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Prevalence of temporomandibular disorders in patients with Hashimoto thyroiditis

Prävalenz von kraniomandibulären Dysfunktionen bei Patienten mit Hashimoto-Thyreoiditis

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Abstract

Objectives

Autoimmune thyroid disease (AITD), also known as Hashimoto thyroiditis (HT), is a degenerative inflammatory disease with high prevalence among women and has been associated with fibromyalgia and widespread chronic pain. The goal was to determine the frequency of temporomandibular disorders (TMD) in patients with HT.

Methods

In all, 119 women (age 19–60 years) were divided into a study (52 women diagnosed with HT) and a control (67 healthy individuals, of which 15 were excluded) group. Serum concentrations of thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), anti-thyroglobulin (Tg) and anti-thyroid peroxidase (TPO) antibody levels were measured. The temporomandibular jaw and muscles were examined using the German Society of Functional Diagnostics and Therapy guidelines. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was used to assess TMD. Standardized questionnaires, incorporating epidemiological criteria, state and treatment of the thyroid disease, Helkimo Index (HI), and Fonseca Anamnestic Index (FAI), were filled out by all patients.

Results

The two groups did not differ in terms of demographic parameters or mandibular jaw mobility. Significantly higher levels of anti-TPO and anti-Tg were attested in all subjects of the HT group. Markedly elevated prevalence of TMD was found in the HT group. Muscle pain and stiffness were found in 45 (86.5%) subjects of the HT group (p < 0.001), of whom 33 (63.4%) also had disc displacement with reposition (p < 0.001). Whereas 50% of the control group showed no TMD symptoms, all subjects in the HT group had symptoms.

Conclusions

A significantly elevated prevalence of TMD was found in patients with HT. Thus, patients with TMD who do not respond to therapy should be referred for thyroid diagnostic workup.

Zusammenfassung

Ziel

Die Autoimmun- oder Hashimoto-Thyreoiditis (HT) ist eine entzündliche degenerative Erkrankung mit hoher Prävalenz unter Frauen, die häufig mit Fibromyalgie und chronischen generalisierten Schmerzen assoziiert ist. Ziel war es, die Prävalenz temporomandibulärer Dysfunktionen (TMD) bei HT-Patientinnen zu untersuchen.

Material und Methodik

Insgesamt 119 Frauen (18–60 Jahre) mit und ohne diagnostizierte HT wurden eingeteilt in eine Studien- (n = 52) und eine Kontrollgruppe (n = 67; 15 wurden ausgeschlossen). Bestimmt wurden die Serumkonzentrationen von Thyreotropin (TSH), freiem Trijodthyronin (fT3) und Thyroxin (fT4), Antithyreoglobulin- (Tg-AK) sowie Thyreoperoxidaseantikörpern (TPO-AK). Kiefergelenke (KG) und -Kaumuskulatur wurden unter Beachtung der Richtlinien der DGFDT (Deutsche Gesellschaft für Funktionsdiagnostik und -therapie) untersucht, zur Auswertung dienten die RDC/TMD (Research Diagnostic Criteria for Temporomandibular Disorders). Von allen wurde ein standardisierter Fragebogen ausgefüllt, der epidemiologische Kriterien, Zustand und Behandlung der Schilddrüsenerkrankung sowie den HI (Helkimo-Index) und den FAI (Fonseca Anamnestic Index) implizierte.

Ergebnisse

Die Gruppen unterschieden sich nicht in den untersuchten demographischen Parametern (p > 0,05) oder in der Unterkieferbeweglichkeit (p > 0,05). Signifikant höhere Konzentrationen von TPO- und Tg-AK wurden bei allen Probanden der Studiengruppe gefunden. Die TMD-Prävalenz war signifikant höher in der HT-Gruppe (p < 0,001). Muskelsteifheit und Schmerzen zeigten sich bei 45 (86,5 %) Probandinnen der HT-Gruppe (p < 0,001), von diesen wiesen 33(63,4 %; p < 0,001) zusätzlich eine Diskusverlagerung mit Reposition auf. In der HT-Gruppe gab es keine symptomfreien Probandinnen, in der Kontrollgruppe dagegen zeigten 50 % keine TMD-Symptome.

Schlussfolgerung

Bei HT-Probandinnen wurde eine signifikant erhöhte Prävalenz von KG- und Muskelbeschwerden nachgewiesen. Patienten mit TMD, die nicht auf eine konventionelle Therapie ansprechen, sollten zur weiterführenden Schilddrüsendiagnostik überwiesen werden.

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Acknowledgements

The present work was performed in fulfillment of the requirements for obtaining the degree “Dr. med. dent.”. The authors wish to thank the German Orthodontic Society DGKFO for financially supporting this study and the Friedrich-Alexander-University Erlangen-Nürnberg (FAU). They are indebted to Torsten Kuwert, Hans Drexler, Klaus Schmid, Klaus Hertrich, and Holmer Graap for the support. Nikolai Grozni provided editorial assistance.

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Authors and Affiliations

  1. Department of Orthodontics and Orofacial Orthopedics, University of Erlangen Medical School, Erlangen, Germany

    Alina Grozdinska & Ursula Hirschfelder

  2. Department of Orthodontics and Orofacial Orthopedics, University of Regensburg Medical School, Regensburg, Germany

    Elisabeth Hofmann

  3. Department of Medical Biometry, Informatics and Epidemiology, Rheinische Friedrichs-Wilhelms University, Bonn, Germany

    Matthias Schmid

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  1. Alina Grozdinska
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Correspondence to Alina Grozdinska.

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Conflict of interest

A. Grozdinska, E. Hofmann, M. Schmid, and U. Hirschfelder declare that they have no competing interests.

Ethical standards

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics comittee and in accordance with national low and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Grozdinska, A., Hofmann, E., Schmid, M. et al. Prevalence of temporomandibular disorders in patients with Hashimoto thyroiditis. J Orofac Orthop 79, 277–288 (2018). https://doi.org/10.1007/s00056-018-0140-6

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  • DOI: https://doi.org/10.1007/s00056-018-0140-6

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