anti-TPO Ab Research Articles

Idiopathic Hypophysitis

Introduction: Hypophysitis is a heterogeneous condition that leads to inflammation of the sella / suprasellar region, potentially resulting in hormonal deficiencies or mass effects. Prevalence of hypophysitis ranges from 0.2% to 0.88%. Annual incidence of hypophysitis is 1 case per 9 million individuals. We present an interesting case of idiopathic hypophysitis. Clinical Case: A 52-year-old female was evaluated for secondary hypothyroidism. Patient complained of excess fatigue, weight gain, headaches, polyuria with nocturia and vision changes. She was seen by ophthalmology for formal visual field testing revealing right superior quadrantanopia. Labs significant for TSH 4 uIU/mL (ref range 0.27-4.2uIU/mL), FT4 0.72ng/dL (ref range 0.93-1.7 ng/dL), Anti TPO ab negative, AM cortisol 8.9UG/dL, ACTH 18pg/mL, IGF1 127ng/mL, prolactin 7ng/mL, FSH 102MIU/mL, LH 41 MIU/mL. MRI sella revealed homogenous enhancement of the pituitary with convex superior margin - 0.8*1*0.9cm concerning for hyperplasia. Due to the concern for hypophysitis, an extensive inflammatory workup was pursued which was negative. She was started on thyroid hormone replacement and DDAVP. An empiric trial of high dose steroids failed to provide any relief. During workup, patient complained of transient right sided face and arm tingling, diagnosed with TIA and started on aspirin. Due to worsening headaches, a pituitary biopsy was pursued. Pathology significant for glandular tissue ruling out inflammatory, neoplastic, and infectious etiologies. Neurology diagnosed the patient with hemicrania continua. Patient is currently maintained on thyroid hormone replacement and DDAVP with close follow-up. Discussion: The incidence of hypophysitis has recently increased due to increased awareness and also due to the use of medications like ICI. Primary hypophysitis is mostly due to autoimmune etiology. Secondary hypophysitis could result from infections, neoplastic conditions or an adverse effect of medications. Clinical presentations ranges from being asymptomatic to having features of hypopituitarism. Usually presents with mass effect, visual symptoms due to the upward expansion of the pituitary gland impinging the dura mater and optic chiasm. This is followed by symptoms of hormone deficiency, central DI and hyperprolactinemia. Central AI has been reported in 20%-75%, central hypogonadism in 15%-60%, central hypothyroidism in 25%-58%, GH deficiency in 5%-41%, and prolactin deficiency in 13%-25%. Typical MRI findings include, homogeneous pituitary contrast enhancement, pituitary stalk thickening and loss of posterior pituitary bright spot, ‘figure of 8’ appearance, ‘dural tail’. Treatment consists of surgery, anti-inflammatory medications, and radiotherapy. Glucocorticoid treatment is the cornerstone for medical management; however, the overall recurrence rate is high.

A Case of T3 Thyrotoxicosis With Concomitant Follicular Thyroid Carcinoma

Introduction: The coexistence of hyperthyroidism and thyroid cancer is considered a rare event. In these cases, the follicular thyroid carcinoma subtype is an even more rare finding. It is highly unlikely to find follicular carcinoma in a hyperactive thyroid nodule. Clinical Case: We report a case of an 85-year-old female with a past medical history of atrial fibrillation presenting to the clinic after she has noticed enlargement of her neck two weeks prior. The patient was seen by her primary care physician who ordered a CT neck that revealed a goiter and the patient was subsequently referred to our clinic. On further questioning, the patient denied palpitations, sweats, difficulty swallowing, heat or cold intolerance, weight changes, bowel changes, or any other complaints. The patient denied any prior history of thyroid disease or exposure to goitrogens. Her past medical history was not significant for any auto-immune related diseases. She denied any family history of thyroid disease or malignancy. On physical examination, the patient had a normal eye exam and mild goiter with a small palpated right thyroid nodule. Initial thyroid ultrasound revealed a heterogenous right lobe measuring 7.1 cm x 7.3 cm x 5.9 cm with one superior nodule measuring 1.3 cm x 0.7 cm x 0.8 cm and a heterogenous left lobe measuring 2.0 cm x 1.5 cm x 1.1 cm. Laboratory blood work up revealed total T4 of 10.5 μg/dL(normal: 5.0 to 12.0μg/dL), elevated total T3 at 322 ng/dl (normal: 80-220 ng/dL), suppressed TSH <0.01 uIU/mL (normal: 0.40-4.00 uIU/mL), markedly elevated thyroglobulin 2828 ng/mL(normal: 1-84 ng/mL), as well as elevated anti-TPO Ab 63.5 IU/mL (10.0-35.0 IU/mL). The patient underwent a thyroid uptake scan that revealed increased uptake in the right lobe. Three months after presentation, the patient underwent fine-needle aspiration (FNA) which was benign (Bethesda classification II). A decision was made to start the patient on Methimazole and the subsequent thyroid profile showed an improvement in her T3 and TSH, but thyroglobulin continued to uptrend despite treatment. The patient then underwent another thyroid ultrasound one year later that revealed increased right lobe size to 10.3 cm x 6.3 cm x 6.4 cm with enlargement of the superior nodule to 8.5 cm x 4.6 cm x 6.4 cm. The left lobe was also enlarged from the prior scan measuring 3.9 cm x 1.2 cm x 1.0 cm. The patient underwent a second FNA from that nodule which also revealed benign hyperplastic nodule (Bethesda classification II). Despite the benign FNA finding, a decision was made to perform genetic testing given the rapid progressive enlargement of the nodule. The genetic testing revealed TERT promoter gene mutation with a high risk for malignancy. The patient then underwent total thyroidectomy and the pathological analysis showed a 9 cm follicular thyroid carcinoma of the right nodule. The patient then underwent successful I-131 radioactive Iodine ablation. Subsequent thyroid ultrasounds were negative and TSH continued to downtrend while the patient continued to take thyroid hormone replacement. This patient’s presentation is unique in many aspects. The patient presented with a hyperactive hot nodule while follicular carcinoma of the thyroid gland is typically associated with clinical euthyroidism and a scan showing a cold nodule(1). In a study of 425 hyperthyroid patients, thyroid cancer was diagnosed in 7 (1.65%) hyperthyroid patients, and histological examination revealed the presence of papillary carcinoma in 5 cases and follicular carcinoma in only 2 cases (2). Our patient also had two negative FNAs despite the presence of follicular carcinoma. Hence, we are shedding the light on the importance of genetic testing in the setting of negative FNA for rapidly enlarging thyroid nodules. Conclusion: We urge physician’s awareness that on rare occasions, follicular thyroid carcinoma can be present in a hyperactive thyroid with a hot nodule. In the presence of negative FNA, hyperfunctioning rapidly growing thyroid nodules should be carefully evaluated by further genetic testing for the presence of concurrent malignancy.

Predicting positive anti-thyroid peroxidase antibody chance in vitamin D deficient patients

Introduction: The relationship between vitamin D deficiency and thyroid gland disorders is controversial. Objectives: Given the prevalence of vitamin D deficiency and the significance of thyroid disorders, the purpose of the study was to examine the relationship between anti-thyroid peroxidase (anti-TPO) antibody and vitamin D deficiency. Patients and Methods: This cross-sectional study was conducted on 35 patients with vitamin D deficiency and 35 people as a control group with normal vitamin D considered more than 20 ng/mL. Serum TSH and anti-TPO antibody tests were assessed for all subjects in both groups. The level of 25 [OH] D3 less than 20 ng/mL was considered as the deficiency of vitamin D and the serum level of anti-TPO antibody more than 40 IU/mL as positive level. Results: Mean age of patients with vitamin D deficiency was 37.00 ± 13.8 years and 46.3 ± 15.9 years in the control group. Mean age in the two groups was different (P=0.010). Around 51.4% of patients had vitamin D deficiency. There were no significant differences in TSH level among the groups (P=0.436). Anti-TPO antibody (anti-TPO Ab) level in 31.4% of the patients with vitamin D deficiency and in 11.4% of patients in the control group was positive with a significant difference (P=0.041). Logistic regression analysis showed the chance of positive anti-TPO Ab in people with vitamin D deficiency was 3.55% of the subjects without vitamin D deficiency (OR = 3.55, 95%, CI: 1.01-12.55, P=0.049). Conclusion: Considering the greater chance (three-fold) of positive anti-TPO Ab titers in patients with vitamin D deficiency in this study, more interventional studies are suggested concerning the effect of vitamin D deficiency on anti-TPO Ab.

THYROID STATUS IN CHILDREN WITH TYPE 1 DIABETES MELLITUS

The mutually aggravating effect of comorbid diseases of diabetes mellitus (DM) and autoimmune thyroiditis (AIT) is of scientific interest to researchers. Timely assessment of the thyroid status in children with DM and correction of thyroid pathology (TP) will improve metabolic control in these patients. Аmong 972 children with DM, 478 (49.2%) were assessed for thyroid status. It is noted that every year the determination of thyroid hormone levels in children increased from 7.6% (in 2014) to 92.1% (in 2019). Among 478 examined children, 319 (66.7%) had significantly revealed thyroid dysfunction. In the structure of thyroid pathologies, the frequency of hypothyroidism was 12.5% (in 11.3% - subclinical form), hyperthyroidism - 4%. functional changes in the concentration of thyroid hormones as Euthyroid sick syndrome were observed in 23.8%. The most common type of dysfunction was an isolated increase in free T3 (isolated T3 toxicosis) – in 43.3% of cases. In 2 cases out of 18 (0.6%), a complete picture of AIT was presented, and in the remaining 16 (5.1%), signs of AIT were observed only on ultrasound of the thyroid gland, and were not confirmed by the concentrations of anti-TPO Ab, anti-TG Ab. In 47 (14.7%) children, laboratory data on thyroid hormone levels showed elevated values of TSH, free T3, free T4. Keywords: children, diabetes mellitus, thyroid status, autoimmune thyroiditis

Utilization of Anti-Thyroid Peroxidase Antibody in Local Clinics and Hospitals and Intraindividual Changes in Korean Patients.

Limited data are available for test utilization and intraindividual changes in anti-thyroid peroxidase antibodies (anti-TPO Ab) in Korean patients. Using a laboratory information system, we retrospectively investigated longitudinally measured anti-TPO Ab along with thyroid function test (TFT) in Korean patients visiting local clinics. During the two-year study period, 542 test results from 183 Korean patients were requested from 51 local clinics and hospitals. Among all 183 patients, 94 (51.4%) exhibited positive anti-TPO Ab (> 34 IU/mL) at initial measurement. Among them, 13.8% (13/94) changed to negative anti-TPO Ab at least once during follow-up. Among 89 patients with initial negative anti-TPO Ab result, five (5.6%) changed to positive anti-TPO Ab at least once during follow up. Some patients exhibited qualitative changes in anti-TPO Ab. Future studies are needed to clarify the clinical implication of such changes.

Effect of Selenium-Enriched Yeast Supplementation on Serum Thyroid-Stimulating Hormone and Anti-Thyroid Peroxidase Antibody Levels in Subclinical Hypothyroidism: Randomized Controlled Trial.

Background:In the subclinical hypothyroidism, T4 or T3 levels are normal and thyroid-stimulating hormone (TSH) is slightly high. Selenium deficiency can lead to thyroid dysfunction. The present study aims to investigate the effect of selenium supplementation on the thyroid hormone and anti-thyroid peroxidase antibody (anti-TPO AB) levels.Materials and Methods:In this double-blinded, randomized, placebo-controlled clinical trial, 42 patients with subclinical hypothyroidism were randomly assigned to receive 200 μg selenium or placebo for 8 weeks. In the both groups, the serum TSH and anti-TPO antibody levels were measured and assessed before and after the intervention.Results:After the interventions, the mean serum TSH reduction in the intervention and placebo groups was −10.98 ± 33.31 and −3.20 ± 38.36, respectively, which were not statistically significant. However, the mean serum anti-TPO Ab concentration increased in the intervention and placebo groups (109.81 ± 51.49% vs. 173.17 ± 96.26%), between which the difference was not statistically significant (P >0.05) despite a slight increase in the mean anti-TPO level in the intervention group.Conclusion:The results of the current study indicated that selenium supplementation has no significant effect on serum anti-TPO Ab and TSH levels in the patients with subclinical hypothyroidism. Studies with larger sample size and with different doses of selenium are needed to reach more precise results.

The association of neuropsychiatric disorders and endocrine parameters in hashimoto thyroiditis

Hashimoto thyroiditis is the most common thyroid disease. This form of pathology has a diverse clinical picture, including neuropsychiatric disorders. There are frequent cases of comorbidity of autoimmune thyroiditis and psychiatric forms of pathology, along with such a nosological entity as Hashimotos encephalopathy (aka: Steroid-responsive encephalopathy of autoimmune thyroiditis), characterized by an increased level of antithyroid autoantibodies and various mental disorders, with still unclear pathogenesis. The question arises, how to regard patients with psychiatric disorders and Hashimoto thyroiditis either as patients having autoimmune thyroiditis, comorbid with psychiatric forms of pathology, or as patients with Hashimotos encephalopathy? We studied groups of patients with autoimmune thyroiditis free from any psychiatric disorders, autoimmune thyroiditis comorbid with psychiatric forms of pathology, and a group of healthy donors similar as regards to their age and sex. We also studied medical history, clinical manifestations of the disease, instrumental data and the serum levels of thyrotropin, thyroid hormones, various antithyroid autoantibodies, and prolactin. We analyzed the correlation of laboratory and instrumental parameters and clinical data in all groups of patients. Therewas a significant relationship (p 0,05) between various psychiatric symptoms and a decreased level of free thyroxine, an increased level of thyroid stimulating hormone (TSH), an increased level of prolactin and an increased volume of a thyroid gland. Asignificant relationship (p 0,05) was also found between various symptoms of hypothyroidism and a decreased level of free triiodothyronine (FT3), an increased level of antibodies to thyroglobulin (anti-TG Ab), and an increased level of antibodies to thyroid peroxidase (anti-TPO Ab).

Thyroid Function, Urinary Iodine, and Thyroid Antibody Status Among the Tribal Population of Kashmir Valley: Data From Endemic Zone of a Sub-Himalayan Region.

Background: There are scarce data on the prevalence of thyroid disorders and urinary iodine status among tribal populations of India, with no reported data from Kashmir valley.Objectives: To estimate the prevalence of thyroid disorders and evaluate urinary iodine concentration (UIC) and thyroid autoantibody status among Gujjar and Bakerwal tribes of Kashmir valley.Methods: This cross-sectional study recruited tribal subjects using multistage cluster sampling from 5 out of 22 districts of Jammu and Kashmir (J&K). Using a predesigned questionnaire, the details of past or current medical history and drug intake, including thyroid hormone medication etc. were recorded after obtaining an informed consent. Examination included anthropometry (height, weight, waist circumference), blood pressure measurement, and relevant general physical examination focusing on goiter palpation, while as laboratory assessment included estimation of serum thyroid hormone levels, antithyroid peroxidase antibody (anti-TPO Ab), and urinary iodine concentration.Results: A total of 763 subjects (56.4% women and 43.6% men) with a mean(±SD) age of 39.46 (±17.51) ranging from 10 to 85 years and mean(±SD) body mass index (BMI) of 21.28 (±4.16) kg/m2 were studied. Goiter was detected in 6.8%, while 33.2% subjects had some form of thyroid dysfunction (including 24.1% subclinical and 6.8% overt hypothyroidism). Subclinical and overt hyperthyroidism were observed in 1.3 and 0.9% of cases, respectively. Anti-TPO Ab was elevated in 13.6%, while the median [interquartile range (IQR)] for UIC was 154.50 (135) μg/L [156.13 (134) μg/L in men and 147.26 (136) μg/L in women]. A negative correlation was observed between UIC and anti-TPO Ab (r = −0.087, P = <0.05).Conclusion: These novel data on iodine and thyroid status among a tribal population of India generally inhabiting in remote sub-Himalayan belts demonstrate high prevalence of subclinical hypothyroidism (SCH) with persistent iodine deficiency. These preliminary data may warrant large well-designed studies to carry out comprehensive assessment of the problem in this high-risk and marginalized population.

SIGNIFICANT ASSOCIATION BETWEEN ANTI-THYROID PEROXIDASE (ANTI-TPO) ANTIBODIES AND LOW BIRTH WEIGHT IN EUTHYROID PREGNANT WOMEN

Background: Maternal and perinatal morbidities are well-documented complications of pregnancy in women with thyroid dysfunction, both clinical and subclinical. About 2–5% of pregnant women suffer from thyroid disorders and timely intervention can be done if detected early. The presence of anti-TPO Ab is associated with increased rate of pregnancy complications such as miscarriage, preterm delivery, placental abruption, pregnancy-induced hypertension, intrauterine death and low birth weight.&#x0D; Objectives: Study the effect of anti-TPO Ab positivity on pregnancy outcome especially birth weight and estimate the prevalence of anti-TPO Ab in euthyroid pregnant women.&#x0D; Methods: This observational study enrolled 500 euthyroid pregnant women, age 20-35 years, up to 20 weeks gestation. Venous blood samples collected and analyzed for the anti-TPO Ab levels. On the basis of Ab positivity they were divided into anti-TPO Ab positive and Ab negative group. These two groups were followed up till delivery and compared fetal outcomes for birth weight.&#x0D; Result: Prevalence of anti-TPO Ab positivity was 5.2% in euthyroid obstetric women. Most of anti-TPO Ab positive women were overweight. Incidence of low birth weight babies was 4 fold higher in anti-TPO Ab positive women.&#x0D; Conclusion: Anti-TPO Ab positivity significantly associated with prepregnancy BMI and low birth weight of newborns.&#x0D; Keywords: Thyroid peroxidase antibodies, Anti-TPO Ab, Euthyroid, Low birth weight.

The Effect of Selenium on Hashimoto’s Thyroiditis: Systemic Review and MetaAnalysis

Background: Selenium forms a significant component of seleno-proteins in the body. Seleno-methionine is integrated into proteins instead of methionine and acts as a storage pool. In proteins, the active form of Selenium is seleno-cysteine.in this review we aim to prevail the results of selenium effect on thyroid status in recent clinical trials. The systemic review aims to find out the correlation between supplementation of Selenium and anti-TPO antibodies and T4 levels in Hashimoto’s Thyroiditis. Selenium supplementation decreases the level of anti-TPO antibodies. The supplementation of Selenium increases the level of T4 levels. Methods: The mean and standard deviation (SD) of all 8 studies was were calculated. One of the researches had all the information in figures, and only the levels of anti-TPO antibodies and FT4 were obtained. Heterogenicity was estimated using I2. Results: The p-value calculated for Anti-TPO by SPSS of the eight groups had a p-value of 0.142. The p-value calculated for T4 levels by SPSS of the five groups had a p-value of 0.239. The heterogenicity test was zero after the I2 test. The studies that were included in the systematic review were assessed by Prisma diagram and selected among the articles resulted from search keywords selenium and anti TPO and hashimotho thyroiditis on different data sources. All the participants were evaluated by sex, ages, duration of the study and the levels of anti TPO AB and thyroxin (t4) and then using SPSS software to deploy metanalysis in the systematic review. Conclusion: In 6 of 8 studies it was a relation of selenium and thyroid status, whereas 2 studies were not. As we ran meta analysis on the data we realized that there is not significant desired effect from selenium on thyroid antibodies against previous metanalysis done by other researchers.

SUN-523 Thyroid Storm: A Rare Presentation of HCG Producing Metastatic Choriocarcinoma

Background: The beta subunit of human Chorionic Gonadotropin (hCG) and TSH are very similar and hCG is known to weakly bind the TSH receptor. hCG induced hyperthyroidism has been previously reported as a rare paraneoplastic syndrome in non-seminomatous germ-cell tumors and usually presents with subclinical thyrotoxicosis. We present a noteworthy case of thyroid storm in a patient with hCG producing testicular Choriocarcinoma. Clinical case: A 19-year-old Hispanic man presented to an outside emergency department (ED) with one day of abdominal pain, nausea, recurrent emesis and subjective fever. He had presented to the same ED 9 days prior with similar symptoms which prompted contrasted CT Abdomen/Pelvis demonstrating hepatic masses and a large right testicular mass, suspicious for primary testicular malignancy. On return evaluation, he was noted to have tachycardia with HR 165, mild scleral icterus, tenderness to palpation of right upper quadrant, abdominal pain and a right scrotal mass (5x5 cm). CBC revealed; WBC 12.0 k/uL (n: 4-10.8), AST: 428 u/L (n: 3-34); ALT: 176 u/L (n: 15-41); total bilirubin: 6.3 mg/dL (n: 0.2-1.3), TSH <0.005 uIU/mL (n: 0.4-4.0) and FT4 5.02 ng/dL (n: 0.7-1.4). Clinical scenario was consistent with thyrotoxicosis concerning for thyroid storm (Burch-Wartofsky Point Scale: 50) requiring intensive care for which he was transferred to our institution. Thyroid US revealed increased thyroid vascularity without nodularity. Laboratory workup revealed negative TG Ab, Anti-TPO Ab, TRAb, and TSIG. Conversely, TBG was elevated at 31.2 mcg/ml (n: 13-30). Initial hCG level was obtained as 6,074. After re-testing with dilution was specifically requested, initial hCG was corrected to 6,760,713. Oncologic workup confirmed diagnosis of hCG producing testicular choriocarcinoma with liver and lung metastases. On admission, he was started on oral methimazole and propranolol as well as intravenous steroids which led to marked symptomatic improvement and normalization of FT4 to 1.37 allowing for discontinuation of antithyroid medication on 7th day of hospitalization. He completed 1 cycle of cisplatin/etoposide and experienced marked reduction of his hCG level to 951,460 which correlated with improvement of his TFTs and resolution of his hyperthyroid symptoms.Conclusion:A low threshold of suspicion should be maintained for the possibility of hyperthyroidism in patients with suspected testicular choriocarcinoma, particularly in the context of recent iodinated contrast imaging. If the clinical picture does not support a primary etiology of hyperthyroidism and hCG is not concordantly elevated, re-assessment of hCG by dilution should be considered as hCG assay is also subject to prozone (hook) effect. Hyperthyroidism should be actively managed and closely monitored as response to treatment can be rapid.

Case Report on Importance of Role of Selenium Supplementation in Autoimmune Thyroiditis: 8 Months Follow-Up with Variable Doses

Introduction: India in present situation has passed through the Iodine deficient to Iodine sufficient country due to higher access of iodised salt to people consuming higher iodine intake. Higher iodine intake increases the risk of lymphocytic infiltration of thyroid gland by 3 folds, and this has increased the prevalence of thyroid autoantibody positivity by almost 40-50%. Background: Selenium as know n has an antioxidant and anti-inflammatory property, and has the highest concentration in the thyroid gland. Several studies have shown that or studied that selenium has a close relationship with Hashimotos Thyroiditis characterized by presence of antithyroid peroxidase auto antibody. Aims and Objective: To study the effect of selenium supplementation in autoimmune thyroid disease. Two patients A and B with hypothyroidism both females with mean age 40+2 years were taken for this study, euthyroidism was achieved with substitutional therapy of levothyroxine of 100mcg dose. Both were then supplemented with selenium therapy. Results: Female patient A whose (mean TPOAb was 815) received 200 mg L-selenomethionine per day, orally for 4 months, and other female patient B whose (mean TPOAb was 790 IU/ml) also received 200mg of L-selenomethionine per day for duration of 4 months. The profile was assessed with the compared value of Anti TPO Ab and found decrease in the level of TPO antibodies by around 10-12 % after 8 weeks of therapy as assessed by the lab values, patient A values were 716 IU/ml and patient B values were 695 IU/ml, and 18-20 % at the end of 16 weeks i.e. 4 months, patient A values were 669 IU/ml and patient B values were 631 IU/ml. After 1st phase the thyroid profile of both the patients were stable on 100mcg. After duration of 6 months Female A was continued on L-selenomethionine 200 mg/day, while other female B the dose was reduced to 100 mg/day. Serum titers of TPOAb was assessed in both the female patients after 4 months. TPOAb titers increased significantly in female patient B with values of 820IU/ml around 30% as compared to female patient A with further decrease in titre values of 600 IU/ml.

Study of Epstein–Barr virus serological profile in Egyptian patients with Hashimoto’s thyroiditis: A case-control study

BackgroundHashimoto’s thyroiditis (HT) is now considered one of the most prevalent autoimmune diseases. The aim of the present study was to determine the prevalence of different types of EBV antibodies in patients with HT in comparison to healthy controls, and to detect any correlation between EBV serological markers and different laboratory findings in HT patients. Subjects & methodsThis case-control study was conducted on 120 subjects divided into two groups: Sixty patients with HT (patients group), and sixty age and sex matched healthy volunteers (control group). All the participants were subjected to: Thyroid ultrasound, laboratory assessment including: Serum thyroid -stimulating hormone (TSH), free tetraiodothyronine (FT4), free triiodothyronine (FT3), anti-thyroid peroxidase antibody (anti-TPO Ab) and anti-thyroglobulin antibody (anti-TG Ab). Four types of EBV antibodies (VCA IgM, VCA IgG, EA IgG, and EBNA-1IgG) were measured in serum using ELISA. ResultsThe mean serum levels of EBV VCA IgG and EA IgG were significantly higher in HT patients group in comparison to control group. In euthyroid HT patients, a significant positive correlation was observed between the age and EBV EA IgG. While in hypothyroid HT patients, a significant positive correlation between thyroid isthmus and EBNA-1IgG was observed. A significant negative correlation was found between the serum FT3 and EBNA-1IgG and a significant positive correlation was observed between serum TSH and EBV VCA IgG. ConclusionsThe high serum levels of EBV VCA IgG and EBV EA IgG in patients with HT suggest a possible association between EBV and HT.

Comparative study of female hypothyroid patients having autoimmune thyroiditis with the clinico-pathological parameters

Introduction: Hypothyroidism during reproductive age group is responsible for menstrual irregularities, infertility along with miscarriages and congenital malformation s during pregnancy. It has a prevalence of 5-20% in child bearing age. Autoimmune thyroiditis is the common cause of subclinical hypothyroidism in adult female population. Presence of thyroid autoantibodies is high in subclinical hypothyroidism. American Thyroid Association (ATA) & American Association of Clinical Endocrinologist (AACE) recommends for treatment of these patients. Lack of obvious signs and symptoms in subclinical hypothyroidism creates dilemma and challenge for diagnosis. Hypothesis: This was a retrospective study conducted in Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar during the period from January 2017 to January 2019. Women of reproductive age group having thyroid swellings were subjected to Fine needle aspiration cytology (FNAC), Thyroid function test and Anti TPO Ab levels in serum. Cytological grading was done and it was correlated with clinical presentation and serological parameters. Results: Out of 120 cases, 56.7% patients were hypothyroid. Increased titre of Anti- TPO Ab levels in serum was observed in 91.4%, 95.3% and 95% cases of Grade I, Grade II & Grade III categories of autoimmune thyroiditis respectively. Conclusion: Autoimmune thyroiditis is the common cause of hypothyroidism in adult females. Early detection and management with low dose of thyroxine will prevent the complications during reproductive period. Keywords: Autoimmune thyroiditis, Hypothyroidism, Anti-TPO Antibody, TFT.

Thyroid autoimmunity markers in women with polycystic ovary syndrome and controls

This study was performed to compare the prevalence of autoimmune thyroid disease (AITD) assessed by thyroid peroxidase antibody (anti-TPO Ab) and thyroid ultrasonography (USG) in Korean women with polycystic ovary syndrome (PCOS) (n = 210) and age-matched controls (n =343). We also compared the clinical features of women with PCOS according to the presence of AITD. Patients and controls were enrolled from a population who visited a screening centre for a general health check-up. There was no difference in the frequency of anti-TPO Ab positivity between the women with PCOS and the controls (4.8% (5/104) in patients and 7.6% (18/238) in controls). The frequency of heterogeneous or hypoechoic parenchyma on USG also did not differ between the patients and controls (9.3% (11/118) in patients and 12.3% (40/325) in controls). Within the PCOS group, the subjects with AITD (who had either Ab positivity or sonographic findings compatible with thyroiditis) showed significantly higher body mass indexes, waist circumferences and homeostasis model assessment for insulin resistance levels than the patients without AITD. In conclusion, AITD was not more prevalent in women with PCOS than in controls. However, among women with PCOS, subjects with AITD showed significantly higher adiposity and insulin resistance index than those without AITD.

Thyroid Function and Anti-TPO Antibody Status among Tribal Perimenopausal Women Near Bengaluru, Karnataka, India

Introduction: Higher prevalence of thyroid diseases are noted with increasing age. Symptoms of thyroid disorders often develop so insidiously, that they go unnoticed and there is also the risk of being misinterpreted for menopausal symptoms. Present study was executed in view of paucity of data regarding thyroid disorders among tribal perimenopausal age group and there was a need for timely intervention of this chronic non-communicable disorder among these women. Aim: To determine the thyroid function and anti-Thyroid Peroxidase Antibody (anti-TPO Ab) status among the tribal perimenopausal women. Materials and Methods: A descriptive, cross-sectional study was conducted for a period of six months from July 2017 to December 2017 among perimenopausal women in the age group of 40-55 years residing at Hakki Pikki Tribal Colony near Bengaluru, Karnataka, India. Thyroid Stimulating Hormone (TSH), Total T3 (Total Tri iodothyronine), Total T4(Total Tetraidiodothyronine) and anti-TPO antibody levels were estimated by Chemiluminescence Immuno Assay (CLIA). Data was analysed using Open Epi software to find out Mean±SD, p-value (Student’s t-test with significance set at p&lt;0.05) and r-value (Pearson’s correlation coefficient). Results: Subclinical Hypothyroidism (SCH) was observed in 3 (7.32%) women and anti-TPO Ab positivity (anti-TPO antibody level &gt;30 IU/mL) was found in 14 (34.14%) women amongst 41 perimenopausal subjects. Raised anti-TPO Ab was observed in all the 3 (100%) SCH women and 11 (26.82%) euthyroid women. Significant difference (p&lt;0.001) between anti-TPO Ab values among SCH and euthyroid women with significant positive correlation (r-value 0.7023 and p&lt;0.05) between TSH and anti-TPO Ab values in anti-TPO Ab positive women was noted. Conclusion: Anti-TPO Ab positivity was seen in 34% of perimenopausal women, out of them majority 79% was in euthyroid state and 21% had SCH. Hence in addition to routine thyroid profile, we suggest estimation of anti-TPO Ab levels in this age group.

Study of Autoantibodies and DQ Antigens in Patient with Celiac Disease

Introduction: Celiac Disease (CD) is a chronic autoimmune mediated disorder triggered by the ingestion of gluten. It is seen in genetically predisposed person and results in small intestine injury. Its aetiopathogenesis is not clear. Simple histopathology is not able to diagnose the disease many times. Aim: Aim of present study was to assess the prevalence of HLA DQ alleles and autoantibodies in diagnosis of the disease and association of DQ antigens with Type 1 Diabetes mellitus (T1DM) and autoimmune hypothyroidism in CD patients. Materials and Methods: Total 100 cases of CD and 31 healthy controls were studied, within a period of January 2015 to Febuary 2016. Autoantibodies like ANA, anti-tTg, anti-TPO and anti-scl 70 were done by ELISA kits. HLA DQ typing was done in 44 cases of CD, 20 cases of CD with T1DM, 22 cases of CD with autoimmune thyroid disease and 31 healthy controls. HLA DQ typing was done by SSO hybridisation method by Mr. SPOT machine. Results: About 70% patients were children between 6 months to 20 years of age and female formed the maximum number of cases (60%). Anti-tTg ab was positive in all cases (100%), anti-Scl 70 Ab was positive in 25%, anti-TPO ab was found in 22% and ANA was positive in only 10% cases. Most frequent DQβ1 haplotype in CD were DQβ1*02:01 (45.5%, p&lt;0.001) and DQβ1*02:02 (20.5%, p=0.007) while DQ*06:01 was significantly more common in controls suggesting its protective role. Among DQα1 typing DQα1*05:01 (45.5%, p&lt;0.001) and DQα1*05:05 (40.9%, p&lt;0.001) which were significantly more in CD than controls. Contrary to this DQα1*01:01, DQα1*01:03 and DQα1*01:04 were significantly reduced in CD patients. CD patients associated with T1DM and autoimmune thyroid disease had significantly more DQβ1 02:01, DQβ1*02:02, DQα1*05:01 and DQα1*05:05. Conclusion: CD is an autoimmune disease, DQ typing should be kept in diagnostic criteria of CD. Association of autoimmune thyroid diseases and T1DM in CD is due to common sharing of these DQ antigens suggesting its role in predisposing autoimmune diseases.

Prevalence of thyroid autoimmunity in first-degree relatives of patients with celiac disease.

Patients with celiac disease (CeD) are prone to develop other autoimmune diseases such as autoimmune thyroid disease and type 1 diabetes. While 7.5% of first-degree relatives (FDRs) of patients with CeD develop CeD, it is not clear whether FDRs of patients with CeD are at higher risk of developing autoimmune thyroid disease. In this prospective case-control study, we recruited 194 FDRs (males 53.1%) of 91 patients with CeD and 140 age-matched healthy controls (males 76.4%). They were screened for CeD using anti-tissue transglutaminase antibodies (anti-tTG Ab) and thyroid disease using a symptom questionnaire, anti-thyroid peroxidase antibodies (anti-TPO) and serum thyroid-stimulating hormone (TSH). Subjects having positive anti-TPO but a normal TSH were classified as having thyroid autoimmunity and those with elevated TSH with or without positive anti-TPO Ab were classified as having autoimmune thyroid dysfunction. The prevalence of thyroid autoimmunity and autoimmune thyroid dysfunction in FDRs was significantly higher than that in healthy controls (17.5% vs. 5.0%, p < 0.01; 11.8% vs. 3.5%, p < 0.01), respectively. A significantly higher number of FDRs had a positive anti-tTG Ab in comparison with controls (13.9% vs. 2.2%, p < 0.001). Amongst FDRs having thyroid autoimmunity, 44.1%, 47.0% and 8.8% were siblings, parents and children of patients with CeD, respectively. Familial clustering was seen only in 1 family. FDRs of patients with CeD have 3-fold higher risk of developing autoimmune thyroid disorders and associated thyroid dysfunction. Therefore, it is advisable for early screening of FDRs for CeD and associated thyroid autoimmune through screening measures.

Study the association between IL-17 level and autoimmune antibodies in hypo and hyper thyroidisms patients

The current study included measuring the level of IL-17A and IL-17F and some autoimmune antibodies related to the thyroid gland in case of hypo and hyperthyroid in Iraqi patients to evaluate the correlation between all the measured parameters in this study.The study has been carried out in AL-Kindey Endocrine Gland and Diabetic Center in Baghdad during the period between February 2018 and May 2018, included: 88 patients were divided into three groups, The first group composed of 30 patients of Hypothyroidism that included (26) of them were females, (4) of them males. The second group composed of 30 of patients of Hyperthyroidism that included (20) of them were females, (10) of them were males . and second groups were conducted with hypo and hyperthyroidism respectively.While the third group composed of 28 of healthy individuals (Control) that composed of (25) of them were females, (3) of them were males was represented as control .The results revealed a significant (P &lt; 0.05) correlation between TSH concentration and age in patients groups. When the age is more than 40 years, the concentration of TSH was noticed to be higher than that in patients aged less than 40 years. The results show that the level of antibodies was significantly increased (P&lt;0.01) in hypo and hyperthyroid patients in comparison with the control group. At the same time the level of Anti-TG antibodies was higher significantly in the hypothyroid patients than its level in hyperthyroid patients group. No significant differences have been found between hypo and hyperthyroid patients in the level of Anti-TPO and Anti TSH-R antibodies. But its noticed that the higher level of Anti-TPO Ab. was found in the hypothyroid group where as higher level of Anti TSH-R Ab. was found in the hyperthyroid group and simultaneously both types were significantly higher than their levels in the control group As well as the results demonstrated a highly significant increase (P&lt; 0.01) in the levels of IL-17 Types (A and F) in hypo and hyperthyroid patients with bias toward the comparison with the control group. The statistical study showed a significant negative correlation between the level of TSH and Anti-TG levels (r= -0.33). While a significant positive correlation between the level of Anti-TG and level of IL-17F (r= 0.39) in hypothyroid patients. Also in hypothyroid patients, there is a significant positive correlation between the level of Anti-TPO and IL-17A (r= 0.33). In conclusion: The positive correlation between IL-17F and Anti-TG and between IL-17A and Anti- TPO in hypothyroid patients refer to increase in the concentration of IL-17 may lead to increase the thyroid autoantibodies, which affect thyroid tissue potency, decreasing thyroid hormone production, according to feedback inhibition loop.

Can Supplementation with Vitamin D Modify Thyroid Autoantibodies (Anti-TPO Ab, Anti-Tg Ab) and Thyroid Profile (T3, T4, TSH) in Hashimoto's Thyroiditis? A Double Blind, Randomized Clinical Trial.

Hashimoto's thyroiditis (HT) is the most prevalent autoimmune disorder characterized by the destruction of thyroid cells caused by leukocytes and antibody-mediated immune processes accompanied by hypothyroidism. In recent years, evidence has emerged pointing to various roles for vitamin D, including, proliferation and differentiation of normal and cancer cells, cardiovascular function, and immunomodulation. Vitamin D deficiency has been especially demonstrated in HT patients. The aim of this study was to investigate the effect of vitamin D on circulating thyroid autoantibodies and thyroid hormones profile (T4, T3, and TSH) in females with HT. Forty-two women with HT disease were enrolled in this randomized clinical trial study and divided into vitamin D and placebo groups. Patients in the vitamin D and placebo groups received 50 000 IU vitamin D and placebo pearls, weekly for 3 months, respectively. The serum levels of 25-hydroxy vitamin D [25(OH) D], Ca++ion, anti-thyroperoxidase antibody (anti-TPO Ab), anti-thyroglobulin antibody (anti-Tg Ab), T4, T3, and TSH were measured at the baseline and at the end of the study using enzyme-linked immunosorbent assays. The results of this study showed a significant reduction of anti-Tg Ab and TSH hormone in the Vitamin D group compared to the start of the study; however, there was a no significant reduction of anti-TPO Ab in the Vitamin D group compared to the placebo group (p=0.08). No significant changes were observed in the serum levels of T3 and T4 hormones. Therefore, vitamin D supplementation can be helpful for alleviation of the disease activity in HT patients; however, further well controlled, large, longitudinal studies are needed to determine whether it can be introduced in clinical practice.