This increase was statistically significant in the repeated-measures analysis reported in the Supplemental Data. repository up Bioymifi to 7 yr before the clinical diagnosis, for a total of 2088 samples. == Results: == In Hashimoto thyroiditis, TPO antibodies were found in about 66% of the cases at all time points. Tg antibodies showed a similar stationary trend, at a lower prevalence of about 53%at all time points. No TSH-R antibodies were found. In Graves disease, TPO antibodies gradually increased from 31% at 57 yr prior to diagnosis to 57% at diagnosis and Tg antibodies from 18 to 47%. TSH-R antibodies were present before diagnosis and showed an increasing prevalence from 2, 7, 20, to 55%. == Conclusions: == Antibodies to Tg, TPO, and TSH-R precede by years the development of the diagnostic autoimmune thyroid diseases phenotype. Overall, the presence of thyroid antibodies in apparently healthy individuals should not be neglected. Autoimmune thyroid diseases (ATD) comprise Graves disease and Hashimoto thyroiditis. ATD affect predominantly women and are the most common autoimmune diseases in the United States, with female population prevalence around 0.5% (1,2). Although managed relatively well in most patients with current treatments, ATD are associated with decreased quality of life and significant morbidity from ophthalmological manifestations (3), osteoporosis (4), and cardiovascular diseases (5). ATD are characterized immunologically by the presence of serum antibodies directed against thyroid-specific or thyroid-restricted antigens like the TSH receptor (TSH-R), thyroperoxidase (TPO), and thyroglobulin (Tg). The last decade has seen a resurgent interest in using antibodies as a clinical tool due to the discovery that antibodies can predict the development of overt clinical disease (6). For example, antibodies to glutamic acid decarboxylase-65 and insulin Bioymifi autoantibody-2 predict the development of type 1 diabetes in asymptomatic first-degree relatives (7), and antibodies to Ro and La (8) and to cyclic citrullinated protein (9) precede by several years the diagnosis of Bioymifi systemic lupus erythmatosus (SLE) and rheumatoid arthritis. Thyroid antibodies have been associated with subsequent hypothyroidism and ATD in those with a family history of ATD (10,11). Using the Department of Defense Serum Repository (DoDSR) and the Defense Medical Surveillance System, we designed a nested case-control study to examine whether females with ATD are more likely than age-matched controls to have thyroid antibodies before diagnosis. == Subjects and Methods == == Study population == The DoDSR stores sera of active-duty military personnel collected biannually and before and after each deployment Bioymifi for human immunodeficiency virus testing. Approximately 50 million samples have been collected and stored since 1985. The Defense Medical Surveillance System maintains records of inpatient and outpatient medical diagnoses among all active-duty military personnel at the Military Healthcare System treatment facilities and purchased civilian care sites coded byInternational Classification of Disease, Clinical Modification 9(ICD-9-CM) codes (10). The eligible study population was all female, active-duty, U.S. military personnel between January 1, 1998, and December 31, 2007, who utilized the Defense Medical Surveillance System and who had at least four serum specimens available for retrieval in the DoDSR during the specified time intervals. Men were excluded because Graves disease and Hashimoto thyroiditis affect predominantly women, and an oversampling of male cases would have been required to have a sample size sufficient to make meaningful inferences. == Autoimmune thyroiditis cases (n = 174) == Cases were selected from the eligible study population with a specific diagnosis of either Graves disease (ICD-9-CM 242.0) or Hashimoto thyroiditis (ICD-9-CM 245.2). Cases were defined as individuals in the Defense Medical Surveillance System with either one inpatient ICD-9-CM diagnosis code in any diagnosis position (DX1-DX8) or two or more primary (i.e.first diagnosis position) outpatient ICD-9-CM diagnosis codes separated by at least 7 d between diagnosis visits reported at rheumatology, endocrinology, obstetrics and gynecology, family medicine, or internal medicine clinics within the Military Bioymifi Healthcare System or from a civilian care setting. The first inpatient or outpatient diagnosis code was considered the date of clinical onset (the index date). One thousand six hundred eighty-four cases were identified among 543,097 female active military duty personnel during the study period. One hundred seventy-four cases meeting the inclusion criteria were randomly chosen as part of this study: 87 with Graves disease and 87 with Hashimoto thyroiditis. == Healthy controls (n Rabbit polyclonal to Icam1 = 348) == For each case we selected two age-matched (1 yr) apparently healthy controls. All controls were required to be on active duty.