Significance of Testing Anti-Thyroid Autoantibodies in Patients with Deranged Thyroid Profile

Nutritional interventions in the treatment of Hashimoto’s disease: A systematic review

BACKGROUND

Hashimoto’s thyroiditis (HT) is an autoimmune dysfunction caused by genetic and environmental changes that attack the thyroid gland. HT affects approximately 2% to 5% of the population, being more prevalent in women. It is diagnosed through a blood test (anti-thyroid peroxidase). Pharmacological treatment consists of daily administration of the synthetic hormone levothyroxine on an empty stomach. The most common signs and symptoms are: Tissue resistance to triiodothyronine T3, weight gain, dry skin, hair loss, tiredness/fatigue, and constipation, and nutritional therapy appears to help reduce these symptoms.

AIM

To analyze nutritional interventions for treating HT.

METHODS

This is an integrative review of original studies on nutritional interventions for treating Hashimoto’s disease. Articles were searched in the MEDLINE/PubMed and Latin American and Caribbean Literature on Health Sciences (LILACS) databases via virtual health library, using controlled vocabulary and free terms. A total of 70 articles were found: 67 from PubMed and 3 from LILACS. After exclusions, 9 articles met the eligibility criteria, including dietary interventions for maintaining and restoring the patient’s quality of life.

RESULTS

The reviewed articles evaluated the nutritional treatment of HT through supplementation of deficient micronutrients, anti-inflammatory diets, gluten-free diets, exclusion of foods that cause food sensitivities, lactose-free diet, paleo diet, and calorie restriction diets. However, some results were controversial regarding the beneficial effects of HT.

CONCLUSION

In general, it was observed that nutritional interventions for HT are based on the recovery of micronutrient deficiencies, treatment of the intestinal microbiota, diet rich in foods with anti-inflammatory properties, lifestyle changes, and encouragement of healthy habits.

Determination of the levels and possible associations of alpha2-macroglobulin with autoantibodies in the serum of patients with various forms of autoimmune thyroiditis

Antibodies to thyroid peroxidase (AB-TPO), antibodies to thyroglobulin (AB-TG), and the content of α2-macroglobulin (α2-MG) have been studied in serum samples of patients with autoimmune thyroiditis (AIT). All the patients were divided into 3 groups depending on age: 25-35, 36-50, 51-65 years. We found a significant change in the thyroid panel parameters in AIT, but without significant changes in the average concentration of α2-MG in the age groups of patients. This may be due to the accumulation and retention of complexes of defective forms of α2-MG in the circulation associated with their decreased ability to bind to receptors.

Autoimmune thyroid status in subclinical thyroid disorders in patients attending a tertiary care center in Nepal: a hospital-based cross-sectional study

BACKGROUND

Thyroid dysfunction is the leading endocrine disorder worldwide. Iodine deficiency disorders, which were once the major etiology of thyroid dysfunctions, now have been succeeded by autoimmune thyroid diseases with the rise in aberrant salt ionization protocols. This study endeavors to access the level of thyroid autoantibodies viz. anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (TGA), and anti-thyroid stimulating hormone receptor (TRAb) in individuals with subnormal thyroid profiles.

METHODS

This hospital-based cross-sectional study was conducted at the Department of Clinical Biochemistry, Tribhuvan University for a period of six months. Using non-probability (purposive) sampling method, a total of 60 patients were enrolled with subnormal thyroid profiles to include the population who have not yet started medication. Thyroid hormones (free T3, free T4, TSH) and thyroid antibodies (anti-TPO, TGA, and TRAb) were measured. For non-parametric data, Chi-square test and Kruskal-Wallis test were used. Spearman's correlation was done to determine the association between variables.

RESULTS

Out of 60 participants, the majority of the population between 25 and 44 years were diagnosed with thyroid dysfunction with female preponderance. Among all, 40% (n = 24) had subclinical hyperthyroid states while, 60% (n = 36) had subclinical hypothyroid states, and 75% (n = 45) of the total exhibited positive thyroid antibodies. In subclinical hypothyroid patients with TSH above 10 µIU/ml, anti TPO (58.5%) and TGA (66.7%) positivity were highly prevalent. On the other hand, TRAb was exclusively positive in hyperthyroid condition (50% among the group) which is by far the first of its kind reported in Nepal.

CONCLUSION

The rise in autoimmune thyroid disease among the Nepalese population infers that addressing iodine deficiency simply through salt iodinization may not be adequate to deal with the rising burden of thyroid disorders, especially in iodine-depleted areas. Also, the increasing prevalence of thyroid autoantibodies positivity in subclinical hypothyroidism in the Nepalese population accounts for the arduous screening and monitoring of autoimmune thyroid disorders in Nepal.

Patient genetics shape the autoimmune response in the blistering skin disease pemphigus vulgaris

Background and aim

Pemphigus vulgaris (PV) is known to have one of the strongest HLA associations among autoimmune diseases. DRB1*0402 and DQB1*0503 in particular are significantly overrepresented in PV patients in certain worldwide populations. Yet, there remain significant gaps in our understanding regarding the precise link between PV-associated HLA molecules, the specificity of the autoimmune response, and clinical expression. In this study we assessed correlations between factors including HLA genotype, ethnicity, autoantibody levels, and lesion distribution in a cohort of 293 patients.

Methods and population

Participants were recruited from multiple outpatient dermatology clinic settings and patient support meetings in the USA. On intake, patients provided venous blood samples and answered questionnaires regarding their current disease activity.

Results

Eighty-one percent of patients typed as either DRB1*0402 or DQB1*0503 with a high prevalence of DRB1*0402 in patients of Ashkenazi Jewish or Caucasian (non-Jewish) descent (86% and 42%, respectively) and DQB1*0503 in patients of Southeast Asian descent (78%). Patients typing as HLA DRB1*0402 had higher levels of anti-desmoglein (Dsg)3 antibodies (204.6 +/- 340.5 IU/ml) than patients without DRB1*0402 (138.5 +/- 236.4 IU/ml) (p=0.03) and had mucosal only lesions more often than cutaneous only or mucocutaneous lesions. Patients typing as DQB1*0503 had higher levels of anti-Dsg1 antibodies (47.3 +/- 59.8 IU/ml) compared to other groups (27.8 +/- 43.7 IU/ml) (p=0.06) and higher rates of mucocutaneous disease than other lesion types. We also report an unexpected HLA association of DRB1*0804 in PV patients of African descent. Sixty-four percent of this population carried the DRB1*0804 allele, and presented with highly elevated levels of anti-Dsg3 (p=0.02). However, neither African heritage nor the presence of DRB1*0804 correlated with a predilection to any specific lesion morphology. Patients that carried neither DRB1*0402, nor DQB1*0503 or DRB1*0804 had the lowest levels of anti-Dsg3 antibodies (60.0 +/- 80.0 IU/ml) and the highest rate of solely cutaneous disease compared to carriers of these alleles.

Conclusion

Our data illuminate the broader impact of genetic factors on disease development by showing that differences in HLA expression among patients and ethnicities play a large role in driving distinct patterns of antibody selection and disease phenotype in PV. These findings provide insights regarding clinical heterogeneity, and are relevant to developing improved, patient tailored management strategies.

Desmoglein compensation hypothesis fidelity assessment in Pemphigus

The pemphigus group of autoimmune blistering diseases encompasses pemphigus vulgaris (PV) and pemphigus foliaceus (PF). Lesion location in pemphigus has been elegantly postulated by the Desmoglein Compensation Hypothesis (DCH), which references the distribution of desmoglein (Dsg) proteins in the epidermis along with a patient’s autoantibody profile to describe three different lesion phenotypes: PF is characterized by subcorneal lesions in the presence of anti-Dsg1 antibodies only, while lesions in PV are suprabasilar and accompanied by anti-Dsg3 antibodies only in mucosal PV, or both anti-Dsg3 and anti-Dsg1 in the case of mucocutaneous PV. While the validity of this hypothesis has been supported by several studies and is prominently featured in textbooks of dermatology, a number of logical inconsistencies have been noted and exceptions have been published in several small-scale studies. We sought to comprehensively assess the extent to which patient clinical and autoantibody profiles contradict the DCH, and characterize these contradictions in a large sample size of 266 pemphigus patients. Remarkably, we find that roughly half of active PV and PF patients surveyed present with a combination of lesion morphology and anti-Dsg3/1 levels that contradict the DCH, including: patients with a cutaneous only PV presentation, mucocutaneous disease in the absence of either Dsg3, Dsg1, or both, and mucosal disease in the absence of Dsg3 or presence of Dsg1. We also find stark differences in fidelity to the DCH based on ethnicity and HLA-association, with the lowest proportion of adherence in previously understudied populations. These findings underscore the need to expand our understanding of pemphigus morphology beyond the DCH, in particular for populations that have not been a focus in previous investigation.

Reference intervals for thyroid-stimulating hormone, free thyroxine, free triiodothyronine, and total triiodothyronine in the Lebanese adult population

BACKGROUND

For a better assessment of thyroid function, each laboratory should establish its own reference intervals (RI). In Lebanon, no previous study has been conducted to establish the reference values for thyroid function tests.

METHODS

This cross-sectional study included 301 volunteers aged between 18 and 65 years (65.8% women, 34.2% men), free from any thyroid pathology and any condition that could affect thyroid function tests. The reference intervals of thyroid-stimulating hormone (TSH), free T4 (FT4), free T3 (FT3), and total T3 (TT3) were measured on the Roche Cobas e411 machine. 39 subjects tested positive for thyroid peroxidase antibodies (TPOAb) and/or thyroglobulin antibodies (TGAb), were excluded from the study.

RESULTS

There was an increase in the 2.5^th percentile for the TSH compared to the value provided by the manufacturer (from 0.27 to 0.53 mlU/L) as well as a decrease in the 97.5^th percentile for the FT4, TT3, and FT3 (respectively, from 22 to 19.78 pmol/L for FT4, from 3.1 to 2.71 nmol/L for TT3, and from 6.80 to 6.10 pmol/L for FT3). Higher TT3 and FT3 values were noted in men compared to women (respectively, p = 0.068 and p < 0.0001). An age decrease in FT4 and FT3 was also observed (respectively, p = 0.045 and p < 0.0001).

CONCLUSION

The established RI of thyroid function tests for the Lebanese population were significantly different from the values recommended by the manufacturer (Roche Diagnostics). Changing our RI values will allow a more accurate diagnosis of thyroid dysfunction.

Prevalence of Components of Metabolic Syndrome Among Adults with the Presence of Autoimmune Thyroid Condition in an Iodine-Sufficient Region

The presence of autoimmune thyroid condition could lead to thyroid dysfunction in adults. In addition, thyroid antibody positivity has been suggested to be associated with hyperuricemia, diabetes and obesity in individuals with thyroid autoimmune diseases. Currently, there are limited studies that assessed the relationship of thyroid antibody with the components of metabolic syndrome in adults, especially from iodine-sufficient regions. Therefore, the aim of this study was to determine the prevalence of components of metabolic syndrome in Chinese adults with autoimmune thyroid condition. Medical records of adult inpatients in the Suzhou Ninth People's Hospital, Suzhou, Jiangsu, China, from January 2016 to September 2019 were reviewed and included after screening for eligibility. A total of 1105 participants were included in our final analysis, and of these, 77.5% (n = 856) were females. There was a higher prevalence of thyroid antibodies in females than males (30.6% vs. 23.7%) (p = 0.034). Although there were significant differences in mean TSH, FT3 and FT4 values between participants positive and negative for thyroid antibodies, these values were still within the normal reference range. No differences in the mean BMI, prevalence of diabetes, hyperuricemia, hypertriglyceridemia and hypercholesterolemia between participants positive and negative for thyroid antibodies were reported (p > 0.05). In conclusion, our study reported that participants positive for thyroid antibodies did not appear to be accompanied by abnormal thyroid function, lipid profile, uric acid and glucose concentrations.

Daily intake of yogurt drink fortified either with vitamin D alone or in combination with added calcium causes a thyroid-independent increase of resting metabolic rate in adults with type 2 diabetes: a randomized double blind clinical trial

We investigated the effect of daily intake of yogurt drink fortified with either vitamin D alone or with added calcium on resting metabolic rate (RMR), thyroid hormones and homeostatic model assessment for insulin resistance (HOMA-IR) in subjects with type 2 diabetes (T2D). A total of 75 adult subjects with T2D were randomly assigned to one of the three groups to receive either D-fortified yogurt drink (DY; 1000 IU vitamin D/d), Ca-D-fortified yogurt drink (CDY; 1000 IU vitamin D plus 500 mg calcium), or plain yogurt drink (PY) for 12 weeks. All assessments were done at the baseline and after the intervention. The concentrations of anti-thyroid peroxidase antibody (anti-TPO-Ab), intact parathyroid hormone (iPTH) and thyroid stimulating hormone (TSH) had significant decline compared with baseline values only in CDY group. The mean RMR increased in both DY and CDY groups (p<0.001 for both). Also, changes of serum concentrations of 25(OH)D (B= 2.96, 95%CI= 1.3- 4.6, p=0.001) and iPTH (B= -2.41, 95%CI= -4.5- -0.31, p=0.025) remained significant predictors of RMR changes even after adjustment for changes of serum concentrations of TSH (B= -18.2, 95%CI= -61.7- 25.2, p=0.406). Daily intake of vitamin D together with calcium at physiological doses has attenuating effect on anti-TPO-Ab and TSH. Also, vitamin D with or without added calcium causes a significant thyroid-independent increase in RMR in euthyroid subjects with T2D. Registered at clinicaltrials.gov as NCT01229891. Novelty: Daily intake of vitamin D with calcium at physiological doses has attenuating effect on anti-TPO-Ab and TSH. Vitamin D with or without added calcium causes a thyroid-independent increase in RMR in euthyroid subjects with T2D.

Development of new predictive equations for basal metabolic rate in Iranian healthy adults: negligible effect of sex

Some studies have reported inaccuracy of predicting basal metabolic rate (BMR) by using common equations for Asian people. Thus, this study was undertaken to develop new predictive equations for the Iranian community and also to compare their accuracy with the commonly used formulas. Anthropometric measures and thyroid function were evaluated for 267 healthy subjects (18-60 y). Indirect calorimetry (InCal) was performed only for those participants with normal thyroid function tests (n = 252). Comparison of predicted RMR (both kcal/d and kcal.kg.wt^-1.d^-1) using current predictive formulas and measured RMR revealed that Harris-Benedict and FAO/WHO/UNU significantly over-estimated and Mifflin-St. Jeor significantly under-estimated RMR as compared to InCal measurements. In stepwise regression analysis for developing new equations, the highest r² (=0.89) was from a model comprising sex, height and weight. However, further analyses revealed that unlike the subjects under 30 y, the association between age and the measured RMR in subjects 30 y and plus was negative (r = -0.241, p = 0.001). As a result, two separate equations were developed for these two age groups. Over 80 percent of variations were covered by the new equations. In conclusion, there were statistical significant under- and over-estimation of RMR using common predictive equations in our subjects. Using the new equations, the accuracy of the calculated RMR increased remarkably.

[Thyroid antibodies levels in euthyroid men and women - residents of the Arctic Zone of the Russian Federation.]

The aim of the study was to determine the levels of thyroid antibodies and their relationship with thyroid hormones and thyroglobulin in euthyroid men and women, residents of the Arctic zone of the Russian Federation. A total of 208 apparently healthy people were enrolled in this study and classified into two groups depending on gender and level of autoantibodies in the blood. Serum hormones of the pituitary-thyroid system, thyroglobulin and antibodies concentration was measured by enzyme immunoassay. The prevalence of positive antibodies among various examined groups was determined and the characteristics of euthyroid subjects with abnormal thyroid antibodies levels were studied. Circulating positive thyroid antibodies were found in 20% of the surveyed residents of the Arctic zone of the Russian Federation. The median serum antibodies against thyroid peroxidase (AntiTPO) or thyroglobulin (AntiTG) levels and the percentage of people in general population with positive antibodies (i.e. AntiTPO ≥ 50 IU / ml and / or AntiTG ≥ 100 IU / ml) were statistically significant higher in women than in men, p < 0.01. Such thyroid antibodies levels were associated with a higher thyroid gland functional activity in women, which was demonstrated by significantly higher thyroxin level and lower thyroglobulin value in the peripheral blood. Part of women positive for AntiTPO increased with age from 18 to 33% (in groups aged 18-44 and 45-59 years, p = 0.04). The findings of the study reveal correlation between thyroid function test and thyroid antibodies levels, elaborating the clinical importance of thyroid antibodies in clinical examination and follow-up of patients with autoimmune thyroid disorders.