gastrins and Graves-Disease

Topics: Adrenal Cortex Hormones; Animals; Central Nervous System; Gastrins; Graves Disease; Histamine; Humans; Hypertension; Male; Peptic Ulcer; Psychophysiology; Psychosomatic Medicine; Rats; Research

Patients with autoimmune thyroid disease (AITD) have a higher prevalence of pernicious anemia compared with the general population. Clinical signs of B12 deficiency may be subtle and missed, particularly in patients with known autoimmune disease. We assessed the prevalence of vitamin B12 deficiency in patients with AITD and whether their evaluation may be simplified by measuring fasting gastrin levels.. Serum B12 levels was measured in 115 patients with AITD (7 men and 108 women), with a mean age of 47 +/- 15 years. In patients with low serum B12 levels (< or =133 pmol/L), fasting serum gastrin and parietal cell antibodies (PCA) were measured.. Thirty-two patients (28%) with AITD had low B12 levels. Fasting serum gastrin was measured in 26 and was higher than normal in 8 patients. PCA were also measured in 27 patients with B12 deficiency and were positive in 8 patients. Five patients with high gastrin levels underwent gastroscopy with biopsy, and atrophic gastritis was diagnosed in all. The prevalence of pernicious anemia as assessed by high serum gastrin levels in patients with low B12 was 31%.. Patients with AITD have a high prevalence of B12 deficiency and particularly of pernicious anemia. The evaluation of B12 deficiency can be simplified by measuring fasting serum gastrin and, if elevated, referring the patient for gastroscopy.

Topics: Adolescent; Adult; Aged; Female; Gastrins; Graves Disease; Hashimoto Disease; Humans; Male; Middle Aged; Prevalence; Thyroiditis, Autoimmune; Vitamin B 12 Deficiency

To evaluate the prevalence of hypergastrinemia in patients with hyperthyroidism and hypothyroidism and to determine whether gastrin-induced hypercalcitonemia could explain the high prevalence of thyroid C-cell hyperplasia among patients with hyperthyroidism.. Concentrations of gastrin and of hCT were determined by commercially available radioimmunoassays.. Elevated serum concentrations of gastrin were found in 17 of 161 (10.5%) patients with manifest hyperthyroidism (Graves' disease) and in 4 of 37 (10.8%) and 23 of 255 (9.0%) patients with manifest or subclinical hypothyroidism, respectively. Only 2 cases of hypergastrinemia of 255 subclinically hypothyroid patients (0.8%) could not be linked to thyroid autoimmune disease by either biochemical or sonographic criteria. Four patients with Graves' disease presented elevated plasma concentrations of calcitonin, but none of these patients also had an elevated serum gastrin.. The prevalence of hypergastrinemia in autoimmune thyroid disease is about 10%. The determination of gastrin in subclinical hypothyroidism is not cost-effective in the absence of biochemical and/or sonographic markers of autoimmune thyroid disease. The determination of gastrin is of no use to predict the presence of C-cell hyperplasia commonly seen in patients with Graves' disease.

Topics: Aged; Calcitonin; Female; Gastrins; Graves Disease; Humans; Hyperthyroidism; Hypothyroidism; Male; Middle Aged; Reference Values; Thyroid Gland; Thyroid Hormones; Thyrotropin; Thyroxine; Triiodothyronine

This study aimed to investigate the cause of persistently increased serum gastrin concentration seen in some Graves' disease patients even when euthyroid during antithyroid drug treatment. The subjects studied consisted of three groups: 33 patients with a common-type of Graves' disease, 14 with triiodothyronine (T3)-predominant Graves' disease (characterized from previous studies as having potent immunologic abnormalities including greater concentrations of thyroid-stimulating antibodies together with larger goiter size), and a group of 20 normal subjects. Fasting serum gastrin concentrations in common Graves' disease patients were significantly higher than those of normal subjects (58.4 +/- 38.9 pmol/L vs. 37.8 +/- 18.9 pmol/L [mean +/- SD], p < 0.05). The serum gastrin concentrations were even greater in T3-predominant Graves' disease patients than common Graves' disease patients (162.9 +/- 224.0 pmol/L vs. 58.4 +/- 38.9 pmol/L, p < .05). Serum pepsinogen I (PGI) concentrations were significantly lower in the T3-predominant patient group than the common Graves' group (24.0 +/- 12.9 ng/mL vs. 39.7 +/- 19.6 ng/mL, p < .05). Serum ratios of PG I to PG II were significantly lower in the T3-predominant Graves' disease patients than normal subjects (3.59 +/- 2.66 vs. 5.97 +/- 1.56, p < .01). The ratios also had a significant (p < .05) inverse correlation with serum gastrin concentrations in T3-predominant Graves' disease patients. The results suggest that autoimmune gastritis is associated with Graves' disease, particularly in patients with potent thyroid-autoimmunity.

Topics: Adolescent; Adult; Autoimmune Diseases; Female; Gastrins; Gastritis; Graves Disease; Humans; Immunoglobulins, Thyroid-Stimulating; Male; Middle Aged; Pepsinogens; Triiodothyronine

Infection by viral or bacterial pathogens has been suspected in playing a role in the development of autoimmune thyroid disease. Because Helicobacter pylori might be involved in the development of nongastrointestinal conditions such as rosacea, ischemic heart disease, and diabetes mellitus, we evaluated the prevalence of H. pylori infection in patients with autoimmune thyroid disease. Fifty-nine patients with autoimmune thyroid disease were included: autoimmune atrophic thyroiditis (n=21), Hashimoto's thyroiditis (n=18), and Graves' disease (n=20). Twenty patients with nontoxic multinodular goiter served as controls for nonautoimmune thyroid disease, and 11 patients with Addison's disease served as controls for nonthyroid endocrine autoimmune disease. The levels of anti-H. pylori immunoglobulin G (IgG) were determined, and a radiolabeled urea breath test were performed. The prevalence of H. pylori infection was markedly increased in the patients with autoimmune atrophic thyroiditis (85.7%), compared with the controls with nontoxic multinodular goiter (40%) and Addison's disease (45.4%). Infection by H. pylori resulted in increased levels of gastrin, pepsinogen I, and pepsinogen II in the H. pylori-positive groups, compared with the H. pylori-negative groups. A positive linear regression was found between the levels of microsomal autoantibodies and those of anti-H. pylori IgG in patients with autoimmune atrophic thyroiditis (n=21; r=0.79; p < 0.01). Finally, and although the overall prevalence of H. pylori infection was not increased, the anti-H. pylori IgG levels and the results from the breath test were higher in the patients with Graves' disease and Hashimoto's thyroiditis patients than in the controls. Clearly, the prevalence of H. pylori infection is increased in autoimmune atrophic thyroiditis and results in abnormalities of gastric secretory function. The strong relation between the levels of anti-H. pylori IgG and the levels of microsomal antibodies suggests that H. pylori antigens might be involved in the development of autoimmune atrophic thyroiditis or that autoimmune function in autoimmune atrophic thyroiditis may increase the likelihood of H. pylori infection.

Topics: Addison Disease; Adult; Antibodies, Bacterial; Cross-Sectional Studies; Female; Gastric Mucosa; Gastrins; Graves Disease; Helicobacter Infections; Helicobacter pylori; Humans; Linear Models; Male; Pepsinogens; Prevalence; Seroepidemiologic Studies; Thyroiditis, Autoimmune

A 63-year-old woman was diagnosed as autoimmune gastritis by the presence of serum antibody against alpha-subunit of gastric H+,K(+)-ATPase. The patient did not have pernicious anemia, but showed achlorhydria, marked hypergastrinemia, enterochromaffin-like cell hyperplasia and an extremely high histidine decarboxylase activity in the gastric fundic mucosa. Intragastric acidification by infusion of hydrochloric acid via a nasogastric tube induced a transient reduction of serum gastrin level and fundic mucosal histidine decarboxylase activity. A marked increase in fundic mucosal histidine decarboxylase activity as well as hypergastrinemia appears to be the pathophysiologic response to achlorhydria caused by autoimmunity against gastric H+,K(+)-ATPase.

Topics: Achlorhydria; Autoimmune Diseases; Enterochromaffin Cells; Female; Gastric Fundus; Gastric Mucosa; Gastrins; Gastritis; Graves Disease; H(+)-K(+)-Exchanging ATPase; Histidine Decarboxylase; Humans; Hyperplasia; Middle Aged; Parietal Cells, Gastric; Polyps; Stomach Neoplasms

Hypergastrinemia is a very important clinical condition for the reason that a growing body of evidence obtained from animal and human experiments has revealed gastric carcinoids induced by hypergastrinemia. We investigated 35 patients with Basedow's disease (BD) to elucidate the mechanism of hypergastrinemia associated with BD as well as the relationship between type A gastritis and BD. Fasting serum gastrin levels in BD (296.1 +/- 251.4 pg/ml; mean +/- S.D.) were significantly (p less than 0.001) higher than those in age-matched 27 healthy subjects (106.1 +/- 69.2), and in the BD group, significant positive correlation was detected between fasting serum gastrin levels and thyroid hormones (i.e. T3 and free T4). In the hyperchlorhydria group in BD with hypergastrinemia, the levels of fasting serum gastrin were normalized after euthyroidism was attained due to antithyroidal drugs. On the other hand, in the achlorhydria group in BD significant hypergastrinemia was persisted in spite of normalization of thyroid function. Twenty % of the BD patients had histologically proved type A gastritis with achlorhydria, and all patients with type A gastritis were older than 60 years old. Endoscopic examination revealed that one patient with type A gastritis had an early gastric cancer. However, no gastric carcinoids were demonstrated in this study. In conclusion, the results described as above suggested, 1) hypergastrinemia observed in patients with BD may be induced by gastrin hypersecretion due to hyperthyroidism as well as type A gastritis, 2) BD patients with type A gastritis were recommended to undertake regular endoscopic examination for detecting gastric cancers as well as gastric carcinoids.

Topics: Adult; Aged; Female; Gastrins; Gastritis; Graves Disease; Humans; Male; Middle Aged

We describe autoantibodies against iodinated gastrin in a patient with Graves' disease. Values for serum gastrin differed in this case, depending on which of two different radioimmunoassay (RIA) kits was used. RIA with the dextran-coated charcoal method for separation of free tracer gastrin gave a value less than 9.5 pmol/L, whereas the value by a RIA kit by the double-antibody method was 318 pmol/L. The patient's serum contained a binding protein for 125I-labeled gastrin, as detected by Sephadex G-200 column chromatography. The IgG fraction was responsible for the ability of serum to bind 125I-labeled gastrin. Interestingly, of the two possible forms of iodinated gastrins, monoiodinated (MIT) and diiodinated (DIT) tyrosine-125I-labeled gastrin, only the latter bound to patient's IgG. Furthermore, DIT-gastrin, but not gastrin or MIT-gastrin, inhibited the binding of DIT-125I-labeled gastrin. The patient's serum evidently contains autoantibodies against DIT-gastrin that interfere with RIA of gastrin.

Topics: Adult; Autoantibodies; Gastrins; Graves Disease; Humans; Immunoglobulin G; Iodine Radioisotopes; Male; Protein Binding; Radioimmunoassay; Reagent Kits, Diagnostic

The relationship between thyroid disorders and gastric pathophysiology has been studied mainly from standpoints of gastric histology and gastric acid output capacity. Though anti-gastric antibody has been thought to play a part in this relationship, there have been no clear conclusions obtained about that. Since blood gastrin levels are easily measurable by radioimmunoassay today, the relationship between thyroid disorders and gastric pathophysiology has drawn attention again from a standpoint of gastrin levels. Seino et al. have reported about hypergastrinemia in hyperthyroidism, speculating that beta-adrenergic hyperresponsiveness of gastrin-producing cells could be the mechanism of hypergastrinemia. However, there are other reports which mentioned feedback mechanism between gastrin and gastric acid or interaction of gastrointestinal hormones as the main mechanism of hypergastrinemia. In this study, the problem of gastrin in Graves' disease and chronic thyroiditis were studied by measurement of fasting serum gastrin levels and gastric juice excretion in view of feedback mechanism between gastrin-producing cells and parietal cells which are the target cells of gastrin. Following results were obtained. Fasting serum gastrin levels in Graves' disease were 236.2 +/- 39.1 (mean +/- SE) pg/ml for 39 hyperthyroid patients and 126.3 +/- 23.9 pg/ml for 35 euthyroid patients. These levels were significantly higher than those of sex and age-matched control subjects with P less than 0.001 and P less than 0.05, respectively. Fasting serum gastrin levels in serial studies of 13 patients with Graves' disease were 222.3 +/- 56.7 pg/ml before treatment and 167.3 +/- 56.6 pg/ml at the time of euthyroid state after a mean observation period of 6.6 +/- 1.1 months. Fasting serum gastrin levels at the time of euthyroid state decreased significantly when compared with fasting serum gastrin levels before treatment (P less than 0.05). Fasting serum gastrin levels in chronic thyroiditis were 160.7 +/- 51.1 pg/ml for 24 hypothyroid patients and 96.4 +/- 24.7 pg/ml for 31 euthyroid patients. Each of these levels had no significant differences when compared with sex and age-matched control subjects. Fasting serum gastrin levels in serial studies of 10 patients with chronic thyroiditis were 81.1 +/- 18.0 pg/ml at the time of hypothyroid state and 91.5 +/- 15.2 pg/ml at the time of euthyroid state after a mean observation period of 7.1 +/- 2.1 months. Fasting serum gastrin levels bef

Topics: Adolescent; Adult; Aged; Autoantibodies; Chronic Disease; Female; Gastric Juice; Gastrins; Graves Disease; Humans; Male; Middle Aged; Thyroglobulin; Thyroid Diseases; Thyroid Function Tests; Thyroid Gland; Thyroiditis, Autoimmune

High gastrin levels were found in twenty-one out of fifty-six consecutive patients (38%) with thyrotoxicosis. Following return to euthyroidism gastrin levels generally fell, but twelve patients (21%) remained hypergastrinaemic. Six of these patients (11%) had achlorhydria indicating atrophic gastritis of the antrum sparing type. No correlation between gastrin and triiodothyronine values was found. It is suggested that gastrin levels should be measured in thyrotoxic patients after treatment, and further control instituted in patients with raised gastrin levels. The relationship between gastric function, gastrin release and thyroid function seems complex. The interactions may involve both a direct effect of thyroid hormone on gastric acid production, adrenergic influences on gastrin release and linked phenomena with development of thyroid and gastric auto-immune diseases.

Topics: Adolescent; Adult; Aged; Allergy and Immunology; Autoantibodies; Female; Gastric Acid; Gastrins; Goiter, Nodular; Graves Disease; Humans; Male; Middle Aged; Triiodothyronine

Serum gastrin concentrations were measured in 22 untreated and 10 treated thyrotoxic patients. In contrast to similar studies carried out in Japan, serum gastrin levels were normal in hyperthyroid subjects. The mean value in hyperthyroid subjects (94.8 +/- 34.5 pg/ml) was higher than that in the treated patients (73.6 +/- 33.2 pg/ml), but the difference was not significant (P greater than 0.05).

Topics: Adult; Aged; Female; Gastrins; Graves Disease; Humans; Hyperthyroidism; Male; Middle Aged

Fasting plasma gastrin levels measured by radioimmunoassay were found to be elevated in patients with hyperthyroidism. The intravenous injection of arginine caused an increase of plasma gastrin in hyperthyroid patients as in normal subjects. The elevated gastrin level in patients with hyperthyroidism was significantly lowered after the thyroid function was normalized by treatment.

Topics: Adolescent; Adult; Arginine; Blood Glucose; Fasting; Female; Gastrins; Graves Disease; Humans; Male; Methimazole; Middle Aged; Propylthiouracil

Topics: Adult; Aged; Arrhythmias, Cardiac; Female; Gastric Acidity Determination; Gastric Juice; Gastric Mucosa; Gastrins; Goiter; Graves Disease; Humans; Hypothyroidism; Male; Middle Aged; Thyroid Diseases