October - December 2013, Volume 9, Issue 4

Baser H, Tuzun D, Balkan F, Dirikoc A, Saglam F, Ersoy R, Cakir B

Myeloperoxidase and Proteinase-3 Antineutrophill Cytoplasmic Antibody Titers in Graves Disease Patients Treated with Propylthiouracil

Acta Endo (Buc) 2013, 9 (4): 543-550
doi: 10.4183/aeb.2013.543

Background. Antineutrophil cytoplasmic antibodies (ANCA) positivity is usually determined in vasculitis of medium and large arteries. In literature, data related to the prevalence of ANCA positivity and the development of antibodies after antithyroid therapy in Graves’ disease are quite rare. Aim. To investigate the titers of myeloperoxidase (MPO)-ANCA and proteinase 3 (PR3)-ANCA in Graves’ patients treated with propylthiouracil (PTU) and to determine the factors that may contribute to ANCA positivity. Subjects and Methods. Fifty-two Graves’ patients treated with propylthiouracil (PTU) were included into the study. The control group consisted of 37 healthy subjects. MPO-ANCA and PR3-ANCA titers were measured in both groups. Results. Mean titer of PR3-ANCA in Graves’ group was significantly higher than in controls (p=0.025), but no significant difference was found in the titer of MPOANCA between two groups (p=0.060). A positive correlation was observed between PR3-ANCA titer, and anti-thyroid peroxidase antibody and anti-thyroglobulin antibody levels in Graves’ patients (p=0.001, r=0.447 and p=0.030, r=0.310, respectively). PR3-ANCA titer in anti-thyroglobulin antibody positive patients was higher than those with negative antibody (p=0.018). A positive correlation was detected between the duration of treatment and PR3-ANCA titer (p=0.024, r=0.314). Both MPO-ANCA and PR3-ANCA were positive in two Graves’ patients, while only MPO-ANCA was positive in two patients. No signs of vasculitis in ANCA positive patients were observed. Conclusion. Propylthiouracil (PTU) may cause ANCA positivity, but no vasculitis may develop in most of the cases. A correlation was determined between PR3- ANCA titer, and thyroid autoantibodies and the duration of treatment.

Keywords: Graves’ disease, myeloperoxidase antineutrophil cytoplasmic antibody, proteinase 3 antineutrophil cytoplasmic antibody.

Correspondence: Husniye Baser MD, Ataturk Education and Research Hospital, Department of Endocrinology and Metabolism, Öveçler 4. cadde 1356.sokak Gül apartmani No: 3/18 Çankaya, Ankara 06460, Turkey, E-mail: drhusniyebaser@yahoo.com.tr