scholarly journals Postpartum Thyroiditis and Autoimmune Thyroiditis in Women of Childbearing Age: Recent Insights and Consequences for Antenatal and Postnatal Care

2001 ◽  
Vol 22 (5) ◽  
pp. 605-630 ◽  
Author(s):  
Alex F. Muller ◽  
Hemmo A. Drexhage ◽  
Arie Berghout
Keyword(s):  
Autoimmune Thyroiditis ◽  
Thyroid Autoimmunity ◽  
Fetal Loss ◽  
First Year ◽  
Thyroid Peroxidase ◽  
Childbearing Age ◽  
Activated T Cells ◽  
Postpartum Thyroiditis ◽  
Autoimmune Thyroid ◽  
Significant Impairment

Abstract Postpartum thyroiditis is a syndrome of transient or permanent thyroid dysfunction occurring in the first year after delivery and based on an autoimmune inflammation of the thyroid. The prevalence ranges from 5–7%. We discuss the role of antibodies (especially thyroid peroxidase antibodies), complement, activated T cells, and apoptosis in the outbreak of postpartum thyroiditis. Postpartum thyroiditis is conceptualized as an acute phase of autoimmune thyroid destruction in the context of an existing and ongoing process of thyroid autosensitization. From pregnancy an enhanced state of immune tolerance ensues. A rebound reaction to this pregnancy-associated immune suppression after delivery explains the aggravation of autoimmune syndromes in the puerperal period, e.g., the occurrence of clinically overt postpartum thyroiditis. Low thyroid reserve due to autoimmune thyroiditis is increasingly recognized as a serious health problem. 1) Thyroid autoimmunity increases the probability of spontaneous fetal loss. 2) Thyroid failure due to autoimmune thyroiditis—often mild and subclinical—can lead to permanent and significant impairment in neuropsychological performance of the offspring. 3) Evidence is emerging that as women age subclinical hypothyroidism—as a sequel of postpartum thyroiditis—predisposes them to cardiovascular disease. Hence, postpartum thyroiditis is no longer considered a mild and transient disorder. Screening is considered.

scholarly journals Increase of Circulating CXCL9 and CXCL11 Associated with Euthyroid or Subclinically Hypothyroid Autoimmune Thyroiditis

2011 ◽  
Vol 96 (6) ◽  
pp. 1859-1863 ◽  
Author(s):  
Alessandro Antonelli ◽  
Silvia Martina Ferrari ◽  
Silvia Frascerra ◽  
Andrea Di Domenicantonio ◽  
Andrea Nicolini ◽  
...  
Keyword(s):  
Linear Regression ◽  
Regression Model ◽  
Multiple Linear Regression ◽  
Autoimmune Thyroiditis ◽  
Linear Regression Model ◽  
Thyroid Autoimmunity ◽  
Thyroid Volume ◽  
Multiple Linear Regression Model ◽  
Thyroid Peroxidase ◽  
Autoimmune Thyroid

Context: Recently, CXCL9 and CXCL11 have been shown to be involved in autoimmune thyroid disorders; however, no data are present about CXCL9 and CXCL11 circulating levels in thyroid autoimmunity. Objective: Our objective was to evaluate circulating CXCL9 and CXCL11 in autoimmune thyroiditis (AIT). Design and Patients or Other Participants: Serum CXCL9 and CXCL11 have been measured in 141 consecutive patients with newly diagnosed AIT (AIT-p), 70 euthyroid controls, and 35 patients with nontoxic multinodular thyroid. The three groups were similar in gender distribution and age; among the AIT-p, 26% had subclinical hypothyroidism. Results: Serum CXCL9 and CXCL11 levels were significantly (P < 0.0001 for both) higher in AIT-p (143 ± 164 and 121 ± 63 pg/ml, respectively) than in controls (68 ± 37 and 65 ± 19 pg/ml, respectively) or patients with multinodular thyroid (87 ± 43 and 71 ± 20 pg/ml, respectively). Among AIT-p, CXCL9 and CXCL11 levels were significantly higher in patients older than 50 yr or those with a hypoechoic ultrasonographic pattern or with hypothyroidism. In a multiple linear regression model including age, thyroid volume, hypoechogenicity, hypervascularity, TSH, anti-thyroglobulin, and anti-thyroid peroxidase, only age and TSH were significantly (P < 0.05) related to serum CXCL9 or CXCL11 levels. In a multiple linear regression model of CXCL9 vs. age, TSH, and CXCL11, TSH (P = 0.032) and CXCL11 (P = 0.001) were significantly and independently related to CXCL9. Conclusions: We first show that circulating CXCL9 and CXCL11 are increased in patients with thyroiditis and hypothyroidism and are related to each other. These results underline the importance of a Th1 immune attack in the initiation of AIT.

scholarly journals Angioedema in a Patient with Autoimmune Thyroiditis – A Case Report

2020 ◽  
Vol 47 (2) ◽  
pp. 34-37
Author(s):  
S. Dermendzhiev ◽  
A. Dzhambov ◽  
T. Dermendzhiev
Keyword(s):  
Autoimmune Thyroiditis ◽  
Hashimoto’S Thyroiditis ◽  
Immunoglobulin E ◽  
Thyroid Autoimmunity ◽  
Hormonal Control ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Peroxidase ◽  
Normal Range ◽  
History Of ◽  
One Year

AbstractWe present a case of a 29-year-old Bulgarian woman with autoimmune thyroiditis and recurrent angioedema. The patient presented with a one-year-long history of recurrent angioedema and Hashimoto’s thyroiditis. Physical examination showed oedema surrounded by erythema on the forearms, and erythematous, itchy plaques spreading over her face, neck, chest, abdomen, and extremities. Blood tests showed elevated total immunoglobulin E (IgE). The patient had been diagnosed with Hashimoto’s thyroiditis and hypothyroidism. She had been taking levothyroxine 50 μg/d, resulting in a good hormonal control; however, her anti-thyroid peroxidase (anti-TPO) antibodies were high. She was started on methylprednisolone and antihistamines. In three weeks, we observed a good therapeutic response to the treatment and the lesions remitted. IgE dropped within normal range. Levels of anti-TPO antibodies were persistently high. In conclusion, patients with angioedema should be tested for thyroid autoimmunity. Further delve into the pathogenesis of angioedema in them is warranted in order to explore the possibility of an underlying atopy in those not responding to the standard treatment with levothyroxine.

scholarly journals Functional Ovarian Reserve in Women With Infertility and Euthyroidism: What Is the Role of Thyroid Autoimmunity?

2021 ◽  
Author(s):  
Diana Festas Silva ◽  
Tânia Carvalho ◽  
Leonor Gomes ◽  
Isabel Paiva ◽  
Paulo Cortesão ◽  
...  
Keyword(s):  
Ovarian Reserve ◽  
Polycystic Ovary ◽  
Thyroid Autoimmunity ◽  
Univariate Analysis ◽  
Human Reproduction ◽  
Thyroid Peroxidase ◽  
Childbearing Age ◽  
Autoimmune Pathology ◽  
Cervical Surgery ◽  
Tsh Levels

Abstract Background: Thyroid dysfunction is the most common endocrine disorder in women of childbearing age, and is associated with menstrual irregularities, anovulation and infertility. Whether it is thyroid function, thyroid autoimmunity (AI) or both that affects functional ovarian reserve remains to be clarified. The aim of this study was to evaluate the association between functional ovarian reserve and thyroid AI in women with infertility in euthyroidism.Methods: retrospective study of women with infertility, in euthyroidism, followed in a Human Reproduction Department, between May 2016 and January 2020. TSH, anti-thyroid peroxidase (TPO) antibodies, anti-thyroglobulin (TG) antibodies were measured. Functional ovarian reserve was assessed by anti-Müllerian hormone (AMH) levels with antral follicle count (AFC) performed by endovaginal ultrasound. Women with at least one of the following criteria were excluded: prior thyroidectomy, radioactive iodine treatment, cervical surgery/radiotherapy, oophorectomy, malignant/autoimmune pathology, chronic kidney disease, liver disease, polycystic ovary syndrome, current pregnancy and current medication with levothyroxine, methimazole or propylthiouracil. Results with p<0.05 were considered statistically significant.Results: 730 women were evaluated, with mean age of 34.9±3.9 years, with positive thyroid AI (≥ 1 positive antibody) present in 14.8% of cases. Anti-TPO antibodies were positive in 11.0% of patients and anti-TG antibodies in 7.0%. Mean TSH level was 1.6±0.7 µIU/mL (NR: 0.4-4.0). Median body mass index (BMI) was 22.8 kg/m2 (IQR 5.1). Median AMH was 1.7ng/mL (IQR 2.1), and mean AFC was 10.2±6.3. Patients with positive and negative thyroid AI did not differ significantly with age (p=0.133), BMI (p=0.784], AFC (p=0.508) and AMH (p=0.825). TSH levels were significantly higher in the positive AI group (2.0±0.8 vs 1.5±0.7µIU/mL; p<0.001).In the univariate and multivariate analysis, only patient's age and AFC were predictive of AMH levels (p<0.001; p<0.001, respectively). TSH levels, BMI and thyroid AI were not predictive of AMH levels.In regard to AFC, in the univariate analysis, only age was predictive (p<0.001). TSH levels, BMI and thyroid AI were not predictive of AFC.Conclusions: In this study we found that thyroid autoimmunity, in women with infertility and TSH levels in the normal range, apparently, do not have a predictive role for functional ovarian reserve.

scholarly journals Analysis of Blimp-1 and PD-1/PD-L1 Immune Checkpoint in an Autoimmune Thyroiditis Animal Model

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Xue Zhang ◽  
Xiaoshu Lv ◽  
Mengya Chen ◽  
Haixia Liu
Keyword(s):  
Signaling Pathway ◽  
Autoimmune Thyroiditis ◽  
Pregnancy Loss ◽  
B Lymphocyte ◽  
Fetal Loss ◽  
Control Group ◽  
Autoimmune Thyroid ◽  
Female Mice ◽  
Maturation Protein ◽  
Cell Death Protein

Objective. B lymphocyte-induced maturation protein 1 (Blimp-1) and programmed cell death protein 1 (PD-1) have opposing roles in the development of T cells; however, the mechanism of autoimmune thyroiditis- (AIT-) associated abortion is unclear. The present study investigated the expression of Blimp-1 and PD-1/PD-ligand 1 (PD-L1) in AIT-associated pregnancy loss and elucidated the related signaling pathway involving in the inflammatory response. Methods. An experimental fetal loss model with autoimmune thyroiditis was established after murine thyroglobulin- (mTg-) immunized CBA/J female mice mating with Balb/c males. ELISA was employed to investigate the TgAb level in the serum of CBA/J female mice. The expression of Blimp-1, PD-1/PD-L1, mammalian target protein rapamycin (mTOR), and Foxp3 proteins in the placenta and spleen was detected through immunofluorescence staining and western blotting. Results. ELISA indicated that the serum TgAb level in the mTg group was higher than that in the control group (P<0.001). Fetal resorption rates increased in the mTg group compared with those in the control group (45.63% vs. 3.1%, P<0.05). Blimp-1 levels in the placenta and spleen were higher in the AIT-related miscarriage group than in the control group. However, the expression of PD-1/PD-L1 and Foxp3 was significantly decreased in the placenta and spleen in the AIT-related miscarriage group. Conclusion. Blimp-1 participates in the pathogenesis of autoimmune thyroid disease-associated pregnancy loss through the inflammatory immune response, which is potentially mediated through the PD-1/PD-L1 signaling pathway.

Thyroid peroxidase antibodies are common in children with HLA-conferred susceptibility to type 1 diabetes, but are weakly associated with thyroid function

2020 ◽  
Vol 33 (8) ◽  
pp. 1027-1030
Author(s):  
Liisa Saare ◽  
Aleksandr Peet ◽  
Vallo Tillmann
Keyword(s):  
Type 1 Diabetes ◽  
Thyroid Function ◽  
Thyroid Autoimmunity ◽  
Risk Groups ◽  
Thyroid Peroxidase ◽  
Cross Sectional ◽  
Autoimmune Thyroid ◽  
Thyroid Peroxidase Antibodies ◽  
Hla Dq

AbstractObjectivesThe need for screening for autoimmune thyroid disease in children who have HLA-conferred susceptibility to type 1 diabetes (T1D), but have not yet been diagnosed with T1D, has not been thoroughly studied. The aim of this study was to describe the prevalence of positive thyroid peroxidase antibodies and its effect on thyroid function in children with genetic susceptibility to T1D as well as to describe the association between thyroid autoimmunity and HLA-DQ genotypes.MethodsCross-sectional study in 223 children (112 boys) aged 7.4–10.5 years with HLA-conferred susceptibility to T1D. TPOAb were measured in all children; thyroglobulin antibodies (TGAb) and thyroid function in TPOAb positive subjects.ResultsGirls had a significantly higher median TPOAb concentration than boys (12 vs 11 kU/L; p=0.001). Positive TPOAb occurred in 13.9% and positive TGAb in 4% of subjects. Only two children had mild changes in thyroid function. There was no association between HLA risk groups and the prevalence of TPOAb.ConclusionsTPOAb are common in children with HLA-conferred susceptibility to T1D, yet are weakly associated with thyroid function, suggesting limited value of thyroid screening in this cohort.

scholarly journals Impact of Abdominal Obesity on Thyroid Auto-Antibody Positivity: Abdominal Obesity Can Enhance the Risk of Thyroid Autoimmunity in Men

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Jazyra Zynat ◽  
Suli Li ◽  
Yanrong Ma ◽  
Li Han ◽  
Fuhui Ma ◽  
...  
Keyword(s):  
Waist Circumference ◽  
Abdominal Obesity ◽  
Thyroid Autoimmunity ◽  
Large Population ◽  
Overweight And Obesity ◽  
Thyroid Peroxidase ◽  
Hip Circumference ◽  
Autoimmune Thyroid Diseases ◽  
Autoimmune Thyroid ◽  
Logistic Analysis

Background. The interrelation between obesity and autoimmune thyroid diseases is complex and has not been confirmed. The aim of the present study was to observe the relationship between thyroid autoimmunity and obesity, especially abdominal obesity, in a large population. Methods. A total of 2253 residents who had lived in Xinjiang for more than 3 years were enrolled. Serum thyroid hormone concentration, thyroid autoantibodies, lipid parameters, Weight, height, and waist and hip circumference were measured. Results. The prevalence of thyroid peroxidase antibody (TPOAb) and/or thyroglobulin antibody (TgAb) positive was 32.1% (21.2% in men and 37% in women, P<0.01). Compared with women, men had significantly higher TG levels, waist circumference, and hip circumference levels (P<0.01), while women showed higher TSH, TPOAb, and TgAb levels (P<0.01). The prevalence of overweight and obesity was 71.1% in men and 63.5% in women. Men had a higher prevalence of abdominal obesity than women (56.6% in men and 47.6% in women, P<0.01). TPOAb correlates positively with waist circumference (r = 0.100, P<0.05) in men. Binary logistic analysis showed that TPOAb positivity had increased risks of abdominal obesity in men, and the OR was 1.1044 (95% CI 1.035, 1.151, P<0.05). Conclusion. Our results indicate that men had higher lipid levels, thicker waist circumference, and higher prevalence of overweight, obesity, and abdominal obesity. Abdominal obesity is a risk factor for TPOAb positivity in men, suggesting that abdominal obesity can enhance the risk of thyroid autoimmunity in men.

scholarly journals Autoimmune Thyroiditis and Exposure to Iodine 131 in the Ukrainian Cohort Study of Thyroid Cancer and Other Thyroid Diseases after the Chornobyl Accident: Results from the First Screening Cycle (1998–2000)

2006 ◽  
Vol 91 (11) ◽  
pp. 4344-4351 ◽  
Author(s):  
M. D. Tronko ◽  
A. V. Brenner ◽  
V. A. Olijnyk ◽  
J. Robbins ◽  
O. V. Epstein ◽  
...  
Keyword(s):  
Cohort Study ◽  
Thyroid Cancer ◽  
Autoimmune Thyroiditis ◽  
Thyroid Autoimmunity ◽  
Large Cohort ◽  
Radioactive Isotopes ◽  
Thyroid Peroxidase ◽  
Subsequent Increase ◽  
Iodine 131 ◽  
Radioactivity Measurements

Abstract Context: Due to the Chornobyl accident, millions were exposed to radioactive isotopes of iodine and some received appreciable iodine 131 (131I) doses. A subsequent increase in thyroid cancer has been largely attributed to this exposure, but evidence concerning autoimmune thyroiditis (AIT) remains inconclusive. Objective: The objective of the study was to quantify risk of AIT after 131I exposure. Design/Setting/Participants: Baseline data were collected from the first screening cycle (1998–2000) of a large cohort of radiation-exposed individuals (n = 12,240), residents of contaminated, iodine-deficient territories of Ukraine. Study individuals were under the age of 18 yr on April 26, 1986, and had thyroid radioactivity measurements made shortly after the accident. Outcomes: AIT was defined a priori based on various combinations of elevated antibodies to thyroid peroxidase (ATPO), TSH, and clinical findings; elevated ATPO were considered to be an indicator of thyroid autoimmunity. Results: No significant association was found between 131I thyroid dose estimates and AIT, but prevalence of elevated ATPO demonstrated a modest, significant association with 131I that was well described by several concave models. This relationship was apparent in individuals with moderately elevated ATPO and euthyroid, thyroid disease-free individuals. Conclusions: Twelve to 14 yr after the Chornobyl accident, no radiation-related increase in prevalence of AIT was found in a large cohort study, the first in which 131I thyroid doses were estimated using individual radioactivity measurements. However, a dose-response relationship with ATPO prevalence raises the possibility that clinically important changes may occur over time. Thus, further follow-up and analysis of prospective data in this cohort are necessary.

scholarly journals A study of Anti Thyroid Peroxidase (TPO) Antibody Titres in patients seeking treatment at a tertiary health care centre

2019 ◽  
Vol 3 (2) ◽  
pp. 9-13
Author(s):  
Prajaya Sikar Shrestha ◽  
Alark Devkota Rajouria ◽  
Dipak Malla ◽  
Samyukta Bhattarai ◽  
Bharat Bahadur Amatya ◽  
...  
Keyword(s):  
Antibody Titre ◽  
Thyroid Disease ◽  
Thyroid Autoimmunity ◽  
Cross Sectional Study ◽  
Thyroid Peroxidase ◽  
Community Studies ◽  
Health Care Centre ◽  
Cross Sectional ◽  
Autoimmune Thyroid ◽  
Antibody Titres

Background: One of the main cause of thyroid disease is autoimmune thyroid disease and anti thyroid peroxidase (TPO) antibodies is a major marker of the condition. There are very few studies in the country regarding the etiology of thyroid disorders and hence this study is being conducted for it. Methods: This is retrospective cross sectional study from 28 January 2019 to 29 July 2019 done at National Academy of Medical Sciences, Bir Hospital, Kathmandu. The laboratory serum sample data of all Anti TPO antibody results from patients seeking treatment at the instituition were analyzed for age and gender variation. Anti TPO antibody titre of equal or more than 34 IU/ml was considered as positive. Results: Out of 768 samples analysed for study, 79.9% were of women and 20.1 % were of men. A total of 205 (26.7%) were positive for anti TPO antibodies of which 83.4% were women and 16.6% were men . Women had more patients with anti TPO antibodies positive as compared men (27.9 vs 21.1%). Mean Anti TPO titre were also more in women as compared to men (61.01 vs 48.20 IU/ml). Conclusions: About one fourth of the patients had siginificant titers of anti TPO antibodies suggestive of thyroid autoimmunity. Both prevalence of positive anti TPO antibody titres and the mean anti TPO antibody titre values were more in women as compared to men. Further well designed larger community studies are required.

The role of hereditary and environmental factors in autoimmune thyroid diseases

2012 ◽  
Vol 153 (26) ◽  
pp. 1013-1022 ◽  
Author(s):  
Csaba Balázs
Keyword(s):  
Environmental Factors ◽  
Thyroid Disease ◽  
Autoimmune Thyroid Disease ◽  
Thyroid Autoimmunity ◽  
Thyroid Diseases ◽  
Thyroid Peroxidase ◽  
Autoimmune Thyroid Diseases ◽  
Autoimmune Thyroid ◽  
Histocompatibility Complex

Autoimmune thyroid diseases are the most common organ-specific autoimmune disorders affecting 5% to 10% of the population in Western countries. The clinical presentation varies from hyperthyroidism in Graves’ disease to hypothyroidism in Hashimoto’s thyroiditis. While the exact etiology of thyroid autoimmunity is not known, the interaction between genetic susceptibility and environmental factors appears to be of fundamental importance to initiate the process of thyroid autoimmunity. The identified autoimmune thyroid disease susceptibility genes include immune-modulating genes, such as the major histocompatibility complex, and thyroid-specific genes, including TSH receptor, thyroglobulin and thyroid peroxidase. The majority of the anti-TSH-receptor antibodies have a stimulating capacity and are responsible for hyperthyroidism. The anti-thyroglobulin- and anti-thyroid peroxidase antibodies belonging to the catalytic type of antibodies destroy the thyrocytes resulting in hypothyroidism. The appearance of anti-thyroid peroxidase antibodies precedes the induction of thyroiditis and the manifestation of hypothyroidism. The molecular analysis of thyroglobulin gene polymorphism is important in the mechanism of autoimmune thyroiditis. The autoantigen presentation by major histocompatibility complex molecules is a key point of the autoimmune mechanism. It has been shown that a HLA-DR variant containing arginine at position 74 of the DRβ1 chain confers a strong genetic susceptibility to autoimmune thyroid diseases, Graves’ disease and Hashimoto’s thyroiditis, while glutamine at position DRβ1-74 is protective. Human thyroglobulin 2098 peptide represents a strong and specific DRβ1-Arg74 binder, while a non-binding control peptide, thyroglobulin 2766 fails to induce this response. Moreover, thyroglobulin 2098 stimulated T-cells from individuals who were positive for thyroglobulin antibodies, demonstrating that thyroglobulin 2098 is an immunogenic peptide capable of being presented in vivo and activating T-cells in autoimmune thyroid diseases. Taken together these findings suggest that thyroglobulin 2098, a strong and specific binder to the disease-associated HLA-DRβ1-Arg74, is a major human T-cell epitope and it participates in the pathomechanism of the autoimmune thyroid disease. The exact nature of the role of environmental factors in the autoimmune thyroid disease is still not well known, but the importance of several factors such as iodine, drugs and infections has been reported. Further knowledge of the precise mechanisms of interaction between environmental factors and genes in inducing thyroid autoimmunity could result in the development of new strategies for diagnosis, prevention and treatment. Orv. Hetil., 2012, 153, 1013–1022.

scholarly journals The relationship between circulating estradiol and thyroid autoimmunity in males

2014 ◽  
Vol 170 (1) ◽  
pp. 63-67 ◽  
Author(s):  
La-or Chailurkit ◽  
Wichai Aekplakorn ◽  
Boonsong Ongphiphadhanakul
Keyword(s):  
Thyroid Autoimmunity ◽  
Serum Levels ◽  
Mean Value ◽  
Thyroid Peroxidase ◽  
Test Results ◽  
Autoimmune Thyroid ◽  
Thyroid Peroxidase Antibody ◽  
Thyroglobulin Antibody ◽  
The Difference ◽  
The Relationship

IntroductionAlthough autoimmune thyroid disease is less common in males, it is unclear whether estrogen contributes to the difference in susceptibility among males.ObjectiveTo examine whether circulating estradiol (E2) is related to thyroid autoimmunity in males.Patients and methodsOne-thousand two-hundred and sixty-three males aged 15–94 years were studied. Serum levels of E2, TSH receptor antibody (TRAb), thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb), free thyroxine (FT4), and TSH were measured by ELISA.ResultsCirculating E2varied widely in males, ranging 18.4–403.7 pmol/l with a mean value of 136.2±51.7 pmol/l. E2increased with age (r=0.18,P<0.001). No relationship between E2and BMI was found. When comparing the difference in E2according to the test results of TRAb, TPOAb, and TgAb, it was found that E2was significantly higher in subjects with positive TRAb (TRAb positive, E2=170.3±59.8 pmol/l; TRAb negative, E2=134.0±50.6 pmol/l;P<0.001). No difference in E2was demonstrated according to the results of TPOAb or TgAb. Logistic regression analysis showed that E2was a determinant of positive TRAb, independent of age and BMI. There was no relationship between serum E2and TSH or FT4. However, E2was negatively related to TSH (r=−0.45,P<0.01) in subjects whose TSH levels fell below the reference range (0.3–4.2 mIU/l).ConclusionHigher circulating E2is related to thyroid autoimmunity in males as reflected by positive TRAb.

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