Antineutrophil cytoplasmic antibodies in autoimmune thyroid disorders

Afeltra, Antonella; Paggi, A; Rosa, Francesco Giuseppe De; Manfredini, P; Addessi, Maria Assunta; Amoroso, Antonio

doi:10.1080/07435809809135527

Cited by 23 publications

(11 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although it was reported that aspecific (atypical) ANCAs were detected by immunofluorescence in some patients with Graves' disease [24,25], MPO-ANCA assessed by ELISA may not appear in untreated patients with Graves' disease [14, 24,25]. There may be a specific reason why the anti-thyroid drug itself, especially PTU, can induce MPO-ANCA and ANCA-associated vasculitis.…”

Section: Discussionmentioning

confidence: 99%

Anti-Thyroid Drug-Induced ANCA-Associated Vasculitis. A Case Report and Review of the Literature.

2000

View full text Add to dashboard Cite

Abstract.We report a case of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis induced by propylthiouracil (PTU), and review the literature concerning to anti-thyroid drug-induced ANCA-associated vasculitis.A 45-year-old man treated with PTU developed fever and arthralgia without pulmonary, skin or eye involvement. These symptoms persisted for a long period without specific symptom, sign or laboratory data of other arthritis. Laboratory findings of urine and blood were normal, except for positive MPO-ANCA (191EU) and PR3-ANCA (37EU) findings. After PTU was discontinued without steroids or immune modulating drugs, both symptoms disappeared.Our patient had a high titer of MPO-ANCA. Moreover, titers of ANCA fell in correlation with the course of symptoms after the cessation of PTU, and we diagnosed PTU-induced ANCA-associated vasculitis. Most patients with pulmonary renal syndrome receive anti-thyroid drugs over a prolonged period, but the duration of our case was shorter than those of these patients.It is suggested that our patient was diagnosed at an early stage of ANCA-associated vasculitis before the start of pulmonary or renal involvement.

show abstract

Section: Discussionmentioning

confidence: 99%

Anti-Thyroid Drug-Induced ANCA-Associated Vasculitis. A Case Report and Review of the Literature.

2000

View full text Add to dashboard Cite

show abstract

“…The same study also reported a significantly higher rate of ANCA positivity for patients under PTU treatment when compared to those receiving carbimazole. Another study investigating ANCA frequency with IFA in autoimmune thyroid diseases reported ANCA positivity in 28.5% of patients with Graves' disease and in 9% of those with Hashimoto's disease [32]. Although no significant difference was detected in overall ANCA positivity between the two groups in our study (P = 0.13), p-ANCA and mpo-ANCA positivity had a significantly higher frequency in the on-treatment group (P = 0.04 and P = 0.01, respectively).…”

Section: Discussionmentioning

confidence: 97%

“…High ANCA titers have been observed in patients' serum samples obtained before treatment in studies with Graves' disease patients, which has been associated with the nature of the disease [3,32,34]. Other studies have reported marked decreases in ANCA levels with MMI treatment.…”

Section: Discussionmentioning

confidence: 97%

A comparison of antineutrophil cytoplasmic antibody prevalence in patients treated and untreated for hyperthyroidism

Çalhan

Şenateş

Cebeci³

et al. 2010

Endocr

View full text Add to dashboard Cite

We aimed to compare the prevalence of antineutrophil cytoplasmic antibody (ANCA) and its subgroups between on-treatment (with anti-thyroid drugs; propylthiouracil, methimazole) and untreated patients with hyperthyroidism in our unit. Overall 78 consecutive patients were enrolled in the study; 45 patients were on-treatment (female/male 31:14) and 33 were newly diagnosed (female/male 20:13). We have studied ANCA, perinuclear-ANCA (p-ANCA), cytoplasmic-ANCA (c-ANCA), myeloperoxidase-ANCA (mpo-ANCA), and proteinase 3-ANCA (pr3-ANCA) in sera of all the patients. The data about clinical status, laboratory tests, and physical examination and mean duration of treatment in treated group were recorded. There was no statistically significant difference between the two groups for ANCA, c-ANCA, and pr3-ANCA (P=0.13, P=0.07, and P=0.63 respectively). p-ANCA and mpo-ANCA prevalences were significantly higher in on-treatment group than in untreated group (P=0.04 and P=0.01, respectively). The mean duration of treatment was 17 months in on-treatment group. The use of antithyroid drugs (propylthiouracil, methimazole) seems to be correlated with increased prevalence of ANCA. These drugs may especially increase p-ANCA and mpo-ANCA positivity.

show abstract

“…9,10 Unfortunately, good longitudinal studies assessing baseline prevalence of the various antibody species and conversion rates after thioamide exposure are lacking. [11][12][13][14] Indeed, there are conflicting data on the prevalence of ANCAs before thioamide initiation causing some to attribute the ANCAs to the autoimmune thyroid disease state. 6 The occurrence of ANCAs with other medications, including hydralazine, minocycline, and sulfasalazine, supports thioamide causality 15,16 as does ANCA occurrence in normal cats after propylthiouracil treatment 17 and in nonimmune-mediated disease and multinodular goiter, albeit with lower titers than in Graves disease.…”

Section: Discussionmentioning

confidence: 99%

“…Atypical perinuclear-ANCA staining in which the immunofluorescence is more homogeneously distributed has been described. 7,11,15,30,31 Often, the enzyme-linked immunosorbent assay is negative for myeloperoxidase. Antilactoferrin and antielastase antibodies account for many atypical ANCA results, especially when drug-associated.…”

Section: Discussionmentioning

confidence: 99%

Atypical Antineutrophil???Cytoplasmic Antibodies and Vasculitis-Like Syndrome With Aphthous Ulcer and Violaceous Pinnae after Retreatment With Propylthiouracil for Graves Disease

Koller

Svoboda

Jones

et al. 2006

The Endocrinologist

View full text Add to dashboard Cite

Rash with thioamides is not uncommon, but vasculitis is rare. The vasculitis is thought to be mediated by antibodies directed against proteins in the cytoplasmic granules of myeloid cells (antineutrophil-cytoplasmic antibodies ͓ANCAs͔). We report the case of a 47-year-old white male with a vasculitis-like syndrome after propylthiouracil for recurrent Graves disease. He was initially treated with propylthiouracil (150 mg every 6 hours) for approximately 18 months with clinical remission. Two months after propylthiouracil discontinuation, he had recurrence (T4-free 5.56 ng/mL ͓normal, 0.75-1.54 ng/mL͔, antithyroglobulin antibodies Ͼ90 IU/mL ͓normal, 0 -2 IU/mL͔, antithyroperoxidase antibodies 13.6 IU/mL ͓nor-mal, 0 -2 IU/mL͔, anti-TSH-receptor antibodies 74% ͓normal, Ͻ10%͔), and propylthiouracil was restarted with rapid titration to 200 mg every 4 to 6 hours. After 1 month, skin and mouth lesions appeared in the setting of neutropenia (700/L). Propylthiouracil was stopped for 1 week with improvement. Physical examination revealed proptosis, purple pinnae with lobe sparing, hoarse voice, 1-cm aphthous ulcer, 80-g goiter, erythematous skin lesions with dark centers, and joint effusions limiting hand, knee, and ankle mobility. Labs revealed C-reactive protein of 3.2 mg/dL (normal, Ͻ0.7 mg/dL), rheumatoid factor of Ͻ0.9 IU/mL (normal, Ͻ40 IU/mL), antinuclear antibody: negative, and ANCAs 1:1024 (normal, Ͻ1:16) with a perinuclear pattern. Symptoms abated with propylthiouracil cessation and thyroidectomy. P-ANCA levels declined over 8 months. Despite the extensive exposure to propylthiouracil, our patient did not experience symptoms until rechallenged at high doses. He had prompt recovery on withdrawal. Although some clinical findings were consistent with relapsing polychondritis, type II collagen antibody levels were unremarkable. His antineutrophil-cytoplasmic antibodies were atypical; antimyeloperoxidase and antiserine proteinase 3 antibodies were not the primary antibody types. Future investigation may identify the causative antibodies for the vasculitis variant expressed by our patient.

show abstract

Antineutrophil cytoplasmic antibodies in autoimmune thyroid disorders

Cited by 23 publications

References 14 publications

Anti-Thyroid Drug-Induced ANCA-Associated Vasculitis. A Case Report and Review of the Literature.

Anti-Thyroid Drug-Induced ANCA-Associated Vasculitis. A Case Report and Review of the Literature.

A comparison of antineutrophil cytoplasmic antibody prevalence in patients treated and untreated for hyperthyroidism

Atypical Antineutrophil???Cytoplasmic Antibodies and Vasculitis-Like Syndrome With Aphthous Ulcer and Violaceous Pinnae after Retreatment With Propylthiouracil for Graves Disease

Contact Info

Product

Resources

About