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Effects of Removing Thyroid Antigens in Patients with Autoimmune Thyroid Disease FREE

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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.

Ann Intern Med. 2003;139(5_Part_1):I-75. doi:10.7326/0003-4819-139-5_Part_1-200309020-00005
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What is the problem and what is known about it so far?

The thyroid gland is located in the neck just above the breastbone. This gland makes hormones that control how the body uses energy. Hypothyroidism is the condition that occurs when the thyroid doesn't make enough hormones. Patients with hypothyroidism may feel tired and have dry skin, hoarse voice, constipation, thinning or loss of hair, and slow reactions. Hyperthyroidism is a condition that occurs when the thyroid gland produces excess thyroid hormones. Patients with hyperthyroidism are hyperactive and may lose weight; they have moist skin and increased heart rate.

Hypothyroidism is often caused by inflammation of the thyroid gland. The most common type of thyroid inflammation is caused by an autoimmune disorder (chronic autoimmune thyroiditis). Another autoimmune disorder, called Graves disease, is a main cause of hyperthyroidism. In autoimmune disorders, the body's immune system mistakenly attacks its own healthy tissue with antibodies. No one understands why the body makes antibodies against thyroid tissue. Some people believe that cells called lymphocytes, passing from the blood into the thyroid gland, come in contact with substances (antigens) in the gland that trigger production of antibodies against thyroid tissue. A good test of this concept would be to see whether the body produces antibodies against thyroid tissue after removal of the thyroid gland and its antigens.

Why did the authors do this particular study?

To see whether antibodies against thyroid in patients with chronic autoimmune thyroiditis and Graves disease disappear after thyroid tissue antigens are removed.

Who was studied?

182 patients with thyroid cancer who also had chronic autoimmune thyroiditis or Graves disease and antibodies to thyroid in their blood.

How was the study done?

To treat their cancer, all patients had their thyroid glands removed surgically and also received radioactive iodine. (After these treatments, patients should have no thyroid tissue.) The researchers then followed patients for 4 to 20 years. They checked periodically, using special scans and blood tests, to see whether patients had any remaining thyroid tissue. They also regularly tested blood samples for antibodies against thyroid tissue antigens.

What did the authors find?

After surgery, blood levels of antibodies against thyroid antigens gradually decreased. The antibodies eventually disappeared in most patients over several years. However, the rate of disappearance was much slower than would be expected if only lymphocytes contained in the thyroid, and thus in direct contact with thyroid tissue antigens, produced the antibodies.

What were the limitations of the study?

The study was based on retrospective review of patients' records, and patients weren't always followed and monitored in the same manner.

What are the implications of the study?

Gradual rather than abrupt disappearance of antibodies after thyroid removal suggests that tissues other than the thyroid contain lymphocytes, which may contribute to antibody production in patients with chronic autoimmune thyroiditis or Graves disease. However, continued antibody production seems to depend on persistence of thyroid tissue antigens in the body.





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