Incidence of TPOAb over a 4-year follow-up period: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

ABSTRACT Objective: Although some previous data have suggested a high iodine intake in Brazil, the prevalence of antithyroperoxidase antibodies (TPOAb) in the country is compatible with rates from countries with adequate iodine intake. This observation emphasizes the importance of knowing the incidence of TPOAb in Brazil. Materials and methods: This prospective analysis included euthyroid participants with negative TPOAb at baseline and a thyroid function assessment at a 4-year follow-up. TPOAb was measured by electrochemiluminescence and considered positive when titers were ≥34 IU/mL. TSH and free T4 (FT4) levels were determined by a third-generation immunoenzymatic assay. The incidence of TPOAb is expressed in percentage per year or as a cumulative incidence within the 4-year follow-up period. Results: Of 8,922 euthyroid participants (mean age 51.1 years; 50.9% women) with a negative TPOAb test at baseline, 130 presented incident TPOAb at the 4-year follow-up, yielding an annual incidence of TPOAb of 0.38%/year (95% confidence interval [95% CI], 0.37-0.39%/year) and a cumulative incidence over 4 years of 1.46% (95% CI, 1.21-1.71%). In men, the annual incidence was 0.32% (95% CI, 0.31-0.33%), and the cumulative incidence over 4 years was 1.23% (95% CI, 0.90-1.56%). In women, the annual incidence was 0.43%/year (95% CI, 0.42-0.44%/year) and the cumulative incidence over 4 years was 1.67% (95% CI, 1.30-2.04%). The only factor associated with incident TPOAb was the occurrence of thyroid diseases at follow-up. No differences in TPOAb incidence were detected across ELSA-Brasil research centers. Conclusion: Based on the results of this study, the incidence of TPOAb per year and at a 4-year follow-up period are compatible with those of a country with adequate iodine intake.

Therapeutic effect of Xiakucao Oral Liquid combined with 131I on Graves disease / 中草药

Objective: To observe the therapeutic effect of Xiakucao Oral Liquid combined with 131I on Graves disease and its effect on antibodies. Methods: The efficacy of 96 patients with Graves disease treated with Xiakucao Oral Liquid and 131I (observation group) was compared with those only treated with 131I (control group). The levels of TRAb, TGAb, and TPOAb were compared between the two groups before and after treatment. Results: The efficacy after 6 months of treatment between the observation group and the control group was statistically different (P 0.05). The TRAb level in the observation group decreased significantly after 6 months, and the difference between two groups was statistically significant (P < 0.01). The levels of TGAb and TPOAb increased in the two groups after 6 months of treatment, especially in the control group, and the differences were statistically significant (P < 0.05). Conclusion: Xiakucao Oral Liquid combined with 131I can effectively reduce the levels of serum TRAb, TGAb, and TPOAb in patients with Graves disease, and the efficacy of Xiakucao Oral Liquid combined with 131I is significantly better than 131I treatment only.

Identification and treatment of Hashimoto's hyperthyroidism / 中国实用内科杂志

Hashitoxicosis patients have the clinical characteristics of Graves' disease with hyperthyroidism and the pathological phenotype of Hashitoxicosis. The initial stage of hyperthyroidism is almost indistinguishable from Graves' disease in clinical manifestations, including increased uptake of radioactive iodine in the thyroid and positive antibodies to thyrotropin receptors, as well as high levels of thyroid peroxidase antibodies and/or thyroglobulin antibodies. Generally, the symptoms of hyperthyroidism are relatively mild, and the stage of hyperthyroidism is relatively short. Hashitoxicosis patients are sensitive to antithyroid drugs and are prone to hypothyroidism in the course of treatment. It will develop into permanent hypothyroidism after 3-24 months. Therefore, antithyroid drugs should be started at low doses, thyroid function should be detected frequently, and timely drug adjustment should be made.Radioactive iodine or surgical treatment should be avoided.

The clinical observation of Chinese medicine on TPOAb, TGAb of the patients with Hashimoto's thyroiditis / 国际中医中药杂志

Objective To observe the effect of the Chinese medicine on the patients’ thyroid autoantibodies TPOAb and TGAb of Hashimoto's thyroiditis. Methods 100 cases of Hashimoto's thyroiditis were randomly divided into group A and group B, with 50 cases in each group. Group A was given levothyroxine sodium(L-T4) to maintain thyroid function(FT3,FT4,TSH)in the normal range, at the same time Chinese medicines of soothing liver and strengthening spleen, nourishing the liver and kidney, activating blood and removing blood stasis were additionally added;while group B was taken L-T4 to maintain the thyroid function in the normal range. The levels of TPOAb, TGAb were determined before and after treatment in both groups. Results After the treatment, the level of TGAb and TPOAb[respectively(106.3±29.5)IU/ml,(871.5± 209.3)IU/ml] in group A were decreased compared with their previous level [respectively(385.5±76.6)IU/ml, (1621.5±399.2)IU/ml], the difference was statistically significant(t were 48.2、10.6,P<0.01). The level of TGAb and TPOAb [respectively(437.6±135.4)IU/ml,(1798.6±434.6)IU/ml] in group B were slightly increase than their previous level[respectively(383.9±105.8)IU/ml,(1633.2±396.5)IU/ml], with no significant difference. The levels of TPOAb and TGAb in group A had significant difference than those in group B after the treatment(t were 22.3、19.6,P<0.01). Conclusion TCM combined with L-T4 can reduce the level of thyroid autoantibodies of TPOAb and TGAb-in patients.

Influence of TPO-Ab on in vitro fertilization and embryo transfer ending / 实用医学杂志

Objective To Study the effect of thyroid peroxidase-Ab (TPO-Ab) on in vitro fertilization and embryo transfer (IVF-ET) ending. Methods From March 2011 to October 2013, a total of 378 assisted reproduction cycles in Reproductive Medical Center of Qinghai Provincial People ’s Hospital were retrospectively analyzed in. Experiment group included 69 cycles from patients with positive thyroid peroxidase antibody and normal thyroid function and control group 309 cycles from those with negative thyroid peroxidase antibody and normal thyroid function. Results IVF fertility rate (79.76%) and high quality embryo rate (46.59%) in experiment group were significantly lower than those in control group (84.08%, 54.49% respectively) and the difference was statistically significant (P < 0.05); abortion rate (33.33%) in experiment group was obviously higher than that in control group (16.11%), which was statistically significant (P < 0.05). Conclusion Positive thyroid peroxidase antibody exerts adverse effects on IVF-ET ending since TPO-Ab reduces IVF fertilization rate and high quality embryo rate and increases the rate of abortion.

The prevalence of thyroid dysfunction according to TSH level alone in She ethnic minority group of Fujian province / 中华内分泌代谢杂志

In 2009,5 523 participants of She nationality living in Ningde City of Fujian province were multistage-stratified and randomly collected,and 5 080 were enrolled in analysis eventually.The TSH screening (reference range,0.3-3.0 mIU/L) revealed biochemical hyperthyroidism in 2.4％ (2.1％ of males and 2.7％ of females) and biochemical hypothyroidism in 9.7％ (7.4％ of males and 11.4％ of females) of the participants.The prevalence of positive TPOAbs was 10.8％ (7.4％ of males and 13.5％ of females).TSH values outside the normal reference range were associated with a higher prevalence of positive TPOAbs,indicating that autoimmunity seems to be an important factor in both hyperthyroidism and hypothyroidism.

Clinical significance of serum TPOAb monitoring during 131I treatment in patients with Graves' disease / 国际检验医学杂志

Objective The investigate the clinical significance of serum anti-thyroid peroxidase antibody(TPOAb)monitoring in therapeutic effect judgment and prognosis evaluation during 131I treatment in patients with Graves disease.Methods A total of 112 patients with Graves disease(hyperthyroidism group)and 50 healthy controls(healthy control group)were enrolled in the investigation.Serum concentration of TPOAb was measured with chemiluminescent immunoassay(CLIA)in healthy control group and hyperthyroidism group(at time points of 0,3,6,12 and 24 months after 131I treatment,i.e.T0,T3,T6,T12 and T24).Variance analysis and t test were adopted.Results The mean level of TPOAb was significantly higher in patients with Graves' disease before 131I treatment than that in healthy controls(P＜0.01).In hypenthyroidism group,serum concentration of TPOAb was evidently higher at T3[(108.94±70.15)IU/mL]than T0[(81.95±47.64)IU/mL](P＜0.01);TPOAb level began to decline at T6[(42.78±28.68)IU/mL],but still higher than that of healthy control group;while where was no statistical difference in TPOAb level between hyperthyroidism group at T24[(7.89±4.01)IU/mL]and healthy control group(F＞0.05).Conclusion Serum level of TPOAb before treatment may be used as an auxiliary indicator of 131I dosage.Posttreatment TPOAb level monitoring contributes to therapeutic effect evaluation,follow-up visit and immunorcaction state understanding.

Clinical significance of thyroid peroxidase antibody level in the diagnosis and treatment of hyperthyroidism and thyroid gland tumor / 基础医学与临床

Objective To observe the change of serum thyroid peroxidase antibody(TPOAb) in the patients with Hyperthyroidism and Thyroid gland tumor of different phases.Methods The level of TPOAb was observed,the relation between the changed TPOAb level and reduced thyroid function was studied.Results Among 89 cases,50 cases had normal or slightly elevated TPOAb level.However,after treatment,31 cases showed a raised TPOAb level.Of 19 cases with hypothyroidism or its sub-clinical type.There were 39 cases with positive TPOAb.After the treatment,2 cases changed to negative TPOAb,26 cases lowered,and 3 cases had hypothyroidism.There were 29 cases taking thyroid tablets without hypothyroidism.Conclusion The change of TPOAb level can be observed during the treatment for hyperthyroidism and t hyroid gland tumor.The elevated TPOAb level often predicts the decreased thyroid function.The patients with positive TPOAb should be carefully followed,and for hyperthyroidism patients the treatment should be taken with care.

Autoinmunidad y función tiroidea en escolares de 2 regiones del Estado Mérida con deficiencia de yodo corregida

Objetivos: El presente estudio transversal fue planificado para evaluar la presencia de anticuerpo antitiroideo antiperoxidasa (ac.anti-TPO) y la función tiroidea, en dos áreas endémicas de bocio, con deficiencia de yodo corregida. Métodos: Se estudiaron 109 escolares, de ambos sexos, entre 6-12 años de edad, procedentes de Bailadores (BA=54) y Mucuchíes (MU=55). El diagnóstico de bocio se obtuvo por palpación clínica. La yoduria se determinó en 34 niños de BA y en 37 de MU, mientras que la concentración sérica de T4 libre (T4L), T3 libre (T3L), T3 total (T3T), TSH y ac.anti-TPO fueron determinadas en todos los escolares estudiados. Adicionalmente se realizó la cuantificación de T3T y ac.anti-TPO en uno de los progenitores de cada niño. Resultados: En BA, el 53,5% de los escolares presentaron bocio y en MU el 42,5%. La mediana de la excreción urinaria de yodo no fue estadísticamente diferente entre ambos grupos (BA=181 µg/L, MU=200 µg/L). La frecuencia global de detectabilidad de ac.anti-TPO en escolares fue del 45,5%, pero solo el 5% presentó seropositivad. Una concentración de ac. anti-TPO, entre 10 y 30 UI/mL, se observó en el 39% de los niños de BA y 40% en MU; 87% en adultos de BA y 54% en MU. En BA, concentraciones de ac.anti-TPO mayores de 30 UI/mL se observaron en el 10% de los niños y en el 17% de los adultos; en MU, no se observó ningún caso positivo para ac.anti-TPO en niños, mientras que en adultos la frecuencia de positividad fue del 8%. Las pruebas de función tiroidea de los escolares y de los progenitores de ambas regiones fueron similares y compatibles con estado de eufunción No hubo asociación entre la presencia de ac.anti-TPO y bocio. Conclusiones: Estos resultados indican que la corrección de la deficiencia de yodo en las áreas endémicas estudiadas se asocia con una alta frecuencia de detectabilidad de ac.anti-TPO, sin cambios en la función tiroidea.

Objective: This cross-sectional study was designed to evaluate the thyroid peroxidase autoantibody (TPO-Ab) concentrations and thyroid function in schoolchildren from two geographic regions were iodine deficiency was corrected. Methods: One hundred nine schoolchildren 6 to 12 years of age were studied: Bailadores (BA=54) and Mucuchíes (MU=55). Goiter size, urinary iodine, and serum freeT4, freeT3, total T3, TSH and TPO-Ab were measured. Total T3 and TPO-Ab were also determined in some parents. Results: Overall frequency of TPO-Ab detectability and positivity in schoolchildren were 45,5% and 5% respectively. TPO-Ab concentration ranging between 10-30 UI/mL was observed in 39% of children from BA and 40% from MU; 87% of parents from BA and 54% from MU. TPO-Ab concentration >30 UI/mL was observed in 10% of children and 17% of their parents. None of the children from MU had positive TPO-Ab, while 8% of their parents were positive. Median urinary iodine was similar in both regions (BA=181 µg/L, MU=200 µg/L). Thyroid function tests were normal in all cases. Goiter was found in 53,5% of children from BA and 42,5% from MU . No association between goiter and ac.TPO-Ab concentration was observed. Conclusions: These results suggest that in both endemic goiter regions, sufficient iodine prophylaxis by iodized salt is frequently associated with low detectable TPO-Ab levels and no changes in thyroid function.

Therapeutic effect of Jianing Decoction on experimental autoimmune thyroiditis / 中成药

AIM: To evaluate the therapeutic effect of Jianing Decoction (Rhizoma sparganii, Rhizoma curcumae, Radix bupleuri, Fructus schisandrae chinensis, Spuama manis, Radix polygoni multifrori, Spica prunellae, Flos chrysanthemi indici, Fructus ligustri lucidi) (JN) on autoimmune thyroiditis. METHODS: An animal model of experimental autoimmune thyroiditis (EAT) in rats was developed by using thyroglobulin of porcine (PTg). These animals were divided into JN group, triptolide (TP) group and control group. Pathological changes were observed in the thyroid tissues and serum thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TGAb) were determined by the method of radiorimmuoussay. RESULTS: The serum TGAb and TPOAb were significantly higher in EAT model group than those in normal group (P