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An autoimmune condition of the thyroid gland (a gland located beneath the larynx).

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Hashimoto's thyroiditis is a common disease in which a form of chronic inflammation of the thyroid gland results in reduced function of the gland. It is an auto‐immune disorder, which means that a person's own immune system attacks the thyroid gland, so that it no longer makes adequate quantities of thyroid hormones (hypothyroidism). Common clinical manifestations include feeling cold, depressive mood, dry skin, puffy eyes, constipation, weight gain, slowed heart rate, joint and muscle pain and fatigue. Some but not all people with Hashimoto's thyroiditis have an enlarged gland, also called a goitre. Hashimoto's thyroiditis is more common in women than in men and tends to run in families. Other auto‐immune diseases often occur simultaneously, such as vitiligo, rheumatoid arthritis and diabetes type 1. The disease does not always require treatment, but when it does, it is treated with synthetic thyroid hormone replacement (sometimes desiccated thyroid hormone is used, which is not synthetic). Selenium is an essential trace element that is required in small amounts for correct functioning of the immune system and the thyroid gland.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

CD40 plays a pathogenic role in various autoimmune diseases. However, studies investigating the association between CD40 C/T-1 polymorphism and autoimmune thyroid diseases risk have reported conflicting results and their relative population effect remains unclear; therefore, a meta-analysis was conducted. The data for this meta-analysis included 14 (4214 cases and 3851 controls) and 4 studies (623 cases and 774 controls) for the association of the CD40 C/T-1 polymorphism with Graves' disease (GD) and Hashimoto's thyroiditis (HT), respectively. Results suggested significant association for CD40 C/T-1 polymorphism (odds ratio 1.267 per C allele, p = 0.000) with GD but without HT. The individuals who carried the C/C or C/T genotype have significantly increased GD risk compared with those who carried T/T genotype (C/C vs. T/T: OR = 1.596, 95% CI, 1.256~2.028; C/T vs. T/T: OR = 1.210, 95% CI, 1.032~1.419; dominant model: OR = 1.366, 95% CI, 1.175~1.587; recessive model: OR = 1.322, 95% CI, 1.147~1.523), while no association was observed in HT. When stratified by ethnicity, the significant association between polymorphism and GD risk of Caucasians was found only in recessive models; but that of Asians was found in all models. In the subgroup analysis of study design, we found thyroid antibody status should be ascertained in controls and euthyroidism subjects with higher levels of thyroid antibody should be excluded from control and included into HT to avoid bias. Our meta-analysis showed that CD40 C/T-1 polymorphism plays different roles in GD and HT. Further studies will be needed to confirm our findings.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

The polymorphism +49A/G in the cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) gene has been implicated in susceptibility to Hashimoto's thyroiditis (HT), but the findings are not clear-cut. This study aimed to investigate the association between CTLA-4 polymorphisms and HT risk using an updated meta-analysis. A meta-analysis was carried out of 14 previous studies that investigated the CTLA-4 +49A/G polymorphism and HT risk. +49A/G was associated with a significantly increased HT risk in both allele analysis and all genetic models (allele analysis: G vs. A: P < 0.001, OR = 1.379, 95 % CI = 1.244-1.529). Subgroup analysis by ethnicity showed a significantly increased HT risk with the G allele and all other genetic models in the Asian subgroup (P < 0.001). In the Caucasian subgroup, no significant association was detected between the CTLA-4 +49 G allele and HT, or in the genetic model analysis (P = 0.05). This gene-based analysis indicates that the cumulative effect of the +49A/G polymorphism in CTLA-4 is associated with HT in Asians, but appears to have no effect on HT in Caucasians.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

BACKGROUND: Evidence suggests that selenium (Se) supplementation could be useful as an adjunctive therapy to levothyroxine (LT₄) in the treatment of Hashimoto's thyroiditis (HT). To summarize evidence regarding its effect on thyroid autoantibodies' titers, demands in LT₄ replacement therapy, ultrasonographic thyroid morphology, and mood in patients with HT under LT₄ treatment, a systematic review and meta-analysis of relevant literature were performed.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

The association between cytotoxic T-lymphocyte associated antigen 4 (CTLA-4) exon-1 +49 A/G polymorphism and Hashimoto's thyroiditis (HT) has been widely studied. The results, however, are mixed. This study provides a comprehensive evaluation of the relationship between the genetic risks of CTLA-4 +49 A/G polymorphism and HT. A meta-analysis was conducted in over 4,600 subjects included in 18 case-control studies that were published up to November 15th, 2012. Our meta-analysis indicated that the CTLA-4 genotype was associated with the risk of HT in the allele comparison, homozygote comparison, heterozygote comparison, the dominant genetic model and the recessive genetic model. In the dominant genetic model, variant G allele carriers (GG + GA) of CTLA-4 +49 A/G polymorphism increased the risk of HT comparing to the homozygote AA [odds ratio (OR) = 1.70, 95% confidence interval (CI) 1.37-2.12 for GG + AG vs. AA]. The analysis by ethnicity groups suggested that Asian population (OR = 2.13, 95% CI 1.48-3.07 for GG + AG vs. AA) and Caucasian population (OR = 1.47, 95% CI 1.13-1.91 for GG + AG vs. AA) had significant increased HT risks. The association remained significant after adjusting for publication bias using the trim and fill method. Sensitivity analysis showed that the results were less stable, suggesting that these results should be explained with caution. In summary, this meta-analysis suggested that CTLA-4 +49 A/G polymorphism may be a risk factor for HT.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

If you constantly feel unmotivated, have a low pulse and are constipated, you may wonder what the cause is. There are many possible reasons for these sorts of symptoms, but they are all typical of an underactive thyroid. A blood test can help you find out for sure.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: August 10, 2017

Subclinical (latent) hypothyroidism means that the thyroid gland is still producing enough thyroid hormones. But some blood values may suggest the early stages of a hormone deficiency. Experts don't agree on whether subclinical hypothyroidism should be treated. It's not clear in which cases treatment would have advantages.If you already have noticeable (“overt” or “manifest”) hypothyroidism, the thyroid is no longer producing enough thyroid hormones. Thyroxine is the most important of the thyroid hormones. It helps regulate many of the body’s functions to balance your metabolism. Too little thyroxine can cause a number of different health problems. The symptoms range from cold hands to physical weakness, difficulty concentrating and depression. Hypothyroidism can be treated easily by taking a tablet containing the thyroid hormone once a day. These tablets act to replace the thyroxine that is not being produced. This usually makes the symptoms disappear completely.Because it doesn't cause any symptoms, subclinical hypothyroidism isn't noticeable. The TSH (thyroid-stimulating hormone) value is too high, but the thyroid is still producing enough hormones. This hormone is produced in the pituitary gland and acts as a trigger for the thyroid to start producing the thyroid hormones. TSH levels that are just a little too high may be the first sign of the early stages of hypothyroidism: The pituitary gland responds to lower levels of thyroid hormones by increasing TSH production to activate the thyroid.It is estimated that about 5 out of 100 people have subclinical hypothyroidism. Slightly elevated TSH levels are usually detected by accident during a routine examination. But taken on their own they don't pose any health risk. It's also possible that TSH levels are high only temporarily, for example after intense physical activity. Experts don't fully agree on how to decide when subclinical hypothyroidism should be treated.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: August 10, 2017

The core outcomes set in disease modification trials in mild to moderate dementia should include cognition markers for all trial participants and a structural magnetic resonance imaging scan for a subset.

Health Technology Assessment - NIHR Journals Library.

Version: May 2017

Lower limb peripheral arterial disease (known in the document as peripheral arterial disease, PAD) is a marker for an increased risk of potentially preventable cardiovascular events even when it is asymptomatic. If it becomes symptomatic it can lead to significant impairment of quality of life through limiting mobility and in its more severe manifestations may lead to severe pain, ulceration and gangrene and is the largest single cause of lower limb amputation in the UK.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: August 2012

Coeliac disease is an autoimmune condition associated with chronic inflammation of the small intestine, which can lead to malabsorption of nutrients. Dietary proteins, known as glutens, which are present in wheat, barley and rye activate an abnormal mucosal immune response. Clinical and histological improvements usually follow when gluten is excluded from the diet.

NICE Guideline - Internal Clinical Guidelines Team (UK).

Version: September 2015

The guideline applies to adults (aged 18 and over) with symptoms suggestive of dyspepsia, symptoms suggestive of gastro-oesophageal reflux disease (GORD), or both.

NICE Clinical Guidelines - Internal Clinical Guidelines Team (UK).

Version: September 2014

This guideline covers identifying, diagnosing and assessing disease severity in adults, children and young people with non-alcoholic fatty liver disease (NAFLD). It also covers both pharmacological and non-pharmacological treatments, disease monitoring and the risk of extra-hepatic conditions associated with NAFLD.

NICE Guideline - National Guideline Centre (UK).

Version: July 2016

This report evaluates the current state of evidence regarding effectiveness and harms of noninvasive technologies for the diagnosis of coronary artery disease (CAD) or dysfunction that results in symptoms attributable to myocardial ischemia in stable symptomatic patients who have no known history of CAD.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: March 2016

The guideline covers adults and children (from birth) with lower urinary tract dysfunction resulting from neurological disease or injury.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: August 2012

The thyroid is a vitally important hormonal gland, which mainly works for the body’s metabolism. It is located in the front part of the neck below the voice box and is butterfly-shaped. The functions of the thyroid gland include the production of the thyroid hormones triiodothyronine (T3) and tetraiodothyronine, also called thyroxine (T4).

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: December 30, 2016

This study found that the effectiveness of fibrin sealants do not appear to vary according to surgical procedures with regard to reducing the risk of seroma or haematoma.

Health Technology Assessment - NIHR Journals Library.

Version: December 2016

Type 1 diabetes affects over 370,000 adults in the UK, representing approximately 10% of adults diagnosed with diabetes. Given the complexity of its treatment regimens, successful outcomes depend, perhaps more than with any other long-term condition, on full engagement of the adult with type 1 diabetes in life-long day-by-day self-management. In order to support this, the health service needs to provide informed, expert support, education and training as well as a range of other more conventional biomedical services and interventionsfor the prevention and management of long term complications and disability.

NICE Guideline - National Clinical Guideline Centre (UK).

Version: August 2015

The thyroid is a vitally important hormonal gland that regulates metabolism and growth in the body. The thyroid hormones T3 and T4 increase the basal metabolic rate. In other words, they make the body cells work harder, using more energy. If more energy is needed for metabolic processes in the body – for instance for growth, when it is cold, or during pregnancy – more hormones are produced and transported into the blood.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 7, 2015

Screening may lead to detection and treatment of asymptomatic subclinical thyroid dysfunction or undiagnosed overt thyroid disease, potentially resulting in improved clinical outcomes.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: October 2014

To conduct a systematic review of the literature on the safety of vaccines recommended for routine immunization of children, adolescents, and adults in the United States as of 2011.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: July 2014

Systematic Reviews in PubMed

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