Significance of Anti-TPO as an Early Predictive Marker in Thyroid Disease

Siriwardhane, Thushani; Krishna, Karthik; Ranganathan, Vinodh; Jayaraman, Vasanth; Wang, Tianhao; Bei, Kang; Ashman, Sarah; Rajasekaran, Karenah; Rajasekaran, John J.; Krishnamurthy, Hari Krishnan

doi:10.1155/2019/1684074

Cited by 40 publications

(37 citation statements)

References 25 publications

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“…Furthermore, our novel observation of incident anti-TPO positivity post-acute COVID-19 suggested potential perturbation of thyroid autoimmunity after COVID-19, and an additional concern for potential incident thyroid dysfunction as the occurrence of anti-TPO can precede thyroid dysfunction. 31 Hence, our data further supported the need for follow-up TFTs.…”

Section: Discussionsupporting

confidence: 74%

Long COVID in Patients With Mild to Moderate Disease: Do Thyroid Function and Autoimmunity Play a Role?

et al. 2021

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Objective Long COVID (LC) is an emerging global health issue. Fatigue is a common feature. Whether thyroid function and autoimmunity play a role is uncertain. We aimed to evaluate the prevalence and predictors of LC and the potential role of thyroid function and autoimmunity in LC. Methods We included consecutive adults without known thyroid disorder, admitted to a major COVID-19 centre for confirmed COVID-19 from July to December 2020 who had thyroid function tests (TFTs) and anti-thyroid antibodies measured on admission and at follow-up. LC was defined by the presence or persistence of symptoms upon follow-up. Results In total, 204 patients (median age: 55.0 years; 46.6% men) were reassessed at a median of 89 days (IQR: 69–99) after acute COVID-19. Forty-one (20.1%) had LC. Female (adjusted odds ratio [aOR] 2.48, p=0.018) and SARS-CoV-2 PCR cycle threshold value <25 on admission (aOR 2.84, p=0.012) independently predicted the occurrence of LC. Upon follow-up, most abnormal TFTs in acute COVID-19 resolved, and incident thyroid dysfunction was rare. Nonetheless, we observed incident anti-TPO (anti-thyroid peroxidase) positivity. While baseline or follow-up TFTs were not associated with the occurrence of LC, among 172 patients symptomatic in acute COVID-19, symptom resolution was more likely in those with positive anti-TPO upon follow-up (p=0.043). Conclusion LC is common among COVID-19 survivors, with female and those with higher viral load in acute COVID-19 particularly vulnerable. The observation of incident anti-TPO positivity warrants further follow-up for thyroid dysfunction. Whether anti-TPO plays a protective role in LC remains to be elucidated.

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Section: Discussionsupporting

confidence: 74%

Long COVID in Patients With Mild to Moderate Disease: Do Thyroid Function and Autoimmunity Play a Role?

et al. 2021

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“…Our findings may add to the existing list of autoantibodies and autoimmune conditions in neurological, hematological, and rheumatological systems occurring after COVID-19 [ 20 ]. As the occurrence of anti-TPO can precede thyroid dysfunction [ 21 ], further follow-up is warranted for potential subsequent thyroid dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Insights from a Prospective Follow-up of Thyroid Function and Autoimmunity among COVID-19 Survivors

et al. 2021

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Background The occurrence of Graves’ disease and Hashimoto thyroiditis after coronavirus disease 2019 (COVID-19) raised concerns that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may trigger thyroid autoimmunity. We aimed to address the current uncertainties regarding incident thyroid dysfunction and autoimmunity among COVID-19 survivors. Methods We included consecutive adult COVID-19 patients without known thyroid disorders, who were admitted to Queen Mary Hospital from July 21 to September 21, 2020 and had serum levels of thyroid-stimulating hormone, free thyroxine, free triiodothyronine (fT3), and anti-thyroid antibodies measured both on admission and at 3 months. Results In total, 122 patients were included. Among 20 patients with abnormal thyroid function tests (TFTs) on admission (mostly low fT3), 15 recovered. Among 102 patients with initial normal TFTs, two had new-onset abnormalities that could represent different phases of thyroiditis. Among 104 patients whose anti-thyroid antibody titers were reassessed, we observed increases in anti-thyroid peroxidase (TPO) ( P <0.001) and anti-thyroglobulin ( P <0.001), but not anti-thyroid stimulating hormone receptor titers ( P =0.486). Of 82 patients with negative anti-TPO findings at baseline, 16 had a significant interval increase in anti-TPO titer by >12 U, and four became anti-TPO-positive. Worse baseline clinical severity ( P =0.018), elevated C-reactive protein during hospitalization ( P =0.033), and higher baseline anti-TPO titer ( P =0.005) were associated with a significant increase in anti-TPO titer. Conclusion Most patients with thyroid dysfunction on admission recovered during convalescence. Abnormal TFTs suggestive of thyroiditis occurred during convalescence, but infrequently. Importantly, our novel observation of an increase in anti-thyroid antibody titers post-COVID-19 warrants further follow-up for incident thyroid dysfunction among COVID-19 survivors.

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“…Moreover, we noted a trend towards more abnormal TFTs upon reassessment in interferon-treated patients, although most of these were not clinically overt. Despite a modest magnitude of anti-TPO titre elevation among patients who developed incident anti-TPO positivity, further follow-up is warranted for potential subsequent thyroid dysfunction as the occurrence of anti-TPO can precede thyroid dysfunction ( 25 ). Hence, our findings would suggest the need for TFT and anti-thyroid antibody monitoring, especially in COVID-19 patients treated with interferon beta-1b.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Interferon Beta-1b Therapy on Thyroid Function and Autoimmunity Among COVID-19 Survivors

Lui

Lee

et al. 2021

Front. Endocrinol.

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BackgroundSome studies have indicated that interferon (IFN) may be valuable in COVID-19. We aimed to evaluate the impact of short-term IFN on incident thyroid dysfunction and autoimmunity among COVID-19 survivors.MethodsWe included consecutive adults without known thyroid disorder admitted to Queen Mary Hospital for COVID-19 from July 2020 to January 2021 who had thyroid function tests (TFTs) and anti-thyroid antibodies measured both on admission and at three months.Results226 patients were included (median age 55.0 years; 49.6% men): 135 were IFN-treated. There tended to be more abnormal TFTs upon reassessment in IFN-treated patients (8.1% vs 2.2%, p=0.080). 179 patients (65.4% IFN-treated) had a complete reassessment of anti-thyroid antibodies. There were significant increases in titres of both anti-thyroid peroxidase antibodies (anti-TPO: baseline 29.21 units [IQR: 14.97 – 67.14] vs reassessment 34.30 units [IQR: 18.82 – 94.65], p<0.001) and anti-thyroglobulin antibodies (anti-Tg: baseline 8.23 units [IQR: 5.40 – 18.44] vs reassessment 9.14 units [IQR: 6.83 – 17.17], p=0.001) in the IFN-treated group but not IFN-naïve group. IFN treatment (standardised beta 0.245, p=0.001) was independently associated with changes in anti-TPO titre. Of the 143 patients negative for anti-TPO at baseline, 8 became anti-TPO positive upon reassessment (seven IFN-treated; one IFN-naïve). Incident anti-TPO positivity was more likely to be associated with abnormal TFTs upon reassessment (phi 0.188, p=0.025).ConclusionIFN for COVID-19 was associated with modest increases in anti-thyroid antibody titres, and a trend of more incident anti-TPO positivity and abnormal TFTs during convalescence. Our findings suggest that clinicians monitor the thyroid function and anti-thyroid antibodies among IFN-treated COVID-19 survivors, and call for further follow-up studies regarding the clinical significance of these changes.

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Significance of Anti-TPO as an Early Predictive Marker in Thyroid Disease

Cited by 40 publications

References 25 publications

Long COVID in Patients With Mild to Moderate Disease: Do Thyroid Function and Autoimmunity Play a Role?

Long COVID in Patients With Mild to Moderate Disease: Do Thyroid Function and Autoimmunity Play a Role?

Insights from a Prospective Follow-up of Thyroid Function and Autoimmunity among COVID-19 Survivors

The Impact of Interferon Beta-1b Therapy on Thyroid Function and Autoimmunity Among COVID-19 Survivors

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