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Blomqvist L, Nyström HF, Hellgren M, Strandell A. Preconceptual thyroid peroxidase antibody positivity in women with recurrent pregnancy losses may contribute to an increased risk for another miscarriage. Clin Endocrinol (Oxf) 2023; 98:259-269. [PMID: 36146941 DOI: 10.1111/cen.14825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 07/04/2022] [Accepted: 09/07/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To investigate preconceptual thyroid peroxidase antibody (TPO-ab) positivity and/or thyroid stimulating hormone (TSH) levels in the upper range of normal as risk factors for recurrent unexplained first-trimester miscarriage. DESIGN A post-hoc study of a randomized trial, in which acetylsalicylic acid did not affect the risk of a new miscarriage. PATIENTS Women (n = 483) with at least three unexplained recurrent first-trimester miscarriages investigated at a Swedish secondary referral center. MEASUREMENTS The levels of TPO-ab and TSH were determined before pregnancy. The occurrence of a new first-trimester miscarriage was analyzed by logistic regression with adjustments when applicable, for age, number of previous miscarriages, obesity and the investigated covariates levels of TPO-ab and TSH. RESULTS Including all first trimester miscarriages, odds ratio (OR) according to presence of TPO-ab was 1.60 (95% confidence interval [CI]; 0.99-2.57), after adjustment 1.54 (95% CI; 0.94-2.53). Very early (biochemical) pregnancy losses occurred more often in women with than without preconceptual TPO-ab (6.8% vs. 2.0%), OR 3.51 (95% CI; 1.15-10.71), after adjustment 2.91 (95% CI; 0.91-9.29). There was no association between TSH in the upper range of normal and a new miscarriage, adjusted OR 0.76 (95% CI; 0.32-1.83). A prediction model for a new miscarriage included number of previous miscarriages, woman's age and presence of TPO-ab. CONCLUSION In women with at least three recurrent unexplained pregnancy losses, the presence of TPO-ab may contribute to an increased risk of a first-trimester miscarriage, possibly more pronounced in very early pregnancy. TSH levels 2.5-4.0 mU/L do not seem to increase the miscarriage risk.
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Affiliation(s)
- Lennart Blomqvist
- Department of Obstetrics and Gynaecologist, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and, gynaecologistsödra Älvsborg's Hospital, Borås, Sweden
| | - Helena F Nyström
- Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Center for Molecular and Translational Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Margareta Hellgren
- Department of Obstetrics and Gynaecologist, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynaecologist, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annika Strandell
- Department of Obstetrics and Gynaecologist, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynaecologist, Sahlgrenska University Hospital, Gothenburg, Sweden
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Andersen SL, Bruun NH, Christensen PA, Lykkeboe S, Handberg A, Hansen AB, Lundgaard MH, Knøsgaard L, Uldall Torp NM, Carlé A, Karmisholt J, Bülow Pedersen I, Vestergaard P, Andersen S. Cut-offs for thyroid peroxidase and thyroglobulin antibodies in early pregnancy. Eur Thyroid J 2022; 11:e220142. [PMID: 36169923 PMCID: PMC9641784 DOI: 10.1530/etj-22-0142] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 09/28/2022] [Indexed: 11/08/2022] Open
Abstract
Objective Thyroid disease in women of reproductive age is mainly of autoimmune origin, and thyroid peroxidase antibodies (TPO-Ab) as well as thyroglobulin antibodies (Tg-Ab) are key markers. Adding to this, much focus in pregnancy is on euthyroid women who are thyroid antibody positive. Evidence to substantiate the cut-offs for the definition of thyroid autoantibody positivity in early pregnant women is warranted. Methods Stored serum samples from 14,030 Danish pregnant women were used for the measurement of TPO-Ab, Tg-Ab, TSH, and free thyroxine (ADVIA Centaur XPT, Siemens Healthineers). Among all women, a reference cohort of 10,905 individuals was identified for the establishment of antibody cut-offs. Percentile cut-offs for TPO-Ab and Tg-Ab were determined using regression on order statistics (the reference cohort). The established cut-offs were then applied (the full cohort), and frequencies of early pregnancy as well as later diagnosis of hypothyroidism were evaluated. Results The highest established cut-offs (95th, 97.5th, and 99th percentiles) were 59, 68, and 81 U/mL for TPO-Ab and 33, 41, and 52 U/mL for Tg-Ab. When the cut-offs were applied in the full cohort, 11.0, 10.2, and 9.7% were TPO-Ab positive, whereas 13.3, 12.3, and 11.2% were Tg-Ab positive. Antibody-positive women (TPO-Ab and/or Tg-Ab) had higher median TSH and were more likely to have hypothyroidism in early pregnancy and to be diagnosed with hypothyroidism during follow-up. Conclusions This large study established and evaluated pregnancy-specific cut-offs for TPO-Ab and Tg-Ab. The findings are important regarding the classification of exposure in pregnancy and assessment of thyroid autoimmunity per se.
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Affiliation(s)
- Stine Linding Andersen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Niels Henrik Bruun
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Astrup Christensen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Simon Lykkeboe
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Aase Handberg
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Annebirthe Bo Hansen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Maja Hjelm Lundgaard
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Louise Knøsgaard
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Nanna Maria Uldall Torp
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Allan Carlé
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Jesper Karmisholt
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Inge Bülow Pedersen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Vestergaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
| | - Stig Andersen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Geriatrics, Aalborg University Hospital, Aalborg, Denmark
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Qiu Y, Xing Z, Xiang Q, Yang Q, Zhu J, Su A. Insufficient evidence to support the clinical efficacy of selenium supplementation for patients with chronic autoimmune thyroiditis. Endocrine 2021; 73:384-397. [PMID: 33774780 DOI: 10.1007/s12020-021-02642-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/18/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study critically reappraises the documentation on the clinical efficacy of selenium supplementation in chronic autoimmune thyroiditis (AIT) with the goal of improving the normalization of the treatment of this disease. METHODS A literature search was performed in the Medline, Embase, and Cochrane Library databases. Twenty-three trials conducted in adults with AIT comparing the efficacy of selenium with or without levothyroxine (LT4) versus placebo and/or LT4 were eligible. The assessed outcomes were primarily pooled using a random- or fixed effects model based on the results of the heterogeneity test. The quality of evidence was assessed per outcome. RESULTS In LT4-treated populations, patients receiving selenium demonstrated lower thyroid peroxidase antibody (TPOAb) levels at 3 months (mean difference [MD], -236.88; 95% confidence interval [CI], -353.35 to -120.41; p < 0.0001), 6 months (MD, -407.17; 95% CI, -623.60 to -190.73; p = 0.0002), and 12 months (MD, -327.03; 95% CI, -613.78 to -40.28; p = 0.0254), while thyroglobulin antibody (TgAb) levels only decreased at 12 months. In non-LT4-treated population, the selenium group demonstrated significantly lower TPOAb levels after 3 months (MD, -203.07; 95% CI, -395.44 to -10.70; p = 0.0385) and 6 months (MD, -322.27; 95% CI, -597.50 to -47.04; p = 0.0217) but not after 12 months, while TgAb levels only decreased at 3 months. There was no significant change in thyroid stimulating hormone (TSH) levels. Lower thyroid echogenicity was observed in all patients receiving selenium at 3, 6, and 12 months. However, these participants had a significantly higher risk of reported adverse effects. CONCLUSIONS Current evidence does not justify the emerging use of selenium supplementation in the treatment of AIT, despite it resulting in a decrease in autoantibody levels.
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Affiliation(s)
- Yuxuan Qiu
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhichao Xing
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qiao Xiang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Qianru Yang
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Jingqiang Zhu
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Anping Su
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China.
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Shimizu Y, Kawashiri SY, Noguchi Y, Nagata Y, Maeda T, Hayashida N. Normal range of anti-thyroid peroxidase antibody (TPO-Ab) and atherosclerosis among eu-thyroid population: A cross-sectional study. Medicine (Baltimore) 2020; 99:e22214. [PMID: 32957357 PMCID: PMC7505314 DOI: 10.1097/md.0000000000022214] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Anti-thyroid peroxidase antibody (TPO-Ab), which is the known cause of autoimmune thyroid disease, enhances proinflammatory cytokine responses. Since low-grade inflammation is a known risk factor for atherosclerosis, a normal range of TPO-Ab (TPO-Ab negative) could be positively associated with atherosclerosis among participants with normal thyroid function. However, no study reported the association between normal range of TPO-Ab and atherosclerosis among eu-thyroid participants. A cross-sectional study was conducted with 1165 Japanese individuals with normal thyroid function (ie, normal range of free triiodothyronine [free T3] and free thyroxine [free T4]), aged 40 to 74 years, who participated in an annual health checkup in 2014. Among the study population, 115 were diagnosed as having atherosclerosis. A normal range value of TPO-Ab titer is revealed to be positively associated with atherosclerosis; sex, age, thyroid function (free T3 and thyroid-stimulating hormone), and known cardiovascular risk factor adjusted odds ratio and 95% confidence interval of atherosclerosis for logarithmic values of TPO-Ab was 2.23 (1.11, 4.47). When we limited the analysis to participants with normal levels of thyroid-stimulating hormone, this association became slightly stronger (2.65 [1.27,5.51]). Among the eu-thyroid general population, a normal range of TPO-Ab titer is revealed to be positively associated with atherosclerosis. Even though a TPO-Ab titer is not clinically relevant and is not associated with autoimmune thyroid disease, it could influence endothelial remodeling including atherosclerosis.
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Affiliation(s)
- Yuji Shimizu
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
- Department of Cardiovascular Disease Prevention, Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka
| | - Shin-Ya Kawashiri
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
| | - Yuko Noguchi
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
| | | | - Takahiro Maeda
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
- Department of General Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Naomi Hayashida
- Division of Strategic Collaborative Research, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki
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Korevaar TIM, Pop VJ, Chaker L, Goddijn M, de Rijke YB, Bisschop PH, Broeren MA, Jaddoe VWV, Medici M, Visser TJ, Steegers EAP, Vrijkotte TG, Peeters RP. Dose Dependency and a Functional Cutoff for TPO-Antibody Positivity During Pregnancy. J Clin Endocrinol Metab 2018; 103:778-789. [PMID: 29240902 DOI: 10.1210/jc.2017-01560] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 12/07/2017] [Indexed: 02/13/2023]
Abstract
OBJECTIVE To investigate a dose dependency of thyroperoxidase antibody (TPOAb) concentrations in relation to thyroid function and premature delivery and define a population-based, pregnancy-specific, functional cutoff for TPOAb positivity. DESIGN Individual participant meta-analysis of three prospective birth cohorts: the Amsterdam Born Children and their Development study, and the Holistic Approach to Pregnancy. SETTING Population-based studies in the Netherlands (2002 to 2014). PARTICIPANTS A total of 11,212 pregnant women (<20 weeks' gestation). MAIN OUTCOME MEASURES Thyrotropin (TSH) and FT4 concentrations, premature delivery. RESULTS In all cohorts, there was a dose-dependent positive association of TPOAb concentrations with TSH concentrations, as well as a dose-dependent negative association with FT4 concentrations during early pregnancy (all P < 0.0001). There was a dose-dependent association of TPOAb concentrations with the risk of premature delivery, which was also modified by TSH concentrations. Women with TPOAb concentrations from the 92nd percentile upward had a higher TSH and a higher risk of a TSH >2.5 mU/L (range, 19.4% to 51.3%). Stratified analyses showed that women with TPOAb concentrations below manufacturer cutoffs already had a higher risk of premature delivery, especially when TSH concentrations were high or in the high-normal range. CONCLUSIONS This study demonstrated a dose-dependent relationship between TPOAbs and thyroid function as well as the risk of premature delivery. Furthermore, our results indicate that the currently used cutoffs for TPOAb positivity may be too high. Furthermore, the use of a population-based cutoff for TPOAbs may identify women with a clinically relevant extent of thyroid autoimmunity and a higher risk of premature delivery but that would not be considered TPOAb positive or eligible for treatment otherwise.
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Affiliation(s)
- Tim I M Korevaar
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
- Rotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, the Netherlands
- Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Victor J Pop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Layal Chaker
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
- Rotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, the Netherlands
- Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Mariette Goddijn
- Department of Reproductive Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Yolanda B de Rijke
- Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Peter H Bisschop
- Department of Endocrinology, Academic Medical Center, Amsterdam, the Netherlands
| | - Maarten A Broeren
- Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands
- Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Pediatrics, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marco Medici
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
- Rotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, the Netherlands
- Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Theo J Visser
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
- Rotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, the Netherlands
- Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Eric A P Steegers
- Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Tanja G Vrijkotte
- Department of Public Health, Academic Medical Center, Amsterdam, the Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
- Rotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, the Netherlands
- Sophia Children's Hospital, Rotterdam, the Netherlands
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D'Aurizio F, Metus P, Ferrari A, Caruso B, Castello R, Villalta D, Steffan A, Gaspardo K, Pesente F, Bizzaro N, Tonutti E, Valverde S, Cosma C, Plebani M, Tozzoli R. Definition of the upper reference limit for thyroglobulin antibodies according to the National Academy of Clinical Biochemistry guidelines: comparison of eleven different automated methods. AUTOIMMUNITY HIGHLIGHTS 2017. [PMID: 28631225 PMCID: PMC5476530 DOI: 10.1007/s13317-017-0096-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose In the last two decades, thyroglobulin autoantibodies (TgAb) measurement has progressively switched from marker of thyroid autoimmunity to test associated with thyroglobulin (Tg) to verify the presence or absence of TgAb interference in the follow-up of patients with differentiated thyroid cancer. Of note, TgAb measurement is cumbersome: despite standardization against the International Reference Preparation MRC 65/93, several studies demonstrated high inter-method variability and wide variation in limits of detection and in reference intervals. Taking into account the above considerations, the main aim of the present study was the determination of TgAb upper reference limit (URL), according to the National Academy of Clinical Biochemistry guidelines, through the comparison of eleven commercial automated immunoassay platforms. Methods The sera of 120 healthy males, selected from a population survey in the province of Verona, Italy, were tested for TgAb concentration using eleven IMA applied on as many automated analyzers: AIA-2000 (AIA) and AIA-CL2400 (CL2), Tosoh Bioscience; Architect (ARC), Abbott Diagnostics; Advia Centaur XP (CEN) and Immulite 2000 XPi (IMM), Siemens Healthineers; Cobas 6000 (COB), Roche Diagnostics; Kryptor (KRY), Thermo Fisher Scientific BRAHMS, Liaison XL (LIA), Diasorin; Lumipulse G (LUM), Fujirebio; Maglumi 2000 Plus (MAG), Snibe and Phadia 250 (PHA), Phadia AB, Thermo Fisher Scientific. All assays were performed according to manufacturers’ instructions in six different laboratories in Friuli-Venezia Giulia and Veneto regions of Italy [Lab 1 (AIA), Lab 2 (CL2), Lab 3 (ARC, COB and LUM), Lab 4 (CEN, IMM, KRY and MAG), Lab 5 (LIA) and Lab 6 (PHA)]. Since TgAb values were not normally distributed, the experimental URL (e-URL) was established at 97.5 percentile according to the non-parametric method. Results TgAb e-URLs showed a significant inter-method variability. Considering the same method, e-URL was much lower than that suggested by manufacturers (m-URL), except for ARC and MAG. Correlation and linear regression were unsatisfactory. Consequently, the agreement between methods was poor, with significant bias in Bland–Altman plot. Conclusions Despite the efforts for harmonization, TgAb methods cannot be used interchangeably. Therefore, additional effort is required to improve analytical performance taking into consideration approved protocols and guidelines. Moreover, TgAb URL should be used with caution in the management of differentiated thyroid carcinoma patients since the presence and/or the degree of TgAb interference in Tg measurement has not yet been well defined.
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Affiliation(s)
- F D'Aurizio
- Clinical Pathology Institute, University Hospital, P.le S. Maria della Misericordia, 33100, Udine, Italy.
| | - P Metus
- Clinical Pathology Laboratory, 'S. Maria degli Angeli' Hospital, Pordenone, Italy
| | - A Ferrari
- Clinical Pathology Laboratory, University Hospital, Verona, Italy
| | - B Caruso
- Clinical Pathology Laboratory, University Hospital, Verona, Italy
| | - R Castello
- General Medicine and Endocrinology, University Hospital, Verona, Italy
| | - D Villalta
- Allergology and Immunology, 'S. Maria degli Angeli' Hospital, Pordenone, Italy
| | - A Steffan
- Oncological Clinical Pathology Laboratory, CRO, IRCCS, Aviano, Italy
| | - K Gaspardo
- Oncological Clinical Pathology Laboratory, CRO, IRCCS, Aviano, Italy
| | - F Pesente
- Clinical Pathology Laboratory, 'S. Antonio Hospital', Tolmezzo, Italy
| | - N Bizzaro
- Clinical Pathology Laboratory, 'S. Antonio Hospital', Tolmezzo, Italy
| | - E Tonutti
- Laboratory of Immunopathology and Allergology, University Hospital, Udine, Italy
| | - S Valverde
- Laboratory Medicine, 'Madonna della Navicella' Hospital, Chioggia (Ve), Italy
| | - C Cosma
- Department of Laboratory Medicine, University Hospital, Padua, Italy
| | - M Plebani
- Department of Laboratory Medicine, University Hospital, Padua, Italy
| | - R Tozzoli
- Clinical Pathology Laboratory, 'S. Maria degli Angeli' Hospital, Pordenone, Italy
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7
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Mirjanic-Azaric B, Avram S, Stojakovic-Jelisavac T, Stojanovic D, Petkovic M, Bogavac-Stanojevic N, Ignjatovic S, Stojanov M. Direct Estimation of Reference Intervals for Thyroid Parameters in the Republic of Srpska. J Med Biochem 2017; 36:137-144. [PMID: 28680357 PMCID: PMC5471646 DOI: 10.1515/jomb-2017-0008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/03/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the reference values for thyrotropin (TSH), thyroid hormones (total and free thyroxine, T4 and fT4; total and free triiodothyronine, T3 and fT3), thyroglobulin (Tg) and thyroid antibodies (thyroid peroxidase, TPOAb and thyroglobulin antibody, TgAb) in the population of the Republic of Srpska. METHODS A total of 250 euthyroid subjects were enrolled in this study. A direct method for choosing reference subjects was used to establish reference intervals. The hormones and thyroid antibodies were measured by an electrochemiluminescence immunoassay method (ECLIA, Roche Diagnostics, Mannheim, Germany). We calculated the reference intervals by MedCalc, version 12.1.4.0 (MedCalc software, Belgium) as recommended by the IFCC (CLSI C28-A3). RESULTS Using guidelines recommended by the National Academy of Clinical Biochemistry (NACB) and based on standard statistical approaches, the reference intervals derived for TSH, fT4, T4, fT3, T3 were 0.75-5.32 mIU/L, 12.29-20.03 pmol/L, 73.49-126,30 nmol/L, 4.11-6.32 pmol/L, 1.15-2.32 nmol/L and for Tg, TPOAb, TgAb were 3.63-26.00 μg/L, <18.02 mIU/L, < 98.00 mIU/L, respectively. We found a significant difference (p<0.05) in TSH and fT3 values between different age groups as well as in T4, fT4 and fT3 values between ge nder groups. CONCLUSIONS The established reference values for the population of the Republic of Srpska were significantly different from the values recommended by the manufacturer of reagents (Roche Diagnostics). Our results showed that a laboratory needs to establish its own reference values in order to set up a proper diagnosis, as well as to treat patients successfully.
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Affiliation(s)
- Bosa Mirjanic-Azaric
- University Clinical Centre of the Republic of SrpskaBanja Luka, Bosnia and Herzegovina, Serbia
| | - Sanja Avram
- University Clinical Centre of the Republic of SrpskaBanja Luka, Bosnia and Herzegovina, Serbia
| | | | - Darja Stojanovic
- Health Centre Laktasi, the Republic of Srpska, Bosnia and HerzegovinaSerbia
| | - Mira Petkovic
- Institute for Sport and Occupational Medicine Banja Luka, Bosnia and HerzegovinaSerbia
| | | | - Svetlana Ignjatovic
- Institute of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Serbia
- Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia
| | - Marina Stojanov
- Institute of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Serbia
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Winther KH, Wichman JEM, Bonnema SJ, Hegedüs L. Insufficient documentation for clinical efficacy of selenium supplementation in chronic autoimmune thyroiditis, based on a systematic review and meta-analysis. Endocrine 2017; 55:376-385. [PMID: 27683225 PMCID: PMC5272877 DOI: 10.1007/s12020-016-1098-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/17/2016] [Indexed: 12/20/2022]
Abstract
By a systematic review and meta-analysis to investigate clinically relevant effects of selenium supplementation in patients with chronic autoimmune thyroiditis. Controlled trials in adults (≥18 years) with autoimmune thyroiditis, comparing selenium with or without levothyroxine substitution, versus placebo and/or levothyroxine substitution, were eligible for inclusion. Identified outcomes were serum thyrotropin (thyroid stimulating hormone) levels in LT4-untreated patients, thyroid ultrasound and health-related quality of life. Eleven publications, covering nine controlled trials, were included in the systematic review. Random effects model meta-analyses were performed in weighted mean difference for thyroid stimulating hormone, ultrasound and health-related quality of life. Quality of evidence was assessed per outcome, using GRADE. Meta-analyses showed no change in thyroid stimulating hormone, or improvements in health-related quality of life or thyroid echogenicity (ultrasound), between levothyroxine substitution-untreated patients assigned to selenium supplementation or placebo. Three trials found some improvement in wellbeing in patients receiving levothyroxine substitution, but could not be synthesized in a meta-analysis. The quality of evidence ranged from very low to low for thyroid stimulating hormone as well as ultrasound outcomes, and low to moderate for health-related quality of life, and was generally downgraded due to small sample sizes. We found no effect of selenium supplementation on thyroid stimulating hormone, health-related quality of life or thyroid ultrasound, in levothyroxine substitution-untreated individuals, and sporadic evaluation of clinically relevant outcomes in levothyroxine substitution-treated patients. Future well-powered RCTs, evaluating e.g. disease progression or health-related quality of life, are warranted before determining the relevance of selenium supplementation in autoimmune thyroiditis.
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Affiliation(s)
- Kristian Hillert Winther
- Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 10, 6th floor, Odense C, 5000, Denmark.
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense C, 5000, Denmark.
| | - Johanna Eva Märta Wichman
- Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 10, 6th floor, Odense C, 5000, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense C, 5000, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 10, 6th floor, Odense C, 5000, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense C, 5000, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 10, 6th floor, Odense C, 5000, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense C, 5000, Denmark
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9
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Korevaar TI. Thyroid Autoimmunity in Euthyroid Women: No Effects on Early Reproduction but Confirmed Consistency for Risk of Miscarriage and Preterm Delivery. ACTA ACUST UNITED AC 2016. [DOI: 10.1089/ct.2016;28.226-228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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10
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Amouzegar A, Bakhtiyari M, Mansournia MA, Etemadi A, Mehran L, Tohidi M, Azizi F. Sex- and Age-Specific Reference Values and Cutoff Points for TPOAb: Tehran Thyroid Study. Thyroid 2016; 26:458-65. [PMID: 26650261 DOI: 10.1089/thy.2015.0276] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Current guidelines used for establishing reference intervals for thyroid peroxidase antibodies (TPOAb), recommended by the National Academy of Clinical Biochemistry, have been a matter of controversy. The present study sought to determine TPOAb reference intervals for different age and sex groups, as well as the TPOAb cutoff points for subclinical and overt hypothyroidism in an iodine-sufficient population. METHODS This cross-sectional study was conducted within the framework of the prospective Tehran Thyroid Study (TTS), in which 4174 healthy euthyroid individuals were followed for 10 years. Thyroid function tests and TPOAb were assessed. RESULTS The mean age ± standard deviation of participants was 39.3 ± 15.2 years. Estimated reference intervals for TPOAb corresponding to the 2.5th and 97.5th percentiles were 1.5-32.8 and 2.1-35 IU/mL in males and females, respectively. There were no significant variations in the different age groups in either sex. The optimal cutoff points for TPOAb were 18.38 and 14.77 IU/mL for predicting clinical and subclinical hypothyroidism, respectively. CONCLUSIONS This study establishes the reference intervals and the optimal cutoff points for TPOAb in an iodine-sufficient population.
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Affiliation(s)
- Atieh Amouzegar
- 1 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Mahmood Bakhtiyari
- 1 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
- 2 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences , Tehran, Iran
| | - Mohammad Ali Mansournia
- 2 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences , Tehran, Iran
| | - Ali Etemadi
- 1 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Ladan Mehran
- 1 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Maryam Tohidi
- 3 Prevention of Metabolic Disorder Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Fereidoun Azizi
- 1 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
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11
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Tozzoli R, D'Aurizio F, Ferrari A, Castello R, Metus P, Caruso B, Perosa AR, Sirianni F, Stenner E, Steffan A, Villalta D. The upper reference limit for thyroid peroxidase autoantibodies is method-dependent: A collaborative study with biomedical industries. Clin Chim Acta 2015; 452:61-5. [PMID: 26519836 DOI: 10.1016/j.cca.2015.10.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/12/2015] [Accepted: 10/23/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND The determination of the upper reference limit (URL) for thyroid peroxidase autoantibodies (TPOAbs) is a contentious issue, because of the difficulty in defining the reference population. The aim of this study was to establish the URL (eURL) for TPOAbs, according to the National Academy of Clinical Biochemistry (NACB) guidelines and to compare them with those obtained in a female counterpart, by the use of six commercial automated platforms. METHODS 120 healthy males and 120 healthy females with NACB-required characteristics (<30years, TSH between 0.5 and 2.0mIU/L, normal thyroid ultrasound, without personal/family history of thyroid and non-thyroid autoimmune diseases) were studied. Sera were analyzed for TPOAbs concentration using six immunoassay methods applied in automated analyzers: Advia Centaur XP (CEN), Siemens Healthcare Diagnostics; Maglumi 2000 Plus, Shenzen New Industries Biomedical Engineering; Architect ci4100, Abbott; Cobas e411 (COB) Roche Diagnostics; Unicel DxI (UNI) and Lumipulse G1200, Fujirebio. RESULTS Within each method, TPOAbs values had a high degree of dispersion and the eURLs were lower than those stated by the manufacturer. A statistically significant difference (p<0.05) between medians of males and females was observed only for COB and for UNI. However, the comparison of the male and female proportions positive for TPOAbs using the eURL of the counterpart, showed the lack of clinical significance of the above differences (Chi-square test, p>0.05). CONCLUSIONS Despite the analytical harmonization, the wide dispersion of the results and the differences of the eURLs between methods suggest the need of further studies focusing on TPO antigen preparations as the possible source of variability between different assays. In addition, the lack of clinical significant difference between males and females, in terms of TPOAb eURLs, confirms the suitability of the NACB recommendations.
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Affiliation(s)
- Renato Tozzoli
- Laboratory of Clinical Pathology, Department of Laboratory Medicine, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - Federica D'Aurizio
- Laboratory of Clinical Pathology, Department of Laboratory Medicine, S. Maria degli Angeli Hospital, Pordenone, Italy.
| | - Anna Ferrari
- Laboratory of Clinical Pathology, University Hospital, Verona, Italy
| | - Roberto Castello
- Department of Internal Medicine and Endocrinology, University Hospital, Verona, Italy
| | - Paolo Metus
- Laboratory of Clinical Pathology, Department of Laboratory Medicine, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - Beatrice Caruso
- Laboratory of Clinical Pathology, University Hospital, Verona, Italy
| | - Anna Rosa Perosa
- Laboratory of Clinical Pathology, Latisana General Hospital, Latisana, Italy
| | - Francesca Sirianni
- Laboratory of Clinical Pathology, Latisana General Hospital, Latisana, Italy
| | | | - Agostino Steffan
- Department of Diagnostic Laboratory and Cellular Therapy, C.R.O., Aviano, Italy
| | - Danilo Villalta
- Allergology-Clinical Immunology, Department of Laboratory Medicine, S. Maria degli Angeli Hospital, Pordenone, Italy
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12
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D'Aurizio F, Metus P, Polizzi Anselmo A, Villalta D, Ferrari A, Castello R, Giani G, Tonutti E, Bizzaro N, Tozzoli R. Establishment of the upper reference limit for thyroid peroxidase autoantibodies according to the guidelines proposed by the National Academy of Clinical Biochemistry: comparison of five different automated methods. AUTOIMMUNITY HIGHLIGHTS 2015; 6:31-7. [PMID: 26275915 PMCID: PMC4633414 DOI: 10.1007/s13317-015-0070-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 07/30/2015] [Indexed: 02/03/2023]
Abstract
Aim of the study The estimation of the upper reference limit (URL) for autoantibodies against thyroid peroxidase (TPOAbs) is a controversial issue, because of an uncertainty associated with the criteria used to correctly define the reference population. In addition, the URL of TPOAbs is method-dependent and often arbitrarily established in current laboratory practice. The aim of this study was to determine the reference limits of TPOAbs in a male sample according to the National Academy of Clinical Biochemistry (NACB) guidelines, and to compare them with those obtained in a female group, for five third-generation commercial-automated immunoassay (IMA) platforms. Methods 120 healthy males and 120 healthy females with NACB-required characteristics (younger than 30 years, TSH between 0.5 and 2.0 mIU/L, normal thyroid ultrasound, absence of thyroid disease and absence of other autoimmune diseases) were studied. Sera were analyzed for TPOAbs concentration using five IMA methods applied in automated analyzers: Immulite 2000 XPi (IMM); Maglumi 2000 Plus (MAG); Kryptor Compact Plus (KRY); Phadia 250 (PHA) and Liaison XL (LIA). Results A statistically significant difference (p < 0.05) between medians in male and female groups was observed for PHA (2.6 and 3.1 IU/mL, respectively) but not for the other four methods. Scatter plots of TPOAbs values revealed a wide dispersion with very different coefficients of variation between the five methods, varying from 48.6 % for KRY in females to 126.3 % for MAG in females. The URLs differed in males and females according to the method: 28.7 and 29.0 IU/mL for IMM, 24.6 and 25.4 IU/mL for MAG, 6.4 and 6.9 IU/mL for KRY, 8.3 and 10.0 IU/mL for PHA and 14.2 and 17.9 IU/mL for LIA, respectively. Such URLs were lower than those stated by the manufacturers except for LIA in females. The difference between URLs ranged from a minimum of 11.3 % (LIA in males) to a maximum of 66.8 % (PHA in males). Conclusions Differences in URLs could result from the different coating preparations of the TPO antigen (purified native or recombinant) on solid phase, which affect the proper exposure of the immunodominant epitopes recognized by the polyclonal antibodies present in serum of patients with autoimmune thyroid disease (AITD). Based on these findings, we suggest to overcome the proposal of the NACB guidelines which recommend to involve a single group of young male subjects, and propose, instead, to utilize two distinct groups: one of males and one of females. This new proposal removes the apparent contrast of an all-male reference group for a disease (such as AITD) that affects mainly females. However, in spite of the harmonization among methods provided by the use of an international standard preparation, the wide dispersion of quantitative results still observed in this study suggests the need for further efforts to better understand the cause of these discrepancies, focusing on TPO antigen preparations as the possible source of variability among different assays.
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Affiliation(s)
- Federica D'Aurizio
- Laboratory of Clinical Pathology, Department of Laboratory Medicine, S. Maria degli Angeli Hospital, Pordenone, Italy.
| | - Paolo Metus
- Laboratory of Clinical Pathology, Department of Laboratory Medicine, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - Annalisa Polizzi Anselmo
- Laboratory of Clinical Pathology, Department of Laboratory Medicine, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - Danilo Villalta
- Allergology-Clinical Immunology, Department of Laboratory Medicine, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - Anna Ferrari
- Laboratory of Clinical Pathology, University Hospital, Verona, Italy
| | - Roberto Castello
- Department of Internal Medicine and Endocrinology, University Hospital, Verona, Italy
| | - Graziella Giani
- Laboratory of Clinical Pathology, General Hospital, S. Vito al Tagliamento, PN, Italy
| | - Elio Tonutti
- Allergology and Immunopathology, University Hospital, Udine, Italy
| | - Nicola Bizzaro
- Laboratory of Clinical Pathology, General Hospital, Tolmezzo, UD, Italy
| | - Renato Tozzoli
- Laboratory of Clinical Pathology, Department of Laboratory Medicine, S. Maria degli Angeli Hospital, Pordenone, Italy
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Winther KH, Bonnema SJ, Cold F, Debrabant B, Nybo M, Cold S, Hegedüs L. Does selenium supplementation affect thyroid function? Results from a randomized, controlled, double-blinded trial in a Danish population. Eur J Endocrinol 2015; 172:657-67. [PMID: 25740851 DOI: 10.1530/eje-15-0069] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/04/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Selenium is present in the active site of proteins important for thyroid hormone synthesis and metabolism. The objective of this study is to investigate the effect of selenium supplementation in different doses on thyroid function, under conditions of suboptimal dietary selenium intake. DESIGN The Danish PREvention of Cancer by Intervention with SElenium pilot study (DK-PRECISE) is a randomized, double-blinded, placebo-controlled trial. A total of 491 males and females aged 60-74 years were randomized to 100 μg (n=124), 200 μg (n=122), or 300 μg (n=119) selenium-enriched yeast or matching yeast-based placebo tablets (n=126). A total of 361 participants, equally distributed across treatment groups, completed the 5-year intervention period. METHODS Plasma samples were analyzed for selenium and serum samples for TSH, free triiodothyronine (FT3), and free thyroxine (FT4) at baseline, and after 6 months, and 5 years of supplementation. RESULTS Plasma selenium concentrations increased significantly and dose-dependently in treatment groups receiving selenium (P<0.001). Serum TSH and FT4 concentrations decreased significantly and dose-dependently by 0.066 mIU/l (P=0.010) and 0.11 pmol/l (P=0.015), respectively, per 100 μg/day increase, with insignificant differences between 6 months and 5 years. No significant effects were found for FT3 and FT3:FT4 ratio. CONCLUSIONS In euthyroid subjects, selenium supplementation minutely and dose-dependently affects thyroid function, when compared with placebo, by decreasing serum TSH and FT4 concentrations. Based on these findings, selenium supplementation is not warranted under conditions of marginal selenium deficiency. However, a role for selenium supplementation in the treatment of autoimmune thyroid diseases is still unresolved.
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Affiliation(s)
- Kristian Hillert Winther
- Department of Endocrinology and MetabolismOdense University Hospital, Kloevervaenget 10, 6. Sal, DK-5000 Odense C, DenmarkDepartment of OncologyOdense University Hospital, Odense, DenmarkDepartment of EpidemiologyBiostatistics and Biodemography, University of Southern Denmark, Odense, DenmarkDepartment of Clinical Biochemistry and PharmacologyOdense University Hospital, Odense, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology and MetabolismOdense University Hospital, Kloevervaenget 10, 6. Sal, DK-5000 Odense C, DenmarkDepartment of OncologyOdense University Hospital, Odense, DenmarkDepartment of EpidemiologyBiostatistics and Biodemography, University of Southern Denmark, Odense, DenmarkDepartment of Clinical Biochemistry and PharmacologyOdense University Hospital, Odense, Denmark
| | - Frederik Cold
- Department of Endocrinology and MetabolismOdense University Hospital, Kloevervaenget 10, 6. Sal, DK-5000 Odense C, DenmarkDepartment of OncologyOdense University Hospital, Odense, DenmarkDepartment of EpidemiologyBiostatistics and Biodemography, University of Southern Denmark, Odense, DenmarkDepartment of Clinical Biochemistry and PharmacologyOdense University Hospital, Odense, Denmark
| | - Birgit Debrabant
- Department of Endocrinology and MetabolismOdense University Hospital, Kloevervaenget 10, 6. Sal, DK-5000 Odense C, DenmarkDepartment of OncologyOdense University Hospital, Odense, DenmarkDepartment of EpidemiologyBiostatistics and Biodemography, University of Southern Denmark, Odense, DenmarkDepartment of Clinical Biochemistry and PharmacologyOdense University Hospital, Odense, Denmark
| | - Mads Nybo
- Department of Endocrinology and MetabolismOdense University Hospital, Kloevervaenget 10, 6. Sal, DK-5000 Odense C, DenmarkDepartment of OncologyOdense University Hospital, Odense, DenmarkDepartment of EpidemiologyBiostatistics and Biodemography, University of Southern Denmark, Odense, DenmarkDepartment of Clinical Biochemistry and PharmacologyOdense University Hospital, Odense, Denmark
| | - Søren Cold
- Department of Endocrinology and MetabolismOdense University Hospital, Kloevervaenget 10, 6. Sal, DK-5000 Odense C, DenmarkDepartment of OncologyOdense University Hospital, Odense, DenmarkDepartment of EpidemiologyBiostatistics and Biodemography, University of Southern Denmark, Odense, DenmarkDepartment of Clinical Biochemistry and PharmacologyOdense University Hospital, Odense, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology and MetabolismOdense University Hospital, Kloevervaenget 10, 6. Sal, DK-5000 Odense C, DenmarkDepartment of OncologyOdense University Hospital, Odense, DenmarkDepartment of EpidemiologyBiostatistics and Biodemography, University of Southern Denmark, Odense, DenmarkDepartment of Clinical Biochemistry and PharmacologyOdense University Hospital, Odense, Denmark
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14
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Kristensen B, Hegedüs L, Lundy SK, Brimnes MK, Smith TJ, Nielsen CH. Characterization of Regulatory B Cells in Graves' Disease and Hashimoto's Thyroiditis. PLoS One 2015; 10:e0127949. [PMID: 26016954 PMCID: PMC4446335 DOI: 10.1371/journal.pone.0127949] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 04/21/2015] [Indexed: 12/21/2022] Open
Abstract
A hallmark of regulatory B cells is IL-10 production, hence their designation as IL-10+ B cells. Little is known about the ability of self-antigens to induce IL-10+ B cells in Graves’ disease (GD), Hashimoto’s thyroiditis (HT), or other autoimmune disease. Here we pulsed purified B cells from 12 HT patients, 12 GD patients, and 12 healthy donors with the thyroid self-antigen, thyroglobulin (TG) and added the B cells back to the remaining peripheral blood mononuclear cells (PBMCs). This procedure induced IL-10+ B-cell differentiation in GD. A similar tendency was observed in healthy donors, but not in cells from patients with HT. In GD, B cells primed with TG induced IL-10-producing CD4+ T cells. To assess the maximal frequency of inducible IL-10+ B cells in the three donor groups PBMCs were stimulated with PMA/ionomycin. The resulting IL-10+ B-cell frequency was similar in the three groups and correlated with free T3 levels in GD patients. IL-10+ B cells from both patient groups displayed CD25 or TIM-1 more frequently than did those from healthy donors. B-cell expression of two surface marker combinations previously associated with regulatory B-cell functions, CD24hiCD38hi and CD27+CD43+, did not differ between patients and healthy donors. In conclusion, our findings indicate that autoimmune thyroiditis is not associated with reduced frequency of IL-10+ B cells. These results do not rule out regulatory B-cell dysfunction, however. The observed phenotypic differences between IL-10+ B cells from patients and healthy donors are discussed.
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Affiliation(s)
- Birte Kristensen
- Institute for Inflammation Research, Department of Infectious Diseases and Rheumatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Steven K. Lundy
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Marie K. Brimnes
- Institute for Inflammation Research, Department of Infectious Diseases and Rheumatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Terry J. Smith
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center and Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Claus H. Nielsen
- Institute for Inflammation Research, Department of Infectious Diseases and Rheumatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- * E-mail:
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15
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Brix TH, Hegedüs L, Weetman AP, Kemp HE. Pendrin and NIS antibodies are absent in healthy individuals and are rare in autoimmune thyroid disease: evidence from a Danish twin study. Clin Endocrinol (Oxf) 2014; 81:440-4. [PMID: 24612086 DOI: 10.1111/cen.12434] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 01/28/2014] [Accepted: 02/14/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Antibodies against thyroglobulin, thyroid peroxidase and the TSH receptor are accepted as pathophysiological and diagnostic biomarkers in autoimmune thyroid disease (AITD). In contrast, the prevalence, aetiology and clinical relevance of autoantibodies against the human sodium-iodine symporter (NISAb) and pendrin (PenAb) remain unclear. The objectives of the study were to investigate the presence of NISAb and PenAb in Danish twins, with and without AITD, to study whether the published variations in NISAb and PenAb frequencies were related to differences in methodology or study populations, and to evaluate whether the presence of NISAb or PenAb most likely results from genetic or nongenetic factors. METHODS Sera from 93 patients with AITD and 230 healthy controls were evaluated for NISAb and PenAb using radioligand binding assays (RBA). RESULTS Patients with AITD had a higher prevalence than the controls: NISAb: 17% vs 0% (P < 0·001) and PenAb: 11% vs 0% (P < 0·001). Subdividing according to cause of AITD yielded similar results: 20% (11/56) of patients with Graves' disease (GD) and 14% (5/37) of patients with Hashimoto's thyroiditis (HT) had NISAb, (P < 0·05, vs control population). Seven of 56 (13%) patients with GD and three of 37 (8%) patients with HT had PenAb (P < 0·05 vs control population). No twin pairs were concordant for NISAb or PenAb, not even among twin pairs concordant for AITD. CONCLUSIONS In accord with studies using the same RBAs, the frequency of NISAb and PenAb was low in Danish patients with AITD and absent in healthy individuals, suggesting that differences between studies rely on assay differences. The skewed distribution of NISAb and PenAb within AITD concordant twin pairs suggests that NISAb and PenAb are likely attributable to the effects of environmental factors acting in genetic susceptible individuals.
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Affiliation(s)
- Thomas H Brix
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, UK
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16
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Taubner K, Schubert G, Pulzer F, Pfaeffle R, Körner A, Dietz A, Thiery J, Kiess W, Kratzsch J. Serum concentrations of anti-thyroid peroxidase and anti-thyroglobulin antibodies in children and adolescents without apparent thyroid disorders. Clin Biochem 2013; 47:3-7. [PMID: 24103918 DOI: 10.1016/j.clinbiochem.2013.09.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 09/18/2013] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The age-dependent prevalence and clinical relevance of anti-thyroid peroxidase (TPOAb) and anti-thyroglobulin (TGAb) antibodies in children and adolescents without thyroid diseases are unknown. The aim of this study was to measure the concentration of these thyroid autoantibodies in a large cohort of hospitalized and out-patient subjects. Additionally, we investigated the correlation of TPOAb and TGAb with thyroid parameters as well as with putative confounding parameters such as standard deviation scores (SDS) of height, BMI-SDS and CRP. METHODS Serum samples from 841 patients with non-thyroid related diseases between 1 day post partum and 20 years of age were used in a cross-sectional study. TPOAb, TGAb, thyroid parameters (TSH, fT3, fT4 and thyroglobulin) and CRP were measured by the Modular System (Roche, Mannheim). RESULTS The values of TPOAb and TGAb showed an age-dependent maximum of antibody frequency for both genders during the first year of life with concentrations of 163 IU/mL and 161 IU/mL in the 95th percentile. In girls, a second maximum was observed during puberty with concentrations of 82 IU/mL TPOAb and 582 IU/mL TGAb in the 95th percentile. Both antibodies correlated significantly (p<0.05) with each other, with fT3, fT4, BMI-SDS (only TPOAb) and CRP and TSH (only TGAb). CONCLUSION The prevalence of TPOAb and TGAb was shown to be age-dependent with increased values in the first year of life and during puberty. The increased "physiological" concentrations of TPOAb and TGAb have to be considered when used as diagnostic indicators of autoimmune thyroid disease in a paediatric population.
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Affiliation(s)
- Katharina Taubner
- Hospital for Children and Adolescents, Department for Women and Child Health, University Hospital Leipzig, Centre for Paediatric Research, University of Leipzig, Liebigstraße 20a, D-04103 Leipzig, Germany
| | - Georg Schubert
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital, Paul-List-Str. 13-15, D-04103 Leipzig, Germany
| | - Ferdinand Pulzer
- Hospital for Children and Adolescents, Department for Women and Child Health, University Hospital Leipzig, Centre for Paediatric Research, University of Leipzig, Liebigstraße 20a, D-04103 Leipzig, Germany
| | - Roland Pfaeffle
- Hospital for Children and Adolescents, Department for Women and Child Health, University Hospital Leipzig, Centre for Paediatric Research, University of Leipzig, Liebigstraße 20a, D-04103 Leipzig, Germany
| | - Antje Körner
- Hospital for Children and Adolescents, Department for Women and Child Health, University Hospital Leipzig, Centre for Paediatric Research, University of Leipzig, Liebigstraße 20a, D-04103 Leipzig, Germany
| | - Andreas Dietz
- Department of Otorhinolaryngology, University Hospital, Leipzig, Germany
| | - Joachim Thiery
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital, Paul-List-Str. 13-15, D-04103 Leipzig, Germany
| | - Wieland Kiess
- Hospital for Children and Adolescents, Department for Women and Child Health, University Hospital Leipzig, Centre for Paediatric Research, University of Leipzig, Liebigstraße 20a, D-04103 Leipzig, Germany
| | - Jürgen Kratzsch
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital, Paul-List-Str. 13-15, D-04103 Leipzig, Germany.
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17
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Frost M, Petersen I, Hegedüs L, Christiansen L, Brix T, Christensen K. Regulation of the pituitary-thyroid axis in adulthood is not related to birth weight: evidence from extremely birth weight-discordant monozygotic Danish twin pairs. Thyroid 2013; 23:785-90. [PMID: 23308389 PMCID: PMC3704111 DOI: 10.1089/thy.2012.0095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Low birth weight has been linked with changes in thyroid function in adulthood, but it is unknown whether fetal programming or underlying genetic and environmental factors explains the association. We hypothesized that birth weight influences the pituitary-thyroid set point in adults. METHODS A total of 152 birth weight-discordant monozygotic twin pairs with a median age of 57 years (interquartile range: 33-63) were ascertained from the Danish Twin Registry in 2010. Serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), and triiodothyronine (T3) levels were measured. Birth weights were retrieved from midwife records (individuals born before 1973) and the Danish Birth Record Registry (all other participants) RESULTS Birth weight was inversely associated with serum levels of FT4 (β=-0.48 pmol/[L·kg], p=0.014) and serum T3 (β=-0.09 nmol/[L·kg], p=0.010), but not serum TSH after adjustment for age, sex, and current use of tobacco products, when the twins were investigated as singletons. Serum levels of TSH and T3 were similar in within twin-pair analyses, while serum FT4 was higher in twins with the lowest birth weight (median difference 0.3 mIU/L). When the analyses were repeated in twin pairs (n=46 pairs) characterized by extreme difference in birth weight (>0.5 kg), serum TSH, T3, and FT4 levels were similar in twins with high and low birth weight. The proportion of individuals with serum TSH level >4 mIU/L or <0.3 mIU/L was identical in both groups. CONCLUSIONS No overall evidence of an association between birth weight and adult pituitary-thyroid axis set point, after control for genetic and environmental factors, could be demonstrated.
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Affiliation(s)
- Morten Frost
- The Danish Twin Registry, Danish Aging Research Center, University of Southern Denmark, Odense, Denmark.
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Nielsen CH, Bendtzen K. Immunoregulation by naturally occurring and disease-associated autoantibodies : binding to cytokines and their role in regulation of T-cell responses. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 750:116-32. [PMID: 22903670 PMCID: PMC7123141 DOI: 10.1007/978-1-4614-3461-0_9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The role of naturally occurring autoantibodies (NAbs) in homeostasis and in disease manifestations is poorly understood. In the present chapter, we review how NAbs may interfere with the cytokine network and how NAbs, through formation of complement-activating immune complexes with soluble self-antigens, may promote the uptake and presentation of self-molecules by antigen-presenting cells. Both naturally occurring and disease-associated autoantibodies against a variety of cytokines have been reported, including NAbs against interleukin (IL)-1α, IL-6, IL-8, IL-10, granulocyte-macrophage colony-stimulating factor, interferon (IFN)-α, IFN-β, IFN-γ, macrophage chemotactic protein-1 and IL-21. NAbs against a variety of other self-antigens have also been reported, and using thyroglobulin as an example we discuss how NAbs are capable of promoting uptake of immune complexes via complement receptors and Fc-receptors on antigen-presenting cells and thereby regulate T-cell activity. Knowledge of the influence of NAbs against cytokines on immune homeostasis is likely to have wide-ranging implications both in understanding pathogenesis and in treatment of many immunoinflammatory disorders, including a number of autoimmune and autoinflammatory diseases.
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Affiliation(s)
- Claus H Nielsen
- Institute for Inflammation Research, Department of Rheumatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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Thyroid autoimmunity may represent a predisposition for the development of fibromyalgia? Rheumatol Int 2010; 32:335-41. [PMID: 21085966 DOI: 10.1007/s00296-010-1620-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 10/25/2010] [Indexed: 10/18/2022]
Abstract
In our previous study, we observed that the presence of autoimmune thyroid disease worsens fibromyalgia (FM) symptoms. The aims of this study are to evaluate whether there is a predisposition for the development of FM in patients with Hashimoto's thyroiditis (HT) with or without subclinical hypothyroidism (SCH) and in patients with SCH alone and what is the weight of antithyroid antibody positivity and SCH on FM comorbidity. Fifty-two patients, 39 affected by HT with or without SCH and 13 by SCH, were matched with 37 patients affected by FM and 25 healthy subjects. Blood samples were collected from all study subjects for the determination of serum TSH, free triiodothyronine, free thyroxine, antithyroperoxidase antibody (TPOAb), antithyroglobulin antibody (TgAb) and non-organ-specific autoantibodies. Clinical assessment of patients and controls included the "Fibromyalgia Impact Questionnaire" (FIQ), while pain severity was evaluated using a visual analogue scale (VAS). Patients and controls were also characterized by the presence of diffuse pain, fatigue, paresthesiae, muscle spasms, non-restful sleep, tension headache and presence of mood disorders. FM comorbidity resulted in twelve HT subjects (31%) and none in SCH patient. In particular, FM comorbidity in HT patients without SCH was 33.3% and in HT patients with SCH was 28.5%. Based on our data, we speculate that maybe there is more than a hypothesis regarding the cause-effect relation between thyroid autoimmunity and the presence of FM, thus suggesting a hypothetical role of thyroid autoimmunity in FM pathogenesis.
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Brix TH, Hansen PS, Kyvik KO, Hegedüs L. The pituitary-thyroid axis set point in women is uninfluenced by X chromosome inactivation pattern? A twin study. Clin Endocrinol (Oxf) 2010; 73:666-70. [PMID: 20718768 DOI: 10.1111/j.1365-2265.2010.03848.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The pituitary-thyroid axis (PTA) set point is determined by a combination of genetic and environmental factors. However, despite considerable efforts to characterize the background, the causative genes as well as environmental factors are not well established. Theoretically, as shown for autoimmune thyroid disease, the pattern of X chromosome inactivation (XCI) could offer a novel explanation for the observed variability of the PTA set point in women. DESIGN AND PATIENTS To examine the impact of XCI pattern on the PTA set point, we studied whether within-cohort (n = 318 subjects) and within-twin pair (n = 159 pairs) differences in XCI are correlated with serum concentrations of thyrotropin (TSH), free triiodothyronine (FT3) and free thyroxine (FT4). METHODS X chromosome inactivation was determined by PCR analysis of a polymorphic CAG repeat in the first exon of the androgen receptor gene. Thyroid variables were measured using a solid-phase time-resolved fluoroimmunometric assay. Zygosity was established by DNA fingerprinting. RESULTS In the overall study population (within cohort), no significant correlations were found between TSH [regression coefficient (β) = -0·28 (95% confidence intervals, -0·66 to 0·11), P = 0·158], FT3 [β = -0·25 (-0·85 to 0·34), P = 0·403], FT4 [β = 0·08 (-0·91 to 1·07), P = 0·876] and XCI pattern. Essentially similar results were found in the within-pair analysis. Controlling for confounders such as age, body mass index, smoking and zygosity did not change the findings. CONCLUSIONS In a sample of female twins, we found no evidence of a relationship between XCI pattern and PTA set point.
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Affiliation(s)
- Thomas H Brix
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark.
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Jorgensen GH, Ornolfsson AE, Johannesson A, Gudmundsson S, Janzi M, Wang N, Hammarström L, Ludviksson BR. Association of immunoglobulin A deficiency and elevated thyrotropin-receptor autoantibodies in two Nordic countries. Hum Immunol 2010; 72:166-72. [PMID: 20977916 DOI: 10.1016/j.humimm.2010.10.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 09/29/2010] [Accepted: 10/19/2010] [Indexed: 01/01/2023]
Abstract
Immunoglobulin A deficiency (IgAD) is the most common primary immunodeficiency, with suggested association with various types of autoimmunity, including Graves' disease. This study investigated the association of IgAD with elevated thyrotropin-receptor autoantibodies (TRAb). IgA was measured in TRAb-seropositive individuals from both Iceland (N = 299] and Sweden (N = 841]. In addition, TRAb levels were evaluated in 43 Icelandic and 50 Swedish IgAD individuals using Medizym TRA immunoassay, and positive samples were re-evaluated using BRAHMS TRAK human RIA. The IgAD individuals were HLA-genotyped to determine the HLA-B, DR, and DQ alleles. None of the 299 Icelandic TRAb-seropositive individuals had IgAD, whereas, a high prevalence of IgAD (14/841 (1:60)) was observed in the Swedish cohort (p = 0.027). The prevalence of TRAb-seropositivity in IgAD individuals was, however, increased in both cohorts. The HLA-DQ6 allele was associated with TRAb-seronegativity within the Icelandic IgAD cohort (p = 0.037). The prevalence of IgAD in TRAb-seropositive individuals in Sweden is 10 times higher than expected in the general population. Furthermore, TRAb seropositivity is common among IgAD individuals, both in Iceland and Sweden, suggesting a predisposition toward Graves' disease. These findings underline the significant association of IgAD with autoimmunity and its possible association with certain HLA-DQ alleles.
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Takasu N, Yoshimura Noh J. Hashimoto's thyroiditis: TGAb, TPOAb, TRAb and recovery from hypothyroidism. Expert Rev Clin Immunol 2010; 4:221-37. [PMID: 20477052 DOI: 10.1586/1744666x.4.2.221] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Hashimoto described four patients with goiter. The histology of the goiter was characterized by diffuse lymphocytic infiltration, fibrosis and epithelial cell destruction. Thyroglobulin antibody (TGAb) and thyroid peroxidase antibody (TPOAb) have been used to diagnose Hashimoto's thyroiditis. Patients with positive TGAb and/or TPOAb have been assumed to have Hashimoto's thyroiditis. Approximately 10% of those with positive TGAb and/or TPOAb have hypothyroidism. There are two types of autoimmune thyroiditis: goitrous Hashimoto's thyroiditis and atrophic thyroiditis. The latter patients have blocking antibody (thyroid-stimulating hormone [TSH]-stimulation blocking antibody [TSBAb]). TSBAb is a TSH-receptor antibody (TRAb). TSBAb causes thyroid atrophy and hypothyroidism. TGAb and/or TPOAb do not necessarily cause hypothyroidism. Hypothyroid patients with Hashimoto's thyroiditis usually receive life-long l-thyroxine therapy. However, spontaneous recovery from hypothyroidism has been reported. Patients who had Hashimoto's hypothyroidism and then Graves' hyperthyroidism (and vice versa), have also been reported. Hashimoto's hypothyroidism and Graves' hyperthyroidism could be the opposite spectrums of one disease.
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Affiliation(s)
- Nobuyuki Takasu
- Department of Endocrinology and Metabolism, University of the Ryukyus, Uehara 207, Nishihara, Okinawa 903-0215, Japan.
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Nielsen CH, Brix TH, Leslie RGQ, Hegedüs L. A role for autoantibodies in enhancement of pro-inflammatory cytokine responses to a self-antigen, thyroid peroxidase. Clin Immunol 2009; 133:218-27. [PMID: 19726232 DOI: 10.1016/j.clim.2009.07.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Revised: 07/21/2009] [Accepted: 07/29/2009] [Indexed: 12/31/2022]
Abstract
The role of thyroid peroxidase (TPO) antibodies (TPOAbs) in the pathogenesis of autoimmune thyroid disease is unclear. We selected sera with a high concentration of TPOAbs from eleven patients with Hashimoto's thyroiditis (HT), ten healthy monozygotic co-twins to HT patients, and twelve healthy individuals with no familiar disposition to AITD, and mixed each serum with normal mononuclear cells (MNCs). Following challenge with TPO, the MNCs' production of the pro-inflammatory cytokines TNF-alpha, IL-6 and IFN-gamma, and the anti-inflammatory cytokine IL-10, correlated with the TPOAb content of the serum present in the culture (p=0.0002-0.05). Enrichment of foetal calf serum-containing media with IgG with a high content of TPOAbs enhanced the TPO-elicited production of TNF-alpha, IL-6 and IFN-gamma by normal MNCs in a dose- and Fcgamma-receptor dependent manner (p<0.0002-0.05). The data indicate that TPO-induced release of pro-inflammatory cytokines from phagocytic cells and T-cell responses to TPO are promoted by TPOAbs.
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Affiliation(s)
- Claus H Nielsen
- Department of Clinical Immunology, section 7631, Rigshospitalet University Hospital, Copenhagen, Denmark.
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Springer D, Zima T, Limanova Z. Reference intervals in evaluation of maternal thyroid function during the first trimester of pregnancy. Eur J Endocrinol 2009; 160:791-7. [PMID: 19228824 DOI: 10.1530/eje-08-0890] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Insufficient function of the thyroid gland can cause low concentrations of thyroid gland hormones which are necessary for the proper development of the foetus brain, especially during the beginning of pregnancy. We determined the reference interval for TSH in the first trimester of pregnancy and the decision point for anti-TPO antibodies' positivity. METHODS We tested 5520 women from the central part of the Czech Republic during the first trimester of pregnancy for serum TSH, anti-TPO and FT4 by chemiluminometric immunoanalysis on an ADVIA Centaur system (Siemens). The reference interval for TSH during the first trimester of pregnancy was determined using the log transformation, and then summarized as the geometrical mean (95% CI); following which, a suitable decision point for anti-TPO positivity was set. RESULTS The reference interval for TSH was determined to be 0.06-3.67 mU/l. The suppression of TSH was found in 2.93% of the women; a raised concentration of TSH had been found in 4.48% of the women. For anti-TPO, the cut-off was established at 143 kU/l; 11.2% of the pregnant women were found to be anti-TPO positive. CONCLUSION Determination of the reference interval for TSH during early pregnancy is one of the basic requirements when implementing a general examination of the thyroid gland at the beginning of pregnancy. The decision level for positivity of anti-TPO is more than double the manufacturer's reference interval.
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Affiliation(s)
- Drahomira Springer
- Department of Clinical Biochemistry and Laboratory Medicine, General Teaching Hospital, First Faculty of Medicine Charles University, U Nemocnice 2, 120 00 Prague, Czech Republic.
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Tozzoli R, Giavarina D, Villalta D, Soffiati G, Bizzaro N. Definition of reference limits for autoantibodies to thyroid peroxidase and thyroglobulin in a large population of outpatients using an indirect method based on current data. Arch Pathol Lab Med 2009; 132:1924-8. [PMID: 19061292 DOI: 10.5858/132.12.1924] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT The reference limits for thyroid antibodies are generally made by measuring thyroid peroxidase and thyroglobulin antibody values in a group of healthy subjects (direct method), as proposed by the National Academy of Clinical Biochemistry. OBJECTIVE To define the upper reference limits of thyroid peroxidase and thyroglobulin, by using an indirect method to analyze data from a large number of outpatients that were stored in the information system of a general hospital laboratory. DESIGN Thyroid peroxidase and thyroglobulin values from 21 492 patients, who had undergone antithyroid antibody measurements, were retrieved from the laboratory information system; the upper reference limits (in the top 97.5 percentile) were calculated using the indirect Kairisto method, after exclusion of outliers. RESULTS The mean upper reference limits for females and males were 15 kIU/L and 9 kIU/L for thyroid peroxidase, and 21 kIU/L and 19 kIU/L for thyroglobulin, respectively. The upper limits showed minimal or no differences in the different age classes in either females or males. CONCLUSIONS Using a vast population of patients, we demonstrated that the upper limits for thyroid antibodies are much lower than the values obtained with classic, direct methods and that they do not vary in relation to age and sex.
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Affiliation(s)
- Renato Tozzoli
- Laboratory of Clinical Pathology, Ospedale Civile, Latisana, Italy
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Abstract
Thyroid hormones play a critical role in the metabolic activity of the adult brain, and neuropsychiatric manifestations of thyroid disease have long been recognised. However, it is only recently that methodology such as functional neuroimaging has been available to facilitate investigation of thyroid hormone metabolism. Although the role of thyroid hormones in the adult brain is not yet specified, it is clear that without optimal thyroid function, mood disturbance, cognitive impairment and other psychiatric symptoms can emerge. Additionally, laboratory measurements of peripheral thyroid function may not adequately characterise central thyroid metabolism. Here, we review the relationship between thyroid hormone and neuropsychiatric symptoms in patients with primary thyroid disease and primary mood disorders.
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Affiliation(s)
- M Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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Nielsen CH, Brix TH, Gardas A, Banga JP, Hegedüs L. Epitope recognition patterns of thyroid peroxidase autoantibodies in healthy individuals and patients with Hashimoto's thyroiditis*. Clin Endocrinol (Oxf) 2008; 69:664-8. [PMID: 18363888 DOI: 10.1111/j.1365-2265.2008.03245.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Thyroid peroxidase antibodies (TPOAb) are markers of autoimmune thyroid disease (AITD), including Hashimoto's thyroiditis (HT), but naturally occurring TPOAb are also detectable in healthy, euthyroid individuals. In AITD, circulating TPOAb react mainly with two immunodominant regions (IDR), IDR-A and IDR-B. The present study was undertaken in order to compare the epitope recognition pattern of TPOAb in HT patients and healthy subjects. DESIGN Sera from 21 out of 98 healthy controls were selected on the basis of high TPOAb values, required for determination of TPOAb recognition pattern; as were sera from 92 HT patients. MEASUREMENTS Measurement of IDR-reactivity was possible in 90 patients and 12 controls. IDR-A-, IDR-B- and non-IDR-A/non-IDR-B-Ab constituted 24 +/- 11%, 50 +/- 15% and 26 +/- 12%, respectively, in the patients. The distribution in the controls was distinctly different, only 12 +/- 13% being directed against IDR-A (P < 0.002) and 66 +/- 22% against IDR-B (P < 0.002). Half of the healthy individuals, vs. none of the HT patients, lacked IDR-A reactivity completely (P < 0.0001). In HT patients, IDR-B-Ab proportions increased slightly with increasing TPOAb levels (P < 0.05), while IDR-B-Ab of the controls showed a strong opposite trend (P < 0.0001). Accordingly, the proportion of non-A/non-B-Ab correlated with TPOAb levels in the healthy controls (P < 0.008), and an inverse correlation was seen in HT patients (P < 0.02). CONCLUSION The data suggest that TPOAb do not differ only in quantity between HT patients and healthy individuals, but may also follow distinct qualitative patterns. Larger studies are required to confirm this, and to determine whether the propensity to produce antibodies to certain TPO epitopes, for example, IDR-A, is of pathogenic relevance.
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Affiliation(s)
- Claus H Nielsen
- Department of Clinical Immunology, Section 7631, Rigshospitalet University Hospital, Copenhagen, Denmark.
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Abdelouahab N, Mergler D, Takser L, Vanier C, St-Jean M, Baldwin M, Spear PA, Chan HM. Gender differences in the effects of organochlorines, mercury, and lead on thyroid hormone levels in lakeside communities of Quebec (Canada). ENVIRONMENTAL RESEARCH 2008; 107:380-392. [PMID: 18313043 DOI: 10.1016/j.envres.2008.01.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 10/29/2007] [Accepted: 01/03/2008] [Indexed: 05/26/2023]
Abstract
Environmental chemicals can disrupt endocrine balance and in particular thyroid hormone (TH) homeostasis. However, studies differ with respect to thyroid profile changes and gender differences are rarely examined. This study investigated the THs, triodothyronine (T3), thyroxine (T4), and thyroid stimulating hormone (TSH), in relation to serum organochlorines (OCs), bioindicators of mercury (Hg) and blood lead (Pb) in 211 freshwater fish consumers (124 men and 87 women) from two communities in Canada. Thyroid hormones were within the normal range and the bioindicators of exposure were low compared to other reports on fish consumers. Stratified analysis showed that for women, serum T3 concentrations were negatively related to serum concentrations of PCB 138, PCB 153, the non-coplanar congeners, Arochlor 1260, and SigmaPCB, as well as p,p'-DDE. No relations were observed between T4 and any of the chemicals measured, but TSH was negatively related to blood Pb. For men, serum T4 was inversely related to PCB 138, non-ortho-substituted (dioxin-like) PCBs and SigmaPCB. A significant positive relationship was observed between serum TSH and different PCB congeners (PCB 138, PCB 180, non-coplanar congeners, mono-ortho coplanar congeners, dioxin-like PCBs), as well as SigmaPCB. Serum TSH increased with hair and blood Hg concentrations and was highest among those in the highest 50th percentile for both Hg and dioxin-like PCB congeners compared to the others. No associations were observed for T3 in men. These findings suggest that even at low concentrations, these environmental contaminants can interfere with thyroid status and effects may differ by gender.
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Affiliation(s)
- Nadia Abdelouahab
- Centre de Recherche Interdisciplinaire en Biologie, Santé, Société et Environnement CINBIOSE, Université du Québec à Montréal, Montréal, Québec, Canada.
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Abstract
Laboratory tests are the most commonly used aids in the diagnosis and monitoring of individuals who have thyroid disease. This article briefly summarizes the common methods of laboratory testing relating to thyroid disease and discusses specific information for individual tests on methods of analysis, their limitations, and situations where caution should be used in interpreting the results of thyroid tests.
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Affiliation(s)
- D Robert Dufour
- Pathology and Laboratory Medicine Service, Veterans Affairs Medical Center, and George Washington University Medical Center, 2300 Eye Street, NW, Washington, DC 20037, USA.
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Gellerstedt M, Petersen PH. Partitioning reference values for several subpopulations using cluster analysis. ACTA ACUST UNITED AC 2007; 45:1026-32. [PMID: 17902200 DOI: 10.1515/cclm.2007.192] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A crucial question when developing reference intervals is whether different subpopulations need their own reference interval or if a single joint reference interval can be used. It is reasonable to use partitioned reference intervals in situations where a single interval results in considerable variation in sensitivity between subpopulations. The aim of partitioning is to harmonize the sensitivity of the reference intervals, i.e., to make the sensitivity similar for all patients, regardless of patient characteristics. Statistical criteria to identify when partitioning is adequate have been developed over the last two decades. These criteria are applicable when considering two subpopulations, but recently a procedure for considering several subpopulations has been developed. When several subpopulations are considered, there is a possibility that some subpopulations could form a group or cluster that could share a common reference interval. However, there is no formal systematic approach to indicate how to divide these subpopulations into clusters. The aim of this study was to suggest such a systematic approach for clustering. METHODS A clustering technique was applied to data including several subpopulations. The technique is based on measuring the distance between separated reference limits and successively pooling subpopulations divided by short distances. A cluster is defined by a group of subpopulations that are close to each other and that differ from subpopulations in another cluster. A cluster recruits new subpopulations as long as the subpopulations can be pooled without violating a partitioning criterion. CONCLUSIONS We have suggested a procedure for partitioning a number of Gaussian (or Gaussian-transformable) subpopulations into clusters. This is the only formalized procedure indicating how to analyze several subpopulations and identify a suitable number of groups and reference intervals. Using a computer program developed for partitioning issues, the approach was easy to adopt.
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Affiliation(s)
- Martin Gellerstedt
- Department of Informatics, University of West Sweden, Trollhättan, Sweden.
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Jensen E, Petersen PH, Blaabjerg O, Hegedüs L. Biological variation of thyroid autoantibodies and thyroglobulin. ACTA ACUST UNITED AC 2007; 45:1058-64. [PMID: 17902201 DOI: 10.1515/cclm.2007.185] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND It has been shown that the level of serum thyroid antibodies affects serum thyrotropin (TSH) concentrations in men and women, and that these autoantibodies in combination with serum TSH are predictive of future thyroid disease. As the biological variation of these autoantibodies is unknown, we investigated this in fertile women during one complete regular menstrual cycle. METHODS A total of 24 healthy women (23-46 years) were investigated twice a week between 07:30 and 11:00 h. Antibodies against thyroid peroxidase (TPOAb), thyroglobulin (TgAb), and thyrotropin receptor (TRAb) were measured in serum, as well as thyroglobulin (Tg). TPOAb, TgAb and Tg were determined on an AutoDELFIA system (Perkin Elmer/Wallac) and TRAb by a radioreceptor assay from Brahms Diagnostica. RESULTS All 24 women had measurable levels of TPOAb and TgAb in all samples, and nine women had antibodies above the upper reference limit of the laboratory (6 had TPOAb >10 kIU/L, 6 had TgAb >20 kIU/L and 1 had TRAb >0.75 IU/L). Eight women had Tg below the lower reference limit, five of whom had elevated TgAb. Variations in the thyroid antibodies were random and not related to the menstrual cycle. For TPOAb (2.5-258 kIU/L), the CV biological was 11.3%, while the CV analytical was 10.6%. For TgAb (5.6 to 148 kIU/L) CV biological was 8.5% and CV analytical was 9.0%. The woman with TRAb had a CV biological of 4.8%, while the analytical variation in duplicates was 3.9% at a level of 2.8 IU/L. CONCLUSIONS It is possible to measure TPOAb and TgAb in all samples with the AutoDELFIA. There is no systematic variation in autoantibodies during the menstrual cycle. The biological coefficient of variation for TPOAb and TgAb was 11.3% and 8.5%, respectively.
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Affiliation(s)
- Esther Jensen
- Department of Clinical Biochemistry, Odense University Hospital, 5000 Odense C, Denmark.
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Brix TH, Hansen PS, Rudbeck AB, Hansen JB, Skytthe A, Kyvik KO, Hegedüs L. Low birth weight is not associated with thyroid autoimmunity: a population-based twin study. J Clin Endocrinol Metab 2006; 91:3499-502. [PMID: 16822815 DOI: 10.1210/jc.2006-1348] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Low birth weight has been proposed as a risk factor for the development of antibodies toward thyroid peroxidase (TPOAb) and thyroglobulin (TgAb) in adult life. However, the association could also be due to genetic or environmental factors affecting both birth weight and the development of thyroid autoantibodies. The effect of these confounders can be minimized through investigation of twin pairs. OBJECTIVE AND DESIGN To examine the impact of low birth weight on the development of thyroid autoimmunity, we studied whether within-twin-cohort and within-twin-pair differences in birth weight are associated with differences in the serum concentration of TPOAb and TgAb in adult life. PARTICIPANTS We studied 1024 euthyroid twin individuals who were distributed in 512 same-sex twin pairs. METHODS Original midwife protocols were traced manually through the Provincial Archives of Denmark. TPOAb and TgAb were measured using solid-phase time-resolved fluoroimmunometric assays. RESULTS There were no statistically significant associations between birth weight and serum concentrations of TPOAb [regression coefficient (beta) = 0.003 (95% confidence interval, -0.010 to 0.015); P = 0.67] or TgAb [beta = 0.002 (-0.010 to 0.014); P = 0.77]. When restricting the analysis to twin pairs with a within-pair difference in birth weight of 500 g or greater or to twin pairs born 4 wk or more before term, the regression coefficients were almost unchanged. Controlling for potential confounders (sex, zygosity, gestational age, TSH, and smoking) did not change the findings of nonsignificant regression coefficients. CONCLUSION Low birth weight per se has no evident role in the etiology of thyroid autoimmunity.
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Affiliation(s)
- Thomas Heiberg Brix
- Department of Endocrinology and Metabolism, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark.
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