Clinical, laboratory and ultrasound heterogeneity of Graves’ disease with coexistence of Antinuclear antibodies

Abstract

Background The most common cause of hyperthyroidism is Graves’ disease (GD), which is caused by stimulating thyroid-stimulating hormone receptor autoantibodies (TRAbs). Many observational studies discussed the heterogeneity of other systemic autoimmune diseases with coexistence of antinuclear antibodies (ANAs), but the relevance between ANA and GD has rarely been reported. Methods This retrospective study was conducted in four medical centers in China. We included 241 patients with GD and correlated their laboratory tests, paraclinical immunological evaluation, ultrasound features, main symptoms, and follow-up outcomes. Results Compared with patients with ANA-negative GD, 44.8% (108) of patients with ANA-positive GD had higher serum IgG, IgA, total cholesterol (TC), FT4, and TRAb levels and lower serum triglyceride (TG) levels, which were correlated with ANA titer. The prevalence of thyroid peroxidase antibody (TPO-Ab), anti-thyroglobulin antibody (TG-Ab), weight loss, and anemia were significantly higher in ANA-positive patients, whereas the incidence of coexisting Graves’ ophthalmopathy (GO) and hypokalemia were significantly higher in the ANA-negative group. Subgroup analysis showed that patients with TG-Ab, TPO-Ab, anemia, and weight loss had a higher proportion of ANA titer. At ultrasound, TRAb levels were correlated with bilateral thyroid volume, thyroid isthmus length, and total thyroid volume. ANA titer was correlated with length, width, thickness, left thyroid volume, and total thyroid volume. The remission rate of the ANA-positive group was significantly lower than that of the ANA-negative group. Conclusion ANAs were frequent in patients with GD. The coexistence of ANAs in patients with GD showed distinct differences in laboratory tests, clinical manifestations, ultrasound features, and ANA-positive patients more easily develop a severe disease course. Our findings indicated the clinically importantance to screen ANAs in patients with GD.