Thyroperoxidase Antibodies Research Articles

Association of hepatitis B virus and thyroid hormones during pregnancy

This study aims to evaluate the correlation between serum thyroid hormone levels and hepatitis B virus (HBV) DNA and HBV genotypes in pregnant women with chronic hepatitis B. A total of 96 pregnant women with chronic HBV-infected pregnant women between January 2020 and December 2022 were selected as the observational study subjects. About 50 HBV-uninfected pregnant women during the same period were selected as the control group. Serum thyroid hormone levels at different stages of pregnancy, including free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), thyroperoxidase antibody (TPOAb), and thyroglobulin antibody (TGAb), were compared between the 2 groups. Thyroid hormones levels were also compared between HBV-DNA-positive and HBV-DNA-negative women in the HBV-infected pregnancy group, and to determine the correlation between thyroid hormones levels and HBV-DNA load and HBV genotype in HBV-DNA-positive pregnant women. The TSH levels in mid and late pregnancy and TPOAb levels in early, mid, and late pregnancy of HBV-infected pregnant women were higher than those in the same period in HBV-uninfected pregnant women (P < .05). The TPOAb and TGAb levels in early, mid, and late pregnancy of HBV-DNA-positive pregnant women were higher than those in the same period in HBV-DNA-negative pregnant women (P < .05). The HBV-DNA load and FT3 or FT4 levels were negatively correlated (P < .05), and the HBV-DNA load and TGAb levels were positively correlated (P < .05). However, there was no statistical difference in thyroid hormone levels between different HBV genotypes (P > .05). The thyroid hormone levels will change in pregnant women infected with hepatitis B virus, and there is a certain correlation between HBV-DNA load and thyroid hormone levels. Therefore, timely monitoring of thyroid hormones and HBV-DNA load can provide early prevention and treatment for HBV infection in pregnant women, ensuring the health of pregnant women and fetuses.

Expression of thyroid antigens in the female reproductive system.

Thyroid autoimmunity (TAI) has been linked to fertility disorders and pregnancy complications, even in euthyroid women. However, the exact pathophysiological mechanism underlying this association is not fully understood. This study seeks to investigate the expression of thyroid antigens within the human female reproductive system, potentially identifying targets for thyroid antibodies. Human biopsies of endometrium and follicular granulosa cells were collected and thyroperoxidase (TPO) and thyroglobulin (TG) expression was evaluated in these tissues by immunohistochemistry. Results showed, for the first time, the expression of TG protein and confirmed the presence of thyroid TPO in human endometrium and granulosa cells. Results suggest that TPO antibodies (TPOAbs) and TG antibodies (TGAbs) could interact with TPO and TG expressed in the reproductive system in patients with positive thyroid antibodies, thereby disrupting the function of TPO and TG and generating an inflammatory response, leading to fertility disorders and pregnancy complications.

Kikuchi-Fujimoto disease co-occuring with Hashimoto thyroiditis: A case report and literature review.

We introduce a 16-year-old female who presented with tender cervical lymphadenopathy, prolonged fever, and hypothyroidism. After excluding common causes of fever of unknown origin, a surgical biopsy of cervical lymph nodes revealed Kikuchi-Fujimoto disease. The patient showed improvement with a short-term course of NSAIDs. An increased titre of thyroperoxidase antibody led to a diagnosis of Hashimoto's thyroiditis during stable condition. This report underscores the importance of considering Kikuchi-Fujimoto disease in the differential diagnosis of prolonged fever of unknown origin with lymphadenopathy and highlights the association with Hashimoto's thyroiditis, advocating for vigilance regarding hypothyroidism in long-term follow-up after Kikuchi-Fujimoto disease recovery.

Thyroid function monitoring during pregnancy in euthyroid women with thyroid autoimmunity.

Thyroid autoimmunity (TAI) may be present in 1-17% of pregnant women. Monitoring of thyroid function in euthyroid pregnant women positive for anti-thyroperoxidase antibodies (TPOAb+) is recommended. To determine the prevalence and possible clinical and biological risk factors of biochemical progression (rise in serum thyroid-stimulating hormone (TSH) > 2.5 mU/L) at second blood sampling during pregnancy, in euthyroid women (TSH ≤ 2.5 mU/L) according to their TPOAb status. This study included demographic and biological data from two previously published cohorts (n = 274 women from August 1996 to May 1997 Copenhagen cohort, and n = 66 women from January 2013 to December 2014 Brussels cohort) having at least two measurements of TSH and free thyroxine (FT4) and at least one of TPOAb during spontaneously achieved singleton pregnancies. The majority of women studied did not show biochemical progression. Only 4.2% progressed, significantly more frequently among TPOAb+ women, as compared to TPOAb- group (9.4 vs 2.7%, P = 0.015). No rise in serum TSH > 4 mU/L at 2nd sampling was observed. Higher baseline TSH levels were associated with biochemical progression in both TPOAb+ (P = 0.05) and TPOAb- women (P < 0.001), whereas maternal age, BMI, multiparity, smoking, FT4, and TPOAb concentrations were not significantly different between women with and without progression. Only a minority of euthyroid women with thyroid autoimmunity presented biochemical progression and none with a TSH > 4 mU/L. Larger studies are needed to better target the subset of women who would benefit most from repeated thyroid function monitoring during pregnancy.

Reexamining the Utility of Measuring Thyroperoxidase and Thyroglobulin Antibodies in Medically Treated Graves’ Disease and Orbitopathy

Reexamining the Utility of Measuring Thyroperoxidase and Thyroglobulin Antibodies in Medically Treated Graves’ Disease and Orbitopathy

Impaired embryo development potential associated with thyroid autoimmunity in euthyroid infertile women with diminished ovarian reserve.

The aim of this study was to evaluate the associations of thyroid autoimmunity (TAI) with the number of oocytes retrieved (NOR), fertilization rate (FR), and embryo quality (EQ) in euthyroid women with infertility and diminished ovarian reserve (DOR). This retrospective cohort study involved 1,172 euthyroid women aged 20-40 years with infertility and DOR who underwent an oocyte retrieval cycle. TAI was diagnosed in the presence of serum thyroperoxidase antibody (TPOAb) concentrations higher than 34 IU/ml and/or serum thyroglobulin antibody (TgAb) concentrations exceeding 115.0 IU/ml. Among these women, 147 patients with TAI were classified as the TAI-positive group, while 1,025 patients without TAI were classified as the TAI-negative group. Using generalized linear models (GLMs) adjusted for confounding factors, we evaluated the associations of TAI and the serum TPOAb and TgAb concentrations and NOR, FR, and EQ in this study's subjects. The TPOAb and TGAb values were subjected to log10 transformation to reduce skewness. Logistic regression models were used to estimate the effects of TPOAb and TgAb concentrations on the probabilities of achieving a high NOR (≥7) and high FR (>60%). For the whole study population, women with TAI had a significantly lower NOR and poorer EQ than women without TAI (P < 0.001 for both). Interestingly, in the TSH ≤2.5 subgroup, the TAI-positive group also had a significantly lower NOR and poorer EQ than the TAI-negative group (P < 0.001 for both). Furthermore, negative associations were observed between log10(TPOAb) concentrations and NOR and the number of high-quality embryos and available embryos (P < 0.05 for all). The log10(TgAb) concentrations were inversely associated with NOR and the number of high-quality embryos (P < 0.05 for all). In the regression analysis, the log10(TPOAb) concentrations had lower probabilities of achieving a high NOR [adjusted odds ratio (aOR): 0.56; 95% confidence interval (95% CI) 0.37, 0.85; P = 0.007]. TAI and higher TPOAb and TgAb concentrations were shown to be associated with reductions in the NOR and EQ in the study population. Our findings provide further evidence to support systematic screening and treatment for TAI in euthyroid women with infertility and DOR.

Potential implications of thyroid autoantibodies in children, adolescents, and young adults with thyroid nodules in Japan: The Fukushima Health Management Survey.

There have been no systematic epidemiological evaluations of the relationship between thyroid autoimmunity and the clinical background of young patients with thyroid nodules. We aimed to clarify the clinical features associated with thyroglobulin or thyroperoxidase antibodies (thyroid autoantibodies [Tabs]) in children and young adults with nodules. We performed a cross-sectional study using data from 3,018 participants of 3-29 years of age with nodules, including thyroid cancer, from the Fukushima Health Management Survey. After stratification of the data for body mass index (BMI) and the bilateral width and thickness of the area (BWTAR) as indicators of thyroid volume for age, sex, body surface area (BSA), and sex-adjusted standard deviation score (SDS), trend analyses were performed. A logistic regression analysis was performed using tab-positivity as an objective variable. The overall prevalence of tab-positivity is 13.9%. It was high in females (17%), participants with diffuse goiter (DG) (19.2%), and those with papillary thyroid carcinoma (PTC) (12.8%). The age- and sex-adjusted odds ratios (95% confidence intervals) for BMI-SDS, BWTAR-SDS, presence of DG, diagnosis of PTC, and TSH concentrations were 0.962 (0.863-1.073), 1.263 (1.171-1.361), 7.357 (4.816-11.239), 2.787 (1.965-4.014), and 1.403 (1.257-1.564), respectively. Tab positivity was independently associated with a large thyroid, the presence of DG, the presence of PTC, and a high TSH concentration in patients with nodules. Based on the systematic epidemiologic evidence shown in young patients, Tab positivity might complement ultrasonography for the assessment of the thyroid function and identification of malignancy in younger patients with asymptomatic thyroid nodules.

Association between thyroid autoimmunity and antinuclear antibody prevalence among pregnant women: a cross-sectional study in Qingdao, China.

To identify the relationship between thyroid autoimmunity and antinuclear antibody (ANA) prevalence in Chinese pregnant women. The study involved 1923 first-trimester women who were measured for thyroid stimulating hormone (TSH) level, thyroid autoantibodies (thyroperoxidase antibody [TPOAb] and thyroglobulin antibody [TgAb]) and ANA titer. Social demographic data were collected through standardized questionnaires. In this study, 23.3% of pregnant women tested positive for TPOAb and 9.9% tested positive for TgAb. Women with a positive ANA were more likely to be TPOAb-positive or TgAb-positive than women with a negative ANA (adjusted odds ratio [AOR] 1.96, 95% confidence interval [CI] 1.47-2.62 for TPOAb [+]; AOR 3.12, 95% CI 2.18-4.48 for TgAb[+]). In addition, ANA titers were closely associated with thyroid autoimmunity. Women with an ANA titer of >1:320 had a significant higher risk of being TPOAb positive or TgAb positive (AOR 4.49, 95% CI 1.48-13.66 for TPOAb [+]; AOR 5.51, 95% CI 1.65-18.49 for TgAb [+]). The higher the ANA titer, the greater the risk of developing thyroid autoimmunity, especially for those with a high ANA titer. ANA positivity is strongly correlated with thyroid autoimmunity. Further study is warranted to clarify the causal relationship between thyroid autoimmunity and ANA in pregnant women.This research is essential to evaluate and predict the risk of co-existing autoimmune disorders,leading to improved care for pregnancy and neonatal health.

Evans Syndrome in a Patient with Auto Immune Thyroiditis – A Rare Association

A 46-year-old woman, diagnosed with hypothyroidism, was on treatment with synthetic thyroxine 100 micrograms per day for one year. She complained of recent-onset exertional dyspnoea, and had malaise, lethargy, and pica. Investigations revealed significant anaemia and severe thrombocytopenia, necessitating blood transfusion. She had Coombs-positive autoimmune haemolytic anaemia and immune thrombocytopenic purpura, confirming a diagnosis of Evans syndrome. She also had a positive antinuclear antibody test but had no other notable findings of autoimmune disease, suggesting a diagnosis of primary Evans syndrome. The patient was treated with intravenous dexamethasone for four days, followed by oral prednisolone at 1mg/kg/ day, with supplemental calcium and vitamin D. Thyroperoxidase antibody was positive and there was reduced uptake in thyroid scintigraphy, confirming a diagnosis of autoimmune thyroiditis. Hashimoto’s thyroiditis frequently coexists with non-endocrine autoimmune disorders. Presence of antithyroid antibodies is sometimes observed in Evans syndrome, a condition where there is simultaneous occurrence of autoimmune Haemolytic Anaemia, Cytopoenia and immune thrombocytopenic purpura. However, the development of Evans syndrome in patients with overt hypothyroidism and Hashimoto’s thyroiditis is rare. This case implies the potential existence of a shared immunogenetic pathway among three distinct autoimmune diseases, namely autoimmune haemolytic anemia, immune thrombocytopenic purpura, and Hashimoto’s thyroiditis, in the pathogenesis.

Thyroid Function Test Abnormalities in Children and Adolescents with COVID-19: A Case-Control Study

Background: There is a lack of conclusive evidence regarding thyroid function test (TFT) abnormalities in COVID-19, especially among children. Objectives: This study aimed to investigate TFT abnormalities in COVID-19 pediatric patients compared to healthy children. Methods: This study was conducted on 37 COVID-19-positive children who were admitted to Namazi Hospital from January 21 to March 1, 2022, compared with 37 healthy children. Within 48 h of positive real-time polymerase chain reaction (PCR) results for severe acute respiratory syndrome coronavirus 2, a blood sample was taken to measure serum levels of thyroid-stimulating hormone (TSH) and total thyroxine (tT4) in the two groups. Additional tests, including free and total triiodothyronine, free T4, and thyroperoxidase antibodies, were also conducted on cases. The chi-square, Pearson correlation coefficient, and analysis of variance tests were used for data analysis. Results: Twenty-five patients were male, and 49 were female, with a mean age of 7.99 ± 5.02. The abnormal TFT and TSH frequency was significantly higher in the case group than in the control group. Nevertheless, there was no significant difference between the case and control groups regarding tT4 abnormalities. We could not establish an association between the mean of TSH and tT4 and age groups in the two groups and between abnormalities of TFTs and COVID-19 severity. Conclusions: Although abnormalities of TFT were significantly more common among COVID-19 children, they were not associated with the disease severity. However, studies with larger sample sizes are recommended to evaluate thyroid abnormalities and their clinical course in COVID-19 children.

Significance of thyroperoxidase and thyroglobulin antibodies in medically treated Graves' disease.

Thyroperoxidase (TPOAb) and thyroglobulin (TgAb) antibodies are highly prevalent in Graves' disease (GD), but their significance is controversial. We retrospectively analyzed TPOAb and TgAb levels and evolution in 136 patients with newly diagnosed GD between 2000 and 2022, treated with anti-thyroid drugs (ATD) in a block-and-replace (B+R) regimen for at least 12 months and followed up for at least 1 year after ATD discontinuation or until disease relapse. At diagnosis, 98 out of 136 (72%) patients were TPOAb positive and 73 out of 136 (54%) patients were TgAb positive. The presence of TPOAb or TgAb antibodies at diagnosis was generally not related to GD presentation and did not influence the risk of relapse (P = 0.304 and P = 0.348, respectively). There was less TED (thyroid eye disease) in TgAb-positive patients than TgAb-negative patients at diagnosis (11 out of 73 (15.1%) versus 21 out of 63 (33.3%) P = 0.012). In contrast, the presence of TPOAb at diagnosis was not associated with TED (P = 0.354). The absence of TgAb at diagnosis (P = 0.05) and time to euthyroidism (P = 0.009), but not smoking or TRAb levels, were associated with TED in multivariate logistic regression. TPOAb and TgAb levels during treatment and after its discontinuation were not predictive of relapse, except for lower titers of TgAb at 18 months in patients who relapsed (P = 0.034). In GD patients treated with a first course of ATD in a B+R regimen we observed lower titers of TgAb at the end of treatment in patients who relapsed and a significant protection against TED in patients with positive TgAb at diagnosis, irrespectively of TPOAb.

Investigating the association between hyperprolactinemia and thyroid autoimmunity in women

Aims: Hyperprolactinemia (HPRL), a condition characterized by elevated levels of prolactin (PRL) hormone, is considered to be related to various autoimmune diseases, such as thyroid autoimmunity (TAI). The association between HPRL and TAI still evokes controversy. Our study intends to examine the possible relationship between HPL and TAI in young women. Methods: This retrospective study was done between January 2018 and December 2022, including 90 women with HPRL and 90 control subjects of similar age and gender. A retrospective examination was conducted on the medical records of 90 patients with HPRL to gather relevant data. Information regarding related parameters was analyzed and compared to the control group data. Results: Our results found that thyroid stimulating hormone (TSH) levels were notably elevated in patients with HPRL compared to healthy women (2.24 vs. 1.86). Also, a statistically significant association between the case and control regarding serum free triiodothyronine (fT3) (p&lt;0.05). No statistically significant difference was found between the case and control regarding serum free thyroxin (fT4) (p&gt;0.05). Patients with HPRL demonstrated considerably higher anti thyroperoxidase antibody (anti-TPO) levels (46.08 vs. 43.95). Significantly elevated antithyroglobulin antibody (anti-Tg) levels were observed in patients with HPRL (1.07 vs. 0.84). Conclusion: The study suggests a potential link between HPRL and TAI. Further research is needed to explore this relationship and its implications for patient care.

Associations of thyroid status and thyroperoxidase antibodies with serum trace elements

BACKGROUND: Studies on the relationship between thyroid autoimmunity and serum trace elements (TE) are ongoing in different parts of the world, however, the data obtained are often contradictory, which determines the relevance of this study.AIM: The aim of the study was to identify associations between thyroid status and Anti-Thyroid Peroxidase antibodies (TPOAb) with serum TE among young women.MATERIALS AND METHODS: The study participants were 859 women aged 18–45, whose Thyroid-Stimulating Hormone (TSH) was in the reference range or above 3.4 µIU/ml and with free Thyroxine (fT4) in the reference range. The exclusion criteria were the presence of menopause and decompensation of chronic diseases. The participants were subdivided into 2 groups: a group of women with TPOAb less than 30 U/ml, designated as TPOAb(-), and a group of women with TPOAb more than 30 U/m, designated as TPOAb (+). The detection of TSH, fT4, and TPOAb in serum was provided by enzyme immunoassay on the Evolis Robotized System using “Thyroid — ELISA- TSH, 0.23–3.4 µIU/ml”, “Thyroid — ELISA free T4, 10–23.2 pmol/l”, “Thyroid ELISA — TPOAb&lt;30 U/ml” test systems. The reference values were taken from the instructions of the manufacturer Alkor Bio group (Russia). Logistic regression analysis was applied to adjudge associations between TPOAb status and serum trace elements.RESULTS: The level of fT4 was lower in the AT-TPO (+) group compared to the AT-TPO (-), p=0.006; Triglycerides, aspartate aminotransferase, alkaline phosphatase was higher in the AT-TPO (+) group compared to the AT-TPO (-). There were more smoking women in the AT-TPO group (-) 4.1% versus 1.3% in AT-TPO (+). It was found that, after adjusting for likely cofounding factors, participants with antibody positivity had significantly lower concentrations of selenium; zinc, iodine, iron. When serum trace elements levels were analyzed in tertiles, the odds ratios TPOAb positivity of tertile 1 were higher that of tertile 3.CONCLUSION: The associations between TPOAb and microelements demonstrate their involvement in autoimmune processes in the thyroid gland.

FRI537 Thyrotropin Receptor Blocking Antibodies - A Multicenter, 4-Assay Comparison

Abstract Disclosure: A. George: None. A.T. Bossowski: None. B. Hatun: None. J. König: None. M.A. Lupo: None. L. Frommer: None. J. Wolf: None. G.J. Kahaly: None. Background: Thyrotropin receptor (TSH-R) blocking autoantibodies (TBAb) are present in 10-15% of patients with autoimmune thyroid disease (AITD). TBAb are functional, impact thyroid function, and are clinically relevant. This multicenter study compares, in a large collective of AITD subjects, the sensitivity and specificity of four immunoassays for the measurement of TBAb and introduces a novel and ultra-rapid TBAb bioassay. Methods: Serum samples from AITD patients were tested with a TSH-R binding immunoassay (Cobas e411, Roche, Penzberg, Germany), an established cell-based TBAb reporter bioassay (Thyretain®, Quidel, San Diego, USA) with expression of a Luciferase transgene as readout and a new “TurboTM” TBAb bioassay (Quidel) with a readout that is based on a cyclic AMP-activated luciferase. A Passing-Bablok regression and intra- and inter-assay validations were performed. All samples were also tested for stimulating TSH-R-Ab (TSAb, Thyretain®, Quidel). Results: Of 1011, unselected, consecutive AITD patients (Graves’ disease and Hashimoto thyroiditis), 132 patients and 212 samples were TBAb positive. Median age was 32 years (25/75 percentile 13.25/46.5 years) and female: male ratio was 2.86:1. Of 212 samples, 149 (70.3%), 47 (23,1%) and 16 (7,5%) were hypothyroid, euthyroid and hyperthyroid, respectively. Thyroperoxidase and thyroglobulin antibodies were present in 136 (64.15%) and 70 (33.02%) samples, respectively. The four TSH-R-Ab assays were negative in 90 control subjects devoid of autoimmune thyroid and endocrine disorders. In contrast, the TurboTM cAMP TBAb, Luciferase TBAb and the Cobas binding assays detected TBAb in 212 (100%), 168 (79%) and 137/180 (76%) samples, respectively (Chi-square test p&amp;lt;0.001). The TurboTM TBAb bioassay highly correlated with thyroid function (p=0.007). Furthermore, the magnitude of percentage inhibition in both TurboTM and Luciferase TBAb bioassays correlated with TSH-R-Ab binding assay positivity (both p&amp;lt;0.001). Seventeen of 212 (8%) samples showed dual TSH-R-Ab positivity in the Turbo TBAb and TSAb bioassays, while 13 (6.1%) samples showed dual positivity for TSAb and TBAb in all three bioassays. The two TBAb bioassays correlated (Spearman’s r =0.59, p&amp;lt; 0.001). Single-user testing and intra-assay validation demonstrated adequate precision with very low coefficient of variation (CV 0.05) and low CV (0.14) at 92% and 44% inhibition (serum TBAb positivity), respectively. Conclusions: This is the largest reported collective of TBAb-positive samples in AITD patients, measured with four different immunoassays. TBAb markedly affects thyroid function. The novel, easy-to-perform, rapid and reliable TurboTM blocking bioassay detected significantly more TBAb than the established immunoassays demonstrating both its higher analytical performance and clinical utility in the management of AITD patients. Presentation: Friday, June 16, 2023

SAT472 A Case of Contrast Induced Thyrotoxicosis in a Patient Newly Diagnosed with Hyperthyroidism

Abstract Disclosure: E. Askar: None. B. Reddy: None. Background: It is quite uncommon for thyrotoxicosis to manifest itself after the administration of iodinated contrast. Although the actual prevalence has not yet been identified, estimates showed that the prevalence in areas with iodine deficiency is 0.25 to 0.5% and 0.025% in non-iodine-deficient areas with higher risk in elderly patients. Clinical Case: A 68-year-old female presented to the emergency department for 2 weeks of intermittent substernal chest pain associated with diaphoresis. She was diagnosed with hyperthyroidism by an outside clinic approximately one week prior to her presentation and was prescribed methimazole but did not start it. Her physical examination was significant for mild exophthalmos. EKG showed ST depression in anterolateral leads. Laboratory data showed a troponin of 0.328 ng/ml (0.0.015-0.45) which trended up to 4.830 after 3 hours and TSH of &amp;lt;0.005 mIU/L (0.358-3.74), otherwise BMP and CBC were within normal limits. Patient was started on aspirin, statin and heparin infusion along with methimazole. Patient was transferred to tertiary hospital for urgent cardiac catheterization that showed 90 % stenosis of left anterior descending artery (LAD) and 95 % stenosis in distal right coronary artery (RCA). A successful drug eluting stent was deployed in LAD with a plan of staged PCI in RCA. An hour after the procedure, Patient complained of palpitations and diaphoresis. Laboratory findings at that time revealed Free T4 of 17.5 ng/dl (0.9-1.8), Free T3 of 12.3 pg/ml (1.8-4.6) with positive Thyroperoxidase antibody, TSI and TSH Receptor Antibody. Thyroid ultrasound revealed diffusely heterogeneous thyroid gland with increased vascularity, consistent with Graves’ disease. The patient was diagnosed with thyrotoxicosis secondary to contrast administration. She was treated with methimazole 20 mg TID, metoprolol tartrate 25mg BID and hydrocortisone 25 mg BID. Decision was made to postpone the second procedure until trending down of thyroid hormones and improvement of symptoms. A successful staged RCA PCI was performed eight days later and patient did not experience any complications despite exposure to the same dose of iodinated contrast. Conclusion: Rarely, hyperthyroid patients may experience chest discomfort and EKG abnormalities that are consistent with cardiac ischemia. This usually happens in older patients with known underlying coronary artery disease in response to the rise in cardiac contractility and strain caused by thyrotoxicosis. Our case did not have any history or risk factors of coronary artery disease other than hyperthyroidism. This case highlights how recognition of hyperthyroidism may alter management, because the use of some procedures or treatments may acutely exacerbate the condition of the patient. Presentation Date: Saturday, June 17, 2023

GlycA as a Novel Biomarker of Systemic Inflammation in Hypothyroidism.

Background: GlycA is a novel glycoprotein biomarker of systemic inflammation and cardiovascular risk. Our objective was to assess the levels of GlycA in individuals with hypothyroidism. We also explored whether levothyroxine (LT4)-treated patients had different levels of GlycA, with attention to thyrotropin (TSH) levels. Methods: We performed a cross-sectional analysis, using baseline data from the ELSA-Brasil cohort study. We included only participants with serum TSH and GlycA levels measurements, using magnetic resonance spectroscopy (n = 4745). We excluded individuals with endogenous hyperthyroidism and those using drugs impacting thyroid function. Participants not taking LT4 and whose serum TSH was 0.4-4.0 mIU/L were classified as euthyroid (EU) and those with elevated TSH as undiagnosed hypothyroidism (UH). For those on LT4 (n = 345), adequacy of treatment was defined as TSH within the reference range. Those with TSH <0.4 mIU/L were considered over-treated (OT), and those >4.0 mIU/L, under-treated (UT). Both (UT+OT) were considered inadequately treated (IT). Group comparisons were performed by Kruskal-Wallis, adjusted Chi-square, and the post hoc Dunn test. Additional subgroup analysis were performed in patients with circulating thyroperoxidase antibodies (TPO-Ab+). Respective multivariable analyses were performed to evaluate the relationship between thyroid-related variables and GlycA levels (Generalized Linear Model), as well as an abnormal GlycA (>400 μmol/L; Logistic Binary Regression). Results: The prevalence rate of UH was 9.8% (467/4745) and, among those on LT4, only 61.7% (213/345) were adequately treated (AT). GlycA levels were higher in IT in comparison to EU (429 vs. 410 μmol/L, p < 0.01) but did not differ between UH (413 μmol/L) and euthyroidism. However, the subgroup analysis of those TPO-Ab+ showed that not only those with IT, but also those with UH, had higher levels of GlycA in comparison to euthyroidism (423 and 424 vs. 402 μmol/L, p = 0.04). This association between higher levels of GlycA and IT was maintained even in multivariable analysis (odds ratio 1.53, confidence interval 1.03 to 2.31) Lower levels of GlycA were detected in AT (405 μmol/L,) compared with OT (432 μmol/L, 0.04) and UT (423 μmol/L, p = 0.02). Conclusions: Patients with IT, both OT and UT, had higher GlycA levels, which may be associated with low-grade systemic inflammation and, possibly, increased cardiovascular risk.

ANAMNESIS, CLINICAL AND PARACLINICAL CHARACTERISTIC OF CHILDREN WITH AUTOIMMUNE THYROIDITIS

Purpose. &#x0D; To conduct a comparative characterization of anamnesis and clinical and paraclinical data of children suffering from autoimmune thyroiditis and those with no thyroid pathology in order to optimize early diagnosis of the disease.&#x0D; Materials and Methods. &#x0D; This examination was carried out on 132 children (55 boys and 77 girls) diagnosed with autoimmune thyroiditis at the age of 11.68±0.35. For comparison, 577 children (268 boys and 309 girls) without thyroid pathology at the age of 11.49±0.17 were included in the control group. Statistical study techniques were applied using the licensed software package Statistica. The differences of р&lt;0.05, р&lt;0.01, р&lt;0.001 were considered statistically significant.&#x0D; Results. &#x0D; The comparative study of children diagnosed with autoimmune thyroiditis and those with no thyroid pathology showed that euthyroidism was diagnosed in 78.31% of patients in the primary observation group, hypothyroidism in 17.39%, and hyperthyroidism in 4.3% of patients. Children diagnosed with autoimmune thyroiditis showed thyroperoxidase antibody levels ranging from 209.7 to 694.7 IU/mL, TSH from 0.01 to 5.93 to 89.9 IU/mL, and free T4 from 1.14 to 28.8 ng/dL. The criteria for early diagnosis of autoimmune thyroiditis included: a burdened familial history of thyroid disease (15.9%); complaints of psychoemotional, neurological (35.6%) and heart rhythm disorders (14.4%), predominantly in boys (58.2% and 18.18%), prolonged low-grade fever (5.3%), predominantly in girls (6.5%); comorbid conditions: respiratory tract diseases (25.76%) and lymphadenitis (28.03%); ultrasonic changes of the thyroid gland with increased (31.06%) or decreased (4.55%) volume, cystous nodules (40.15%), increased vascular pulsation (39%) and changes in echogenicity of the thyroid gland.&#x0D; Conclusion. &#x0D; At the current stage, early diagnosis of autoimmune thyroiditis in children is important for the timely prevention of the negative impact of the disease on the functional state and development of the child's body.

Characterization, treatment preferences, and outcomes of 390 Egyptian Graves’ disease patients: a retrospective study

BackgroundGraves’ disease is the most common cause of thyrotoxicosis worldwide. Patient characteristics may vary according to ethnicity, iodine status, and age. Studies on characterization of Graves’ disease in Egypt are lacking. The present study aims to report the patient characteristics, as well as treatment preferences and outcomes of Graves' disease patients from Alexandria, Egypt.MethodsA retrospective review of demographic, biochemical, serological, sonographic, and treatment data of Graves' disease patients attending endocrinology outpatient clinic, Alexandria faculty of medicine, Egypt.ResultsThree hundred ninety patients were included. Females were 75.9%, peak age was 21–40 years representing 53.1%, and family history of thyroid disease was positive in 60% of patients. Overt hyperthyroidism was present in 93.9%, TSH receptor antibodies were positive in 97.1%, and thyro-peroxidase antibodies in 74.8%. Goiter was present in 72.8%, nodularity in 18.4%, and thyroid eye disease in 17.7%. Medical treatment was used in 90% of patients, surgery in 5.4%, and radioiodine in 4.3%. For patients on medical treatment, 17.7% achieved remission, 29% relapsed, and 2.85% developed hypothyroidism.ConclusionA typical Graves’ disease patient in Egypt is a middle-aged female with a positive family history of thyroid disease. Overt hyperthyroidism was the most common presentation and goiter was a common sign at presentation. The sensitivity of TRAb’s for diagnosing Graves’ disease was excellent (97.1%). ATD’s was the commonest treatment modality with a remission rate of 17.7% and a relapse rate of 29%.

Anti-TPO-mediated specific features of the placenta immunohistochemical profile and possible mechanisms for fetal loss.

Passive transfer of antithyroid antibodies in mice leads to reproductive disorders. The purpose was to assess the placental tissue of experimental animals under the influence of the circulating thyroperoxidase antibodies. We performed an immunohistochemical examination of murine placentae after a passive transfer of thyroperoxidase antibodies. Placentae of mice that passively transferred IgG from healthy donors were used as control samples. For histological examination, 30 placental samples were selected from mice from the anti-TPO group and 40 placental samples were taken from mice from the IgG group. Immunostaining for VEGFR1, THBS 1, Laminin, CD31, CD34, FGF-β, CD56, CD14, TNF-α, kisspeptin, MCL 1, and Annexin V was performed. There is a significant decrease in the relative area of the expression of VEGFR1 (23.42 ± 0.85 vs. 33.44 ± 0.35, P < 0.01), thrombospondin 1 (31.29 ± 0.83 vs. 34.51 ± 0.75, P < 0.01), CD14 (25.80 ± 0.57 vs. 32.07 ± 0.36, P < .01), CD56 (30.08 ± 0.90 vs. 34.92 ± 0.15, P < 0.01), kisspeptin (25.94 ± 0.47 vs. 31.27 ± 0.57, P < 0.01), MCL 1 (29.24 ± 1.06 vs. 38.57 ± 0.79, P < 0.01) in the labyrinth zone of the placentae of mice from the anti-TPO group compared with control group. A significant increase in the relative expression of laminin and FGF-β was noted in the group of mice to which antibodies to thyroperoxidase were transferred, compared with the control group (36.73 ± 1.38 vs. 29.83 ± 0.94, P < 0.01 and 23.26 ± 0.61 vs. 16.38 ± 1.01, P < 0.01respectively). Our study exposed an imbalance of pro- and anti-angiogenic factors, decreased representation of placental macrophages and NK cells, abnormal trophoblast invasion processes, and insufficient expression of antiapoptotic factors in the placentae of mice in which anti-TPO antibodies were passively transferred.

Abstract #1408136: The Calm Before the Storm: Cardiogenic Shock in Graves’ Disease

This case highlights the endocrine and cardiopulmonary physiology of thyroid storm in a patient with comorbid rapid atrial fibrillation, severe heart failure with reduced ejection fraction and resultant cardiogenic shock in order to raise awareness regarding the risk of circulatory collapse, as well as the value of bedside ultrasound in management. A 42-year-old man presented to our hospital with 2 months of worsening dyspnea and lower extremity edema, 2 years of diarrhea and 50-pound weight loss followed by weight gain. He was hypertensive and in rapid atrial fibrillation (HR 180/min). A diltiazem drip was initiated, but he continued to be tachycardic (HR 120/min). Bedside point-of-care ultrasound (POCUS) was concerning for a severe cardiomyopathy. Chest x-ray demonstrated pulmonary edema. Labs demonstrated TSH < 0.01 mcIUnit/mL, free T4 2.9 mcg/dL (0.7-1.5 mcg/dL), and free T3 12.1 pg/mL (1.6-3.9 pg/mL). He met criteria highly suggestive of thyroid storm by the Burch-Wartofsky Point Scale, scoring 70 points, so management became focused on this. The diltiazem drip was discontinued in favor of an intravenous metoprolol challenge. Soon thereafter, his heart rate decreased to 80 bpm with low-normal mean arterial pressures. He developed acute hypoxemic respiratory failure with cool, cyanotic extremities. He was placed on non-invasive positive pressure ventilation with norepinephrine and dobutamine for treatment of cardiogenic shock secondary to thyroid storm. Hydrocortisone and propylthiouracil were administered. Echocardiogram showed severe left ventricular global hypokinesis with ejection fraction of 15%. As vasopressors were weaned, he underwent cautious diuresis. A short course of propranolol was started, which was subsequently switched to metoprolol tartrate. Thyrotropin receptor and thyroperoxidase antibodies were elevated. Thyroid ultrasound suggested autoimmune thyroiditis. He was transitioned to methimazole and discharged home. Thyroid storm patients are at risk of circulatory collapse after treatment with rate-control agents, especially in the presence of systolic dysfunction. In one study, underlying hyperthyroidism was unknown in 32% of patients admitted to the ICU for thyroid storm, and ICU mortality rates were 17%. Thyroid hormone sensitizes the myocardium to adrenergic input by upregulating adrenergic receptors, resulting in baseline tachycardia to maintain cardiac output and subsequent high-output heart failure.