anti-TPO Abs Research Articles

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).

Evaluation of Caspase-8 Level in Serum of Patients with Autoimmune Thyroid Disorders

Autoimmune thyroid diseases (AITDs), including Graves' disease and Hashimoto's thyroiditis, are characterized by lymphocytic infiltration of the thyroid and the production of thyroid autoantibodies. While the etiology of AITDs is still not fully understood, a combination of genetic susceptibility and environmental triggers is believed to contribute to the breakdown in immune tolerance. This study aimed to evaluate the levels of thyroid hormones (T3, T4, TSH), Anti-thyroid peroxidase Abs (Anti-TPO Abs), Anti-Thyroglobulin Abs (Anti-TG(, and apoptosis marker (Caspase-8 ) in Iraqi patients with AITDs compared to healthy controls. A total of 1000 patients participated in the study 820 were excluded from the study because it was non-immune thyroid disease, and 180 subjects were recruited, including 60 Graves’ disease patients, 60 HT patients, and 60 healthy controls. Serum levels of T3, T4, TSH, Anti-TPO Abs and Anti-TG, caspase 8, and inhibin were measured. T3 and T4 levels were significantly decreased in Hashimoto's thyroiditis patients and increased in Graves’ disease patients compared to controls. TSH was significantly elevated in Hashimoto's thyroiditis and reduced in Graves’ disease patients. Caspase-8 was significantly higher in Hashimoto's groups compared with the control group, and Significantly lower in Graves group compared with the control group. In conclusion, an altered balance in thyroid hormones, Anti-TPO Abs, Anti-TG, and apoptosis markers occurs in AITDs. Elevated caspase-8 suggests that increased apoptosis may contribute to thyroid damage in AITDs. Further research is needed to clarify the roles of these mediators in AITD pathogenesis.

Abstract #1403921: Characteristics of Children and Adolescents with Hashimoto’s Thyroiditis in a Multiethnic Community Hospital

Hashimoto's thyroiditis (HT), an autoimmune thyroid disorder, is the most common cause of acquired hypothyroidism in children and adolescents. HT is familial with female predominance. It has peak incidence in school-aged children and adolescents. It is most common in Whites and Asians and in those with other autoimmune conditions. In addition to goiter, poor linear growth and disruption of pubertal development are common. The diagnosis is made by presence of thyroid autoantibodies (Abs) and can be confirmed by heterogeneous echogenicity on sonogram. There is increased risk for papillary thyroid carcinoma (PTC) in HT. The aim of this study was to explore the characteristics of pediatric patients with HT in a multiethnic community hospital where the majority of patients are Hispanic and Asian. A retrospective review was conducted. Patients 0-21 years with HT seen in Pediatric Endocrine Clinic at Flushing Hospital Medical Center between 2013 and 2021were included. Data extracted from EHR included demographics, clinical findings, comorbidities, thyroid function tests, thyroid autoantibodies, sonogram findings, fine needle aspiration (FNA) results and treatment. The sample was characterized using descriptive statistics. Of 114 patients identified with HT, 80 (70%) were female. The mean age at time of diagnosis was 12.6+4.2 years. Of 66 patients with documented ethnicity, 59% were Hispanic. Family history of thyroid dysfunction was present in 35%. The most common presenting complaint was goiter (47%). Elevated thyrotropin was present in 86%. Comorbidities included diabetes (5%), celiac disease (2%) and vitiligo (2%). Both anti-thyroglobulin antibodies (anti-Tg Abs) and anti-peroxidase (anti-TPO) Abs were present in 60%, anti-TPO Abs only in 22% and anti-Tg Abs only in 9%. All patients had thyroid sonogram: 64% revealed heterogeneous echogenicity, 4% homogeneous echogenicity and 32% normal. Both nodules and cysts were reported in 12%, nodules only in 24%, and cysts only in 9%. No patient met criteria for FNA. All patients with overt hypothyroidism or nodules/cysts were prescribed levothyroxine. Our patients were mostly of Hispanic ethnicity, an underrepresented population in previous studies. Female to male ratio was almost 4:1 with mean age of 12.6 years, concurring with known epidemiology. Hypothyroidism and goiter were common. Having both anti-TPO Abs and anti-Tg Abs was more common than having only one Abs. Thyroid sonogram was confirmatory in two-thirds. Nodules and cysts were common but did not lead to FNA. Future research exploring associations with development of PTC will require extended follow up.

Immune-related thyroid dysfunctions during anti PD-1/PD-L1 inhibitors: new evidence from a single centre experience.

The role of anti-thyroid peroxidase antibodies (anti-TPO Abs) in the development of abnormal thyroid function tests (DYSTHYR) during treatment with immune checkpoint inhibitors (ICIs) is not fully understood; moreover, controversial data exist about the relationship between ICI-related thyroid dysfunction (TD) and survival. We retrospectively analyzed the onset or the worsening of DYSTHYR in patients treated with programmed cell death protein-1 (PD-1) or its ligand (PD-L1) inhibitors between 2017 and 2020. In patients without previous TD, we focused on the association between baseline anti-TPO Abs level and DYSTHYR. Furthermore, the relationship between DYSTHYR and progression-free survival (PFS) or overall survival (OS) was explored. We included 324 patients treated with anti PD-1 (95.4%) or anti PD-L1 inhibitors. After a median of 3.3months, DYSTHYR was registered in 24.7%, mostly hypothyroidism alone (17%). Patients with pre-existing TD (14.5% of the sample) were at higher risk of DYSTHYR compared to patients without previous TD (adjusted OR 2.44; 95% IC 1.26-4.74). In patients without known previous TD, high anti-TPO Abs level, even below the positivity cut-off, was a risk factor for developing DYSTHYR (adjusted OR 5.52; 95% IC 1.47-20.74). DYSTHYR was associated with a longer 12-month OS (87.3% vs 73.5%, p = 0.03); no statistically significant difference in terms of PFS was observed between the DYSTHYR+ and DYSTHYR- group. DYSTHYR is common during anti PD-1/anti PD-L1 treatment, especially in patients with pre-existing TD. In subjects without known previous TD, high anti-TPO Abs level at baseline can be a predictive biomarker of DYSTHYR. An improved OS is observed in patients with anti PD-1/anti PD-L1-induced DYSTHYR.

The Clinical Implications of Anti-thyroid Peroxidase Antibodies in Graves' Disease in Basrah.

Background Graves' disease (GD) is an autoimmune disease, with thyrotropin receptor antibodies (TRAbs) being the most important cause in the pathogenesis. The aim of this study is to assess the clinical significance of anti-TPO Abs in GD. Methods A retrospective study was conducted at the Faiha specialized Diabetes, Endocrine, and Metabolism Center (FDEMC) in Basrah during the period between December 2021 and December 2022. A total of 141 patients with GD were involved in this study, and of them, 97 (68.8%) were women. They were divided into two groups: patients with positive and negative anti-TPO Abs groups. Results Positive anti-TPO Abs were seen in 83 patients (58.9%) with GD. Pretreatment-free thyroxine level (ng/dL) was higher in the anti-TPO Abs positive GD patients than in those with negative antibodies (3.7±0.2 versus 3.0±0.2 with a p=0.021). Similarly, higher TRAb titers (IU/ml) at baseline were also seen in patients with positive anti-TPO Abs (9.8±0.7 versus 6.8±0.8) with a p=0.008. Giraffe appearance on thyroid ultrasound was more common in the group with positive anti-TPO Abs as compared to patients with negative anti-TPO Abs: 20 (87.0%) versus 3 (13.0%) with a p=0.005. A higher anti-TPO Abs titer (IU/mL) was associated with a baseline TRAb level of more than 6.4 IU/mL, and giraffe appearance on thyroid ultrasound (206.5±20.0 p-value<0.0001 and 228.0±35.3 p value=0.007, respectively). Conclusion A positive anti-TPO Abs in GD is associated with a high TRAb titer and free T4 level at baseline, as well as a giraffe appearance on thyroid ultrasound.

Unexpected high frequency of anti-thyroid peroxidase (anti-TPO) antibodies in Golestan province, Iran.

Anti-TPO antibodies are one of the characteristic factors in autoimmune thyroiditis (AIT). Previous studies reported a high prevalence of anti-TPO antibodies (Abs) in Iran. We have therefore assessed the prevalence of anti-TPO Abs in Gorgan, Iran. This cross-sectional study, conducted from 2015 to 2018 in Gorgan city, Northeast of Iran. The Participants included women with Poly cystic ovary syndrome (PCOs), celiac patients, men with hepatitis C infection, and age and sex-matched controls. ELISA method was used for the analysis of laboratory tests. The number of enrolled subjects in PCOs, celiac disease, and Hepatitis C infection groups were 76, 67, and 60, respectively. Anti-TPO Abs positivity was significantly higher in patients with PCOS than in the control group (18.4% vs. 0.00%; p = 0.000). There were no significant differences in the frequency of anti-TPO Abs positive cases between CD patients and the controls (26.9% vs. 21.1% p =0.413). The incidence of anti-TPO Abs positivity was significantly higher in the control group (10% vs. 25%; P = 0.031). Very high level of anti-TPO Abs was observed in both patients and healthy population in Golestan province. Considering this rate and its association with autoimmune disorders, it is suggested to prioritize screening programs for related disease in this area.

The role of anti-TPO as an additional analytical marker in thyroid disease patients in Erbil City

Background: There is a connection among anti-TPO and anti-TG antibodies and levels of thyroid hormone and both alone or in grouping have been utilized to expect perfection of hypo or hyperthyroidism. Objective: Both alone or in grouping have been utilized to expect perfection of hypo or hyperthyroidism. Patients and Methods: This is a cross-sectional study achieved in the laboratories of Rizgary Teaching Hospital and Erbil Teaching Hospital in Erbil, Iraq, within the period of May 2020 to April 2021. The study included 66 patients, both males and females included. These patients had clinical indications and were suspected of having a sort of thyroiditis. Anti-TPO electrochemiluminescence immunoassay analysis has been included by the analysts in conjunction with conventional markers immunoassay of thyroid TSH, T3, and Free T4 trusting that this would help in lessening morbidity and related wellbeing concerns. Results: There was an increase in the level of anti-TSH antibodies in the hyperthyroidism group (60.6%) which was more than in those with hypothyroidism (36.4%), significant association exist (P≤0.049). Moreover, the level of Anti-TPO Abs was higher among hypothyroidism patients (63.6%) than among hyperthyroidism cases (33.3%), this association was statistically significant (P≤0.014). Conclusion: Demonstrating the clinical importance of this antibody and the benefit of adding anti-TPO, in combination with TSH and FT4. Addition of one test could potentially save expenditure on long-term diseases such as overt thyroid disease and its attended morbidities. Keywords:Thyroid autoantibodies, thyroid peroxidase, thyroglobulin, thyroid-stimulating hormone receptor

The role of anti-TPO as an additional analytical marker in thyroid disease patients in Erbil City

Background: There is a connection among anti-TPO and anti-TG antibodies and levels of thyroid hormone and both alone or in grouping have been utilized to expect perfection of hypo or hyperthyroidism.&#x0D; Objective: Both alone or in grouping have been utilized to expect perfection of hypo or hyperthyroidism.&#x0D; Patients and Methods: This is a cross-sectional study achieved in the laboratories of Rizgary Teaching Hospital and Erbil Teaching Hospital in Erbil, Iraq, within the period of May 2020 to April 2021. The study included 66 patients, both males and females included. These patients had clinical indications and were suspected of having a sort of thyroiditis. Anti-TPO electrochemiluminescence immunoassay analysis has been included by the analysts in conjunction with conventional markers immunoassay of thyroid TSH, T3, and Free T4 trusting that this would help in lessening morbidity and related wellbeing concerns. &#x0D; Results: There was an increase in the level of anti-TSH antibodies in the hyperthyroidism group (60.6%) which was more than in those with hypothyroidism (36.4%), significant association exist (P≤0.049). Moreover, the level of Anti-TPO Abs was higher among hypothyroidism patients (63.6%) than among hyperthyroidism cases (33.3%), this association was statistically significant (P≤0.014).&#x0D; Conclusion: Demonstrating the clinical importance of this antibody and the benefit of adding anti-TPO, in combination with TSH and FT4. Addition of one test could potentially save expenditure on long-term diseases such as overt thyroid disease and its attended morbidities.

Evaluation of Thyroid Dysfunction in Adult Patients of Celiac Disease

OBJECTIVES: &#x0D; To assess free thyroxine (fT4), thyroid stimulating hormone (TSH), and anti thyroid peroxidase antibodies (anti TPO abs) in adult Celiac disease patients and non-celiac controls and to find out any statistically significant difference in their corresponding means between the two groups.&#x0D; METHODOLOGY:&#x0D; The study design was analytical cross sectional. Sixty adult patients of celiac disease (CD) and 30 apparently healthy non-celiac adults were included in the study. CD patients had earlier been diagnosed by elevated levels of serological evidence of elevated (greater than 15X ULN) anti tissue transglutaminase (TTG) (IgA class) antibodies. CD was ruled out in the control group by normal levels of the antibodies. TSH, fT4 and anti TPO abs were obtained from all individuals of CD patient and control groups. &#x0D; RESULTS:&#x0D; Mean age of Celiac disease in patients was 23.85±5.43 years. Mean age of individuals in the control group was 24.26±5.55 years. Statistically significant difference in mean TSH and anti-TPO abs levels between the CD patient group and control group (p values of 0.03 and 0.038, respectively) was present. No statistically significant difference was seen between mean fT4 of patients and control group (p=0.74). Subclinical and overt hypothyroidism was present in 10% and 5% of CD patients, while anti TPO abs was positive in 16.6% of CD patients.&#x0D; CONCLUSION:&#x0D; There is a considerably high prevalence of subclinical and overt hypothyroidism as well as serological evidence of thyroid dysfunction in adult patients of CD.

Relation between Obesity and Maternal Hypothyroxenemia during Early Pregnancy

Abstract Aim of the Work To study the relation between maternal obesity (indicated by BMI), maternal hypothyroidism, thyroid peroxidase antibodies and anti-thyroglobulin positivity during early pregnancy. Patients and Methods The study was conducted in Ain shams University Hospital and National Institute of Diabetes and Endocrinology. The study included women aged 19–40 who were pregnant at the 4th –8th weeks of gestation. Results obese group had the highest prevalence of overt (5.33%) and subclinical hypothyroidism (2.6%), highest mean TSH value, p value (0.007*). And the lowest mean FT4 with p value (0.017*) .Also obesity was associated with the highest prevalence of anti TPO (16%) and anti TG Abs (12%). Conclusion we concluded that maternal obesity may be associated with TPO anti TG positivity, subclinical hypothyroidism and overt hypothyroidism. Screening of thyroid function in obese pregnant females can detect maternal hypothyroidism and prevention of its hazard’s effects for both mother and fetus.

Antiphospholipid antibodies in patients with Graves' orbitopathy: preliminary data.

Graves' orbitopathy (GO) is an inflammatory autoimmune disorder of the orbit and while the antiphospholipid antibodies (aPL) Abs were associated with the markers of inflammation in the antiphospholipid syndrome (APS), there is no literature that investigate the presence of aPL Abs in GO. We analyzed the prevalence of aPL Abs and the differences between aPL (+) and aPL (-) subgroups of GO patients. Study included consecutive patients with GO (66 with Graves' (GD), 10 with Hashimoto (HD), and 8 were euthyroid). Anticardiolipin (aCL) and anti-beta 2glycoprotein I (aβ2gpI) Abs were measured by ELISA. aPL Abs were present in 9/84 (10.71%) patients. The IgM aβ2gpI Abs were present in 8/66 and in 1/10 patients with GD and HD. The IgG aCL Abs were present in one GD patient, and IgM aCL were present in 3/66 GD and in 1/10 patients with HD. In GD group, anti-Tg Abs were in positive correlation with aβ2gpI IgG (p = 0.000) and with anti-TPO Abs (p = 0.016). In HD group, anti-Tg Abs were in positive correlation with IgM aCL (p = 0.042), while anti-TPO Abs were in positive correlation with aβ2gpI IgM (p = 0.014). This study is the first report of the aPL Abs presence in GO patients. The anti-thyroid Abs were linked to aPL suggesting that their presence is not the sole consequence of hyperstimulation of autoreactive B-lymphocytes. Larger studies are necessary to confirm potential cause-effect relations.

Headache, Pituitary Apoplexy and Diabetes insipidus: Suspect Necrotizing Hypophysitis

Background: Necrotizing hypophysitis (NH) is an exceedingly rare clinical entity; we found only 5 reported cases in a literature review. CASE: A 34-year-old female with a history of primary hypothyroidism developed a headache, double vision, nausea, vomiting, decrease in appetite, galactorrhea, and weight loss. An MRI of the brain showed a 0.9 cm T2 hyperintense pituitary lesion with features suggestive of cystic degeneration or apoplexy of an adenoma There was effacement of the optic nerve anterior to the optic chiasm. Eye examination revealed optic nerve edema and a cranial nerve VI palsy. Laboratory studies revealed a normal prolactin 20.0 (3.3-26.7 ng/ml), and IGF-1 189 (RR: 66 - 303 ng/ml). The pituitary-adrenal axis and pituitary-gonadal axis appeared intact. After short treatment with dexamethasone, her primary symptom of severe headache improved but she later developed polyuria. The evaluation confirmed diabetes insipidus. Her headache worsened after the completion of the brief course of steroids. After a repeat MRI showed mild interval enlargement of the hypo-enhancing posterior pituitary, she underwent transsphenoidal pituitary tumor surgery. A biopsy showed necrotizing inflammation with foci of acute necrosis accompanied by polymorphonuclear cells. There was no granuloma seen. Special stains were negative for fungal, acid-fast, and bacterial organisms. Laboratory studies revealed negative ANA, negative ANCA, PR-3 Ab, MPO Ab, and anti-TPO Abs. The ACE enzyme was elevated at 85 (RR: 8-53 U/l), but the repeat test was within the normal range. A chest CT was not suggestive of pulmonary sarcoidosis. A post-surgery MRI demonstrated a decrease in pituitary size. Her headache worsened with a reduction in prednisone below 20 mg daily. In order to attempt further reduction in prednisone, azathioprine was started as a steroid-sparing agent. Titration of azathioprine up to 175 mg allowed prednisone to be reduced to the replacement dose of prednisone 5 mg daily. An MRI showed the pituitary mass to be unchanged. DISCUSSION: Hypophysitis is associated with diffuse enlargement and dysfunction of the pituitary gland. This case of NH is of unclear cause. There was no evidence of other inflammatory causes such as sarcoidosis, IgG4-related disease, ANCA-associated vasculitis, or infectious cause. As with typical lymphocytic hypophysitis, NH can present with sudden-onset hypopituitarism, neural compression, diabetes insipidus, and radiologic features of ischemic pituitary apoplexy. Signs and symptoms at diagnosis, as well as pituitary hormone abnormalities, vary on the degree of pituitary involvement. Pituitary adenoma commonly does not cause diabetes Insipidus. Radiologic findings consistent with ischemic pituitary apoplexy coupled with the presence of diabetes insipidus is suggestive of NH. A definitive diagnosis of NH, however, requires histopathology.

HOSPITAL-BASED CLINICAL STUDY ON PREVALENCE OF TPO ANTIBODIES IN ASSOCIATION TO AUTOIMMUNE THYROID DISEASES IN TERTIARY CARE HOSPITAL

Objective: Autoimmune thyroid disease is one of the organs specific autoimmune disorders. The onset is much more common in women than in men. Worldwide, 2–4% of women and only 1% of men have affected and the rate increases with age. Thyroperoxidase (TPO) antibodies (Abs) level helps to diagnose autoimmune thyroid disease along with levels of thyroid stimulating hormone (TSH), Free Tri-iodotyrosine (Free T3), and Free Thyroxin(Free T4) and it helps in differentiation between subclinical and overt thyroidism. The core objective of clinical study was to evaluate prevalence of anti-TPO Abs in association to autoimmune thyroid disease in a tertiary care hospital – Punjab.&#x0D; Methods: A cross-sectional study of random patient (n=200 patients) at a tertiary care hospital, Mohall – Punjab was carried out. All the patients fall in the age group 12–89 years. The parameters, which were used for the diagnosis of autoimmune thyroid disease, were anti-TPO level, Free T3 level, and Free T4 level. The patients were divided in different group on the basis of their age, gender, and their clinical conditions. The level of TPO Abs, TSH, Free T3, and Free T4 was noted for each patient. Electrochemiluminescence immunoassay method was used for determination of TPO Abs and other thyroid parameters. After a period of 16 weeks, subjects from different groups had great difference in their anti-TPO values in the autoimmune thyroid disease.&#x0D; Results: TPO Abs positive is one of the most common associated with hypothyroidism which was 36.5%, among them 20.5% suffered from subclinical hypothyroidism, whereas other remaining suffered from clinical hypothyroidism, clinical hyperthyroidism, and other autoimmune disease.&#x0D; Conclusion: TPO Abs level helps to diagnose autoimmune thyroid disease, along with this the level of TSH, Free T3, and Free T4 helps in differentiation between subclinical and overt thyroidism.

Hashimoto's Encephalopathy: A Case Report and Literature Review of an Encephalopathy With Many Names.

We present the case of a male patient, initially treated for myxedema coma secondary to Hashimoto’s thyroiditis, who was discharged on levothyroxine and a low-dose steroid taper but was re-admitted for the treatment of status epilepticus. During the second admission, the patient developed encephalopathy and cognitive dysfunction. Thyroid peroxidase (TPO) antibodies (Abs) were elevated and the patient was treated with high-dose steroids with clinical improvement. The patient was determined to have Hashimoto’s encephalopathy (HE) due to the clinical picture as well as the response to high-dose glucocorticoid therapy. Cerebrospinal fluid (CSF) analysis demonstrated elevated protein, immunoglobulin G (IgG) index, and IgG synthesis rate; however, albumin index was elevated, indicating a disrupted blood-brain barrier. We suggest that HE be considered in the differential diagnosis for patients presenting with seizures, coma, stroke-like symptoms, behavior changes, and unexplained encephalopathy. After ruling out more common pathologies, HE should be considered by testing for anti-TPO Abs.

Association of Anti-TPO Antibodies with Insulin Resistance in Patients of Hypothyroidism with Metabolic Syndrome: A Cross-sectional Study

Introduction: Hypothyroidism and Metabolic Syndrome (MetS) are associated with insulin resistance. Exact reason for development of insulin resistance in hypothyroidism is still unclear. Aim: To determine the association between Anti-Thyroid Peroxidase Antibodies (Anti-TPO Abs) and Thyroid Stimulating Hormone (TSH) with components of MetS, Fasting Insulin (FSI) and Homeostatic Model Assessment Index for Insulin Resistance (HOMA-IR). Materials and Methods: Total 118 subjects of hypothyroidism were included in this cross-sectional study. The diagnosis of MetS was made based on National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Independent association of components of MetS, FSI and HOMA-IR with TSH and anti-TPO Abs was analysed by multivariate linear regression analysis. Results: MetS was more prevalent in subclinical hyperthyroidism (53.0%) compared to overt hypothyroidism (49.3%). Serum anti-TPO Abs level was significantly high in MetS group compared to non-MetS group in both overt (200.0±170.2 and 122.8±98.9, p=0.02*) and subclinical (184.9±142.9 and 114.5±90.9, p=0.04*) hyperthyroidism. Waist Circumference (WC), Fasting Plasma Glucose (FPG), FSI and HOMA-IR were independently associated with anti-TPO Abs in both overt and subclinical hypothyroidism. Anti-TPO was also increased significantly in linear trend along with increased in the number of MetS components in both overt and subclinical hypothyroidism. Conclusion: MetS is highly prevalent in hypothyroidism and anti-TPO Abs rather than TSH and is more associated with insulin resistance in patients of hypothyroidism with MetS.

Rapid Evolution of Thyroid Dysfunction in Patients Treated with Nivolumab

To describe the evolution of thyroid dysfunction in a series of patients with cancer treated with the immune checkpoint inhibitor anti-programmed cell death protein-1 (PD-1) monoclonal antibody, nivolumab. Cases of thyroid dysfunction after initiation of checkpoint inhibitor treatment were identified from the Division of Endocrinology clinical practice at Mount Sinai Hospital, New York from April 2016 to February 2017. Charts were reviewed to identify patients treated with nivolumab with new onset of thyroid dysfunction. Nine cases of thyroid function in patients who were treated with nivolumab were identified. There were 4 male and 5 female patients, with a mean age of 66 years (range 50-76 years). Seven patients ultimately developed hypothyroidism. Five of the 7 patients developed abnormal thyroid function tests within the first 90 days of starting therapy (range 21-84 days), 3 of whom had transient hyperthyroidism. Transient hyperthyroidism evolved rapidly to hypothyroidism; elevated thyroid-stimulating hormone (TSH) levels were detected within 16 to 32 days of the last documented low TSH. In the 2 patients without a hyperthyroid phase, TSH levels >50 were found 18 to 28 days after the last normal TSH value. As the use of immune checkpoint inhibitor therapy increases, the need for prompt diagnosis and treatment of drug-induced thyroid disease will become more important. As illustrated in this case series, in contrast to other causes of auto-immune thyroiditis, hypothyroidism can develop rapidly within 3 months of treatment. Close monitoring is necessary to detect the development of thyroid dysfunction and avoid preventable morbidity. Anti-TPO Abs = anti-thyroglobulin antibodies; CT = computed tomography; CTLA-4 = cytotoxic T-lymphocyte-associated protein 4; FDA = U.S. Food & Drug Administration; FDG-PET = fluorodeoxyglucose-positron emission tomography; PD-1 = programmed cell death protein-1; PD-L1 = programmed death-ligand 1; T3 = triiodothyronine; T4 = thyroxine; TG = thyroglobulin; TPO = thyroperoxidase; TSH = thyroid-stimulating hormone.

Monitoring the prevalence of thyroid disorders in the adult population of Northeast Germany.

BackgroundOnly a few studies like ours have investigated the effect of long-term stable iodine supply on thyroid disorders in a historically iodine-deficient population, but not with a long follow-up time of 10 years.MethodsData were derived from two independent population-based cohorts of the Study of Health in Pomerania (SHIP-0 [1997–2001] and SHIP-TREND [2008–2012]) comprising 4308 and 4420 subjects, respectively. Diagnosed thyroid disorders were assessed. Thyroid gland dimensions were examined by ultrasound. Levels of serum thyrotropin (TSH) and autoantibodies to thyroperoxidase (anti-TPO Abs) were measured from blood samples.ResultsMedian urinary iodine excretion levels decreased from 123.0 μg/l to 112.0 μg/l (p = <0.001) between 2000 and 2010. The prevalence of known thyroid disorders increased from 7.6 % [CI 6.9–8.5] to 18.9 % [CI 17.6–20.1] and of thyroid medication use from 6.2 to 11.1 %. The prevalence of goiter decreased from 35.1 to 29.4 % (p = <0.001), while the prevalence of positive anti-TPO Abs decreased from 3.9 to 2.9 % (p = 0.022). Median serum TSH levels increased from 0.69 mIU/L to 1.19 mIU/L (p = <0.001). Consequently, prevalence of high TSH (mIU/L) increased from 2.6 to 2.9 % (p = 0.452), and low TSH (mIU/L) decreased from 6.6 to 6.4 % (p = 0.737).ConclusionThe decreased prevalence of iodine-deficient disorders and a stable prevalence of markers of autoimmune thyroid disorders argue for an improved iodine supply of the adult population in Northeast Germany. In contrast, the prevalence of diagnosed thyroid disorders and the intake of thyroid medication increased, although this might be related to inappropriate therapeutic decisions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12963-016-0111-3) contains supplementary material, which is available to authorized users.

050 Anti-thyroid peroxidase antibodies demonstrate functional effects on keratinocyte signaling and cell-adhesion in Pemphigus vulgaris

It is increasingly recognized that Pemphigus vulgaris (PV) patients develop autoantibodies (autoAbs) directed at targets additional to desmoglein (Dsg) 3 and 1. We have previously identified a subset of patients that harbor autoAbs against thyroid peroxidase (TPO). We have also shown that commercially available anti-TPO Abs are capable of disrupting cell-cell adhesion in keratinocyte monolayers and can modulate signaling pathways known to be relevant to blister formation. To further investigate the extent to which anti-TPO autoAbs play a role in disease pathogenesis we evaluated the affect of anti-TPO Abs in several in vitro assays. 1) We show that commercially available anti-TPO Abs increase p38MAPK activation within 4 h after treatment. 2) We demonstrate that depletion of either anti-TPO or anti-Dsg3 autoAbs from IgG purified from patient sera (PVIgG) dampens the ability of PVIgG to increase intracellular calcium levels in keratinocytes. 3) We demonstrate that the adsorption of anti-TPO autoAbs from patient sera reduces the ability of PVIgG to cause fragmentation of a keratinocyte monolayer. This effect is less dramatic compared to the depletion of anti-Dsg3 autoAbs and is most pronounced when using PVIgG from patients shown by ELISA to possess anti-TPO but not anti-Dsg3 or -1 autoAbs. We also show that PVIgG from patients who do not possess autoAbs against Dsg3, Dsg1, or TPO is still pathogenic, suggesting other autoAb specificities may also be relevant to disease in some patients. Collectively, our data suggests that anti-TPO autoAbs may contribute to disease pathogenesis in PV and that, in some cases, autoAbs directed against targets beyond TPO, Dsg3, or Dsg1 may be relevant in disease. Further studies are needed to characterize the broader scope, specificity, and pathogenicity of the autoAb response in PV in vivo.

Antithyroperoxidase Antibodies in Encephalopathy: Diagnostic Marker or Incidental Finding?

Patients with acute encephalopathy who are thoroughly examined for an underlying diagnosis and in whom infectious, metabolic, and malignant causes are excluded can form a true diagnostic dilemma. If antithyroperoxidase antibodies (anti-TPO abs) are present, the diagnosis “steroid responsive encephalopathy, associated with autoimmune thyroiditis” (SREAT), better known as Hashimoto encephalitis, will often be considered. The precise pathophysiology of SREAT, including the possible role of the anti-TPO abs and the possible relationship between the encephalopathy and thyroid function, remains to be elucidated. Here we present three young patients with SREAT. Our patients illustrate that in unexplained encephalopathy, after exclusion of other causes (diagnosis of exclusion), determination of the anti-TPO abs may contribute to the diagnosis of SREAT. They also illustrate that thyroid function or the concentration of the anti-TPO abs does not seem to be associated with the severity of the clinical presentation of SREAT. We hypothesize that SREAT has an immunologic etiology. The presence of anti-TPO abs, however, should be considered to be a marker for autoimmunity and not a causative. It probably reflects the presence of predisposition of autoimmunity in these patients. Therefore, this condition should not be called Hashimoto encephalitis any longer.

STUDYING SOME IMMUNOLOGICAL PARAMETERS IN PREGNANT WOMEN WITH THYROID GLAND PROBLEMS

This study was carried out to determine some hormonal and immunological parameters in women who attended Maternity and Children teaching hospital in Ramadi city , from 1st of August 2014 to 1st of April 2015. Ages of patients ranged from 16 - 49 years . The study included 358 blood samples from pregnant and non-pregnant women . sixty five samples were found to be abnormal thyroid function . The remaining 293 samples from healthy pregnant and not pregnan-pregnant women were used as a controls . Women under study were divided into three groups: Pregnant Women with thyroid disorder( Group I ) , Pregnant Women without thyroid disorder (Group II ,control 1) , and non- Pregnant Women without thyroid disorder (Group III , control 2). The study showed that there was no significant differences in T3 ,T4and FTI levels in patient compared with control 1 ( p-value >0.05) while it showed significant difference between patient and control 2 with p-value (<0.05). the means of T3,T4 and FTI in patient were 4.08 ng/ml, 91.09 μg/dl, 69.55 respectively. While there was no significant difference in level of TSH in cases and control 1 and control 2 with p-value >0.05. The mean level of TSH of patient was 18.65 μIU/ml . A comparison in Immunological parameters between the three groups with each other showed that there was significant increase in levels of Anti thyroxin peroxidase abs and Anti thyroglobulin abs in cases compared with control 2 with p-value <0.05,but didn’t show significant difference between cases and control 1 with p-value >0.05.The mean levels of patients for Anti TPO abs was 302.10 IU/ml and for Anti TG abs was 143.21 IU/ml.