Thyroid Peroxidase and Thyroglobulin Antibodies and Ophthalmopathy in Patients with Graves’ Disease, Hashimoto Thyroiditis and Transient Thyroiditis

BackgroundInflammation of the orbital connective tissue, extraocular muscles and upper eyelids occurs in about 40% of patients with Graves hyperthyroidism [Graves Ophthalmopathy (GO)] while mild eye signs including upper eyelid retraction are found in as many as 25% of patients with Hashimoto thyroiditis and, occasionally, transient thyroiditis.Some workers have proposed a relationship between Thyroid Peroxidase (TPO) and Thyroglobulin (TG) antibodies and GO. MethodsTPO and TG antibodies were measured using a Standard Enzyme-Linked Immunosorbent Assay (ELISA) in 84 well-characterised patients 39 with Graves' Disease (GD), 33 with Hashimoto thyroiditis and 12 with transient (subacute, silent) thyroiditis, with and without eye signs. ResultsTwenty-one % of GD patients with active ophthalmopathy and 30% of those without eye signs had negative TPO antibody tests and the ranges of titres and mean titres were similar in the two groups, for both antibodies.Although the prevalence of negative TPO antibody tests in patients with long standing (chronic) Graves disease and ophthalmopathy (67%) was greater than that in patients with long standing hyperthyroidism but no eye signs (20%) this difference was not statistically significant, possibly because the group sizes were small.In patients with Hashimoto thyroiditis and transient (sub acute, silent) thyroiditis the prevalence's of negative TPO antibody tests, range of titres and mean (+/-SE) titres, were again not significantly different between those with and without eye signs for either disorder.Similar results were found for TG antibodies in all groups of patients, with no significant differences between those with and without ophthalmopathy. ConclusionOverall, we have not shown any significant relationship between negative TPO or TG antibody tests, or low serum titres of either antibody, and eye signs, in patients with GD, Hashimoto thyroiditis or transient thyroiditis.TPO and TG antibodies are thus unlikely to play a major role in the pathogenesis of GO.