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Lee, Jo, Ku, Shong, Kim, and Ro: Change in Thyroid Autoantibodies According to the Clinical Course of Painless Thyroiditis Excluding Postpartum Thyroiditis
Original Article
Journal of Korean Endocrine Society

Journal of Korean Endocrine Society 2008; 23(4): 245-252.

Published online: 31 August 2008

DOI: https://doi.org/10.3803/jkes.2008.23.4.245

Change in Thyroid Autoantibodies According to the Clinical Course of Painless Thyroiditis Excluding Postpartum Thyroiditis

Ihn Suk Lee, Young Suk Jo1, Bon Jeong Ku, Minho Shong, Young Kun Kim, Heung-kyu Ro

Department of Internal Medicine, Chungnam National University, College of Medicine, Korea.

1Department of Internal Medicine, Eulji University, College of Medicine, Korea.

Received 21 February 2008       Accepted 13 May 2008

Copyright © 2008 Korean Endocrine Society

Abstract

Background

Painless thyroiditis is characterized by painless, destructive inflammation of the thyroid gland. Although thyroid autoantibodies are frequently detected in patients suffering from this condition, the clinical significance of these antibodies is not well understood. Therefore, this study was conducted to investigate the relationship between thyroid function and thyroid autoantibodies in painless thyroiditis according to clinical course.

Methods

Patients proven to have painless thyroiditis were retrospectively included in this study. We analyzed their clinical features, thyroid function and titers of thyroid autoantibodies according to clinical course, which was divided into three phases; thyrotoxic, hypothyroid and recovery.

Results

Of the 21 patients included in this study, 2 were male and 19 were female. During the thyrotoxic phase, the mean free T4 concentration was 4.03 (2~6.8) ng/mL and the mean concentration of thyroid stimulating hormone (TSH) was 0.02 (0.01~0.07) U/mL. In addition, the titer of antithyroglobulin antibody and antithyroid peroxidase antibody was 298 (4.8~995) U/mL and 3318 (0.1~25280) U/mL, respectively during this phase. During the hypothyroid phase, the mean TSH was 16.3 (4.3-49.5) U/mL and was found to be positively correlated with the level of free T4 observed during the thyrotoxic phase (r = 0.523, P = 0.031). During the recovery phase, the titer of antithyroglobulin antibody was significantly reduced to 180 (38~487) U/mL when compared with the titer taken during the thyrotoxic phase (P = 0.016). Additionally, during the hypothyroid phase, patients found to have antithyroid peroxidase antibody had a higher titer of TSH than those that did not (23.9 (6.5~49.5) vs. 11.2 (5.3~18.2) U/mL, P = 0.004).

Conclusion

The titer of free T4 and the presence of antithyroid peroxidase observed during the thyrotoxic phase were related to the titer of TSH during hypothyroid phase. Additionally, the titer of antithyroglobulin antibody was significantly reduced during the recovery phase.

Keywords: autoimmune thyroiditis, anti thyroglobulin antibody, thyroid microsomal antibody

Figures and Tables

Fig. 1
The correlation between free T4 in thyrotoxic period and thyroid stimulating hormone (TSH) in hypothyroid phase. A and B. Changes of free T4 (A) and TSH (B) according to clinical course. C. Positive linear relationship between free T4 in thyrotoxic period and TSH in hypothyroid phase (r = correlation coefficiency).
jkes-23-245-g001
Fig. 2
Changes of anti-thyroglobulin antibody (A) and anti-thyroid peroxidase antibody (B) according to clinical course of painless thyroiditis. P-values were calculated by paired t-test. *P-value < 0.05.
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Table 1
Clinical characteristics and laboratory findings of the patients in thyrotoxic phase
jkes-23-245-i001

ALT, alanine aminotransferase; AST, aspartate aminotransferase; ESR, erythrocyte sedimentation rate; RATcU, radioactive 99mTcO4- uptake; WBC, white blood cell count; *Data are presented as mean ± SD.

Table 2
Changes of thyroid function and titers of thyroid auto-antibodies according to clinical course
jkes-23-245-i002

Anti-TG Ab, anti-thyroglobulin antibody; Anti-TPO Ab, anti-thyroid peroxidase antibody; nd, not determined; TBII, thyrotropin binding inhibitory immunoglobulin; TSH, thyroid stimulating hormone. All data are presented as mean value (minimum vaue-maximum value). *This data means total duration from initial visit to euthyroid state. †P-values were calculated by repeated measures ANOVA test.

Table 3
Correlation between TSH in hypothyroidism and thyroid function and thyroid auto-antibodies in thyrotoxicosis
jkes-23-245-i003

Anti-TG Ab, anti-thyroglobulin antibody; Anti-TPO Ab, anti-thyroid peroxidase antibody; TSH, thyroid stimulating hormone; TBII, thyrotropin binding inhibitory immunoglobulin.

Table 4
Clinical characteristics according to presence or absence of anti-thyroid peroxidase antibody
jkes-23-245-i004

All data are presented as mean value (minimum vaue-maximum value). *P-values were calculated by Mann-Whitney U-test.

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