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Thyroid Diseases

Autoimmune thyroid diseases (AITDs) are one of the most prevalent autoimmune diseases.1

Undiagnosed AITDs can put patients at risk for certain serious conditions, such as cardiovascular diseases, osteoporosis, and infertility. Despite the consequences of AITDs, and the relatively high prevalence, approximately 5% of the population2 (up to 60% of people with AITDs) are unaware of their condition.3 The use of laboratory diagnostics can support you in differentiating between the ambiguous symptoms of AITDs.4

AITDs affect women at a higher incidence than it does in men, with population prevalence up to 4.6% in women and only 2.83% in men.5

AITDs are among the most common autoimmune diseases, and their vague symptoms mean they often go undiagnosed.


AITDs affects up to 5% of the general population in western countries2

Diagnosis of AITDs

AITDs include a number of conditions in which thyroid dysfunction is caused by abnormal cellular or immune responses. Hashimoto’s thyroiditis and Graves' disease are the two most clinically significant forms of AITDs.1

Hashimoto’s thyroiditis and Graves' disease often cause the following symptoms:6,7

Hashimoto's thyroiditis
(symptoms of hyperthyroidism)

Graves' disease
(symptoms of hyperthyroidism)

Decreased concentration ability

Anxiety

Depression

Irritability

Excessive sleepiness

Sleeping difficulty

Leg swelling

Fatigue

Bradycardia

Rapid or irregular heartbeat

Cold intolerance

Heat sensitivity

Modest weight gain

Weight loss, despite normal food intake

Goiter

Goiter

Constipation

Diarrhea

There are differences in the onset and type of symptoms in these two AITDs:

  • Hashimoto’s thyroiditis is typically an insidious syndrome and presents as hypothyroidism. Patients may have the disease for months or years without noticing a single symptom4,8
  • Graves' disease has a more sudden onset and presents as hyperthyroidism. Heart palpitations and nervousness are frequent first symptoms4

Valuable Tools to Aid in Diagnosis

Serological testing can help diagnose an AITD and to distinguish it from other forms of thyroid dysfunction.

International guidelines classification criteria recommend laboratory testing for autoantibodies against:4

  • Thyroid peroxidase (TPO)
  • Thyroglobulin (TG)
  • Thyroid stimulating hormone receptor (TSH-R)

The measurement of anti-TPO antibodies is the most common test for AITDs; these antibodies can be detected in Graves' disease or Hashimoto’s thyroiditis.

Patients suffering from AITDs might only have one positive autoantibody test result. For example, 6% of patients with Hashimoto’s thyroiditis have isolated anti-TG positivity,9 therefore measurement of all 3 autoantibodies is recommended. Anti-TSH-R has the highest prevalence in untreated Graves’ disease.10 Besides AITDs, anti-TG antibodies are a critical biomarker in patients with thyroid cancer – these antibodies may interfere with the measurement of TG protein levels.11

Allergy Testing

Tests

Testing is simple, specific and reliable. Discover how antibody testing can aid in the diagnosis of AITDs and why they are such a valuable tool for your practice.

References
  1. Bliddal S, Nielsen CH, Feldt-Rasmussen U. Recent advances in understanding autoimmune thyroid disease: the tallest tree in the forest of polyautoimmunity. F1000Res. 2017;6:1776
  2. Tomer Y, Huber A. The Etiology of Autoimmune Thyroid Disease: A Story of Genes and Environment. J Autoimmun. 2009;32(3-4):231–239.  
  3. American Thyroid Association. Prevalence and Impact of Thyroid Disease. https://www.thyroid.org/media-main/about-hypothyroidism/. Accessed December 2017.
  4. Slatosky J, Shipton B, Wahba H. Thyroiditis: Differential Diagnosis and Management. Am Fam Physician. 2000;15;61(4):1047-1052.
  5. Madariaga AG, Palacios SS, Guillén-Grima F. The Incidence and Prevalence of Thyroid Dysfunction in Europe: A Meta-Analysis. J Clin Endocrinol Metab. 2014;99(3):923-931.  
  6. Mayo Clinic. Hypothyroidism (underactive thyroid). https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284.  Accessed December 2017.  
  7. Mayo Clinic. Hyperthyroidism (overactive thyroid). https://www.mayoclinic.org/diseases-conditions/hyperthyroidism/symptoms-causes/syc-20373659. Accessed December 2017.
  8. Iddah MA, Macharia BN. Autoimmune thyroid disorders. ISRN Endocrinol. 2013;2013:509764.
  9. Tozzoli R, Villalta D, Kodermaz G, et al. Autoantibody profiling of patients with autoimmune thyroid disease using a new multiplexed immunoassay method. Clin Chem Lab Med. 2006;44:837-842.  
  10. Zöphel K, Roggenbuck D, Schott M. Clinical review about TRAb assay’s history. Autoimmun Rev. 2010; 9:695-700.    
  11. Ringel MD, Nabhan F.  Approach to Follow-Up of the Patient With Differentiated Thyroid Cancer and Positive Anti-Thyroglobulin Antibodies. J Clin Endocrinol Metab. 2013; 98: 3104-3110.