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Thyroid Diseases

  • Autoimmune Thyroid Diseases (AITDs) are among the most common autoimmune diseases in western countries.1,2

  • AITDs affects women at a higher incidence rate than men, with population prevalence of up to 4.6% in women and only 2.83% in men.6

  • Hashimoto's thyroiditis and Graves' disease are the two most clinically significant forms of AITDs.1

 


AITDs affect up to 5% of the general population in western countries.2

Hashimoto's thyroiditis and Graves' disease often cause the following symptoms:3,4

Hashimoto's thyroiditis
(symptoms of hypothyroidism)

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

The vague symptoms of AITDs mean they often go undiagnosed. When left undiagnosed, patients are at an increased risk for certain serious conditions, such as cardiovascular diseases, osteoporosis, and infertility.5
 

AITDs include a number of conditions in which thyroid dysfunction is caused by abnormal cellular or immune responses. AITDs include Graves' disease (GD) and Hashimoto's thyroiditis (HT) which are the most common causes of thyroid gland dysfunctions. These conditions are characterized by reactivity to self-thyroid antigens which are expressed as distinctive inflammatory autoimmune disease.7 The results of laboratory testing, including those used to measure antibodies against Thyroid Peroxidase (TPO), Thyroglobulin (TG), and Thyroid Stimulating Hormone Receptor (TSH-R), can allow clinicians to differentiate between the ambiguous symptoms of AITDs and get patients the treatment needed to avoid the consequences of these diseases.


The role of testing to aid in the AITD diagnosis

The presence of AITDs, especially Hashimoto’s thyroiditis, increases the risk for other autoimmune diseases including Type 1 diabetes mellitus and Addison’s disease.8

Serological testing can help diagnose an AITD and distinguish it from other forms of thyroid dysfunction. Classification criteria recommend laboratory testing for autoantibodies against:9
 

  • Thyroid Peroxidase (TPO)
  • Thyroglobulin (TG)
  • Thyroid Stimulating Hormone Receptor (TSH-R)


Measuring these antibodies is invaluable in a clinician’s ability to correctly identify an AITD. For example, anti-TPO antibodies can be detected in Graves’ disease or Hashimoto’s thyroiditis. Testing can also help rule out AITDs. With over 98% of thyroiditis patients having autoantibodies to either or both TG and TPO antigens, a negative test can virtually exclude a diagnosis of thyroiditis.7
 

Learn more about the assays that help diagnose AITD

References
  1. Bliddal S, Nielsen CH, Feldt-Rasmussen U. Recent advances in understanding autoimmune thyroid disease: the tallest tree in the forest of polyautoimmunity. F1000Research. 2017;6:1776.
  2. Tomer Y, Huber A. The etiology of autoimmune thyroid disease: a story of genes and environment. J Autoimmun. 2009;32:231-239.
  3. Mayo Clinic. Hypothyroidism (underactive thyroid). https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284. Accessed December 2017.
  4. Mayo Clinic. Hyperthyroidism (overactive thyroid). https://www.mayoclinic.org/diseases-conditions/hyperthyroidism/symptoms-causes/syc-20373659. Accessed December 2017.
  5. McLachlan S, Nagayama Y, Puchurin P, et al. The link between Graves' disease and Hashimoto's thyroiditis: a role for regulatory T cells. Endocrinology. 2007;148:5724-5733.
  6. Garmendia Madariaga A, Santos Palacios S, Guillén-Grima F. The Incidence and Prevalence of Thyroid Dysfunction in Europe: A Meta-Analysis. J Clin Endocrinol Metab. 2014;99(3)923-931.
  7. Iddah MA, Macharia BN. Autoimmune thyroid disorders. ISRN Endocrinol. 2013;2013:509764.
  8. Wiebolt J, Achterbergh R, den Boer A, et al. Clustering of additional autoimmunity behaves differently in Hashimoto's patients compared with Graves' patients. Eur J Endoncrinol.
  9. Spencer CA. Assay of Thyroid Hormones and Related Substances. [Updated 2017 Feb 20]. In: De Groot LJ, Chrousos G, Dungan K, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279113/