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The presence of anti-thyroglobulin (TgAb) and/or anti-thyroperoxidase antibodies (TPOAb) does not exclude the diagnosis of type 2 amiodarone-induced thyrotoxicosis

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Abstract

Purpose

It is widely accepted that type 2 amiodarone-induced thyrotoxicosis (AIT) generally occurs in patients with a normal thyroid gland without signs of thyroid autoimmunity. However, it is currently unknown if the presence of anti-thyroglobulin (TgAb) and/or anti-thyroperoxidase antibodies (TPOAb) in AIT patients without other signs of an underlying thyroid disease may impair the response to glucocorticoid therapy.

Methods

We performed a pilot retrospective cohort study with matched-subject design and an equivalence hypothesis, comparing the response to glucocorticoid therapy between 20 AIT patients with a normal thyroid gland, low radioiodine uptake, undetectable TSH receptor antibodies and positive TgAb and/or TPOAb (Ab+ group), and 40 patients with the same features and absent thyroid antibodies (Ab− group).

Results

The mean cure time was 54 ± 68 days in the Ab+ group and 55 ± 49 days in the Ab− group (p = 0.63). The equivalence test revealed an equivalent cure rate after 60, 90 and 180 days (p = 0.67, 0.88 and 0.278, respectively). The occurrence of permanent hypothyroidism was higher in the Ab+ group than in the Ab− group (26.3 vs 5.13 %, p = 0.032).

Conclusions

The presence of TgAb and/or TPOAb does not affect the response to glucocorticoid therapy, suggesting that the patients with features of destructive form of AIT should be considered as having a type 2 AIT irrespective of the presence of TGAb or TPOAb. These patients have a higher risk of developing hypothyroidism after the resolution of thyrotoxicosis and should be monitored accordingly.

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Author information

Authors and Affiliations

  1. Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Ospedale Cisanello, Via Paradisa, 2, 56124, Pisa, Italy

    L. Tomisti, C. Urbani, F. Latrofa, C. Sardella, L. Manetti, I. Lupi, C. Marcocci, E. Martino & F. Bogazzi

  2. Endocrine Unit, Department of Clinical and Experimental Medicine, University of Insubria, 21100, Varese, Italy

    L. Bartalena

  3. Unit of Epidemiology and Biostatistics, Institute of Clinical Physiology, National Research Council, 56184, Pisa, Italy

    G. Rossi & O. Curzio

Authors
  1. L. Tomisti
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  2. C. Urbani
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  3. G. Rossi
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  4. F. Latrofa
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  5. C. Sardella
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  6. L. Manetti
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  7. I. Lupi
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  8. C. Marcocci
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  9. L. Bartalena
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  10. O. Curzio
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  11. E. Martino
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  12. F. Bogazzi
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Corresponding author

Correspondence to F. Bogazzi.

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Funding

The work was partially supported by grants from the University of Pisa (Fondi d’Ateneo) to Fausto Bogazzi.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards, and the study was approved by the Internal Review Board of our department.

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Informed consent was obtained for all individual participants included in the study.

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Tomisti, L., Urbani, C., Rossi, G. et al. The presence of anti-thyroglobulin (TgAb) and/or anti-thyroperoxidase antibodies (TPOAb) does not exclude the diagnosis of type 2 amiodarone-induced thyrotoxicosis. J Endocrinol Invest 39, 585–591 (2016). https://doi.org/10.1007/s40618-015-0426-0

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  • DOI: https://doi.org/10.1007/s40618-015-0426-0

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