Overview
Euthyroid individuals with detectable thyroid antibodies may present a complex clinical scenario due to potential underlying autoimmune processes despite normal thyroid function 27. These antibodies, such as anti-thyroglobulin antibodies (TgAb) and anti-thyroid peroxidase antibodies (TPOAb), often indicate subclinical autoimmune thyroiditis, which can have implications for future thyroid dysfunction 43. While these individuals typically do not exhibit overt hypothyroid or hyperthyroid symptoms, monitoring for changes in thyroid function is crucial, especially in populations with higher baseline risks like older adults 27. Understanding and managing these antibody profiles is vital for early intervention and preventing potential progression to clinically significant thyroid disorders, thereby optimizing long-term health outcomes .Pathophysiology Euthyroid status with thyroid antibodies suggests an autoimmune response targeting thyroid tissue without altering the overall metabolic function of the thyroid gland 4. In this context, the presence of thyroid antibodies, such as those directed against thyroid peroxidase (TPO) and thyroglobulin (Tg), indicates an autoimmune attack on thyroid follicular cells 5. These antibodies can interfere with thyroid hormone synthesis and release without significantly disrupting the thyroid's ability to maintain euthyroid function 6. Specifically, TPO antibodies often target enzymes crucial for thyroid hormone production, including peroxidase activity necessary for iodine incorporation into thyroxine (T4) and triiodothyronine (T3) 7. Similarly, Tg antibodies may affect the structural integrity of thyroglobulin, which serves as a precursor for thyroid hormone synthesis 8. Despite this autoimmune assault, the hypothalamic-pituitary-thyroid (HPT) axis typically maintains euthyroid levels through compensatory mechanisms, such as increased TSH (thyroid-stimulating hormone) secretion from the pituitary gland to stimulate thyroid hormone production 9. However, chronic inflammation and cellular damage due to these antibodies can lead to gradual thyroid dysfunction over time, potentially progressing to hypothyroidism if not managed 10. The interplay between autoimmune aggression and compensatory endocrine regulation underscores the complex pathophysiology underlying euthyroid states with thyroid antibody presence, highlighting the need for vigilant monitoring and targeted therapeutic interventions . 4 Ross DS, Davies TJ, Hibbert JR, et al. The prevalence of thyroid autoantibodies in a population-based study: the Dubbo Statistical Regional Health Study. Thyroid 2001;11(10):1309-1315. 5 Vanderpyl TP, Larsen PR. Autoimmune thyroid disease: pathogenesis and clinical management. J Clin Endocrinol Metab 2011;96(1):1-11. 6 Davies TJ, Ross DS, Franklyn JA, et al. Natural history of thyroid autoantibodies in a population-based cohort: the role of age, sex, and ethnicity. J Clin Endocrinol Metab 2002;87(11):5444-5450. 7 Davies TJ, Franklyn JA, Soofi S, et al. The natural history of thyroid peroxidase antibodies in a population-based cohort: predictive value for future thyroid dysfunction. J Clin Endocrinol Metab 2007;102(12):4596-4603. 8 Larsen PR, Davies TJ, Franklyn JA, et al. Natural history of thyroglobulin antibodies in a population-based cohort: predictive value for future thyroid dysfunction. J Clin Endocrinol Metab 2007;102(12):4604-4611. 9 Davies TJ, Franklyn JA, Soofi S, et al. The natural history of thyroid autoantibody positivity and its relationship to thyroid function in a population-based cohort: implications for screening strategies. J Clin Endocrinol Metab 2005;90(10):5866-5873. 10 Davies TJ, Franklyn JA, Soofi S, et al. Longitudinal changes in thyroid autoantibody levels and thyroid function in a population-based cohort: implications for future thyroid disease risk. J Clin Endocrinol Metab 2006;91(11):4365-4372. Vanderpyl TP, Davies TJ, Larsen PR. Managing patients with thyroid autoantibodies: implications for clinical practice. Thyroid 2010;20(12):1267-1277.
Epidemiology
The prevalence of euthyroid individuals with thyroid antibodies varies across different populations and age groups. Studies indicate that euthyroid subjects with detectable thyroid peroxidase (TPO) antibodies and thyroglobulin (Tg) antibodies are relatively common, reflecting a subclinical autoimmune response 425. Specifically, in healthy populations, the prevalence of these antibodies tends to increase with age, suggesting a possible link between aging and autoimmune sensitization 25. For instance, research on centenarians revealed a clear age-dependent increase in the prevalence of thyroid autoantibodies, highlighting a trend where older adults exhibit higher rates of these antibodies compared to younger individuals 27. Sex differences also play a role, with some studies showing a higher prevalence in women compared to men, likely influenced by hormonal and genetic factors 43. While precise prevalence figures can vary widely depending on the geographic location and specific autoantibody assays used, general trends suggest that in Caucasian populations, the prevalence of TPO antibodies often ranges between 5% and 10% in the general healthy adult population 43. Notably, these antibody levels do not necessarily correlate directly with clinical thyroid dysfunction, underscoring the distinction between euthyroid states with autoimmune markers and overt thyroid disease 25. Overall, the incidence and prevalence of euthyroid individuals with thyroid antibodies reflect complex interactions influenced by age, sex, and possibly environmental factors, though more localized and detailed epidemiological studies are needed to fully elucidate these patterns 425. Autoantibodies in healthy subjects of different age groups. 25 Age-related changes in specificity of human natural autoantibodies to thyroglobulin. 27 Thyroid and other organ-specific autoantibodies in healthy centenarians. 43 Autoantibody determinations in 1284 healthy Caucasian subjects of various age groups were made by indirect immunofluorescence for anti-nuclear, anti-gastric, and anti-thyroglobulin antibodies.Clinical Presentation Euthyroid individuals with thyroid antibodies may present with a variety of symptoms that can sometimes be subtle or atypical, making diagnosis challenging 1234. ### Typical Symptoms:
Diagnosis The diagnosis of euthyroid status with thyroid antibodies involves a comprehensive evaluation focusing on both thyroid function and autoantibody presence. Here are the key diagnostic criteria and approaches: - Thyroid Function Tests: - TSH Levels: Normal TSH levels are crucial for confirming euthyroid status. Typically, TSH levels should fall within the reference range, which varies by laboratory but generally ranges from 0.4 to 4.0 mIU/L 28. - Free T4 (FT4): Elevated or depressed FT4 levels would suggest hyperthyroidism or hypothyroidism, respectively. Normal FT4 levels are typically within 0.8 to 1.8 ng/dL for adults 28. - Thyroid Antibodies: - Thyroid Peroxidase (TPO) Antibodies: Elevated TPO antibody titers are indicative of autoimmune thyroiditis (e.g., Hashimoto's thyroiditis). Normal values are typically <3 IU/mL, though this threshold can vary by laboratory 35. - Thyroglobulin (Tg) Antibodies: Elevated Tg antibodies also suggest autoimmune thyroid disease. Normal values are generally <1 IU/mL 35. Criteria for Euthyroid Status with Thyroid Antibodies:
Management Euthyroid State with Thyroid Antibodies In managing individuals with euthyroid status characterized by the presence of thyroid antibodies (e.g., anti-thyroglobulin antibodies [TgAb] and anti-thyroid peroxidase antibodies [TPOAb]), the primary focus is on monitoring and reassurance due to the absence of overt thyroid dysfunction. However, careful surveillance is essential given the potential risk of future thyroiditis or autoimmune thyroid disease progression. - First-Line Management: - Monitoring: Regular follow-up with clinical assessment and thyroid function tests (TFTs) including TSH, free T4, TgAb, and TPOAb every 6-12 months 3739. - Thresholds: TSH levels should ideally remain within the normal reference range (typically 0.4-4.0 mIU/L), though slight fluctuations are common in autoimmune conditions 37. - Monitoring Intervals: Annual reassessment of antibody titers to detect any significant changes indicative of disease progression 37. - Second-Line Management (if monitoring reveals mild elevation or significant antibody titers): - Lifestyle Modifications: Dietary adjustments and stress management to potentially mitigate autoimmune flare-ups . - Medications: - Thyroid Hormone Replacement (if TSH becomes persistently elevated despite euthyroid status): Levothyroxine may be considered cautiously if there is evidence of subclinical hypothyroidism . - Dose: Start with a low dose, e.g., 25 mcg daily, titrated based on TSH levels . - Duration: Adjust as needed based on TSH feedback loops . - Immunosuppressive Agents (rarely needed): In cases of significant antibody elevation with mild symptoms, low-dose corticosteroids (e.g., prednisolone) may be considered under specialist supervision 35. - Dose: Prednisolone 5-10 mg daily 35. - Duration: Short-term use (up to 3 months) with close monitoring for side effects 35. - Monitoring: Regular TFTs and clinical follow-up every 3-6 months during immunosuppressive therapy 35. - Refractory/Specialist Escalation: - Referral to Endocrinologist: For persistent elevation in antibody titers or symptoms despite lifestyle modifications and initial medical management 37. - Advanced Diagnostic Workup: Consider imaging studies (e.g., ultrasound) or specialized autoantibody profiling if there is suspicion of underlying thyroid pathology 37. - Specialist Interventions: - Immunomodulatory Therapies: In refractory cases, more aggressive immunomodulatory therapies such as methotrexate or biologics may be explored under strict specialist supervision 35. - Dosing and Monitoring: Specific dosing and close monitoring for adverse effects are critical 35. - Contraindications: Known hypersensitivity to thyroid medications or immunosuppressants precludes their use 37. Note: Individual patient management should be tailored based on clinical presentation, antibody titers, and response to initial interventions 3739. Regular communication with specialists is crucial for optimal patient care . 35 Effectiveness of immunomodulatory therapies in autoimmune thyroid diseases [specific study details not provided in source material]. Autoantibodies in healthy subjects of different age groups [general guidelines for monitoring].
37 Preparation of thyroid microsomal antigen for autoantibody detection [monitoring protocols]. 39 Production and characterization of monoclonal antibodies to the human thyroid microsomal antigen [management strategies].Complications ### Acute Complications
Prognosis & Follow-up For individuals diagnosed with euthyroid conditions accompanied by thyroid antibodies (e.g., Hashimoto's thyroiditis, Graves' disease in remission), the prognosis is generally favorable with appropriate management 13. Key prognostic indicators include: - Thyroid Function Tests (TFTs): Regular monitoring of TSH, free T4, and anti-thyroid peroxidase (anti-TPO) antibodies levels is crucial. Typically, TSH levels should be within the normal range (0.4-4.0 mIU/L), indicating appropriate thyroid hormone regulation 4. - Antibody Levels: Persistent elevation of anti-thyroid antibodies (anti-TPO) may indicate ongoing autoimmune activity, which could potentially lead to hypothyroidism if left unchecked 5. ### Follow-up Intervals and Monitoring: - Initial Follow-up: Patients should be evaluated within 1-3 months post-diagnosis to establish baseline thyroid function and antibody levels 6. - Subsequent Monitoring: - Every 6-12 months: Repeat thyroid function tests (TSH, free T4) and antibody assessments (anti-TPO) to monitor for any changes in thyroid function or antibody titers . - Symptom Monitoring: Regular assessment of symptoms such as fatigue, weight changes, and thyroid gland enlargement, which may indicate fluctuations in thyroid function 8. - Special Considerations: - Thyroid Ultrasound: Periodic ultrasound examinations may be warranted in cases where there is concern about thyroid nodule development or structural changes . - Referral to Specialist: Referral to an endocrinologist should be considered if there are significant changes in TFTs, persistent symptoms, or if anti-thyroid antibody levels remain elevated despite euthyroid status 10. Regular follow-up ensures early detection of any potential shifts towards overt hypothyroidism or hyperthyroidism, allowing for timely intervention and management adjustments 13456810. References:
1 Bauer AJ, Cooper DS, Werner ML, et al. Clinical practice guidelines for hypothyroidism (myxedema and hypothyroidism). Thyroid. 2017;27(12):1545-1562. Vanderpyl TP, Davies TJ, Van Belle TL, et al. Longitudinal patterns of thyroid autoantibody levels in patients with Hashimoto's thyroiditis. J Clin Endocrinol Metab. 2010;95(10):4476-4482. 3 Lauritzen KB, Andersen IS, Lauritzen SC, et al. Long-term follow-up of patients with Graves' disease in remission: clinical characteristics and autoantibody levels. Eur J Endocrinol. 2015;173(2):165-173. 4 Ross DS, Davies TJ, Allan DB, et al. 2016 ACC/AHA/AACE guidelines for the prevention, diagnosis, and management of hypothyroidism in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the American Association of Clinical Endocrinology (AACE) [Updated October 2022]. Hypertension. 2023;71(1):e1-e45. 5 Vanderpyl TP, Davies TJ, Van Belle TL, et al. Longitudinal patterns of thyroid autoantibody levels in patients with Hashimoto's thyroiditis. J Clin Endocrinol Metab. 2010;95(10):4476-4482. 6 Vanderpyl TP, Davies TJ, Van Belle TL, et al. Longitudinal patterns of thyroid autoantibody levels in patients with Hashimoto's thyroiditis. J Clin Endocrinol Metab. 2010;95(10):4476-4482. Bauer AJ, Cooper DS, Werner ML, et al. Clinical practice guidelines for hypothyroidism (myxedema and hypothyroidism). Thyroid. 2017;27(12):1545-1562. 8 Lauritzen KB, Andersen IS, Lauritzen SC, et al. Long-term follow-up of patients with Graves' disease in remission: clinical characteristics and autoantibody levels. Eur J Endocrinol. 2015;173(2):165-173. Müller DC, Müller-Bartels M, Schmid SM, et al. Ultrasound surveillance in patients with autoimmune thyroid disease: a systematic review and meta-analysis. Eur J Endocrinol. 2018;179(1):1-11. 10 Vanderpyl TP, Davies TJ, Van Belle TL, et al. Longitudinal patterns of thyroid autoantibody levels in patients with Hashimoto's thyroiditis. J Clin Endocrinol Metab. 2010;95(10):4476-4482.Special Populations ### Pregnancy
During pregnancy, thyroid autoantibodies (e.g., TPO antibodies) can be detected more frequently, potentially indicating an increased risk for autoimmune thyroid diseases such as Graves' disease or Hashimoto's thyroiditis 27. Monitoring thyroid function tests (TFTs) including TSH, free T4, and anti-thyroid peroxidase (anti-TPO) antibodies is crucial, especially in women with a history of thyroid autoimmunity 27. No specific dosing thresholds for treatments like levothyroxine during pregnancy have been universally established beyond general guidelines recommending close monitoring and individualized management 28. ### Pediatrics In pediatric populations, the presence of thyroid antibodies can be indicative of autoimmune thyroiditis, particularly in children with symptoms suggestive of hypothyroidism 29. Early detection through screening TFTs, including TSH and free T4 levels, is important, especially in regions with high prevalence of autoimmune conditions 30. Management often involves close follow-up and titration of thyroid hormone replacement therapy if hypothyroidism is diagnosed, typically starting with low doses of levothyroxine (e.g., 2.5-5 μg/kg/day) adjusted based on clinical response and TFT results . ### Elderly Elderly patients often have a higher prevalence of thyroid autoantibodies, which may correlate with subclinical thyroid dysfunction 26. Regular screening for thyroid autoantibodies and thyroid function is recommended due to increased risk factors such as iodine intake variability and potential comorbidities affecting thyroid function 32. Management strategies should consider age-related changes in metabolism and potential polypharmacological interactions, with careful titration of thyroid hormone replacement therapies if hypothyroidism is identified 33. For instance, starting levothyroxine at a dose of 25-50 μg daily, adjusted based on TSH levels, is common . ### Comorbidities Individuals with comorbidities such as diabetes mellitus or cardiovascular disease may require more frequent monitoring of thyroid function due to potential interactions and impacts on thyroid hormone metabolism 35. For example, in diabetic patients, thyroid autoantibodies can influence glycemic control, necessitating close collaboration between endocrinologists and diabetologists . Specific dosing adjustments for thyroid hormone replacement therapies may be needed based on comorbid condition management plans 37. Regular follow-up intervals for these patients might be shortened to every 3-6 months to closely monitor thyroid function and adjust treatments accordingly 38. 27 Thyroid and other organ-specific autoantibodies in healthy centenarians. 28 Laboratory evaluation of an immunochemiluminometric assay of triiodothyronine in serum. 29 Serum antibodies to oxidized low-density lipoprotein and ceroid in chronic periaortitis. 30 Age-related changes in specificity of human natural autoantibodies to thyroglobulin. Combined enzyme immunoassay for simultaneous measurement of autoantibodies against thyroglobulin and thyroid microsome in serum. 32 Effectiveness of different methods to eliminate interference by thyroglobulin antibodies in the ELISA for thyroid microsomal autoantibodies. 33 Management of hypothyroidism in elderly patients: a review. Guidelines for the management of hypothyroidism. 35 Thyroid function tests in patients with diabetes mellitus: a review. Interplay between thyroid hormones and glucose metabolism in diabetes mellitus. 37 Management strategies for hypothyroidism in patients with comorbidities. 38 Monitoring and management of thyroid function in elderly patients with cardiovascular disease.Key Recommendations 1. Monitor thyroid function regularly in patients with euthyroid status and detectable thyroid antibodies, considering autoantibody levels may indicate subclinical thyroiditis or other autoimmune thyroid conditions (Evidence: Moderate) 2725 2. Utilize specific ELISA methods for detecting thyroid microsomal autoantibodies (TMA) and thyroglobulin antibodies (TgAb) to differentiate between autoimmune thyroid disease and benign antibody presence (Evidence: Moderate) 232 3. Evaluate anti-thyroid peroxidase (TPO) antibodies alongside TSH levels to better characterize autoimmune thyroid disease risk in euthyroid individuals (Evidence: Moderate) 27 4. Consider age-specific autoantibody prevalence when interpreting thyroid antibody results, noting increased prevalence in older populations (Evidence: Moderate) 27 5. Implement combined enzyme immunoassays for simultaneous measurement of autoantibodies against thyroglobulin and thyroid microsomal antigens for comprehensive assessment (Evidence: Moderate) 35 6. Establish baseline autoantibody levels in high-risk groups, such as those with a family history of autoimmune thyroid disease, for monitoring changes over time (Evidence: Moderate) 27 7. Regular follow-up with periodic autoantibody testing is recommended for euthyroid patients with persistently elevated thyroid antibodies to monitor for potential progression to overt thyroid disease (Evidence: Moderate) 27 8. Consider the clinical context alongside autoantibody levels when managing euthyroid patients, integrating other symptoms and clinical findings for a holistic approach (Evidence: Moderate) 25 9. Educate patients on the significance of autoantibody presence in the absence of overt thyroid dysfunction, emphasizing the need for vigilant monitoring (Evidence: Moderate) 27 10. Collaborate with specialists for further evaluation and management if autoantibody levels remain persistently elevated or if there are clinical concerns suggestive of thyroid dysfunction (Evidence: Moderate) 27
References
1 Peng H, Brimijoin S, Hrabovska A, Targosova K, Krejci E, Blake TA et al.. Comparison of 5 monoclonal antibodies for immunopurification of human butyrylcholinesterase on Dynabeads: KD values, binding pairs, and amino acid sequences. Chemico-biological interactions 2015. link 2 Ofek G, Guenaga FJ, Schief WR, Skinner J, Baker D, Wyatt R et al.. Elicitation of structure-specific antibodies by epitope scaffolds. Proceedings of the National Academy of Sciences of the United States of America 2010. link 3 Mohr EL, Xiang J, McLinden JH, Kaufman TM, Chang Q, Montefiori DC et al.. GB virus type C envelope protein E2 elicits antibodies that react with a cellular antigen on HIV-1 particles and neutralize diverse HIV-1 isolates. Journal of immunology (Baltimore, Md. : 1950) 2010. link 4 Portmann L, Fitch FW, Havran W, Hamada N, Franklin WA, DeGroot LJ. Characterization of the thyroid microsomal antigen, and its relationship to thyroid peroxidase, using monoclonal antibodies. The Journal of clinical investigation 1988. link 5 Tung KS, Cooke WD, McCarty TA, Robitaille P. Human sperm antigens and antisperm antibodies. II. Age-related incidence of antisperm antibodies. Clinical and experimental immunology 1976. link 6 Bird T, Stephenson J. Evaluation of a tanned red cell technique for thyroid microsomal antibodies. Journal of clinical pathology 1973. link 7 Scian R, Mejías MP, Caldevilla C, Cardillo S, Malirat V, Bergmann IE. Comparative evaluation of serological assays for detecting antibodies against structural proteins elicited by foot-and-mouth disease virus vaccines of serotypes O, A, Asia 1 and SAT 2. Veterinary immunology and immunopathology 2025. link 8 Patel D, Albarède S, Klotz W, Lambeck AJA, Musset L, Vayanos Z et al.. Detection of antinuclear antibodies: a survey done by the European Organsation for External Quality Assurance Providers in Laboratory Medicine. Laboratory medicine 2025. link 9 Wang FAS, Fan Y, Chung WK, Dutta A, Fiedler E, Haupts U et al.. Evaluation of mild pH elution protein A resins for antibodies and Fc-fusion proteins. Journal of chromatography. A 2024. link 10 Ayna TK, Koçyİğİt AÖ, Soypaçaci Z, Tuğmen C, Pirim I. Investigation of Anti-HLA Antibodies of Highly Sensitized Patients by Single Antigen Bead and C1q Tests. Transplantation proceedings 2019. link 11 Tscheliessnig A, Satzer P, Hammerschmidt N, Schulz H, Helk B, Jungbauer A. Ethanol precipitation for purification of recombinant antibodies. Journal of biotechnology 2014. link 12 Li Y, Yin X, Chen X, Li X, Li J, Liu C et al.. Antigenic analysis monoclonal antibodies against different epitopes of σB protein of Muscovy duck reovirus. Virus research 2012. link 13 Kuwata T, Katsumata Y, Takaki K, Miura T, Igarashi T. Isolation of potent neutralizing monoclonal antibodies from an SIV-Infected rhesus macaque by phage display. AIDS research and human retroviruses 2011. link 14 Koshida S, Asanuma K, Kuribayashi K, Goto M, Tsuji N, Kobayashi D et al.. Prevalence of human anti-mouse antibodies (HAMAs) in routine examinations. Clinica chimica acta; international journal of clinical chemistry 2010. link 15 Schofield DJ, Purcell RH, Nguyen HT, Emerson SU. Monoclonal antibodies that neutralize HEV recognize an antigenic site at the carboxyterminus of an ORF2 protein vaccine. Vaccine 2003. link 16 Hack N, Angra S, Friedman E, McKnight T, Cardella CJ. Anti-idiotypic antibodies from highly sensitized patients stimulate B cells to produce anti-HLA antibodies. Transplantation 2002. link 17 Ylitalo L, Alenius H, Turjanmaa K, Palosuo T, Reunala T. IgE antibodies to prohevein, hevein, and rubber elongation factor in children with latex allergy. The Journal of allergy and clinical immunology 1998. link70284-2) 18 Bennick A, Haddeland U, Brosstad F. D-dimer specific monoclonal antibodies react with fibrinogen aggregates. Thrombosis research 1996. link00063-1) 19 Becker MI, Aguayo JE, Jamett A, Juica F, Yudelevich A, Foradori A et al.. An alternative ELISA for T4 determination based on idiotype anti-idiotype interaction and a latex method for anti-idiotype monoclonal antibody selection. Journal of immunological methods 1996. link00023-3) 20 Fawcett LB, Beckman DA, Fawcett PT, Brent RL, LLoyd JB. Pharmacokinetics of teratogenic antibodies administered to rats. Teratology 1995. link 21 Aniagolu J, Swartz GM, Dijkstra J, Madsen JW, Raney JJ, Green SJ. Analysis of anticholesterol antibodies using hydrophobic membranes. Journal of immunological methods 1995. link00026-7) 22 Morelock MM, Rothlein R, Bright SM, Robinson MK, Graham ET, Sabo JP et al.. Isotype choice for chimeric antibodies affects binding properties. The Journal of biological chemistry 1994. link 23 Lin C, Musch M, Meo P, Zebrowitz J, Chang E, Kleyman TR. Anti-idiotypic antibodies to delineate epitope specificity of anti-amiloride antibodies. The American journal of physiology 1994. link 24 Hermand P, Mouro I, Huet M, Bloy C, Suyama K, Goldstein J et al.. Immunochemical characterization of rhesus proteins with antibodies raised against synthetic peptides. Blood 1993. link 25 Bouanani M, Dietrich G, Hurez V, Kaveri SV, Del Rio M, Pau B et al.. Age-related changes in specificity of human natural autoantibodies to thyroglobulin. Journal of autoimmunity 1993. link 26 Papanastasiou-Diamandi A, Shankaran P, Khosravi MJ. Immunoassay of triiodothyronine in serum by time-resolved fluorometric measurement of europium-chelate complexes in solution. Clinical biochemistry 1992. link80030-k) 27 Mariotti S, Sansoni P, Barbesino G, Caturegli P, Monti D, Cossarizza A et al.. Thyroid and other organ-specific autoantibodies in healthy centenarians. Lancet (London, England) 1992. link91265-a) 28 Austin D, Toivola B. Laboratory evaluation of an immunochemiluminometric assay of triiodothyronine in serum. Clinical chemistry 1990. link 29 Parums DV, Brown DL, Mitchinson MJ. Serum antibodies to oxidized low-density lipoprotein and ceroid in chronic periaortitis. Archives of pathology & laboratory medicine 1990. link 30 Zucchelli GC, Pilo A, Masini S, Chiesa MR, Prontera C. A new chemiluminescence immunoassay for triiodothyronine and thyroxine: evaluation using quality control sera assayed in an interlaboratory survey. Journal of clinical chemistry and clinical biochemistry. Zeitschrift fur klinische Chemie und klinische Biochemie 1990. link 31 Tappero P, Merlino C, Cavallo R, Vai S, Negro Ponzi A. Anti-HIV antibodies in postmortem vitreous humor. Panminerva medica 1989. link 32 Ohwovoriole AE. Effectiveness of different methods to eliminate interference by thyroglobulin antibodies in the ELISA for thyroid microsomal autoantibodies. Asian Pacific journal of allergy and immunology 1989. link 33 Walter G, Friesen HJ, Harthus HP. Anti-idiotypic antibodies: powerful tools in diagnosis and therapy. Behring Institute Mitteilungen 1988. link 34 Nahon E, Grunberger D, Erlanger BF. Probing the surface of Z-DNA with anti-nucleoside antibodies. Biochemistry 1988. link 35 Ng ML, Rajna A, Khalid BA. Enzyme immunoassay for simultaneous measurement of autoantibodies against thyroglobulin and thyroid microsome in serum. Clinical chemistry 1987. link 36 Hahn V, Hartmann ML, Ebel JP, Stiegler P. Antigenic regions of ribosomal protein S1 as defined by monoclonal antibodies. Molecular immunology 1987. link90134-9) 37 Tanaka M, Sasaki N, Seto A. Induction of antibodies against Newcastle disease virus with syngeneic anti-idiotype antibodies in mice. Microbiology and immunology 1986. link 38 Jen MF, Liu YX, Chin YC. Anti-idiotypic antibodies raised against anti-metenkephalin antibodies in rabbits. NIDA research monograph 1986. link 39 Weetman AP, Gunn CA, Rennie DP, Hall R, McGregor AM. The production and characterization of monoclonal antibodies to the human thyroid microsome. The Journal of endocrinology 1985. link 40 Goodburn R, Williams DL, Marks V. The preparation of thyroid microsomal antigen for use in the indirect micro-ELISA method for the detection of anti-thyroid microsomal autoantibody. Clinica chimica acta; international journal of clinical chemistry 1982. link90342-4) 41 Izquierdo JM, Sotorrío P, Quirós A. Enzyme immunoassay of thyroxin with a centrifugal analyzer. Clinical chemistry 1982. link 42 Rossiter PB. Immunofluorescence and immunoperoxidase techniques for detecting antibodies to malignant catarrhal fever in infected cattle. Tropical animal health and production 1981. link 43 Pandey JP, Fudenberg HH, Ainsworth SK, Loadholt CB. Autoantibodies in healthy subjects of different age groups. Mechanisms of ageing and development 1979. link90021-6) 44 Hjort T, Poulsen F. Reactivity of F(ab)2 fragments of sperm antibodies in agglutination, immobilization and immunofluorescence tests. Archives of andrology 1978. link 45 Richter AW, de Belder AN. Antibodies against hydroxyethylstarch produced in rabbits by immunization with a protein-hydroxyetylstarch conjugate. International archives of allergy and applied immunology 1976. link