Clinical Features of Patients with Autoantibody Positive Hashimoto Thyroiditis: A Single- Center Study

Abstract

Objectives: Hashimoto’s thyroiditis is an autoimmune condition in which thyroid cells are damaged by immunological pathways that are both cellular and antibody-mediated. Materials and Methods: The study analyzed data from 192 patients who tested positive for at least one of the anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) values and underwent thyroid ultrasonography during follow-up in an endocrinology outpatient clinic between June 2019 and 2023. The assessment included demographic information, levothyroxine (L-T4) doses, autoimmune diseases and markers, thyroid volume, and nodules Results: The study population was 87.5% female, mean age 48.98±13.45 years and mean follow-up 7.70±4.53 years. The dose of L-T4 administered median value was 50 mcg/day (minimum: 0, maximum: 225). Only 5.2% of patients achieved optimal vitamin D levels (>30 ng/mL), while 42.3% had severe vitamin D deficiency (<10 ng/mL). Additionally, 43.4% were found to have vitamin B12 deficiency. Thyroid ultrasonography revealed heterogeneous thyroid parenchyma in 93.2% of patients and at least one thyroid nodule in 34%. The rate of isolated anti-TPO positivity was 26.6%, while the rate of isolated anti-Tg positivity was 6.3%, and both autoantibodies were positive in 67.2% of patients. We observed a significant correlation between L-T4 doses and anti-TPO levels (r=0.294, p<0.001) as well as thyroid volumes (r=-0.239, p=0.001), but not with anti-Tg levels (r=-0.005, p<0.945). Type 1 diabetes mellitus, rheumatoid arthritis, and Addison’s disease were the most common comorbid autoimmune diseases. The most commonly co-occurring autoimmune markers were anti-nuclear antibodies (40.6%) and tissue transglutaminase IgA (27.3%). Conclusion: Based on the data we obtained, we believe that increasing our awareness of other potential issues that may accompany this patient population in our clinical practice will help us understand how to manage these issues

Keywords

• Hashimoto’s thyroiditis
• autoimmunity
• thyroid antibodies

Otoantikor Pozitif Hashimoto Tiroiditi Hastalarının Klinik Özelliklerinin İncelenmesi: Tek Merkez Deneyimi

Abstract

References

1. 1. Chistiakov DA. Immunogenetics of Hashimoto’s thyroiditis. J Autoimmune Dis. 2005;2:1-21.
2. 2. Mincer DL, Jialal I. Hashimoto thyroiditis. 2017. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
3. 3. Pedersen IB, Knudsen N, Jørgensen T, et al. Thyroid peroxidase and thyroglobulin autoantibodies in a large survey of populations with mild and moderate iodine deficiency. Clin Endocrinol (Oxf). 2003;58:36-42.
4. 4. Ban Y, Greenberg DA, Davies TF, et al. Linkage analysis of thyroid antibody production: evidence for shared susceptibility to clinical autoimmune thyroid disease. J Clin Endocrinol Metab. 2008;93:3589-3596.
5. 5. Weetman A. Cellular immune responses in autoimmune thyroid disease. Clin Endocrinol (Oxf). 2004;61:405-413.
6. 6. Chiovato L, Magri F, Carlé A. Hypothyroidism in context: where we’ve been and where we’re going. Adv Ther. 2019;36(Suppl 2):47-58.
7. 7. Weetman A. An update on the pathogenesis of Hashimoto’s thyroiditis. J Endocrinol Invest. 2021;44:883-890.
8. 8. McLeod DS, Cooper DS. The incidence and prevalence of thyroid autoimmunity. Endocrine. 2012;42:252-265.

9. 9. Akçeşme AB, Merdin FA, Bahçecioğlu AB, et al. Determination of the Frequencies of Various Thyroid Autoantibodies in Autoimmune Thyroid Diseases and Evaluation of Their Relationship with Sonographic Findings: A Single-Center Study. Turk J Endocrinol Metab. 2022;26.
10. 10. Mahmoud R, Azeem KM, Sayed ASA, et al. Role of ultrasound and Doppler findings as a predictor of thyroid hormonal levels in cases of Hashimoto thyroiditis. Beni-Suef Univ J Basic Appl Sci. 2022;11:28.
11. 11. Takashima S, Matsuzuka F, Nagareda T, et al. Thyroid nodules associated with Hashimoto thyroiditis: assessment with US. Radiology. 1992;185:125- 130.
12. 12. Isik S, Gokay F, Ozuguz U, et al. Comparison of the prevalence and sonographic features of thyroid nodules accompanying autoimmune thyroid diseases. Endokrynologia Polska. 2010;61:658-664.
13. 13. Mukasa K, Noh JY, Kunii Y, et al. Prevalence of malignant tumors and adenomatous lesions detected by ultrasonographic screening in patients with autoimmune thyroid diseases. Thyroid. 2011;21:37-41.
14. 14. Stuart J. The Impact of Hashimoto’s Thyroiditis on Thyroid Nodule Cytology & Risk of Thyroid Cancer: Harvard University;2019.
15. 15. Sgarbi JA, Ward LS. A practical contemporary approach to decision-making on subclinical hypothyroidism. Arch Endocrinol Metab 2020;65:32-39.
16. 16. Okuroglu N, Ozdemir A, Sertbas Y, et al. The relationship between thyroid antibody titer and levothyroxine dose in patients with overt primary hypothyroidism. Ann Saudi Med. 2017;37:189-193.
17. 17. Weetman A. Autoimmune thyroiditis: predisposition and pathogenesis. Clinical Endocrinology. 1992;36:307-323.
18. 18. Kasagi K, Kousaka T, Higuchi K, et al. Clinical significance of measurements of antithyroid antibodies in the diagnosis of Hashimoto’s thyroiditis: comparison with histological findings. Thyroid. 1996;6:445-450.
19. 19. Schmidt M, Voell M, Rahlff I, et al. Long-term follow-up of antithyroid peroxidase antibodies in patients with chronic autoimmune thyroiditis (Hashimoto’s thyroiditis) treated with levothyroxine. Thyroid. 2008;18:755- 760.
20. 20. Vieira IH, Rodrigues D, Paiva I. Vitamin D and Autoimmune Thyroid Disease- Cause, Consequence, or a Vicious Cycle? Nutrients. 2020;12:2791.
21. 21. Fang F, Chai Y, Wei H, et al. Vitamin D deficiency is associated with thyroid autoimmunity: results from an epidemiological survey in Tianjin, China. Endocrine. 2021;73:447-454.
22. 22. Tamer G, Arik S, Tamer I, et al. Relative vitamin D insufficiency in Hashimoto’s thyroiditis. Thyroid. 2011;21:891-896.
23. 23. Filipova L, Lazurova Z, Fulop P, et al. Vitamin D insufficiency is not associated with thyroid autoimmunity in Slovak women with Hashimoto’s disease. Bratisl Lek Listy. 2023;124:182-186.
24. 24. Aktaş HŞ. Vitamin B12 and vitamin D levels in patients with autoimmune hypothyroidism and their correlation with anti-thyroid peroxidase antibodies. Med Princ Pract. 2020;29:364-370.
25. 25. Jabbar A, Yawar A, Waseem S, et al. Vitamin B12 deficiency common in primary hypothyroidism. J Pak Med Assoc. 2008;58:258-261. Erratum in: J Pak Med Assoc. 2009;59:126. Wasim, Sabeha [corrected to Waseem, Sabiha].
26. 26. Todorović-Đilas L, Ičin T, Novaković-Paro J, et al. [Autoimmune thyroid disease and other non-endocrine autoimmune diseases]. Med Pregl. 2011;64:183-187.
27. 27. Utiyama S, De Bem R, Skare T, et al. Anti-parietal cell antibodies in patients with autoimmune thyroid diseases. J Endocrinol Invest. 2018;41:523-529.
28. 28. Collins AB, Pawlak R. Prevalence of vitamin B-12 deficiency among patients with thyroid dysfunction. Asia Pac J Clin Nutr. 2016;25:221-226.
29. 29. Boelaert K, Newby PR, Simmonds MJ, et al. Prevalence and relative risk of other autoimmune diseases in subjects with autoimmune thyroid disease. The Am J Med. 2010;123:183.e1-e9.
30. 30. Soy M, Guldiken S, Arikan E, et al. Frequency of rheumatic diseases in patients with autoimmune thyroid disease. Rheumatol Int. 2007;27:575- 577.
31. 31. Omma A, Can Sandıkçı S, Omma T, et al. The prevalence of anti-cyclic citrullinated peptide (anti-CCP) antibodies in patients with thyroid autoimmunity. Ortadogu Tıp Derg. 2016;8:182-185.
32. 32. Harper L, Chin L, Daykin J, et al. Propylthiouracil and carbimazole associated‐antineutrophil cytoplasmic antibodies (ANCA) in patients with Graves’ disease. Clin Endocrinol (Oxf). 2004;60:671-675.
33. 33. Afeltra A, Paggi A, De Rosa FG, et al. Antineutrophil cytoplasmic antibodies in autoimmune thyroid disorders. Endocr Res. 1998;24:185-194.
34. 34. Lionaki S, Hogan SL, Falk RJ, et al. Association between thyroid disease and its treatment with ANCA small-vessel vasculitis: a case–control study. Nephrol Dial Transplant. 2007;22:3508-3015.
35. 35. Riseh SH, Farhang MA, Mobasseri M, et al. The relationship between thyroid hormones, antithyroid antibodies, anti-tissue transglutaminase and antigliadin antibodies in patients with Hashimoto’s thyroiditis. Acta Endocrinol (Buchar). 2017;13:174-179.
36. 36. Sattar N, Lazare F, Kacer M, et al. Celiac disease in children, adolescents, and young adults with autoimmune thyroid disease. J Pediatr. 2011;158:272- 275.e1.
37. 37. Ashok T, Patni N, Fatima M, et al. Celiac disease and autoimmune thyroid disease: the two peas in a pod. Cureus. 2022;14:e26243.
38. 38. Gerenova JB, Manolova IM, Tzoneva VI. Clinical significance of autoantibodies to parietal cells in patients with autoimmune thyroid diseases. Folia Med (Plovdiv). 2013;55:26-32.
39. 39. Checchi S, Montanaro A, Pasqui L, et al. L-thyroxine requirement in patients with autoimmune hypothyroidism and parietal cell antibodies. J Clin Endocrinol Metab. 2008;93:465-469.
40. 40. Valentino R, Savastano S, Maglio M, et al. Markers of potential coeliac disease in patients with Hashimoto’s thyroiditis. Eur J Endocrinol. 2002;146:479-483.
41. 41. Sari S, Yesilkaya E, Egritas O, et al. Prevalence of celiac disease in Turkish children with autoimmune thyroiditis. Dig Dis Sci. 2009;54:830-832.