Skip to main content

Advertisement

SpringerLink
Log in

A comparison of antineutrophil cytoplasmic antibody prevalence in patients treated and untreated for hyperthyroidism

  • Original Article
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

We aimed to compare the prevalence of antineutrophil cytoplasmic antibody (ANCA) and its subgroups between on-treatment (with anti-thyroid drugs; propylthiouracil, methimazole) and untreated patients with hyperthyroidism in our unit. Overall 78 consecutive patients were enrolled in the study; 45 patients were on-treatment (female/male 31:14) and 33 were newly diagnosed (female/male 20:13). We have studied ANCA, perinuclear-ANCA (p-ANCA), cytoplasmic-ANCA (c-ANCA), myeloperoxidase-ANCA (mpo-ANCA), and proteinase 3-ANCA (pr3-ANCA) in sera of all the patients. The data about clinical status, laboratory tests, and physical examination and mean duration of treatment in treated group were recorded. There was no statistically significant difference between the two groups for ANCA, c-ANCA, and pr3-ANCA (P = 0.13, P= 0.07, and P = 0.63 respectively). p-ANCA and mpo-ANCA prevalences were significantly higher in on-treatment group than in untreated group (P = 0.04 and P = 0.01, respectively). The mean duration of treatment was 17 months in on-treatment group. The use of antithyroid drugs (propylthiouracil, methimazole) seems to be correlated with increased prevalence of ANCA. These drugs may especially increase p-ANCA and mpo-ANCA positivity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. A.P. Weetman, Graves’ disease. N. Engl. J. Med. 343(17), 1236–1248 (2000)

    Article  CAS  PubMed  Google Scholar 

  2. K. Gungor, S. Gonen, G. Kisakol, O. Dikbas, A. Kaya, ANCA positive propylthiouracil induced pyoderma gangrenosum. J. Endocrinol. Invest. 29, 575–576 (2006)

    CAS  PubMed  Google Scholar 

  3. M. Gumà, I. Salinas, J.L. Reverter, J. Roca, M. Valls-Roc, M. Juan, A. Olivé, Frequency of antineutrophil cytoplasmic antibody in Graves’ disease patients treated with methimazole. J. Clin. Endocrinol. Metab. 88, 2141–2146 (2003)

    Article  PubMed  Google Scholar 

  4. Y. Gao, M. Chen, H. Ye, X.H. Guo, M.H. Zhao, H.Y. Wang, Follow-up of avidity and titre of anti-myeloperoxidase antibodies in sera from patients with propylthiouracil-induced vasculitis. Clin. Endocrinol. (Oxf) 66, 543–547 (2007)

    CAS  Google Scholar 

  5. J.E. Gunton, J. Stiel, R.J. Caterson, A. McElduff, Clinical case seminar: antithyroid drugs and antineutrophil cytoplasmic antibody positive vasculitis. A case report and review of the literature. J. Clin. Endocrinol. Metab. 84, 13–16 (1999)

    Article  CAS  PubMed  Google Scholar 

  6. S. Lionaki, S.L. Hogan, R.J. Falk, M.S. Joy, H. Chin, C.E. Jennette, J.C. Jennette, P.H. Nachman, Association between thyroid disease and its treatment with ANCA small-vessel vasculitis: a case-control study. Nephrol. Dial. Transplant. 22, 3508–3515 (2007)

    Article  PubMed  Google Scholar 

  7. B. Bonaci-Nikolic, M.M. Nikolic, S. Andrejevic, S. Zoric, M. Bukilica, Antineutrophil cytoplasmic antibody (ANCA)-associated autoimmune diseases induced by antithyroid drugs: comparison with idiopathic ANCA vasculitides. Arthritis Res. Ther. 7, R1072–R1081 (2005)

    Article  CAS  PubMed  Google Scholar 

  8. P.F. Tripodi, R.M. Ruggeri, A. Campenni, Central nervous system vasculitis after starting methimazole in a woman with Graves’ disease. Thyroid 18, 1011–1013 (2008)

    Article  CAS  PubMed  Google Scholar 

  9. T. Bakırcı, K. Nilgün ve ark, A case of propylthiouracil-induced alveolar haemorrhage (article in Turkish language). Solunum Hastalıkları 15, 149–153 (2004)

    Google Scholar 

  10. M. Ohtsuka, Y. Yamashita, M. Doi, S. Hasegawa, Propylthiouracil-induced alveolar haemorrhage associated with antineutrophil cytoplasmic antibody. Eur. Respir. J. 10, 1405–1407 (1997)

    CAS  PubMed  Google Scholar 

  11. T. Saeki, S. Miyamura, M. Nakano, M. Arakawa, A case of Grave’s disease with MPO-ANCA-associated glomerulonephritis during propylthiouracil (PTU) therapy following interstitial pneumonitis. Nippon Jinzo Gakkai Shi 39, 167–171 (1997)

    CAS  PubMed  Google Scholar 

  12. C.G. Kallenberg, J.W. Tervaert, F.J. van der Woude, R. Goldschmeding, A.E. Von dem Borne, J.J. Weening, Autoimmunity to lysosomal enzymes: new clues to vasculitis and glomerulonephritis? Immunol. Today 12, 61–64 (1991)

    Article  CAS  PubMed  Google Scholar 

  13. J.C. Jennette, R.J. Falk, Small-vessel vasculitis. N. Engl. J. Med. 337, 1512–1523 (1997)

    Article  CAS  PubMed  Google Scholar 

  14. K.M. Dolman, R.O. Gans, T.J. Vervaat, G. Zevenbergen, D. Maingay, R.E. Nikkels, A.J. Donker, A.E. von dem Borne, R. Goldschmeding, Vasculitis and antineutrophil cytoplasmic autoantibodies associated with propylthiouracil therapy. Lancet 342, 651–652 (1993)

    Article  CAS  PubMed  Google Scholar 

  15. B.A. Vogt, Y. Kim, J.C. Jennette, R.J. Falk, B.A. Burke, A. Sinaiko, Antineutrophil cytoplasmic autoantibody-positive crescentic glomerulonephritis as a complication of treatment with propylthiouracil in children. J. Pediatr. 124, 986–988 (1994)

    Article  CAS  PubMed  Google Scholar 

  16. M. Tanemoto, H. Miyakawa, J. Hanai, M. Yago, M. Kitaoka, S. Uchida, Myeloperoxidase-antineutrophil cytoplasmic antibody-positive crescentic glomerulonephritis complicating the course of Graves’ disease: report of three adult cases. Am. J. Kidney Dis. 26, 774–780 (1995)

    Article  CAS  PubMed  Google Scholar 

  17. S.J. Stankus, N.T. Johnson, Propylthiouracil-induced hypersensitivity vasculitis presenting as respiratory failure. Chest 102, 1595–1596 (1992)

    Article  CAS  PubMed  Google Scholar 

  18. D. D’Cruz, A.M. Chesser, C. Lightowler, M. Comer, M.J. Hurst, L.R. Baker, A.E. Raine, Antineutrophil cytoplasmic antibody-positive crescentic glomerulonephritis associated with antithyroid drug treatment. Br. J. Rheumatol. 34, 1090–1091 (1995)

    Article  PubMed  Google Scholar 

  19. T. Kitahara, K. Hiromura, A. Maezawa, K. Ono, N. Narabara, S. Yano, T. Naruse, K. Takenouchi, Y. Yasumoto, Case of propylthiouracil-induced vasculitis associated with antineutrophil cytoplasmic antibody (ANCA); review of literature. Clin. Nephrol. 47, 336–340 (1997)

    CAS  PubMed  Google Scholar 

  20. S. Yuasa, M. Hashimoto, T. Yura, T. Sumikura, N. Takahashi, T. Shoji, K. Uchida, H. Fujioka, M. Kihara, H. Matsuo, Antineutrophil cytoplasmic antibodies (ANCA)-associated crescentic glomerulonephritis and propylthiouracil therapy. Nephron 73, 701–703 (1996)

    Article  CAS  PubMed  Google Scholar 

  21. Y. Kawachi, H. Nukaga, M. Hoshino, M. Iwata, F. Otsuka, ANCA-associated vasculitis and lupus-like syndrome caused by methimazole. Clin. Exp. Dermatol. 20, 345–347 (1995)

    Article  CAS  PubMed  Google Scholar 

  22. J.E. Gunton, J. Stiel, P. Clifton-Bligh, E. Wilmshurst, A. McElduff, Prevalence of positive antineutrophil cytoplasmic antibody (ANCA) in patients receiving antithyroid medication. Eur. J. Endocrinol. 142, 587 (2000)

    Article  CAS  PubMed  Google Scholar 

  23. N. Wada, M. Mukai, M. Kohno, A. Notoya, T. Ito, N. Yoshioka, Prevalence of serum anti-myeloperoxidase antineutrophil cytoplasmic antibodies (MPO-ANCA) in patients with Graves’ disease treated with propylthiouracil and thiamazole. Endocr. J. 49, 329–334 (2002)

    Article  CAS  PubMed  Google Scholar 

  24. Aydıntuğ Olca (1992) Antineutrophil cytoplasmic antibody (ANCA) and associated diseases (article in Turkish language), İmmünoloji Romatoloji, T Klin Tıp Bilimleri 12.

  25. M. Fujieda, M. Hattori, H. Kurayama, Y. Koitabashi, Clinical features and outcomes in children with antineutrophil cytoplasmic autoantibody-positive glomerulonephritis associated with propylthiouracil treatment. J. Am. Soc. Nephrol. 13, 437–445 (2002)

    CAS  PubMed  Google Scholar 

  26. J.W. Cohen Tervaert, F.J. Van der Woude, A.S. Fauci et al., Association between active Wegener’s granulomatosis and anticytoplasmic antibodies. Arch Intern Med 149, 2461–2465 (1989)

    Article  Google Scholar 

  27. H. Sato, M. Hattori, M. Fujieda, S. Sugihara, H. Inomata, M. Hoshi, S. Miyamoto, High prevalence of antineutrophil cytoplasmic antibody positivity in childhood onset Graves’ disease treated with propylthiouracil. J. Clin. Endocrinol. Metab. 85, 4270–4273 (2000)

    Article  CAS  PubMed  Google Scholar 

  28. M. Simon, R. Helfgott, N. Smith, Case Records of The Massachusetts General Hospital Weekly clinicopathological exercises. Case 21-2002. A 21-year-old man with arthritis during treatment for hyperthyroidism. N. Engl. J. Med. 347, 122–130 (2002)

    Article  Google Scholar 

  29. L. Harper, L. Chin, J. Daykin, A. Allahabadia, J. Heward, S.C. Gough, C.O. Savage, J.A. Franklyn, Propylthiouracil and carbimazole associated-antineutrophil cytoplasmic antibodies(ANCA) in patients with Graves’ disease. Clin Endocrinol (Oxf) 60, 671–675 (2004)

    Article  CAS  Google Scholar 

  30. Y. Gao, M. Chen, H. Ye, X.H. Guo, M.H. Zhao, H.Y. Wang, The target antigens of antineutrophil cytoplasmic antibodies (ANCA) induced by propylthiouracil. Int. Immunopharmacol. 7, 55–60 (2007)

    Article  CAS  PubMed  Google Scholar 

  31. E.M. Jacobs, A. Hartkamp, H.A. Kaasjager, PTU-associated cutaneous vasculitis with ANCA anti-MPO and anti-PR3 antibodies. Neth. J. Med. 61, 296–299 (2003)

    CAS  PubMed  Google Scholar 

  32. A. Afeltra, A. Paggi, F.G. De Rosa, P. Manfredini, M.A. Addessi, A. Amoroso, Antineutrophil cytoplasmic antibodies in autoimmune thyroid disorders. Endocr. Res. 24, 185–194 (1998)

    CAS  PubMed  Google Scholar 

  33. N. Sera, K. Ashizawa, T. Ando et al., Treatment with propylthiouracil is associated with appearance of antineutrophil cytoplasmic antibodies in some patients with Graves’ disease. Thyroid 10, 595–599 (2000)

    Article  CAS  PubMed  Google Scholar 

  34. J.Y. Noh, T. Asari, N. Hamada et al., Frequency of appearance of myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) in Graves’ disease patients treated with propylthiouracil and the relationship between MPO-ANCA and clinical manifestations. Clin. Endocrinol. (Oxf) 54, 651–654 (2001)

    Article  CAS  Google Scholar 

  35. Y. Gao, M.H. Zhao, X.H. Guo, G. Xin, H.Y. Wang, The prevalence and target antigens of antithyroid drugs induced antineutrophil cytoplasmic antibodies (ANCA) in Chinese patients with hyperthyroidism. Endocr. Res. 30, 205–213 (2004)

    Article  CAS  PubMed  Google Scholar 

  36. R.S. Bahn, H.S. Burch, D.S. Cooper, J.R. Garber, C.M. Greenlee, I.L. Klein et al., The role of propylthiouracil in the management of Graves’ disease in adults: report of a meeting jointly sponsored by the American Thyroid Association and the Food and Drug Administration. Thyroid 19(7), 673–674 (2009)

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgment

This study was supported by the Research Projects Fund Unit of Istanbul University, Grant No. 1860, 2008.

Author information

Authors and Affiliations

  1. Internal Medicine Department, Istanbul University Cerrahpaşa Faculty of Medicine, Istanbul, Turkey

    Turan Çalhan, Ebubekir Şenateş & Sayid Shafi Zuhur

  2. Istanbul Education and Research Hospital, Istanbul, Turkey

    Egemen Cebeci

  3. Fikret Biyal Central Research Laboratory, Istanbul University Cerrahpaşa Faculty of Medicine, Istanbul, Turkey

    Fatma Özbakır

  4. Endocrinology and Metabolism Department, Istanbul University Cerrahpaşa Faculty of Medicine, Istanbul, Turkey

    Uğur Görpe

  5. Haydarpaşa Numune Education and Research Hospital, Gastroenterology Clinic, Istanbul, Turkey

    Ebubekir Şenateş

Authors
  1. Turan Çalhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ebubekir Şenateş
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Egemen Cebeci
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sayid Shafi Zuhur
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fatma Özbakır
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Uğur Görpe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ebubekir Şenateş.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Çalhan, T., Şenateş, E., Cebeci, E. et al. A comparison of antineutrophil cytoplasmic antibody prevalence in patients treated and untreated for hyperthyroidism. Endocr 38, 199–205 (2010). https://doi.org/10.1007/s12020-010-9373-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-010-9373-x

Keywords

Search

Navigation