Persisting symptoms in patients with Hashimoto’s disease despite normal thyroid hormone levels: Does thyroid autoimmunity play a role? A sys

[helvella]

A review with an unsurprising conclusion. And the usual "more research"…

Persisting symptoms in patients with Hashimoto’s disease despite normal thyroid hormone levels: Does thyroid autoimmunity play a role? A systematic review

Karelina L.Groenewegen Christiaan F.Mooij A.S. Paulvan Trotsenburg

Highlights

• This review reports on a relation between thyroid autoimmunity and symptoms.

• Persisting symptoms in euthyroid HD patients may be associated with autoimmunity.

• Thyroid autoimmunity and symptoms were associated in population-based studies.

Abstract

Objective

Patients with hypothyroidism due to Hashimoto’s disease (HD) may experience persisting symptoms despite normal serum thyroid hormone (TH) levels. Several hypotheses have been postulated to explain these persisting symptoms. We hypothesized that thyroid autoimmunity may play a role.

Design

A systematic literature review.

Methods

A PubMed search was performed to find studies investigating the relation between the presence of thyroid autoimmunity and (persisting) symptoms. Included studies were critically appraised by the Newcastle – Ottawa Scale (NOS) and then subdivided into (A) disease-based studies, comparing biochemically euthyroid patients with HD, and euthyroid patients with non-autoimmune hypothyroidism or euthyroid benign goitre, and (B) (general) population-based studies. Due to different outcome measures among all studies, meta-analysis of data could not be performed.

Results

Thirty out of 1259 articles found in the PubMed search were included in this systematic review. Five out of seven disease-based studies found an association between thyroid autoimmunity and symptoms or lower quality of life (QoL). Sixteen of 23 population-based studies found a comparable positive association. In total, the majority of included studies reported an association between thyroid autoimmunity and persisting symptoms or lower QoL in biochemically euthyroid patients.

Conclusion

(Thyroid) autoimmunity seems to be associated with persisting symptoms or lower QoL in biochemically euthyroid HD patients. As outcome measures differed among the included studies, we propose the use of similar outcome measures in future studies. To prove causality, a necessary next step is to design and conduct intervention studies, for example immunomodulation vs. placebo preferably in the form of a randomized controlled trial, with symptoms and QoL as main outcomes.

Pleasant surprise to have free access to a paper on Elsevier:

sciencedirect.com/science/a...

[tattybogle]

Is it me ...• Persisting symptoms in euthyroid HD patients may be associated with autoimmunity.

Everyone with HD has autoimmunity ?... so persisting symptoms must be "associated" with autoimmunity.. surely ?

Ok i'm being pedantic , but,

Isn't that a bit like saying "cold heads found in patients with baldness might be associated with lack of hair"

To prove causality, a necessary next step is to design and conduct intervention studies, for example immunomodulation vs. placebo preferably in the form of a randomized controlled trial, with symptoms and QoL as main outcomes......

Wonder how they're going to do that then ? immuno suppressants ?

[Tythrop]

So I take this to mean that autoimmune people are people with anti-thyroid antibodires? I wonder if the level of anti thyroid antibodies were considered? Eg the higher the antibody count the worse the symptoms?

[helvella Administrator in reply to Tythrop]

Most patients with autoimmune thyroid disease do have Thyroid peroxidase antibodies (TPOab). However, some don't - they might have Thyroglobulin antibodies (TGab). And many have some TPOab but never seem to suffer thyroid disease.

Even if antibody levels are seen to go hand-in-hand with symptom level, it is difficult to be sure why. Do antibodies rise when the disease process increases in severity? Some suggest that antibody levels cause an increase in disease severity but I am not at all convinced of that.

[TSH110 in reply to helvella]

I thought studies were unable to link levels of antibodies with disease severity, mind you I don’t know how many studies have looked at it or if they were any cop

[helvella Administrator in reply to TSH110]

Yes - but even if they did!

We have had many posts where members have had multiple tests and feel that there is some association between antibody level and symptom severity. I am not convinced but it seems feasible that at least in some people it could look like it were so.

[TSH110 in reply to helvella]

Yes it seems odd to me that they would not be related. I think Dr Tania Smith did a blog post about it or she discussed it and seemed to imply the two are not always running in parallel so to speak. I will try and find it and reread it to see what explanation she had for this anomaly

[tattybogle in reply to Tythrop]

I wonder if the level of anti thyroid antibodies were considered?

Almost certainly not...this article is a simply a 'systematic literature search', rather than an actual research study of anything.

Since the only information usually collected is an initial antibody test done at the time of diagnosis , that is all they would have had to look at .

A lot of 'autoimmune' people don't even get that done.. it's just treated as 'hypothyroidism' , without looking for a cause. Since the cause makes no difference to current treatment.