الفهرس 
AUTOIMMUNE THYROID DISEASES
Antibodies to Thyroid AntigensOnly 14 pages are availabe for public view
 |  | from | 234 |  |  |
| | | from | 234 | | |
Abstract
Multiple sclerosis (MS) occurs with immune-mediated
mechanisms and its pathogenesis is not known accurately.
There have been reports of MS coexistence with other
autoimmune diseases, and the autoimmune pathogenesis of MS
is well accepted. In recent years there have been some case
reports of MS associated with autoimmune thyroid diseases as
Hashimoto thyroiditis.
Hashimoto thyroiditis is one of the most frequent causes
of primary hypothyroidism. Histopathologic thyroid findings of
Hashimoto disease show widespread lymphocyte infiltration. In
the early period of the disease, hyperthyroidism, and in the later
period، hypothyroidism can be more prominent. Twenty
percent of patients with Hashimoto disease are hypothyroid
upon presentation. Because the incidence of the association of
MS and Hashimoto thyroiditis is rare, we assessed the
association of Hashimoto thyroiditis and MS among the
patients being followed in our outpatient MS clinic.
The aim of this study is to evaluate thyroid function and
autoimmunity in patients with multiple sclerosis before and
after 6 months of starting multiple sclerosis treatment with
IFN-β.
It was conducted on a hundred (100) subjects; their ages
ranges from 20 to 50 yrs recruited from the inpatient and outpatient clinic of Internal Medicine department, Neurology
Unit of Ain Shams University Hospitals during the period from
February 2016 to August 2017. Informed consents were
obtained from all subjects included in the study.
We classified our subjects into two groups:
group I:
included 50 patients newly diagnosed as multiple
sclerosis according to Macdonald’s criteria 2010 before and
after 6 months of multiple sclerosis medical treatment with
IFN-β.
group II:
Included 50 normal subjects. They were 30 females and
20 males.
All participants were subjected to full medical history
taking, Thorough clinical examination (emphasizing on thyroid
examination and neurological examination including Expanded
disability status scale (EDSS) scoring), Laboratory
investigations including (serum Free T4, Free T3 , TSH ,Anti
TPO antibodies and Antithyrogobulin antibodies ) and
radiological studies (MRI brain and Neck ultrasonography).
Subjects known to have previous history of any thyroid
diseases (autoimmune thyroid diseases, thyroid tumors,
thyroiditis), Family history of thyroid diseases, History of previous thyroid operation or radioactive iodine, History of
previuos prolonged exposure to radiations, On drugs altering
thyroid function, History of other autoimmune disorder , Other
neurological concomitant disease, History of interferon therapy
or with EDSS > 6.5 were excluded from our study.
Our results revealed the following:
On comparing control group and drug naïve MS patients
group before treatment with IFN β, there was a statistical
significant difference between the control group and the drug
naive MS patients group as regards anti TG level being higher
in patients before treatment than in control group with (pvalue=
0.001).While there was no statistical significant
difference between the control group and the drug naïve
patients group as regards anti TPO level (p- value > 0.05), in
addition , This study showed normal thyroid profile including
TSH, FT3 and FT4 in both groups.
On comparing drug naïve patients group before treatment
and after their treatment with IFN β, there was a statistical
significant difference between the drug naïve patients group
and their follow up after treatment regarding anti TPO and
antiTG levels being higher after treatment with interferon beta
than before treatment (P-value ˂0.05) but no statistical
significant difference regarding thyroid profile (FT3, FT4,
TSH) as well as neck U/S findings between MS patients before treatment with interferon beta and after 6 months of starting
IFN β with (p- value > 0.05).
On correlating between anti TG, TPO and other
parameters in drug naïve patients group before and then after
treatment with interferon beta, there was a highly significant
positive correlation between anti TPO level and anti TG level
in drug naïve patients before and after treatment with interferon
beta (r=0.648) and (r=0.725) respectively but there was no
statistical significant correlation between each of them and
other parameters including age, free T4, FT3, TSH (r=-0.081),
EDSS (r=-0.205) and duration (r=-0.134) before and after
treatment with interferon beta with (p-value >0.05).
Multiple logestic regression analysis showed that anti
TPO level independently correlates with the level of FT3 after
6 months of treatment with interferon beta.