ORIGINAL ARTICLE
Frequency of Thyroid Antibodies at the Diagnosis of Subacute Thyroiditis
Subakut Tiroidit Hastalığında Tanı Sırasında Tiroid Antikor Sıklığı
Received Date : 12 Feb 2020
Accepted Date : 14 May 2020
Available Online : 20 May 2020
Muhammed Erkam SENCAR, Murat ÇALAPKULU, Davut SAKIZ*, Sema HEPSEN, Pınar AKHANLI, İlknur ÖZTÜRK ÜNSAL, Erman ÇAKAL
University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, TURKEY
*Mardin State Hospital, Clinic of Endocrinology and Metabolism, Mardin, TURKEY
Doi: 10.25179/tjem.2020-74287 - Makale Dili: EN
Turk J Endocrinol Metab. 2020;24:144-148
ABSTRACT
Objective: Although subacute thyroiditis (SAT) is not an autoimmune
disease, the presence of antithyroid antibodies has
been reported in this disease too. This study aims to determine
the frequency of antithyroid antibodies at the time of diagnosis
of SAT. Material and Methods: Quantitative measurements
of antithyroid peroxidase antibody (anti-TPO),
antithyroglobulin antibody (anti-Tg), and thyroid-stimulating
hormone (TSH) receptor autoantibodies (TRAb) were made in
76 patients at the diagnosis of SAT. Cytopathological examination
and iodine uptake test was performed to exclude Graves’
disease and Hashimoto’s disease in suspected patients. Multiple
multinuclear giant cells and granulomatous formations, including
epithelioid histiocytes, were the cytological findings
employed to support the diagnosis of SAT in suspicious cases.
Results: The median erythrocyte sedimentation rate and Creactive
protein levels were found to be 49 mL/hour (21-130)
and 54 mg/L (8-179), respectively. TSH, free T4, and free T3
levels were determined to be 0.01 mIU/L (0.003-5.2), 1.98
ng/dL (0.78-6.1) and 5.51 ng/L (3.07-14), respectively. During
the initial presentation, 88% of the patients were
hyperthyroid, and 9% of the patients were euthyroid. Anti-TPO
and anti-Tg antibody levels were detected to be above the
assay-specific cut-off in 11.8% and 10.5% of SAT patients, respectively,
at the time of diagnosis. Elevated TRAb was detected
in 6.6% of all SAT patients. The median anti-TPO, anti-Tg, and
TRAb levels of antibody-positive patients were 55 IU/mL (38-
1.078), 163 IU/mL (5.5-876), 5 IU/L (1.9-23), respectively.
Conclusion: Although uncommon, antibody positivity can also
be observed in SAT disease. This study has proved that the previous
studies claiming the absence of thyroid antibodies in SAT
are flawed. SAT must be considered while assessing the differential
diagnosis of Graves’ and Hashimoto’s disease.
Keywords: Subacute thyroiditis; antithyroid peroxidase antibody; antithyroglobulin antibody; TSH receptor autoantibody
ÖZET
Amaç: Subakut tiroidit (SAT) otoimmün bir hastalık olmamasına
rağmen antitiroid antikorlarının pozitif olabileceği literatürde
bildirilmiştir. Bu çalışmanın amacı, SAT’de tanı
anında antitiroid antikorlarının sıklığını belirlemektir. Gereç
ve Yöntemler: Toplam 76 SAT hastasının antitiroid peroksidaz
antikoru (anti-TPO), antitiroglobulin antikoru (anti-Tg) ve
TSH reseptörü otoantikorlarının [receptor autoantibodies
(TRabs)] tanı anında kantitatif ölçümleri yapıldı. Tanısı şüpheli
hastalarda Graves ve Hashimoto hastalığını dışlamak için
radyoiyot uptake testi ve sitopatolojik inceleme yapıldı. Sitolojik
incelemede çok çekirdekli dev hücrelerin ve epiteloid
histiyosit içeren granülomatöz oluşumların saptanması şüpheli
vakalarda SAT tanısını desteklemek için kullanıldı. Bulgular:
Ortalama eritrosit sedimentasyon hızı ve C-reaktif
protein düzeyleri sırasıyla 49 mL/saat (21-130) ve 54 mg/L
(8-179) olarak saptandı. TSH, serbest T4 ve serbest T3 düzeyleri
sırasıyla 0,01 mIU/L (0,003-5,2), 1,98 ng/dL (0,78-
6,1) ve 5,51 ng/L (3,07-14) olarak saptandı. İlk başvuru
anında hastaların %88'i hipertiroidik, %9'u ötiroid idi. Tanı
anında hastaların sırasıyla %11,8 ve %10,5’inde anti-TPO ve
anti-Tg antikorlarının pozitif olduğu saptandı. Hastaların
%6,6’sında TRAb pozitifliği saptandı. Antikor düzeyi pozitif
olan hastaların medyan anti-TPO, anti-Tg ve TRAb seviyeleri
sırasıyla 55 IU/mL (38-1.078), 163 IU/mL (5,5-876) ve 5
IU/L (1,9-23) olarak saptandı. Sonuç: Sık olmasa da antitiroid
antikor pozitifliği SAT hastalarında da görülebilir. Bu çalışma,
SAT'de tiroid antikorlarının saptanamayacağını iddia
eden önceki çalışmaların hatalı olduğunu kanıtlamıştır. Bu
nedenle SAT hastalığı, Graves ve Hashimoto hastalıklarının
ayırıcı tanısında göz önünde bulundurulmalıdır.
Anahtar Kelimeler: Subakut tiroidit; antitiroid peroksidaz antikoru; antitiroglobulin antikoru; TSH reseptörü otoantikoru
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