Autoimmune thyroid disease is characterized by the presence of autoantibodies against thyroid peroxidase (TPO), thyroglobulin (Tg), and the thyroid simulating hormone receptor (TSHR). The thyroid gland is a site of autoantibody secretion in autoimmune thyroid disease by the B cells infiltrated into the thyroid. Hashimoto's thyroiditis, a chronic autoimmune thyroid disease, characterized by the occurrence of high levels of serum thyroid antibodies for TPO and Tg and goiter, is the most common type of thyroiditis. A firm, diffuse, painless goiter is the most common initial finding in Hashimoto's thyroiditis. Some patients have atrophic thyroid glands rather than goiter, which may represent the final stage of thyroid failure in Hashimoto's thyroiditis. Levothyroxine is the treatment of choice for Hashimoto's thyroiditis presenting overt hypothyroidism. Patients with Hashimoto's thyroiditis and a thyroid nodule should undergo fine-needle aspiration biopsy to rule out lymphoma and thyroid carcinoma. Graves' disease is the most common cause of spontaneous hyperthyroidism in patients younger than 40 years of age. Patients with Graves' disease reveal heterogeneous lymphocytic infiltration without follicular destruction and also show various clinical presentations.
Antibodies ; Autoantibodies ; B-Lymphocytes ; Biopsy, Fine-Needle ; Goiter ; Graves Disease ; Hashimoto Disease ; Humans ; Hyperthyroidism ; Hypothyroidism ; Iodide Peroxidase ; Lymphoma ; Thyroglobulin ; Thyroid Diseases ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroiditis ; Thyroxine

Thyroid nodular lesions and thyroiditis are commonly observed in population over thirties. Since the whole-body F18-fluorodeoxyglucose positron emission tomography (PET-CT) system is widely utilized in clinical application, the detection of incidental thyroid uptake has increased significantly. Unexpected thyroid uptake on PET-CT can be divided into three distinguishable patterns: focal, diffuse, or diffuse plus focal. Focal uptake, incidentaloma, is clinically significant because of its high risk of malignancy at the range of 25-50%. Therefore, the cytologic diagnosis should be additionally performed in these patients. Diffuse pattern of thyroid uptake is very likely secondary to thyroiditis and/or hypothyroidism. Although the clinical meaning of diffuse plus focal uptake of thyroid observed on PET-CT is not clear, the risk of malignancy was increased when it compared with diffuse uptake pattern only. However, further evaluation is required to define its clinical significance.
Fluorodeoxyglucose F18 ; Humans ; Hypothyroidism ; Positron-Emission Tomography ; Thyroid Gland ; Thyroiditis

A 55-year-old male was admitted to emergency department with a hypoglycemic shock of unknown origin. He was presented with tonic seizure activity after admission. Initial diagnostic procedure could exclude diabetes mellitus, drug side effects, and exogenous insulin application. Detailed evaluation of the patient's history revealed that the patient had experienced repeated hypoglycemic episodes for 2 years. He was diagnosed with hypothyroidism six years ago. Initial laboratory investigations revealed hypoglycemia, hyponatremia, and low plasma cortisol level (0.18 microg/dL). Sellar magnetic resonance imaging showed empty sella. Replacement therapy with hydrocortisone resulted in the improvement of clinical symptoms. Combined pituitary stimulation test with exception of hypoglycemia induced growth hormone and cortisol stimulation test was performed. The response of thyroid stimulating hormone, prolactin, follicle-stimulating hormone, and luteinizing hormone was normal. We report the case of empty sella syndrome associated with hypoglycemic shock due to with multiple anterior pituitary hormone deficiencies.
Coma* ; Diabetes Mellitus ; Emergency Service, Hospital ; Empty Sella Syndrome* ; Follicle Stimulating Hormone ; Growth Hormone ; Humans ; Hydrocortisone ; Hypoglycemia ; Hyponatremia ; Hypothyroidism ; Insulin ; Luteinizing Hormone ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Plasma ; Prolactin ; Seizures ; Shock ; Thyrotropin

The author regrets that the second author's name should read Jong Ryeal Hahm as shown here, not Jong-Ryeal Hahm as in the original version.

No abstract available.
Humans

Here we report the case of a 20-year-old female patient previously diagnosed with Hashimoto's thyroiditis and overt hypothyroidism, and who had been taking synthetic thyroxine (100micro/day) for eight months. She experienced intermittent dizziness and generalized weakness, and was diagnosed as having severe autoimmune hemolytic anemia (AIHA). We prescribed prednisolone treatment and continued synthetic thyroxine administration. Two years and five months later, she developed idiopathic thrombocytopenic purpura (ITP) and was diagnosed with Evans' syndrome. Thereafter, laparoscopic splenectomy was performed because her autoimmune hemolytic anemia was refractory and dependent on steroid therapy. The HLA genotypes of the patient were HLA-A*020101/A*2602, HLA-B*270502/B*5401, HLA-Cw*0102/Cw*020202, HLA-DRB1*0404/DRB1*0405, and HLA-DQB1*0302/DQ B1*0401. Hashimoto's thyroiditis is often associated with other nonendocrine autoimmune diseases, and antithyroid antibodies are frequently observed in Evans' syndrome (coexistence of AIHA and ITP). However, there is no report of Evans' syndrome developing in patients with overt hypothyroidism and Hashimoto's thyroiditis. This case suggests that three autoimmune diseases (AIHA, ITP, and Hashimoto's thyroiditis) might share a common immunogenetic pathway in pathogenesis.
Purpura, Thrombocytopenic/blood/*complications ; Humans ; Hashimoto Disease/*complications/radionuclide imaging ; Female ; Anemia, Hemolytic, Autoimmune/blood/*complications ; Adult

PURPOSE: This study aimed to characterize and identify the factors affecting fatigue in patients with type II diabetes mellitus in Korea. METHODS: A total of 180 patients with type II diabetes mellitus were recruited from the outpatient clinic of a tertiary care hospital. For data collection, a questionnaire survey of diabetes history, hypoglycemia symptoms, and fatigue was conducted between January and February 2011. Data were analyzed using t test, analysis of variance, Pearson's correlation, and hierarchical multiple regression. RESULTS: The mean fatigue and hypoglycemia symptom scores of patients with type II diabetes mellitus were 2.88 +/- 0.61 and 6.18 +/- 12.60, respectively. Hypoglycemia symptoms (p = .004), disease duration (p < .001), and age (p < .001) correlated positively with fatigue. Hierarchical multiple regression analysis revealed that hypoglycemia symptoms was the variable positively influencing fatigue in patients with type II diabetes mellitus after adjustment for influences of demographic and clinical characteristic variables. CONCLUSIONS: Hypoglycemia symptoms were confirmed to be a predictor of fatigue. Consequently, it is essential to consider age, and disease duration as well as hypoglycemia symptoms to intervene fatigue effectively among patients with type II diabetes mellitus.
Adult ; Aged ; Aged, 80 and over ; Analysis of Variance ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2/complications/*epidemiology ; Fatigue/complications/*epidemiology ; Female ; Humans ; Hypoglycemia/complications/*epidemiology ; Male ; Middle Aged ; Regression Analysis ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Surveys and Questionnaires ; Young Adult

This study investigates whether personality characteristics and learning behaviors can predict medical students’ academic achievement in Korea, specifically in terms of successfully completing medical school without delays or achieving a high grade point average (GPA) in their final year. In May 2018, 316 medical students took the Multi-Dimensional Learning Strategy Test, 2nd edition, which provided data on their personality and learning behavioral characteristics. Their final year’s GPA and any delays in completing medical school were ascertained by reviewing all electronic academic records of each semester they had been enrolled. The combination of personality and learning behavioral characteristics was significantly associated with completing medical school without delays, even after adjusting for sex and admission path. A multiple logistic regression analysis showed that the adjusted odds ratios and 95% confidence intervals for completing medical school without delays were 1.52 (95% confidence interval [CI], 0.83–2.78) and 3.64 (95% CI, 1.70–7.82) for “others” and “both high” categories, respectively, when compared with the “both low” category. For 235 students who completed medical school without delays, their learning behavioral characteristics (scores) were significantly associated with their final year’s GPA even after adjusting for sex, admission path, and personality characteristics (scores) as determined by the multiple linear regression analysis. This study suggests that individual personality and learning behavior characteristics are predictors of medical students’ academic achievement. Therefore, interventions such as personalized counseling programs should be provided in consideration of such student characteristics.

A 54-year-old female patient was referred due to a mass in the left salivary gland. A neck CT was performed and surgery was agreed due to a suspected Warthin tumor. The patient was also diagnosed with Sjogren's syndrome and Hashimoto's thyroiditis and treated. Warthin tumor and extranodal marginal zone B-cell lymphoma were also diagnosed after parotidectomy. The coexistence of the two autoimmune diseases, Hashimoto's thyroiditis and Sjogren's syndrome, has been reported, as has the coexistence of Warthin tumor and malignant tumor within a single salivary gland. However, these four diseases have not previously been reported in an individual patient. The authors treated a patient who was first diagnosed with Sjogren's syndrome and Hashimoto's thyroiditis, and subsequently also with Warthin tumor and extranodal marginal zone B-cell lymphoma after superficial parotidectomy. Therefore, this case is reported together with a related literature review.
Adenolymphoma* ; Autoimmune Diseases ; Female ; Humans ; Lymphoma, B-Cell, Marginal Zone* ; Middle Aged ; Neck ; Parotid Gland* ; Salivary Glands ; Sjogren's Syndrome* ; Thyroid Gland* ; Thyroiditis*

A 30-year-old man was admitted due to decreased mentality. He was diagnosed as a diabetic ketoacidosis by hyperglycemia, metabolic acidosis, and positive urinary ketone bodies. Two weeks later, despite the improved state of ketoacidosis, he complained of dysphagia, quadriparesis, and respiratory difficulty. Cerebrospinal fluid analysis showed albumino-cytologic dissociation. Nerve conduction study revealed axonal motor neuropathy. His neurological deficit was rapidly improved by intravenous immunoglobulin. We report a case of Guillain-Barre syndrome just after a ketoacidosis.
Acidosis ; Adult ; Axons ; Cerebrospinal Fluid ; Deglutition Disorders ; Diabetic Ketoacidosis* ; Guillain-Barre Syndrome* ; Humans ; Hyperglycemia ; Immunoglobulins ; Ketone Bodies ; Ketosis ; Neural Conduction ; Quadriplegia