TPOAb Titer Research Articles

Diagnostic value of antithyroid peroxidase antibody for incidental autoimmune thyroiditis based on histopathologic results

Detection of antithyroid peroxidase antibody (TPOAb) is widely used in the diagnosis of autoimmune thyroiditis (AIT), but no research has evaluated the diagnostic accuracy of TPOAb detection using histopathologic reference standards. To fill this research gap, this study assessed the diagnostic accuracy of detection of TPOAb and that of other serological markers in asymptomatic patients who had been diagnosed with AIT by histopathologic analysis after thyroid surgery. After review of patient records, 598 patients who had undergone thyroid nodule surgery were enrolled for examination for thyroid parenchyma by a pathologist and classification into no co-existing lymphocytic thyroiditis, Hashimoto thyroiditis, or non-Hashimoto type of lymphocytic thyroiditis (NHLT). The correlation between patient serological data and thyroid parenchyma pathology was analyzed. Statistically significant differences (P < 0.05) were found between co-existing lymphocytic thyroiditis and no co-existing lymphocytic thyroiditis groups regarding thyroid-stimulating hormone (TSH) and TPOAb levels. And, TPOAb titer was significantly associated with the degree of inflammation. An abnormal TPOAb titer was found in 86 of the 598 patients (14.4 %) and the specificity of TPOAb detection for AIT diagnosis was found to be 96.9 %. The prevalence of Hashimoto thyroiditis and NHLT in the 560 papillary thyroid cancer (PTC) patients was found to be 7.9 and 17.9 %, respectively. The results indicate that TPOAb titer is associated with the degree of thyroid inflammation and that detection of TPOAb is a very specific means of diagnosing AIT. The results also indicate that the incidence of AIT and PTC coexistence is relatively high.

Association between Helicobacter Pylori infection and autoimmune hypothyroidism in Egyptian population

Autoimmune hypothyroidism commonly affecting females is one of the commonest causes of thyroid disease in adults. Among the various autoantibody tests applied in research and clinical practice, the determination of thyroid microsomal antibodies (TPO) and thyroglobulin antibodies (TG Ab) still retains its strong value in the screening for thyroid autoimmunity. Helicobacter pylori (H. pylori) infection plays an important role in the pathogenesis of chronic gastritis, peptic ulcer disease, MALT (Mucosa Associated lymphocyte T) Lymphoma and gastric cancer. Aim of the work: The aim of this work was to study the relationship between H.pylori infection and autoimmune hypothyroidism in Egyptian population. Subjects and Methods: This study was carried out on 147 Egyptian persons divided into 3 groups: Hypothyroid Group: Included 49 patients with autoimmune hypothyroidsm and positive antithyroid antibodies with no history of dyspeptic symptoms or peptic ulcer. H.pylori positive Group: Included 50 patients with dyspeptic symptoms or peptic ulcer with H.pylori positive antibodies with no history of any thyroid disease. Control Group: Included 48 apparently healthy persons serving as control. Serum Free T3, Free T4 and TSH were done for all subjects together with Antimicrosomal antibodies (TPO-Ab), Antithyroglobulin antibodies (TG-Ab) and Helicobacter Pylori antibodies (H. pylori Ab). Result There was no significant difference between all groups as regards age. Also there was significant difference between Hypothyroid and H.pylori positive groups as regarding TSH and Free T3, TG-Ab, TPO-Ab and H. pylori Ab. There is also significant difference between Hypothyroid and control groups regarding TSH, free T3, TG-Ab, TPO-Ab, and H. pylori Ab. There is significant difference between H.pylori positive and control groups regarding FT3 and H. pylori AB. Hypothyroid Group was divided according to the presence of H. pylori Ab into –ve &+ve H. pylori Ab subgroups. There was significant difference between the –ve and +ve subgroups as regard TSH, free T4 and TG-Ab. H.pylori positive Group was divided according to the presence of TG Ab & TPO Ab into–ve and +ve subgroups. There was significant difference between the –ve and +ve cases in TSH, free T4, Free T3, and H.Pylori Antibody. Positive correlation was found between H pylori Ab titer and age, TSH, TG-Ab and TPO-Ab titers. There was also negative correlation between H. pylori Ab titer and free T4. There is no correlation between H. pylori Ab titer and free T3. (Correlation is referred to all subjects of the study = 147). Conclusion This study revealed that patients with positive TG & TPO antibodies, showed (+ve) H. pylori Ab, with significant high titer in their sera. The patients with positive H. Pylori Ab showed high serum titer of TG-Ab. In our study H. pylori-Ab correlates to thyroid function tests and thyroid antibodies.

Association between Helicobacter Pylori infection and autoimmune hypothyroidism in Egyptian population

Autoimmune hypothyroidism commonly affecting females is one of the commonest causes of thyroid disease in adults. Among the various autoantibody tests applied in research and clinical practice, the determination of thyroid microsomal antibodies (TPO) and thyroglobulin antibodies (TG Ab) still retains its strong value in the screening for thyroid autoimmunity. Helicobacter pylori (H. pylori) infection plays an important role in the pathogenesis of chronic gastritis, peptic ulcer disease, MALT (Mucosa Associated lymphocyte T) Lymphoma and gastric cancer. Aim of the work: The aim of this work was to study the relationship between H.pylori infection and autoimmune hypothyroidism in Egyptian population. Subjects and Methods: This study was carried out on 147 Egyptian persons divided into 3 groups: Hypothyroid Group: Included 49 patients with autoimmune hypothyroidsm and positive antithyroid antibodies with no history of dyspeptic symptoms or peptic ulcer. H.pylori positive Group: Included 50 patients with dyspeptic symptoms or peptic ulcer with H.pylori positive antibodies with no history of any thyroid disease. Control Group: Included 48 apparently healthy persons serving as control. Serum Free T3, Free T4 and TSH were done for all subjects together with Antimicrosomal antibodies (TPO-Ab), Antithyroglobulin antibodies (TG-Ab) and Helicobacter Pylori antibodies (H. pylori Ab). Result There was no significant difference between all groups as regards age. Also there was significant difference between Hypothyroid and H.pylori positive groups as regarding TSH and Free T3, TG-Ab, TPO-Ab and H. pylori Ab. There is also significant difference between Hypothyroid and control groups regarding TSH, free T3, TG-Ab, TPO-Ab, and H. pylori Ab. There is significant difference between H.pylori positive and control groups regarding FT3 and H. pylori AB. Hypothyroid Group was divided according to the presence of H. pylori Ab into –ve &+ve H. pylori Ab subgroups. There was significant difference between the –ve and +ve subgroups as regard TSH, free T4 and TG-Ab. H.pylori positive Group was divided according to the presence of TG Ab & TPO Ab into–ve and +ve subgroups. There was significant difference between the –ve and +ve cases in TSH, free T4, Free T3, and H.Pylori Antibody. Positive correlation was found between H pylori Ab titer and age, TSH, TG-Ab and TPO-Ab titers. There was also negative correlation between H. pylori Ab titer and free T4. There is no correlation between H. pylori Ab titer and free T3. (Correlation is referred to all subjects of the study = 147). Conclusion This study revealed that patients with positive TG & TPO antibodies, showed (+ve) H. pylori Ab, with significant high titer in their sera. The patients with positive H. Pylori Ab showed high serum titer of TG-Ab. In our study H. pylori-Ab correlates to thyroid function tests and thyroid antibodies.

Tissue Transglutaminase Antibodies in Individuals with Celiac Disease Bind to Thyroid Follicles and Extracellular Matrix and May Contribute to Thyroid Dysfunction

Individuals with active celiac disease (CD+) have an increased incidence of thyroid dysfunction, which improves on a gluten-free diet (CD-). We investigated whether tissue transglutaminase-2 IgA antibodies (anti-TGase II) present in sera of patients with celiac disease react with thyroid tissue and possibly contribute to thyroid disease. Serum from 40 active celiac patients taken before a gluten-free diet (CD+), 46 patients on a gluten-free diet (CD-), 40 normal controls (NC), and 25 with Crohn's disease (CROHN) was used. All sera were screened for antithyroperoxidase antibodies (TPO-AB) and thyroglobulin antibodies (TG-AB), and indirect immunofluorescence (IIF) was performed on primate thyroid tissue sections using TPO-AB- and TG-AB-negative sera. IIF with thyroid seronegative, anti-TGase II-positive CD+ sera (n = 23) demonstrated staining of thyroid follicular cells and extracellular matrix, in an identical pattern with monoclonal anti-human TGase II antibody. Evidence of TGase II as the antigen in thyroid tissue was supported by elimination of the IIF pattern when sera were depleted of anti-TGase II by pretreatment with human recombinant TGase II. No staining of thyroid tissue was observed when sera from CD+ patients that were negative for TGase II antibodies, or sera from NC subjects were used. Thyroid antibodies were found in 43% of CD+ patients, significantly higher than NC and CROHN patients (p < 0.0001). In addition, a positive correlation was observed between anti-TGase II and TPO-AB titers (p = 0.0001; r = 0.63). Anti-TGase II antibodies bind to TGase II in thyroid tissue, and titers correlate with TPO antibody titers. These findings suggest that anti-TGase II antibodies could contribute to the development of thyroid disease in celiac disease.

Selenium Supplementation in Autoimmune Thyroiditis Female Patient—Effects on Thyroid and Ovarian Functions (Case Study)

Recently published biochemical data suggest the significant role of selenium compounds as the adjuvants combined with L: -thyroxine therapy, which can reduce antithyroid peroxidase antibodies' (TPOAb) levels in patients with Hashimoto disease. The study was undertaken to document in a more detailed way the changes in parameters expressing the thyroid and ovarian function brought about by selenium supplementation (50-100 microg/day) in a woman undergoing autoimmune thyroiditis (AIT) therapy. This prospective observational case study lasted for 14 months plus additional 5 months as a follow-up period. Parameters reflecting selenium status, thyroid metabolism, and sex hormones secretion were determined at the onset and end of the study period, as well as in some of its middle points. During the supplementation trial, serum selenium (Se) increased by 45% and plasma glutathione peroxidase (GPX3) by 21%. TPOAb decreased by 76%. All other parameters also fluctuated during the supplementation period, but all results were always within normal physiological ranges. After withdrawal of the supplementation, the sharp fall of Se and GPX3 promptly occurred, and this phenomenon was accompanied with a marked increase in TPOAb. This report stresses the importance of selenium supplementation in AIT treatment. However, the efficiency and durability of the effect of Se supplementation on the TPOAb titer remain an open question. The clarification of mechanism(s) underlying Se interaction with autoimmune processes should throw new light on this issue.

Espessura íntima-média carotídea como marcador de risco cardiovascular em pacientes com hipotireoidismo subclínico

Subclinical hypothyroidism (SH) has been associated with an increased risk for coronary disease. Carotid intima-media thickness (IMT), as assessed by ultrasonography, is a precise marker of atherosclerotic changes and can be used as an endpoint for cardiovascular events. Aims of this study were to determine carotid IMT in a group of patients with SH and its possible association with an increase in cardiovascular risk. There were no significant differences in mean carotid IMT between patients and controls. Results of both groups were, respectively: common carotid arteries, 0.573 +/- 0.070 mm and 0.576 +/- 0.068 mm (p= 0.904); carotid bifurcation, 0.602 +/- 0.079 mm and 0.617 +/- 0.102 mm (p= 0.714). Similar results were obtained when analyzing subgroups with serum TSH < or > 8 mIU/L and with positive or negative titers of TPOAb. The mean carotid IMT in these subgroups were: TSH 4-8 mIU/L: 0.579 +/- 0.070 mm and 0.586 +/- 0.063 mm; TSH > 8 mIU/L: 0.569 +/- 0.073 mm and 0.616 +/- 0.091 mm; TPOAb+: 0.585 +/- 0.070 mm and 0.621 +/- 0.085 mm; TPOAb-: 0.554 +/- 0.072 mm and 0.571 +/- 0.066 mm. No differences in the lipid profile and in the apoprotein B and lipoprotein (a) levels between the groups were found. These findings suggest that mild SH with no related metabolic changes is not associated with an increase in cardiovascular risk, as assessed by carotid IMT.

Spontaneous Hypothyroidism in the Follow up of Graves Hyperthyroid Patients Treated with Antithyroid Drugs

Spontaneous hypothyroidism may follow the natural course of Graves disease (GD) after treatment with antithyroid drugs (ATD). We studied retrospectively 139 remitted Graves hyperthyroid patients treated with ATD, with a follow-up period of 17.5 years (range 6 to 25 years). Elevated serum concentration of thyroid-stimulating hormone and low serum thyroxine concentrations confirmed the diagnosis. Thirteen patients (median age, 41 years; 26 to 48 years) developed spontaneous hypothyroidism, 4 to 144 months (median, 48 months ) following withdrawal of ATD. The prevalence of hypothyroidism was 9.3% and the incidence was 2.3% per year (13/ 563.6 patients/year of observation). There was no association with types of drugs used or the regimens. Spontaneous hypothyroid patients showed elevated titers (P = 0.02) of serum antithyroid peroxidase antibody (TPOAb) at the end of treatment with ATD, compared with the titers found at the beginning. These patients also had higher titers of TPOAb (P = 0.01) in relation to euthyroid patients. In contrast, the changes in serum antithyroglobulin antibody titers were not significant. Because of the shift from euthyroidism to spontaneous hypothyroidism, GD patients demanded a strict follow up after ATD therapy. It seems that there is an effect of TPOAb on thyroid destruction.

The Relation Between Gestational Thyroid Parameters and Depression: A Reflection of the Downregulation of the Immune System During Pregnancy?

To assess the relation between thyroid parameters and an episode of major depression at different trimesters during pregnancy, taking into account possible confounders. Prospective follow-up of 1017 pregnant women from the general population with assessment of thyroid parameters and depression using syndromal diagnosis interviews at 12, 24, and 36 weeks' gestation. The prevalence of major depression decreased from 5.3% to 2.9%, and that of elevated concentrations of thyroid peroxidase antibody (TPOAb) titers from 8.4% to 6.5% toward the end of term. Subclinical hyperthyroidism not related to TPO-Ab (odds ration [OR] 3.6; 95% confidence interval [CI]: 1.2-0.2) and TPO-Ab (OR 2.1; 95% CI: 1.1-5.8) at 12 weeks' gestation, and TPO-Ab (OR 2.8; 95% CI 1.9-7.1) at 24 weeks' gestation were independently related to major depression. Anxiety and the occurrence of stressful life events were related to depression at all trimesters. The occurrence of major depression and high titers of TPO-Ab show a similar pattern of decline throughout pregnancy. During early gestation, thyroid autoimmunity seems to be related to depression while at the end of term-when there is maximal downregulation of the immune system-autoimmunity does not seem to play an important role with regard to the occurrence of depression.

Prevalence of Thyroid Peroxidase, Thyroglobulin and Thyrotropin Receptor Antibodies in a Long-Term Follow-Up of Juvenile Graves Disease

Objective - To relate the presence of thyroid peroxidase antibodies (TPO ab), thyroglobulin antibodies (Tg ab) and thyrotropin receptor antibodies (TSH-R ab) to the clinical course in a long-term follow-up of patients with juvenile Graves'disease (JGD). Design - Patients with JGD were drawn from a Danish retrospective study and reexamined. Results - A number of 105 patients were reexamined 4-21 years (median 10 years) after diagnosis. Three groups were formed; Gr. 1: euthyroid patients with anti-thyroid drug (ATD) cessation more than 12 months before reexamination (n=41). Gr.2: patients still on ATD (n=24). Gr.3: subtotally thyroidectomized patients (n=40). Positive TPO ab titers were found in 75% of the patients. In 13% of the patients the titers were very high: +10,000 U/ml. Positive Tg ab were found in 51 %. The prevalence of TPO ab and Tg ab was the lowest in group 3. Stimulating TSH-R ab titers were found in 13%. No patients had blocking TSH-R ab. The prevalence of TSH-R ab was 3% in the euthyroid patients, without surgery performed, 15% in the surgical patients, and 25% in the patients still on ATD. Conclusions - Many JGD patients were euthyroid at the long-term follow-up in spite of high TPO ab and Tg ab titers. Stimulating TSH-R ab were rare (13%). According to this presence of TPO ab, Tg ab or TSH-R ab does not predict the final outcome of JGD. Further studies are needed

Management of hypothyroidism during pregnancy.

Hypothyroidism during pregnancy occurs in 1/1600-2000 deliveries, according to the most recent publications. The most common causes are chronic autoimmune thyroid disease, radiodine-131 treatment, or surgical removal. The diagnosis is difficult to make on clinical grounds alone, even in advanced cases, and a high index of suspicion is needed. Some women are at high risk of developing hypothyroidism, and they should be screened. These women may have had previous treatment for hyperthyroidism; high-dose neck irradiation, evidence of thyroid autoimmunity, amiodarone therapy, suspected hypopituitarism, and type I diabetics. The best laboratory test is the serum TSH, followed, if elevated, by a free T4 index and a TPO-ab titer. Thyroid antibodies have been associated with an increased (double) risk of miscarriage and postpartum thyroiditis. Frequent (22-44%) pregnancy-induced hypertension leading to preterm delivery, and prematurity is the main complication observed in those still hypothyroid near term. Proper therapy eliminates or reduces the risk. No congenital anomalies have been reported in the most recent studies, and the data available shows that both physical and mental development have been normal until children are 10 years old. However, one study reported lower IQs in children of euthyroid women with positive TPO-ab than in children of TPO-ab negative mothers. Levothyroxine is the treatment of choice. Euthyroidism must be reached and maintained in a timely fashion. Many women need more thyroxine during pregnancy, and surveillance of thyroid function is needed throughout gestation to make dose adjustments when needed. During the postpartum periods the thyroxine requirements decrease to preconception levels.

Maternal thyroid peroxidase antibodies during pregnancy: A marker of impaired child development?

We recently reported that 5 year old children of women with antibodies against the enzyme thyroid peroxidase (TPO-Ab) during pregnancy, but normal thyroid function, are found to be at risk for impaired development (after correction for confounding variables such as maternal educational level or maternal depression). Until now the presence of maternal TPO-Ab during gestation was not considered to be harmful. The children of TPO-Ab antibody positive mothers however had an increased risk for low scores at the general cognitive scale of the McCarthy scales: O.R. = 10.5, 95% CI = 3 – 34. However, it might be questioned whether the scores of infant cognitive functioning at preschool age are not impaired by other factors which could not yet be taken into account.Therefore, in order to study if this relation between the mothers condition with regard to thyroid peroxidase during pregnancy and child development can also be found at an earlier age, we now assessed 240 infants at nine months with the Bayley scales. The first results show a significant difference on the motor scale. The group of 18 children whose mothers had elevated TPO-Ab titers during pregnancy had a significantly lower mean score than the children of TPO-Ab negative mothers (mean difference 11.5, 95% CI 3 – 19). Children of TPO-Ab antibody positive mothers also had lower scores on the mental and nonverbal scale (mean difference respectively 5.9 and 5.6), which did not reach significance levels. Moreover we found that the titer of TPO-Ab during gestation was of importance: only children of women who had elevated titers both at 12 and 32 weeks' gestation (the titer declines physiologically during pregnancy) had significantly different scores.This study indicates again that elevated titers of maternal thyroid peroxidase antibodies during pregnancy may be seen as a risk factor for developmental delay of the children.

Maternal thyroid peroxidase antibodies during pregnancy: a marker of impaired child development?

Women with antibodies against the enzyme thyroid peroxidase [TPO-Ab; formerly microsomal antibodies (MsAb)] are at particular risk for developing postpartum thyroid dysfunction; the latter is significantly associated with postpartum depression. Although the negative effect of postpartum maternal depression on child development is well documented, the consequences of elevated titers of TPO-Ab during pregnancy and subsequent postpartum thyroid dysfunction on child development are not known. In a prospective study of a cohort of 293 pregnant women, the occurrence of TPO-Ab during gestation, thyroid dysfunction, and depression was investigated. Five years after delivery, child development was assessed in 230 children of the original cohort using the Dutch translation of the McCarthy Scales of Children's Abilities. Children of women with TPO-Ab during late gestation (n = 19, with normal thyroid function) had significantly lower scores (by t test) on the McCarthy Scales of Children's Abilities than antibody-negative women. The difference on the General Cognitive Scale, which reflects IQ scores, was substantial (10.5 points; t = 2.8; P = 0.005). After correction for possibly confounding variables, maternal TPO-Ab during gestation was found to be the most important factor related to the scores on the General Cognitive Scale (odds ratio = 10.5; 95% confidence interval = 3-34; P = 0.003). We conclude that children of pregnant women who had elevated titers of TPO-Ab but normal thyroid function are at risk for impaired development.