Positive Thyroid Autoantibodies Research Articles

Painless Thyroiditis and Fulminant Type 1 Diabetes Mellitus in a Patient Treated with an Immune Checkpoint Inhibitor, Nivolumab

The programmed cell death-1 (PD-1) pathway is a novel therapeutic target in immune checkpoint therapy for cancer. Nivolumab, an anti-PD-1 monoclonal antibody, blocks PD-1 and can restore anti-cancer immune responses by disrupting the signal that inhibits T-cell activation. Nivolumab may induce endocrine-related adverse events, including hypophysitis, autoimmune thyroiditis, and type 1 diabetes mellitus. Here we report a 68-year-old female patient with advanced renal cell carcinoma who was treated with nivolumab. She had positive anti-thyroglobulin antibodies and anti-thyroid peroxidase antibodies with slightly elevated thyroid-stimulating hormone (9.048 μU/mL), and was diagnosed as chronic thyroiditis with subclinical hypothyroidism before nivolumab therapy. She developed painless thyroiditis after the first cycle of the therapy (Day 14). At the 7th cycle of nivolumab therapy (Day 98), hyperglycemia (473 mg/dL) was noted, whereas glycated hemoglobin level was 6.9%. Islet-related autoantibodies were all negative. The glucagon tolerance test showed complete depletion of insulin. Human leukocyte antigen typing showed haplotype DRB1*09:01-DQB1*03:03, which was reported to be closely associated with type 1 diabetes mellitus in Japan. Fulminant type 1 diabetes mellitus was diagnosed, and she was immediately treated with multiple daily injections of insulin. Fulminant type 1 diabetes mellitus is characterized by rapid-onset diabetic ketoacidosis, and negative islet-related autoantibodies, and was proposed as a novel subtype of non-autoimmune diabetes. Preceding painless thyroiditis with positive thyroid autoantibodies observed in the present case, however, raises the possibility that autoimmune mechanisms are involved in the pathogenesis of nivolumab-induced fulminant type 1 diabetes mellitus.

Detection of thyroid autoantibodies in patients with chronic urticaria and analysis of clinical features

Objective To investigate clinical and serological characteristics of thyroid autoanti-body-positive patients with chronic urticaria. Methods A total of 70 inpatients with chronic urticaria were enrolled from the Department of Dermatology of Hangzhou Third Hospital between January and December in 2016, and divided into 2 groups according to the presence or absence of thyroid autoantibodies. Clinical manifestations, autologous serum skin test (ASST) results, hospital days, discharge outcome, routine blood test results, antibodies, and total serum IgE and IgG levels were compared between the 2 groups. Results Of 70 patients with chronic urticaria, 26 (37.1%) had positive thyroid autoantibodies, while 44 (62.9%) had negative thyroid autoantibodies. Compared with patients with negative thyroid autoantibodies, patients with positive thyroid autoantibodies showed significantly larger wheals and more severe itching (z= 4.399, P 0.05) . Conclusion Chronic urticaria patients with positive thyroid autoantibodies show more severe urticarial condition, and are commonly complicated by positive ASST and decreased levels of basophilic granulocytes. Key words: Urticaria; Thyroid gland; Autoantibodies; Autoimmunity; Basophils

The effect of thyroid autoantibody positivity on the functions of internal ear.

The objective of the study is to investigate if any significant difference exists in hearing thresholds and tympanometric examination results among patients whose thyroid antibody positivity was detected approximately 1year or at least 5years ago. Study population aged less than 40years consisted of 17 patients who had thyroid antibody positivities for an average of 1year (first group), 15 patients who were followed up for at least 5years for thyroid antibody positivity (second group), and 18 volunteers (third group). Tympanometric examination results, stapes reflex, SRT, SD, and pure tone values were examined. When the second group and the third group were compared, significant results were obtained at hearing frequencies between 500 and 4000Hz. When the first group and the third group were compared, only at 1000Hz threshold significant results were obtained. During evaluation of hearing frequencies between 250 and 8000Hz, significant results were not observed between the second group and the first group. When the first and the second groups were compared with the control group, significant results were obtained as for tympanometric examination findings and significant results were not observed between the second group and the first group. A significant difference was not detected as for the results of stapes reflex. Since thyroid antibody positivity affects the functions of internal ear, these patients should be more closely monitored. Since these effects become deeper in line with increased exposure to autoantibody positivity, variations in auditory responses should be more attentively monitored.

Thyroid profile and autoantibodies in Type 1 diabetes subjects: A perspective from Eastern India.

Context:There has been a rise in the incidence of type 1 diabetes mellitus (T1DM) in India. The prevalence of thyroid autoantibodies and thyroid dysfunction is common in T1DM.Aims:The aim of this study is to determine the incidence of thyroid dysfunction and thyroid autoantibodies in T1DM subjects, without any history of thyroid disease, and the prevalence of glutamic acid decarboxylase (GAD) antibody, Islet antigen-2 antibody (IA2), thyroid peroxidase (TPO), and thyroglobulin autoantibodies (Tg-AB) in T1DM subjects.Settings and Design:This was a cross-sectional clinical-based study.Subjects and Methods:Fifty subjects (29 males, 31 females) with T1DM and without any history of thyroid dysfunction were included in the study. All subjects were tested for GAD antibody, IA2 antibody, TPO antibody, thyroglobulin antibody, free thyroxine, and thyroid-stimulating hormone.Statistical Analysis Used:A Chi-square/pooled Chi-square test was used to assess the trends in the prevalence of hypothyroidism. A two-tailed P < 0.05 was considered statistically significant.Results:The mean age of the subjects was 23.50 years. 9.8% of subjects were below the age of 12 years, 27.45% of subjects were of age 12–18 years, 37.25% of subjects were of age 19–30 years, and 25.49% of subjects were above 30 years. 78% were positive autoantibody for GAD, 30% for IA-2, 24% for TPO, and 16% were positive for Tg-AB. A total of 6.0% of T1DM subjects had evidence of clinical hypothyroidism, but the prevalence of subclinical hyperthyroidism (SCH) varied from 32% to 68.0% for we considered different definitions of SCH as advocated by different guidelines. All subjects with overt hypothyroidism had positive GAD and thyroid autoantibodies. One (2%) subject had clinical hyperthyroidism with strongly positive GAD, TPO, and Tg-AB.Conclusions:We found a high prevalence of GAD, IA2, TPO, and Tg-AB in our T1DM subjects. A substantial proportion of our subjects had undiagnosed thyroid dysfunction with a preponderance of subclinical hypothyroidism. All T1DM subjects with overt hypothyroidism or hyperthyroidism had positive GAD and thyroid autoantibodies. The high prevalence of undiagnosed thyroid dysfunction highlights the importance of regular thyroid screening in T1DM subjects.

Study of the Relationship between Anti-Peroxidase Antibody and Miscarriage, Preterm Labor and IUGR in Egyptian Pregnant Women

Background: This research studied the relationship between anti-peroxidase anti-body in euthyroid pregnant female and miscarriage, preterm labor and IUGR in Egyptian patients. Patients and Methods: This prospective study was carried on patients who attended to the Obstetrics and Gynecology department of Tanta University Hospital for routine antenatal care from January 2016 to November 2016. 80 women enrolled in the study and were divided into four groups, 20 cases for each group, a control group, recurrent unexplained abortion group, preterm labor group and IUGR group. A Thyroperoxidase (TPO) antibody was measured in all cases. Results & Discussion: The eighty patients were randomly enrolled into 4 groups, 20 patients in each group. Their age ranged from 20 to 35 years and BMI ranged from 18 to 35. The percentage of +ve TPO Ab of the control group was 5% and of the recurrent abortion group was 20% and of the preterm labor group was 15% and of the IUGR group it was 5%. (P value 0.026) indicating statistically significant correlation between TPO Ab and recurrent unexplained abortion and preterm labor. Conclusion: The presence of (TPO) antibodies could be correlated to recurrent unexplained abortion and preterm labor. More studies are required to determine whether an intervention is needed to treat thyroid autoantibody positivity during pregnancy.

Relationship between the thyroid autoimmunity and the risk of preterm birth in pregnant women: a meta-analysis

To evaluate the relationship between thyroid autoimmunity and the risk of preterm birth. Literature search was done among PubMed, Embase, Wanfang Medical Database, China Academic Journal Network Publishing Database and China Biology Medicine disc from Jan. 1(st) 1980 to July 31(st), 2015. (1) Literature were extracted according to inclusion and exclusion standards, and the quality of the extracted literature were evaluated by Newcastle-Ottawa Scale (NOS). (2) Meta-analysis was performed by RevMan 5 software formulated by using the Cochrane library databases. Various heterogeneity of the research was inspected firstly. According to the results of the inspection a certain effect model was selected (including fixed effects model, the random effects model) to be utilized in merger analysis. In this study pregnant women with both thyroid peroxidase antibodies (TPO-Ab) and thyroglobulin (TG-Ab) positive were defined as thyroid antibody positive pregnant women. Pregnant women with only TPO-Ab positive were defined as TPO-Ab positive pregnant women. Then the relationship of antibody positive and the risk of a preterm birth was analyzed respectively. (1) Ten cohort studies were enrolled, of which NOS scale score were 7 or higher. All the studies are of medium quality and above. A total of 1 322 cases of preterm birth occurred among 19 910 pregnant women. (2) Positive thyroid autoantibodies did not increase the risk of preterm birth in euthyroid pregnant women (OR=1.41, 95%CI: 0.83-2.40, P=0.200) or in pregnant women with hypothyroidism (OR=0.68, 95% CI: 0.32-1.44, P=0.310) . Positive TPO-Ab in euthyroid pregnant women increase the risk of preterm birth significantly (OR=2.08, 95%CI: 1.09-3.97, P=0.030), but positive TPO-Ab in pregnant women with hypothyroidism did not increase the risk of preterm birth significantly (OR=1.21, 95%CI: 0.65-2.24, P=0.550). Positive TPO-Ab is an independent risk factor of preterm birth in euthyroid pregnant women.

The analysis of the changes of maternal thyroid autoantibodies during early pregnancy

Objective To investigate the changes and related factors of maternal thyroid autoantibodies during early pregnancy. Methods Urinary iodine concentration(UIC), serum thyroid stimulating hormone(TSH), free thyroxine(FT4), thyroid-peroxidase antibody(TPOAb), thyroglobulin antibody(TgAb)concentrations were determined in 7 190 women during early pregnancy in an iodine-sufficient region of China. Results The prevalence of TPOAb positivity and TgAb positivity were 8.7% and 12.0% respectively. The prevalence of overt hypothyroidism and subclinical hypothyroidism increased significantly in group of thyroid antibody positivity. The prevalence of TPOAb positivity and TgAb positivity presented a U-shaped curve, ranging from mild iodine deficiency to iodine excess, especially increased significantly in the group with UIC<100 μg/L. Conclusion Prevalence of thyroid antibodies positivity became higher during early pregnancy. The positive thyroid autoantibodies during pregnancy were significantly associated with maternal hypothyroidism. Both iodine excess and iodine deficiency are risk factors of positive thyroid antibodies. (Chin J Endocrinol Metab, 2016, 32: 376-379) Key words: Thyroid; Pregnancy; Thyroid antibody; Iodine

The higher incidence of autoimmune thyroid disease in prolactinomas than in somatotrophinomas

ObjectiveMany studies have shown that prolactin (PRL) plays an important role in autoimmune diseases. The aim of this study was to compare the current frequency of autoimmune thyroid disease (ATD) in prolactinomas with another type of functional pituitary adenoma (FPA), somatotrophinoma. Another aim of the study was to evaluate possible factors related to thyroid autoimmunity and the process of ATD in FPAs. MethodsWe retrospectively evaluated the presence of thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) and thyroid morphologic findings in our patients with FPA (78 with acromegaly and 83 with prolactinoma). The relationship of autoantibody positivity with baseline PRL levels, activity of acromegaly, and treatment of dopamine agonists (DA) and hypogonadism was also assessed. Patients with ATD and hypothyroidism due to autoimmune thyroiditis were also evaluated. ResultsATD (Hashimoto's thyroiditis) was detected more frequently in patients with prolactinoma than in patients with acromegaly (33% and 17%, respectively; p=0.01). Thyroid autoantibody positivity was found more frequently in females in the whole group (p=0.02) and in the acromegaly group (p=0.008). There was no difference according to sex among the patients with prolactinoma (p=0.800). ATD was found not to be related with baseline PRL levels, treatment of DA, and presence of hypogonadism (p=0.232, p=0.435, p=0.464, respectively) in the prolactinoma group, and activity of acromegaly, presence of hypogonadism in the acromegaly group (p=0.753, p=0.654, respectively). Autoimmune hypothyroidism was more frequent in the prolactinoma group than in the acromegaly group among patients with thyroid autoantibody positivity (p=0.004). ConclusionThyroid autoantibodies should be evaluated both at the time of diagnosis and during the course of treatment in patients with prolactinoma, and thyroid function tests should be closely monitored in patients with autoantibody positivity.

Does TSH Trigger the Anti-thyroid Autoimmune Processes? Observation on a Large Cohort of Naive Patients with Thyroid Hemiagenesis.

Thyroid hemiagenesis (THA) is a rare abnormality characterized by the absence of one thyroid lobe. Elevated thyroid stimulating hormone (TSH) level and higher incidence of thyroid diseases were reported in THA. The aim of the study is to evaluate the thyroid autoimmunity incidence in patients with THA and influence of higher than average TSH level on thyroid volume (TV) and its change with age. The study included a group of naive patients with THA and a control group of subjects with bilobate thyroid. All patients underwent clinical examination, thyroid ultrasound, scintiscan and laboratory tests. In the studied and control group the presence of thyroid autoantibodies (TAb) was evaluated. The THA group consisted of 65 patients. In THA group 53.85 % of patients were positive for TAb. Patients with positive TAb were older (46.0 ± 18.3 years) than those with negative (35.0 ± 19.8 years); p = 0.02. The incidence of TAb was lower in controls (13.85 %, p < 0.0001). In the study group, positive correlation between the age and TV (r = 0.46, p = 0.0001), and negative correlations between the age and TSH level (r = −0.31, p = 0.01), and TSH concentration and TV (r = −0.35, p = 0.004) were found. In a subgroup of 30 patients with THA negative for TAb, even stronger correlations were observed. The median single lobe volume and median TSH level were higher in patients with THA when compared to controls (13.60 vs 8.20 ml, p < 0.0001; 3.23 vs 1.48 µU/ml, p < 0.0001, respectively). Patients with THA constitute an in vivo model of long-term thyroid TSH overstimulation. Further studies are needed to reveal, whether TSH overstimulation may be the trigger for thyroid autoimmunity.

Reference intervals of thyroid hormones in a previously iodine-deficient but presently more than adequate area of Western China: a population-based survey.

The aim of our study is to establish the reference intervals (RIs) of thyroid hormones in a previously iodine-deficient area but presently more than iodine-adequate area of Western China, and also to investigate the factors which affect thyroid function. The cross-sectional study conducted in Xi'an, was based on 2007-2008 China National Diabetes and Metabolic Disorders Survey. Among 1286 participating adults, 717 were finally included as reference population. Thyrotropin (TSH), total triiodothyronine (T3), free triiodothyronine (FT3), total thyroxine (T4), free thyroxine (FT4), thyroperoxidase antibody (TPO-Ab) and thyroglobulin antibody (Tg-Ab) were measured. Thyroid ultrasound examination was also performed. The present study established the new RIs of serum TSH (0.43-5.51 mIU/L), FT4 (11.0-20.4 pmol/L), FT3 (3.63-5.73 pmol/L), T4 (67.8-157 mmol/L) and T3 (1.08-2.20 mmol/L), which were different from the data provided by the manufacturers. Significant differences among all the age groups were observed in FT3, but neither in TSH nor in FT4. The TSH levels in adults with pathologic ultrasonography results or positive thyroid autoantibody were significantly higher than those in reference adults. Our present results provide valuable references for the diagnosis of thyroid diseases in population of Western China. Considering that most inland areas of China have faced the challenge of the transition from iodine deficiency to adequacy or more than adequacy, we recommend physicians utilize our RIs to determine thyroid diseases in the similar areas with Xi'an in China.

Coexistence of endocrinopathies in children with rheumatic diseases.

Background and objectivesTo examine the frequency of endocrinopathies in children with systemic lupus erythematosus (SLE) and juvenile idiopathic arthritis (JIA).Design and settingA cross-sectional study.Patients and methodsA study was conducted in Saudi children with SLE and JIA who were seen at King Faisal Specialist Hospital and Research Centre, Riyadh, between September 2013 and April 2015. All enrolled patients completed the clinical evaluation, which included information about family history of autoimmune disease, growth parameters and tanner stage, as well as the following assessments: vitamin D profile (parathyroid hormone and 25-OH vitamin D levels), TSH, FT4 and total T3, thyroglobulin antibodies, thyroperoxidase antibodies, random blood sugar, HbA1C, IGF1, IGFBP-3, LH, and FSH.ResultsA total of 42 patients, 22 with JIA and 20 with SLE, were included in the study. The mean participant age was 12.2 ± 5.3 years with a mean disease duration of 3.2 ± 3.4 years. Female gender was predominant (17 SLE, 13 JIA) in the patient population. Fifteen patients (35.7%) presented with a family history of autoimmune disease. The most frequently detected endocrinopathies were vitamin D insufficiency (35%) and thyroid disease (31%). Eight JIA patients and 7 SLE patients exhibited low vitamin D levels; 10 patients presented with hyperparathyroidism. Thyroid dysfunction was observed in 13 patients (8 SLE, 5 JIA), and 2 patients were found to be euthyroid (normal TSH, FT4) with positive thyroid autoantibodies. Furthermore, 7 patients presented with subclinical hypothyroidism (high TSH, normal FT4), and 4 patients presented with overt hypothyroidism (high TSH, low FT4). Seven patients (4 SLE and 3 JIA) presented with short stature due to growth hormone insufficiency (low IGF1, IGFBP-3). Two patients exhibited delayed puberty accompanied by low LH levels. Diabetes mellitus was more frequently observed in patients with JIA (4 patients) than in patients with SLE (1 patient).ConclusionOur findings demonstrated that coexistence of endocrinopathies is not uncommon in children diagnosed with JIA and SLE. Abnormal thyroid function occurs frequently and at a similar rate in children diagnosed with SLE and JIA. Thus, screening for endocrinopathies, namely thyroid disease, during the assessment of childhood SLE and JIA is worth consideration.

Type of fish consumed and thyroid autoimmunity in pregnancy and postpartum.

Fish consumption or supplementation with omega-3 fatty acids was reported to cure and/or prevent autoimmune and nonautoimmune disorders. Serum positivity for thyroid autoantibodies is a predictive marker of postpartum thyroiditis and postpartum depression. We hypothesized that stable consumption of the omega-3-rich oily fish was associated with a more favorable profile of serum thyroid antibodies throughout pregnancy and early postpartum compared with stable consumption of swordfish, a predator that concentrates pollutants. We prospectively measured serum thyroglobulin antibodies and thyroperoxidase antibodies in pregnancy (first, second trimesters) and postpartum (day 4), in 236 thyroid disease-free, nonsmoker Caucasian women with stable dietary habits. We did not measure thyroid autoantibodies prior to pregnancy. Women were divided into groups A (n = 48; swordfish), B (n = 52; oily fish), C (n = 68; swordfish + other fish, not necessarily oily fish), and D (n = 68; fish other than swordfish and oily fish). Major endpoints were positivity rates and serum concentrations of the two autoantibodies. We resorted to previous studies for the estimated content of fatty acids and microelements in the consumed fish. Positivity rates and serum concentrations of both antibodies were the greatest in group A and the lowest in group B (P < 0.001 and P < 0.05 to < 0.001, respectively). Relationship between monthly fish consumption and serum concentrations of either antibody was direct in group A but inverse in group B. The estimated content of omega-3 fatty acids in fish consumed by group B was the greatest (P < 0.001 vs. any other group). These data reinforce recommendations that pregnant women should avoid consuming swordfish and indicate consumption of oily fish as a favorable alternative. Because thyroid autoantibodies are markers of autoimmune-related postpartum problems, our data suggest a dietary prophylaxis of such problems.

Thyroid Gland Volume Is Significantly Smaller in Patients With Psychiatric Disorders Than in Those Without Psychiatric Disorders

To the Editor: The thyroid gland normally secretes thyroxine and triiodothyronine. A previous study reported that partial substitution of triiodothyronine for thyroxine improved mood and neuropsychological functions in hypothyroid patients treated with only thyroxine,1 suggesting an importance of the integrity of the thyroid gland for neuropsychological functions. It is clear that thyroid hormone plays an important role in the brain, influencing mood and cognition; however, the detail mechanisms remain to be elucidated. Here, we investigated the differences of thyroid gland volume, thyroid hormones, and thyroid autoantibodies between individuals with and without psychiatric disorders. Method. The study protocol was approved by the Medical Ethics Committee of the National Center for Global Health and Medicine, Tokyo. Of 282 patients who had thyroid ultrasonography between October 2011 and December 2013, we investigated 239 subjects retrospectively. We excluded subjects with autoimmune thyroid diseases and thyroid carcinoma and patients taking lithium. Eighty-one subjects were diagnosed as having psychiatric disorders including schizophrenia (35%), depression (19%), bipolar disorder (7%), neurosis (5%), anxiety disorder (11%), and mood disorders (23%) per DSM-IV criteria by psychiatrists. We measured serum levels of thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) by chemiluminescent enzyme immunoassay (Lumipulse Presto, Fujirebio Inc, Tokyo, Japan). We also measured serum levels of antithyroglobulin antibodies, antithyroid peroxidase antibodies, and TSH receptor antibodies by electrochemiluminescence immunoassay (ECLusys Anti-Tg, Anti-TPO and TRAb, Roche Diagnostics KK, Tokyo, Japan). Thyroid gland volume was determined by ultrasonography for each lobe individually using Brunn’s formula: 0.479 × length × depth × width.2 Results. Thyroid gland volume of patients with psychiatric disorders was significantly smaller than that of individuals without psychiatric disorders (mean ± SD = 11.1 ± 9.3 mL vs 12.5 ± 7.1 mL, P = .005, Mann-Whitney U test) (Figure 1). There were no differences in serum levels of TSH, FT3, and FT4 and positivity for thyroid autoantibodies between individuals with and without psychiatric disorders. Observational epidemiologic studies reported a positive correlation of thyroid volume with body weight, body mass index, and body surface area.3 However, we did not observe significant differences in these anthropometric measurements between the 2 groups. Thyroid gland volume was not correlated with the duration of psychiatric disorders. Among physiologic factors that influence the thyroid gland volume,3,4 only age was significantly lower in patients with psychiatric disorders (50.5 ± 17.4 years, P < .001) compared with individuals without psychiatric disorders (63.7 ± 16.6 years). According to previous studies showing an inverse correlation between thyroid gland volume and age,3 our patients with psychiatric disorders showed remarkably smaller thyroid gland volume compared with individuals without psychiatric disorders for their age. Figure 1. Thyroid Gland Volume of Patients With Psychiatric Disorders Was Significantly Smaller Than That of Individuals Without Psychiatric Disordersa Charlier et al5 studied a correlation between suicide risk and the weight of the thyroid gland by investigating 576 autopsies, including 299 cases of completed suicide. They found that thyroid weight was significantly smaller in cases of suicide compared with those who died of other causes.5 To take their and our results into consideration, the thyroid gland volume may affect the development and severity of mood and psychiatric disorders. However, several limitations should be considered. Selection bias might have occurred in the present study, and the potential confounding factors including medications might have affected the thyroid gland volume. We cannot explain the underlying mechanisms for the association between thyroid gland volume and psychiatric disorders by the present study. Further studies will be needed to elucidate the association of thyroid gland with psychiatric disorders.

Occurrence and risk factors of thyroid dysfunction in chronic hepatitis C patient received interferon treatment

Objective To investigate the antiviral treatment for patients with chronic hepatitis c(CHC) the influence of thyroid function and its related risk factors. Methods Used polyethylene glycol(peg)interferon (PegIFNα-2a)plus ribavirin(RBV)for the treatment of 122 cases of patients with CHC data were retrospectively analyzed.All of the patients before treatment thyroid function were normal.According to the thyroid function after treatment they were divided into normal thyroid function and abnormal thyroid function groups.Adopting the method of case-control study and Logistic regression we analyzed correlative risk factors of thyroid dysfunction. Results 122 CHC patients completed 48 weeks of treatment, and follow-up of 24 weeks,34 patients with thyroid dysfunction, rate of 27.9%. Logistic regression analysis showed that women, a positive thyroid autoantibodies, health care and smoking might be risk factor for thyroid dysfunction(OR=4.470,4.470,4.757 and 7.306,P<0.05 or P<0.01). Conclusion Interferon plus RBV during the treatment of CHC patients with a high incidence of thyroid dysfunction, including women, a positive thyroid autoantibodies, the health, and smoking could be a risk factor for thyroid dysfunction. Key words: Hepatitis C; Interferon; Thyroid Function; Factor analysis, statistical

Patients with systemic lupus erythematosus have higher prevalence of thyroid autoantibodies: a systematic review and meta-analysis.

BackgroundThyroid autoimmunity is considered the most common type of organ-specific autoimmune disorder and can be associated with other autoimmune endocrine disorders or non-endocrine diseases. Systemic lupus erythematosus is a prototypical autoimmune disorder with multifactorial etiology. The pathogenesis and development of the disease may result from a loss of immune tolerance and the resulting synthesis of autoantibodies against nuclear antigens. Autoimmune factors may be common features of both thyroid autoimmunity and systemic lupus erythematosus, making it likely that both conditions may coexist within some patients.Methods and FindingsA number of studies have investigated whether an association between thyroid autoimmunity and systemic lupus erythematosus exists. However, the results of these studies have been inconsistent. Furthermore, most of these studies have had relatively small sample sizes, which have rendered them insufficiently powerful to determine whether there is an association between systemic lupus erythematosus and thyroid autoimmunity. The main objective of this meta-analysis is to provide reliable estimates of the extent of any association between thyroid autoimmunity and systemic lupus erythematosus by combining the primary data from all relevant studies. Literature databases were searched, including the Medline, Embase, Web of Science, Chinese Wanfang and CBM databases, from January 1970 to May 2014. A total of 1076 systemic lupus erythematosus cases and 1661 healthy controls were included in this study. From these data, the odds ratio (OR) and the corresponding 95% confidence interval (95% CI) were calculated. The meta-analysis results showed that the prevalence of thyroid autoantibody positivity in patients with systemic lupus erythematosus was higher than in healthy controls (TgAb: OR = 2.99, 95% CI = 1.83–4.89; TPOAb: OR = 2.20, 95% CI = 1.27–3.82, respectively).ConclusionThe results of this meta-analysis suggest that thyroid autoimmunity is more prevalent in patients with systemic lupus erythematosus than in a control group.

Increased risk of thyroid autoimmunity in rheumatoid arthritis: a systematic review and meta-analysis.

Thyroid autoimmunity, which is the most common immune-mediated disease, is frequently together with other organ- as well as nonorgan-specific autoimmune disorders. Meanwhile, rheumatoid arthritis (RA) is a chronic immune-mediated inflammatory disorder that mainly results in cartilage destruction as well as synovial joint inflammation, and both the adaptive and innate immune responses involve in the progression of this disease. Considering that autoimmune elements may be common characteristics of thyroid autoimmunity and RA, it is likely that both disorders may coexist within some patients. A great number of studies have researched whether an association between thyroid autoimmunity and RA exists; however, the results of these studies have been inconsistent. Most of these studies have included relatively small sample sizes, which have rendered them insufficiently powerful to determine whether there is a relationship between RA and thyroid autoimmunity. The main objective of this meta-analysis was to provide reliable estimates of the extent of any association between thyroid autoimmunity and RA by combining the primary data from all related studies. Literature databases, including the Embase, Medline, Web of Science, Chinese Wanfang, and CBM databases, were searched for studies published from January 1980 to May 2014, with a language restriction of English and Chinese. A total of 1,021 RA cases and 1,500 healthy controls were included in this study. From these data, the odds ratios (OR) and the corresponding 95 % confidence intervals (95 % CI) were calculated. The results of the meta-analysis showed that the prevalence of thyroid autoantibody positivity in patients with RA was higher than that in healthy controls (TgAb: OR 3.17, 95 % CI 2.24-4.49; TPOAb: OR 2.33, 95 % CI 1.24-4.39). The results of this meta-analysis suggest that thyroid autoimmunity is more prevalent in patients with RA than in the control population.

Isolated Vitamin D Deficiency Is Not Associated with Nonthyroidal Illness Syndrome, but with Thyroid Autoimmunity

Aim. This study aimed to compare thyroid functions, thyroid autoantibodies, and the existence of nonthyroidal illness syndrome (NTIS) according to vitamin D level. Materials and Methods. The study included age- and BMI-matched healthy volunteers with and without vitamin D deficiency. In addition, the nonthyroidal illness syndrome status was evaluated. Results. Anti-TPO positivity was significantly more common in those with severe and moderate vitamin D deficiency, as compared to those with a normal 25(OH)D level. Furthermore, TSH levels were significantly lower in those with severe and moderate vitamin D deficiency than in those with a normal 25(OH)D level. In addition, there was a significant weak inverse correlation between anti-TPO positivity and the 25(OH)D level and a positive correlation between the TSH level and 25(OH)D level. Only 1 thyroid function test result was compatible with NTIS among the participants with moderate vitamin D deficiency; therefore the difference was not significant. Conclusions. The prevalence of thyroid autoantibody positivity was higher in those with severe and moderate vitamin D deficiency than in those with a normal 25(OH)D level. Additional large-scale studies must be conducted to determine if vitamin D deficiency plays a causal role in the pathogenesis of Hashimoto's thyroiditis and NTIS.

A longitudinal study of thyroid autoantibodies in pregnancy: the importance of test timing.

Thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TGAb) are frequently measured to investigate thyroid dysfunction in pregnancy. Despite the recognized fall of these autoantibodies in pregnancy, there is limited guidance on the timing of such testing. We assessed optimal test timing of TPOAb/TGAb for the detection of Hashimoto's thyroiditis and post-partum thyroid dysfunction (PPTD). Prospective longitudinal study with recruitment in Trimester 1. Healthy women ≤13weeks' gestation from Mercy Hospital for Women, a tertiary obstetric hospital in Melbourne. Serum TPOAb, TGAb, TSH and fT4 were measured at Trimester 1 (T1), Trimester 2(T2), Trimester 3(T3) and postpartum (PP) in each participant. Post-partum thyroid dysfunction (PPTD) was defined if TSH deviated from the assay's nonpregnant reference interval. Longitudinal random-effect logistic regression was used to investigate the association between time and positive/negative thyroid autoantibody status. Samples from 140 women at T1 (12·0: 10·3-13·0) (median: IQR weeks' gestation); 95 at T2 (24·3: 23·0-25·9), 79 at T3 (35·9: 34·8-36·7) and 83 at PP (12·4: 10·8-14·6weeks post-partum) were attained. At T1, 13 (9%) and 15 (11%) women had positive TPOAb and TGAb, respectively. The odds of having a positive TPOAb were 96% lower at T2 [OR=0·04 (95% CI: 0·02-0·8; P=0·03)] and 97% lower at T3 [OR=0·03 (95% CI: 0·001-0·6; P=0·02)] than at T1. Similarly, the odds of having a positive TGAb were 99·4% lower [OR=0·006 (95% CI: 0-0·3; P=0·01)] at T2, and 99·5% lower [OR=0·005 (95% CI: 0-0·4; P=0·02)] at T3 than at T1. The ROC analysis diagnostic ORs for a positive TPOAb and/or TGAb to predict PPTD were 7·8 (95% CI: 2·2-27·6), 1·2 (95% CI: 0-8·9), 2·0 (95% CI: 0-16·8), and 12·2 (95% CI: 3·3-44·9) at T1, T2, T3 and post-partum, respectively. A significant proportion of pregnant women lose their thyroid autoantibody positivity after T1. The gestation-dependent loss of TPOAb/TGAb positivity and reduction in diagnostic accuracy for predicting PPTD limits the value of testing at T2 and T3.

The prevalence of thyroid autoimmunity in patients with urticaria: a systematic review and meta-analysis.

Thyroid autoimmunity is the most common organ-specific autoimmune disorder, which is characterized by the production of thyroid autoantibodies and lymphocytic infiltration into the thyroid. The majority cases of chronic urticaria have unknown (idiopathic) causes, with about 30-40 % possibly having an autoimmune substrate. Considering that autoimmune factors may be the common features of both thyroid autoimmunity and urticaria, it is likely that both entities may coexist within the same patient. A number of studies have investigated the association between thyroid autoimmunity and urticaria. However, most of these studies are relatively small sample size, the power achieved in those studies was not sufficient to detect whether there is an association between urticaria and thyroid autoimmunity. The aim of this study is to combine primary data from all relevant studies to produce reliable estimates of the associations between thyroid autoantibodies and urticaria. Literature databases were searched including Medline, Embase, Web of Science, Chinese Wanfang, and CBM databases from January 1980 to December 2013. A total of 14,203 urticaria cases and 12,339 non-urticaria controls were included in this study. From these data, the odds ratio (OR) with 95% confidence interval (95% CI) was calculated. The meta-analysis results showed that the prevalence of positive thyroid autoantibodies in patients with urticaria was higher than non-urticaria controls (TgAb: OR 6.55, 95% CI 3.19-13.42, P<0.00001, I2=67%; TmAb: OR 4.51, 95% CI 2.78-7.33, P<0.00001, I2=47%; TPOAb: OR 8.71, 95% CI 6.89-11.01, P<0.00001, I2=20%, respectively). The results of this meta-analysis suggested that patients with urticaria were more likely to have thyroid autoimmunity than the control groups.

Factors associated with GAD antibody titer in subtypes of type 1 diabetes

The objective of this study was to compare factors associated with glutamic decarboxylase antibody (GADAb) titer between acute-onset and slowly progressive type 1 diabetes. We used a cross-sectional study to investigate 90 cases of GADAb-positive type 1 diabetes, including 40 acute-onset and 50 slowly progressive cases, to clarify factors associated with GADAb positivity in the two disease subtypes. We performed multivariate linear regression analysis to clarify factors associated with GADAb titer. In acute-onset cases, positive insulinoma-associated antigen-2 antibody (IA-2Ab) was negatively correlated with GADAb titer (β = −1.29, p = 0.048). In slowly progressive cases, GADAb titer was positively correlated with age (β = 0.05, p = 0.035) and positive thyroid autoantibodies (β = 1.59, p = 0.023), and negatively correlated with duration of diabetes (β = −1.34, p = 0.003). In slowly progressive cases, female gender (β = 1.65, p = 0.009) and age (β = 0.05, p = 0.048) were positively correlated, and duration of diabetes (β = −1.34, p = 0.004) and IA-2Ab positivity (β = −1.92, p = 0.029) were negatively correlated with GADAb titer only in cases with high GADAb titer. GADAb titer was associated with autoimmune activity of pancreatic beta cells in acute-onset and slowly progressive cases with high GADAb titer, and duration of diabetes in slowly progressive cases.