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D Cappellani, C Sardella, M C Campopiano, A Falorni, P Marchetti and E Macchia

Chemistry and Laboratory Medicine 2016 54 1715 – 1724 . ( ) 7 Uchigata Y Omori Y Nieda M Kuwata S Tokunaga K Juji T. HLA-DR4 genotype and insulin-processing in insulin autoimmune syndrome . Lancet 1992

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E Rapti, S Karras, M Grammatiki, A Mousiolis, X Tsekmekidou, E Potolidis, P Zebekakis, M Daniilidis and K Kotsa

antibodies are rarely detected in LADA ( 3 ). Results demonstrated a positive titer at 32U/mL (six times the upper limit) (GAD-abs normal values <5U/mL) ( Table 2 ). HLA genotyping for DR- and DQ-encoding loci were performed and results were HLA-DRB1

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Marcos M Lima-Martínez, Ernesto Guerra-Alcalá, Miguel Contreras, José Nastasi, Janelle A Noble and Constantin Polychronakos

/dl. Urinalysis revealed glycosuria and ketonuria. Glutamic acid decarboxylase (GAD) antibody resulted positive (46 U/ml, reference range 1–5), but islet cell antibody and anti-insulin tests were negative. Human leukocyte antigen (HLA) genotyping for DR and DQ

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Marina Yukina, Nurana Nuralieva, Maksim Solovyev, Ekaterina Troshina and Evgeny Vasilyev

. Additionally, in view of the IRI-Ab increase, we performed HLA-typing and revealed DRB1*03-DQA1*05:01-DQB1*02/DRB1*04-DQA1*03:01-DQB1*03:02 genotype ( Table 4 ). The presence of a DRB1*04 allele in a high-risk haplotype was shown, which is consistent with data

Open access

Takashi Matsuo and Yoshihiko Ushiroda

HU/mean splenic HU; HU, Hounsfield unit; IVC, inferior vena cava. Discussion HLA genotyping in this patient revealed the presence of DRB1*04:05 and DRB1*04:01, which confer susceptibility to FT1DM ( Table 1 ) ( 5 , 6 ). Although we did

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Isabella Lupi, Alessandro Brancatella, Mirco Cosottini, Nicola Viola, Giulia Lanzolla, Daniele Sgrò, Giulia Di Dalmazi, Francesco Latrofa, Patrizio Caturegli and Claudio Marcocci

. Analysis of HLA-DQ genotypes and susceptibility in insulin-dependent diabetes mellitus . New England Journal of Medicine 1990 1836 – 1841 . ( )

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A Veltroni, G Zambon, S Cingarlini and M V Davì

-peptide concentrations are typically increased or incompletely suppressed ( 3 ). The exact mechanisms that cause IAS are not entirely clear. It is well known that there is a strong association with the HLA haplotype, and, in addition, it has been demonstrated that

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Shinya Makino, Takeshi Uchihashi, Yasuo Kataoka and Masayoshi Fujiwara

examination of thyroid autoantibodies revealed the presence of Hashimoto's thyroiditis. Plasma cortisol and adrenocorticotropin (ACTH) were normal, indicating no presence of Addison's disease. These findings suggested a diagnosis of APS type 3. HLA typing

Open access

Junji Kawashima, Hideaki Naoe, Yutaka Sasaki and Eiichi Araki


Anti-tumor necrosis factor (TNF)-α therapy is established as a new standard for the treatment of various autoimmune inflammatory diseases. We report the first case showing subacute thyroiditis-like symptoms with an amyloid goiter after anti-TNF-α therapy. A 56-year-old man with Crohn's disease presented with fever and a diffuse, tender goiter. To control the diarrhea, anti-TNF therapy (infliximab) was administered 4 weeks before the thyroid symptoms emerged. The patient reported a swollen neck with tenderness on the right side and fever 4 days after the second infliximab injection. An elevated serum C-reactive protein (CRP) and serum thyroid hormone level with suppressed serum thyrotropin were observed. The thyroid-stimulating antibody was not elevated. An ultrasonograph of the thyroid revealed an enlarged goiter with posterior echogenicity attenuation and a low echoic region that was tender. The thyroid uptake value on technetium-99m scintigraphy was near the lower limit of the normal range. The patient was initially diagnosed with thyrotoxicosis resulting from subacute thyroiditis. Administration of oral prednisolone improved the fever, thyroid pain, and thyroid function, but his thyroid remained swollen. The patient developed diarrhea after prednisolone withdrawal; therefore, adalimumab, another TNF inhibitor, was administered. After three injections, his abdominal symptoms were alleviated, but the thyroid pain and fever recurred. Elevated serum CRP levels in the absence of thyroid dysfunction were observed. The patient's symptoms resolved after prednisolone retreatment, but an elastic, firm goiter persisted. A fine-needle biopsy revealed amyloid deposition in the thyroid.

Learning points

  • Many cases with thyroid dysfunction accompanied by amyloid goiter have been reported.
  • There are cases that develop amyloid goiter with subacute thyroiditis-like symptoms after anti-TNF therapy.
  • When the thyroid remains swollen after improvement of thyrotoxicosis following treatment with prednisolone, it should be assessed to differentiate between an amyloid goiter and common subacute thyroiditis.

Open access

Pooja Sahni, Nitin Trivedi and Abdulkadir Omer

). One Bulgarian person with IAS reported to have DRB1*04:03, DRB1*15 ( 10 ) and a 7-year-old Brazilian women with IAS syndrome was reported to have HLA -DRB1*1104 genotype ( 11 ). There is no report showing HLA B1*03 and B3*02 and DRB1*14 (as detected