Thyroid Function and Prevalence of Anti-Thyroperoxidase (TPO) and Anti-Thyroglobulin (Tg) Antibodies in Outpatients Hospital Setting in an Area with Sufficient Iodine Intake: Influences of Age and Sex
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Abstract
In order to examine the prevalence of thyroid disease in a hospital outpatient setting, in an area of sufficient iodine intake, serum levels of TSH, T4, T3, anti-Tg and anti-TPO antibodies were examined in 909 individuals with an age range of 12.4 to 88.5 years, participating in a checkup outpatient setting. The study was conducted in Henry Dynant Hospital located in the metropolitan area of Athens, Greece, during a 2 year period. Hormonal parameters were determined by chemiluminescence immunoassay. Overt thyrotoxicosis was found in 4.95% of the total population and subclinical thyrotoxicosis in 5.5%. Overt hypothyroidism was found in 1.43% and subclinical hypothyroidism in 4.51%. In male population, overt thyrotoxicosis was found in 4.4 % and subclinical thyrotoxicosis was also found in 4.4%. On the other hand, overt hypothyroidism was found in 1.4% and subclinical hypothyroidism was found in 3.7% in males. In female population, overt thyrotoxicosis was found in 5.2% whereas subclinical thyrotoxicosis was found in 6.0%. Overt hypothyroidism was found in 1.5% and subclinical hypothyroidism was found in 4,9% in females. Positive anti-TPO antibodies were detected more often (30.4%) than anti-Tg (15.4%) in the tested population. The positivity in both anti-TPO and anti-Tg antibodies was correlated with abnormally high TSH concentrations after the age of 50 years, especially in female population. In conclusion distinct profile of thyroid hormonal parameters was observed in inhabitants in the metropolitan area of Athens, with overt thyrotoxicosis strikingly overcome overt hypothyroidism while subclinical forms of each dysfunction also exhibit analogous results.
Vanderpump MPJ, Tunbridge WMG. The epidemiology of thyroid diseases. In: L.E. Bravermann, R.D. Utiger, eds: Werner & Ingbar’s. The thyroid: a fundamental and clinical text. 8th edition. Philadelphia: Lippincott-Raven Publishers 2000; p. 467-73.
Jarlov AE, Nygaard B, Hegedus L, Hartling SG, Hansen JM. Observer variation in the clinical and laboratory evaluation of patients with thyroid dysfunction and goiter. Thyroid 1998;8(5):393–8.
Ladenson PW, Singer PA, Ain KB, Bagchi N, Bigos ST, Levy EG, Smith SA, Daniels GH, Cohen HD. American Thyroid Association guidelines for detection of thyroid dysfunction. Arch Intern Med 2000;160(11):1573–5.
Ross DS. Subclinical hypothyroidism. In: L.E. Bravermann. Utiger RD, eds:Werner & Ingbar’s. The thyroid: a fundamental and clinical text. 8th edition, Philadelphia: Lippincott-Raven Publishers;2000. p. 1001-6.
Ross DS. Subclinical thyrotoxicosis. In: L.E. Bravermann. Utiger RD. eds: Werner & Ingbar’s. The thyroid: a fundamental and clinical text.8th edition. Philadelphia: Lippincott-Raven Publishers 2000; p. 1007-12.
Duntas LH. Subclinical hypothyroidism: a misnomer in search of a new name. Thyroid 2001;11( 4):361- 2.
Goulis DG, Tsimpiris N, Delaroudis S, Maltas B, Tzoiti M, Dagilas A, Avramides A. Stapedial reflex: a biological index found to be abnormal in clinical and subclinical hypothyroidism. Thyroid1998;8(7):583-7.
Monzani F, Caraccio N, Siciliano G, Manca L, Murri L, Ferrannini E. Clinical and biochemical features of muscle dysfunction in subclinical hypothyroidism. J Clin Endocrinol Metab 1997;82(10):3315-8.
Zulewski H, Muller B, Exer P, Miserez AR, Staub JJ. Estimation of tissue hypothyroidism by a new clinical score: evaluation of patients with various grades of hypothyroidism and controls. J Clin Endocrinol Metab 1997;82(3):771-6.
Fatourechi V. Subclinical thyroid disease. Mayo Clin Proc 2001;76(4): 413-6.
Smallridge RC. Disclosing subclinical thyroid disease. An approach to mild laboratory abnormalities and vague or absent symptoms. Postgrad Med 2000;107(1):143-6.
Samuels MH. Subclinical thyroid disease in the elderly. Thyroid 1998;8(9): 803-13.
Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med 2000;160(4):526-34.
Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA. Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002;87(2):489-99.
Tunbridge WM, Evered DC, Hall R, Appleton D, Brewis M, Clark F. The spectrum of thyroid disease in a community: the Whickham Survey. Clin Endocrinol (Oxf) 1997;7(8):481-93.
Sawin CT, Castelli WP, Hershman JM, McNamara P, Bacharach P. The aging thyroid.Thyroid deficiency in the Framingham Study. Arch Intern Med 1985; 145(8):1386-8.
Laurberg P, Pedersen KM, Hreidarsson A, Sigfusson N, Iversen E, Knudsen PR. Iodine intake and the pattern of thyroid disorders: a comparative epidemiological study of thyroid abnormalities in the elderly in Iceland and in Jutland, Denmark. J Clin Endocrinol Metab 1998;83(3):765-9.
Surks MI, Ocampo E. Subclinical thyroid disease. Am J Med 1996;100(2):217-23.
Helfand M, Redfern CC. Screening for thyroid disease: an update. Ann Intern Med 1998;129(2)144-58.
Cooper DC. Subclinical thyroid disease: a clinician’s perspective. Ann Intern Med 1999;129(12):135- 7.
Hak AE, Pols HAP, Visser TJ, Drexhage HA, Hofman A, Witteman JCM. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study. Ann Intern Med 2000;132(4):270-8.
Morris MS, Bostom AG, Jacques PF, Selhub J, Rosenberg IH. Hyperhomocysteinemia and hypercholesterolemia associated with hypothyroidism in the third U.S. National Health and Nutrition Examination Survey. Atherosclerosis 2001;155(1):195-200.
Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med 2000;160(4):526-34.
Knudsen N, Jorgensen T, Rasmussen S, Christiansen E, Perrild H. The prevalence of thyroid dysfunction in a population with borderline iodine deficiency. Clin Endocrinol (Oxf) 1999;51(3 ):361-7.
Volzke H, Alte D, Kohlmann T, Ludemann J, Nauck M, John U. Reference intervals of serum thyroid function tests in a previously iodine-deficient area. Thyroid 2005;15(3):279-85.
Malamos B, Koutras DA, Kostamis P, Kralios AC, Rigopoulos G, Zerefos N. Endemic goiter in Greece: Epidemiologic and genetic Studies. Journal of Clinical Endocrinology and Metabolism 1966; 26(7): 688-95.
Malamos B, Koutras DA, Marketos SG, Rigopoulos GA, Yataganas XA, Binopoulos D, Sfontouris J, Pharmakiotis AD, Vought RL, London WT. Endemic goiter in Greece: An iodine balance study in the field. Journal of Clinical Endocrinology and Metabolism 1967; 27(17):1372-80.
Malamos B, Miras K, Koutras DA, Kostamis P, Binopoulos D, Mantzos J, Levis G, Rigopoulos G, Zerefos N, Tassopoulos CN. Endemic goiter in Greece: metabolic= studies. Journal of Clinical Endocrinology and Metabolism 1966;26(7):696- 704.
Koutras DA, Papadopoulos SN, Sfontouris J, Rigopoulos GA, Pharmakiotis AD, Malamos B. Endemic goiter in Greece: Clinical and metabolic effects of iodized salt. Journal of Clinical Endocrinology and Metabolism 1968;28(11):1651-6.
Malamos B, Koutras DA, Mantzos J, Chiotaki L, Sfontouris J, Papadopoulos SN. Endemic goiter in Greece: effects of iodized oil injection. Metabolism 1970;19(8):569-80.
Moulopoulos DS, Koutras DA, Mantzos J, Souvatzoglou A, Piperingos GD, Karaiskos KS, Makriyannis D, Sfontouris J, Moulopoulos SD. The relation of serum T4 and TSH with the urinary iodine excretion. Journal of Endocrinological Investigation 1988;11(6): 437-9.
Kahaly GJ, Dienes HP, Beyer J, Hommel G. Iodide induces thyroid autoimmunity in patients with endemic goitre: a randomised, double blind, placebo-controlled trial. European Journal of Endocrinology 1998;139(21):290-7.
Bagchi N, Brown TR, Urdanivia E, Sundick RS. Induction of autoimmune thyroiditis in chickens by dietary iodine. Science 1985; 230(4723):325-7.
Sundick RS, Herdegen DM, Brown TR, Bagchi N. The incorporation of dietary iodine into thyroglobulin increases its immunogenicity. Endocrinology 1987;120(5,):2078-84.
Rezvanfar MR, Farahany H, Chehreiy A, Nemati M, Rostamy S, Karimy E. Urinary iodine excretion and antiperoxidase enzyme antibody in goitrous and healthy primary school children of Arak, Iran. J Endocrinol Invest 2007;30(4): 274-8.
Fountoulakis S, Philippou G, Tsatsoulis A. The role of iodine in the evolution of thyroid disease in Greece: from endemic goiter to thyroid autoimmunity. Hormones (Athens) 2007;6(1)25-35.
Zois C, Stavrou I, Svarna E, Seferiadis K, Tsatsoulis A. Natural course of autoimmune thyroiditis after elimination of iodine deficiency in northwestern Greece. Thyroid 2006;16(3):289-93.
Surks MI, Hollowell JG. Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US= population: implications for the prevalence of subclinical hypothyroidism. J Clin Endocrinol Metab 2007;92(12):4575–82.
Atzmon G, Barzilai N, Hollowell JG, Surks MI, Gabriely I. Extreme Longevity Is Associated with Increased Serum Thyrotropin. J Clin Endocrinol Metab 2009;94(4):1251–4.
Ravaglia G, Forti P, Maioli F, Nesi B, Pratelli L, Savarino L, Cucinotta D, Cavalli G. Blood micronutrient and thyroid hormone concentrations in the oldest-old. J Clin Endocrinol Metab 2000;85(6):2260–5.
Tietz NW, Shuey DF, Wekstein DR. Laboratory values in fit aging individuals-sexagenarians through centenarians. Clin Chem 1992;38:1167–85.
van den Beld AW, Visser TJ, Feelders RA, Grobbee DE, Lamberts SW. Thyroid hormone concentrations, disease, physical function, and mortality in elderly men. J ClinEndocrinol Metab 2005; 90(12):6403–09.
Magri F, Muzzoni B, Cravello L, Fioravanti M, Busconi L, Camozzi D, Vignati G, Ferrari E. Thyroid function inphysiological aging and in centenarians: possible relationships with some nutritional markers. Metabolism 2002;51(1):105–9.
Boucai L, Surks MI. Reference limits of serum TSH and free T4 are significantly influenced by race and age in an urban outpatient medical Practice. Clinical Endocrinology 2009;70(5):788–93.
Vanderpump MP, Tunbridge WM, French JM, Appleton D, Bates D, Clark F, Evans GJ, Hasan DM, Rodgers H, Tunbridge F. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf) 1995;43(1):55-68.
Hoogendoorn HE, Hermus RA, de Vegt F, Ross HA, Verbeek AL, Kiemeney LA, Swinkels DW, Sweep FC, den Heijer M. Thyroid Function and Prevalence of Anti- Thyroperoxidase Antibodies in a Population with Borderline Sufficient Iodine Intake: Influences of Age and Sex. Clinical Chemistry 2006; 52(1)104-11.
Andersen S, Pedersen KM, Bruun HN, Laurberg P. Narrow Individual Variations in Serum T4 and T3 in Normal Subjects: A Clue to the Understanding of Subclinical Thyroid Disease. J Clin Endocrinol Metab 2002;87(3):1068-72.
Meier CA, Maisey MN, Lowry A, Muller J, Smith MA. Interindividual differences in the pituitary-thyroid axis influence the interpretation of thyroid function tests. Clin Endocrinol 1993;39(1): 101-17.
Spencer CA, Lopresti JS, Patel A, Guttler RB, Eigen A, Shen D, Gray D, Nicoloff JT. Applications of a new chemiluminometric thyrotropin assay to subnormal measurement. J Clin Endocrinol Metab 1990;70(2):453-60.
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| Issue | Vol 51, No 1 (2013) | |
| Section | Original Article(s) | |
| Keywords | ||
| Autoimmunity Population study Thyroid function | ||
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