Significance of Prediagnostic Thyroid Antibodies in Women with Autoimmune Thyroid Disease

Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland 21287, USA.
The Journal of Clinical Endocrinology and Metabolism (Impact Factor: 6.21). 06/2011; 96(9):E1466-71. DOI: 10.1210/jc.2011-0228
Source: PubMed


Antibodies to thyroglobulin (Tg), thyroperoxidase (TPO), and TSH receptor (TSH-R) are prevalent in autoimmune thyroid diseases. We aimed to assess whether females with Graves disease or Hashimoto thyroiditis are more likely than age-matched controls to have thyroid antibodies before clinical diagnosis and to measure the timing of antibody seroconversion.
This was a nested case-control study using the Department of Defense Serum Repository and the Defense Medical Surveillance System, 1998-2007. We assessed thyroid antibodies in the serum of 522 female, active-duty, military personnel including: 87 Graves disease cases, 87 Hashimoto thyroiditis cases, and 348 age matched controls. One serum sample was available at the time of the clinical diagnosis (±6 months); three additional samples were retrieved from the repository up to 7 yr before the clinical diagnosis, for a total of 2088 samples.
In Hashimoto thyroiditis, TPO antibodies were found in about 66% of the cases at all time points. Tg antibodies showed a similar stationary trend, at a lower prevalence of about 53%at all time points. No TSH-R antibodies were found. In Graves disease, TPO antibodies gradually increased from 31% at 5-7 yr prior to diagnosis to 57% at diagnosis and Tg antibodies from 18 to 47%. TSH-R antibodies were present before diagnosis and showed an increasing prevalence from 2, 7, 20, to 55%.
Antibodies to Tg, TPO, and TSH-R precede by years the development of the diagnostic autoimmune thyroid diseases phenotype. Overall, the presence of thyroid antibodies in apparently healthy individuals should not be neglected.

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Available from: Monica V Talor, Jul 27, 2015
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    • "Autoimmune thyroid disease, including Graves’ disease and Hashimoto's thyroiditis, is one of the most common immune-mediated conditions.[19] Autoimmune thyroid disease is characterized by the presence of serum antibodies against thyroid-specific or thyroid-restricted antigens like the thyroid stimulating hormone receptor, thyroperoxidase, and thyroglobulin).[20] The prevalence of autoimmune thyroid disease in the general population varies among countries. "
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    • "Studies have also shown that thyroid autoantibodies TgAb and TPOAb are prognostic indicators for long-term risk of hypothyroidism (Li et al., 2008; Vanderpump et al., 1995; Walsh et al., 2010), a disorder of thyroid hormone deficiency more prevalent in women and most commonly caused by autoimmune thyroiditis (NIH, 2011). Most recently, Hutfless et al. (2011) found increased odds for autoimmune thyroid disease associated with TgAb or TPOAb positivity during the 2–7 years preceding diagnosis. The measurement of thyroid stimulating hormone, or thyrotropin, is the most valuable test to diagnose hypothyroidism and subclinical hypothyroidism, or mildly elevated thyrotropin (Baskin, 2006). "
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    • "The relevance of TPO-Ab in this respect was confirmed by a recent case-control study in which thyroid antibodies were measured at four time points: between 7 and 5 years, between 5 and 2 years, between 2 and 0.5 years before and at the time of the clinical diagnosis of Hashimoto's hypothyroidism or Graves' hyperthyroidism [33]. In Hashimoto's thyroiditis, TPO-Ab were found in about 66% of the cases at all time points while in Graves' disease the presence of TPO-Ab gradually increased from 31% at 5–7 years before the diagnosis to 57% at diagnosis. "
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