Advances in Graves' Disease

摘要: “From the very commencement student should set out to witness progress and effects of sickness ought persevere in daily observation disease during whole period his studies.” It was Dr. Robert J. Graves who used pronounce this statement at inauguration yearly university lectures Dublin. This nineteen century he had only just described Graves' disease, most common hyperthyroid condition that is so widely recognized today. There could be least two complementary ways interpreting perennial advice. The first way from a practical viewpoint. It emphasizes importance monitoring clinical evolution. an important good-practice guide for doctors (and students) are patient's bedside. approach promotes deep scrutiny taking into consideration it not abstract concept, but ailment embodied given patient. second interpretation more theoretical. Thus significance supports concept laboratory research. Physicians must participate research all levels: basic, translational, clinical. counsel encourages efforts achieve knowledge as individual entities. Therefore, both objectives, theoretical, closely entwined—laboratory advances connected bedside—what we now call translational medicine. Unfortunately, link often weak. Since 1835, when dramatic has been made our illness. During these nearly centuries, have come understand variety molecular, genetic, autoimmune mechanisms give rise maintain disease. However, also true despite recent advances, management changed little over last few decades. Nevertheless, thanks group outstanding physician-investigators able integrate with bedside, sense exciting changes hand. Currently, instance, there several molecular target therapies under development will significantly alter within next years. special issue intended highlight some breakthroughs area. includes complete overview: basic reviews papers through studies. T. F. Davies et al. summarizes new genetic insights thyroid diseases (AITDs), complex topic actively being investigated. At present, than twenty genes associated AITD can categorized groups: immune regulatory (which other diseases) thyroid-specific genes. Despite gene-AITD association, gene contribution complex. Furthermore, no single polymorphism seems contribute substantially reaction diseases. emerging evidence indicates environmental and/or epigenetic modifications predisposing background change expression, which subsequently elicits manifestation. Although findings emphasized identification components interact host factors diseases, elusive far AITD. Unfortunately clinician, profiling patients unlikely productive near future, corresponding limitation strategies prevention predictive treatment. The role microchimerism subject C. Galofre's review article. In paper author updates main suggests close relationship linking fetal Certainly, presence intrathyroidal cells maternal attractive candidate mechanism modulation pregnancy postpartum period. however, responsibility generation remains hypothesis. In their articles, M. Žarkovic L. H. Duntas address matter: oxidative stress on pathogenesis its specific treatment, respectively. describes how indeed factor induces maintains ophthalmopathy. Subsequently selenium treatment Both contributors tackle question inflammatory process imbalance antioxidant-oxidant detail. authors illustrate increased production radical oxygen species cytokines, sustain perpetuate stressed selenium, potent antioxidant, recently applied mild ophthalmopathy, slowing progression decreasing activity score, appreciably improving quality life. Questions remain open further such whether enforced nutritional supplementation same results prolonging administration may impact disease. S. El-Kaissi R. Wall original study determinants extraocular muscle volume (assessed by MRI) 39 shows diagnosed enlargement higher serum TSH severe hyperthyroidism baseline without enlargement, difference anti-TSH-R antibody positivity comparing groups. C. Kamath summarize thyrotrophin receptor (TR-Ab) assays TR-Ab commonly available clinicians, measure thyroid-binding inhibiting immunoglobulins (TBII or assays), do differentiate between stimulating (TRS-Ab), neutral, blocking antibodies (TRB-Ab). induce confusion managing although patient best bioassay. current 2nd-3rd highly sensitive functional types TR-Ab. encourage measuring pregnant women appropriate circumstances. data conclusive about use predicting outcome after antithyroid drug therapy, significant variability assay methodology, population characteristics (e.g., iodine intake), design published data. An example inherent difficulties positive significance, postulated article, illustrated N. Takasu Matsushita TRB-Ab TRS-Ab levels 34 TRB-Ab-positive hypothyroidism 98 TRS-Ab-positive hyperthyroidism. covers ten-year Serum remained elevated entire half initial hypothyroidism. Interestingly, hypothyroid were divided according atrophic goitrous thyroiditis. TRB-Ab, form recovered whereas 21% evolved euthyroidism. Around 10% circulating end follow-up continued due On hand, remission occurs 82% whom disappeared serum. switch vice versa took place 5.8% 2.0%, respectively, always inducing gland function. authors' conclusion manifestations: hypothyroidism. M. O. Hegazi S. Ahmed article focuses atypical manifestations Some features specifically related (including anemia, vomiting, jaundice, right heart failure), while others similarly found forms Pulmonary hypertension reported reportedly responds treatment. Such signs symptoms considered suspect allowed delay diagnosis unnecessary investigation. We sincerely hope present help clinicians work field thyroidology studies benefit patients. Juan Galofre Leonidas Duntas L. D. Premawardhana Terry