Thyroperoxidase Antibodies Research Articles

Systematic review and trail sequential analysis of preparation of Xiakucao for Hashimoto's thyroiditis

To systemically evaluate the clinical efficacy and safety of oral preparation of Xiakucao with levothyroxine(LT4) on Hashimoto's thyroiditis(HT), so as to provide the evidence for its clinical application in the future. All the included studies were retrieved from four Chinese databases and three English databases from their inception to December 2019. ROB assessment tool of cochrane system and the evidence classification recommended by GRADE were used to evaluate the quality of evidences in all included studies. RevMan 5.3 was used for Meta-analysis of the outcomes. Software TSA 0.9(trail sequential analysis) was used to estimate the sample size for Meta-analysis. The results showed that 11 randomized controlled trials and totaling 1 215 patients were included. Preparation of Xiakucao combined with LT4 was adopted as intervention in experimental group, while patients in control group were treated with LT4 alone. Meta-analysis results showed that as compared with control group, the rate of total efficacy in experimental group was significant improved, including improvement of thyroid function and thyroid autoantibodies, shrinkage of thyroid gland and nodule, and improvement of clinical symptoms such as fatigue and cold intolerance(RR=1.15, 95%CI[1.09, 1.21]). The experimental group significantly decreased the serum level of thyroperoxidase antibody TPO-Ab(SMD=-0.91, 95%CI[-1.40,-0.41]), and reduced the size of left thyroid lobe(MD=-1.46, 95%CI[-1.82,-1.11]), right thyroid lobe(MD=-1.45, 95%CI[-1.96,-0.94]) and isthmus of thyroid gland(MD=-1.08, 95%CI[-1.20,-0.95]). After evaluation based on GRADEpro, the results showed that the evidence quality of all included studies was low or very low. The result of TSA showed that the cumulative sample size had reached the expected value. However, the pooled results may be affected by one study with high bias risk, with not so high effect intensity of evidences. From this review, we can see that in treatment of HT, intervention of preparation of Xiakucao combined with LT4 has advantages on improvement of clinical efficiency, decreasing serum level of TPO-Ab and shrinkage of thyroid gland. However, due to the quality of evidence, more rigorously designed and high-quality trials are needed in the future to verify the clinical efficacy and safety of preparation of Xiakucao in treating HT.

Autoimmunological serum parameters and bone mass density in premature ovarian insufficiency: a retrospective cohort study

PurposeIt is still not clear whether to screen women with primary premature ovarian insufficiency for autoimmunity. Moreover, a possible association of autoimmunity with decreased bone mass density in premature ovarian insufficiency patients has not been evaluated. Thus, the objectives of this study were to review our experience with the use of an autoimmune screening panel in premature ovarian insufficiency women and to focus on bone mass density.MethodsIn a retrospective cohort study, 76 chromosomally normal women with primary premature ovarian insufficiency were included. The main outcome parameters were the results of an autoimmune screening panel and of dual-energy X-ray absorptiometry.ResultsMedian age was 33 years. Sixty percent of premature ovarian insufficiency patients revealed abnormal dual-energy X-ray absorptiometry results (minimal T-score < −1.0). Any signs of autoimmunity were found in 21 women (36.2%). The most frequent abnormal results were increased thyroperoxidase antibodies (24.1%) and thyroglobulin antibodies (20.7%). A longer duration of amenorrhea (β = −0.015; p = 0.007), any abnormality during autoimmune screening (β = −0.940; p = 0.010), and a lower body mass index (β = −0.057; p = 0.036) were associated with a lower minimal T-score.ConclusionIn chromosomally normal women with primary premature ovarian insufficiency, the prevalence of autoimmunity and decreased bone mass density seem high. Our data highlight the association between autoimmune abnormalities and decreased dual-energy X-ray absorptiometry results.

Quality of Life After Thyroidectomy for Hashimoto Disease in Patients With Persistent Symptoms.

To determine whether thyroidectomy improves quality of life in patients with Hashimoto thyroiditis with persistent symptoms despite biochemical euthyroidism. A retrospective cohort study was conducted of patients undergoing thyroidectomy for Hashimoto thyroiditis at our institution between 2014 and 2018. The following variables were collected: age, race, body mass index, preoperative symptoms, preoperative thyroid peroxidase antibody titer, thyroglobulin antibody titer, thyroid-stimulating hormone, free thyroxine, specimen weight, and histologic presence of thyroiditis. Outcomes included general health score on the Short Form 36 (SF-36) Health and responses to a questionnaire addressing postoperative disease management. A total of 19 patients were included in the study, 18 of whom were female with a mean age of 48 years. The majority of patients were Caucasian. There were no significant differences between the postoperative general health scores of the patients with Hashimoto thyroiditis and scores from a healthy control population (66.9 vs 74.1; 95% CI: -16.9 to +2.5, P = .16). There were also no differences between groups within the 7 SF-36 subscores. Elevation in preoperative thyroperoxidase antibody correlated with lower reported postoperative energy levels (r = -0.63, P = .016) and emotional well-being (r = -.55, P = .041); 87.5% of respondents reported being moderately or extremely happy with their decision to proceed with surgery. Quality of life in patients with Hashimoto thyroiditis who undergo thyroidectomy is equivalent to the general population, and the majority are satisfied with surgery. Thyroidectomy is a consideration for patients with persistent symptoms despite optimization on medical therapy.

Is there any association between psoriasis, psoriatic arthritis and thyroid autoimmunity?

Autoimmune diseases share a significant part of their genetic background and tend to coexist in the same patient. Some studies have investigated the possible association between autoimmune thyroiditis and psoriasis or psoriatic arthritis (PsA), with conflicting results. This study aimed to investigate the prevalence of autoimmune thyroiditis in psoriatic patients with (PsA) or without (PsC) joint involvement. 208 patients with psoriasis and/or PsA were recruited. These patients were divided into two groups: psoriasis patients (without PsA) (PsC group: 100 patients; mean age of 50.1±11.7years) and subjects with psoriasis and psoriatic arthritis (PsA group: 108 subjects: mean age of 39.8±10.8years). Assessment of psoriasis severity was conducted using the Psoriasis Area and Severity Index (PASI) score. The diagnosis of psoriatic arthritis was made according to CASPAR criteria. All patients had thyroid evaluation through evaluation of thyroid function, thyroperoxidase antibodies and thyroid ultrasound examination. A statistically significant difference was found between the prevalence of autoimmune thyroiditis in the PsA group than the PsC group (25.9 vs 9.0 %; P=0.018) with higher trends to hypothyroidism in the PsA group compared to the PsC group (13.9% vs 2.0%, P=0.0018). The higher prevalence of autoimmune thyroiditis in the PsA group may be due to an immune dysfunction pathway in patients with psoriatic arthritis with a higher risk to develop other autoimmune diseases. This evidence confirms that psoriatic arthritis is an autoimmune disease with an overactive immune system that can involve multiple organs. Thyroid function evaluation should be part of the clinical and laboratory examination of patients with psoriatic arthritis.

Clinical Validity of Serum Antibodies to SARS-CoV-2 : A Case-Control Study.

The clinical utility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies remains undefined. To determine the clinical validity and utility of SARS-CoV-2 antibodies. Case-control study. First month of testing for coronavirus disease 2019 (COVID-19) by using a nucleic acid amplification test (NAAT) on nasopharyngeal swabs at the Johns Hopkins Hospital, Baltimore, Maryland (11066 persons). Of the 11066 tested persons, 115 (1%) were hospitalized adults investigated for COVID-19. Clinical record review was performed to classify them into a COVID-19 case group (n= 60) or a non-COVID-19 control group (n= 55). The laboratory control groups comprised 513 persons not tested by NAAT: 160 healthy laboratory employees, 101 persons positive for IgG antibodies against Epstein-Barr virus capsid antigen, 215 positive for thyroperoxidase antibody, and 37 positive for rheumatoid factor. Serum IgG and IgA antibodies against SARS-CoV-2 spike protein were detected by using enzyme-linked immunosorbent assay. Sensitivity and specificity of the SARS-CoV-2 IgG assay were 0.976 (95% CI, 0.928 to 0.995) and 0.988 (CI, 0.974 to 0.995), respectively, when performed 14 days or later after symptom onset, but sensitivity decreased at earlier time points. Immunoglobulin G developed rapidly and was sustained at high levels throughout follow-up (up to 58 days). Antibodies to SARS-CoV-2 predicted the odds of developing acute respiratory distress syndrome, which increased by 62% (CI, 48% to 81%; P< 0.001) for every 2-fold increase in IgG. Of 11066 NAAT-tested patients, 457 were repeatedly NAAT-negative, and serum samples were obtained for 18 such patients (6 COVID-19 case patients and 12 non-COVID-19 control patients). Antibodies were present in 5 of 6 case patients and none of the 12 control patients (P= 0.001). The study was retrospective and performed at a single center; the sample was small; follow-up was limited; and selection bias may have occurred. Antibodies to SARS-CoV-2 demonstrate infection when measured at least 14 days after symptom onset, are associated with clinical severity, and provide valuable diagnostic support in patients who test negative by NAAT but remain clinically suspicious for COVID-19. Clinical Immunology Laboratory, Department of Pathology, Johns Hopkins Hospital.

To evaluate the presence of subclinical thyroid disorder in type 2 diabetes mellitus

Objectives: Our objective is to determine the prevalence of subclinical thyroid disorders in patients with type 2 diabetes mellitus (T2DM) and to analyze the clinical and metabolic profile of patients with this dual endocrine disorder. Methods and Results: Sixty consecutive type 2 diabetic patients without clinical manifestations of thyroid disorders were screened for SCH and subclinical hyperthyroidism using serum free T 3, free T 4 and thyroid stimulating hormone (TSH) levels. Individuals of subclinical thyroid disease were further screened for thyroperoxidase (TPO) antibodies. SCH was detected in 13% of type 2 diabetic patients and none had subclinical hyperthyroidism in our study. SCH was common among females with type 2 diabetes (84.6%). Elevated TPO antibody levels were present in 84.6% SCH patients. Diabetic retinopathy among SCH patients showed significant association with higher serum TSH levels. Left ventricular diastolic dysfunction was present in 30.8% of SCH patients. Conclusion: SCH is common among type 2 diabetic patients, especially in females. It is most commonly secondary to autoimmune thyroid disease. Microvascular complications are commonly observed in this group of patients with dual endocrinal disorder and treating physician should be aware of the impact and should routinely screen SCH to prevent complications.

Surgical treatment of Hashimoto’s thyroiditis. Indication and evaluation of results from a quality of life standpoint

Background. Patients with Hashimoto’s thyroiditis have hypothyroidism, goiter, and extrathyroidal lesions.Replacement therapy with exogenous thyroxine is not effectivein some cases. Westudiedthe feasibility of surgical treatment,namely removal of the active site of autoimmune aggression. Objective — to study the effect of thyroidectomy on the quality of life of patients with Hashimoto’s thyroiditis with extrathyroidal manifestations. Material and methods. 61 patients with Hashimoto’s thyroiditis were examined. Among them 29 patients were treated with medications (control group) and 32 with surgery (main group). The duration of Hashimoto’s thyroiditis before inclusion in the study ranged from 7 to 19 years (11.80 ± 0.53), and treatment with levothyroxine lasted from 2 to 8 years (4.20 ± 0.32). The mean age of patients, duration of disease and dose of levothyroxine replacement therapy in both groups did not differ significantly. The quality of life was assessed using the SF-36 questionnaire. TSH levels within eut­hyroidism were controlled and the level of thyro­peroxidase (TPO)antibodies was determined. Results. Two years after the surgical treatment, the studied quality of life indicators was improved significantly. The increase in individual indicators ranged from 34 (role-functioning, condi­tioned by emotional state) to 57 % (vital activity), and the overall health indicator increased by 52 %. The level of TPO antibodies decreased almost to normal. In the group of patients receiving drug treatment, overall quality of life indicators did not change significantly, but there was a tendency to worsen. The level of TPO antibodies remained high without significant changes. Thyroidectomy in patients with Hashimoto’s thyroiditis with hypothyroidism, local and extrathyroid symptoms on the background of on-treatment laboratory euthyroidism can improve quality of life. Identification of the cause of improved quality of life and the role of decreased serum levels of TPO antibodies is one of the ways to reveal the pathogenetic mechanisms of extrathyroid complications of Hashimoto’s thyroiditis. Conclusions. Surgical treatment of patients with Hashimoto’s thyroiditis improves quality of life. TPO antibodies after thyroidectomy are reduced to almost physiologicallevels.

Association of breastfeeding with thyroid function and autoimmunity in postmenopausal women.

Whether breastfeeding influences thyroid function and autoimmunity is not elucidated. We examined the association of history of breastfeeding with thyroid hormones and thyroperoxidase antibody (TPOAb). Cross-sectional study of data from the 2013-2015 Korea National Health and Nutrition Examination Survey. A total of 816 postmenopausal women were stratified into three groups according to the duration of breastfeeding and number of breastfed children. Thyroid hormones levels, TPOAb titers, and the prevalence of hypothyroidism and TPOAb positivity were evaluated in each group. Subjects with a history of prolonged breastfeeding had lower levels of thyrotropin (TSH) and TPOAb than the others. After adjusting for multiple confounding factors, the estimated means of TSH and TPOAb were associated with cumulative duration of breastfeeding. Duration of breastfeeding per child was associated with TSH levels, and number of breastfed children was associated with TPOAb titers. The odds ratio (OR) of hypothyroidism was significantly lower in group for ≥36 months of cumulative duration of breastfeeding, and the OR of TPOAb positivity was significantly lower in group with ≥3 breastfed children. In addition, duration of breastfeeding and the number of breastfed children were linearly correlated with log TSH and TPOAb each other in the multivariate model. The present study showed that prolonged breastfeeding was inversely associated with TSH and the prevalence of hypothyroidism. Moreover, TPOAb and the prevalence of TPOAb positivity were inversely associated with number of breastfed children. These results indicate that breastfeeding may exert a protective effect on thyroid function and autoimmunity.

Urinary Concentrations of Phthalate Metabolite Mixtures in Relation to Serum Biomarkers of Thyroid Function and Autoimmunity among Women from a Fertility Center.

Background:Although previous epidemiological studies have explored associations of phthalate metabolites with thyroid function, no studies to date have assessed associations of mixtures with thyroid function and autoimmunity among potentially susceptible subgroups such as subfertile women.Objective:We aimed to explore associations of mixtures of urinary phthalate metabolites with serum markers of thyroid function and autoimmunity.Methods:This cross-sectional study included 558 women attending a fertility center who provided one spot urine and one blood sample at enrollment (2005–2015). We quantified urinary concentrations of eight phthalate metabolites using mass spectrometry, and biomarkers of thyroid function [thyroid-stimulating hormone (TSH), free and total thyroxine (, ) and triiodothyronine (, ), and autoimmunity [thyroid peroxidase and thyroglobulin antibodies (TPOAb and TgAb, respectively)] in serum using electrochemiluminescence assays. We applied principal component analysis (PCA) and Bayesian kernel machine regression (BKMR) to identify the main patterns of urinary phthalate metabolites. We used linear mixed models to assess the association between PCA-derived factor scores in quintiles and serum thyroid function and autoimmunity, adjusting for age, body mass index (BMI), specific gravity (SG), and, for the PCA, other factor scores.Results:We observed two factors using PCA, one representing the di(2-ethylhexyl) (DEHP) and another non-DEHP metabolites. Compared to women in the lowest quintile of the DEHP factor scores, women in the highest quintile had significantly lower serum concentrations of , , , and [absolute difference: ; 95% confidence interval (CI): , ; ; absolute difference: ; 95% CI: , ; ; absolute difference: ; 95% CI: 0.54, ; ; and absolute difference: ; 95% CI: , ; , respectively]. Using BKMR, we observed that mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) was the primary contributor to these negative associations. DEHP and non-DEHP factor scores were not associated with serum TSH, TgAb, or TPOAb.Conclusions:Mixtures of urinary DEHP metabolites were inversely associated with serum biomarkers of thyroid function but not with autoimmunity, which were within normal ranges for healthy adult women. https://doi.org/10.1289/EHP6740

Thyroxine-binding globulin, peripheral deiodinase activity, and thyroid autoantibody status in association of phthalates and phenolic compounds with thyroid hormones in adult population

Exposure to consumer chemicals such as phthalates and phenolic compounds has been associated with thyroid hormone disruption in humans. However, information related to factors that may influence such associations, e.g., transport and activation of the hormones, and autoimmunity status, is limited. In the present study, we employed a subpopulation of adults (n = 1,254) who participated in the Korean National Environmental Health Survey (KoNEHS) 2015–2017, and associated urinary concentrations of major phthalate metabolites, bisphenol A (BPA), and parabens, with thyroid hormone-related measures, including free and total T3 and T4, TSH, thyroxine-binding globulin (TBG), calculated peripheral deiodinase (DIO) activity, and thyroid autoantibodies of thyroperoxidase (TPO) and thyroglobulin (Tg). Phthalate metabolites were negatively associated with total T4 and free T3, and positively associated with total T3. These observations could be explained by TBG levels and calculated peripheral DIO activity that were positively associated with phthalates exposure. In contrast, BPA was positively associated with total T4 and negatively associated with total T3, without any changes in TBG concentration. Serum TPO and Tg antibodies were not associated with urinary phthalate metabolites and BPA. However, thyroid autoantibody status appeared to modulate the association of some phthalates with thyroid hormones. For parabens, little to negligible association was observed. The results of our observation show potential underlying mechanisms of phthalates-induced thyroid hormone disruption, and suggests the importance of consideration of thyroid autoimmunity status in association studies for thyroid disrupting chemicals.

The characteristics and clinical significance of serum TRAb IgG subtype in patients with thyroid associated ophthalmopathy

Objective To explore the distribution of serum TRAb IgG subtypes in patients with thyroid-associated ophthalmopathy(TAO) at different stages and its value in assessing TAO activity. Methods Forty-three patients with TAO, 30 patients with Graves′ disease (GD group), 19 patients with Hashimoto′s thyroiditis (HT group), and 50 healthy subjects (NC group)admitted to the First Affiliated Hospital of Zhengzhou University were collected from August 2018 to February 2019. According to the clinical activity score (CAS), the patients with TAO were further divided into the active period group (AP group, CAS≥3 points, 22 cases) and the inactive period group (IP group, CAS<3 points, 21 cases). The basic clinical data of subjects in each group were collected. The serum concentrations of FT3, FT4, TSH, thyroperoxidase antibody (TPOAb), thyroglobulin antibody (TgAb), and thyroid-stimulating hormone receptor antibody (TRAb) were detected by chemiluminescence immunoassay and the binding rate in percentage (B) of serum TRAb IgG and IgG subtypes were detected by ELISA. The positive rate in each group and relative content of positive samples were compared. Results (1)Compared with HT group, the positive rates of IgG1 and IgG2 in TAO group and GD group were significantly decreased (P 0.05). (2)Compared with the IP group, IgG1(B) and the positive rates of IgG1 in the AP group were increased while IgG4(B) and the relative contents of IgG4 were reduced (P<0.05). (3)IgG1(B)was positively correlated with TAO activity (B=6.190, P=0.007), and higher IgG4(B)indicated more inclinations to the inactive period (B=-16.390, P=0.052). (4) The area under the curve of receiver operating characteristic (ROC) for TAO developing into active period assessed by activity rate was 0.859 (95%CI 0.746-0.973, P<0.05). When the activity rate was 4.29, the Jordon index showed the largest, with sensitivity of 81.8% and specificity of 81.0%. Conclusions Elevated levels of TRAb IgG1 in the patients with TAO indicate a tendency to active period, while elevated levels of TRAb IgG4 indicate a tendency to inactive period. The activity rate can provide a reference for assessing whether TAO is active or not. Key words: Thyroid-associated ophthalmopathy; IgG subtype; Clinical activity score

Relationship between autoimmune liver disease and autoimmune thyroid disease: a cross-sectional study

Background: A high prevalence of autoimmune thyroid disease (AITD) has been observed in patients with autoimmune liver disease (AILD); however, data on the clinical relationship between AILD and AITD remain scant. We aimed to evaluate the relationship between AILD and AITD.Methods: We performed a retrospective study using medical records from 324 patients with AILD, 113 of whom had concurrent AITD.Results: Patients with autoimmune hepatitis (AIH) were more likely to develop AITD (45.8%), followed by autoimmune hepatitis-primary biliary cholangitis overlap syndrome (AIH-PBC OS) (39.5%) and PBC (22.6%). Patients with concurrent AILD and AITD showed higher levels of immunoglobulin G (IgG) (21.5 g/L vs 16.3 g/L, p < .0001) and gamma globulin (γ-globulin) (27.1% vs 21.9%, p < .0001). IgG was positively correlated with thyroid antibodies [thymoglobulin antibody (TGAb) and thyroperoxidase antibody (TPOAb)] (r = 0.396, 0.322; p < .0001, p = .002, respectively). TPOAb positivity was highest in PBC patients with concurrent AITD (83.9%). Patients with concurrent PBC and AITD were significantly older than those with PBC alone (p = .0004). Patients with concurrent AIH and AITD had a higher homogenous nuclear pattern of antinuclear antibody positivity compared to those with AIH alone (p = .019). Thyroid dysfunction in AILD patients with concurrent AITD was principally characterized by Hashimoto’s thyroiditis (65.5%), and diffuse lesions were mainly found by thyroid ultrasound (53.1%).Conclusions: The high incidence of AILD concomitant with AITD, the higher levels of serum IgG and γ-globulin, and the strong correlation between thyroid antibodies and IgG suggest that close screening for AITD and accurate physical examinations should be performed for all patients with AILD.

Features of women’s reproductive dysfunctions associated with prolonged stressful situations

The number of appeals of migrant women and servicewomen for specialized gynecological care has increased during the years of the armed conflict in Eastern Ukraine. The aim of the work was a comprehensive study of the hormonal function of pituitary gland, ovaries, thyroid gland and adrenal glands in women of reproductive age with various types of menstrual cycle disorders caused by a prolonged stressful situation. Materials and methods. With the help of immune-enzyme analysis the authors have conducted a study of pituitary hormones (FSH, LH, prolactin), ovarian hormones (estradiol, progesterone, free T), thyroid hormones (TSH, FТ 4 ) and thyroid peroxidase antibodies, as well as adrenal glands hormones (ACTH, cortisol (urine), DHEA-s) of 74 migrant women and servicewomen with menstrual disorders caused by a stressful situation. According to complaints, women were divided into 2 subgroups: with amenorrhea 34 (45.9 %) and abnormal uterine bleeding – 40 (54.1 %). Results. Women with stressed amenorrhea had a significant 2 times (P < 0.05) increase in FSH; 1.9 times – LH; 1.6 times – prolactin (which is not typical for classical hyperprolactinemia) and 3.2 times decrease in estradiol, 3.9 times – progesterone in comparison to the control group. Dysfunction of the thyroid gland was recorded, in particular 2 times decrease in FT 4 and 1.7 times increase in thyroperoxidase antibodies relative to the control. A significant 1.6 times increase in ACTH, 1.8 times increase in cortisol (urine) and 1.6 times increase in DHEA-s were detected compared with the control. Women with abnormal uterine bleeding had a significant 1.5 times (P < 0.05) increase in prolactin, 1.3 times increase in estradiol, and a 2.5 times decrease in progesterone compared to the control women group. 90.5 % of women of reproductive age with menstrual cycle disorders caused by the influence of prolonged stress factor had hormonal disorders of the ovaries, adrenal glands and thyroid gland. Conclusions . In women with stress-related amenorrhea there is a violation of the relationship in the hypothalamic – pituitary system while maintaining the negative feedback loops of the pituitary-ovarian axis or ovarian depletion; post-traumatic stress disorders have a significant pathological effect on the reproductive system of women who have experienced such suffering.

Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients; the 2019 Italian Survey

Background: The incidence and prevalence of hypothyroidism are increasing and the threshold for the treatment of hypothyroid as well as individuals without evident thyroid disease with thyroid hormone is declining. Objective: To investigate endocrinologists’ use of thyroid hormones in hypothyroid and euthyroid patients in Italy, a country where different formulations of levothyroxine (LT4; tablet, liquid solution and soft-gel capsule) are available on the market. Methods: Members of the Associazione Medici Endocrinologi (Italian Association of Clinical Endocrinologists) were invited to participate in a web-based survey investigating the topic. Results: A total of 797 of 2,028 (39.3%) members completed all the sections of the survey; 98.7% declared that the treatment of choice for hypothyroidism is LT4. A significant minority (37.3%) indicated that LT4 may be considered in infertile euthyroid women seeking pregnancy and harbouring positive thyroperoxidase antibodies (TPOAb) and in goitre increasing in size (18.1%). LT4 + LT3 was considered by 43.2% for LT4-replaced patients and normal TSH, if they reported persistent symptoms. High percentages of respondents chose LT4 in a liquid solution or soft-gel capsules when taken together with other drugs interfering with LT4 absorption (81.8%), in patients with a history of celiac disease, malabsorption, lactose intolerance, intolerance to common excipients (96.6%), or unexplained poor biochemical control of hypothyroidism (74.4%), or in patients not able to adhere to ingesting LT4 fasted and/or separated from food/drink (98.9%). In total, 43.6% of responders would use LT4 in a liquid solution or soft-gel capsules for hypothyroid patients with biochemical euthyroidism on LT4, who had persistent symptoms. Conclusions: The preferred treatment for hypothyroidism is LT4; LT3 + LT4 combination treatment is mainly considered in patients with persistent symptoms. A significant minority would offer LT4 to euthyroid women with positive TPOAb and infertility and to euthyroid patients with progressive simple goitre. Alternative LT4 formulations like liquid solution or soft-gel capsules are largely reserved for specific conditions (interfering drugs, actual or suspected malabsorption, inability to take LT4 in the fasting state, unexplained poor biochemical control of hypothyroidism).

The Evaluation of Epicardial Fat Thickness and Carotid Intima-Media Thickness in the Patients with Subclinical and Overt Hypothyroidism

Bacgrounds: The studies conducted have shown that epicardial fat thickness (EFT) and Carotid intima-media thickness (CIMT) are closely associated with cardiovascular diseases and that this may be an indicator for the prediction of early atherosclerosis. In this study, we have attempted to identify EFT and CIMT in patients with hypothyroidism and to reveal the relationship between them and thyroid hormones.Material and method: 82 patients diagnosed with primary hypothyroidism and 37 patients from healthy control group were included in the study. The subclinic hypothyroidism group (SH) was made up of 50 patients; the overt hypothyroidism group (OH) was composed of 32 patients. Cases’ thyroid-stimulating hormone (TSH), FT3, FT4, thyroperoxidase antibodies (anti-tpo) and anti-tiroglobulin antibodies (anti-tg) were studied. Their EFT and CIMT values were measured. The statistical analysis was applied to EFT and CIMT. Results: Compared with the CG, the thickness of epicardial fat tissue increased in OH and SH groups (p&amp;lt;0,001, p&amp;lt;0,001 respectively). In terms of EFT, there was no significant difference between OH and SH groups. Compared with the CG, the mean CIMT increased in OH and SH (p&amp;lt;0,001, p&amp;lt;0.001 respectively), but there was no significant difference between OH and SH in terms of CIMT. In addition, there was a positive correlation between EFT and CIMT (p&amp;lt;0.001). Conclusions: The measurement of EFT and CIMT can be used as a marker for the diagnosis of early atherosclerosis both in OH and in SH patients. Because the thickness of EFT and CIMT increased in patients with SH who are debated as to whether they should be treated, it leads us to think that these patients should be treated in order to reduce the risk of cardiovascular diseases in these patients.

Preoperative Thyroid Autoimmune Status and Changes in Thyroid Function and Body Weight After Bariatric Surgery.

Bariatric surgery has emerged as the most effective therapy for morbid obesity. There is increasing evidence that bariatric surgery could alleviate systemic inflammation and influence thyroid function. The current study aimed to investigate the associations of preoperative thyroid autoimmune status with the changes in body weight and thyroid function after bariatric surgery. We recruited 101 patients with morbid obesity (44 men and 57 women) who received bariatric surgery at Zhongshan Hospital, Fudan University. Those who had used thyroid hormone replacement or antithyroid drugs were excluded. General linear models were used to compare the changes in body weight and thyroid function in participants with different thyroid autoimmune statuses. After bariatric surgery, serum-free triiodothyronine (FT3) (4.94 ± 0.73 vs 4.33 ± 0.59pmol/L, P < 0.001) and thyroid-stimulating hormone (TSH) (3.13 ± 1.59 vs 2.26 ± 1.26μIU/mL, P < 0.001) were significantly reduced, accompanied by reductions in BMI (42.1 ± 7.6 vs 31.4 ± 6.5kg/m2, P < 0.001), and estimated basal metabolic rate (2002 ± 398 vs 1700 ± 336kcal/day, P = 0.001) and an improvement in lipid profiles. Serum thyroperoxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) levels also decreased significantly from 79.3 and 177.1IU/mL to 57.8 and 66.0IU/mL in participants with positive thyroid antibodies (P < 0.05). Further analysis showed that the positive preoperative thyroid autoimmune status was associated with less reduction in serum TSH (0.05 ± 1.59 vs - 1.00 ± 1.43μIU/mL, P = 0.021) and BMI (- 8.3 ± 3.6 vs - 11.0 ± 4.5kg, P = 0.049) after bariatric surgery. Our study highlights a group of patients with morbid obesity, who have positive preoperative thyroid autoimmunity and less reduction in serum TSH levels and body weight after bariatric surgery.

Correlation between vitamin D deficiency and high levels of thyroperoxidase antibodies in a group of Albanian patients

Correlation between vitamin D deficiency and high levels of thyroperoxidase antibodies in a group of Albanian patients

Hashimoto's Encephalopathy and Seizure Disorders.

Hashimoto's encephalopathy (HE) is a rare, clinically heterogeneous condition associated with positive thyroid autoantibodies. It is increasingly recognized as an important and treatable cause of autoimmune encephalopathy. Thyroid-associated antibodies such as thyroperoxidase (TPO) antibody, thyroglobulin (TG) antibody, and thyrotropin receptor (TR) antibody were found in HE patients with seizure disorders. Although antithyroid antibodies are required for the diagnosis of HE, their role in the pathogenesis of HE remains uncertain. Instead of playing a key role in the pathophysiology processes of HE, it is suggested that thyroid-associated antibodies are hallmarks of HE. Seizure disorders were found in approximately two-thirds of HE patients, and common anticonvulsant therapy alone is usually ineffective. Some patients did not respond to any antiepileptic drugs. The use of immunotherapy can effectively control seizure disorders. Electroencephalography and imaging findings are not specific to HE patients and can also be seen in other causes of encephalopathies. However, the prognosis in the majority of patients with HE was usually good if it is diagnosed and treated correctly.

Correlations between thyroperoxidase antibody titers and Levothyroxine dose in patients with primary hypothyroidism

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Thyroid hormones and neurobehavioral functions among adolescents chronically exposed to groundwater with geogenic arsenic in Bangladesh

Groundwater, the major source of drinking water in Bengal Delta Plain, is contaminated with geogenic arsenic (As) enrichment affecting millions of people. Children exposed to tubewell water containing As may be associated with thyroid dysfunction, which in turn may impact neurodevelopmental outcomes. However, data to support such relationship is sparse. The purpose of this study was to examine if chronic water As (WAs) from Holocene alluvial aquifers in this region was associated with serum thyroid hormone (TH) and if TH biomarkers were related to neurobehavioral (NB) performance in a group of adolescents. A sample of 32 healthy adolescents were randomly drawn from a child cohort in the Health Effects of Arsenic Longitudinal Study (HEALS) in Araihazar, Bangladesh. Half of these participants were consistently exposed to low WAs (<10 μg/L) and the remaining half had high WAs exposure (≥10 μg/L) since birth. Measurements included serum total triiodothyronine (tT3), free thyroxine (fT4), thyrotropin (TSH) and thyroperoxidase antibodies (TPOAb); concurrent WAs and urinary arsenic (UAs); and adolescents' NB performance. WAs and UAs were positively and significantly correlated with TPOAb but were not correlated with TSH, tT3 and fT4. After accounting for covariates, both WAs and UAs demonstrated positive but non-significant relationships with TSH and TPOAb and negative but non-significant relationships with tT3 and fT4. TPOAb was significantly associated with reduced NB performance indicated by positive associations with latencies in simple reaction time (b = 82.58; p < 0.001) and symbol digit (b = 276.85; p = 0.005) tests. TSH was significantly and negatively associated with match-to-sample correct count (b = −0.95; p = 0.05). Overall, we did not observe significant associations between arsenic exposure and TH biomarkers although the relationships were in the expected directions. We observed TH biomarkers to be related to reduced NB performance as hypothesized. Our study indicated a possible mechanism of As-induced neurotoxicity, which requires further investigations for confirmatory findings.