In the case of autoimmune thyrotoxicosis / hyperthyroidism, anti-TPO and anti-Tg antibodies should not be sought; search instead for anti-TSHR antibodies (TRAb). Do not request anti-TPO (anti-thyroid peroxidase) and anti-Tg (anti-thyroglobulin) antibody tests in the monitoring of autoimmune thyroid disease.

Type of practice

Laboratory tests

In the diagnosis of hyperthyroidism, the research of anti-TPO and anti-Tg is widely requested as a first test, while the diagnostic antibody is the one directed towards the TSH receptor. The research of anti-TPO is useful only in case of negativity of TRAb (possible diagnosis of non-Graves thyrotoxicosis). The repetition over time of anti-TPO and anti-Tg antibodies for follow-up, in case of diagnosed autoimmune thyropathy, has no clinical utility.

Sources

1. Tozzoli R, Bagnasco M, Giavarina D, et al. TSH receptor autoantibody immunoassay in patients with Graves' disease: improvement of diagnostic accuracy over different generations of methods. Systematic review and meta-analysis. Autoimmun Rev 2012; 12:107-13. doi: 10.1016/j.autrev.2012.07.003.
2. Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 2016; 26:1343-421. doi: 10.1089/thy.2016.0229.
3. Schmidt M, Voell M, Rahlff I, et al. Long-term follow-up of antithyroid peroxidase antibodies in patients with chronic autoimmune thyroiditis (Hashimoto’s thyroiditis) treated with levothyroxine. Thyroid 2008;18:755-60. doi: 10.1089/thy.2008.0008.
4. Tozzoli R. The increasing clinical relevance of thyroid-stimulating hormone receptor autoantibodies and the concurrent evolution of assay methods in autoimmune hyperthyroidism. J Lab Prec Med 2018; 3:3-27. doi: 10.21037/jlpm.2018.
5. Vargas-Uricochea H, Nogueira JP, Pinzòn-Fernàndez MV, et al. The usefulness of thyroid antibodies in the diagnostic approach to autoimmune thyroid disease. Antibodies 2023; 12:48. doi: 10.3390/antib12030048.

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Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.