This review of literature attempts to identify the factors that are involved in the pathogenesis of Hashimoto thyroiditis, an immune defect in an individual with genetic susceptibility accompanied with environmental factors. The frequency of Hashimoto’s disease is a growing trend and among Caucasians it is estimated at approximately 5%. The dysfunction of the gland may be clinically evident (0.1–2% of the population) or subclinical (10–15%). The pathology is diagnosed five to ten times more often in women than men and its incidence increases with the age (the peak of the number of cases is between 45 and 65); however, it can also be diagnosed in children. The pathogenesis of Hashimoto’s thyroiditis is still not fully comprehended. In the etiology of Hashimoto thyroiditis excessively stimulated T CD4+ cells are known to play the most important role. Recent research has demonstrated an increasing role of newly discovered cells such as Th17 (CD4+IL-17+) or T regulatory cells (CD4+CD25+highFoxP3+) in the induction of autoimmune disorders. The process of programmed cell death also plays an equally important role in the pathogenesis and the development of hypothyroidism.

PD-1 maintains tolerance and inhibits autoimmune responses. Graves' disease (GD) is one of the most frequent autoimmune diseases of unclear etiology. The aim of this study was to evaluate the percentage and absolute counts of PD-1 positive T and B cells in newly diagnosed, untreated patients with hyperthyroidism due to GD. The study group included 30 patients and the control group comprised of 20 age- and sex-matched healthy individuals. Results showed significantly higher frequencies and absolute counts of PD-1 positive CD3+CD4+ T cells, CD3+CD8+ T cells and CD19+B cells in patients with GD in comparison to the healthy volunteers. Moreover, higher mean fluorescence intensity of PD-1 was found on CD3+CD4+ T cells, CD3+CD8+ T cells and CD19+B cells in the study group than in the control group. These results suggest that PD-1 protein might involved in the pathogenesis of GD.

The Facilitated Immunoglobulin Administration Registry And Outcomes (FIGARO) Study was a European, multicenter, prospective, observational study conducted across Europe designed to provide insights on the clinical use and tolerability of facilitated subcutaneous immunoglobulin (fSCIG). Data herein are reported for the cohort of patients with secondary immunodeficiency (SID), with a subgroup analysis by age. The SID cohort included 31 patients: 1 pediatric, 15 adult, and 15 older adult patients. Over the 36-month observation period, the median monthly dose of fSCIG (30 g) and median monthly infusion volume per patient (300 mL) remained constant in both adult-age cohorts. Serum trough levels tended to increase over time. Most patients required only one infusion site and could receive the full dose every 3–4 weeks. There was a trend toward self-administration at home. In the adult group, infusion site inflammation and headache were reported at the inclusion visit (n = 1 each), with no adverse drug reactions reported at any of the follow-up visits. No acute severe bacterial infections were reported during the study follow-up. These results demonstrate the feasibility and tolerability of fSCIG use in patients with SID and the flexibility of administration settings including self-administration at home in patients aged ≥65 years.

Introduction: Programmed death-1 (PD-1) is one of the most important inhibitory co-receptors. Studies show that the PD-1/PD-L1 pathway regulates the induction and maintenance of peripheral tolerance and protects tissues from autoimmune attack in physiological conditions. Several studies have shown association of PD-1/PD-L1 pathway with several autoimmune diseases although, to date, no such studies have been performed for Graves’ disease (GD). Aims: The aim of this study was to describe the frequencies of T and B lymphocytes expressing PD-1 and PD-L1 molecules in patients with GD. The relationships between PD-1+ and PD-L1+ cells, and selected clinical parameters were also assessed. Material and methods: The expression of PD-1 and PD-L1 was analyzed using flow cytometry on T and B lymphocytes collected from 45 adult patients with newly diagnosed, untreated GD. The control group consisted of 20 healthy subjects. Results: We observed high expression of PD-1 and PD-L1 on analyzed lymphocytes subpopulations of GD patients. Among T cells, the expression of PD-1 on protein level was higher on CD4+ cells in GD patients (mean: 31.54±13.74%) than in healthy controls (mean: 5.35±1.54%, P<0.001). Moreover, higher frequencies of PD-1+/CD8+ cells and PD-1+/CD19+ cells in the study group than in healthy volunteers were observed (mean: 18.71±10.37% vs 3.6±1.45%, P=0.015 and 12.07±4.34% vs 1.67±0.84%, P=0.017, respectively). There was a positive correlation of PD-1 and PD-L1 expressions on CD19+B cells (r=0.43, P=0.026) in patients with GD, and a positive correlation of the frequencies of PD-1+/CD4+ cells and the serum concentration of anti-TPO antibodies (r=0.61, P=0.014). Interestingly, there was also a positive correlation between the frequencies of PD-1+/CD19+ cells and the serum concentration of anti-TR antibodies (r=0.53, P=0.019). Conclusion: High expression of PD-1 and PD-L1 on T and B cells could represent the hallmark of immune system reaction to chronic antigenic exposition in patients with GD.

Introduction: Neurohormonal diabetes insipidus (DI) is a rare disorder caused by partial or total vasopressin deficiency which results in diluted urine characterized by polyuria and polydipsia. In 30–50% of the cases the cause of the disease is unknown; it is the so-called idiopathic diabetes insipidus. Other causes include: tumors of the CNS most commonly craniopharyngioma, pituitary macroadenomas, central nervous system trauma, inflammatory state of hypothalamus or pituitary gland, CNS surgery, congenital organic diseases or genetic defects. The treatment includes long-action vasopressin analogues. We present the similarity of the clinical course of infundibuloma irrespective of the patient’s gender. Case report: A 39-year-old male perfectly mentally and physically healthy three years ago diagnosed with central diabetes insipidus with focal lesion 5×5 mm in size, confined to the pituitary stalk supporting optic chiasm and characteristic of DI low signal intensity on T1-weighted MR images of the nerves. The field of vision was normal. After a year the patient presented symptoms of hypogonadism (hypogonadotrophic hypogonadism), which required additional replacement treatment with desmopressin and parenteral testosterone with a good clinical result. A 42-year-old female with central diabetes insipidus diagnosed at the age of 33 caused by thickening pituitary stalk to 5 mm with no accompanying symptoms. After a year of replacement therapy with desmopressin appeared the symptoms of hypogonadism in the form of secondary amenorrhea at the age of 34. Conclusions: The primary clinical symptom of infundibuloma is diabetes insipidus followed by hypopituitarism in the course of which the gonadotrophic axis defect prevails irrespective of the patient’s gender.