Association between serum 25-hydroxyvitamin D and thyroid autoantibodies and thyroid nodules in women for health examination in Shanghai / 上海预防医学

ObjectiveTo determine the level of serum 25-hydroxyvitamin D （25（OH）D） and its association with thyroid autoantibodies and thyroid nodules in adult women for health examination in Shanghai. MethodsWe recruited a total of 2 108 healthy women for examination in the hospital. According to the serum 25-hydroxyvitamin D， the women were classified into four groups： 25（OH）D≥30 μg·L-1 as sufficient group， 20 μg·L-1≤25（OH）D<30 μg·L-1 as insufficient group， 10 μg·L-1≤25（OH）D<20 μg·L-1 as the deficiency group， and<10 μg·L-1 as severe deficiency group. The association was determined between the serum 25（OH）D and thyroid autoantibodies and thyroid nodules. ResultsThe prevalence of deficiency in adult women was determined to be 69.31%. Alkaline phosphatase （ALP）， low-density lipoprotein （LDL）， anti-thyroglobulin antibodies （TGAB） and anti-thyroid peroxidase autoantibody （TPOAB） levels significantly differed between the severe deficiency group and sufficient group （each P<0.05）. Moreover， prevalence of thyroid nodules， TGAB， TGAB and/or TPOAB differed significantly across the four groups （each P<0.05）. Logistic regression analysis showed that decrease of serum 25（OH）D was significantly associated with age and increasing prevalence of thyroid nodules， TGAB， TGAB and/or TPOAB. ConclusionVitamin D deficiency remains high in adult women for health examination in Shanghai. Serum 25（OH）D insufficiency or deficiency is associated with age， thyroid autoantibodies and thyroid nodules.

Warthin-like and classic papillary thyroid cancer have similar clinical presentation and prognosis

ABSTRACT Objective Warthin-like papillary thyroid cancer (WL-PTC) is an uncommon variant of PTC, usually associated with lymphocytic thyroiditis. Scarce evidence suggests that WL-PTC has similar clinical presentation to classic PTC (C-PTC), with no studies comparing risks of recurrence and response to treatment between both variants. Our objective was to describe the clinical presentation and prognosis of WL-PTC and compare it to C-PTC. Subjects and methods Retrospective analysis of a prospective cohort, including 370 (96%) patients with C-PTC and 17 (4%) with WL-PTC, consecutively treated with total thyroidectomy with or without RAI, followed for at least 6 months. We compared clinical presentation, risk of mortality and recurrence, as well as response to treatment between both variants. Results Of the total cohort: 317 (82%) female, 38 ± 13.5 years, median follow-up 4 years (0.5-28.5); most of them stage I and low/intermediate risk of recurrence. We found no differences regarding clinical-pathological data and risk of recurrence. WL-PTC was associated with a higher rate of anti-thyroglobulin antibodies (TgAb) (65% vs. 36%, p = 0.016) and lymphocytic thyroiditis (59% vs. 34%, p = 0.03). The rates of biochemical and structural incomplete responses were similar in both variants. WL-PTC had a lower rate of excellent response (23% vs. 54%, p = 0.01), which became non-significant when performing analysis by TgAb presence (50% vs. 67%, p = NS). Conclusions WL-CPT and C-CPT have similar clinical presentation and rate of recurrence. The lower rate of excellent response to treatment in WL-PTC is due to a higher frequency of TgAb. WL-PCT should not be considered an aggressive variant of PTC.

A study of prevalence of autoantibodies in patients with lichen planus from Mumbai, India

Background: Lichen planus is a common chronically relapsing autoimmune skin condition with poorly understood etiology. Apart from cellular immunity, presence of various antibodies has been hypothesized. Various studies have found the presence of serum anti-nuclear antibody, anti-mitochondrial antibody, anti-desmoglein 1 and 3 antibodies, anti-keratinocyte antibody and anti-thyroglobulin antibody in patients of cutaneous and oral lichen planus. Aim: To study the prevalence of autoantibodies and the clinical spectrum of disease in an Indian patient subpopulation with lichen planus. Methods: A cross-sectional epidemiological study comprising 100 lichen planus patients was conducted in the dermatology outpatient department of Seth G.S Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India. Serum concentrations of circulating anti-nuclear antibodies, anti-desmoglein 1 antibody, anti-desmoglein 3 antibody, anti-keratinocyte antibodies, anti-mitochondrial antibodies and anti-thyroglobulin antibodies were determined by indirect immunofluorescence. Pairs of groups were compared using “Student's t-test” for normally distributed continuous data. The “χ2-test” was used for the categorical variables as needed. Statistical significance was set at P < 0.05. Results: It was found that 65 (65%) patients showed the presence of at least one of the six autoantibodies that we studied, while 35 (35%) tested negative for all six of them. Positivity of anti-keratinocyte antibody in 26 (26%), anti-nuclear antibody in 22 (22%), anti-desmoglein 1 antibody in 19 (19%), anti-desmoglein 3 antibody in 16 (16%), anti-mitochondrial antibody in 9 (9%) and anti-thyroglobulin antibody in 6 (6%) patients was detected. It was observed that 55 (71.4%) patients of cutaneous lichen planus, 6 (46.1%) patients of mucosal lichen planus and 4 (40%) patients of cutaneous and mucosal lichen planus overlap showed presence of at least one autoantibody. Conclusion: This study provides the serological parameters of a population of lichen planus from western India. Presence of autoantibodies in lichen planus suggests the possible role of humoral immunity in lichen planus. Identifying antibodies linked to lichen planus may help in identifying suitable diagnostic tests and therapeutic targets. Well-controlled studies with larger sample size are the need of the hour to confirm the role of humoral immunity in lichen planus. Limitations: Studies with a larger number of patients as well as controls should be undertaken to further evaluate the role of autoantibodies in lichen planus.

Langerhans' Cell Histiocytosis Masquerading as Metastatic Papillary Thyroid Cancer on F-18 FDG PET/CT: Diagnostic Dilemma Solved by PET/CT-Guided Biopsy / 대한핵의학회잡지

We present a case of papillary thyroid cancer (post-thyroidectomy status) on regular treatment with suppressive Levothyroxine therapy. On follow-up at 6 months after radioactive iodine ablation for remnant thyroid tissue, her thyroglobulin, and anti-thyroglobulin levels were 0.06 ng/ml and 670 IU/ml, respectively. Low-dose whole-body I-131 scan was negative. To look for the cause of isolated increased anti-thyroglobulin level, a whole-body ¹⁸F-FDG PET/CT was done which revealed multiple FDG-avid lytic skeletal lesions suggestive of metastases. For confirmation of diagnosis, ¹⁸F-FDG PET/CT-guided metabolic biopsy was done, which revealed Langerhans' cell histiocytosis on histopathological examination.

Clinical implications of anti-thyroglobulin antibody measurement before surgery in thyroid cancer

Thyroglobulin antibody (TgAb) is a class G immunoglobulin and a conventional marker for thyroid autoimmunity. From a clinical perspective, TgAb is less useful than thyroid peroxidase antibodies for predicting thyroid dysfunction. However, TgAb is found more frequently in differentiated thyroid cancer (DTC) and can interfere with thyroglobulin (Tg) measurements, which are used to monitor the recurrence or persistence of DTC. Recent studies suggested a small but consistent role for preoperative TgAb in predicting DTC in thyroid nodules, and in reflecting adverse tumor characteristics or prognosis, including lymph node metastasis, but this is still controversial. Postoperative TgAb can serve as a biomarker for remnant thyroid tissue, so follow-up measures of TgAb are useful for predicting cancer recurrence in DTC patients. Since high serum TgAb levels may also affect the fine needle aspiration washout Tg levels from suspicious lymph nodes of DTC patients, it is important to use caution when interpreting the washout Tg levels in patients who are positive for TgAb.

Métodos de tiroglobulina de primera y segunda generación: su utilidad en pacientes con cáncer diferenciado de tiroides / First and second generation thyroglobulin measurement methods: Their usefulness in patients with thyroid cancer

El cáncer diferenciado de tiroides (CDT) es el cáncer endocrinológico más frecuente y en las últimas décadas su incidencia ha aumentado. El seguimiento de la enfermedad se efectúa con la medición de tiroglobulina (Tg) sérica, ecografía cervical y barrido corporal total diagnóstico. Los métodos de Tg han evolucionado a través del tiempo. Actualmente, los ensayos inmunométricos de Tg se clasifican en 1.ª y 2.ª generación (1.ª G y 2.ª G). Comprobamos que los ensayos de 2.ª G alcanzan una precisión adecuada para medir valores del orden de 0,1 ng/ml y los de 1.ª G de 1 ng/ml. La bibliografía señala que en el caso de los pacientes de bajo riesgo, una Tg bajo levotiroxina indetectable por un método de 2.ª G puede evitar la realización de Tg estimulada, sea por la suspensión de la terapia hormonal como por el empleo de la TSH recombinante humana, debido a su mayor sensibilidad. Sin embargo, por su menor especificidad, un valor detectable no asegura la presencia de enfermedad, y debería confirmarse. Para optimizar la utilidad clínica de dicha medición se podrían emplear valores de cortes de acuerdo con la población y el método en lugar de la sensibilidad funcional o límite de cuantificación del mismo. Se señalan también otros aspectos críticos en la medición de Tg como son la discordancia entre distintas metodologías y las interferencias en su medición, principalmente por anticuerpos antitiroglobulina. En presencia de interferencias pierden utilidad los ensayos de Tg de 1.ª y 2.ª G. El seguimiento de los pacientes con Tg interferida tiene limitaciones todavía no resueltas. Es importante consensuar entre médicos y bioquímicos las dificultades técnicas y los criterios de interpretación de los valores de Tg en el seguimiento de los pacientes con CDT.

Differentiated thyroid cancer (DTC) is the most common endocrine cancer (tumour) and its incidence has risen in the past decades. Its follow-up includes measuring serum thyroglobulin (Tg), performing neck ultrasound and a diagnostic whole-body scan. Tg assays have evolved with time. At present immunoassays for Tg are classified as 1 st and 2 nd generation assays (1 st G and 2 nd G). 2 nd G assays show an adequate (good) precision at levels close to 0.1 ng/ml and 1 st G assays at levels close to 1 ng/ml. The literature shows that for low risk patients on levothyroxine treatment, who undetectable levels by 2 aG assays can avoid the stimulation test performed by thyroid hormone withdrawal or after recombinant human TSH, due to better sensitivity. However, due to lower specificity, detectable levels do not confirm the presence of disease (tumour), and should be confirmed. To optimise the clinical usefulness of the test, cut-off values specific for population and method should be used, instead of functional sensitivity or quantification limit. Critical issues for measuring Tg are discussed, such as non-harmonisation of methods, and interferences, mainly by antithyroglobulin antibodies (ATg). 1 st and 2 nd G assays are less useful in presence of ATg, and follow up of such patients is limited. Consensus between physicians and the laboratory on technical issues and interpretation criteria of Tg values is of outmost importance in the follow-up of DTC patients.

Clinical impact of thyroglobulin (Tg) and Tg autoantibody (TgAb) measurements in needle washouts of neck lymph node biopsies in the management of patients with papillary thyroid carcinoma

ABSTRACT Objectives The presence of thyroglobulin (Tg) in needle washouts of fine needle aspiration biopsy (Tg-FNAB) in neck lymph nodes (LNs) suspected of metastasis has become a cornerstone in the follow-up of patients with papillary thyroid carcinoma (PTC). However, there are limited data regarding the measurement of anti-Tg antibodies in these washouts (TgAb-FNAB), and it is not clear whether these antibodies interfere with the assessment of Tg-FNAB or whether there are other factors that would more consistently justify the finding of low Tg-FNAB in metastatic LNs. Materials and methods We investigated 232 FNAB samples obtained from suspicious neck LNs of 144 PTC patients. These samples were divided according to the patient’s serum TgAb status: sTgAb- (n = 203 samples) and sTgAb+ (n = 29). The TgAb-FNAB levels were measured using two different assays. Tg-FNAB was also measured using two assays when low levels (< 10 ng/mL) were identified in the first assay of the metastatic LNs from the sTgAb+ samples. Results The TgAb-FNAB results were negative in both assays in all samples. Low levels of Tg-FNAB were identified in 11/16 of the metastatic LNs of the sTgAb+ patients and 16/63 of the sTgAb- patients (p < 0.05) using assay 1. The measurement of the Tg-FNAB levels using assay 2 indicated additional metastases in 5 LNs of the sTgAb+ patients. Conclusions Factors other than the presence of TgAb-FNAB may contribute to the higher number of metastatic LNs with undetectable Tg-FNAB in the sTgAb+ group. In addition, the measurement of Tg-FNAB using different assays was useful to enhance the diagnosis of metastatic LNs, particularly when cytological and Tg-FNAB results are discordant.

Significance of TPO-Ab,TSH,TGA detection in thyroid disease screening among pregnant women / 国际检验医学杂志

Objective To investigate the application value of anti‐thyroid peroxidase antibodies(TPO‐Ab) ,thyroid stimulating hormone(TSH) ,anti‐thyroglobulin antibody(TGA) in screening thyroid disease among pregnant women .Methods A total of 125 pregnant women of thyroid nodule diagnosed by neck ultrasonography in our hospital from January 2014 to June 2015 were selected as the thyroid disease group ,other 120 pregnant women with no thyroid disease family history or past disease history by the routine antenatal examination were selected as the pregnant control group .And 100 non‐pregnant child‐bearing healthy women were select‐ed as the healthy control group .The levels of serum TPO‐Ab ,TSH and TGA ,and positive rate in each group were detected by u‐sing the chemiluminescence method .The receiver operation working(ROC) curve was adopted to evaluate the application value of TPO‐Ab ,TSH and TGA in screening early thyroid disease among pregnant women .Results The serum TPO‐Ab ,TSH and TGA levels and positive rate in the thyroid disease group were significantly higher than those in the pregnant control group and healthy control group(P<0 .05) ,the ROC curve analysis showed that the sensitivity from high to low were TPO‐Ab ,TSH and TGA ;the specificity from high to low were TPO‐Ab ,TSH ,TGA ;the sensitivity and specificity in TPO‐Ab ,TSH and TGA combined diagno‐sis were higher than those in single index diagnosis .Conclusion TPO‐Ab ,TSH and TGA can be used as diagnostic indicators for pregnant women thyroid disease ,the joint diagnosis method can increase their clinical application value .

Comparison of Thyroglobulin Measurements Using Three Different Immunoassay Kits: A BRAMHS Tg-Plus RIA Kit, a BRAMHS hTg Sensitive Kryptor Kit, and a Beckman Coulter ACCESS Immunoassay Kit

BACKGROUND: Second-generation thyroglobulin immunometric assays (Tg-IMAs) have been developed with improved sensitivity. Our aim was to compare the diagnostic value of Tg-IMA measurements using a Kryptor (BRAHMS AG) kit (Tg-K) and an ACCESS (Beckman Coulter) kit (Tg-A) with that of the first-generation Tg measurement using a Tg-plus (BRAHMS AG) kit (Tg+). METHODS: We enrolled 82 differentiated thyroid cancer patients who underwent total thyroidectomy with radioactive iodine remnant ablation and who underwent diagnostic whole body scan using recombinant human thyroid stimulating hormone (rhTSH). The Tg+, Tg-K, and Tg-A were measured before rhTSH administration during levothyroxine treatment (suppressed Tg) from the same sample. Serum Tg+ was measured after rhTSH stimulation (stimulated Tg). RESULTS: Suppressed Tg+ was more significantly correlated with suppressed Tg-K (R²=0.919, P<0.001) than with suppressed Tg-A (R²=0.536, P<0.001). The optimal cut-off values of suppressed Tg+, Tg-K, and Tg-A for predicting stimulated Tg+ of 1 ng/mL were 0.3, 0.2, and 0.2 ng/mL, respectively. The sensitivity, specificity, and accuracy of suppressed Tg+ were 67%, 100%, and 90%, respectively; those of suppressed Tg-K were 83%, 90%, and 88%; those of suppressed Tg-A were 96%, 82%, and 87%, respectively. The positive predictive and negative predictive values of Tg+ were 100% and 87%, respectively; those of Tg-K were 79% and 92%; and those of Tg-A were 73% and 98%. CONCLUSION: We could not clearly demonstrate which kit had better diagnostic performance after comparison of first-generation Tg measurements with Tg-IMA measurements. Also, there were kit-to-kit variations between Tg-IMA kits. Suppressed Tg measured by Tg-IMA was insufficient to completely substitute for a stimulated Tg measurement.

Importancia de la detección de ATPO y ATg en pacientes con TSH entre 2, 5 a 4, 5 mU/L y su prevalencia en el Hospital Aeronáutico Córdoba / Importance of detection of anti-TPO and ATG in patients with TSH values between 2.5 and 4.5 mU/l and their prevalence at the Hospital Aeronáutico Córdoba

Introducción: La enfermedad tiroidea autoinmune (EAT) causa daño celular y altera la función tiroidea por acción de los anticuerpos antitiroperoxidasa (ATPO) y antitiroglobulina (ATg).Estudios longitudinales demuestran que personas con tirotrofina (TSH) entre 2,5 a 4,5 mU/L y autoanticuerpos tiroideos (ATPO y ATg) positivos tienen un riesgo aumentado de desarrollar hipotiroidismo franco, definiendo a esta población como una categoría de riesgo intermedio. Objetivo: destacar la importancia de la detección de anticuerpos antitiroideos en la población con TSH entre 2,5 a 4,5 mU/L y conocer su prevalencia en la población del Hospital Aeronáutico Córdoba. Materiales y métodos: se midió ATPO y ATg a 216 muestras depacientes mayores a 20 años con TSH entre 2,5 a 4,5 mU/L que concurrieron al laboratorio del Hospital Aeronáutico Córdoba y se excluyeron a las mujeres embarazadas, aquellos pacientes condopajes previos de TSH mayores a 2,5 mU/L y aquellos bajo tratamiento con levotiroxina. Las determinaciones se realizaron por el inmunoanálisis quimioluminiscente de micropartículas (CMIA). Resultados: se observó mayor prevalencia del sexo femenino, aumentando con la edad y la presencia de un 30% de pacientes con anticuerpos antitiroideos positivos en la población estudiada Se demostró que es más frecuente la presencia de ATPO que de ATg y que no hay diferencia significativa entre el dosaje de ATPOy ATg en conjunto y ATPO como única medida. Conclusiones: se recomienda valorar la presencia de anticuerpos antitiroideos, principalmente ATPO, en las poblaciones más susceptibles: pacientes con TSH entre 2,5 – 4,5mU/L, mujeres mayores a 60 años y embarazadas.

Introduction: Autoimmune thyroid disease (EAT) causes cellulardamage and alters thyroid function by the action of anti thyroid peroxidase antibodies (ATPO) and anti thyroglobulin(ATg). Longitudinal studies show that people with thyrotropin (TSH) between 2.5 to 4.5 mU/L and positive thyroid autoantibodies (ATPO and ATg) have an increased risk of developing overthypothyroidism, defined this population as intermediate risk category.Objective: Highlight the importance of the detection of antithyroid antibodies in the population with TSH between 2.5 to 4.5 mU/L and determine their prevalence in the population of HospitalAeronáutico Córdoba. Materials and methods: We measured ATg and ATPO in 216 samples of patients aged over 20 years with TSH between 2.5 to 4.5 mU/L who attended the Hospital Aeronáutico Córdoba laboratory and excluded pregnant women, patients with previousdoping TSH greater than 2.5 mU/L and those treated with levothyroxine. Determinations were performed by thechemiluminescent microparticle immunoassay (CMIA). Results: We observed a higher prevalence of female gender, increasing with age and the presence of 30% of patients withpositive antithyroid antibodies in this population. We proved that ATPO is more frequent than ATg and there was no significant.

Analysis of the factors affecting A-TG increased after the DTC operation and 131 I treatment / 国际检验医学杂志

Objective To analyze influence factors of serum A-TG level after DTC 131 I treatment ,to explore whether A-TG can be used as an indicator of follow-up ,recurrence and metastasis of DTC .Methods From 2008 January to 2013 February ,a total of 106 DTC patients underwent operation excisions of thyroid radioiodine were treated with 131 I .Before and 1 month after treatment , the levels of A-TG ,TG ,THS were measured .The relationship of A-TG and thyroid operation range operation times ,thyroid gland residual volume and time ,the levels of TSH and TG ,thyroid cancer metastasis and recurrence were examined .Results Serum A-TG concentration associated with operation scope ,frequency(P<0 .05) .It was showed that the A-TG concentration was positively correlated with the metastasis of thyroid cancer .Conclusion The serum TG level detection combined with A-TG and 131 I-WBS can improve the diagnostic sensitivity and accuracy of DTC recurrence and metastasis .

Correlations between Anti-Mast Cell Autoantibodies and Chronic Idiopathic Urticaria

BACKGROUND: The etiology of chronic idiopathic urticaria (CIU) is not completely clear. There are a few antibodies were reported to correlate with CIU. OBJECTIVE: To investigate the correlation these antibodies and CIU. METHODS: The autologous serum skin test (ASST) and allergens were performed. Serum levels of immunoglobulin E (IgE), anti-FcepsilonRI and anti-IgE, anti-Helicobacter pylori (HP) antibodies and anti-thyroglobulin antibody (TGAb) were measured in 100 patients with CIU, acute urticaria (AU) and normal controls respectively. RESULTS: Eighty-six percent food or inhalant allergens were detected in AU patients, but no allergens were detected in CIU patients and normal controls. Serum anti-FcepsilonRI antibody and anti-IgE antibody levels were higher in the CIU than that in the AU patients and normal controls (p<0.05, respectively). IgE level was lower in the CIU patients (T=190.00, p< 0.05), but increased in the AU patients (T=226.00, p<0.05) compared with the normal controls. The ASST positive rates in the CIU and the AU patients were 53.4% and 12.6% respectively, but all normal controls were negative. The anti-FcepsilonRI antibody level was higher in the ASST-positive CIU patients than those negative ones (T=101.73, p<0.05). In anti-HP antibody positive and TGAb positive CIU patients, anti-FcepsilonRI antibody positive rate was higher than AU patients (p<0.01) and normal controls (p<0.01). CONCLUSION: The anti-FcepsilonRI and anti-IgE antibodies play a key role in CIU, but anti-HP antibody and TGAb have an indirect correlation with CIU.

Changes of antithroglobulin antibody in children with congenital hypothyroidism

PURPOSE: It has been reported that antithroglobulin (anti-TG) antibody is increased in the sera of both children with transient congenital hypothyroidism and their mothers. And transplacental transport of thyroid autoantibody was proposed as the pathogenesis of transient congenital hypothyroidism. However this is not known in nontransient congenital hypothyroidism. This study was done to see changes of anti-TG antibody in children with nontransient congenital hypothyroidism. METHODS: Study patients consisted of 60 patients diagnosed as congenital hypothyroidism in the Department of Pediatrics, Kyungpook National University Children's Hospital, Daegu, Republic of Korea between January 2010 and March 2013. Healthy control were 45 children showing normal thyroid function. Anti-TG antibody and various laboratory tests were analyzed retrospectively, and compared in both children with congenital hypothyroidism and controls. RESULTS: Anti-TG antibody was significantly higher in children with congenital hypothyroidism compared to healthy controls, 119.4+/-34.7 U/mL versus 80.6+/-19.6 U/mL, respectively (P<0.001). There was no significant difference of anti-TG antibody in gender and age. CONCLUSION: We observed a significant increase of anti-TG antibody in children with nontransient congenital hypothyroidism compared to healthy controls. Further study focusing pathogenetic role of anti-TG antibody in nontransient congenital hypothyroidism is necessary. Furthermore, the clinical significance in the course of congenital hypothyroidism need to be known.

Comparison of Particle Agglutination Assay and ELISA for Anti-thyroid Autoantibodies

BACKGROUND: Measurements of serum anti-thyroglobulin antibody (anti-Tg) and anti-thyroid peroxidase antibody (anti-TPO) are important for the diagnosis of autoimmune thyroid diseases. Although ELISA is most commonly used for the detection of anti-thyroid autoantibodies, other methods like particle agglutination assay (PA) or radioimmunoassay (RIA) are still being used in clinical laboratories. There are few studies about the comparison between PA and ELISA, and we evaluated the validity of these assays in this study. METHODS: We have used three methods, PA (Fujirebio Inc.), ELISA-1 (Zeus Scientific Inc.), and ELISA-2 (Orgentec Diagnostika) for the measurements of titers or concentrations of anti-thyroid autoantibodies. A total of 212 patients belonging to six different disease groups were tested: 40 patients for anti-Tg only, 64 for anti-TPO (or anti-microsome) only, and 108 for both antibodies. All test results were compared with each other in six disease groups. RESULTS: Concordance of positive or negative results was obtained in 78.5-97.3% of the samples tested, and positive rates of three methods were similar in autoimmume thyroid disease group. In the comparable concentration range, the correlation coefficients were 0.328-0.820 between the two ELISAs or between ELISA and PA. CONCLUSIONS: Positive or negative decisions by three assay systems have high concordance rates, and antibody levels measured by three methods correlate well in the comparable concentration range. The ELISA-1 shows less non-specific reactions, better discrimination in low level of autoantibodies, and the highest positive rate in autoimmume thyroid disease group.

Association Between Thyroid Associated Ophthalmopath and Thyroid Autoantibody

PURPOSE: The same autoimmune process is thought to cause thyroid associated ophthalmopathy (TAO) and Graves' disease. The aim of this study is to determine hether thyroid autoantibody is related to the development of thyroid associated ophthalmopathy. METHODS: A retrospective chart analysis was performed on patients with a newly diagnosed Graves' disease, who presented to our ophthalmology clinic between January 2006 and December 2009. Thyroid autoantibody titers were obtained at the time of diagnosis and were used to determine the presence or absence of TAO. In addition, any correlations between thyroid autoantibodies were analyzed in patients with TAO. RESULTS: Thyroid autoantibody levels correlated with the development of TAO. Fifty-eight (69%) out of 84 patients with positive thyroid-stimulating hormone receptor antibody (TRAB) levels at the time of diagnosis had TAO. Only 50 (51%) of the 99 patients with negative TRAB levels had TAO. This difference between the two groups was statistically significant (odds ratio, OR=2.2, p=0.013). A statistically significant correlation with the development of TAO was also found in thyroid peroxidase antibody (TPOAb) and anti-thyroglobulin antibody (TgAb), respectively (OR=0.5, p=0.317; OR=0.3, p=<0.001). In patients with TAO, the correlation between TPOAb and TgAb levels was very high (r=0.64, p=<0.001). CONCLUSIONS: A significant association was determined to exist between the development of TAO and thyroid autoantibody level. This result demonstrates the clinical utility of thyroid autoantibody for the diagnosis of TAO in patients with newly diagnosed Graves' disease.

Prevalencia de hipotiroidismo y anticuerpos antitiroglobulina en pacientes mexicanos con esclerosis sistémica / Systemic sclerosis and hypothyroidism

Objetivo: Investigar la prevalencia de hipotiroidismo y anticuerpos antitiroglobulina (AATg) en pacientes mexicanos con esclerosis sistémica (ES). Material y métodos: Se estudió la función tiroidea en pacientes con ES y controles. Se les determinaron los niveles séricos de triyodotironina, tiroxina, hormona estimulante de la tiroides (TSH) y AATg. Resultados: Fueron 110 pacientes (106 mujeres y 4 hombres), edad promedio de 48.1 ± 28.5 años, versus 80 controles (76 mujeres y 4 hombres), edad promedio 47.5 ± 28.8 años. El hipotiroidismo clínico se encontró en 19% de pacientes con ES y en 1.3% de los controles (p < 0.01). Las medianas respectivamente de triyodotironina en ES y controles fueron: 82 versus 160 ng/dl, p < 0.01; tiroxina 5.4 versus 7 ng/dl, p < 0.01; TSH 8.2 versus 1.1 μUI/ml, p < 0.001. El hipotiroidismo subclínico se observó en 35% de los pacientes con ES y en 0% de los controles. Los valores de TSH en ES y en controles fueron 7.2 versus 1.2 μUI/ml, p < 0.01; triyodotironina 116 versus 160 ng/dl, p ns; tiroxina 7 versus 7 ng/dl, p ns, respectivamente. Los AATg estuvieron presentes en 54% de los pacientes y 2.5% en el grupo control, p < 0.01. Conclusiones: Los pacientes con ES presentan elevada prevalencia de hipotiroidismo, especialmente subclínico, por lo que debe investigarse la función tiroidea para iniciar tratamiento oportuno.

OBJECTIVE: Assess the prevalence of hypothyroidism and anti-thyroglobuline antibodies (AbATg) among Mexican patients with systemic sclerosis (SSc). MATERIAL AND METHODS: Thyroid function was studied in SSs patients and controls. Triiodothyronine, thyroxine, thyroid stimulant hormone (TSH) and AbATg were measured. RESULTS: 110 SSc patients (106 women and 4 men), mean age 48.1 +/- 28.5 yrs versus 80 healthy controls (76 women and 4 men) with mean age 47.5 +/- 28.8 yrs were included. Hypothyroidism was diagnosed in 19% patients compared with 1.3% in the control group. The following results were found; triyodotironina: 82 ng/dl versus 160 ng/dl, p < 0.000; tiroxina: 5.4 ng/dl versus 7ng/dl, p < 0.01; TSH: 8.2 uUl/ mL versus 1.1 +/- 2 uUl/mL, p < 0.000. Subclinical hypothyroidism was observed in 35% patients versus 0% controls, TSH: 7.2 uUl/ml versus 1.2 +/- 1.4 uUl/ml, p < 0. 000; triyodotironina: 116 ng/dl compared with 160 ng/dl, p = ns; tiroxina: 7.0 ng/dl vs. 7.0 ng/dl, p ns; AbATg were positive in patients 54% and 2.5%, p < 0.001 in the control group. CONCLUSIONS: Our study reports a high prevalence of hypothyroidism among SSc Mexican patients, especially of the subclinical type. We need to consider hypothyroidism as a clinical entity often found among SSc patients, and start hormone replacment treatment accordingly.

Effects of Anti-thyroglobulin Antibody on the Measurement of Thyroglobulin: Differences Between Immunoradiometric Assay Kits Available / 대한핵의학회잡지

PURPOSE: Thyroglobulin (Tg) is a valuable and sensitive tool as a marker for diagnosis and follow-up for several thyroid disorders, especially, in the follow-up of patients with differentiated thyroid cancer (DTC). Often, clinical decisions rely entirely on the serum Tg concentration. But the Tg assay is one of the most challenging laboratory measurements to perform accurately owing to antithyroglobulin antibody (Anti-Tg). In this study, we have compared the degree of Anti-Tg effects on the measurement of Tg between availale Tg measuring kits. MATERIALS AND METHODS: Measurement of Tg levels for standard Tg solution was performed with two different kits commercially available (A/B kits) using immunoradiometric assay technique either with absence or presence of three different concentrations of Anti-Tg. Measurement of Tg for patient's serum was also performed with the same kits. Patient's serum samples were prepared with mixtures of a serum containing high Tg levels and a serum containg high Anti-Tg concentrations. RESULTS: In the measurements of standard Tg solution, presence of Anti-Tg resulted in falsely lower Tg level by both A and B kits. Degree of Tg underestimation by A kit was more prominent than B kit. The degree of underestimation by B kit was trivial therefore clinically insignificant, but statistically significant. Addition of Anti-Tg to patient serum resulted in falsely lower Tg levels with only A kit. CONCLUSION: Tg level could be underestimated in the presence of anti-Tg. Anti-Tg effect on Tg measurement was variable according to assay kit used. Therefore, accuracy test must be performed for individual Tg-assay kit.

Influence of Anti-thyroglobulin Antibody on the Measurement of Thyroglobulin using the Immunoradiometric Assay / 대한내분비학회지

BACKGROUND: Serum thyroglobulin(Tg) is a valuable and sensitive tool needed in the follow-up of patients with differentiated thyroid cancer(DTC), but antithyroglobulin antibody(Anti-Tg), common in patients with DTC, can interfere with the assay for Tg. In this study, we evaluated the influence of Anti-Tg on the measurement of Tg using the immunoradiometric assay(IRMA). METHODS: In using ELSA-hTg in vivo test(CIS international, Schering, France), a solid phase two-site IRMA was used to measure Tg(23.5ng/mL, 62.5ng/mL) under the absence or presence of three concentrations of Anti-Tg(25U/mL, 50U/mL, 100U/mL). We also performed Tg measurement using patients serum that was mixed with patients serum containing high Anti-Tg. ANOVA and Scheffe tests were performed to evaluate the effect of Anti-Tg on Tg IRMA, and an inverse regression was made to calculate the level of Tg from measured Tg and used Anti-Tg levels and also to assess the degree of effect of anti-Tg on Tg IRMA. RESULTS: In measuring Tg using the standard solution, the presence of Anti-Tg resulted in a falsely suppressed Tg value. The IRMAs for 23.5ng/mL of the standard Tg solution resulted in 24.5+/-.1 ng/mL under no Anti-Tg, 11.8+/-.4ng/mL under 25U/mL of Anti-Tg, 7.7+/-.1ng/mL under 50U/mL of Anti-Tg, and 4.5+/-.4ng/mL under 100U/mL of Anti-Tg. IRMAs 62.5ng/mL of the standard Tg solution resulted in 65.9+/-.7ng/mL under no Anti-Tg, 36.3+/-.2ng/mL under 25U/mL of Anti-Tg, 23.7+/-.7ng/mL under 50U/mL of Anti-Tg, and 14.0+/-.0ng/mL under 100U/mL of Anti-Tg. (ANOVA test, p=0.000). The degree of suppression of the measured Tg value was positively correlated with the Anti-Tg level (Quadratic model regression, Sig T=0.000). The presence of Anti-Tg also resulted in a falsely suppressed Tg value for the Tg measurement using patient's serum. CONCLUSION: The presence of Anti-Tg could consist of the use of Tg as a tumor, therefore Anti-Tg should be measured in all patients diagnosed with DTC. The interpretation of the Tg level must be performed with extreme caution in patients with Anti-Tg.

The Incidence of Postpartum Thyroiditis and Effect of High Iodine Intake on it in Korean Women / 대한내분비학회지

BACKGROUND: Postpartum thyroiditis(PPT) is one of syndromes of thyroid dysfunction that occurs in the first year after parturition. Reported incidence of PPT is 3.9-8.2% of postpartum women in several studies from different countries. The fact that 52-100% of patients with PPT have thyroid autoantibodies, and that lymphocytic infiltration of thyroid gland is the characteristic pathological feature of PPT suggest that PPT is an autoimmune disease. High iodine intake in short term period is known to aggrevate the experimental autoimmune thyroiditis. This study was performed to investigate the incidence and clinical features of PPT in Korean postpartum women who usually ingest excessive amount of idine in immediate postpartum period and to investigate the predictive value of thyroid autoantibodies in the development of PPT in them. METHOD: Between March 1996 and February 1997, 99 women without previous history of any thyroid disease who delivered babies at Boramae hospital were enrolled. Thyroid function parameters(T3, T4, free T4, TSH), thyroid autoantibodies(anti-microsomal antibody, anti-thyroglobulin antibody) and urinary iodine excretion were measured prospectively before and 1, 3 months after delivery. Dietary iodine intake during postpartum period was evaluated by questionnaire, and clinical parameters were followed up. RESULTS: During 3 months of observation, PPT developed in 8.1%(8/99) of postpartum women. Five cases had typical course having thyrotoxic phase and the other 3 cases had hypothyroid phase without toxic phase. However, only one of those required thyroid hormone replacement therapy in the latter group. There were no differences in age, baseline thyroid function parameters, parity, percent cases with family history of thyroid disease between those developed PPT (n=8) and those did not develop PPT(n=91). Duration of high iodine intake(3.8 +- 0.5 wk. vs. 3.7 +- 0.8 wk., p>0.05), total ingested amount of high iodine diet(77 +- 28 vs. 79 +- 24 bowels of miyokguk, p)0.05), and the urinary iodine excretion(1.9 +- 1.4 mg/g creatinine vs. 3.7 +- 3.7mg/g creatinine, p0.05) at 1 month postpartum were not different between two groups. Of 99 total subjects, anti-microsomal antibody(AMA) was present in 13.1%(13/99) before delivery in their sera. Positive predictive value of the presence of AMA before delivery in predicting the development of PPT was 30.8%. CONCLUSION: The fact that incidence of PPT in normal Korean postpartum women who usually have high iodine intake in immediate postpartum period is not higher than those of other countries, and that there was no difference in the amount of iodine intake between those developed PPT and those did not suggest that high iodine intake in immediate postpartum period do not influence on the incidence of PPT. The presence of AMA before delivery had low specificity in prediction of development of PPT, so the measurement of AMA seems not to be a useful screening test.