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From: mikes on 17 Jul 2008 02:25
It was known that thyroid autoantibodies tend to decrease during
replacement therapy. Now this is supported by quantitative analysis.
In average, it takes more than 4 years to see the significant result
(sometimes antibodies disappear completely!).
*******************************************
LONG-TERM FOLLOW-UP OF ANTITHYROID PEROXIDASE ANTIBODIES IN PATIENTS
WITH CHRONIC AUTOIMMUNE THYROIDITIS (HASHIMOTO'S THYROIDITIS) TREATED
WITH LEVOTHYROXINE

Schmidt, Voell, Rahlff et al. Thyroid, July 1, 2008, 18 (7), p.
755-760.
Department of Nuclear Medicine, University of Cologne, Cologne,
Germany.

BACKGROUND: A number of studies show that the serum levels of
antithyroid peroxidase antibodies (TPO-Ab) in patients with
Hashimoto's thyroiditis decline during levothyroxine treatment, but do
not provide quantitative data or report the fraction of patients in
whom test for TPO-Ab became negative (“normalization percentage”). The
objective of the present study was to provide this information.
METHODS: This was a retrospective study of TPO-Ab concentrations in 36
women and 2 men (mean age 51 ± 16 years; range 19–81 years) with
Hashimoto's thyroiditis as defined by the following criteria: elevated
plasma TPO-Ab and typical hypoechogenicity of the thyroid in high-
resolution sonography at first presentation or during follow-up and
low pertechnetate uptake in thyroid scintigraphy. When first studied
17 women and 1 man were not yet taking levothyroxine. The remaining 20
patients were receiving levothyroxine. At initial examination 18
patients had serum thyroid-stimulating hormone (TSH) concentrations
above normal. Results of up to eight (mean = 5.8) measurements
obtained over a mean period of 50 months while patients were receiving
levothyroxine were analyzed. In addition, serum TSH, free
triiodothyronine (fT3), and free thyroxine (fT4) were measured, and
ultrasound of the neck was performed at each follow-up examination.
RESULTS: In terms of TPO-Ab levels, 35 of 38 patients (92%) had a
decrease, 2 patients had undulating levels, and 1 patient had an
inverse hyperbolic increase in her TPO-Ab levels. In the 35 patients
in whom there were decreasing TPO-Ab values, the mean of the first
value was 4779 IU/mL with an SD of 4099 IU/mL. The mean decrease after
3 months was 8%, and after 1 year it was 45%. Five years after the
first value, TPO-Ab levels were 1456 ± 1219 IU/mL, a decrease of 70%.
TPO-Ab levels became negative, < 100 IU/mL, in only six patients, a
normalization percentage of 16%. There were no correlations between
changes in thyroid volume and changes in TPO-Ab.
CONCLUSION: Serum TPO-Ab levels decline in most patients with
Hashimoto's thyroiditis who are taking levothyroxine, but after a mean
of 50 months, TPO-Ab became negative in only a minority of patients.
From: Rod on 17 Jul 2008 03:03
mikes wrote:
> It was known that thyroid autoantibodies tend to decrease during
> replacement therapy. Now this is supported by quantitative analysis.
> In average, it takes more than 4 years to see the significant result
> (sometimes antibodies disappear completely!).
> *******************************************
> LONG-TERM FOLLOW-UP OF ANTITHYROID PEROXIDASE ANTIBODIES IN PATIENTS
> WITH CHRONIC AUTOIMMUNE THYROIDITIS (HASHIMOTO'S THYROIDITIS) TREATED
> WITH LEVOTHYROXINE
>
> Schmidt, Voell, Rahlff et al. Thyroid, July 1, 2008, 18 (7), p.
> 755-760.
> Department of Nuclear Medicine, University of Cologne, Cologne,
> Germany.
>
> BACKGROUND: A number of studies show that the serum levels of
> antithyroid peroxidase antibodies (TPO-Ab) in patients with
> Hashimoto's thyroiditis decline during levothyroxine treatment, but do
> not provide quantitative data or report the fraction of patients in
> whom test for TPO-Ab became negative (�normalization percentage�). The
> objective of the present study was to provide this information.
> METHODS: This was a retrospective study of TPO-Ab concentrations in 36
> women and 2 men (mean age 51 � 16 years; range 19�81 years) with
> Hashimoto's thyroiditis as defined by the following criteria: elevated
> plasma TPO-Ab and typical hypoechogenicity of the thyroid in high-
> resolution sonography at first presentation or during follow-up and
> low pertechnetate uptake in thyroid scintigraphy. When first studied
> 17 women and 1 man were not yet taking levothyroxine. The remaining 20
> patients were receiving levothyroxine. At initial examination 18
> patients had serum thyroid-stimulating hormone (TSH) concentrations
> above normal. Results of up to eight (mean = 5.8) measurements
> obtained over a mean period of 50 months while patients were receiving
> levothyroxine were analyzed. In addition, serum TSH, free
> triiodothyronine (fT3), and free thyroxine (fT4) were measured, and
> ultrasound of the neck was performed at each follow-up examination.
> RESULTS: In terms of TPO-Ab levels, 35 of 38 patients (92%) had a
> decrease, 2 patients had undulating levels, and 1 patient had an
> inverse hyperbolic increase in her TPO-Ab levels. In the 35 patients
> in whom there were decreasing TPO-Ab values, the mean of the first
> value was 4779 IU/mL with an SD of 4099 IU/mL. The mean decrease after
> 3 months was 8%, and after 1 year it was 45%. Five years after the
> first value, TPO-Ab levels were 1456 � 1219 IU/mL, a decrease of 70%.
> TPO-Ab levels became negative, < 100 IU/mL, in only six patients, a
> normalization percentage of 16%. There were no correlations between
> changes in thyroid volume and changes in TPO-Ab.
> CONCLUSION: Serum TPO-Ab levels decline in most patients with
> Hashimoto's thyroiditis who are taking levothyroxine, but after a mean
> of 50 months, TPO-Ab became negative in only a minority of patients.

Good one mike.

I have been reading up a bit recently and found at least some people
think the TPO-Ab are merely a sign of thyroid damage. (The dustcart
after the Lord Mayor's show.) But I haven't got a clear picture so have
refrained from posting. (Doesn't usually stop me. :-) )

In the UK, they tend to treat TPO-Ab as simply a confirmation of
autoimmune thyroid disease so there is no reason ever to revisit the test...

--
Rod

Hypothyroidism is a seriously debilitating condition with an insidious
onset.
Although common it frequently goes undiagnosed.
<www.thyromind.info> <www.thyroiduk.org> <www.altsupportthyroid.org>
From: mikes on 17 Jul 2008 04:09
On Jul 17, 3:03 am, Rod <polygo...(a)ntlworld.com> wrote:
> I have been reading up a bit recently and found at least some people
> think the TPO-Ab are merely a sign of thyroid damage. (The dustcart
> after the Lord Mayor's show.) But I haven't got a clear picture so have
> refrained from posting. (Doesn't usually stop me. :-)   )

> In the UK, they tend to treat TPO-Ab as simply a confirmation of
> autoimmune thyroid disease so there is no reason ever to revisit the test....


Yes, that's what one endo told me - microsomal anti-TPO are merely
markers of the disease. Microsomes are small fragments of damaged
cells. Although, I don't have clear picture of this subject too.

I have to make a correction to my previous comment. Antibodies did not
disappear completely, they only reduced to the so called
"negativity" (<100) according to the authors. I've read couple times
that results are considered "negative" when antibodies are less than
2.0 (which in reality means zero because such values correspond to the
detection limit or analytical error). And this sounds logical to me.
Zero damaged cells - no pathology.

From: Rod on 17 Jul 2008 04:20
mikes wrote:
> On Jul 17, 3:03 am, Rod <polygo...(a)ntlworld.com> wrote:
>> I have been reading up a bit recently and found at least some people
>> think the TPO-Ab are merely a sign of thyroid damage. (The dustcart
>> after the Lord Mayor's show.) But I haven't got a clear picture so have
>> refrained from posting. (Doesn't usually stop me. :-) )
>
>> In the UK, they tend to treat TPO-Ab as simply a confirmation of
>> autoimmune thyroid disease so there is no reason ever to revisit the test....
>
>
> Yes, that's what one endo told me - microsomal anti-TPO are merely
> markers of the disease. Microsomes are small fragments of damaged
> cells. Although, I don't have clear picture of this subject too.
>
> I have to make a correction to my previous comment. Antibodies did not
> disappear completely, they only reduced to the so called
> "negativity" (<100) according to the authors. I've read couple times
> that results are considered "negative" when antibodies are less than
> 2.0 (which in reality means zero because such values correspond to the
> detection limit or analytical error). And this sounds logical to me.
> Zero damaged cells - no pathology.
>

I guess that a very small number of damaged cells will probably exist at
all times (or maybe just quite a bit of the time) - so a very low level
of antibodies in a test could be due to that (as well as detection
limit/analytical error).

--
Rod

Hypothyroidism is a seriously debilitating condition with an insidious
onset.
Although common it frequently goes undiagnosed.
<www.thyromind.info> <www.thyroiduk.org> <www.altsupportthyroid.org>
From: mikes on 17 Jul 2008 04:34
On Jul 17, 4:20 am, Rod <polygo...(a)ntlworld.com> wrote:

> I guess that a very small number of damaged cells will probably exist at
> all times (or maybe just quite a bit of the time) - so a very low level
> of antibodies in a test could be due to that (as well as detection
> limit/analytical error).

I have to agree. Quite a bit of dead cells can probably form naturally
in the processes of their renewal.
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