Precision Medicine in Autoimmune Thyroiditis and Hypothyroidism

Autoimmune thyroid diseases (AITD) are T-cell-mediated organ specific autoimmune disorders, deriving from an altered response of the immune system that leads to the immune attack to the thyroid. Hashimoto’s thyroiditis (HT) and Graves’ disease (GD) are the two principal AITD clinical presentations....

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Autores principales:	Silvia Martina Ferrari, Francesca Ragusa, Giusy Elia, Sabrina Rosaria Paparo, Valeria Mazzi, Enke Baldini, Salvatore Benvenga, Alessandro Antonelli, Poupak Fallahi
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	Hashimoto’s thyroiditis autoimmune thyroid disorders autoimmune thyroiditis hypothyroidism levothyroxine thyroidectomy Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/a438a238f90141259a6bbea538171bc0
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spelling	oai:doaj.org-article:a438a238f90141259a6bbea538171bc02021-11-17T06:35:57ZPrecision Medicine in Autoimmune Thyroiditis and Hypothyroidism1663-981210.3389/fphar.2021.750380https://doaj.org/article/a438a238f90141259a6bbea538171bc02021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fphar.2021.750380/fullhttps://doaj.org/toc/1663-9812Autoimmune thyroid diseases (AITD) are T-cell-mediated organ specific autoimmune disorders, deriving from an altered response of the immune system that leads to the immune attack to the thyroid. Hashimoto’s thyroiditis (HT) and Graves’ disease (GD) are the two principal AITD clinical presentations. Hypothyroidism and thyrotoxicosis are, respectively, the clinical hallmarks of HT and GD. Patients with autoimmune thyroiditis are treated daily with synthetic L-thyroxine (L-T4) at the dose of 1.5–1.7 μg/kg. Various L-T4 formulations are commercially available (tablet, liquid solution, or soft gel capsule). L-T4 in tablets is generally prescribed to treat hypothyroidism, whereas the liquid formulation, or soft gel capsules, can be administered in hypothyroid patients in case of malabsorption or in patients in therapy with drugs interfering with L-T4 absorption. Furthermore, myoinositol has a crucial role in thyroid autoimmunity and function. Clinical studies reported a significant decline in TSH and antithyroid autoantibodies levels after treatment with myoinositol + selenium in patients with subclinical hypothyroidism and autoimmune thyroiditis. Moreover, thyroidectomy can be rarely recommended in patients with autoimmune thyroiditis, with cosmetic reasons for a goiter, or with important signs or symptoms of local compression, or nodular disease with a “suspicious” cytology for malignancy. Furthermore, a recent randomized trial suggested that total thyroidectomy can improve quality of life and fatigue, while medical therapy did not. In this review, we overview currently available evidence in personalized medicine in patients with autoimmune thyroiditis and hypothyroidism. Further research is needed in larger population to investigate the effect of these new treatments on quality of life.Silvia Martina FerrariFrancesca RagusaGiusy EliaSabrina Rosaria PaparoValeria MazziEnke BaldiniSalvatore BenvengaSalvatore BenvengaSalvatore BenvengaAlessandro AntonelliPoupak FallahiFrontiers Media S.A.articleHashimoto’s thyroiditisautoimmune thyroid disordersautoimmune thyroiditishypothyroidismlevothyroxinethyroidectomyTherapeutics. PharmacologyRM1-950ENFrontiers in Pharmacology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Hashimoto’s thyroiditis autoimmune thyroid disorders autoimmune thyroiditis hypothyroidism levothyroxine thyroidectomy Therapeutics. Pharmacology RM1-950
spellingShingle	Hashimoto’s thyroiditis autoimmune thyroid disorders autoimmune thyroiditis hypothyroidism levothyroxine thyroidectomy Therapeutics. Pharmacology RM1-950 Silvia Martina Ferrari Francesca Ragusa Giusy Elia Sabrina Rosaria Paparo Valeria Mazzi Enke Baldini Salvatore Benvenga Salvatore Benvenga Salvatore Benvenga Alessandro Antonelli Poupak Fallahi Precision Medicine in Autoimmune Thyroiditis and Hypothyroidism
description	Autoimmune thyroid diseases (AITD) are T-cell-mediated organ specific autoimmune disorders, deriving from an altered response of the immune system that leads to the immune attack to the thyroid. Hashimoto’s thyroiditis (HT) and Graves’ disease (GD) are the two principal AITD clinical presentations. Hypothyroidism and thyrotoxicosis are, respectively, the clinical hallmarks of HT and GD. Patients with autoimmune thyroiditis are treated daily with synthetic L-thyroxine (L-T4) at the dose of 1.5–1.7 μg/kg. Various L-T4 formulations are commercially available (tablet, liquid solution, or soft gel capsule). L-T4 in tablets is generally prescribed to treat hypothyroidism, whereas the liquid formulation, or soft gel capsules, can be administered in hypothyroid patients in case of malabsorption or in patients in therapy with drugs interfering with L-T4 absorption. Furthermore, myoinositol has a crucial role in thyroid autoimmunity and function. Clinical studies reported a significant decline in TSH and antithyroid autoantibodies levels after treatment with myoinositol + selenium in patients with subclinical hypothyroidism and autoimmune thyroiditis. Moreover, thyroidectomy can be rarely recommended in patients with autoimmune thyroiditis, with cosmetic reasons for a goiter, or with important signs or symptoms of local compression, or nodular disease with a “suspicious” cytology for malignancy. Furthermore, a recent randomized trial suggested that total thyroidectomy can improve quality of life and fatigue, while medical therapy did not. In this review, we overview currently available evidence in personalized medicine in patients with autoimmune thyroiditis and hypothyroidism. Further research is needed in larger population to investigate the effect of these new treatments on quality of life.
format	article
author	Silvia Martina Ferrari Francesca Ragusa Giusy Elia Sabrina Rosaria Paparo Valeria Mazzi Enke Baldini Salvatore Benvenga Salvatore Benvenga Salvatore Benvenga Alessandro Antonelli Poupak Fallahi
author_facet	Silvia Martina Ferrari Francesca Ragusa Giusy Elia Sabrina Rosaria Paparo Valeria Mazzi Enke Baldini Salvatore Benvenga Salvatore Benvenga Salvatore Benvenga Alessandro Antonelli Poupak Fallahi
author_sort	Silvia Martina Ferrari
title	Precision Medicine in Autoimmune Thyroiditis and Hypothyroidism
title_short	Precision Medicine in Autoimmune Thyroiditis and Hypothyroidism
title_full	Precision Medicine in Autoimmune Thyroiditis and Hypothyroidism
title_fullStr	Precision Medicine in Autoimmune Thyroiditis and Hypothyroidism
title_full_unstemmed	Precision Medicine in Autoimmune Thyroiditis and Hypothyroidism
title_sort	precision medicine in autoimmune thyroiditis and hypothyroidism
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/a438a238f90141259a6bbea538171bc0
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Precision Medicine in Autoimmune Thyroiditis and Hypothyroidism

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