New Approach of Autoimmune Thyroid Disease

The Role of Antibody Test

Mohammad Robikhul Ikhsan

Endocrinology, Metabolic and Diabetes Sub Division
Internal Medicine Division, GMU Faculty of Medicine/Sardjito Centre Hospital

PIT IPD 2023 Hotel Royal Ambarrukmo Yogyakarta, 5-6 Agustus 2023
 Immune Response
Self A complex biological network of
Antigen
Antigen organs, cells and proteins that
defends the body against antigen
Innate Immunity Adaptive Immunity

Aberration in the body's normal

development such that the
immune system mounts an
attack against its own cells/part
of cell

Autoimmunity
Dranoff G. Nat Rev Cancer 2004;4:11-22
Chen JQ, Szodoray P, Zeher M. Clin Rev Allergy Immunol. 2016 Feb;50(1):1-17.
 Autoimmunity
Celuler autoreactivity/
Hyper response
Sel/auto
Antigens

B lymphocytes T-lymphocytes
over synthesis and directed stimulation
secretion of to CD4+ differentiate
auto antibodies and CD8+ activated

Chen JQ, Szodoray P, Zeher M. Clin Rev Allergy Immunol. 2016 Feb;50(1):1-17.
 Autoimmune diseases
Autoantibodies and pro
inflammatory cytokines cause a
pathological and/or functional
damage to the organ/tissue

Andrew W. Campbell, "Autoimmunity and the Gut", Autoimmune Diseases, vol. 2014,
 Autoimmune Thyroid Diseases
• Organ specific autoimmune disorder

• Forms of AITD
• Graves’ disease (GD)
• Hashimoto’s thyroiditis (HT)
• Postpartum thyroiditis (PPT)
• Atrophic autoimmune hypothyroidism
• Thyroid associated orbitopathy (TAO)

Prummel MF, Strieder T, Wiersinga WM. The environment and autoimmune

thyroid diseases. Eur J Endocrinol. 2004;150:605-18.
 Prevalence of AITD

• Increases 2nd and 3rd decades of age

• 8-11 per 1000 and 95% among them are
women (4-8:1)
• Tends to occur more in younger
individuals

Prummel et al. The environment and autoimmune thyroid diseases. Eur J Endocrinol. 2004;150:605-18.
 Physiology of Thyroid

• Thyroid hormones bind to

receptors in all cells
• Regulate whole body
metabolism
The thyroid gland affects every
tissue in the body that requires
increased cellular activity

Hill RN, Crisp TM, Hurley PM, Rosenthal SL, Singh DV (August 1998). "Risk assessment of thyroid
follicular cell tumors". Environ. Health Perspect. 106 (8): 447–57
 Autoimmunity on Thyroid Disorders
Thyroglobulin Thyrotropin
Antibody Receptor
(TgAb) Antibody
(TRAb)

Thyroid
Peroxidase
Antibody
(TPOAb)
Pendrin
TPO TPO Antibody
(AntiNIS) NIS
Antibody
(AntiNIS)
 Autoimmunity on Thyroid Disorders
Environmental factors Genetic factors

Autoantigen

Humoral
immune system

Antibody

TPO TSHR
Antibody Antibody
Prummel MF, Strieder T, Wiersinga WM. Eur J Endocrinol. 2004;150:605-18.
 Pathogenesis Hashimoto’s thyroiditis
Thyroid peroxidase (TPO)
antibodies
Sign of Hashimoto thyroiditis

• Chronic lymphocytic thyroiditis

• 1912 pathology report by
Hashimoto
• Goiter and intense lymphocytic
infiltration of the thyroid

Cruz AA, Akaishi PM, Vargas MA, de Paula SA. Association between thyroid autoimmune dysfunction and non-thyroid autoimmune diseases. Ophthal Plast Reconstr Surg. 2007 Mar-Apr. 23(2):104-8.
Hashimoto's thyroiditis. Zimmerman RS, Brennan MD, McConahey WM, Goellner JR, Gharib H, Ann Intern Med. 1986;104(3):355.
 Chronic
Lymphocytic
Thyroiditis

https://calgaryguide.ucalgary.ca/hashimotos-thyroiditis-
pathogenesis-and-clinical-findings-2/
 Use of Antibody test for Autoimmune thyroid disease

HIPOTHYROID Thyroid Peroxidase

High TSH Low Thyroxine Antibody Test (TPOAb)
• Young DIAGNOSIS
• Female
• Thyroid enlargement
• No evidence of : thyroid
resection, radiation, ablation,
iodine deficiency
Hashimoto Postpartum
• Associated with postpartum Thyroiditis Thyroiditis
E VA L U AT I O N
Patients with elevated TPOab Hormone Evaluation :
but normal thyroid function tests  Hormone level
do not require treatment Replacement Antibody level
Thyroid Peroxidase (Anti-TPO) Autoantibodies
 Antibody test for Graves’ disease
Environment Individu Genetic susceptibility
Thyrotropin (TSH) receptor
antibody (TRAb) Immune system
Sign of Grave's disease changes
Immune tolerant Self antigen
CD4+, FOXP3 (Autologous)
Autoimmunity
• Common cause of
autoimmune
Hyperreactivity
hyperthyroidism Immune System
• Robert J. Graves, MD, 1830 B cell activity
• Causing thyroid growth, TRAb synthesis
hormone synthesis and
Bond to receptor in Thyroid cells
secretion thyroid cells hyperactivity
 Use of Antibody test for Autoimmune thyroid disease

HIPERTHYROID
Low TSH High Thyroxine
Thyrotropin Receptor
• Young Antibody Test (TSHr-Ab)
• Female than male
DIAGNOSIS
• Thyroid enlargement
• Ophthalmopathy
Graves’ Disease

E VA L U AT I O N
Patients with elevated TSHr-ab Anti Thyroid Hormone
but normal thyroid function tests  Hormone level
do not require treatment Treatment Antibody level
TRAb Position in Graves Disease (GD)
 Summary

• Thyroid dysfunctions are common endocrine problems

• Autoimmune thyroid disease (AITD) is a common organ specific
autoimmune disorder on thyroid
• Hashimoto’s thyroiditis (HT), Graves’ disease (GD) are the
commonest type of AITD
• TPOAb and TRAb are mandatory used in autoimmune thyroid
disease for diagnosis, evaluation and prognostic factor of GD
Thank You