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Chen et al., Maidashi, Japan, found that in 5 patients, who had
a history of autoimmune thyroid disease 2 to 16 years earlier (3 Graves',
2 Hashimoto), when they were treated with recombinant interferon-alpha
(rIFN-alpha) for chronic hepatitis C, 4/5 patients developed overt hypothyroidism,
4-7 months after rIFN-a therapy. Strongly positive TSH-receptor blocking
antibodies and an increase in CD19+ intrathyroidal lymphocytes were found.
One patient became later thyrotoxic, due to the induction of TSH-receptor
stimulating antibodies. In all 4 patients thyroid function recovered to
normal. rIFN-a therapy may apparently induce thyroid autoimmunity in patients
with pre-existing autoimmune thyroid disease.
Pop et al., Eindhoven, The Netherlands, examined the question if women, who are thyroperoxidase-antibody (TPO-Ab) positive, are at risk for mental depression. They investigated 2779 women, who were at random chosen from a cohort of 6293 women, being 79% of women between 47 and 53 years of age from the city of Eindhoven, who were invited to participate in a screening program for osteoporosis. In these 2779 women FT4, TSH, and TPO-Ab were assessed and depression was evaluated by means of the Edinburgh Postnatal Depression Scale. From this group 1124 women were at random chosen, who completed also other questionnaires (Beck Depression Scale and other determi-nants on stressful life events). In the regression analysis, the occurence of stress-ful life events, a previous episode of depression and TPO-Ab were significantly associated with depression at the moment of investigation. Moreover, women with depression had an 2.5 times increased risk for positivity of TPO-Ab. It is concluded that an association may be present between depression and autoimmune thyroid disease as reflected by high titers of TPO-Ab. (Comment: Serum TSH levels and FT4 levels were not reported. Thus, it is not known if the patients, who were depressed, had abnormal thyroid function and/or if the mean values of these parameters differed from those without depression.) Muller et al., Rotterdam, The Netherlands, did a prospective study in 173 women out of 467 women, undergoing in vitro fertilisation, to analyze whether spontaneous abortion was related to the presence of TPO-Ab and/or anticardiolipin antibodies (ACL-Ab). Fifty-five women became pregnant, of whom 45 had ongoing pregnancies and 10 miscarried. The prevalence of TPO-Ab in aborters was 4/10 (40%) and in ongoing pregnancies 7/42 (17%) (not signifi-cant). However, the prevalence of TPO-Ab in aborters was different compared to normal non-pregnant females, 78/692 (11%). ACL-Ab in aborters and ongoing pregnancies and in control females were not significantly different. The authors conclude that thyroid autoimmunity before pregnancy is significantly more prevalent in future aborters versus normal female non-pregnant controls. (Comment: So far, maybe to limited number of subjects, the authors have not shown that in pregnancy, due to IVF, abortion is more prevalent in TPO positive subjects. It would be of interest to see a similar study in a larger group of subjects.) Premawardhana et al., Cardiff, UK, studied abnormalities of thyroid function and morphology, as reflected by ultrasound in 134 women, 7 to 10 years following recruitment to a postpartum thyroid dysfunction (PPTD) study. Twenty-nine TPO-Ab negative women formed the control group (21.6%). Of the 105 TPO positive women 57 had no previous evidence of PPTD, and 48 had PPTD in the past. At follow-up, all TPO-Ab negative subjects had normal thyroid function. Of the TPO-Ab positive subjects 23.8% had thyroid dysfunction, predominantly hypothyroidism. Hypothyroidism was much more common (43.7%) in TPO positive women, who previously had PPTD than in those (7.1%) who had not. Thyroid echography was abnormal in 55% of TPO positive women and was even more prevalent in those who had PPTD than in those who had not. There was no correlation between morphological abnormalities and thyroid dysfunction. It is concluded that in TPO positive women, who developed transient PPTD in the past, significant thyroid dysfunction continues to occur 7 to 10 years postpartum. From this study it appeared also that most women, who were hypothyroid, required T4 substitution permanently. Barbesino et al., Pisa and Cagliari, Italy, studied the prevalence of anti-cardiolipin antibodies (aCL) in 35 patients with Graves' disease and in 36 patients with Hashimoto thyroiditis. They found positive aCL in 11/35 (= 31.4%) of Graves' disease patients, and in 2 (5.5%) patients with Hashimoto thyroiditis. The history of spontaneous abortions was not different in aCL positive and aCL negative patients. Treatment of Graves' disease patients with methimazo-le or radioactive iodine effected a decrease in aCL levels. The presence of aCL antibodies was not associated with clinical manifestations of the aCL syndrome. (Comment: this study shows that the prevalence of aCL antibody is rather an epiphenomenon of autoimmune disease than a marker of clinical manifestation of the aCL syndrome.) |
