THYROID AUTOANTIBODIES
Section snippets
IMMUNOBIOLOGY OF THYROID AUTOANTIBODIES
Table 1 summarizes the properties of the four best-defined protein antigenic targets of thyroid autoantibodies. Antibodies to other antigens have also been described, including a second colloid component and growth-stimulating or inhibiting antibodies, but their clinical significance is either controversial or not proved.11, 35, 36, 88, 89, 135 Autoantibodies to the thyroid hormones (T4 and T3) also spontaneously occur, usually in association with anti-Tg antibodies, and can cause important
Antithyroglobulin and Antimicrosomal/Thyroid Peroxidase Assays
Early techniques to measure thyroid autoantibodies included precipitation and diffusion techniques for anti-Tg and the complement fixation test for antimicrosomal antibodies. These tests gave way to immunofluorescence using human or primate thyroid tissue or passive (tanned) erythrocyte hemagglutination assays; however, these assays were only semiquantitative and required experienced interpretative skills. Immunoassays using purified Tg or recombinant TPO (as the microsomal antigen) are now in
Diagnosing the Cause of Thyrotoxicosis
At diagnosis, anti-Tg antibodies are present in as many as 30% and anti-TPO antibodies in as many as 80% of patients with clinical Graves' disease (see Table 2). TSH receptor antibody assays are more sensitive, and TSAb measurements tend to be more sensitive (85% to 100%) than TBII measurements (75% to 96%) in untreated Graves' disease.27, 130, 150 TBII positivity alone still correlates remarkably well with disease, supporting the widespread use of this simpler assay method. As discussed
Differentiated Thyroid Cancer
Serial measurements of serum Tg levels are valuable in identifying recurrences of differentiated thyroid cancer76; however, when anti-Tg antibodies are present, Tg assay results become unreliable owing to immunointerference, even when recovery of added Tg is simultaneously estimated.125 Anti–Tg antibody testing is mandatory in patients in whom serial Tg measurements are planned and is the only indication for antithyroid antibody testing in differentiated thyroid cancer. This indication remains
SUMMARY AND FUTURE PROSPECTS
The prevalence of and predictive value of testing for thyroid autoantibody have been studied in a wide variety of conditions. Table 7 summarizes the authors' view on the current clinical indications for the use of these tests. Anti–TPO antibody testing by immunoassay has replaced anti-Tg and antimicrosomal antibody testing in routine practice because of its improved sensitivity and specificity and should be easily available to all physicians who manage thyroid disease. Currently, the only clear
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2021, Autoimmunity ReviewsCitation Excerpt :Anti-thyroid autoantibodies bind with components on the thyroid including anti-thyroid peroxidase antibodies (TPOAb), anti-thyrotropin receptor antibodies (TRAb), and anti-thyroglobulin antibodies (TgAb). These autoantibodies are frequently elevated in Graves' diseases and Hashimoto's thyroiditis [36]. Anti-neutrophil cytoplasmic antibodies (ANCAs) are a group of autoantibodies which act against antigens in the cytoplasm of neutrophil granulocytes and exist in two subtypes: anti-cytoplasmic ANCA (c-ANCA) and anti-perinuclear ANCA (p-ANCA).
Hashimoto Encephalopathy in Pediatrics: Report of 3 Cases
2021, AACE Clinical Case ReportsTPO antibody positivity and adverse pregnancy outcomes
2020, Best Practice and Research: Clinical Endocrinology and MetabolismImplementation of thyroid function tests algorithms by clinical laboratories: A four-year experience of good clinical and diagnostic practice in a tertiary hospital in Greece
2018, European Journal of Internal MedicineCitation Excerpt :Due to the limited success of these initial measures, in April 2013, the Scientific Committee of the University Hospital of Heraklion adopted a proposal from the heads of the Endocrinology Department and the Laboratory of Experimental Endocrinology, allowing the scientific personnel of the Laboratory to apply a structured algorithm (Fig. 1) on inpatient TFTs orders. Based on the proposed algorithm: (i) if TSH was normal, no further tests were performed; (ii) if TSH was outside normal limits, FT4 was assayed; (iii) FT3 was performed only if a low TSH was accompanied by a normal or low FT4; finally, (iv) anti-thyroid antibodies were performed only in patients with hormone results outside the normal ranges, unless pregnancy was reported [8]. All orders that were considered redundant, based on the algorithm, were not performed (although the samples were stored for at least one week), unless the ordering physician requested a bypass, after personal communication with the laboratory physicians/scientists.
Myofascial Pain Syndrome
2018, Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation
Address reprint requests to Colin M. Dayan, MB, FRCP, PhD, University Division of Medicine Laboratories, Bristol Royal Infirmary, Bristol, United Kingdom BS2 8HW, e-mail: [email protected]
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Division of Medicine, University of Bristol, Bristol, United Kingdom