviewed the current literature on thyroid diseases (excluding cancer) and COVID-19, including data from the previous coronavirus pandemic caused by the SARS-associated coronavirus (SARS-CoV), a member of the same family Coronaviridae leading to severe acute respiratory syndrome (SARS). At the moment there are no data suggesting that thyroid patients are at higher risk of COVID-19, but this requites further research and data analysis.

Background: Hashimoto\'s thyroiditis (HT) and Graves\' disease (GD) are autoimmune thyroid disorders (AITDs). These conditions have been associated to abnormalities in circulating regulatory T cells (Tregs). We postulated that immune perturbations could be more pronounced at the thyroid tissue level. Methods: The phenotype of PBMCs and immune cells infiltrating thyroid tissue from 19 patients with HT, 21 patients with GD, and 30 controls has been analyzed by flow cytometry. Results: We report that blood and thyroid Treg cell subsets are similarly represented in all AITDs patients and controls. Increased Lymphoid tissue inducer (LTi)-like ILC3 and CXCR5+ PD-1hi CD4+ T follicular helper cells (Tfh) tissue-infiltrating cells, together with the prevalence of tertiary lymphoid structures (TLS) and germinal centers (GCs) represented a typical immune signature in all HT and 60% of GD patients. In the remaining group of GD patients, the absence of the aforementioned abnormalities was associated with a higher prevalence of ophthalmopathy. Conclusion: Tissue infiltrating Lymphoid Tissue inducer-like group 3 Innate Lymphoid cells and T follicular helper cells are increased in most thyroid autoimmune disease.

BACKGROUND: Thyroid feedback regulation and equilibria between thyroid hormones differ in the presence or absence of a functioning thyroid remnant.
METHODS: This study examines the relationship between the sensitivity of TSH feedback and thyroid capacity in untreated patients with thyroid autoimmune disease (n = 86) and healthy controls (n = 271). Functional capacity was estimated at maximum TSH stimulation, and pituitary TSH response was FT4-standardised with two established indices, the TSH index and the thyrotroph thyroid hormone resistance index.
RESULTS: The two indices correlated inversely with thyroid volume and functional thyroid capacity. Relationships were shifted upwards in patients with thyroid autoimmune disease. This positioned patients with thyroid autoimmune disease predominantly at the lower capacity range and upper part of TSH index. The relationship was modulated by serum FT3 concentrations, shifting 0.19 [95%CI: 0.12, 0.26] mIU/L per pmol FT3 increase. FT3 correlated with TSH index in total group ( τ  = 0.09, P = 0.009) and both subgroups. FT3 levels were maintained despite a substantial capacity loss by progressively increasing conversion rates of T3 from T4, only collapsing at capacities below <1.5 pmol/s.
CONCLUSIONS: Functional thyroid capacity and preferential T3 generation are essential elements in adjusting the sensitivity of hypothalamic-pituitary-thyroid feedback control and balancing system equilibria. This suggests that the indirect regulatory role of glandular T3 co-secretion exceeds its quantitative contribution to the thyroid hormone pool. Implications for clinical practice extend to the diagnostic use of TSH in patients with impaired thyroid reserve.

BACKGROUND: 99mTc-sestamibi, a radiopharmaceutical widely used in the assessment of myocardial perfusion, can be used as an indicator of thyroid disease due to its oncophilic character. The aim of this study was to establish the usefulness of performing additional examinations of radiotracer uptake in the thyroid gland during standard stress scintigraphy with sestamibi in order to identify thyroid diseases.
METHODS: After a retrospective evaluation of 330 consecutive myocardial perfusion scintigraphies performed in our hospital during one year, 41 patients with a focal accumulation of 99mTc-sestamibi in the thyroid were enrolled in the study. The patients underwent clinical examinations, including thyroid ultrasonography and TSH, fT4, fT3, aTPO, TRAB, calcitonin, and CEA levels. Based on the thyroid ultrasounds, 21 patients were referred for fine-needle aspiration biopsy of the thyroid.
RESULTS: An abnormal accumulation of radiotracer in the thyroid was found in 41(12.4%) of 330 patients who underwent stress cardiac scintigraphy. Thirteen (31.7%) of those patients had multinodular euthyroid goitres, 12 (29.2%) had a single thyroid nodule (including two autonomous nodules), 11 (26.8%) had autoimmune thyroid disease, and one (2.4%) had papillary thyroid carcinoma. In 12 (29.2%) with thyroid tracer uptake there was no thyroid pathology.
CONCLUSIONS: Additional evaluation of radiotracer uptake in the thyroid during standard myocardial perfusion scintigraphy is a valuable tool in the detection of thyroid diseases. The additional or parallel evaluation of radiotracer uptake in the thyroid should be considered during every myocardial scintigraphy.

Only few studies have investigated to now whether the association with Turner syndrome (TS) may affect the course of Hashimoto\'s thyroiditis (HT) in children. Aim of this study was to ascertain whether the presentation and long-term course of HT in TS children may be characterized by a peculiar and atypical pattern. The clinical and biochemical findings at HT diagnosis in 90 TS children (group A) were compared with those recorded in 449 girls with HT but without TS (group B); in group A patients, thyroid function tests were re-evaluated after a median time interval of 4.9 years. At HT diagnosis median TSH levels and the rate of cases presenting with a thyroid dysfunction picture were significantly lower in group A, irrespective of karyotype abnormalities. In group A only 34.8 % of the girls who had initially presented with euthyroidism remained euthyroid even at re-evaluation, whilst 67.7 % of those who had presented with subclinical hypothyroidism became overtly hypothyroid over time; also such evolutive pattern was irrespective of karyotype abnormalities. (1) In TS girls, HT presents with a milder hormonal pattern, which often deteriorates over time; (2) these biochemical features are not necessarily linked with a specific karyotype.