Disappearance of humoral thyroid autoimmunity after removal of thyroid

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http://www.annals.org/cgi/reprint/139/5_Part_1/346.pdf

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Ann Intern Med. 2003 Sep 2;139(5 Pt 1):346-51. Related Articles,

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Ann Intern Med. 2003 Sep 2;139(5 Pt 1):I75.

Disappearance of humoral thyroid autoimmunity after complete removal

of thyroid antigens.

Chiovato L, Latrofa F, Braverman LE, Pacini F, Capezzone M,

Masserini L, Grasso L, Pinchera A.

Universita di Pisa, Pisa, Italy.

BACKGROUND: The development of antibodies to thyroid peroxidase,

thyroglobulin, and thyroid-stimulating hormone (TSH) receptor is a

main feature of autoimmune thyroid diseases. OBJECTIVE: To

investigate whether complete removal of thyroid antigens results in

the abatement of humoral thyroid autoimmunity. DESIGN: Retrospective

chart review study of patients treated and monitored with a standard

prospective protocol. SETTING: University hospital in Pisa, Italy,

between 1976 and 1994. PATIENTS: 182 patients with differentiated

thyroid carcinoma and serum antibodies to thyroid peroxidase,

thyroglobulin, or TSH receptor due to coexistent clinical Hashimoto

thyroiditis, Graves disease, or focal autoimmune thyroiditis.

INTERVENTION: Total thyroidectomy and radioiodine treatment to

ablate residual or metastatic thyroid tissue. Regular follow-up with

iodine-131 whole-body scanning and serum thyroglobulin measurement.

Mean follow-up (+/-SD) was 10.1 +/- 4.1 years (range, 4 to 20

years). MEASUREMENTS: Serum antibodies to thyroid peroxidase,

thyroglobulin, and TSH receptor. RESULTS: Thyroid peroxidase,

thyroglobulin, and TSH-receptor antibodies progressively disappeared

after the initial treatment. The median disappearance time was 6.3

years for thyroid peroxidase antibodies and 3.0 years for

thyroglobulin antibodies. There was a statistically significant

correlation between the disappearance of thyroid tissue and that of

thyroid antibodies. The coexistence of Hashimoto thyroiditis or

Graves disease with thyroid cancer did not modify the pattern of

disappearance of thyroid antibody compared with patients with focal

autoimmune thyroiditis. CONCLUSIONS: Complete ablation of thyroid

tissue with its antigenic components results in the disappearance of

antibodies to all major thyroid antigens, thus supporting the

concept that continued antibody production depends on the

persistence of autoantigen in the body.

PMID: 12965943 [PubMed - indexed for MEDLINE]