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Disappearance of Humoral Thyroid Autoimmunity after Complete Removal of Thyroid Antigens

Luca Chiovato, MD; Francesco Latrofa, MD; Lewis E. Braverman, MD; Furio Pacini, MD; Marco Capezzone, MD; Lucio Masserini, PhD; Lucia Grasso, PhD; and Aldo Pinchera, MD
[+] Article and Author Information

From Università di Pisa, Pisa, Italy; and Boston University School of Medicine, Boston, Massachusetts.


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, a.pinchera@endoc.med.unipi.it.

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.


Ann Intern Med. 2003;139(5_Part_1):346-351. doi:10.7326/0003-4819-139-5_Part_1-200309020-00010
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Sequential measurements of circulating thyroid antibodies in patients with differentiated thyroid carcinoma who had thyroid peroxidase, thyroglobulin, or TSH-receptor antibodies before initial treatment led to 3 findings. First, surgical removal of the thyroid followed by radioablation of residual thyroid tissue resulted in a disappearance of thyroid peroxidase, thyroglobulin, and TSH-receptor antibodies in most patients. For comparison, in a 20-year study of thyroid antibody changes in patients with Hashimoto thyroiditis with nonablated thyroids, thyroid antibodies decreased (but did not disappear) in 21% of patients and either did not change or increased in the remaining patients (12). Second, statistical analysis demonstrated that the disappearance of thyroid peroxidase and thyroglobulin antibodies was statistically significantly correlated with that of thyroid tissue. Third, the pattern of thyroid antibody disappearance did not differ between patients with clinical Hashimoto thyroiditis or Graves disease and patients with focal autoimmune thyroiditis. Thus, persistence of thyroid peroxidase or thyroglobulin antibodies may be a marker of incomplete cure in many patients with differentiated thyroid carcinoma. Other studies also indicate that a decrease in or disappearance of thyroglobulin antibodies is an index of successful treatment of differentiated thyroid carcinoma in patients with positive results on pretreatment thyroglobulin antibody tests (1316). The observational, nonrandomized design of the present study represents its main limitation, but a randomized study with a control group of patients with thyroid cancer and nonablated thyroid would not be ethical.

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Figures

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Figure 1. Kaplan–Meier plot of persistence of thyroid antibodies (thyroid peroxidase or thyroglobulin antibodies) after initial treatment (thyroidectomy and iodine-131) in 182 patients with differentiated thyroid carcinoma. Patients were considered to be negative for thyroid antibodies when both thyroid peroxidase and thyroglobulin antibodies were undetectable in their serum. The numbers of patients with and without antibodies are shown. Kaplan–Meier plots of persistence of thyroid peroxidase or thyroglobulin antibodies after initial treatment (thyroidectomy and iodine-131) in the whole group of patients with differentiated thyroid carcinoma.
Kaplan–Meier plots.Top.Bottom.
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Figure 2. In 172 patients with differentiated thyroid carcinoma and thyroid peroxidase antibodies. The first column for each time point shows the number of patients with persistent thyroid tissue, and the second column shows the number of patients without thyroid tissue. In each group, the numbers of patients with positive and negative test results for thyroid peroxidase antibodies are also shown. In 116 patients with differentiated thyroid carcinoma and thyroglobulin antibodies. The first column for each time point shows the number of patients with persistent thyroid tissue, and the second column shows the number of patients without thyroid tissue. In each group, the numbers of patients with positive and negative test results for thyroglobulin antibodies are also shown.
Number of patients with persistent and ablated thyroid tissue at each 2-year time point.Top.Bottom.
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Summary for Patients

Effects of Removing Thyroid Antigens in Patients with Autoimmune Thyroid Disease

The summary below is from the full report titled “Disappearance of Humoral Thyroid Autoimmunity after Complete Removal of Thyroid Antigens.” It appears in the 2 September 2003 issue of Annals of Internal Medicine (volume 139, pages 346-351). The authors are L. Chiovato, F. Latrofa, L.E. Braverman, F. Pacini, M. Capezzone, L. Masserini, L. Grasso, and A. Pinchera.

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