Serum negative autoimmune thyroiditis displays a milder clinical picture compared with classic Hashimoto's thyroiditis

Rotondi, Mario; Martinis, Luca de; Coperchini, Francesca; Pignatti, Patrizia; Pirali, Barbara; Ghilotti, Stefania; Fonte, R.; Magri, Flavia; Chiovato, Luca

doi:10.1530/eje-14-0147

Cited by 38 publications

(23 citation statements)

References 27 publications

(36 reference statements)

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“…These relevant differences presumably reflect differences in study design (prospective vs retrospective), characteristics of the studied populations, and clinical criteria used to adjust L- In the present study, the positivity of anti-thyroid autoantibodies and, consistently, the autoimmune origin of hypothyroidism resulted statistically significantly associated with the need for L-T 4 adjustment in early pregnancy, indicating that the contribution of the thyroid gland to the maintenance of euthyroidism is further impaired and becomes insufficient during pregnancy. This significant association and the high prevalence (50%) of TAI-negative hypothyroidism in the group of patients who did not need to adjust L-T 4 dosage in early pregnancy indirectly support the thesis of a milder clinical course of TAI-negative hypothyroidism when compared with autoimmune hypothyroidism (22). Finally, it has to be emphasized that only one of the ten studies shown in Table 1 reported data separately for assisted reproductive technology (ART) pregnancies (15), and we cannot exclude that data from other contributions may have been inflated by the inclusion of some IVF pregnancies.…”

Section: Clinical Study a Busnelli And Others Levothyroxine Adjustmenmentioning

confidence: 75%

Levothyroxine dose adjustment in hypothyroid women achieving pregnancy through IVF

Busnelli

Vannucchi

Paffoni

et al. 2015

European Journal of Endocrinology

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Objective: About one out of two women with primary hypothyroidism has to increase the dosage of exogenous levothyroxine (L-T 4 ) during pregnancy. Considering the detrimental impact of IVF on thyroid function, it has been claimed but not demonstrated that L-T 4 dose adjustment may be more significant in hypothyroid women who become pregnant after IVF. Design: Retrospective cohort study. Methods: Hypothyroid-treated women who achieved a live birth through IVF were reviewed. Women could be included if thyroid function was well compensated with L-T 4 before the IVF cycle (i.e., serum TSH !2.5 mIU/l and serum free T 4 within the normal range). Serum TSH and dose adjustment were evaluated at five time points during pregnancy. The trimester ranges for serum TSH considered as reference to adjust L-T 4 therapy were 0.1-2.5 mIU/l for the first trimester, 0.2-3.0 mIU/l for the second trimester, and 0.3-3.0 mIU/l for the third trimester. Results: Thirty-eight women were selected. During the whole pregnancy 32 women (84%; 95% CI: 72-96%) required an increase in the dose of L-T 4 . In most cases (nZ28), this occured within the first 5-7 weeks of gestation (74%, 95% CI: 58-85%). At 5-7 weeks of gestation, the median (interquartile range) increase of L-T 4 dose for the whole cohort was 26% (0-50%). At 30-32 weeks, it was 33% (14-68%). In order to identify predictive factors of dose adjustment, we compared women who did (nZ28) and did not (nZ10) adjust L-T 4 dosage at 5-7 weeks' gestation. Significant differences emerged for thyroid autoimmunity prevalence and for the distribution of hypothyroidism aetiology. Conclusions: The vast majority of hypothyroid-treated women who achieve pregnancy through IVF need an increase in the L-T 4 dose during gestation. This requirement tends to occur very early during gestation.

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Section: Clinical Study a Busnelli And Others Levothyroxine Adjustmenmentioning

confidence: 75%

Levothyroxine dose adjustment in hypothyroid women achieving pregnancy through IVF

Busnelli

Vannucchi

Paffoni

et al. 2015

European Journal of Endocrinology

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“…In the study by Rotondi et al. [25], it was revealed that antibody‐negative HT patients have a milder clinical course, with less overt hypothyroidism, as compared to antibody‐positive patients. Therefore, the poor HRQoL of euthyroid patients with a positive antibody makes it obvious that thyroid antibodies are the markers for the consequent systemic autoimmune disease development with numerous symptoms.…”

Section: Discussionmentioning

confidence: 99%

Autoimmunity affects health‐related quality of life in patients with Hashimoto's thyroiditis

Uysal

Ayhan

2016

The Kaohsiung J of Med Scie

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Hashimoto's thyroiditis (HT) is the most common endocrine disorder leading to hypothyroidism. HT is characterized by the presence of elevated circulating antibodies, especially anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg). In our study, we aimed to reveal the effects of autoimmunity on health-related quality of life of euthyroid HT patients. Patients who were admitted to the Adnan Menderes University Outpatient Clinic were enrolled. The medical records of the patients were surveyed and their demographical data were collected. By using communication data, the patients were invited to our clinic, to inform them about our study and to fill out the health-related quality of life questionnaire. A total of 84 euthyroid HT patients older than 18 years who completed the short form-36 questionnaire, were enrolled. As all patients were euthyroid, there was a significant negative correlation between each domain score and the antibody levels, individually. Patients who had higher anti-TPO and anti-Tg levels had significantly lower quality of life domain scores (p < 0.001). There was statistically no significant correlation between the antibody levels and thyroid function tests (p > 0.05). Additionally, all dimension scores were significantly higher both in the anti-Tg and anti-TPO negative groups, indicating a better quality of life than that in the antibody positive groups. Our study revealed that higher thyroid antibody levels were negatively correlated with life quality scores. Thus, patients who had higher anti-TPO and anti-Tg levels had significantly lower quality of life domain scores. We believe that apart from hypothyroidism, a high antibody level was one of the contributing factors for the development of HT-associated symptoms, leading to a lower quality of life. Other probable contributing factors such as selenium deficiency, thyroid hormone fluctuation, and disease awareness should keep in mind.

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“…If thyroid destruction would mainly be mediated by comple-ment-binding humoral immunity, a clear correlation between TSH and thyroid Abs would be expected, which has not been seen. Additionally, the existence of seronegative AIT patients [36], which are defined as TSH elevation with histologically proven leukocytic infiltration without thyroid Abs appearance, supports this concept. In summary, our data indicate largely elevated levels of TPO-Abs being associated with a moderately increased risk of developing hypothyroidism.…”

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confidence: 75%

Anti-Thyroperoxidase Antibody Levels >500 IU/ml Indicate a Moderately Increased Risk for Developing Hypothyroidism in Autoimmune Thyroiditis

et al. 2016

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Autoimmune Thyroiditis (AIT) is the most common autoimmune disease, which is characterized by cellular and humoral immunity leading to thyroid destruction. The impact of the humoral immunity on the risk to develop hypothyroidism has not exactly been defined yet. The aim of the present study was to investigate the association between thyroid antibody levels and the risk for developing hypothyroidism. In this retrospective study, 335 untreated AIT patients were enrolled. Anti-thyroperoxidase (TPO) antibodies, anti-thyroglobulin (Tg) antibodies (Abs), and the TSH level were measured. Patients with TPO-Ab levels>500 IU/ml showed a moderately increased risk of having elevated TSH levels [p=0.0023; relative risk (95% confidence interval): 1.343 (1.108-1.627)] compared to those below this threshold. AIT patients with TPO- or Tg-Abs<100 IU/ml and between 100-500 IU/ml had no significantly different TSH levels. Presence of Tg-Abs alone or in combination with TPO-Abs did not help to increase the sensitivity to identify patients at risk. Long term follow-up of AIT patients with high TPO-Abs level (>500 IU/ml) showed an increase of TSH levels (mean: 0.5 mIU/l; range: 2.52±2.73 to 3.02±3.05 mIU/l; p=0.0420). Still, these patients remained euthyroid. Our data indicate largely elevated levels of TPO-Abs being associated with a moderately increased risk of developing hypothyroidism.

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Serum negative autoimmune thyroiditis displays a milder clinical picture compared with classic Hashimoto's thyroiditis

Cited by 38 publications

References 27 publications

Levothyroxine dose adjustment in hypothyroid women achieving pregnancy through IVF

Levothyroxine dose adjustment in hypothyroid women achieving pregnancy through IVF

Autoimmunity affects health‐related quality of life in patients with Hashimoto's thyroiditis

Anti-Thyroperoxidase Antibody Levels >500 IU/ml Indicate a Moderately Increased Risk for Developing Hypothyroidism in Autoimmune Thyroiditis

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