Antithyroid Antibody Status During Pregnancy

Background: Gradual alteration of antithyroid antibody level occurs during different trimesters of gestation. The study finds the type of alteration in Bangladeshi population. Objective: The present study was carried out to find out the alterations of antithyroid antibody levels during each trimester in normal pregnant women in Bangladesh. Materials and Methods: This cross sectional study was carried out in the Department of Physiology, Sir Salimullah Medical College (SSMC), Dhaka from July 2016 to June 2017. Total 90 apparently healthy pregnant women of different trimesters, age ranged from 20 to 35 years were selected as study group (Group I). Again according to gestational age, study group was subdivided into 1st trimester of gestation (Group Ia, n=30), 2nd trimester of gestation (Group Ib, n=30) and 3rd trimester of gestation (Group Ic, n=30) respectively for comparison. For assessment of antithyroid antibody status, serum TPO-Ab and Tg-Ab levels were measured by chemiluminescent microparticle immunoassay (CMIA) method in Bangabandhu Sheikh Mujib Medical University (BSMMU). The statistical analysis was done by ANOVA test and Bonferroni test. Results: In this study, mean serum TPO-Ab level was significantly (p≤0.05, p<0.001) lower in 2nd and 3rd trimester in comparison to that of 1st trimester. On the other hand, mean serum Tg-Ab level was significantly (p<0.01, p<0.001) lower in 2nd and 3rd trimester in comparison to that of 1st trimester. Again, this value was significantly (p≤0.05) lower in 3rd trimester than that of 2nd trimester. Conclusion: Antithyroid antibody titre gradually decreases with the progression of trimesters of gestation. KYAMC Journal.2021;12(02): 98-100

Current Concepts in Endocrinology for Clinicians and Medical Students. Hashimoto’s Thyroiditis: clinical and subclinical thyroid dysfunction

Hashimoto’s thyroiditis (HT) is an autoimmune and inflammatory disease in which antibodies are directed against the thyroid gland leading to chronic inflammation and hypothyroidism. The autoimmunity against thyroid antigens can be associated to genetic background and environmental factors. Thyroid peroxidase (TPO) and thyroglobulin (TG) are the major autoantigens for characterizing the disease. And the pathogenic mechanism is related to the activation of autoreactive CD4+ T cells, CD8+ cytotoxic T cells and antithyroid antibody producing-B cells. The treatment for hypothyroidism is based on thyroid hormone replacement, the levothyroxine. This review briefly discusses the clinical and pathogenic profile of HT and the importance of a correct diagnostics.

P.006 Role of repeat antithyroid antibody testing in the diagnosis of Hashimoto’s Encephalopathy

Background: We present a case of a previously well 71-year-old woman who developed rapidly progressive dementia. She had several prolonged hospital admissions and extensive investigations were performed. Her illness was steroid-responsive with clinical features suggestive of Hashimoto’s Encephalopathy (HE). However, multiple thyroid antibody panels acquired were initially normal, becoming elevated during subsequent relapses that occurred 3 years after initial presentation. The case signifies the importance of repeating antithyroid antibody levels in a patient with a clinical picture suggestive of HE. Methods: Case report. Results: The diagnosis of HE was established because of a compatible clinical picture including a relapsing encephalopathy with motor involvement and steroid responsiveness. In addition, although initial antithyroid antibody testing was negative, subsequent attacks were associated with significant elevations and reverted to normal with resolution of the attacks. Conclusions: In a patient with normal levels of antithyroid antibodies and a clinical presentation suggestive of HE, we recommend repeat antithyroid antibody testing to confirm diagnosis. Further studies are necessary to clarify the pathogenic role of elevated antithyroid antibodies in the mechanism of HE.

A correlative study of antithyroid antibodies level, thyroid functional status and histological evidence of thyroiditis in patients subjected to thyroidectomy

Background: There is inadequate data on relationship between histologic thyroiditis, thyroid functional status and antithyroid antibody levels. Aim of the study was to correlate prevalence of antithyroid antibody levels with thyroid functional status and histological evidence of thyroiditis in thyroidectomy specimen.Methods: Thirty-two patients undergoing thyroidectomy were evaluated clinically and with thyroid function tests, preoperative TPOAb and TGOAb, ultrasound neck and FNAC. Histopathological examination to detect histological thyroiditis done. Patients with previous thyroid surgery or on thyroxine, antithyroid drugs, steroids, immune-suppressive drugs were excluded. Results: Overall twenty-five out of thirty-two patients had elevation of one or other thyroid antibody levels (TPOAb- 22/32, TGOAb- 20/32). More than half of the patients with elevated antibodies were euthyroid biochemically, less than quarter each being hypothyroid and hyperthyroid. The incidence of hypothyroid increased in those with elevation of both antibody levels. FNAC reported four as Hashimoto's thyroiditis. Histology on the other hand showed a primary diagnosis of Hashimoto's thyroiditis in three, in one each as the secondary diagnosis with papillary carcinoma being the primary diagnosis in one and follicular adenoma in another. Histologic lymphocytic thyroiditis was seen in three cases and found to be always associated with a primary diagnosis such as colloid goitre. Thus, overall five patients had an additional primary diagnosis with thyroiditis being a secondary diagnosis. When histological thyroiditis was correlated with antibodies, it was seen that only seven out of eight with histological thyroiditis had elevated antibody levels. High titters in patients with histological thyroiditis were associated with euthyroid status in two patients and hyperthyroid status in the remaining three.Conclusions: The study found no correlation between clinical and biochemical functional status with clinical examination under diagnosing both hypothyroidism and hyperthyroidism. No definite correlation was noted with mild increases in antithyroid antibody levels and histological thyroiditis, very high values and raises in both TPOAb and TGOAb may suggest histological thyroiditis.