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Seorang penderita tiroiditis hashimoto dan kaitannya dengan riwayat utikaria kronis serta keganasan rahim

  • I Komang Realiska ,
  • I Made Pande Dwipayana ,

Abstract

Background: Hashimoto's thyroiditis (TH) is a spectrum of autoimmune diseases in the presence of a thyroid. The spectrum begins pathologically from auto-antibodies that attack the thyroid tissue and progress to fibrosis.

Case report: A 28-year-old woman diagnosed with Hashimoto's Thyroiditis (TH) and a history of chronic urticaria and uterine malignancies. Thyroid hormone profile examination showed primary abnormalities thyroid by autoimmune with TSH 8.63 (0.25-5.00) ?IU / mL, FT4 1.06 (0.93-1.70) ng / dL, and anti-thyroid peroxidase (anti-TPO) 3155.38 IU / mL. Thyroid ultrasound examination showed increased parenchymal vascularization, no nodules or cysts, calcifications. Histopathological examination revealed a lymphocytic thyroiditis process—management of patients given levothyroxine, achieve the appropriate clinical resolution and therapeutic targets.

Conclusion: Chronic urticaria condition and uterine malignancy history in patients are suspected to be related to TH. Based on the cycle model theory of autoimmunity and carcinogenesis, malignancy can cause activated immune response, and loss of self-tolerance occurs as induction of autoimmune processes and vice versa inflammation in autoimmune induces malignancy.



Latar Belakang: Tiroiditis Hashimoto (TH) merupakan salah satu spektrum penyakit autoimun pada kelenjar tiroid. Spektrum ini dimulai secara patologi dari terbentuknya auto-antibodi yang menyerang jaringan tiroid, dan berpogresif menjadi fibrosis.

Laporan kasus: Seorang wanita 28 tahun dengan diagnosa Tiroiditis Hashimoto (TH) dan riwayat urtikaria kronis dan keganasan rahim. Pemeriksaan profil hormon tiroid menunjukkan kelainan primer kelenjar tiroid oleh autoimun dengan TSH 8.63 (0.25-5.00) ?IU/mL, FT4 1.06 (0.93-1.70) ng/dL, dan anti-thyroid peroxidase (anti-TPO) 3155.38 IU/mL. Pemeriksaan USG tiroid menunjukkan peningkatan vaskularisasi parenkim, tak tampak nodul/kista, ataupun kalsifikasi. Pemeriksaan histopatologi menunjukkan proses limphocytic thyroiditis. Tatalaksana pada pasien diberikan levotiroksin yang mencapai resolusi klinis dan target terapi yang sesuai.

Simpulan: Pasien memiliki riwayat  keganasan rahim yang diasosiasikan dengan TH. Berdasarkan teori cyclic model of autoimmunity and carcinogenesis mengatakan keganasan dapat menyebabkan teraktivasi respons imun dan terjadi self-tolerance sebagai induksi dari proses autoimun dan sebaliknya inflamasi yang terjadi pada autoimun  menginduksi keganasan.

References

  1. Hiromatsu Y, Satoh H, Amino N. Hashimoto thyroiditis: history and future outlook. Hormons. 2013;12(1): 12-8.
  2. Jaume JC. Endocrine autoimmunity. In Greenspan’s Basic & Clinical Endocrinology 8th ed. Eds: Gardner DG, Shoback DM. New York: McGraw-Hill Medical. 2007.pp.59-79.
  3. Vanderpump MP, Tunbridge WM, French JM. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf).1995; 43(1):55-68.
  4. Weetman AP. Thyroid disease. In The Autoimmune Disease. Eds: Rose NR, Mackay IR. Elsevier. San Diego. 2006.pp.467-82.
  5. Stali A, Mirocha S, Todoreva-Koteva K, Glindberg S, Jaume JC. Hashimoto thyroiditis is more frequent than expected when diagnosed by citology which uncovers a preclinical state. Thyroid research. 2010; 3(11):1-7.
  6. Salvatore D, Davies TF, Schlumberger MJ, Hay ID, Larsen PR. 2016. Thyroid physiology and diagnostic evaluation of patients with thyroid disorders. in Melmed S, Polonsky KS, Larsen PR, Kronenberg HM (eds). Williams textbook of endocrinology 13th ed.pp:333-68. Philadelphia: Elsevier.
  7. Rudijanto A. Hipotiroid. In Buku Ajar Ilmu Penyakit Dalam edisi VI. Eds: Setiati S, Alwi I, Sudoyo AW, Sumadibrata M, Setiyohadi B. Interna Publishing. 2014.pp.2448-54.
  8. Simmonds MJ, Kavvoura FK, Brand OJ, Newby PR, Jackson LE, Hargreaves CE, et al. Skewed X chromosome inactivation and female preponderance in autoimmune thyroid disease: an association study and meta-analysis. J Clin Endocrinol Metab. 2014; 99: 127–31.
  9. Hasham A, Tomer Y. Genetic and epigenetic mechanisms in thyroid autoimmunity. J Immunol Res. 2012; 54: 204-13.
  10. Pyzik A, Grywalska E, Mtyjaszek-Matuszek B, Rolinski J. Immune disorders in Hashimoto’s thyroiditis: what do we know so far?. J Immunol Res. 2015; 2015:979167.
  11. Shankar O, Balraj N, Rakesh G. Clinical study of Hashimoto’s thyroiditis. IAIM. 2016; 3(2): 98-103.
  12. Caturegli P, De Remigis A, Rose NR. Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmun Rev. 2014; 13 (4-5):391-7.
  13. Ott J, Promberger R, Kober F, Neuhold N, Tea M, Huber JC, et al. Hashimoto’s thyroiditis affects symptom load and quality of life unrelated to hypothyroidism: a prospective case–control study in women undergoing thyroidectomy for benign goiter. Thyroid. 2011; 21(2):161-7.
  14. Huber A, Menconi F, Corathers S. Joint genetic susceptibility to type 1 diabetes and autoimmune thyroiditis: from epidemiology to mechanisms. Endocr Rev. 2008; 29(6):697-725.
  15. Kim KW, Park YJ, Kim EH. Elevated risk of papillary thyroid cancer in Korean patients with Hashimoto's thyroiditis. Head Neck. 2011; 33(5):691-5.
  16. Wakasa T, Shintaku M, Tanaka S, Yamada K, Li Y, Kakudo K. Morphological changes of follicular cells in Hashimoto’s disease: a possible cause of overdiagnosis in cytology. JBCM. 2013;2(1):12-6.
  17. Baloch ZW, LiVolsi VA. Fine-needle aspiration of the thyroid: today and tomorrow. Best Pract Res Clin Endocrinol Metab. 2008; 22(6):929-39.
  18. Dorr HG, Bettendorf M, Binder G, Karges B, Kneppo C, Schmidt H, et al. Levothyroxine treatment of euthyroid children with autoimmune Hashimoto thyroiditis: results of a multicenter, randomized, controlled trial. Horm Res Paediatr. 2015; 84(4): 266-74.
  19. Nuzzo V, Tauchmanova L, Colasanti P, Zuccoli A, Colao A. Idiopathic chronic urticaria and thyroid autoimmunity. Dermato-Endocrinology. 2011;3(3):255-8.
  20. Kilic G, Guler N, Suleyman A, Tamay Z. Chronic urticaria and autoimmunity in children. Pediatr Allergy Immunol. 2010; 21(5): 837–42.
  21. Berghi NO. Immunological mechanisms implicated in the pathogenesis of chronic urticaria and Hashimoto thyroiditis. Iran J Allergy, Asthma Immunol. 2017; 16(4):358–66.
  22. Gonzalez-Diaz SN, Sanchez-Borges M, Rangel-Gonzalez DM, Guzman-Avilan RI, Canseco-Villreal JI, Arias-Cruz A. Chronic urticaria and thyroid pathology. World Allergy Organ. J. 2020; 13: 100101.
  23. Kasperska-Zajac A, Grzanka A, Damasiewicz-Bodzek A. IL-6 transsignaling in patients with chronic spontaneous urticaria. In: Fang D, ed. PLOS ONE. 2015; 10(12): e0145751.
  24. Chen Y-K, Lin C-L, Cheng FT-F, Sung F-C, Kao C-H. Cancer risk in patients with Hashimoto’s thyroiditis:a nationwide cohort study. Br J Cancer. 2013;109: 2496-501.
  25. Brinton LA, Sakoda FC, Frederiksen K, Sherman ME, Graubard BI, Olsen JH, et al. Relationships of uterine and ovarian tumors to pre-existing chronic conditions. Gynecol Oncol. 2007; 107(3): 487–94.
  26. Wang Y, Zhou R, Wang J. Relationship between hypothyroidsm and endometrial cancer. AGING DIS. 2019; 10(1): 190-6.
  27. Wang PP, He XY, Wang R. Wang Z. Wang YG. High leptin level is an independent risk factor of endometrial cancer: a meta-analysis. Cell Physiol Biochem. 2014; 34(5): 1477-84.
  28. Zhang Y, Liu L, Li C, Ai H. Correlation analysis between the expressions of leptin and its receptor (obr) and clinicopathology in endometrial cancer. Cancer Biomarkers. 2014; 14(5): 353-9.
  29. Zhou X, Li H, Chai Y, Liu Z. Leptin inhibits the apoptosis of endometrial carcinoma cells through activation of the nuclear factor ?b-inducing kinase/i?b kinase pathway. Int J Gynecol Cancer. 2015; 25(5): 770.
  30. Shin DJ, Osborne TF. Thyroid hormone regulation and cholesterol metabolism are connected through sterol regulatory element-binding protein-2 (SREBP-2). J Biol Chem. 2003; 278(36): 34114.
  31. Franks AL, Slansky JE. Multiple association between a broad spectrum of autoimmune diseases, chronic inflammatory diseases and cancer. Anticancer research. 2012; 32:1119-36.
  32. Brcic L, Ana Baric A, Gracan S, Torlak V, Brekalo M, Skrabic V, et al. Genome-wide association analysis suggests novel loci underlying thyroid antibodies in Hashimoto’s thyroiditis. Scientific reports. 2019; 9 (1): 1-10.

How to Cite

Realiska, I. K., & Dwipayana, I. M. P. (2021). Seorang penderita tiroiditis hashimoto dan kaitannya dengan riwayat utikaria kronis serta keganasan rahim. Intisari Sains Medis, 12(1), 433–436. https://doi.org/10.15562/ism.v12i1.900

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