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Jin Y, Zhai T, Wang Y, Li J, Wang T, Huang J. Recent advances in liquid chromatography-tandem mass spectrometry for the detection of thyroid hormones and thyroglobulin in clinical samples: A review. J Sep Sci 2024; 47:e2400466. [PMID: 39294846 DOI: 10.1002/jssc.202400466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 08/21/2024] [Accepted: 08/24/2024] [Indexed: 09/21/2024]
Abstract
Thyroid hormones (THs), including triiodothyronine (T3), thyroxine (T4), and their metabolites, are essential for regulating development, growth, and energy metabolism. Thyroglobulin (Tg) produced by thyroid follicular cells acts as an essential substrate for TH synthesis. The combination of THs with Tg is a widely used serological laboratory test for thyroid function assessment. Early detection and timely intervention are significant for preventing and managing thyroid disease. In recent years, liquid chromatography-tandem mass spectrometry (LC-MS/MS) has emerged as a powerful tool for the precise detection of small molecular analytes and steroid hormones in clinical practice as a result of its high sensitivity and specificity. While LC-MS/MS has been increasingly used for detecting THs and Tg recently, its application in clinical practice is still in its early stages. Recent advances in the assessment of thyroid metabolism using LC-MS/MS in clinical samples published during 2004-2023 were reviewed, with a special focus on the use of this technique for quantifying molecules involved in thyroid diseases.
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Affiliation(s)
- Yuting Jin
- Department of Laboratory Medicine, The First Hospital of Jilin University, Changchun, China
| | - Taiyu Zhai
- Department of Laboratory Medicine, The First Hospital of Jilin University, Changchun, China
| | - Ying Wang
- Department of Laboratory Medicine, The First Hospital of Jilin University, Changchun, China
| | - Jiuyan Li
- Department of Laboratory Medicine, The First Hospital of Jilin University, Changchun, China
| | - Tingting Wang
- Department of Laboratory Medicine, The First Hospital of Jilin University, Changchun, China
| | - Jing Huang
- Department of Laboratory Medicine, The First Hospital of Jilin University, Changchun, China
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Anderson H, Lim KH, Gull S, Oprean R, Spence K, Cvasciuc T. Predicting clinical outcomes of patients with serum thyroglobulin antibodies after thyroidectomy for differentiated thyroid cancer: a retrospective study from a UK regional center. Minerva Endocrinol (Torino) 2024; 49:60-68. [PMID: 37428110 DOI: 10.23736/s2724-6507.23.03939-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
BACKGROUND Twenty-twenty-five percent of patients with differentiated thyroid cancer (DTC) can have elevated thyroglobulin antibodies (TgAb). The study aimed to find any prognostic significance of elevated TgAb during follow-up. METHODS Ten-year retrospective study from a tertiary center including 79 patients with raised TgAb after total/staged thyroidectomy for DTC. We identified patients with stable (7.6%), increasing (15%) and decreasing levels of TgAb (77.2%); groups 1, 2 and 3 respectively. During follow-up we analyzed TgAb in subcategories by TgAb trend (>50% rise, <50% rise, >50% decline, <50% decline, positive to negative/normalization, negative to positive and stable levels), gender, age, surgery, autoimmune disease, histology, RAI uptake, distant metastases, and recurrence. RESULTS The incidence of raised TgAb levels was 33.2%, with female predominance. No connection was identified regarding other parameters. 11.4% had distant metastases. The highest mean maximum levels of TgAb was in group 2 (1918.75 IU/mL) and the lowest in group 3 (412.70 IU/mL). The recurrence rate changed significantly between the 3 groups: 50% in group 1, 75% in group 2, and 25% in group 3 (P=0.002). Recurrence rates decreased to 15% in the subcategory where TgAb became negative/normal from positive (P=0.0001). In patients with a negative to positive TgAb level trend or >50% rise, recurrence rates were 100% (P=0.041) and 70% (P=0.012) respectively. CONCLUSIONS Patients with increasing TgAb levels during follow-up have a higher rate of recurrence, distinctly for those with negative to positive trend and >50% rise in TgAb. These patients need closer follow-up, and TgAb may be used as a dynamic follow-up marker.
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Affiliation(s)
- Hannah Anderson
- Department of Endocrine Surgery, Royal Victoria Hospital, Belfast, UK -
| | - Kah H Lim
- Department of Endocrine Surgery, Royal Victoria Hospital, Belfast, UK
| | - Sadaf Gull
- Department of Endocrine Surgery, Royal Victoria Hospital, Belfast, UK
| | - Raluca Oprean
- Department of Endocrinology, Royal Victoria Hospital, Belfast, UK
| | - Kirsty Spence
- Endocrine Laboratory, Royal Victoria Hospital, Belfast, UK
| | - Titus Cvasciuc
- Department of Endocrine Surgery, Royal Victoria Hospital, Belfast, UK
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Ni J, Long Y, Zhang L, Yang Q, Kou C, Li S, Li J, Zhang H. High prevalence of thyroid hormone autoantibody and low rate of thyroid hormone detection interference. J Clin Lab Anal 2021; 36:e24124. [PMID: 34850456 PMCID: PMC8761400 DOI: 10.1002/jcla.24124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/03/2021] [Accepted: 11/07/2021] [Indexed: 12/13/2022] Open
Abstract
Objective Thyroid hormone autoantibody (THAb) is a common antibody in autoimmune disease and can interfere with the detection of thyroid hormone (TH). There was no research reporting the prevalence of THAb in Chinese and the rate of THAb interfering with TH detection. Methods We collected 114 patients with autoimmune thyroid disease (AITD) (Hashimoto's thyroiditis, 57 cases; Graves’ disease, 57 cases), 106 patients with nonthyroid autoimmune diseases (NTAID), and 120 healthy subjects. According to the presence or absence of thyroid antibodies, patients with NTAID were divided into two groups: NTAID‐AITD and NTAID groups. Radioimmunoprecipitation technique was used to detect THAb in all subjects. TH was detected on Abbot and Roche platforms in patients with positive THAb. Results The prevalence of THAb was 22.8% in Hashimoto's thyroiditis and 45.6% in Graves’ disease. The prevalence of THAb in AITD group was lower than that in NTAID or NTAID‐AITD groups (34.2% vs. 61.5%, p = 0.014; 34.2% vs. 71.3%, p < 0.01). Among total 98 patients with positive THAb, TH levels of 9 patients were falsely elevated (9.18%). Conclusion The prevalence of THAb in AITD patients was lower than that in NTAID patients. Although THAb had a high frequency in various autoimmune diseases, the prevalence of THAb interfering with TH detection was only 9.18%.
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Affiliation(s)
- Jiajia Ni
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yu Long
- Department of Endocrinology, People's Hospital of Xiangxi Tujia and Miao Autonomous Prefecture, Xiangxi, Hunan, China
| | - Li Zhang
- Department of Vascular Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong, China
| | - Qingqing Yang
- Department of Endocrinology, The first affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Chunjia Kou
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Shuqi Li
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jingyi Li
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Haiqing Zhang
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Benvenga S, Vita R, Di Bari F, Lo Re C, Scilipoti A, Giorgianni G, Grasso L, Galletti MR, Mandolfino MG, Le Donne M. Assessment of serum thyroid hormone autoantibodies in the first trimester of gestation as predictors of postpartum thyroiditis. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2019; 18:100201. [PMID: 31428563 PMCID: PMC6693681 DOI: 10.1016/j.jcte.2019.100201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/22/2019] [Accepted: 07/22/2019] [Indexed: 11/29/2022]
Abstract
Background Measurement of serum thyroperoxidase autoantibodies (TPOAb) during gestation as a classical marker for the risk of postpartum thyroiditis (PPT) predicts PPT in 1/3 to 1/2 of women. Very few studies have measured serum thyroid hormone Ab (THAb) during gestation, and none as a possible marker for PPT. Methods In 412 women who were followed up from 7 to 11 weeks of gestation through 12 months after delivery, we measured THAb (T3.IgM, T3.IgG, T4.IgM, T4.IgG), thyroglobulin autoantibodies (TgAb) and TPOAb at study entry (7–11 week of gestation). Results Sixty-three women (15.3%) developed PPT, which progressed to permanent hypothyroidism (PH) in 34/63 (54%). THAb+ve were 21/412 women (5.1%), the frequency being greater in those who then developed PPT (12/63 [19.0%] vs. 9/349 [2.6%], P = 4.6 × 10−8), and in the PH subgroup (26.5% [9/34] vs. 10.3% [10/29], P = 0.12). THAb positivity occurred in 9/76 women (11.8%) who were TgAb and/or TPOAb+ve compared to 12/336 women who were TgAb and TPOAb negative (3.6%, P = 0.0031). Of these 9 THAb+ve, TgAb and/or TPOAb+ve women, all (100%) developed PPT compared to 3/11 (27.3%, P = 0.0011) THAb+ve, TgAb and/or TPOAb negative women. Of these 9 and 3 PPT women, 8 and 1 progressed to PH (88.9% and 33.3%, respectively, P = 0.12). Conclusions Gestational positivity of THAb enhance enormously the predictivity for PPT of gestational positivity of TPOAb/TgAb. However, their low frequency (5.1%) and their sensitivity (17.5% [21/63]) go against their application in lieu of TPOAb/TgAb.
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Key Words
- DM-1, type 1 diabetes mellitus
- FNAB, fine-needle aspiration biopsy
- FT3, free triiodothyronine
- FT4, free thyroxine
- GD, Graves’ disease
- HT, Hashimoto’s thyroiditis
- L-T4, Levothyroxine
- PH, permanent hypothyroidism
- PPT, Postpartum thyroiditis
- Postpartum
- Postpartum thyroiditis
- Pregnancy
- THAb, thyroid hormone autoantibodies
- TPOAb, thyroperoxidase autoantibodies
- TSH, thyrotropin
- Tg, thyroglobulin
- TgAb, thyroglobulin autoantibodies
- Thyroid autoimmunity
- Thyroid hormone autoantibodies
- US, ultrasound
- UST, ultrasonography signs suggestive of thyroiditis
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Affiliation(s)
- Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Italy.,Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina, Italy.,Interdepartmental Program on Molecular & Clinical Endocrinology, and Women's Endocrine Health, University Hospital, A.O.U. Policlinico G. Martino, 98125 Messina, Italy
| | - Roberto Vita
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Flavia Di Bari
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Carmela Lo Re
- Division of Obstetrics and Gynecology, University Hospital G. Martino, 98125 Messina, Italy
| | - Angela Scilipoti
- Division of Obstetrics and Gynecology, University Hospital G. Martino, 98125 Messina, Italy
| | - Grazia Giorgianni
- Service of Immunometry and Laboratory Diagnosis, University Hospital G. Martino, 98125 Messina, Italy
| | - Loredana Grasso
- Service of Immunometry and Laboratory Diagnosis, University Hospital G. Martino, 98125 Messina, Italy
| | | | | | - Maria Le Donne
- Division of Obstetrics and Gynecology, University Hospital G. Martino, 98125 Messina, Italy.,Department of Human Pathology Gaetano Barresi, University of Messina, Italy
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Cheng X, Yu S, Jin C, Han S, Hu Y, Zhang K, Liu H, Qiu L. Comparison of three different assays for measuring thyroglobulin and thyroglobulin antibodies in patients with chronic lymphocytic thyroiditis. Clin Biochem 2017; 50:1183-1187. [DOI: 10.1016/j.clinbiochem.2017.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/27/2017] [Accepted: 08/08/2017] [Indexed: 11/30/2022]
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Vita R, Santaguida MG, Virili C, Segni M, Galletti M, Mandolfino M, Di Bari F, Centanni M, Benvenga S. Serum Thyroid Hormone Antibodies Are Frequent in Patients with Polyglandular Autoimmune Syndrome Type 3, Particularly in Those Who Require Thyroxine Treatment. Front Endocrinol (Lausanne) 2017; 8:212. [PMID: 28894436 PMCID: PMC5581384 DOI: 10.3389/fendo.2017.00212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/09/2017] [Indexed: 11/30/2022] Open
Abstract
Polyglandular autoimmune syndrome (PAS) type 3 consists of autoimmune thyroid disease (AITD) coexisting with ≥1 non-thyroidal autoimmune disease (NTAID) other than Addison's disease and hypoparathyroidism. We evaluated the prevalence and repertoire of thyroid hormones antibodies (THAb) in PAS-3 patients. Using a radioimmunoprecipation technique, we measured THAb (T3IgM, T3IgG, T4IgM, and T4IgG) in 107 PAS-3 patients and 88 controls (patients with AITD without any NTAID). Based on the selective coexistence of AITD with one NTAID (chronic autoimmune gastritis, non-segmental vitiligo or celiac disease), patients were divided into group 1 (chronic autoimmune gastritis positive, n = 64), group 2 (non-segmental vitiligo positive, n = 24), and group 3 (celiac disease positive, n = 15). At least one of the four THAb was detected in 45 PAS-3 patients (42.1%) and 28 controls (31.8%, P = 0.14), with similar rates in the three PAS-3 groups. The rates of T3Ab, T4Ab, and T3 + T4Ab were similar in groups 1 and 2, while in group 3, T3Ab was undetected (P = 0.02). In PAS-3 patients, the rate of levothyroxine treatment was greater in THAb-positive patients compared to THAb-negative patients (76.7 vs. 56.1%, P = 0.03, RR = 1.4, 95% CI 1.03-1.81). Not unexpectedly, levothyroxine daily dose was significantly higher in group 1 and group 3, namely in patients with gastrointestinal disorders, compared to group 2 (1.9 ± 0.4 and 1.8 ± 0.3 vs. 1.5 ± 0.2 μg/kg body weight, P = 0.0005 and P = 0.004). Almost half of PAS-3 patients have THAb, whose repertoire is similar if chronic autoimmune gastritis or celiac disease is present. A prospective study would confirm whether THAb positivity predicts greater likelihood of requiring levothyroxine treatment.
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Affiliation(s)
- Roberto Vita
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria Giulia Santaguida
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Camilla Virili
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Maria Segni
- Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, Rome, Italy
| | - Marina Galletti
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Mattia Mandolfino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Flavia Di Bari
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Marco Centanni
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Endocrinology Unit, AUSL Latina, Latina, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Master Program on Childhood, Adolescent and Women’s Endocrine Health, University of Messina, Messina, Italy
- Interdepartmental Program of Molecular & Clinical Endocrinology, and Women’s Endocrine Health, University Hospital Policlinico Universitario G. Martino, Messina, Italy
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Mondello P, Mian M, Pitini V, Cuzzocrea S, Sindoni A, Galletti M, Mandolfino M, Santoro D, Mondello S, Aloisi C, Altavilla G, Benvenga S. Thyroid hormone autoantibodies: are they a better marker to detect early thyroid damage in patients with hematologic cancers receiving tyrosine kinase inhibitor or immunoregulatory drug treatments? Curr Oncol 2016; 23:e165-70. [PMID: 27330353 PMCID: PMC4900836 DOI: 10.3747/co.23.3026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Unlike cytotoxic agents, novel antineoplastic drugs can variably affect thyroid function and so impair patient outcomes. However, the widely used standard thyroid tests have demonstrated low sensitivity for detecting early thyroid damage that leads to dysfunction of the gland. To find a more reliable thyroid marker, we assessed the presence of antibodies binding thyroid hormones (thAbs) in a cancer population undergoing potentially thyrotoxic treatment. METHODS From April 2010 to September 2013, 82 patients with hematologic malignancies treated with tyrosine kinase inhibitors or immunoregulatory drugs were recruited. Healthy volunteers (n = 104) served as control subjects. Thyroid function, autoimmunity tests, thAbs, and thyroid sonography were assessed once during treatment. RESULTS Overall, thAb positivity was recorded in 13% of the entire cohort. In most cases, the thAbs were of a single type, with a predominance of T3 immunoglobulin G. More specifically, thAbs were detected in 11 cancer patients; and abnormal levels of thyroid-stimulating hormone, thyroglobulin antibody, and thyroperoxidase antibody were detected in 6 (p = 0.05), 0 (p = 0.0006), and 2 cancer patients (p = 0.001) respectively. Ultrasonographic alterations of the thyroid were observed in 12 cancer patients. In contrast, of the 104 healthy control subjects, only 1 was positive for thAbs (1%). CONCLUSIONS We have demonstrated for the first time that thAbs are a reliable marker of early thyroid dysfunction when compared with the widely used standard thyroid tests. A confirmatory prospective trial aiming at evaluating thAbs at various time points during treatment could clarify the incidence and timing of antibody appearance.
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Affiliation(s)
- P. Mondello
- Department of Human Pathology, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, U.S.A
| | - M. Mian
- Department of Hematology and CBMT, Hospital of Bolzano, Bolzano, Italy
| | - V. Pitini
- Department of Human Pathology, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - S. Cuzzocrea
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - A. Sindoni
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - M. Galletti
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - M. Mandolfino
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - D. Santoro
- Department of Internal Medicine, University of Messina, Messina, Italy
| | - S. Mondello
- Department of Neurosciences, University of Messina, Messina, Italy
| | - C. Aloisi
- Department of Internal Medicine, University of Messina, Messina, Italy
| | - G. Altavilla
- Department of Human Pathology, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - S. Benvenga
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Grani G, Carbotta G, Nesca A, D'Alessandri M, Vitale M, Del Sordo M, Fumarola A. A comprehensive score to diagnose Hashimoto's thyroiditis: a proposal. Endocrine 2015; 49:361-5. [PMID: 25280964 DOI: 10.1007/s12020-014-0441-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 09/26/2014] [Indexed: 12/18/2022]
Abstract
The heterogeneity of diagnostic criteria of Hashimoto's thyroiditis leads to overdiagnosis and prevents strong conclusions from being drawn in clinical studies. The aim of this study is to propose a comprehensive scoring system. A case-control study compared a set of presurgical features of patients with lymphocytic infiltration of the thyroid (Hashimoto's thyroiditis) and controls, in order to design a multi-criteria scoring system. Given a dichotomous outcome (lymphocytic infiltration of the thyroid), a set of covariates was analyzed in 180 patients after total thyroidectomy. A different validation cohort of 1,171 patients was reviewed and classified according to the score. Variables associated with the diagnosis of Hashimoto's thyroiditis were first assessed by univariate analysis. Analysis showed that TPOAb (area under the ROC curve (AUC), 0.67; 95 % CI 0.57-0.77) and TgAb (0.63; 95 % CI 0.54-0.74) were univariate predictors of the diagnosis of HT, which is largely recognized. Combined covariates were then tested using stepwise logistic regression analysis. The final regression model included TPOAb, TgAb, and thyroid vascularity (AUC 0.72; 95 % CI 0.62-0.81). A scoring system was developed, which has a sensitivity of 45.5 % and a specificity of 89.0 %, with a cutoff of 1.7. The likelihood of incident hypothyroidism was higher (OR 2.30; p = 0.004) in the positive (≥1.7) score group. A scoring system has a better performance than any single predictor and is able to identify the subgroup of individuals at higher risk to develop subsequent hypothyroidism.
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Affiliation(s)
- Giorgio Grani
- Department of Experimental Medicine, Sapienza University of Rome, V.le Regina Elena, 324 00161, Rome, Italy
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Spencer C, LoPresti J, Fatemi S. How sensitive (second-generation) thyroglobulin measurement is changing paradigms for monitoring patients with differentiated thyroid cancer, in the absence or presence of thyroglobulin autoantibodies. Curr Opin Endocrinol Diabetes Obes 2014; 21:394-404. [PMID: 25122493 PMCID: PMC4154792 DOI: 10.1097/med.0000000000000092] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW To discuss new insights regarding how sensitive (second-generation) thyroglobulin immunometric assays (TgIMAs), (functional sensitivities ≤0.10 μg/L) necessitate different approaches for postoperative thyroglobulin monitoring of patients with differentiated thyroid cancer (DTC), depending on the presence of thyroglobulin autoantibodies (TgAbs). RECENT FINDINGS Reliable low-range serum thyroglobulin measurement has both enhanced clinical utility and economic advantages, provided TgAb is absent (∼75% DTC patients). Basal [nonthyroid-stimulating hormone (TSH) stimulated] TgIMA measurement obviates the need for recombinant human TSH stimulation because basal TgIMA below 0.20 μg/L has comparable negative predictive value (>95%) to recombinant human TSH-stimulated thyroglobulin values below the cutoff of 2 μg/L. Now that radioiodine remnant ablation is no longer considered necessary to treat low-risk DTC, the trend and doubling time of low basal thyroglobulin values arising from postsurgical thyroid remnants have recognized prognostic significance. The major limitation of TgIMA testing is interference by TgAb (∼25% DTC patients), causing TgIMA underestimation that can mask disease. When TgAb is present, the trend in TgAb concentrations (measured by the same method) can serve as the primary (surrogate) tumor-marker and be augmented by thyroglobulin measured by a TgAb-resistant class of method (radioimmunoassay or liquid chromatography-tandem mass spectrometry). SUMMARY The growing use of TgIMA measurement is changing paradigms for postoperative DTC monitoring. When TgAb is absent, it is optimal to monitor the basal TgIMA trend and doubling time (using the same method) in preference to recombinant human TSH-stimulated thyroglobulin testing. When TgAb is present, interference renders TgIMA testing unreliable and the trend in serum TgAb concentrations per se (same method) can serve as a (surrogate) tumor-marker.
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Affiliation(s)
- Carole Spencer
- University of Southern California, Los Angeles, California, USA
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10
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Colucci R, Lotti F, Dragoni F, Arunachalam M, Lotti T, Benvenga S, Moretti S. High prevalence of circulating autoantibodies against thyroid hormones in vitiligo and correlation with clinical and historical parameters of patients. Br J Dermatol 2014; 171:786-98. [PMID: 25059078 DOI: 10.1111/bjd.13286] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Autoantibodies against thyroid hormones (THAbs) directed towards triiodothyronine (T3-Ab) and/or thyroxine (T4-Ab) are very rare in the general population. They are increased in some nonthyroidal autoimmune diseases, where they seem to predict autoimmune thyroid disorders (ATDs). So far, their presence in patients with vitiligo has not been evaluated, but it might have a possible predictive role. OBJECTIVES To assess the prevalence of THAbs in a group of vitiligo patients and to correlate their presence with clinical and historical parameters. METHODS In total 79 patients with nonsegmental vitiligo and 100 controls were examined. Clinical characteristics of vitiligo and family and personal medical history were evaluated. Antinuclear autoantibodies, thyroid hormones and thyroid autoantibodies were measured. IgM T3-Ab, IgG T3-Ab, IgM T4-Ab and IgG T4-Ab were assayed by a radioimmunoprecipitation technique. Fisher's test, Student's t-test and χ(2)-test were used for statistical analysis. RESULTS Overall 77 of 79 patients (97%) had at least one type of THAb (11 T3-Ab, 10 T4-Ab, 56 both). In the control group, only one person (1%) had THAbs. In patients with vitiligo, T3-Abs were significantly associated with leucotrichia (IgM+IgG, P = 0.033; IgG, P = 0.039; IgM, P = 0.005) and thyroglobulin autoantibodies (IgM+IgG, P = 0.031; IgG, P = 0.058), while the absence of T3-Ab was related to personal history of cancer (IgM+IgG, P = 0.021; IgG, P = 0.039). T4-Abs were significantly associated with vitiligo activity (IgM+IgG, P < 0.001; IgM, P = 0.037) and duration (IgG, P = 0.013). CONCLUSIONS The surprisingly high prevalence of THAb in patients with vitiligo and their associations suggest a possible pathogenetic role in the disease and stress the tight link between vitiligo and ATDs. Further evaluation in a larger group of patients and an adequate follow-up are needed to define their potential predictive role.
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Affiliation(s)
- R Colucci
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
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Loh TP, Leong SM, Loke KY, Deepak DS. Spuriously elevated free thyroxine associated with autoantibodies, a result of laboratory methodology: case report and literature review. Endocr Pract 2014; 20:e134-9. [PMID: 24641934 DOI: 10.4158/ep14059.cr] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We describe a case of spurious hyperthyroxinemia secondary to thyroid hormone autoantibodies (THAAbs) in a clinically euthyroid patient with Turner mosaic syndrome. METHODS Several commonly available laboratory-based approaches were used, which indicated a disproportionate elevation of free thyroxine (T4) and ultimately led to the diagnosis of THAAbs. A literature review was undertaken to examine the clinical and laboratory associations of THAAbs. RESULTS The free T4 result of the patient was highly discrepant when measured using an Advia Centaur platform (5.89 ng/dL) as compared with the Vitros 5600 and DxI 800 platforms (1.03 and 0.74 ng/dL, respectively). Polyethylene glycol precipitation of the patient's sample showed reduced free T4 recovery (26%), suggesting the presence of a high-molecular-weight interfering substance. Rheumatoid factor and heterophile blocking tube studies were negative. These results suggested a presumptive diagnosis of THAAbs. Direct detection of THAAbs using a radiobinding method confirmed the diagnosis. A review of the literature showed that THAAbs are prevalent among patients with (autoimmune and nonautoimmune) thyroid disorders and nonthyroid autoimmune disorders but rarely cause spurious measurements. Possible pathogenesis includes molecular mimicry, exposure of the antigenic surfaces of iodinated thyroglobulin molecules to B lymphocytes in injurious or inflammatory conditions involving the thyroid gland. Free thyroid hormone methods using one-step analog and labeled antibody designs are prone to falsely high measurements, whereas two-step analog designs may produce spuriously low results. CONCLUSION THAAbs are an underrecognized cause of laboratory interference that is best approached by joint clinical-laboratory efforts. The routine laboratory techniques described above can suggest preliminary diagnosis of this rare entity.
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Affiliation(s)
- Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Sai Mun Leong
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Kah Yin Loke
- Department of Pediatric Medicine, National University Hospital, Singapore
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Verburg FA, Luster M, Cupini C, Chiovato L, Duntas L, Elisei R, Feldt-Rasmussen U, Rimmele H, Seregni E, Smit JWA, Theimer C, Giovanella L. Implications of thyroglobulin antibody positivity in patients with differentiated thyroid cancer: a clinical position statement. Thyroid 2013; 23:1211-25. [PMID: 23692026 DOI: 10.1089/thy.2012.0606] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Even though the presence of antithyroglobulin antibodies (TgAbs) represents a significant problem in the follow-up of patients with differentiated thyroid cancer (DTC), the current guidelines on the management of DTC that have been published in recent years contain no text concerning the methods to be used for detecting such antibody-related interference in thyroglobulin (Tg) measurement or how to manage TgAb-positive patients in whom Tg cannot be used reliably as a tumor marker. AIM An international group of experts from the European Thyroid Association Cancer Research Network who are involved in the care of DTC patients met twice to form a consensus opinion on how to proceed with treatment and follow-up in TgAb-positive DTC patients based on the available evidence in the literature. Here we will report on the consensus opinions that were reached regarding technical and clinical issues. RESULTS This clinical opinion article provides an overview of the available evidence and the resulting consensus recommendations. The current literature does not provide sufficient data for giving evidence-based answers to many questions arising in the care of TgAb-positive DTC patients. Where insufficient evidence was available, a thorough discussion by a group of physician-scientists, all of whom have a distinguished track record in thyroid cancer care, was held to arrive at a consensus expert opinion. The questions and answers discussed were then summarized into an algorithm for the management of TgAb-positive patients. CONCLUSION We were able to define 26 consensus expert recommendations and a resulting algorithm for the care of TgAb-positive DTC patients.
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Affiliation(s)
- Frederik A Verburg
- 1 Department of Nuclear Medicine, University Hospital Aachen , Aachen, Germany
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Abstract
Measuring Thyroglobulin Concentrations in Patients with Differentiated Thyroid CarcinomaThyroid carcinomas are the most common malignant endocrine tumors. Thyroglobulin (Tg), a specific thyroid protein, is the most important tumor marker in thyroid oncology. After total thyroidectomy or radioiodine therapy, detectable or increasing serum Tg levels in patients with differentiated thyroid carcinoma indicate persistence of active thyroid tissue or cancer recurrence. Serum Tg concentration primarily reflects three variables: the mass of differentiated thyroid tissue present; the degree of thyrotropin receptor stimulation and the intrinsic ability of the tumor to synthesize and secrete Tg. Measurement of serum Tg by current immunometric (IMA) and radioimmunological (RIA) assays encounters some methodological problems which can diminish its clinical importance. Discrepancy between the results for Tg using different methods may be caused by: different reference materials, specific properties of the primary and secondary antibodies for antigenic determinants on Tg and diverse binding affinities of these epitopes, together with interference by serum factors (usually antibodies to Tg (TgAb)) with the primary and secondary Tg antibodies from the diagnostic set. In the presence of endogenous TgAb, Tg values measured by immunoradiometric assay (IRMA) and similar assays are usually lower than the real concentrations, while in RIA apparently lower or higher results can be obtained. Falsely low values may lead to delay in necessary treatment, while an inappropriately high Tg value can cause patient anxiety and unnecessary scans. Despite current methodological limitations, serum Tg measurement is a useful test for determining worsening disease and monitoring the effects of therapy in patients who have undergone surgery for differentiated thyroid carcinoma.
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Stanojević M, Savin S, Cvejić D, Đukić A, Živančević Simonović S. Correlation of Thyroglobulin Concentrations Measured by Radioimmunoassay and Immunoradiometric Assay and the Influence of Thyroglobulin Antibody. J Immunoassay Immunochem 2009; 30:197-207. [DOI: 10.1080/15321810902782897] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Spencer CA, Lopresti JS. Measuring thyroglobulin and thyroglobulin autoantibody in patients with differentiated thyroid cancer. ACTA ACUST UNITED AC 2008; 4:223-33. [PMID: 18268520 DOI: 10.1038/ncpendmet0757] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Accepted: 01/02/2008] [Indexed: 11/10/2022]
Abstract
Measurement of serum thyroglobulin is primarily used as a tumor marker in the postoperative management of patients with differentiated thyroid cancer. Unfortunately, the technical quality of current thyroglobulin assay methods varies and influences the clinical utility of this test. Two different methodologic approaches are used to measure serum thyroglobulin: the original competitive radioimmunoassay methodology and noncompetitive immunometric assay methods. Although the newer immunometric assays offer the technical benefits of eliminating the use of isotopes, using smaller specimen volumes, and having higher sensitivity potential, shorter turnaround times and the convenience of automation, immunometric assays also have a higher propensity for interference from both thyroglobulin autoantibodies and heterophilic antibodies, if present in the specimen. It is critical that physicians understand the technical limitations inherent in thyroglobulin measurement in order to effectively use this test for the postoperative management of patients with differentiated thyroid cancers.
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Affiliation(s)
- Carole A Spencer
- University of Southern California, Edmondson Building, Room 111, 1840 North Soto Street, Los Angeles, CA 90032, USA.
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Giovanella L, Ceriani L, Ghelfo A, Maffioli M, Keller F. Preoperative undetectable serum thyroglobulin in differentiated thyroid carcinoma: incidence, causes and management strategy. Clin Endocrinol (Oxf) 2007; 67:547-51. [PMID: 17561976 DOI: 10.1111/j.1365-2265.2007.02922.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND In recent years serum thyroglobulin (Tg) measurement during thyroxine (T4) treatment and/or after stimulation by endogenous TSH or recombinant human TSH (rhTSH) has eclipsed other diagnostic procedures in managing patients with differentiated thyroid cancer (DTC). However, preoperative undetectable Tg was reported in up to 12% of patients affected by DTC and recurrences of DTC with no increase in serum Tg have also been described. Clearly, a negative Tg measurement may falsely reassure both the patient and the clinician in these cases. AIM We retrospectively evaluated the incidence of undetectable or reduced preoperative serum Tg in a group of 436 patients affected by DTC. Additionally, we evaluated the role of Tg retesting by two different immunoassays in patients with low Tg at first measurement. METHODS We retrospectively selected 17 patients with undetectable (i.e. less than functional sensitivity of assay method) or reduced Tg (i.e. between functional sensitivity and minimum normal value) among 436 patients with histologically proved DTC. The remaining 419 patients were used as control cases. Frozen sera from all patients were retested by two different Tg immunoassays. RESULTS Globally, 17 out of 436 (3.8%) patients showed undetectable (n = 5, 1.1%) or reduced (n = 12, 2.7%) preoperative Tg. The Tg level was above the minimum normal value in 3 and 4 out of 5, and 8 and 9 out of 12 of these patients, respectively, when two different immunoassays were employed. On the other hand, undetectable or reduced Tg levels were found in 3.0%-5.1% of control cases when different immunoassays were used. CONCLUSIONS Regardless of the method employed, 3.0-5.1% of patients with DTC showed undetectable or reduced preoperative Tg. This fact must be recognized, as Tg cannot be used as a benchmark for DTC follow-up in these cases. However, Tg retesting with different immunoassays seems to be useful in ruling out these pitfalls in a large majority of patients, and also indicates the most effective assay to be employed in these cases.
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MESH Headings
- Adenocarcinoma, Follicular/blood
- Adenocarcinoma, Follicular/radiotherapy
- Adenocarcinoma, Follicular/surgery
- Adenoma, Oxyphilic/blood
- Adenoma, Oxyphilic/radiotherapy
- Adenoma, Oxyphilic/surgery
- Adult
- Aged
- Biomarkers/blood
- Carcinoma, Papillary/blood
- Carcinoma, Papillary/radiotherapy
- Carcinoma, Papillary/surgery
- Case-Control Studies
- Female
- Follow-Up Studies
- Humans
- Immunoradiometric Assay/methods
- Incidence
- Iodine Radioisotopes/therapeutic use
- Male
- Middle Aged
- Neoplasm Recurrence, Local/blood
- Neoplasm Recurrence, Local/radiotherapy
- Radiopharmaceuticals/therapeutic use
- Retrospective Studies
- Sensitivity and Specificity
- Thyroglobulin/blood
- Thyroid Neoplasms/blood
- Thyroid Neoplasms/radiotherapy
- Thyroid Neoplasms/surgery
- Thyroidectomy
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Affiliation(s)
- Luca Giovanella
- Nuclear Medicine and Thyroid Unit, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
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Görges R, Maniecki M, Jentzen W, Sheu SNY, Mann K, Bockisch A, Janssen OE. Development and clinical impact of thyroglobulin antibodies in patients with differentiated thyroid carcinoma during the first 3 years after thyroidectomy. Eur J Endocrinol 2005; 153:49-55. [PMID: 15994745 DOI: 10.1530/eje.1.01940] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE AND DESIGN Cross-sectional studies have reported an increased prevalence of circulating thyroglobulin autoantibodies (TgAbs) in patients with differentiated thyroid carcinoma (DTC). With the advent of more sensitive assays, a longitudinal study monitoring the development of TgAb levels after ablative therapy was warranted. METHODS One hundred and twelve consecutive patients with follicular cell-derived thyroid cancer were followed for 3 years. All patients had been thyroidectomized and received, on average, two radioiodine therapies. Residual tissue was quantified scintigraphically by 131I 24-h uptake. TgAb and thyroglobulin (Tg) serum levels were determined with a sensitive direct radioligand assay and an IRMA respectively. RESULTS The prevalence of TgAbs at the initial examination was 29% (median 130 U/ml). During follow-up, TgAb levels rose transiently in one-tenth of the patients, but the prevalence of demonstrable TgAbs decreased to < 10% after 3 years. The median serum half-life of TgAbs in treated DTC patients was 10 weeks. At initial examination (when all patients still had residual thyroid tissue and 17 had metastases), rising TgAb levels were correlated with the inability to detect Tg in 4, 30 and 73% of the patients, when initial TgAbs were < 6, 6-50 or > 50 U/ml respectively. While the Tg recovery test was valid for all patients, an in vitro dilution assay with TgAb serum reduced Tg values by up to 32%. CONCLUSIONS The development and course of TgAbs in DTC patients cannot be predicted by initial or residual tumour volume, TgAb or Tg levels. The presence of TgAbs, even in low concentrations, may cause Tg underestimation despite valid recovery tests in DTC patients.
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Affiliation(s)
- R Görges
- Department of Nuclear Medicine, University of Duisburg-Essen, Hufelandstrasse 55, 45 122 Essen, Germany.
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Benvenga S, Trimarchi F. Thyroid hormone autoantibodies in Hashimoto's thyroiditis: often transient but also increasingly frequent. Thyroid 2003; 13:995-6; author reply 996. [PMID: 14611712 DOI: 10.1089/105072503322511436] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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