Betekenis van schildklier antistoffen voordat een diagnose wordt gesteld

Antistoffen tegen thyroglobuline (Tg), thyreoperoxidase (TPO) en de TSH-receptor (TSH-R) komen veel voor bij auto-immuunziekten van de schildklier. Onderzocht werd hoe vaak vrouwen met de ziekte van Graves of Hashimoto-thyreoïditis vóór de klinische diagnose schildklierantistoffen hebben.

Significance of prediagnostic thyroid antibodies in women with autoimmune thyroid disease (AITD)
S Hutfless, P Matos, MV Talor, P Caturegli, NR Rose

Antistoffen en de ontwikkeling van euthyreoïdie naar hypo- of hyperthyreoïdie
Uitleg in het Nederlands

Methods

This was a nested case-control study using the Department of Defense Serum Repository and the Defense Medical Surveillance System, 1998–2007. We assessed thyroid antibodies in the serum of 522 female, active-duty, military personnel including: 87 Graves disease cases, 87 Hashimoto thyroiditis cases, and 348 age matched controls. One serum sample was available at the time of the clinical diagnosis (± 6 months); three additional samples were retrieved from the repository up to 7 years before the clinical diagnosis, for a total of 2088 samples.

Results

In Hashimoto thyroiditis, TPO antibodies were found in about 66% of the cases at all time points. Tg antibodies showed a similar stationary trend, at a lower prevalence of about 53% at all time points. No TSH-R antibodies were found.

In Graves disease, TPO antibodies gradually increased from 31% at 5–7 years prior to diagnosis to 57% at diagnosis and Tg antibodies from 18 to 47%. TSH-R antibodies were present before diagnosis and showed an increasing prevalence from 2, 7, 20, to 55%.

Conclusions

Antibodies to Tg, TPO, and TSH-R precede by years the development of the diagnostic autoimmune thyroid diseases phenotype. Overall, the presence of thyroid antibodies in apparently healthy individuals should not be neglected.