Positive Anti-thyroid Peroxidase Antibodies Research Articles

Selenium levels and their association with thyroid autoimmunity and severe preeclampsia in pregnancy: Insights from a prospective ideal breast milk cohort study.

This study aimed to assess selenium status in South Korean pregnant women and its impact on maternal thyroid function and pregnancy outcomes. 'Ideal Breast Milk (IBM) Cohort Study' included 367 pregnant women out of 442 participants and categorized into three groups based on plasma selenium levels: deficient (< 70 μg/L), suboptimal (70-99 μg/L), and optimal (≥ 100 μg/L). During the second or third trimester, various blood parameters, including selenium, thyroid-stimulating hormone, free T4, free T3, and anti-thyroid peroxidase antibody levels, were measured. Thyroid parenchymal echogenicity was assessed as another surrogate marker for thyroid autoimmunity using ultrasonography. The median plasma selenium was 98.8 (range: 46.7-206.4) μg/L, and 30 individuals (8%) were categorized as deficient, while 164 (45%) were classified in the suboptimal group. Selenium deficiency was associated with markers of autoimmune thyroiditis, including positive anti-thyroid peroxidase antibody results (13.3 (deficient) vs 4.6 (optimal) %, P = 0.031) and thyroid parenchymal heterogeneity on ultrasound (33.3 (deficient) vs 14.6 (suboptimal) vs 17.3 (optimal) %, P = 0.042), independently of gestational age. The incidence of severe preeclampsia was higher in the group not taking selenium supplements, particularly among those with twin pregnancies, compared to the group taking selenium supplements (0 (selenium supplement) vs 9.0 (no supplement) %, P = 0.015). Pregnant women experience mild selenium deficiency, which can lead to significant health issues including maternal thyroid autoimmunity and obstetrical complications during pregnancy. Guidelines for appropriate selenium intake according to the stage of pregnancy and the number of fetuses are needed.

Correlation between auto-immune diseases and type 1 diabetes mellitus in the pediatric age group in Erbil city

Background and objective: Type-1 diabetes mellitus is the most common chronic endocrine disorder of childhood and adolescence and is characterized by immune-mediated destruction of pancreatic cells, which has been proven to be correlated with and increase the risk of developing autoimmune thyroid disease, celiac disease, Addison’s disease, and further autoimmune diseases. The aim of this study is to evaluate the prevalence of autoimmune disease-related markers in type 1 diabetes mellitus in children and adolescents in Erbil city. Methods: One hundred children and adolescents with type 1 diabetes mellitus were enrolled in this cross-sectional study. Patients &lt;1 year old were excluded from the study. Autoimmune thyroid antibodies (anti-thyroid peroxidase and anti-thyroglobulin) along with tissue transglutaminase (IgA and IgG) antibodies were measured with further evaluation by thyroid function test and endoscopy with biopsy (for positive serological autoantibodies level). Results: Elevated anti-thyroglobulin, anti-thyroid peroxidase, and tissue transglutaminase IgA and IgG antibodies were determined in 24.0%, 26%, 10%, and 8%, respectively. 50.0% of cases with positive anti-thyroid peroxidase antibodies had overt hypothyroidism; on the flip side, 3.8% had subclinical hypothyroidism. As well, the high level of thyroid autoantibodies was significantly correlated to the prevalence of overt hypothyroidism (P &lt;0.001). Nine of the patients with positive tissue transglutaminase antibodies were verified to have biopsy-proven celiac disease. Conclusion: Children and adolescents with type 1 diabetes mellitus are at risk of developing positive antithyroid and celiac-related autoantibodies, so they are at risk of progressing to autoimmune thyroid and celiac diseases.

Lipoprotein alterations in endocrine disorders - a review of the recent developments in the field.

Dyslipidemia is one of the most common disorders worldwide, which, if left untreated, results in a multitude of complications. Thus proper diagnostics, which includes identifying of secondary causes of dyslipidemia is crucial. Endocrine disorders are an important cause of secondary dyslipidemia. This paper aims to review the publications on lipoprotein alterations in endocrine disorders from the past two years and provide an overview of the recent discoveries in this dynamically developing and large field. Significant changes in lipoprotein serum concentrations are present in most endocrinological diseases and can be modified with proper treatment. Some lipoproteins have also been proposed as markers in some endocrine diseases, e.g., thyroid carcinoma. From the scope of endocrine disorders, the largest number of studies explored the lipoprotein changes in polycystic ovary syndrome and in women during the menopausal and peri-menopausal period. Even though the association of thyroid disorders with dyslipidemia is already well studied, new research has delivered some exciting findings about lipoprotein alterations in euthyroid patients with either positive antithyroid peroxidase antibodies or reduced sensitivity to thyroid hormones. The problem of the adverse metabolic profile, including dyslipidemia in hypoprolactinemia has been recognized. Moreover, this review describes other significant discoveries encompassing lipoprotein alterations in disorders of the adrenals, thyroid, parathyroid glands, pituitary, and gonads. The up-to-date knowledge of the influence of endocrine disorders and hormonal changes on serum lipoproteins is prudent as it can significantly impact therapeutic decisions.

The association between baseline TPOAb and/or TgAb positivity and thyroid immune-related adverse events in patients with malignancies following treatment with immune checkpoint inhibitors

Objective: To investigate the association between positive anti-thyroid peroxidase antibody (TPOAb) and/or anti-thyroglobulin antibody (TgAb) and the occurrence of thyroid immune-related adverse events (irAEs) in patients with malignant tumors who treated with immune checkpoint inhibitors (ICIs). Methods: A case-control study. A total of 116 patients with malignant tumor who received ICIs treatment and underwent thyroid function evaluation at Peking Union Medical College Hospital from January 2017 to April 2023 were enrolled retrospectively, including 77 males and 39 females, with a median age of (M(Q1, Q3)) 63.0 (55.0, 70.0) years. The patients were divided into the euthyroid group (n=58) and the thyroid irAEs group (n=58) according to whether thyroid irAEs occurred after ICIs treatment. The clinical characteristics and baseline anti-thyroid antibodies associated with the occurrence of thyroid irAEs after ICIs treatment in patients with malignant tumors were evaluated. Variables with statistical significance in univariate analysis were included in multivariate logistic regression model to analyze the risk factors for thyroid irAEs in patients with malignant tumors who received ICIs treatment. Results: In irAEs group, therewore 4 (3.4%) cases of clinical thyrotoxicosis, 23(19.8%) cases of subclinical thyrotoxicosis, 23 (19.8%) cases of clinical hypothyroidism, and 8(6.9%) cases of subclinical hypothyroidism. The positive rate of anti-thyroid antibodies at baseline in the thyrioid irAEs group was higher than that in the euthyroid group［16/58（27.6%）vs 3/58（5.2%），P=0.001］. After at least one course of ICIs treatment, the incidence of thyroid irAEs in patients with positive anti-thyroid antibodies at baseline was 84.2% (16/19), whereas it was 43.3% (42/97) in patients with negative anti-thyroid antibodies(P=0.001). Univariate logistic regression analysis showed that gender (OR=2.812, 95%CI:1.257-6.293), baseline thyroid autoantibodies were positive (OR=6.984, 95%CI: 1.909-25.547), baseline TgAb positivity (OR=8.909, 95%CI: 1.923-41.280), and baseline TPOAb positivity (OR=7.304, 95%CI: 1.555-34.308) were associated with thyroid irAEs (all P<0.05). Multivariate logistic regression analysis indicated that baseline TgAb positivity (OR=7.637, 95%CI: 1.617-36.072) was a risk factor for thyroid irAEs (P=0.01). Conclusions: The incidence of thyroid irAEs is higher in patients who are positive for baseline TPOAb and/or TgAb compared to those who are negative for TPOAb and TgAb. Patients with positive TgAb at baseline are at high risk of developing thyroid irAEs.

Body Mass Index and Thyroid Function Tests in Male Adults in Mosul City

The relationship between thyroid gland and body mass index (BMI) is a subject of growing interest. Thyroid hormones' impact on metabolism directly affects energy expenditure which is in turn affect weight balance.&#x0D; Subjects and Method: This study occurred in Mosul city in the north of Iraq, between December 2022 - June 2023, and it comprised one hundred adult males ranging in age from 20 - 60 years. Participants had to be apparently healthy men with appropriate thyroid functions, according to the inclusion criteria. Individuals who used specific medicines known for altering thyroid functions were excluded, those who have positive anti-thyroid peroxidase antibodies (ATPO), a personal or familial history of thyroid diseases, and medical illnesses such as hypertension, diabetes, and cardiac, renal, and liver diseases. The thyroid parameters that’s measured to the subjects were triiodothyronine (FT3), thyroxine (FT4) using immuno-enzymatic competitive assays and Thyroid stimulating hormone (TSH) by two-site immuno-enzymatic (sandwich) method.&#x0D; Results: found no significant relationships between BMI and other thyroid function FT3 no significant increase TSH, on the contrary increased across BMI classes, moreover FT4 decreased.&#x0D; Conclusion: this work showed that the thyroid function of the different BMI groups under investigation showed no significant change.

Maternal thyroid peroxidase antibody positivity and its association with incidence of low birth weight in infants.

Autoimmune thyroid disease is a prevalent condition affecting women of reproductive age, leading to thyroid dysfunction and impacting pregnancy outcomes. While the critical role of thyroid hormone in pregnancy outcomes is well-established, the potential association between positive anti-thyroid peroxidase antibodies (TPOAb) and adverse pregnancy outcomes in pregnant women with normal thyroid function remains unclear. This study aims to investigate the relationship between maternal TPOAb positivity and adverse pregnancy outcomes with normal thyroid function. We collected baseline information from pregnant women who visited our hospital between February 2009 and June 2012. Blood samples were taken to measure thyroid stimulating hormone (TSH), free thyroxine (FT4), TPOAb, and anti-thyroglobulin antibodies (TGAb). The incidence of adverse pregnancy outcomes was compared between TPOAb-positive and TPOAb-negative groups among participants with normal thyroid function. A total of 7,046 pregnant women with normal thyroid function were included, comprising 6,700 with negative TPOAb and 346 with positive TPOAb. The TPOAb-positive group exhibited a higher age (26.0 vs. 27.0 years, p = 0.02) and greater serum TSH levels (1.72 vs. 1.94 mIU/L, p = 0.029), while the gestational week of blood collection was lower (31.9 vs. 26.5 weeks, p = 0.001). Univariate analysis revealed a higher incidence of low birth weight (LBW) in offspring of TPOAb-positive women compared to the TPOAb-negative group (3.5% vs. 1.9%, p = 0.035). After adjusting for confounding factors such as age, gestational week of blood collection, menstrual history, education level, gestational diabetes, gestational hypertension, TGAb, TSH, and FT4, TPOAb positivity emerged as an independent risk factor for LBW infants (OR: 2.317, 95% CI: 1.057-5.076, p = 0.036), while other adverse pregnancy outcomes did not show a significant correlation with TPOAb positivity. Our findings suggest that TPOAb-positive pregnant women with normal thyroid function are more likely to deliver LBW infants. Regular monitoring of TPOAb-positive pregnancies and timely interventions throughout all stages of pregnancy are crucial.

Simultaneous Thyroid Autoimmunity: A Coexistence of Grave's Disease and Hashimoto's Thyroiditis

Introduction: Grave’s Disease (GD) and Hashimoto's Thyroiditis (HT) are two autoimmune diseases whose coexistence is rare. We report a case of a patient in whom both diseases manifested simultaneously. Case report: A 36- year-old woman presented with thyrotoxicosis. She had tachycardia with WHO grade 2 homogeneously non-pulsatile goiter, without exophthalmos. The evaluation revealed peripheral hyperthyroidism with positive anti-thyroid peroxidase (anti-TPO) antibodies and anti-thyroid-stimulating hormone receptor (anti-TSHR) antibodies. Cervical ultrasound revealed a goiter affecting the right lobe in the context of thyroiditis. Thyroid scintigraphy indicated a picture suggestive of Graves' disease in the left lobe and hypocaptating thyroiditis in the right lobe. The patient was treated with propranolol and Carbimazole, with alternating phases of hyperthyroidism and hypothyroidism. Discussion and Conclusion: Autoimmune thyroid diseases, GD and HT, are specific to the thyroid gland and are common in women. They share pathogenic features that could explain their association, including genetic and environmental factors leading to thyroid cell damage, T-cell-mediated autoimmunity, human leukocyte antigen binding, and the presence of autoantibodies such as anti-thyroid peroxidase antibodies in GD. Rare cases have demonstrated that HT can manifest after GD, and vice versa, leading to an alternation of hyperthyroidism and hypothyroidism in certain patients due to changes in the balance between various categories of antibodies. In the present case, the patient simultaneously presented both diseases.

TPOAb positivity can impact ovarian reserve, embryo quality, and IVF/ICSI outcomes in euthyroid infertile women

The aim of this study was to investigate the effects of positive anti-thyroid peroxidase (TPO) antibodies on fertility, embryo quality, and pregnancy outcomes in women with normal thyroid function. A cross-sectional study of 1223 infertile women who received assisted reproductive technology (ART) treatment for the first time was conducted at our hospital from January 2019 to March 2022. Overall, 263 infertile women were included, comprising 263 cycles and 1813 embryos, and were divided into a positive group and a control group based on TPO antibody levels. The positive group was further divided into two subgroups according to the median antibody titer, and the therapeutic indices and pregnancy outcomes for each group were compared. The results showed that the AMH level in the positive group was significantly lower than that in the control group (2.37 (1.26-3.63) ng/ml vs. 3.54 (1.74-5.41) ng/ml, p < 0.001). The high-quality embryo rate (40.04% vs. 45.49%, p = 0.034) and live birth rate (23.26% vs. 36.16, p = 0.035) of the positive group were lower than those of the control group; the miscarriage rate was higher than that of the control group (37.50% vs. 17.95%, p = 0.035). The live birth rate in the low-titer group was significantly higher than that in the high-titer group (32.56% vs. 13.95%, p = 0.041). Studies have shown that positive anti-thyroid peroxidase antibodies are associated with a decreased ovarian reserve and decreased embryo quality. High titers of anti-thyroid peroxidase antibodies can reduce the live birth rate.

ASSOCIATION BETWEEN ANTI-THYROID PEROXIDASE ANTIBODY AND RECURRENT MISCARRIAGE

Background Thyroid disease is the second most commonly affected disease in childbearing women, after diabetes, and thyroid autoimmunity in pregnancy has been connected with adverse pregnancy outcomes such as miscarriage, recurrent miscarriage, preterm birth, and low intelligence.&#x0D; Objectives The study seeks to determine whether there is a significant correlation between anti-thyroid peroxidase antibodies and unexplained recurrent miscarriages.&#x0D; Patients and MethodsA Case-control study was conducted on 124 participants, 62 women who had experienced unexplained recurrent miscarriage and 62 healthy women without a history of miscarriage, from 11.9.2021 until 10.6.2022 in the outpatient and emergency department of Sulaimani Maternity Teaching Hospital and some private clinics in Sulaimani City/Kurdistan Region /Iraq, and screening for TSH and anti–thyroid peroxidase antibody are done for both groups.&#x0D; ResultsThe prevalence of positive anti-thyroid peroxidase antibody in women with recurrent miscarriage was 19.4 %, while in women without miscarriage was 6.5% (which is considerably higher in cases than in women without recurrent miscarriage with a p-value of 0.03 and an odd ratio of 3.48 (95% CI; 1.06-11.48).&#x0D; ConclusionThere is a statistically significant relationship between anti-thyroid peroxidase antibodies and recurrent miscarriage. We recommend screening for TSH and thyroid antibodies for women with recurrent miscarriages and further studies on the effect of levothyroxine therapy for euthyroid women with antibody positive.

STUDY AND CORRELATION OF ANTI THYROID PEROXIDASE ANTIBODY AND ULTRASONOGRAPHY FINDINGS OF THYROID IN PATIENTS OF THYROID DISEASES

Aim: To determine Anti thyroid peroxidase antibody and ultrasonography features of thyroid gland in thyroid disorder patients and study their correlation. Design: This is an observational, cross sectional study and techniques used are clinical and non-invasive. Method: Thyroid function tests, Anti-thyroid peroxidase (Anti-TPO)antibody and ultrasonography neck were performed in 150 patients .Eligible participants were adults of age group 15-70 years with deranged thyroid function tests . Pregnant patients and patients already on thyroid medications were excluded from the study The participants were classified as overt , subclinical hypothyroid or overt, subclinical hyperthyroid. Anti thyroid peroxidase antibody and ultrasonography neck findings obtained were analyzed and correlated using statistical methods. Statistical Analysis: Frequency and percentage were calculated and test of significance such as Chi square test, T test were used. Correlation was assessed using Spearmans correlation coefficient p=&lt;0.05 is considered significant. Result: From January 2020 to August 2021, 150 patients participated in the study in which 50%(n=75) patients were found to be subclinical hypothyroid, 21.3%(n=32) were overt hypothyroid, 21.3% (n=32) were overt hyperthyroid , 6% (n=09) were subclinical hyperthyroid and 1.3%(n=2) were euthyroid with thyroid swelling. 51.3%(n=77) patients had diffuse thyroid disease on ultrasonography neck, normal gland in 19.3%(n=29) patients, thyroiditis in 11.3%(n=17) patients ,Multinodular goiter in 10.6%(n=16) patients, nodule in 6%(n=09) and atrophic gland in 1.34%(n=02) patients. Anti thyroid peroxidase was positive in 62%(n=93) patients. Among patients with diffuse hypoechogenecity on ultrasonography 85%(n=80) patients had positive Anti-TPO antibody with p value 0.05. Conclusion: Maximum number of patients with thyroid diseases had a positive Anti thyroid peroxidase antibody that suggests autoimmunity as a major etiology of thyroid disease.Among patients with diffuse hypogenecity on USG,85%(n=80)patients had positive Anti-TPO antibody with statistical significance(p 0.05). Ultrasonography neck is non invasive ,safe and cost effective method to ascertain the cause of thyroid disease and has a major role in predicting prognosis of the disease. Abbreviations: Anti thyroid peroxidase antibody-Anti-TPO antibody Ultrasonography-USG.

Risk of Thyroid Dysfunction in PD-1 Blockade Is Stratified by the Pattern of TgAb and TPOAb Positivity at Baseline.

Positive antithyroglobulin (TgAb) and/or antithyroid peroxidase antibodies (TPOAb) at baseline indicate a high risk of thyroid immune-related adverse events (irAEs) induced by antiprogrammed cell death-1 antibodies (anti-PD-1-Ab). However, whether the positivity patterns of both antibodies are associated with the risk of thyroid irAEs is unknown. The aim of the present study was to clarify the association of the pattern of TgAb and TPOAb positivity at baseline with the risk of thyroid irAEs induced by anti-PD-1-Ab. Patients (n = 516) were evaluated for TgAb and TPOAb at baseline and prospectively for thyroid function every 6 weeks for 24 weeks after initiating anti-PD-1-Ab. Fifty-one (9.9%) patients developed thyroid irAEs (thyrotoxicosis in 34, hypothyroidism without prior thyrotoxicosis in 17). Twenty-five patients subsequently developed hypothyroidism following thyrotoxicosis. The cumulative incidence of thyroid irAEs differed among 4 groups classified by the presence of TgAb/TPOAb at baseline (group 1: TgAb-(-)/TPOAb-(-), 4.6% [19/415]; group 2: TgAb-(-)/TPOAb-(+), 15.8% [9/57]; group 3: TgAb-(+)/TPOAb-(-), 42.1% [8/19]; group 4: TgAb-(+)/TPOAb-(+), 60.0% [15/25]) as follows: groups 1 vs 2-4 (P ≤ .001) and groups 2 vs 3 (P = .008) and 4 (P < .001). There were different incidences of thyrotoxicosis (groups 1-4, 3.1%, 5.3%, 31.6%, 48.0%, respectively; P < .001) in groups 1 vs 3 and 4, and groups 2 vs 3 and 4, and of hypothyroidism (groups 1-4: 2.9%, 15.8%, 31.6%, 60.0%, respectively; P < .001) in groups 1 vs 2 to 4, and groups 2 vs 4. The risk of thyroid irAEs was affected by the pattern of TgAb and TPOAb positivity at baseline; there were high risks of thyrotoxicosis in patients with TgAb-(+) and of hypothyroidism in patients with TgAb-(+) and those with TPOAb-(+).

Um caso de hipotiroidismo auto-imune como origem de atraso de crescimento e de desenvolvimento neuropsicomotor na primeira infância

A previously healthy 4 and a half year old boy presented to primary health care consultation. Due to red flags in the neurodevelopment evaluation, autism spectrum disorder is suspected and the child was oriented to child psychiatry. Seven months later, he is evaluated once again and, in addition to worsening neurodevelopmental delay and poor school performance, growth retardation is noted, as well as exponential weight gain. Prader Willi syndrome is suspected and the patient was referred to the pediatricians consultation. An analytical study was performed showing an exponentially elevated TSH (&gt;750 mUI/L) associated with a decreased free T4 (0.24 ng/dL). A radiograph of the hand and fist revealed mineral bone age around two years and eight months. The autoimmune study revealed positive antithyroid peroxidase antibodies and antithyroglobulin antibodies and the diagnosis of autoimmune hypothyroidism was established. Levothyroxine was initiated with clinical improvement and return to linear growth. However, cognitive impairment was still present. Autoimmune thyroiditis is the most common cause of acquired hypothyroidism in pediatric age, although it is rare under the age of three. This condition, if not treated in a timely manner, can cause adult height loss and delayed neurodevelopment. The presented case illustrates the importance of including thyroid function in the study of children with growth retardation and unexplained weight gain. Changes in behavior and school performance should also alert to this diagnosis.

ODP510 Pseudolymphoma of the Thyroid Gland in Association with Hashimoto's Thyroiditis: A Benign Lesion in Whitish Thyroid Gland

Abstract Background Pseudolymphoma or reactive lymphoid hyperplasia is a benign localized tumor-forming lymphoid hyperplasia found in various organs. Its occurrence in the thyroid gland is rare and could mimic malignant lesion. Here, we present a case of pseudolymphoma of the thyroid in a patient with Hashimoto's Thyroiditis. Case description A 24-year-old woman without underlying disease presented with incidentally found thyroid nodule. Ultrasound revealed mild thyroid enlargement with diffuse heterogeneous parenchymal echotexture. A 5×7×8.5-mm hypoechoic solid nodule with irregular margin was found in the left upper pole. No microcalcification was detected. Multiple subcentimeter lymph nodes at bilateral cervical group VI and left cervical group IV were also detected, measuring up to 5 mm in short axis. Fine-needle aspiration was performed and suggested malignancy (Bethesda class V). Laboratory testing showed euthyroid state with positive anti-thyroglobulin antibodies and anti-thyroid peroxidase antibodies. The blood test and ultrasound findings suggested the underlying of Hashimoto's thyroiditis. The patient underwent total thyroidectomy and lymph node dissection without postoperative complication. Gross examination of the thyroid showed multiple well-demarcated whitish nodular lesions, ranging from 2-10 mm, in the upper pole of both thyroid lobe and a well-circumscribed area of a 7-mm greyish nodule in left thyroid lobe. Microscopically, the whitish lesion in both lobe composed of hyperplastic lymphoid tissues with many follicular centers on the background of lymphocytic thyroiditis. The immunohistochemistry study revealed a polyclonal nature of the plasma cell infiltrates. No abnormal staining with AE1/AE3 or cyclin D1 was found. Pseudolymphoma was diagnosed based on these findings. Papillary thyroid microcarcinoma (6 mm) without capsular invasion was also diagnosed in the lesion of left mid lobe. The cervical lymph nodes showed metastatic papillary thyroid carcinoma (1.5 mm) in level III cervical lymph nodes. No perinodal extension was found. Postoperative course was unremarkable and the patient was in stable condition at 18 months after the operation. Conclusion Although primary thyroid lymphoma is often considered in patients with Hashimoto's thyroiditis. The possibility of pseudolymphoma characterized by the presence of well-demarcated pearly white nodules and polyclonal cell populations should also be considered. Presentation: No date and time listed

PSAT350 Autoimmune Polyglandular Syndrome Type II Presenting with Hashimoto's Thyroiditis, Diabetes Mellitus Type I and Addison's Disease: A Case Report

Abstract A. BACKGROUND/SIGNIFICANCE Autoimmune polyglandular syndrome Type II (APS-II) is a rare polyendocrinopathy with a prevalence of 1 to 2 in 100,000, instigated by immune-mediated destruction of several organs. Knowledge of APS-II is crucial, especially in the early detection of polyglandular disorder among patients with endocrine autoimmunity. B. CASE This case is of a 40-year-old male who initially presented with Grave's disease after showing signs and symptoms of hyperthyroidism, as supported by low thyrotropin (&amp;lt;0.05 uIU/mL; nv: 0.35-4.94) and high free thyroxine levels (2.05 ng/dL, nv: 0.71-1.85). He was maintained on methimazole. Five months following diagnosis, he developed symptoms of Diabetes Mellitus Type 1 (T1DM) as confirmed by high capillary blood glucose, undetectable C-peptide, and positive anti-Glutamic acid decarboxylase. Insulin and rosuvastatin were added on his maintenance medications. Ten months later, he discontinued methimazole and became lost to follow-up. One month after discontinuation, he sought consult again after experiencing symptoms of fatigue, muscle cramps, cold intolerance, forgetfulness, abdominal pain, diarrhea, and episodes of hypoglycemia at home. On examination, he was noted to have hypotension of 80/60 mmHg and skin hyperpigmentation. His random blood sugar was 408 mg/dL. High thyrotropin (57.8777 uIU/Ml, nv: 0.35-4.94), low free thyroxine (0.57 ng/dL, nv: 0.71-1.85), and positive antithyroid peroxidase antibody levels revealed Hashimoto's thyroiditis. Low fasting 8 am serum cortisol (81 nmol/L, nv: 138-635) and low serum cortisol 30 mins (403.85 nmol/L) and 1 hour (542.31 nmol/L, normal response: &amp;gt;550 nmol/L) after adrenocorticotropic hormone stimulation test in addition to the clinical manifestations, supported the diagnosis of Addison's disease. With the combination of Addison's disease, Autoimmune thyroid disease, and T1DM, a diagnosis of APS Type II was made. Management included insulin, prednisone, and levothyroxine. These resulted in significant improvement in the patient's symptoms. He is now clinically well and compliant to regular follow-up. C. LEARNING POINTS/CONCLUSION It is crucial in APS-II management to identify and manage the associated autoimmune disorders to prevent significant morbidity and mortality. Therefore, in the presence of any autoimmune disorder, a high index of suspicion for APS-II is essential. There should be regular follow-up and observation of patients with autoimmune endocrine disorders to ensure early detection of APS-II. Patient health education must include identifying symptoms of the disorders for which they are at high risk. Keywords: APS Type 2, Addison's Disease, DM Type 1, Hashimoto's Thyroiditis Sources of Support: None Conflicts of Interest: None Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Anti-PD-1 Immunotherapy Changed the Spectrum of Thyroid Dysfunction during Radiotherapy in Patients with Nasopharyngeal Carcinoma

<h3>Purpose/Objective(s)</h3> Programmed cell death protein-1 (PD-1) blockade therapies have demonstrated their efficacy in a variety of malignancies, including nasopharyngeal carcinoma (NPC). Thyroid dysfunction is among the most common immune-related adverse event. However, presently we have a paucity of data on thyroid dysfunction associated with PD-1 blockade in non-metastatic NPC. This study aimed to study the incidence and pattern of immune-related thyroid dysfunction in non-metastatic NPC during radiotherapy <h3>Materials/Methods</h3> From January 1, 2019 to December 31, 2021, 165 pairs of non-metastatic NPC patients matching by propensity score matching (PSM) method to balance prognostic factors were included in this study: 165 cases in control group received conventional treatment (introduction chemotherapy and concurrent chemoradiotherapy), 165 cases in immunotherapy group received conventional treatment and anti-PD-1 immunotherapy before completion of radiotherapy. Thyroid function test and antithyroid antibodies were assessed prospectively before each immunotherapy cycle, beginning before the first treatment. Incidence and clinical pattern of thyroid dysfunction, and association with anti-thyroid antibodies was evaluated. <h3>Results</h3> In control group, 51 patients (30.91%) had thyroid dysfunctions. Among them, 12 patients had hypothyroidism (23.53%), 39 had thyrotoxicosis (76.47%) and none had biphasic hypothyroidism. In immunotherapy group, 47 patients (28.49%) had thyroid dysfunctions. Among them, 24 patients had hypothyroidism (51.06%), 18 had thyrotoxicosis (38.31%) and 5 had biphasic hypothyroidism (10.63%), a distinct pattern only observed in patients received immunotherapy. The positive rates of antithyroid peroxidase antibody (A-TPO) were similar between two groups, 12.12% in control group and 12.73% in immunotherapy group (<i>P</i> = 1). A-TPO was positive in 12 of 47 patients who developed thyroid dysfunction, compared with 11 of 118 who did not (25.53% vs 9.32%, <i>P</i> = 0.014). Especially, all patients with biphasic hypothyroidism had positive A-TPO, and the onset of A-TPO was earlier than that of transient hyperthyroidism. In patients with positive A-TPO and hypothyroidism or thyrotoxicosis, the A-TPO onset coincided with onset of thyroid dysfunction. <h3>Conclusion</h3> In non-metastatic NPC patients, thyroid dysfunction is common during treatment. Hypothyroidism and thyrotoxicosis are the most frequent presentations. Compared with conventional treatment, anti-PD-1 immunotherapy changed the spectrum of thyroid dysfunction but not the incidence. Patients who received anti-PD-1 immunotherapy developed a distinct pattern of thyroid dysfunction, biphasic hypothyroidism. The early elevation of A-TPO without aberrant TSH and FT4 may be a predictive marker for biphasic hypothyroidism. Our result suggested that thyroid functions should be under regular and intensive surveillance in clinical practice of anti-PD-1 immunotherapy in non-metastatic NPC patients.

TH1.10 Antithyroid peroxidase antibodies and histopathological outcomes in Egyptian patients subjected to total thyroidectomy for nonmalignant nodular goiter. Retrospective study

Abstract Introduction Thyroid is an endocrine gland. It produce T3 and T4 hormones through a series of enzymatic actions. These hormones regulate body metabolism and physiology. Immune disorders in this gland can cause hypo/hyperthyroidism. Objective The study aimed to assess antithyroid antibodies in patients with benign thyroid masses and the effect of total thyroidectomy on the antibodies titres. Patients and Methods This is a retrospective work of 112 cases managed with total thyroidectomy who have positive antithyroid peroxidase antibodies (TPO-Ab), antithyroglobulin antibodies (Tg-Ab), or both. All patients were euthyroid before surgery. Thyroid function tests and thyroid antibodies levels were measured before and 6 and 12 months after surgery. Results Histopathological evaluation revealed Hashimoto thyroiditis (47.3%), colloid nodules (22.3%), and lymphocytic thyroiditis (30.4%). All patients were TPO-Ab positive, while 96 patients (85.7%) were Tg-Ab positive before surgery. There was no considerable change in TPO-Ab and Tg-Ab after surgery (p = 0.817, and p=0.560, respectively). Also, there was no significant difference between the three histopathological diagnoses in the levels of TPO-Ab (p = 0.086) or Tg-Ab (p = 0.673). Conclusions Antithyroid antibodies are not valuable markers for diagnosis or prognosis of benign thyroid diseases subjected to total thyroidectomy. We do not recommend their use beyond being a supportive evidence of the possibility of autoimmune nature of the disease if other criteria are confirmed.

Relationship between autoantibodies against type 2 deiodinase and antithyroid autoantibodies in Graves’ disease using antithyroid drug therapy

Background: Previously, the presence of autoantibodies against type 2 deiodinase cys- and hom-peptides was investigated in Graves’ disease with relation to thyroid function, ophthalmopathy and therapy. The new design was to reveal the relationship among antithyroid antibodies involved in hormone synthesis. Aim and scope: To demonstrate some regularity between the appearance of peptide autoantibodies and antithyroid antibodies against TSH receptor, thyroid peroxidase and thyroglobulin, the study followed the main path of hormone synthesis and the effect of antithyroid drug treatment. Has any effect of peptide autoantibodies on the titers of other autoantibodies? Methods: The methods were described in our previous papers detailed. Autoantibodies against type 2 deiodinase peptides were detected with enzyme-linked immunosorbent assay in 78 patients with Graves’ disease and 30 controls. Thyroid hormones (TSH, FT4 and FT3) and antibodies against TSH receptor, thyroid peroxidase and thyroglobulin were measured with chemiluminescence immunoassay. Results: The frequency of cys-peptide antibodies was greater in the new onset of Graves’ disease. Propylthiouracil treatment was associated with increased occurrence of cys-peptide antibodies (p&lt;0.0069). No dose-dependency in methimazole treatment could be demonstrated for cys-peptide antibody levels. Antibodies against hom-peptide or both peptides demonstrated a strong relationship with the appearance of antithyroid antibodies. No peptide antibodies were associated with anti-thyroglobulin antibody positivity (0 cases out of 11 for hom-peptide, p&lt;0.0071 and 0 cases out of 8 for both peptides, p&lt;0.0251). In contrast, all cases with TSH receptor antibody positivity were positive for peptide antibodies (all cases out of 13 for hom-peptide, p&lt;0.0139 and all cases out of 9 for both peptides, p&lt;0.0470). TSH receptor antibody levels were relevantly decreased, when hom-peptide antibodies were present [24.35(15.68-37.8) vs 11.8(8.16-17.07) IU/l, p&lt;0.0437]. Conclusion: The presence of hom-peptide antibodies was connected to the absence of antibodies against thyroglobulin and smaller anti-thyroid peroxidase antibody positivity. The presence and the high titers of TSH receptor antibodies demonstrated a close relationship with the appearance of hom-peptide antibodies. The relationship among the studied autoantibodies may depend on the alteration of thyroid hormone synthesis and the steric hindrance of targets and antithyroid drug treatment. Autoantibodies against type 2 deiodinase peptides can influence the therapeutical effectiveness

Rare Association of Adult Onset Still’s Disease with Autoimmune Thyroid Disease: A Case Report

Adult-onset Still’s disease (AOSD) is an uncommon inflammatory condition presenting with high grade fever, arthralgia, skin rash, and leukocytosis. Autoimmune thyroid disease (AITD) is commonly seen in females in their third to fifth decade and usually missed to screen in other autoimmune diseases. In this study, the case of a 17-year-old female patient from Pune is reported who presented to Bharati hospital in November 2020, with a six-month history of high-grade fever, arthritis, and elevated acute phase reactants along with hypothyroidism. She was diagnosed with AOSD (based on Yamaguchi criteria) and AITD with positive anti-thyroid peroxidase (anti-TPO) antibodies. She responded well to oral steroids and thyroid supplements. This case draws attention to the rare association between AOSD and AITD.

Outcomes of Pregnancy in Euthyroid Women with Positive Thyroid Peroxidase Antibodies

Thyroid disorders are among the most common endocrine disorders affecting pregnant women .Thyroid autoimmunity has been associated with poor pregnancy outcomes. Thyroid Peroxidase antibodies being the most common of thyroid antibodies and it can be considered as a surrogate marker for thyroid related adverse pregnancy outcomes. The present study was conducted to further elucidate the association between these antibodies and adverse pregnancy outcomes. A case control study including 150 randomly selected participant was carried out at AL-Khansaa Teaching Hospital in Mosul, Iraq. over the period of three months. All participants enrolled in the study were screened for Thyroid Function Tests TFTs including Thyroid Stimulating Hormone, Free thyroid hormones (Ft3 and Ft4) as well as Anti-Thyroid Peroxidase antibodies. Pregnant women were then classified depending on their Anti-Thyroid Peroxidase antibodies test results into two groups (positive and negative) groups. All women were followed till delivery to record their pregnancy outcomes. Our results showed that 10% of the screened pregnant women showed positive anti-Thyroid peroxidase antibodies. These women reported a higher incidence of cesarean section and preterm deliveries when compared to negative anti-Thyroid peroxidase antibodies control group. So a conclusion was drawn to recommend anti-Thyroid peroxidase antibodies as screening test during pregnancy especially those with bad obstetric history or history of thyroid disorders.

Antithyroid Peroxidase Antibodies and Histopathological Outcomes in Egyptian Patients Subjected to Total Thyroidectomy for Non-Malignant Nodular Goiter.

ObjectiveThe study aimed to assess antithyroid antibodies in patients with benign thyroid masses and the effect of total thyroidectomy on the antibodies titers.Patients and MethodsThis is a retrospective work of 112 cases managed with total thyroidectomy with positive antithyroid peroxidase antibodies (TPO-Ab), anti-thyroglobulin antibodies (Tg-Ab), or both. All patients were euthyroid before surgery. Thyroid function tests and thyroid antibodies levels were measured before and 6 and 12 months after surgery.ResultsHistopathological evaluation revealed Hashimoto thyroiditis (47.3%), colloid nodules (22.3%), and lymphocytic thyroiditis (30.4%). All patients were TPO-Ab positive, while 96 patients (85.7%) were Tg-Ab positive before surgery. There was no considerable change in TPO-Ab and Tg-Ab after surgery (p = 0.817, and p=0.560, respectively). Also, there was no significant difference between the three histopathological diagnoses in the levels of TPO-Ab (p = 0.086) or Tg-Ab (p = 0.673).ConclusionAntithyroid antibodies are not valuable markers for diagnosis or prognosis of benign thyroid diseases subjected to total thyroidectomy. We do not recommend their use beyond supporting evidence of the possibility of the autoimmune nature of the illness if other criteria are confirmed.