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.

Nov 16, 2018

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

Age

Adult, Geriatric, Pediatric

Topic Area

Laboratory Medicine

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.