2016年11月12日土曜日

Autoimmune Diseases in Endocrinology（2007）






Autoimmune Diseases in Endocrinology（2007）

（page 144）
Thyroid can be exposed to external and internal radiation. Internal radiation can be the consequence of indirect exposure after environmental disasters (fallout) or after therapeutic irradiation with 131-I. External radiations are the consequence of direct exposure after environmental disasters or therapeutic irradiation for diseases of the head and the neck. The effects of environmental irradiation on thyroid autoimmunity are controversial (51).
51.Eheman CR, Garbe P, Tuttle RM. Autoimmune thyroid disease associated with environmental thyroidal irradiation. Thyroid 2003
http://ninteisiryo.blogspot.jp/2016/11/blog-post.html

Hypothyroidism was correlated with exposure to fallout from a hydrogen bomb explosion releasing short-lived radioiodine isotopes (52).
52. Larsen PR, Conard RA, Knudsen KD, Robbins J, Wolff J, Rall JE, et al. Thyroid hypofunction after exposure to fallout from a hydrogen bomb explosion. JAMA 1982
http://jamanetwork.com/journals/jama/article-abstract/369710

  About 6–8 years after the Chernobyl accident, a significant increase in thyroid autoimmunity without evidence of thyroid dysfunction was found in children exposed to radioactive fallout (53).
53. Pacini F, Vorontsova T, Molinaro E, Kuchinskaya E, Agate L, Shavrova E, et al. Prevalence of thyroid autoantibodies in children and adolescents from Belarus exposed to the Chernobyl radioactive fallout. Lancet 1998
https://www.ncbi.nlm.nih.gov/pubmed/9737280

  Pubertal age in girls was a risk factor for increased prevalence of thyroid autoimmunity. In a subsequent analysis with a longer follow-up, no increase has been found by the same group (Pinchera and Elisei, unpublished data), suggesting that this phenomenon is transient. In persons exposed as children to 131-I released in the atmosphere from the Hanford nuclear site, the radiation did not correlate neither with chronic autoimmune thyroiditis nor with autoimmune hypothyroidism 40 years after exposure (54).
54. Davis S, Kopecky KJ, Hamilton TE, Onstad L. Thyroid neoplasia, autoimmune thyroiditis, and hypothyroidism in persons exposed to iodine 131 from the hanford nuclear site. JAMA 2004
https://www.ncbi.nlm.nih.gov/pubmed/15572718

  Although a significant relationship between thyroid radiation dose and autoimmune hypothyroidism was observed in atomic bomb survivors in Nagasaki 40 years after the atomic bomb explosion (55),
55.Nagataki S, Shibata Y, Inoue S, Yokoyama N, Izumi M, Shimaoka K. Thyroid diseases among atomic bomb survivors in Nagasaki. JAMA 1994
https://www.ncbi.nlm.nih.gov/pubmed/8028167

  neither anti-thyroid antibodies nor autoimmune hypothyroidism correlated with thyroid radiation dose in Hiroshima and Nagasaki atomic bomb survivors 55–58 years after radiation exposure (56).
56.  Imaizumi M, Usa T, Tominaga T, Neriishi K, Akahoshi M, Nakashima E, et al. Radiation dose-response relationships for thyroid nodules and autoimmune thyroid diseases in Hiroshima and Nagasaki atomic bomb survivors 55-58 years after radiation exposure. JAMA 2006
https://www.ncbi.nlm.nih.gov/pubmed/16507802

 The role of occupational exposure to ionizing radiation in inducing AITD, which has been reported recently (57),
57.Volzke H, Werner A, Wallaschofski H, Friedrich N, Robinson DM, Kindler S, et al. Occupational exposure to ionizing radiation is associated with autoimmune thyroid disease. J Clin Endocrinol Metab 2005
https://www.ncbi.nlm.nih.gov/pubmed/15886237

 needs confirmation in larger studies. The occurrence of hypothyroidism after neck and head irradiation has been long recognized and histological lymphocytic thyroiditis after low-dose irradiation exposure during childhood has been demonstrated (58).
58.Spitalnik PF, Straus FH. Patterns of human thyroid parenchymal reaction following low-dose childhood irradiation. Cancer 1978
http://onlinelibrary.wiley.com/doi/10.1002/1097-0142(197803)41:3%3C1098::AID-CNCR2820410344%3E3.0.CO;2-%23/abstract

  AITD were more frequent in patients exposed to multiple fluoroscopic examination, although the difference was not statistically significant (59).
59.Kaplan MM, Boice JD, Jr., Ames DB, Rosenstein M. Thyroid, parathyroid, and salivary gland evaluations in patients exposed to multiple fluoroscopic examinations during tuberculosis therapy: a pilot study. J Clin Endocrinol Metab 1988
https://www.ncbi.nlm.nih.gov/pubmed/3339110

  Hypothyroidism has been reported after irradiation for Hodgkin’s disease (60).
60. Hancock SL, Cox RS, McDougall IR. Thyroid diseases after treatment of Hodgkin’s disease. N Engl J Med 1991
https://www.ncbi.nlm.nih.gov/pubmed/1861693

  131-I treatment can induce a transient rise of titers in thyroid autoantibody-positive patients (61)
61. Pinchera A, Liberti P, Martino E, Fenzi GF, Grasso L, Rovis L, et al. Effects of antithyroid therapy on the long-acting thyroid stimulator and the antithyroglobulin antibodies. J Clin Endocrinol Metab 1969
http://press.endocrine.org/doi/10.1210/jcem-29-2-231?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

 and the appearance of thyroid autoantibodies in autoantibody-negative patients (62,63).
62. Chiovato L, Santini F, Vitti P, Bendinelli G, Pinchera A. Appearance of thyroid stimulating antibody and Graves’ disease after radioiodine therapy for toxic nodular goitre. Clin Endocrinol (Oxf) 1994
https://www.ncbi.nlm.nih.gov/pubmed/8033373

 63. Nygaard B, Knudsen JH, Hegedus L, Scient AVC, Molholm Hansen JE. Thyrotropin receptor antibodies and Graves’ disease, a side-effect of 131I treatment in patients with nontoxic goiter. J Clin Endocrinol Metab 1997
https://www.ncbi.nlm.nih.gov/pubmed/9284721

IMMUNOPATHOGENESIS

Autoimmune hypothyroidism results from an interaction of endogenous and environmental factors with thyroid and non-thyroid genes, leading to activation of thyroid autoreactive T cells and ultimately hypothyroidism through immune-mediated inflammation and thyroid tissue destruction. A number of mechanisms are involved in this process.




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