TPOAb Titer Research Articles

Elevated Preoperative TPO Ab Titers Decrease Risk for DTC in a Linear Fashion: A Retrospective Analysis of 1635 Cases.

For some, chronic lymphocytic thyroiditis (Hashimoto thyroiditis) is an important risk factor for differentiated thyroid cancer (DTC). Surgical cohort studies even suggested a potential role for thyroid peroxidase antibodies (TPO-Abs) on that risk. Our clinical observations argued against that possibility. We designed the present study to evaluate the relationship of TPO-Abs and DTC in a large patient population. We recruited individuals who underwent thyroidectomies at 4 different clinical sites (USA: 1 clinic, 2000-2013, and Greece: 3 clinics, 2007-2021). We gathered data on TPO-Abs titers measured with commercially available chemiluminescence immunoassays, and reviewed patients' data including surgical pathology. TPO-Abs of 34 IU/mL or greater was deemed positive (TPO+) and TPO-Abs less than 34 IU/mL was deemed negative (TPO-). Odds ratios (OR) for DTC were calculated with the Fisher exact test and P less than .05 was deemed significant. We reviewed data from 8461 consecutive thyroid surgery cases. TPO-Abs titers were available for 1635 individuals: DTC n = 716 (43.8%), benign pathology n = 919 (56.2%), TPO+ n = 540 (33.0%), and TPO- n = 1095 (67.0%). DTC was found at a lower frequency in TPO+ (198/540, 36.7%) compared to TPO- (518/1095, 47.3%) patients, OR 0.64 (0.52-0.80; P < .0001). Rising TPO-Abs titers conferred protection against DTC in a linear fashion: TPO-Abs less than 10 IU/mL: 59.3%, TPO-Abs less than 34 IU/mL: 47.4%, TPO-Abs 34 to 100 IU/mL: 42.6%, TPO-Abs 100 to 500 IU/mL: 32.0%, TPO-Abs greater than 1000 IU/mL: 19.4%; P less than .0001. Higher TPO-Ab titers appear protective against DTC in our large multicenter cohort of patients who underwent thyroidectomies. Rising preoperative TPO-Abs titers conferred linearly increasing protection against DTC.

Association between Thyroid autoimmunity and Fibromyalgia: Single center retrospective study (P9-6.004)

<h3>Objective:</h3> The objective of this study was to describe the prevalence of anti TPO ab among FM patients, their thyroid status and to evaluate clinical response to corticosteroids. <h3>Background:</h3> Fibromyalgia (FM) is a disorder characterized by widespread musculoskeletal pain and other somatic symptoms. Studies have shown that there is a high prevalence of anti TPO ab (Thyroid peroxidase antibody) positivity among FM patients. It is unknown if thyroid autoimmunity is a predisposing factor for FM. <h3>Design/Methods:</h3> We included 107 patients who were diagnosed with FM based on 2010 American College of Rheumatology Criteria who attended our neurology clinic at Appusami Hospital, India between July 2019 and 2022. We recorded data including age, gender, thyroid profile, anti TPO titer [Negative (&lt;15), positive (15 to 500), strongly positive(&gt;500)] and calculated age adjusted odds ratio for steroid responsiveness. <h3>Results:</h3> Mean age of the study group was 48.29 and 78.5% were females. In our series, 75.7% of FM patients had positive anti TPO ab (Positive- 41.12%;strongly positive-35.51%). 51.40% were euthyroid, 38.32% were hypothyroid and 10.28% were hyperthyroid. Overall 56.8% responded well to steroids. (80.85% of strongly positive;19.15% of positive patients). Age-adjusted odds of steroid response in patients with higher anti TPO ab is 5.2 times that of the one with low ab (p&lt;0.001) (95%CI 3.03;9.04) <h3>Conclusions:</h3> Thyroid autoimmunity is frequently associated with middle aged women with FM. Higher anti TPO ab titers strongly correlated with steroid responsiveness in our study and we recommend a short course of steroids for this subset of patients. These findings need to be confirmed with a larger prospective study. Further research should focus on understanding the pathophysiology of FM and it9s the causal relationship with thyroid autoimmunity. <b>Disclosure:</b> Dr. Eswaradass has nothing to disclose. C Eswaradass, 303 has nothing to disclose. Dr. Thermalingem has nothing to disclose. Dr. Thirunavukkarasu has nothing to disclose. Dr. Gurunathan has nothing to disclose.

Association of High TPO Antibody Titer with Differentiated Thyroid Carcinoma: A Case-Control Study

Background: The most common well-differentiated thyroid carcinomas are papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC). PTC accounts for 80–90% of all thyroid cancers, and follicular carcinoma accounts for 10–15% of all thyroid cancers. Common established risk factors for thyroid carcinoma are head-neck irradiation, a positive family history, and a few genetic disorders. High anti-thyroglobulin antibodies (TgAb) have already been established as predictive markers for thyroid carcinoma, but anti-thyroid peroxidase antibodies (TPO Ab) have not been established as predictive markers till now. Objective: To find out the association of high TPO Ab titer with differentiated thyroid carcinoma (DTC). Patients and Methods: This case-control study was carried out at the National Institute of Nuclear Medicine &amp; Allied Sciences (NINMAS), Dhaka, from September 2020 to November 2021. A total of 52 cytologically diagnosed DTC patients who underwent thyroidectomy were selected as cases. Another 52 age- and sex-matched healthy individuals who had sonographically normal thyroid glands and a biochemically euthyroid state were selected as controls. The total number of participants was 104. Written informed consent was obtained from each of the participants. A detailed history was taken, and a thorough clinical examination was carried out on each patient. High resolution ultrasonography (HRUS) of the thyroid gland, serum thyroid-stimulating hormone (TSH) level, and fine needle aspiration cytology (FNAC) report of the thyroid nodule of each participant were collected. Serum TPO antibody levels were measured in patients with DTC prior to thyroid surgery, as well as in the control group, in the NINMAS laboratory using the CLIA method. After the collection of all the required data, analysis was done by SPSS 24.0. Results: The mean age of the cases was 35.8 ± 13.3 years and 34.6 ± 13.0 years in the control groups. Female patients were predominant in both the case and control groups (63.5% and 69.2%, respectively). Both groups were statistically almost similar in terms of age and sex. Around 46.2 % (n=24) patients in the case group had high serum TPO Ab levels and 15.4 % (n=8) of participants in the control group had high serum TPO Ab levels. The mean serum TPO Ab level in the case group was 306.77± 452.57 U/mL, and the mean serum TPO Ab level in the control group was 75.85±181.47 U/mL. Serum TPO antibody level was significantly higher in the case group compared to the control group (306.77±452.57 vs 75.85±181.47 U/mL, p = 0.001). Conclusion: There was a significant association of high TPO Ab titer found with DTC Bangladesh J. Nuclear Med. 26(1): 34-38, 2023

Anti-thyroid antibodies in the relation to TSH levels and family history of thyroid diseases in young Caucasian women.

In young women, hypothyroidism is associated with impaired fertility, increased risk of pregnancy loss, premature delivery, and impaired infant neurodevelopment, justifying the need to recognize the risk of hypothyroidism in women of reproductive age. Thus, this study aimed at assessing the frequency of occurrence of antibodies against thyroid peroxidase (TPOAb) and thyroglobulin (TGAb) in young Caucasian women in connection with various confounders. The cross-sectional study involved 366 women aged 18-40 years without a diagnosis of thyroid disease. The personal and family medical history was collected, body mass and height were measured and an ultrasound examination of the thyroid gland was performed. Thyrotropin (TSH), free thyroxine, and free triiodothyronine levels, as well as TPOAb and TGAb titers, were determined by ECLIA. Two cases of hyperthyroidism (0.5%) and 6 cases (1.6%) of subclinical hypothyroidism were detected. TPOAb was detected in 21 (5.7%) and TGAb in 31 (8.6%) and any of the antibodies in 42 (11.6%) women. Antibodies were more frequent in the subgroup with TSH levels ≥ 2.5 mIU/L than in the subgroup with lower TSH levels (15.5% vs 6.9%, respectively, p<0.05). Any anti-thyroid antibodies were also detected more frequently in the subgroup with TSH levels ≥ 2.5 mIU/L (18.3% vs 10.0%, respectively, p<0.05). Women with the presence of TGAb or seropositive for either TGAb or TPOAb or TPOAb and TGAb antibodies were more likely to have higher TSH levels (OR = 2.48 and OR = 2.02; respectively, p < 0.05 for both). A family history of any thyroid diseases increased the risk of any anti-thyroid antibodies positivity (OR = 1.94; p < 0.05). The results of our study suggest that TSH ≥ 2.5 mIU/L and a family history of any thyroid diseases justify screening for anti-thyroid antibodies in women of reproductive age, although the occurrence of these antibodies in the majority of cases is not related to thyroid dysfunction.

Role of &lt;i&gt;Toxoplasma gondii&lt;/i&gt; in thyroiditis in pregnant women

Toxoplasmosis (acute and latent) is the most prevalent parasitic infection worldwide and can be associated with some problems in pregnant women. Thyroid diseases are the most common endocrine disorders secondary to diabetes among pregnant women. Previous studies proposed a relationship between latent еoxoplasmosis (LT) and autoimmune thyroiditis diseases (AITDs). This study intended to investigate the frequency and correlation between toxoplasmosis and AITD in pregnant women. In this cross-sectional study, the statistical population included 1248 pregnant women at the gestational age of 916 weeks and in Tehran. The Toxoplasma IgM and IgG tests were assessed with enzyme-linked immunosorbent assay (ELISA). The diagnostic criteria for toxoplasmosis were abnormal IgG and IgM titers. In addition, FT4, TPO Ab, and TSH were evaluated using enzyme-linked fluorescence immunoassay (ELFA). TPO Ab was used to distinguish thyroid patients with autoimmune origin from those with other thyroiditis diseases. The analysis showed no significant relationship between keeping a house cat and acute toxoplasmosis. Acute and latent toxoplasmosis represented 3.4% and 29.6%, respectively. The frequency of thyroid diseases was 18.8% (hypothyroidism 15.8% versus hyperthyroidism 3%). The frequency of autoimmune thyroiditis diseases (AITDs) was 5.5%, and 27.9% of subjects with latent toxoplasmosis (LT) had a thyroiditis disease, but 13.8% of pregnant women with LT had only AITD with a significant correlation (p 0.001). Results show that Toxoplasma IgG+ can increase the risk of AITD by 10.39-fold and a higher TPO Ab titer in people with LT. It seems Toxoplasma gondii may cause thyroiditis in pregnant women likely because antigenic similarity of Toxoplasma and thyroperoxidase leads to cross-reactivity in the immune system, potentially causing AITD. It might be said that the high prevalence of LT among pregnant women may have a potential role in the stimulation of the immune system to the development of autoimmune diseases, such as AITD. So future studies could be conducted with a focus on discovering molecular similarities between thyroperoxidase and Toxoplasma antigens.

ODP456 A rare case of massive goiter with overlapping features of Riedel's thyroiditis and Fibrous Variant of Hashimoto's thyroiditis

Abstract Background Hashimoto's thyroiditis is the most common autoimmune disorder of the thyroid gland associated with hypothyroidism. It is distinguished by painless inflammation and elevated titers of TPO antibodies. Fibrous Variant of Hashimoto's Thyroiditis is a rare condition occurring in about 10% of cases, mainly middle-aged individuals, and characterized by an extensive fibrous proliferation without extension into the surrounding structures. Riedel's thyroiditis is a rare generalized autoimmune disorder involving B lymphocytes and IgG4-secreting plasma cells, clinically characterized by extension of the fibrous process to surrounding tissues in the neck, as well as compression symptoms like dysphagia and dyspnea. It is usually associated with mediastinal and retroperitoneal fibrosis. There is significant clinical, pathological, and laboratory test overlap between these two entities that makes the differential diagnosis difficult. Case report A 54-year-old male diagnosed with hypothyroidism on Levothyroxine, and a large goiter seen with new onset of compressive symptoms including dyspnea and dysphagia since March/April 2021. He complains of having pressure on his neck, difficulty swallowing, and worse symptoms when lying flat on a bed. His thyroid is noted to be extremely large and firm, without evident nodularity on examination. Laboratory exams were significant for TSH 3.21 (0.36-3.74), T4 0.94 (0.76-1.46), vitamin D level 13 (30-100), TPO &amp;gt; 9000 (0-9), IgG4 81.9 (4. 0-86. 0), and a negative ANA screen. Thyroid ultrasound showed an enlarged heterogeneous thyroid gland with no discrete nodules. Given the compressing symptoms the patient presented, he was referred to surgery for total thyroidectomy. Surgery could not be completed due to the inability to safely mobilize the gland and adherence to surrounding tissues. He then underwent a right thyroid lobule core biopsy, showing an inflammatory infiltrate composed primarily of lymphocytes and plasma cells. Atrophic thyroid follicles with prominent fibrosis were noted. IgG4 immunostaining highlights &amp;lt;5 positive plasma cells/HPF and IgG4/IgG &amp;lt;30%, excluding IgG4-related fibrosing disease in this core biopsy material. There was no evidence of malignancy. Considering the prominent fibrosis, very high TPO Ab titer, and a seeming lack of extrathyroidal involvement, Fibrous Variant of Hashimoto's Thyroiditis seems more likely, but Riedel Thyroiditis cannot be completely ruled out. He was placed on Prednisone 40 mg daily, with modest improvement of symptoms. Tamoxifen 20mg daily was later added given literature reports of additional improvement in symptoms associated with its use. Referral to a tertiary center for possible isthmusectomy may be considered if symptoms worsen. Presentation: No date and time listed

Evaluating the Progression to Hypothyroidism in Preconception Euthyroid Thyroid Peroxidase Antibody-Positive Women.

Thyroid peroxidase antibody (TPOAb) positivity is prevalent in women of reproductive age and predisposes to thyroid dysfunction, particularly hypothyroidism, which has adverse effects on pregnancy. This study aimed to report the rate of development of abnormal thyroid function among initially euthyroid TPOAb-positive women recruited into the TABLET trial, to identify factors associated with the development of hypothyroidism, and to compare outcomes between euthyroid and treated hypothyroid individuals. This observational cohort study, conducted at 49 UK hospitals between 2011 and 2016, included euthyroid TPOAb-positive women 16 to 40 years of age with a history of miscarriage or subfertility, planning pregnancy, randomized to levothyroxine 50 mcg daily or placebo. Abnormal thyroid function, conception rate, and live birth rate (LBR) ≥34 weeks were analyzed. Among the women, 70/940 (7.4%) developed subclinical (SCH) or overt (OH) hypothyroidism: 27/470 taking levothyroxine and 43/470 placebo (relative risk [RR] 0.63; 95% CI, 0.39-1.00; P = 0.05); 83% of cases emerged prepregnancy. Baseline median serum TSH concentrations and TPOAb titers were significantly higher in those who developed hypothyroidism vs those who did not (P < 0.001). Treated SCH/OH demonstrated a higher failure-to-conceive rate compared with euthyroid women (adjusted RR 2.02 [1.56-2.62]; P < 0.001). The LBR ≥ 34 weeks was similar in the treated SCH/OH and euthyroid groups (adjusted RR 1.09 [0.77-1.55]; P = 0.6). Approximately 7% of euthyroid TPOAb-positive women will develop hypothyroidism within 1 year preconception or in pregnancy. Conception rates are lower in women with treated SCH/OH compared with euthyroid women, but LBR are comparable. Thyroid function in TPOAb-positive women should be monitored regularly, when trying to conceive, to ensure prompt diagnosis and appropriate treatment initiation.

Association of Antithyroid Antibodies in Checkpoint Inhibitor-Associated Thyroid Immune-Related Adverse Events.

The significance of thyroid peroxidase (TPOAb) and thyroglobulin antibody (TgAb) in the pathogenesis of thyroid immune-related adverse events (irAEs) is unknown. To characterize the association of anti-thyroid antibodies with the development of thyroid immune related adverse events. A retrospective cohort study was conducted of patients with melanoma receiving immune checkpoint inhibitor (ICI) treatment. TPOAb, TgAb, and interleukin-6 (IL-6) were measured retrospectively using tumor-banked samples at baseline and at time of diagnosis of a thyroid irAE. In euthyroid patients (without thyroid irAEs) measures were repeated 30 to 60 days after ICI commencement, which was similar to the median time to onset of thyroid irAEs in other patients. A total of 122 patients were included-31 remained euthyroid, 47 developed subclinical thyrotoxicosis, 37 developed overt thyrotoxicosis, and 7 developed overt hypothyroidism without preceding thyrotoxicosis. Baseline elevation of TPOAb or TgAb was present in 19 (16%) and 28 (23%) patients, respectively. Positive TPOAb or TgAb at baseline was 97% and 100% specific for eventual development of a thyroid irAE, respectively. During ICI treatment, overt thyrotoxicosis, but not other subtypes of thyroid irAE, was associated with statistically significant increases in the titer of TgAb and TPOAb. Baseline IL-6 levels were not associated with thyroid irAE onset but statistically significantly increased during treatment in patients who developed overt hypothyroidism. TPOAb and TgAb positivity at baseline was more prevalent in patients who developed thyroid irAEs. Statistically significant increases or new antibody positivity was observed in association with overt thyrotoxicosis. TPOAb and TgAb positivity or increases during ICI treatment may be a useful biomarker to identify patients at increased risk of thyroid irAEs, particularly overt thyrotoxicosis.

Normal Anti-Thyroid Peroxidase Antibody (TPO-Ab) Titers and Active Arterial Wall Thickening among Euthyroid Individuals: A Prospective Study.

Among euthyroid individuals, having an anti-thyroid peroxidase antibody (TPO-Ab) titer in the normal range (negative) is positively associated with atherosclerosis as evaluated based on carotid intima-media thickness (CIMT). Atherosclerosis is an established risk factor for cardiovascular disease, but no significant association between yearly progression in CIMT and cardiovascular disease has been reported. Therefore, clarifying the association between having a TPO-Ab titer in the normal range and yearly progression in CIMT (i.e., active arterial wall thickening) among euthyroid individuals could help inform strategies for preventing cardiovascular disease. We conducted a prospective study of 1069 Japanese subjects with free triiodothyronine and free thyroxine levels within the normal range. Having a TPO-Ab titer in the normal range was significantly positively associated with baseline atherosclerosis and significantly inversely associated with active arterial wall thickening. After adjusting for known confounding factors, the adjusted odds ratio (OR) and 95% confidence interval (CI) of log (TPO-Ab titer) for baseline atherosclerosis and active arterial wall thickening was 2.16 (1.07, 4.35) and 0.59 (0.37, 0.93), respectively. Since progression in CIMT is a process of aggressive endothelial repair, deficient endothelial repair inhibits active arterial wall thickening. Therefore, high–normal TPO-Ab titers might induce a deficiency in endothelial repair.

EFFECT OF IRON ON BONE TISSUE METABOLISM AND THYROID FUNCTION IN CHILDREN LIVING ON RADIOLOGICALLY CONTAMINATED TERRITORIES SINCE THE ChNPP ACCIDENT.

To assess the metabolic processes in bone tissue and state of thyroid gland depending on iron metabolism parameters in children of pre-pubertal, pubertal and post-pubertal age, living on radiologically contaminated territories after the ChNPP accident. Children (n = 119) aged 6 to 18 years were examined and the 4 study groups were formed, featuring the childhood, pre-pubertal, pubertal and post-pubertal life periods. Clinical symptoms, iron metabolism parameters (serum iron (SI) and ferritin (SF) content, transferrin saturation coefficient), parameters of bone tissue metabolism (serum creatinine and alkaline phosphatase (APh)), and amino acid content in urine were taken into account. Functional state of thyroid, titers of antibodies to thyroperoxidase (TPOAb) and thyroglobulin (TgAb) were assayed. Results and their discussion are presented depending on the age of children, biochemical parameters of blood, iron metabolism findings, thyroid gland function and individualized radiation doses. In 13.4 % of pubertal and post-pubertal children an elevated content of SI and SF was observed. APh levels were increased in 20.2 % of children (758.9 ± 16.3 U/l) being directly correlated with SI levels (rs = 0.50; р < 0.01). In 16.3 % of children of pubertal and post-pubertal age, in whom the level of SI was above 27 μmol/l, a direct correlation with serum thyroid-stimulating hormone (TSH) level was established in case of the hormone content above 2.5 mU/l (rs = 0.50; р < 0.05). Serum creatinine level directly correlated with glycine content in urine (rs = 0.70), which is a part of collagen, and inversely correlated with serum APh (rs = -0.47), (р < 0.05). Under the levels of SI higher than (15.1 ± 1.2) μmol/l and SF higher than (87.5 ± 6.4) ng/ml, the TPOAb titer was higher than at lower iron concentrations (U-test = 64.5, р < 0.05). The TgAb titer directly correlated with SI (rs = 0.39) and TSH (rs = 0.81) levels (р < 0.01). The average effective radiation dose in children was (0.75 ± 0.10) mSv. A direct correlation was established between the child's radiation dose and age (rs = 0.33; р < 0.05). Bone metabolism depends on the age of children, characteristics of pubertal period, excess of iron in the body, and functional state of thyroid system, which is involved in collagen formation and protein metabolism.

Relation between the vitaminD status and the occurrence and severity of thyroid malignancy

Background. In spite of large volume of data linking vitaminD with cardiovascular morbidity, autoimmunity, cancer, and virtually every organ system, vitaminD and thyroid is a lesser-known aspect of vitaminD in clinical practice. The association between vitaminD deficiency and thyroid cancer is controversial. Some studies have demonstrated that higher serum vitaminD levels might protect against thyroid cancer, whereas others have not, or have even indicated the opposite to to be the case. This review intends to highlight the current literature on the impact of vitaminD status on thyroid cancer. Materials and methods. References for this review were identified through searches of PubMed for articles published to from 2005 to June 2021 using the terms “thyroid cancer” and “vitaminD”. Results. A large volume of medical literature is available from observational studies linking vitaminD with thyroid cancer. Data from interventional studies documenting beneficial effects of vitaminD on thyroid autoimmunity is also available, but lesser than that from observational studies. Short-term high dose oral vitaminD supplementation reduces TPOAb titers. Certain vitaminD receptor (VDR) gene polymorphism have been linked to increased occurrence of autoimmune thyroid disorders. VitaminD deficiency, decreased circulating calcitriol has been linked to increased thyroid cancer. Certain VDR gene polymorphisms have been linked with increased as well as decreased occurrence of thyroid cancer. Data is scant on use of vitaminD and its analogues for treating thyroid cancer. The results suggest that VitaminD deficiency may have value as a negative prognostic indicator in papillary thyroid cancer and that pre-operative laboratory evaluation may be less useful. This is important because VitaminD deficiency is modifiable. Conclusions. In spite of large volume of medical literature from observational studies linking vitaminD with thyroid cancer, meaningful concrete clinical data on impact of vitaminD supplementation on hard clinical end points in these disorders is lacking, and should be the primary area of research in the next decade.

Myo-inositol supplementation in women of reproductive age with subclinical hypothyroidism and obesity on the background of vitamin D deficiency

Background. In recent years, thyroid diseases occupy the top places in the structure of the endocrine pathology. There exists a tight functional relationship between the thyroid and reproductive systems, which leads to a high probability of the development of combined disorders in one of these links of homeostasis. The problem of reproductive health disorders is of particular concern around the world and is relevant to the study of the impact of thyroid diseases on both fertility and pregnancy, especially in conditions of comorbidity. The purpose of the study was to investigate the effect of myo-inositol on the reproductive function of women with subclinical hypothyroidism on the background of autoimmune thyroiditis and obesity. Materials and methods. The study included 98 patients aged 18–40 years with subclinical hypothyroidism, overweight, or obesity on the background of autoimmune thyroiditis. They were randomly subdivided into two groups. Patients of the first group (n = 49) before the basic treatment received myo-inositol at a dose of 2000 mg/day and cholecalciferol at a dose of 2000 IU/day. Patients of the second group (n = 49) before the basic treatment received only cholecalciferol at a dose of 2000 IU/day. Results. Vitamin D deficiency was observed in 90.81 % of women with subclinical hypothyroidism, and vitamin D insufficiency in 9.19 %. A negative correlation was found between the level of 25(OH)D and the level of TPO-Ab (r =–0.189; p &lt; 0.05). There was a weak negative correlation between the level of 25(OH)D and the level of the HOMA-IR (r = –0.168; p &lt; 0.05). The administration of myo-inositol together with vitamin D led to a significant increase in the content of 25(OH)D, as well as to a decrease in the titer of TPO-Ab. Conclusions. The positive effect of myo-inositol drugs together with vitamin D on the functional state of the thyroid gland, on the level of TPO-Ab and HOMA-IR in women of reproductive age with subclinical hypothyroidism and obesity has been established.

Влияние обеспечения витамином D на аутоиммунное состояние щитовидной железы

Актуальность. Несмотря на большой объем данных, связывающих витамин D с сердечно-сосудистой заболеваемостью, аутоиммунитетом, раком и практически каждой системой органов, взаимосвязь между витамином D и щитовидной железой остается менее известным аспектом в клинической практике. Причиной активного влияния витамина D является тот факт, что рецепторы витамина D (VDR) размещены практически в каждой ткани и системе органов организма. Цель: осветить данные современной литературы о влиянии витамина D и его обеспечения на аутоиммунитет щитовидной железы. Материалы и методы. Источники этого обзора были определены с помощью поиска в PubMed по статьям, опубликованным с 2015 года по сентябрь 2020 года, с использованием терминов «щитовидная железа» и «витамин D». Результаты. Зарегистрирована достоверная обратная корреляция между антителами к тиреоидной пероксидазе (АТ-ТПО) и содержанием 25-гидроксивитамина D (25(OH)D) в сыворотке крови. Наличие положительных титров АТ-ТПО более распространено у лиц с дефицитом витамина D. В большом объеме медицинской литературы приводятся результаты наблюдательных исследований, связывающих витамин D с аутоиммунитетом щитовидной железы. Также приводятся данные интервенционных исследований, подтверждающих положительное влияние витамина D на аутоиммунитет щитовидной железы. Краткосрочный прием высоких доз пероральных добавок витамина D содействует уменьшению титров АТ-ТПО. Некоторые полиморфизмы гена VDR связаны с увеличением случаев аутоиммунных расстройств щитовидной железы. Данные о том, приводит ли коррекция дефицита витамина D при аутоиммунных расстройствах щитовидной железы к снижению потребности в левотироксине или карбимазоле соответственно при гипотиреозе или болезни Грейвса, отсутствуют. Выводы. Несмотря на большой объем медицинской литературы по обсервационным исследованиям, в которых связывают витамин D с аутоиммунитетом щитовидной железы, отсутствуют важные конкретные клинические данные о влиянии дополнительного назначения витамина D на основные клинические конечные точки при этих расстройствах. Это должно быть основной сферой исследований в следующем десятилетии.

Relationship Between Thyroid Hormonal Status in Patients with a Hypothyroid Form of Hashimoto\u2019s Thyroiditis and Iodine Concentrations in Drinking Water

The current study aimed to identify correlative and regressive dependencies between the water iodine concentration and the levels of TSH (thyroid-stimulating hormone), thyroglobulin antibodies (TgAbs), and thyroid peroxidase (TPOAb) in the serum of 168 in patients (34 men and 134 women) with a hypothyroid form of Hashimoto’s thyroiditis who use water from the supply network and individual wells. Based on the water iodine concentration, low and moderate degrees of iodine endemia in the location of the patients were determined. In the groups of men and women using water from different water supply sources, there were direct correlations between the water iodine concentrations and the TgAbs and TPOAb titers as well as an inverse dependence between iodine and TSH levels. Multivariate regressive analysis indicated that TgAb and TSH in the group of women using water from a supply network and TPOAb titers in the group of women using well water were independent factors associated with water iodine concentrations. Statistically significant correlations and regressive dependencies between the water iodine concentrations and the biomarkers of the thyroid status of the patients indicate the risk of Hashimoto’s thyroiditis progression, especially among women with additional iodine intake.

The evaluation of Hashimoto's thyroiditis with event-related potentials and magnetic resonance spectroscopy and its relation to cognitive function

Thyroid dysfunction is very often accompanied by cognitive and affective disorders. The frequency of these disorders in patients with compensated Hashimoto’s thyroiditis (HT) is unknown. The aim of the present study was to evaluate brain dysfunction in euthyroid HT patients by means of event-related potentials (ERP) and magnetic resonance spectroscopy (MRS) and to correlate it with cognitive function. 68 patients with HT (59 female, 9 male) and 45 healthy controls were included in the study. All the patients underwent ERP including an analysis of N200 and P300 response parameters. MRS voxels were located in the posterior cingulate gyrus (PCG) and the left parietal white matter (PWM). The NAA/Cr, mI/Cr, and Cho/Cr ratios were analysed. The ERP parameters, MRS metabolite ratios and hormonal concentrations (TSH, fT3, fT4) as well as TGAb and TPOAb titer were also correlated. There was a significant prolongation of the latencies of N200 and P300 potentials and a significant decrease of P300 amplitude in HT patients than in the control group. There was a significant positive correlation between the mI/Cr ratio in the PCG area and P300 latencies. NAA/Cr ratio in the PCG region showed significant negative correlations with all N200 latencies. The results may suggest brain dysfunction in neurologically asymptomatic HT patients. ERPs undergo significant changes in patients with HT and may, in combination with MRS, constitute an important element in the recognition and monitoring of cognitive functions in this group of patients.

Research on the Role of Th17Treg Cells and Their Factors in Graves&amp;apos; Disease with Different Iodine Nutritional Status

Introduction: At present, studies on the role of iodine nutrition in thyroid function stratification, antibody titer, Th17/Treg cells and related factors in the pathogenesis of GD have not been carried out. Objective: The acritical aims to investigate the correlation between thyroid function and autoantibody titers of Graves' disease (GD) patients with different iodine nutritional status with Th17/Treg cells, their cytokines and transcription factors, and the role of related factors in the pathogenesis of GD. Method: The levels of serum thyroid hormone, autoantibodies and urine iodine in 100 GD patients and 60 healthy subjects are detected by electrochemiluminescence instrument and iodine-catalyzed arsenic-cerium method, respectively. The ratio of Th17 cells to Treg cells and Th17/Treg ratio in peripheral blood mononuclear cells (PBMC) are detected by immunofluorescence-labeled monoclonal antibodies and flow cytometry. Real-time fluorescence quantitative PCR is used to detect the expression levels of retinoic acid-related orphan receptor (ROR-γt) and fork head/wing-shaped spiral transcription factor 3 (Foxp3) mRNA, and the serum IL-17 and TGF-β levels are detected by ELISA. Result: As a result, the proportion of Th17 cells, serum IL-17 and ROR-γt in PBMC of GD patients with different iodine nutritional status significantly increase, while the proportion of Treg cells, the expression of Foxp3mRNA and serum TGF-β significantly decrease. The ratio of Th17/Treg cells in GD patients is significantly positively correlated with the titers of TPOAb and TgAb, and the titers of TPOAb and TgAb antibodies are significantly correlated with Th17/Treg, IL-17 and ROR-γt. Conclusion: In conclusion, thyroid hormones, autoantibodies, Th17, Treg cell ratios and dysfunctions as well as corresponding cytokines and transcription factors in GD patients with different iodine nutritional status participate in the development of GD.

The association between albuminuria and thyroid antibodies in newly diagnosed type 2 diabetes mellitus patients with Hashimoto\u2019s thyroiditis and euthyroidism

BackgroundMicroalbuminuria is a prognostic marker of diabetes kidney disease. It is generally diagnosed as the ratio of urinary albumin to creatinine (UACR) of 30-300 mg/g. Hashimoto’s thyroiditis is a common disease in the endocrinology and the thyroid antibodies may associated with kidney disease. We investigated the UACR in the newly diagnosed T2DM with Hashimoto’s thyroiditis and tried to detect the relationship between the UACR and thyroid antibodies.MethodsOne hundred twenty newly diagnosed T2DM patients with Hashimoto’s thyroiditis and euthyroidism and 50 sex and age-matched T2DM with non-Hashimoto’s and other thyroid disease were recruited. T2DM patients were divided into 2 groups by the titer of TPOAb: (1). TPOAb (+) group: T2DM with positive TPOAb (n = 105); (2). TPOAb (−) group: T2DM with negative TPOAb (n = 65).ResultsT2DM with positive TPOAb group had higher UACR than T2DM with negative TPOAb group (21.55 ± 7.28 vs 15.13 ± 5.69 mg/g, P < 0.01). UACR were positively related to BMI (r = 0.255, P < 0.05), FPG (r = 0.285, P < 0.05), HbA1c (r = 0.260, P < 0.05) and TPOAb (r = 0.349, P < 0.05). HbA1c (β = 0.793, P < 0.05), BMI (β = 0.342, P < 0.05) and lnTPOAb (β = 1.207, P < 0.05) were independently associated with UACR.ConclusionsIn the newly diagnosed T2DM patients, Hashimoto’s thyroiditis with TPOAb positive had higher UACR levels. TPOAb titer, BMI and HbA1c were independent associated with UACR in these patients.

Elevated TPOAb is a Strong Predictor of Autoimmune Development in Patients of Type 2 Diabetes Mellitus and Non-Alcoholic Fatty Liver Disease: A Case-Control Study.

ObjectiveThe aim of this study was to assess the prevalence of thyroid autoimmunity in T2DM with NAFLD, furthermore explore the relationship between elevated TPOAb titer and the severity of NAFLD.MethodsA total of 400 patients with T2DM were divided into two groups according to NAFLD. Thyroid function and other metabolic indicators were measured.ResultsThere were more TPOAb-positive patients in both groups, and the prevalence of TPOAb positive was significantly different in two groups (17% vs 6.9%, p< 0.01). FT4 was significantly lower in patients with T2DM with NAFLD (median FT4 0.89 vs 1.08, p < 0.001), while TSH was increased (median TSH 2.85 vs 2.28, p < 0.05). In patients with T2DM with NAFLD, the proportion of women in the thyroid autoimmune-positive group was significantly higher than the negative (71.1% vs 46%, p < 0.01). Similarly, thyroid autoimmune-positive T2DM and NAFLD patients had lower FT4 levels (median FT4 0.59 vs 0.92, p < 0.001), higher TSH levels (median TSH 3.65 vs 2.67, p < 0.001), and much higher TPOAb/TGAb (median TPOAb/TGAb 6.8 vs 1.46, p < 0.001). The increase of TPOAb was significantly correlated with the severity of fatty liver. HbA1c, TC, TG, TSH, TPOAb/TGAb and severity of fatty liver were risk factors of thyroid autoimmunity.ConclusionAutoimmune thyroid disease is more common in patients with T2DM complicated with NAFLD. Elevated TPOAb titer is closely related to fatty liver, suggesting that elevated TPOAb titer is a predictor of autoimmune development in T2DM with NAFLD.

Case Report on Importance of Role of Selenium Supplementation in Autoimmune Thyroiditis: 8 Months Follow-Up with Variable Doses

Introduction: India in present situation has passed through the Iodine deficient to Iodine sufficient country due to higher access of iodised salt to people consuming higher iodine intake. Higher iodine intake increases the risk of lymphocytic infiltration of thyroid gland by 3 folds, and this has increased the prevalence of thyroid autoantibody positivity by almost 40-50%. Background: Selenium as know n has an antioxidant and anti-inflammatory property, and has the highest concentration in the thyroid gland. Several studies have shown that or studied that selenium has a close relationship with Hashimotos Thyroiditis characterized by presence of antithyroid peroxidase auto antibody. Aims and Objective: To study the effect of selenium supplementation in autoimmune thyroid disease. Two patients A and B with hypothyroidism both females with mean age 40+2 years were taken for this study, euthyroidism was achieved with substitutional therapy of levothyroxine of 100mcg dose. Both were then supplemented with selenium therapy. Results: Female patient A whose (mean TPOAb was 815) received 200 mg L-selenomethionine per day, orally for 4 months, and other female patient B whose (mean TPOAb was 790 IU/ml) also received 200mg of L-selenomethionine per day for duration of 4 months. The profile was assessed with the compared value of Anti TPO Ab and found decrease in the level of TPO antibodies by around 10-12 % after 8 weeks of therapy as assessed by the lab values, patient A values were 716 IU/ml and patient B values were 695 IU/ml, and 18-20 % at the end of 16 weeks i.e. 4 months, patient A values were 669 IU/ml and patient B values were 631 IU/ml. After 1st phase the thyroid profile of both the patients were stable on 100mcg. After duration of 6 months Female A was continued on L-selenomethionine 200 mg/day, while other female B the dose was reduced to 100 mg/day. Serum titers of TPOAb was assessed in both the female patients after 4 months. TPOAb titers increased significantly in female patient B with values of 820IU/ml around 30% as compared to female patient A with further decrease in titre values of 600 IU/ml.

Anti-thyroid peroxidase antibody and thyroid cysts among the general Japanese population: a cross-sectional study

BackgroundAnti-thyroid peroxidase antibody (TPO-Ab) has been shown to cause autoimmune thyroiditis by inducing a deleterious influence on thyroid hormone synthesis. Further, thyroglobulin, which has an important role in thyroid hormone synthesis, is reported to be high in the fluid from thyroid cysts. Therefore, TPO-Ab could be associated with the presence of thyroid cyst, partly by affecting the activity of thyroid hormone synthesis.MethodsTo investigate the association between TPO-Ab and thyroid cysts, we conducted a cross-sectional study of 1432 Japanese with normal thyroid function [i.e., normal range of free triiodothyronine (free T3) and free thyroxine (free T4)] between the ages of 40 and 74 years, who participated in an annual health check-up.ResultsIn men, the statistical power did not reach a statistical significance value. Additionally, subjects with TPO-Ab showed lower odds ratios (ORs) of thyroid cysts than those without TPO-Ab. In women, subjects with TPO-Ab showed significantly lower ORs of thyroid cysts than those without TPO-Ab. The fully adjusted ORs were 0.68 (0.40, 1.18) for men and 0.40 (0.27, 0.60) for women. When evaluating the association between logarithmic values of TPO-Ab titer and thyroid cysts in both men and women, a notable inverse correlation was observed. The fully adjusted ORs were 0.68 (0.50, 0.92) for men and 0.68 (0.57, 0.81) for women.ConclusionTPO-Ab titer revealed to be inversely associated with thyroid cysts among Japanese with normal thyroid function. The presence of a thyroid cyst could indicate a lower risk of having TPO-Ab among the general population with normal thyroid function.