anti-Tg Antibodies Research Articles

Diagnostic performance of fluorine-18-fluorodeoxyglucose PET/MRI for detection of disease recurrence in differentiated thyroid cancer: a compartment-based analysis.

The objective of this study is to evaluate the diagnostic performance of neck fluorodeoxyglucose (FDG) PET/MRI in addition to whole-body PET/computed tomography (CT) and to compare it with MRI in the detection of suspicion of disease relapse in patients with differentiated thyroid cancer (DTC) who underwent total thyroidectomy and radioactive iodine therapy. Twenty-nine patients with DTC who underwent whole-body 18F-FDG PET/CT followed by neck PET/MRI because of increased serum thyroglobulin (Tg) or anti-Tg antibody levels and negative 131I whole-body scan were included. At least 6 months of clinical and radiological (neck ultrasound) follow-up or histopathological examination results were accepted as the gold standard. Lesion and compartment-based analyses were performed to evaluate the diagnostic performances of PET/CT, MRI, and PET/MRI. In addition, changes of clinical management were evaluated. On lesion-based analysis, for PET/CT, MRI, and PET/MRI: sensitivity: 33.3, 33.3, and 37%; specificity: 90.1, 87.9, and 95.9%; accuracy: 87.5, 85.4, and 93.2 were calculated, respectively. Specificity of PET/MRI was significantly superior to PET/CT and MRI (P of0.001); however, sensitivity of PET/MRI was not significant to PET/CT and MRI (P of0.05). On compartment-based analysis, specificity of PET/MRI and MRI were comparable but significantly superior to PET/CT at levels 1 and 2; however, specificity of PET/CT and PET/MRI were comparable but significantly superior than MRI, especially at levels 3, 4, and 5. PET/MRI especially helps in the accurate exclusion of findings that are suspicious on PET/CT and MRI, and has the potential to change the clinical management by identifying uncertain neck findings.

Prevalence of Vitamin D Deficiency in Patients with Autoimmune Thyroid Disorders at Tertiary Care Hospital, Karachi

Background & Objective: Vitamin D deficiency is commonly observed in patients with autoimmune thyroid disorders, potentially influencing disease severity and management. This study aimed to ascertain the magnitude of vitamin D deficiency in those with autoimmune thyroid disorders (AITDs). Methodology: A cross-sectional study was conducted at the National Institute of Diabetes and Endocrinology, Dow University of Health Sciences, Ojha Campus, Karachi, Pakistan from February 2024 to June 2024. Patients who attended the outpatient department and were diagnosed with AITDs, such as autoimmune hypothyroidism and Grave's disease, based on positive anti-thyroid antibodies were included in the study. The 25-hydroxy vitamin D levels in these patients were then measured. Results: The study had 60 participants, with a mean age of 35.23 ± 9.934 years. The majority of participants had low vitamin D levels (28.3% had insufficient and 48.3% had deficient levels). Additionally, it was discovered that vitamin D status and AITDs were related, where a majority of individuals had low vitamin D levels (P-value = 0.014). Further, it was revealed that anti-TPO antibodies followed by the presence of anti-TG antibodies were more indicative of low vitamin D levels. Conclusion: The individuals with AITDs, specifically hypothyroidism had a noticeably higher prevalence of vitamin D deficiency followed by insufficiency.

The diagnostic performance of neck ultrasound in follow-up of advanced stage differentiated thyroid cancer

BackgroundDifferentiated thyroid cancer (DTC) requires long-term follow-up due to the risk of delayed recurrence. Follow-up surveillance involves serial neck ultrasound (US) and thyroglobulin (Tg); however, the optimal frequency and diagnostic performance of neck US outside of specialized thyroid cancer centres in higher risk patients is not well defined. We sought to evaluate the diagnostic performance of US and serial Tg in advanced stage DTC.MethodsWe retrospectively reviewed our thyroid cancer database for patients with stage III and IV DTC from 2006 to 2018, total thyroidectomy, and at least 2 years follow-up to assess recurrence rates. Those with hemi-thyroidectomy or anti-Tg antibodies were excluded. Diagnostic performance of US and Tg were assessed using a composite reference standard of follow-up imaging and pathology. All relevant US were reviewed by a blinded expert radiologist for uniformity.ResultsOf 136 included patients (91 females, mean age 58.9), 26 (19%) had recurrence of DTC over median follow-up of 6.6 years (IQR 5.3–9.3). The sensitivity and specificity of US in diagnosing cervical recurrence were 73.3% (95% CI 0.51–0.96) and 68.3% (95% CI 0.60–0.77) based on historical reports, respectively, and 80% (95% CI 0.60-1.00) and 87.8% (95% CI 0.82–0.93) based on blinded expert review, respectively. Tg had a sensitivity of 95.5% (95% CI 0.89-1.0) and specificity of 96.2% (95% CI 0.92–0.99) in detecting cervical recurrence or distant metastases. False positive US findings on historical US and subsequent review occurred in 38 (28%) and 15 (11%) patients, respectively, while 5 (3.6%) had false positive Tg results.ConclusionSerial Tg has better sensitivity and specificity than US for detecting recurrence of advanced stage DTC. Furthermore, re-interpretation of abnormal findings using structured US reporting with a subspecialized reader may improve diagnostic performance of US and improve its utility in clinical care.

6771 New onset Graves’ Disease in a Patient with Hashimoto's Thyroiditis and Positive Thyroid Peroxidase Autoantibodies. Case Report

Abstract Disclosure: M.M. Eid: None. J.L. Zapater: None. Introduction: Hashimoto’s Thyroiditis (HT) and Graves’ Disease (GD) are the most common thyroid autoimmune disorders. Transition of GD to HT is common, but transition of HT to GD is rare. Case: A 55 year old, female with depression, HTN and fibromyalgia. She was referred for evaluation of chronic fatigue and reduction in functional capacity. Five years earlier, she had also been evaluated for fatigue. Labs at that time: TSH 3.80 µIU/ml (0.35-3.74 µIU/ml), free T4 0.8 ng/dl (0.76-1.46 ng/dl), thyroid peroxidase antibody (anti-TPO) 605.6 U/ml (0-60 U/ml), and anti-thyroglobulin antibody (anti-TG) 37.2 U/ml (0-60 U/ml). Subclinical hypothyroidism was diagnosed, but no levothyroxine was initiated. Her TSH was found to be normal in 2019 and 2021. At the current clinical encounter, other than fatigue she denies weight/voice change, tremor, palpitation, anxiety, recent flu like illness or radiation exposure, neck swelling/pain, heat intolerance, or difficulty swallowing. Her daily medications are amlodipine 10mg and duloxetine 20mg. She had menopause 2 years ago. She has no known allergy. She has a brother with rheumatoid arthritis. She denies smoking or alcohol consumption. On exam, vital signs are normal, and BMI is 28.1. There is diffuse, firm thyromegaly without a palpable nodule. There is no cervical lymphadenopathy, tremor, neck tenderness, exophthalmos, or lid lag. Creatinine, liver enzymes are normal but hemoglobin is 9gm/dl. Anti-tissue transglutaminase and anti-gliadin antibodies were negative. Her thyroid labs were: TSH <0.008 uIU/ml, free T4 1.06ng/dl, free T3 4.07 pg/ml (2.3-4.2 pg/ml), total T3 1.74 ng/ml (0.60-1.81 ng/ml), anti-TPO antibody 12,414 U/ml, anti-TG antibody 22 U/ml, thyrotropin receptor antibody (TRAB) 15.24 IU/L (0-1.75 IU/L), and thyroid stimulating immunoglobulin (TSI) 331% (<130%). Thyroid uptake scan showed 49% iodine-131 uptake in symmetric and homogenous uptake, and no hot or cold nodules. GD was diagnosed, methimazole 5mg daily was initiated. Conclusion: Our case had subclinical HT with positive anti-TPO antibodies 5 years preceding the onset of GD. Causes of autoimmune conversion are not well understood. Viral infection or radiation exposure in genetic susceptible patients have been assumed as triggers (1). The blocking and stimulating action of TRAB on TSH receptors is considered as a possible mechanism of switching between hypothyroidism and hyperthyroidism. Clinical and biochemical evaluation for possible conversion to GD in patients with HT is recommended (2).

B-167 Quantification of Thyroglobulin in Serum for Clinical Research using SISCAPA Workflow Combined with LC-MS/MS

Abstract Background Accurate measurement of Thyroglobulin (Tg) using existing immunoassay-based techniques can be challenging in the presence of anti-Tg antibodies (TgAb), which can prevent the binding of Tg to assay antibodies thus leading to non-quantifiable Tg concentrations. The Stable Isotope Standards and Capture with Anti-Peptide Antibodies (SISCAPA™) Workflow combined with LC-MS/MS has been successfully employed to circumvent this problem by digesting the serum sample thus eliminating interfering TgAb and measuring a Tg-specific surrogate peptide instead. Methods Using a Andrew+™ Pipetting Robot, denaturation and reduction buffer was added to 250µL serum samples and incubated at 37°C. Internal standard and trypsin were added and samples incubated at 37°C. The samples were quenched with protease inhibitor and Anti-Tg FSP mAb SISCAPA was added to the serum samples and mixed for 60 minutes. Using a magnetic array plate, the beads were left to pull down, samples were discarded, and the beads were twice washed with PBS/CHAPS prior to elution with acetonitrile with formic acid. Using an ACQUITY™ UPLC™ I-Class PLUS FL System, samples were injected onto a Waters™ XSelect™ HSS T3 Column using a water/acetonitrile/formic acid gradient elution profile and the Tg FSP peptide was quantified using a Waters Xevo™ TQ Absolute Mass Spectrometer. Results The method demonstrated no significant carryover or matrix effects and was shown to be linear from 0.1 - 50 ng/mL. Analytical sensitivity investigations indicate the analytical sensitivity of this method would allow precise quantification (<20%) at 0.1 ng/mL with S/N (PtP) >10:1. Coefficients of variation (CV) for total precision and repeatability on 5 analytical runs for low, mid and high QCs were all < 9.5% (n = 25) for both automated and manual precision assessments. Comparison with samples from the UK NEQAS scheme demonstrated significant method bias of -40% for the developed LC-MS/MS method. Re-assignment of the calibrator concentrations using the EQA samples reduced the bias to -5.5%, indicating differences in the calibration materials used for these measurements. Conclusions A LC-MS/MS clinical research method for serum thyroglobulin was developed using SISCAPA, followed by analysis using ACQUITY UPLC I-Class PLUS FL System and the Xevo TQ Absolute Mass Spectrometer. The method provides analytical sensitivity down to 0.1 ng/mL from 250 µL serum, while providing sufficient sample for re-analysis. The method demonstrates excellent linearity across the calibration range, with no significant carryover, interferences, and matrix effects. Total reproducibility and repeatability of the method was ≤9.5% RSD for manual and automated sample preparation, using the Andrew+ Pipetting Robot. In addition, the Andrew+ Pipetting Robot can minimize user touch-time, allowing a full plate to be prepared within four hours without user intervention.

Prospective Follow-Up Study on Anti-Tpo Antibodies and Anti-Tg Antibodies in Euthyroid Subjects

Prospective Follow-Up Study on Anti-Tpo Antibodies and Anti-Tg Antibodies in Euthyroid Subjects

Endocrine Adverse Events Related To Immune Checkpoint Inhibitor Treatment: Relationship Between Antibodies and Severity of Thyroid Dysfunction.

The purpose of this study was to identify predictive and risk factors for the development of immune-related endocrinopathies and to analyze the incidence and characteristics of immune-related endocrinopathies in our population. A retrospective, single-centre cohort carried out at Gregorio Marañón Hospital between January 2018 -December 2019. A total of 163 patients were enrolled. In January 2018 and December 2019, we treated patients who underwent ICI treatment in the Medical Oncology Department of General University Hospital Gregorio Marañón, a tertiary care public hospital in Madrid, as part of an observational, retrospective, single-center cohort study. Endocrinopathies were diagnosed in 19.5% of the patients (n = 32). The tumours with the highest incidence of endocrinopathies were non-small cell lung cancer (25,9%), kidney cell cancer (25%) and hepatocarcinoma (20%). Among the 32 patients who developed endocrinopathy, 18,8%, 19,13%, and 21,28% received anti-CTLA-4, anti-PD-1 and anti-PDL-1, respectively. Thyroid dysfunction was the most frequent endocrinopathy (12,8%). A higher percentage of patients with negative antiTPO and antiTG antibodies developed G1 hypothyroidism compared to patients with positive antibodies who developed a higher proportion of G2 hypothyroidism. The presence of an initial phase of thyrotoxicity was not related to greater severity. We observed longer progression-free survival in patients who developed thyroid dysfunction. Pre-existing antibodies were independently associated with endocrinopathies. Moreover, our study let us conclude that the presence of thyroid autoantibodies may be related to its severity. It is important to determine anti-thyroid antibodies prior to the start of immunotherapy as a risk factor for thyroid dysfunction, which in turn is a prognostic marker.

Data-Driven Thyroglobulin Cutoffs for Low- and Intermediate-Risk Thyroid Cancer Follow-Up: ITCO Real-World Analysis.

The utility of thyroglobulin (Tg) in the follow-up of differentiated thyroid cancer (DTC) patients has been well-documented. Although third-generation immunoassays have improved accuracy, limitations persist (interfering anti-Tg antibodies and measurement variability). Evolving treatment strategies require a reevaluation of Tg thresholds for optimal patient management. To assess the performance of serum Tg testing in two populations: patients receiving total thyroidectomy and radioiodine remnant ablation (RRA), or treated with thyroidectomy alone. Prospective observational study. Setting. Centers contributing to the Italian Thyroid Cancer Observatory (ITCO) database. We included 540 patients with 5 years of follow-up and negative anti-Tg antibodies. Serum Tg levels assessed at 1-year follow-up visit. Detection of structural disease within 5 years of follow-up. After excluding 26 patients with structural disease detected at any time point, the median Tg did not differ between patients treated with or without radioiodine. Data-driven Tg thresholds were established based on the 97th percentile of Tg levels in disease-free individuals: 1.97 ng/mL for patients undergoing thyroidectomy alone (lower than proposed by the MSKCC protocol and ESMO Guidelines, yet demonstrating good predictive ability, with a negative predictive value (NPV) of 98%) and 0.84 ng/mL for patients receiving post-surgical RRA. High sensitivity and NPV supported the potential of these thresholds in excluding structural disease. This real-world study provides evidence for the continued reliability of 1-year serum Tg levels. The data-driven Tg thresholds proposed offer valuable insights for clinical decision-making in patients undergoing total thyroidectomy with or without RRA.

The Impact of Nutritional and Dietary Factors on Hashimoto's Thyroiditis: A Comprehensive Review

Introduction. Hashimoto's disease (HD) is the main cause of hypothyroidism in countries where there is no iodine deficiency in the diet. Characteristic antibodies for it are anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) and their level positively correlates with the severity of HD. Whereas its occurrence is related to genetic, environmental and existential factors. Aim of study. The aim of this study was to analyze dietary factors (protein, fat, vitamin D, iodine, selenium, gluten) and intestinal microbiota on the risk of developing Hashimoto's disease and the influence of each of these factors on its course. Materials and methods. More than 90 articles addressing these issues were analyzed. They were found using the PubMed search engine, and the time frame of these publications covered the last 10 years. Results. Excess iodine is the most important environmental factor influencing the development of Hashimoto's disease. Also, selenium deficiency contributes to the development of HD. On the other hand, the concentration of vitamin D is lower in patients with Hashimoto's disease than in the general population. Furthermore, Vitamin D supplementation reduces the concentration of anti-Tg antibodies. In addition, different types of dietary fat affect thyroid hormone levels differently and a deficiency of protein in the diet causes an increase in TSH and a decrease in thyroid hormones. Moreover, changes in the gut microbiome have been observed in people suffering from Hashimoto's disease. Conclusions. The risk of developing Hashimoto's disease can be increased and decreased by diet and diet allows for the modification of hormone levels in the hypothalamus-pituitary-thyroid axis.

Investigation of the thyroid function in end-stage renal failure disease in a Baquba teaching hospital/Diyala governorate - Iraq

Renal failure is the inability of the kidneys to excrete nitrogenous waste products, resulting in their retention in the bloodstream. Several correlations exist between renal and thyroid functions; however, end-stage renal failure is unlikely to be influenced by thyroid hormone function and is connected to a higher prevalence of hypothyroidism. The purpose of this study is to ascertain how thyroid status and renal function relate to renal failure patients. Serum creatinine and urea levels were tested in 50 healthy persons and 100 patients with renal failure illness. The acquired data showed that, in comparison to the control group, the average levels of creatinine and urea were significantly higher. The sick group recorded (122.98 mg/dL and 6.55 mg/dL) and (28.38 mg/dL and 0.75 mg/dL) in comparison to the control group, which has urea and creatinine values within the virtually normal range, respectively. In contrast, TSH levels showed no significant differences and have values within the normal range of TSH values, with 2.33 mIU/L for the experimental group and 2.0 mIU/L for the control group. In contrast, T4 values of the experimental group showed significantly lower levels than the control group, with 83.42 ng/dL compared to 103.77 ng/dL. T3 values, however, showed no significant changes and remained within the normal range of 1.75 to 1.64 nmol/L. In addition, the results demonstrated significant differences in the mean levels of anti-TPO, anti-Tg, and anti-TSHR antibodies. The anti-Tg showed a significant decrease in mean values, which were 28.89 IU/ml and 79.49 IU/ml compared to the control group ranges of 34.41 and 86.68 IU/mL. Finally, anti-TSHR showed a significant increase in the mean, which was 1.24 IU/L compared to 1.18 IU/L in the control group.

Autoimmune Thyroiditis in Patients With Diabetes Mellitus: Retrospective Study of 91 Cases.

Background Detection and quantification of anti-thyroid antibodies make it possible to confirm the diagnosis of thyroid dysfunction as well as its autoimmune origin and monitor thyroid damage in diabetic patients. The aim of this study is to determinethe seroprevalence of anti-thyroid antibodies in hospitalized diabetic patients. Materials and methods This retrospective study focused on 91 diabetic patients hospitalized in the endocrinology department of Ibn Sina Hospital, Rabat, Morocco, between January 1 and December 31, 2022. The study population was divided into two groups: 19 patients with type 1 diabetes (13 females and six males, with an age range of 20-70 years) and 72 patients with type 2 diabetes (52 females and 20 males, with an age range of 40-71 years). Hemoglobin (HbA1c) levels were determined with high-performance liquid chromatography (Hb-HPLC) analyzer from blood samples collected in EDTA tubes, and anti-thyroid antibodies (anti-TPO and/or anti-TG) were measured by chemiluminescent microparticle immunoassays (CMIA) in human serum using the ALINITY analyzer. Results Among type 1 diabetic patients, 42.1% (n = 8)were positive for anti-TPO and anti-TG antibodies, while 31.5% (n = 6)were positive only for anti-TPO antibodies. Among type 2 diabetic patients, 15.2% (n = 11) were positive only for anti-TPO antibodies, while 20.8% (n = 15) were positive for anti-TPO and/or anti-TG antibodies. The prevalence of anti-thyroid antibodies was higher in females, consistent with other studies. This could be linked to the involvement of autoimmune processes in the development of thyroid dysfunction in type 2 diabetics. Conclusions Testing for anti-thyroid antibodies in diabetic patients and their relatives helps detect subclinical conditions, which could later manifest as biological and clinical deficiencies, guiding monitoring parameters.

The use of anti-transglutaminase and anti-gliadin antibodies to compare the effect of gluten active and gluten-free diet patients suffering from celiac disease in child and adult

Celiac disease is an autoimmune disorder triggered by the ingestion of gluten in genetically susceptible individuals. The current study aimed to compare the levels of these antibodies in celiac disease patients on active gluten-containing diets and those on gluten-free diets to demonstrate the ability to get rid of Celiac Disease by Gluten-Free Diet. The study involved 100 participants, divided into 60 CD patients and 40 controls, where all participant match in age and gender. The patient group was further divided into two subgroups 40 active celiac and 20 GFD. Blood samples were obtained from all participants, and levels of anti-tTG and anti-gliadin antibodies were using Enzyme-Linked Immunosorbent Assay (ELISA) technology. The results showed The F test indicated a significant difference in the levels of anti-tTG and anti-gliadin antibodies between the active group (G1) and the diet group (G2) in comparison to the control group (G3), with a p-value less than 0.001. Upon conducting a deeper analysis using the least significant difference (LSD) on on anti-tTG IgA and IgG indicate that there are no significant differences between the patient groups G1 and G2, as evidenced by p-values of 0.120 for IgA. However, a significant difference was observed between G1 and G2 for IgG, with a p-value of 0.018. When comparing G1 with G3, and G2 with G3, significant differences were observed, with p-values less than 0.001. In the case of anti-gliadin IgA and IgG, the LSD test revealed a highly significant difference between G1 and G2, as indicated by a p-value less than 0.001. However, no significant differences were found between G1 and G3, with p-values of 0.499 for IgA and 0.110 for IgG. A highly significant difference was none the less observed between G2 and G3, with a p-value less than 0.001.In conclusion, This study highlights the importance of dietary adherence in celiac disease management. Patients on gluten-free diets had significantly lower levels of anti-TG and anti-gliadin antibodies, indicating better control of the autoimmune response. Monitoring these antibody levels can be a valuable tool in assessing the effectiveness of dietary interventions in celiac disease patients.

T3, T4, TSH, Anti-TPO, and Anti-TG Autoantibodies Distribution in Autoimmune Thyroid Patients with Chlamydia Trachomatis Infection

Autoimmune thyroid disorders (AITDs) include a variety of inflammatory conditions affecting the thyroid gland, with Graves' disease (GD) and Hashimoto's thyroiditis (HT) being the most commonly seen types. Autoimmune thyroid illnesses often include the existence of antibodies against thyroid peroxidase (TPO), thyroglobulin (Tg), and thyroid stimulating hormone receptor (TSHR). We specifically targeted recently diagnosed adult patients with Graves' disease (GD), Hashimoto's thyroiditis (HT), and those with normal thyroid function as controls. The study looked at and compared different groups' levels of anti-TG antibodies, anti-TPO antibodies, and anti-chlamydia antibodies in the blood, as well as several clinical and biochemical markers, such as thyroid function tests. We analyzed data from a cohort of 60 patients diagnosed with Hashimoto's thyroiditis (HT), 60 patients diagnosed with Graves' disease (GD), and 60 healthy individuals serving as controls. The study found a strong link between having anti-TPO Abs and having Hashimoto's hypothyroidism (63.3%) and Graves' hyperthyroidism (86.7%). In the groups without anti-TPO Abs, Hashimoto's hypothyroidism was found in 36.7% of people and Graves' hyperthyroidism was found in 13.3% (P<0.03). Anti-thyroid peroxidase antibodies (anti-TPO Abs) are found in 86.7% of people with Graves' disease, which is more than the 63.3% of people with Hashimoto's disease who have these antibodies. There is no significant link between the percentage of people who have anti-TG antibodies and either Hashimoto's hypothyroidism (96.7%) or Graves hyperthyroidism (90%), according to the study. The significance level was set at P = 0.143. This is in comparison to the percentage of negativity in Hashimoto's hypothyroidism (3.3%) and Graves's hyperthyroidism (10.0%). The study showed how the groups were spread out based on the presence of Chlamydia trachomatis IgG antibodies. Chlamydia trachomatis IgG antibodies were much more common in people with Hashimoto's hypothyroidism (42) and Graves hyperthyroidism (26) than in the control group (0) (P<0.01).

The role of autoimmune thyroid disorders in patients with alopecia areata

Objective: The aim of this study was to investigate the association of thyroid autoimmunity with alopecia areata (AA) by examining thyroid stimulating hormone (TSH) and thyroid autoantibody levels. In addition, to compare the epidemiologic data obtained with the data of our country. Methods: Our study was organized as a cross-sectional, retrospective study. The study was performed on patients between the ages of 2-65 years who were admitted to our outpatient clinic between 01.01.2008 and 31.12.2011, who were clinically or histopathological diagnosed with AA, examined for etiology and thyroid autoantibodies were requested. Patients under two years of age and over 65 years of age, patients with no thyroid autoantibodies and pregnant patients were excluded. Results were expressed as mean±standard deviation and median values. Mann-Whitney U test was used to compare TSH, anti-TG antibody (Anti-TG) and anti-TPO (Anti-TPO) antibody values in the variables of nail involvement, psychiatry, comorbidity and family history. Spearman correlation analysis was used to examine the relationships between age and disease duration and TSH, Anti-TPO and Anti-TG variables. Results: In our study, 65 (42.8%) of 152 patients were female and 87 (57.2%) were male. The ages of the patients ranged between 2-65 years and the mean age was 26.5±14.6 years. The mean age of females was 27.5±14.4 and 25.7±14.9 in males. Elevated thyroid autoantibodies were found in a total of 29 patients, 21 of whom were female and 8 of whom were male. Of these 29 patients, 10 had hypothyroidism, 2 had chronic thyroiditis and 3 had toxic multinodular goiter. 14 patients did not return after the examination at the internal medicine outpatient clinic, so the diagnosis of thyroid disease could not be reached. The mean TSH, Anti-TG and Anti-TPO values were 2.27±1.57, 29.2±99 and 71.5±2.2, respectively. When these values were analyzed separately as men and women, they were found to be 2.6±2.02, 41.8±1.23 and 134±2.8 in women and 1.99±1.03, 19.8±75.6 and 24.5±1.32 in men. There was a significant difference between men and women in terms of Anti-TG and Anti-TPO values (p=0.011 and p=0.001, respectively). A significant correlation was found between disease duration and Anti-TPO positivity (p=0.045); however, a similar relationship was not found between disease duration and Anti-TG positivity (p=0.34). Conclusions: As a result of this study, although there was a significant correlation between anti-TPO and duration of AA, the association between thyroid autoimmunity and AA was not found to be statistically significant. This may be due to the fact that humoral autoimmunity plays a role in thyroid autoimmunity and primarily cellular autoimmunity plays a role in AA. In addition, the epidemiologic data of our study were similar to the data of studies conducted in our country.

Pituitary Hyperplasia and Overt Hypothyroidism Induced by Methimazole in an Adolescent Girl with Resistance to Thyroid Hormone Accompanying Hashimoto’s Thyroiditis: A Case Report

We describe a 13-year-old girl who presented at her local hospital with a diffuse goiter and had discrepant thyroid function test (TFT) of elevated free T4 (FT4), free T3 (FT3) levels with mildly elevated thyroid-stimulating hormone (TSH) and a pituitary magnetic resonance imaging (MRI) report of a pituitary hyperplasia. She was referred to our hospital where a repeat TFT found low FT4 and high TSH levels, and high levels of antithyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG) antibodies, leading to the diagnosis of Hashimoto’s thyroiditis (HT) with overt primary hypothyroidism. The girl had a good response after daily 100 µg levothyroxine treatment for 8 months with decreased goiter size along with disappearance of the pituitary mass. However, her FT4 and FT3 levels were elevated while the TSH was in the high normal range, although at this time there were no signs of hyperthyroidism. A genetic study confirmed our provisional diagnosis that the patient had a p.Pro453Thr monoallelic loss-of-function mutation of the thyroid hormone receptor beta (THRB) gene, suggesting the diagnosis of coexisting resistance to thyroid hormone-β (RTHβ) and HT in this patient.

Effect of anti-thyroid antibodies on recurrent miscarriage: A meta-analysis.

Previous studies addressed the association between anti-thyroid antibodies and recurrent miscarriage (RM), however, the role of anti-thyroid antibodies in RM patients is debatable. Therefore, we conducted this meta-analysis and the aim of this current study was to assess whether anti-thyroid peroxidase (anti-TPO) and/or anti-thyroglobulin (anti-TG) antibody positivity was associated with RM. A meta-analysis was conducted. Recurrent miscarriage patients. STATA 12.0 software were applied to compute odds ratios (ORs)/relative risks (RRs) and 95% CIs regarding association between anti-TPO and anti-TG antibodies and the prevalence of RM. N = 28 studies (8875 participants) explored effect of anti-thyroid antibodies on RM. Analysis of the 28 studies revealed significant association between anti-TPO, anti-TG antibodies and the prevalence of RM with a random effects model (OR/RR = 2.02; 95% CI: 1.63-2.51, p < 0.001; I2 = 44.3%, p value for Q test = 0.004). Analysis of the 20 studies revealed significant association between anti-TPO antibodies and the prevalence of RM with a random effects model (OR/RR = 1.59; 95% CI: 1.25-2.03, p < 0.001; I2 = 43.1%, p value for Q test = 0.022). Analysis of the 14 studies revealed significant association between anti-TG antibodies and the prevalence of RM with a random effects model (OR/RR = 2.25; 95% CI: 1.56-3.23, p < 0.001; I2 = 49.2%, p value for Q test = 0.019). Based on the currently available analysis, our findings suggest that women with anti-TPO and/or anti-TG antibodies have a higher risk of RM than that in negative antibody women. Further investigation is needed to better clarify the exact role of the anti-thyroid antibodies in RM and whether treatment is of benefit. First, differences from various detection methods and reagents used in different studies may affect the diagnostic interpretation of anti-thyroid antibodies, which might influence the accuracy of this meta-analysis. Second, positive anti-thyroid antibodies seem likely to be part of a more general disorder of maternal immune system, due to restrictions of funding and condition, a complete autoantibody screening investigation is hardly to conduct in all participants, and this could be a possible limitation of all included studies. Third, there is no mention of thyroxine therapy on RM, making the meta-analysis even more limited.

Twisted Ovarian Cyst, Galactorrhea and Pituitary Hyperplasia Misdiagnosed as Prolactinoma: An Overlooked Longstanding Overt Hypothyroidism from Hashimoto’s Thyroiditis

We describe a 14-year-old girl who was referred for management of a prolactin-secreting pituitary adenoma as she had persistent milky discharge from her nipples, an elevated prolactin level and pituitary enlargement. Upon reviewing the medical history, it was noted that she had a history of secondary amenorrhea for 1 year, and had undergone an oophorectomy for twisted left ovarian cyst 5 months earlier. The physical examination found that she had a goiter, short stature and was relatively overweight. Based on these findings, it was thought that the patient likely had longstanding overt hypothyroidism. A thyroid function test (TFT) revealed a free thyroxine (FT4) level of 0.2 ng/dL and thyroid stimulating hormone (TSH) &gt;100 mU/L, with high levels of antithyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG) antibodies, leading to the diagnosis of Hashimoto’s thyroiditis. After 8 months of levothyroxine treatment, the galactorrhea had disappeared, the pituitary enlargement had resolved and her menstruation had resumed normally, along with a 4-kg weight loss and 3-cm height gain. In summary, when evaluating a girl with ovarian cyst(s), especially if accompanied by other clinical findings like goiter, short stature, or menstrual irregularities, the physician should include hypothyroidism in the differential diagnosis. Early diagnosis and treatment of hypothyroidism can have a positive impact on the overall health and well-being of these patients, potentially preventing further complications related to both the thyroid disorder and ovarian cyst(s).

Hypothyroidism and autoimmune thyroid disorders in rheumatoıd arthritis: relationship wıth disease activity.

Background and aims: Thyroid function abnormalities and thyroid autoantibodies have previously been described in rheumatoid arthirits (RA) with limited data. In some studies, a relationship was found between thyroid autoantibodies and RA disease activity. However, there are not strong studies in the literature indicating the relationship between thyroid diseases and RA. The aim of this study was to determine the frequency of hypothyroidism and to investigate the relationship between thyroid hormone levels, autoantibodies and disease activity in patients with rheumatoid arthritis (RA). Methods : 1017 patients with the diagnosis of RA were recruited. This observational study was conducted between January 2014 and July 2015. Demographic variables were recorded. Anti-nuclear antibodies (ANA), anti-cyclic citrulli-nated peptide antibody (anti-CCP), Rheumatoid Factor (RF), C reactive protein (CRP), Erythrocyte Sedimentation Rate (ESR), thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), anti-microsomal antibody (anti-TPO )and anti-thyroglobulin antibody (anti-TG) were determined. Visual analog score and Disease Activiy Score 28 (DAS-28) ESR and DAS-28 CRP were recorded. The relationship between thyroid hormone levels and thyroid antibodies and disease activity parameters were determined. Results: 98 (%9,7) patients had hypothyroidism and 61 (%6) patients had hyperthyroidism. 210 (20,7%) patients with RA was positive for TPOAb and 165(16,3%) for anti-TG. Positive correlation was detected between anti-TPO positivity and anti-CCP levels (p:0.005, r:0,274). In anti-TG antibody positive patients, there was a significant positive correlation of thyroid hormone levels with CRP and DAS 28-CRP (p:0.01, r:0,120; p:0.01, r:0,169). Conclusion: Thyroid autoantibodies were found to be positive in 16-21% of patients with RA. Though hypothyroidism is not very frequent in RA patients, autoimmune thyroid disease is quite common, which may be related to disease activity.

Antithyroid antibody profile and viral markers in autoimmune thyroiditis in Chennai population

Autoimmune thyroid disease (AITD) is the result of a complex interaction between genetic and environmental factors, which leads to failure of one or more mechanisms responsible for controlling thyroid-reactive T and B cells. The most frequently occurring clinical forms of autoimmune thyroiditis include Hashimoto’s thyroiditis and Grave’s disease. Viruses have been implicated in the onset of autoimmune disorders. This study aims to investigate the association between and in autoimmune thyroiditis by assessing virologic and immunologic parameters of cases with clinical indication of AITD. Anti-thyroid peroxidase (TPO) and Anti-thyroglobulin (TG) antibodies were evaluated using ELISA. The presence of Hepatitis C virus (HCV) IgG antibodies and IgM antibodies were evaluated using ELISA. The presence of RNA was investigated by RT-PCR. A total of sixty study subjects were involved in this study. Sixteen male patients (26.66%) and forty-four female patients (68.33%) were positive for Anti-TPO antibodies. Four male patients (6.66%) and twenty-five female patients (41.66%) were positive for Anti-TG antibodies. Four male patients (6.66%) and twenty-two female patients (36.66%) were positive for both Anti-TPO and Anti-TG antibodies. One female patient tested positive for HCV IgG antibodies. Sixteen patients (26.66%) were positive for IgM by ELISA of which 3 patients (5%) were male and 13 patients (21.66%) were female. None of the samples were positive for RNA. We conclude that viral infection may be involved in triggering autoimmune mechanisms. Further studies with a larger population are necessary to establish an association between HCV, and in the pathogenesis of autoimmune thyroid disorders.

P-76 Down Syndrome and Thyroid hormone levels - how low can you go?

Abstract Introduction Down syndrome (DS) is the most common chromosomal condition among live-born infants. It is associated with intellectual disability as well as medical issues ranging from congenital heart disease, obstructive sleep apnea, celiac disease, to endocrinopathies, namely thyroid disorders. The spectrum of thyroid dysfunction in patients with DS include congenital hypothyroidism, subclinical hypothyroidism, acquired hypothyroidism, and hyperthyroidism. Identifying medical comorbidities in these patients can be crucial to optimize their quality of life. Clinical Case This is the case of a male patient, 30 years old, caucasian, institutionalized, with DS and known medical history of esophageal dilation, macroglossia, valvular heart disease with mild aortic insufficiency and left ventricular moderated hypertrophy, macrocytic anemia, and pulmonary embolism 10 months earlier. Due to pallor, somnolence, fatigue, thin and fragile hair, and bradycardia, blood tests were requested and revealed an elevated TSH (385.20 mUI/L, N 0.27-4.20) with undetectable free T4 levels (&amp;lt;0.5 pmol/L, N 12.0-22.0), macrocytic anemia (Hb 11.4 g/dL; MCV 102 fL), renal dysfunction (creatinine 1.73 mg/dL) and hypercholesterolemia (total cholesterol 310 mg/dL; LDL 236 mg/dL). The chest X-ray revealed an heart silhouette enlargement and the echocardiogram showed left ventricular hypertrophy with preserved ejection fraction, diastolic dysfunction, and mild pericardial effusion. The thyroid ultrasound revealed a globally reduced gland, with diffuse hyperechogenicity and heterogeneity, suggesting thyroiditis. The patient was referred to the emergency department and the additional study revealed the presence of anti-TPO and anti-TG antibodies and a severe CK elevation (9280 UI/L, N 46-171). The patient, although lethargic, presented with normal blood pressure, heart rate, and body temperature during the hospital admission. Searching our national health system database, it was found the patient already had TSH elevation with undetectable free T4 levels at least 12 years before, in another hospital, but had lost follow-up there after the blood tests, and therefore remaining undiagnosed and untreated. Oral levothyroxine reposition was started, first with 50 micrograms and then 100 micrograms and the patient was discharged after 5 days with follow-up at the Endocrinology department. Two months later, there were already clinical and laboratory changes, with improved level of consciousness and normalized free T4 levels. Conclusion Although hypothyroidism is a common and widely recognized condition, this case emphasizes how challenging the diagnosis can be in a person with DS. Knowing that this syndrome is associated with several organic dysfunctions, namely endocrine disorders with non-specific clinical manifestations, there must be a high level of suspicion in order to screen, diagnose, and treat the comorbidities that may appear.