Luca Chiovato, MD; Francesco Latrofa, MD; Lewis E. Braverman, MD; Furio Pacini, MD; Marco Capezzone, MD; Lucio Masserini, PhD; Lucia Grasso, PhD; Aldo Pinchera, MD
Drs. Chiovato and Latrofa contributed equally to this paper.
Grant Support: By the University of Pisa (Fondi d'Ateneo) and from the Ministero d'struzione, d'niversità e della Ricerca (MIUR), Rome, Italy.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Aldo Pinchera, MD, Dipartimento di Endocrinologia e Metabolismo, Ortopedia e Traumatologia, Medicina del Lavoro, Università di Pisa, Ospedale di Cisanello, Via Paradisa 2, 56124 Pisa, Italy; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Chiovato: Cattedra di Endocrinologia, Università di Pavia, U.O. di Endocrinologia, Fondazione Salvatore Maugeri I.R.C.C.S., Istituto di Pavia, Via Ferrata 8, 27100 Pavia, Italy.
Dr. Latrofa: Autoimmune Disease Unit, Cedars-Sinai Research Institute and University of California, Los Angeles School of Medicine, 8700 Beverly Boulevard, D-3057, Los Angeles, CA 90048.
Dr. Braverman: Department of Medicine, Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, 88 East Newton Street, Boston University School of Medicine, Boston, MA 02118.
Drs. Pacini, Capezzone, Pinchera, and Grasso: Dipartimento di Endocrinologia e Metabolismo, Ortopedia e Traumatologia, Medicina del Lavoro, Università di Pisa, Ospedale di Cisanello, Via Paradisa 2, 56124 Pisa, Italy.
Dr. Masserini: Dipartimento di Statistica e Matematica Applicata all'Economia, Università di Pisa, Via Ridolfi 10, 56100 Pisa, Italy.
Author Contributions: Conception and design: L. Chiovato, F. Latrofa, A. Pinchera.
Analysis and interpretation of data: L. Chiovato, F. Latrofa, A. Pinchera.
Drafting of the article: L. Chiovato, F. Latrofa, L.E. Braverman, A. Pinchera.
Critical revision of the article for important intellectual content: L. Chiovato, F. Latrofa, L.E. Braverman, A. Pinchera.
Final approval of the article: L. Chiovato, F. Latrofa, L.E. Braverman, A. Pinchera.
Provision of study materials or patients: L. Chiovato, F. Latrofa, F. Pacini, M. Capezzone, L. Grasso, A. Pinchera.
Statistical expertise: F. Latrofa, M. Capezzone, L. Masserini.
Obtaining of funding: A. Pinchera.
Administrative, technical, or logistic support: M. Capezzone.
Collection and assembly of data: F. Latrofa, M. Capezzone.
Chiovato L., Latrofa F., Braverman L., Pacini F., Capezzone M., Masserini L., Grasso L., Pinchera A.; Disappearance of Humoral Thyroid Autoimmunity after Complete Removal of Thyroid Antigens. Ann Intern Med. 2003;139:346-351. doi: 10.7326/0003-4819-139-5_Part_1-200309020-00010
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Published: Ann Intern Med. 2003;139(5_Part_1):346-351.
The development of antibodies to antigenic components of the thyroid is a main feature of autoimmune thyroid diseases. The main thyroid autoantigens are thyroglobulin, thyroid peroxidase, and the thyroid-stimulating hormone (TSH) receptor (1). Thyroglobulin and thyroid peroxidase antibodies are also found in some patients with differentiated thyroid carcinoma (2), reflecting the occurrence of autoimmune thyroiditis in their glands. Antibodies to thyroid antigens are mainly produced by lymphocytes infiltrating the gland and, to a lesser extent, by immune cells in cervical lymph nodes and bone marrow (3). Only rarely do circulating lymphocytes spontaneously produce thyroid antibodies (4). Thus, complete removal of thyroid tissue would be expected to ablate both thyroid antigens and most thyroid antibody–secreting cells. A decrease in circulating thyroid antibodies was reported in patients with Hashimoto thyroiditis or Graves disease after thyroidectomy or radioiodine treatment (5-7). This is not a universal finding (8-9), however, and complete disappearance of thyroid antibodies has been reported in a limited number of patients (10). Thyroid antibody changes were also evaluated after total ablation of the thyroid by surgery and radioiodine treatment (2, 11. These studies, including one performed by our group in the mid-1980s on some of the patients described in this paper (2), investigated a limited number of patients for a short follow-up, thus preventing definitive conclusions about the outcome of thyroid antibodies.
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Endocrine and Metabolism, Thyroid Disorders.
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