Abstract
Out of 35 consecutive patients with decreased plasma-cobalamin 22 had newly diagnosed overt pernicious anemia (PA) six of which had a known history of thyroid disease. At referral, 5 of these 6 were thyroid peroxidase antibody (TPOAb)-positive and 2 were thyroglobulin antibody (TgAb)-positive, while none were thyroid stimulating antibody (TSAb)-positive (an overall autoantibody appearance of 83.3%). Fifty percent of the 22 patients had TPOAb and 13.6% had TgAb compared to 18.2% and 4.5%, respectively in sex and age matched healthy controls. Six PA-patients without a history of thyroid disease had thyroid autoantibodies and another patient seroconverted within the first year during treatment with cyanocobalamin. Measurements of serum concentrations of thyroid hormones and thyroid stimulating hormone were performed during the first year of treatment with cyanocobalamin. Two cases of subclinical myxoedema were found among PA-patients and another case was found among patients with latent PA. The female:male ratio of thyroid disease among PA-patients and among thyroid autoantibody-positive PA-patients was interestingly found to be 1:1. Treatment with cyanocobalamin did not have any systematic effect on thyroid function. Routine screening for thyroid function and thyroid autoantibodies in patients with latent or overt PA is recommended.
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Irvine W.J. The association of atrophic gastritis with autoimmune thyroid disease. Clinics in Endocrinol. Metabol. 4: 351, 1975.
Ardeman S., Chanarin I., Krafchik B., Singer W. Addisonian pernicious anaemia and intrinsic factor antibodies in thyroid disorders. Quart J. Med. 35: 421, 1966.
Furszyfer J., McConahey W.M., Kurland L.T., Maldonado J.E. On the increased association of Graves’ disease with pernicious anemia. Mayo Clin. Proc. 46: 37, 1971.
Tudhope G.R., Wilson G.M. Deficiency of vitamin B12 in hypothyroidism. Lancet 1: 703, 1972.
Davis R.E., McCann V.J., Stanton K.G. Type 1 diabetes and latent pernicious anaemia. Med. J. Australia 156: 160, 1992.
Leshin M. Southwestern Internal Medicine Conference. Polyglandular autoimmune syndromes. Am. J. Med. Sciences 290: 77, 1985.
Humbert P., Dupond J.L. Les syndromes auto-immunes multiples (S.A.M.). Ann. Med. Interne 139: 159, 1988.
Singer W., Sahey B.M. Myastenia Gravis, Hashimoto’s thyroiditis and pernicious anaemia. BMJ 1: 904, 1966.
Feld S., Landau Z., Gefel D., Green L., Resnitzky P. Pernicious anemia, Hashimoto’s thyroiditis and Sjogren’s in a woman with SLE and autoimmune hemolytic anemia. J. Rheumatol 16: 258, 1986.
Rilay W., Toskes P.P., Maclaren N.K., Silverstein J.H. Predictive value of gastric parietal cell autoantibodies as a marker for gastric and hematologic abnormalities associated with insulin-dependent diabetes. Diabetes 31: 1051, 1982.
Krassas W., McHardy-Young S., Ramsay I., Florin-Christensen A. Thyroid function and antibody studies in pernicious anaemia. Clinical Endocrinol. 6: 145, 1977.
Doniach D., Roitt I.M., Taylor K.B. Autoimmune phenomena in pernicious anaemia. Br. Med. J. 1: 1374, 1963.
Markson J.L., Moore J.M. Thyroid autoantibodies in pernicious anaemia. Br. Med. J. 2: 1352, 1962.
Feldt-Rasmussen U., Høier-Madsen M., Bech K., Blichert-Toft M., Bliddal H., Date J., Danneskiold-Samsoe B., Hegedus L., Hippe E., Horness P.J., Kriegbaum N.J., Müller M., Perrild H., Rasmussen N.G., Rasmusson B., Schouboe A. Anti-thyroid peroxidase antibodies in thyroid disorders and non-thyroid autoimmune diseases. Autoimmunity 9: 245, 1991.
Knight A., Knight J., Laing P., Adams D. Coexisting thyroid and gastric autoimmune diseases are not due to cross-reactive autoantibodies J. Clin. Lab. Immunol. 14: 141, 1984.
McNicol G.P. Thyrotoxicosis associated with pernicious anemia. Am. J. Med. Sci 241: 336, 1961.
Chanarin I. The megaloblastic anaemias, Ed. 1; Oxford, England. Blackwell Scientific Publications 1969. p. 505.
Carmel R., Spencer C.A. Clinical and subclinical thyroid disorders associated with pernicious anemia. Arch. Intern. Med. 142: 1465, 1982.
Ogbuawa O., Johnson R. T4-thyroid storm in pernicious anemia. Arch. Intern. Med. 140: 1245, 1980.
Ottesen M., Feldt-Rasmussen U., Andersen J., Hippe E., Schouboe A. Pernicious anaemia. Investigation of the presenting form of the disease and the diagnostic significance of demonstration of the intrinsic factor antibody and parietal cell antibody. Ugeskr Laeger 154: 3758, 1992.
Høier-Madsen M., Feldt-Rasmussen U., Hegedus L, Perrild H., Hansen H.S. Enzyme-linked immunosorbent assay for determination of thyroglobulin autoantibodies. Acta Path. Microbiol. Immunol. Scand. 92: 377, 1984.
Weller T.H., Coons A.H. Fluorescent antibody studies with agents of Varicella and Herpes Zoster propagated in vitro. Proc. Soc. Exp. Biol. Med. 86: 789, 1954.
Schwartz M. Antibody to intrinsic factor. Scand. J. Clin. Lab. Invest. 95: 19, 1968.
Ruf J., Czarnocka B., Ferrand M., Doullais F., Carayon P. Novel routine assay of thyroperoxidase autoantibodies. Clin. Chem. 34: 2231, 1988.
Shewring G., Rees Smith B. An improved radioreceptor assay for TSH receptor antibodies. Clin. Endocrinol. (Oxf.) 77: 409, 1982.
Hemmila I., Dakubu S., Mukala V-M., Siitari H., Lovgren T. Europium as a label in time-resolved immunofluorometric assays. Anal. Biochem. 137: 335, 1984.
Conn D. Intrinsic factor antibody seroconversion. Med. Lab. Sciences 44: 326, 1987.
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Ottesen, M., Feldt-Rasmussen, U., Andersen, J. et al. Thyroid function and autoimmunity in pernicious anemia before and during cyanocobalamin treatment. J Endocrinol Invest 18, 91–97 (1995). https://doi.org/10.1007/BF03349707
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DOI: https://doi.org/10.1007/BF03349707