High Prevalence of Antineutrophil Cytoplasmic Antibody Positivity in Childhood Onset Graves’ Disease Treated with Propylthiouracil
Abstract
Propylthiouracil (PTU)-induced antineutrophil cytoplasmic antibody (ANCA)-related vasculitis and nephritis were recently reported in about 30 patients with hyperthyroidism. The objective of this study was to clarify the prevalence of ANCA and the relationship between ANCA and thyroid antibodies in children with Graves’ disease. Titers of myeloperoxidase (MPO)-ANCA in sera of 51 patients with childhood onset Graves’ disease (16 before treatment, 25 and 10 treated with PTU and methimazole, respectively) were measured by enzyme-linked immunosolvent assay. Antithyroglobulin antibodies (TGAbs) and antithyroperoxidase antibodies (TPOAbs) were also measured by RIA in 25 PTU-treated patients. No patients had clinical manifestations of vasculitis and nephritis. MPO-ANCA was positive in 6.7% of patients before treatment and in 64.0% of those treated with PTU and in none of those treated with methimazole. MPO-ANCA had a significantly positive correlation with TGAbs (P < 0.05) and no significant correlation with TPOAbs. These findings show the high prevalence of the MPO-ANCA positivity in PTU-treated childhood onset Graves’ disease, suggesting that PTU may not be preferred as the first line for the treatment of children with Graves’ disease. The significant correlation between MPO-ANCA and TGAbs indicates that the severity of Graves’ disease may be a factor responsible for the MPO-ANCA positivity. The cross-reactivity between MPO-ANCA and TPOAbs may not play a role in the high prevalence of MPO-ANCA in the patients exposed to PTU.
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Many PTU-treated patients also develop ANCA positivity on treatment but remain asymptomatic.
“Many PTU-treated patients also develop ANCA positivity on treatment but remain asymptomatic (330).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [330]
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- Authors
- Sato, H., Hattori, M., Fujieda, M., Sugihara, S., Inomata, H., Hoshi, M., & Miyamoto, S.
- Affiliations
- Chiba Children's Hospital (JP)
- Kochi Medical School Hospital (JP)
- Tokyo Women's Medical University (JP)
- Teikyo University (JP)
- Matsudo City Hospital (JP)
- Divisions of Endocrinology (H.S., S.M.), Chiba 266-0007
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2000-11-01
- Volume
- 85
- Issue
- 11
- Pages
- 4270-4273
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W1996277373
- Cited by
- 102
- References
- 32
- Citations by year
- 2024: 1 · 2021: 3 · 2020: 3 · 2018: 4 · 2017: 3 · 2016: 2 · 2015: 2 · 2014: 3 · 2013: 3 · 2012: 4
- FWCI
- 5.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Vasculitis and related conditions
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Keywords
- propylthiouracil, antineutrophil cytoplasmic antibodies, MPO-ANCA, antithyroid drug adverse effects, thyroglobulin antibodies, hyperthyroidism, methimazole, disease severity
- MeSH terms
- Adolescent, Child, Child, Preschool, Enzyme-Linked Immunosorbent Assay, Female, Graves Disease, Humans, Iodide Peroxidase, Japan, Male, Methimazole, Peroxidase, Propylthiouracil, Thyroglobulin, Antithyroid Agents, Age of Onset, Immunoglobulins, Thyroid-Stimulating, Antibodies, Antineutrophil Cytoplasmic
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