Title: Anti-Thyroid Peroxidase and Anti-Thyroglobulin Antibodies in patients with Hypothyroidism

Authors: Aziz Muzafar Jafaar, Mohammad Q Meena

 DOI:  http://dx.doi.org/10.18535/jmscr/v4i8.62

Abstract

Background: Autoimmune hypothyroidism is common and well-known in developed countries, the aim of this article is to determine theantithyroid peroxidase and antithyroglobulin antibodies in patients with primary hypothyroidism and comparing it with healthy subjects in Erbil governorate hospitals.

Methods: This case _control study was carried out in Hawler and Rizgary teaching hospitals. Which includes 140 subjects equally distributed in to 70 patients and 70 healthy person, All ages above 18 years were included. The study was carried out in the period between March and December 2015. It includes all patients who has/had hypothyroidism, either newly diagnosed or on treatment, or subclinical. Patients with history of thyroid operation, radioactive iodine treatment and secondary (central) hypothyroidism, were excluded in the study. Control subject was any one with normal thyroid function test and no any history of thyroid diseases, blood withdrawn and sent for assessment for Thyroid Stimulating Hormone (TSH), T4, T3, Thyroid Peroxidase and Anti-thyroglobulin antibodies.

Results: Total of 140 subjects was equally distributed in to 70 cases (patients) and 70 controls (healthy individuals). Their ages ranges between 18-76 years, with the mean age within the cases were 40.3 years and 40.9 years within the control group.

From the total of 140 subjects, 112 were female and 28 were male. Gender distribution within the cases were 55 (78.57%) female and the remaining 15 (21.43%) were males. In the control side 57 (81.42%) were female and the remaining 13 were male with statistically no significant differences in sex distribution between cases and control.

Within the cases the goiter was detected clinically in 40 (57.1%) and no goiter detected in control group with highly significant differences between cases and control (p<0.001). Within the cases high titter of anti-thyroid peroxidase antibody was detected in the serum of 62 (88.6%) patients. While in control group Anti-Thyroid Peroxidase antibody was detected only in 8(11.4%) subjects, indicating highly significant difference between case and control group (p<0.001).

The ant- thyroglobulin antibody was detected in 52(74.3%) cases but in control grouponly in 12 (17.1%)  indicating highly significant difference between the two groups (p<0.001)

Conclusion: 1.The majority of hypothyroid cases were having positive both anti-thyroid peroxidase and anti-thyroglobulin antibodies, and these antibodies were significantly higher in patients when compared with control group (healthy individual).

2.The majority of hypothyroid patients were having goiter when compared with healthy individuals.

3. In this article the majority of cases with hypothyroidism were duo to autoimmune thyroid disease, depending on clinically detected goiter and positive both anti-thyroid peroxidase and anti-thyroglobulin antibodies.

Keywords: autoimmune hypothyroidism, antithyroid peroxidase, antithyroglobulin.

References

 

1.      Roberts CG, Ladenson PW. Hypothyroidism. Lancet. 2004 Mar 6;363(9411):793-803.

2.      Pearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med. 2003;348:2646-2655.

3.      Dayan CM, Panicker V. Novel insights into thyroid hormones from the study of common genetic variation. Nat Rev Endocrinol.2009; 5:211-218.

4.      Hollowell JG, Stehling NW, Flanders WP, Hannon WH, Gunter EW, Spencer CA et al. Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III).  J ClinEndocrinolMetab. 2002;87:489-499.

5.      Zaletel K. Determinants of thyroid autoantibody production in Hashimoto's thyroiditis. Expert Rev. Clin. Immunol. 2007;3:217–223. 

6.      Hocevar M, Auersperg M, Stanovnik L. The dynamics of serum thyroglobulin elimination from the body after thyroid surgery. Eur. J. Surg. Oncol. 1997;23:208–210. 

7.      Saravanan p, Dayan CM. Thyroid Autoantibodies .EndocrinolMetabClin North Am.2001;30:315-17. 

8.      Staii A, Kristina M, Todorova-Koteva K, Glinberg S, Jaume JC. Hashimoto thyroiditis is more frequent than expected when diagnosed by cytology which uncovers a pre-clinical state. Thyroid Res. 2010;3:11–18. 

9.      Di Tomaso L, Battista S, Annarita D, Sciarra A, Morenghi E, Roncalli M. Cracking spaces in Hashimoto thyroiditis are lymphatic and prelymphatic vessels. Am. J. Surg. Pathol. 2010;34:1857–1861. 

10.  Kasagi K, Takahashi N, Inoue G, Honda T, Kawachi Y, Izumi Y. Thyroid function in Japanese adults as assessed by a general health checkup system in relation with thyroid-related antibodies and other clinicaLparameters. Thyroid. 2009;19:937–944. 

11.  Hadj-Kacem H, Rebufat S,  MnifFeki M , Belguith S, AyadiH, and Eraldi-Roux S.“Autoimmune thyroid diseases :genetic susceptibility of thyroid –specific genes and thyroid Auto antigens contributions,” InternationalJournalofImmuno-genetics.2009;36:2,p.85–96.

12.  Amanda  H, Menconi F, Corathers S , M.Jacobson E, and Yaron.T .“Joint genetic susceptibility to type1 diabetes and autoimmune thyroiditis :from epidemiology to mechanisms,” Endocrine Reviews 2008;29 :no.6, p.697–725.

13.  Yaron T and Amanda.H : “the etiology of autoimmune thyroid disease : a story of genes and environment,”  Journal of Autoimmunity 2009;32,3-4,p231–239.

14.  Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH et al. Subclinical thyroid disease: Scientific review and guidelines for diagnosis and management. JAMA. 2004;291:228–38.

15.  Spencer CA, Hollowell JG,  Kazarosyan M, Braverman  LE. National Health and Nutrition Examination Survey III thyroid-stimulating hormone (TSH)-thyroperoxidase anti body relationships demonstrate that TSH upper reference limits may be skewed by occult thyroid dysfunction. J ClinEndocrinolMetab 2007; 92 (11): 4236–40.

16.  Wartofsky L, Dickey RA. The evidence for a narrower thyrotropin reference range is compelling. J ClinEndocrinolMetab 2005; 90 (9): 5483–8.

17.  Baskin HJ, Cobin RH, Duick DS, Gharib H, Guttler RB, Kaplan MM et al. American Association of Clinical Endocrinologists medical guidelinesfor clinical practice for the evaluation and treatment of hyperthyroidism and hypoth-yroidism. EndocrPract2002; 8 (6): 457–69.

18.  Ganaris GJ, ManowitzNR ,Mayor GM  and Ridgway EC. The coloredo thyroid disease prevalence studies .Arch.In.Med. 2000; 160: 526-534.

19.  O'Leary PCFeddema PHMichelangeli VPLeedman PJChew GTKnuiman Metal . Investigations of thyroid hormones and antibodies based on a community health survey: the Busselton thyroid study. Clin Endocrinol (Oxf). 2006 Jan; 64(1):97-104.

20.  Brix TH, Knudsen GP, Kristiansen M ,Kyvik KO, Orstavik KH, and  HegedL.¨us,“High frequency of skewed X-chromosome inactivation in females with autoimmune thyroid disease :apossible explanation for the female predisposition toThyroid autoimmunity,” Journal of Clinical Endocrinology and Metabolism2005:.90:(11).5949–5953.

21.  Hasanat M,   Rumi   M, Alam  M , Hasan K , Salimullah M, Salam MA   et   al.   Status   of   antithyroid   antibodies   in Bangladish .post grad Med J 2000; 76:345-9.

22.  Delemer B,Aubert JP, Nys P, Landron F, Bouee S. An observational study of the initial management of hypothyroidism in France: the ORCHIDEE study Eur J Endocrinol2012 ;167. 817–823.

23.  Tomer Y, Greenberg D, Concepcion E, Ban Y, Davies T .Thyroglobulin is a thyroid specific gene for the familial autoimmune thyroid diseases.  J.Clin. Endocrinol. Metab.2002;87: 404-407.

24.  McLachlanSM And Rapoport B. Why measure thyroglobulin autoantibodies rather than thyroid peroxidase autoanti-bodies?. Thyroid.2004; 14:510–520.

25.  CaturegliP, De Remigis A,  Chuang K,Dembele M,Iwama A,  wama SI. Hashimoto's thyroiditis: celebrating the centennial through the lens of the Johns Hopkins hospital surgical pathology records. Thyroid.2013; 23 .142–150.

Corresponding Author

Aziz Muzafar Jafaar

M.B.Ch.B, F.I.B.M.S (Med),

Department Of Internal Medicine, Hawler Medical University