Skip to main content

Thyroid involvement in ankylosing spondylitis and relationship of thyroid dysfunction with anti-TNF α treatment


Association between rheumatological and autoimmune thyroid disorders has been demonstrated by many studies. However, a few data exist indicating the association between thyroid disorders and ankylosing spondylitis (AS). In this study, the frequency of thyroid disorders in patients with AS and the impact of anti-TNF α therapy on this were investigated. Data of 108 patients (female/male (F/M) 27/81) were analyzed. Data on free T3, free T4, thyroid-stimulating hormone, anti-thyroid peroxidase antibodies (TPO), anti-thyroglobulin antibodies, and thyroid ultrasound were assessed retrospectively. 44 (F/M 15/29) patients were receiving anti-TNF α, while 64 (F/M 12/52) were receiving other drugs [(sulfasalazine, anti-inflammatory drug (NSAIDs)]. Among those not receiving anti-TNF α therapy, TPO level was high in 23 patients (mean TPO value 86.69 ± 65.28 U/ml), while it was high only in nine receiving anti-TNF α (mean TPO 36.61 ± 14.02 U/ml) (p < 0.05). Investigating the data regarding gender in both populations, autoimmune thyroid disease frequency was found to be lower in the patient group receiving anti-TNF α treatment. Subclinical hyperthyroidism was discovered in three patients (one female two male), and subclinical hypothyroidism in two (two male). Thyroid nodule was detected in 29 patients. It was concluded that the frequency of thyroid autoimmune disease was higher in our study than that reported in the literature, and the frequency of thyroid disorder in patients with AS was lower in those receiving anti-TNF α compared to those not. This may arise from the role of TNF α on pathogenesis of thyroid disorders.

This is a preview of subscription content, access via your institution.


  1. Biró E, Szekanecz Z, Czirják L, Dankó K, Kiss E, Szabó N, Szücs G, Zeher M, Bodolay E, Szegedi G, Bakó G (2006) Association of systemic and thyroid autoimmune diseases. Clin Rheumatol 25:240–245

    PubMed  Article  Google Scholar 

  2. Scofield RH, Bruner GR, Harley JB, Namjou B (2007) Autoimmune thyroid disease is associated with a diagnosis of secondary Sjögren’s syndrome in familial systemic lupus. Ann Rheum Dis 66:410–413

    PubMed  Article  Google Scholar 

  3. Boey ML, Fong PH, Long PH, Lee JSC, Ng WY, Thaı AC (1993) Autoimmune thyroid disorders in SLE in Singapore. Lupus 2:51–54

    PubMed  CAS  Google Scholar 

  4. El-Sherif WT, El Gendi SS, Ashmawy MM, Ahmed HM, Salama MM (2004) Thyroid disorders and autoantibodies in systemic lupus erythematosus and rheumatoid arthritis patients. Egypt J Immunol 11(2):81–90

    PubMed  Google Scholar 

  5. Goh KL, Wang F (1986) Thyroid disorders in systemic lupus erythematosus. Ann Rheum Dis 45:579–583

    PubMed  Article  CAS  Google Scholar 

  6. Uozumi K, Makino T, Shimotakahara S, Ishibashi K, Utsunomiya A, Hanada S, Arima T (1992) Cyclic thrombocytopenia with chronic thyroiditis and ankylosing spondylitis. Rinsho Ketsueki 33(9):1215–1222

    PubMed  CAS  Google Scholar 

  7. Bianchi G, Marchesını G, Zoli M, Zolı M, Falcasconı MC, Iervese T, Vecchi F, Magalotti D, Ferri S (1994) Thyroid involvement in chronic inflammatory rheumatological disorders. Clin Rheumatol 13(1):479–484

    Google Scholar 

  8. Lange U, Boss B, Teichmann J, Klett R, Stracke H, Bretzel G, Neeck G (1999) Thyroid disorders in female patients with ankylosing spondylitis. Eur J Med Res 4:468–474

    PubMed  CAS  Google Scholar 

  9. Raterman HG, Jamnıtskı A, Lems WF, Voskuyl AE, Dıjkmans BA, Bos WH, Simsek S, Lıps P, Van de Stadt RJ, de Koning MH, Nurmohamed MT (2011) Improvement of thyroid function in hypothyroid patients with rheumatoid arthritis after 6 months of adalimumab treatment: a pilot study. J Rheumatol 38(2):247–251

    PubMed  Article  CAS  Google Scholar 

  10. Braun J, Ballow M, Remlinger G, Eggens U, Rudwaleit M, Distler A, Sieper J (1998) Prevalence of spondylarthropathies in HLA B27 positive and negative blood donors. Arthritis Rheum 41(1):58–67

    PubMed  Article  CAS  Google Scholar 

  11. Braun J, Bollow M, Neure L, Seipelt E, Seyrekbasan F, Herbst H, Eggens U, Distler A, Sieper J (1995) Use of immunohistologic and in situ hybridization techniques in the examination of sacroiliac joint biopsy specimens from patients with ankylosing spondylitis. Arthritis Rheum 38(4):499–505

    PubMed  Article  CAS  Google Scholar 

  12. Allanore Y, Brémont C, Kahan A, Menkès CJ (2001) Transient hyperthyroidism in a patient with rheumatoid arthritis treated by etanercept. Clin Exp Rheumatol 19(3):356–357

    PubMed  CAS  Google Scholar 

  13. Van Lieshout AW, Creemers MC, Radstake TR, Elving LD, Van Riel PL (2008) Graves’ disease in a patient with rheumatoid arthritis during treatment with anti-tumor necrosis factor-alpha. J Rheumatol 35(5):938–939

    PubMed  Google Scholar 

  14. Chen K, Wei Y, Sharp GC, Braley-Mullen H (2007) Decreasing TNF-alpha results in less fibrosis and earlier resolution of granulomatous experimental autoimmune thyroiditis. J Leukoc Biol 81(1):306–314

    Google Scholar 

  15. Sabugo F, Liberman C, Niedmann JP, Soto L, Cuchacovich M (2008) Infliximab can induce a prolonged clinical remission and a decrease in thyroid hormonal requirements in a patient with SAPHO syndrome and hypothyroidism. Clin Rheumatol 27(4):533–535

    PubMed  Article  Google Scholar 

  16. Miyakoshi H, Ohsawa K, Yokoyama H, Nagai Y, Leki Y, Bando YI, Kobayashi K (1992) Exacerbation of hypothyroidism following tumor necrosis factor-alpha infusion. Intern Med 31(2):200–203

    PubMed  Article  CAS  Google Scholar 

  17. Tunbridge WMG, Evered DC, Hall R, Appleton D, Brewis M, Clark F, Evans JG, Young E, Bird T, Smith PA (1977) The spectrum of thyroid disease in a community. The Whickham Survey. Clin Endocrinol 7:481

    Article  CAS  Google Scholar 

  18. Gordin A, Maatela J, Miettinen A, Helenius T, Lamberg B-A (1979) Serum thyrotrophin and circulating thyroglobulin and thyroid microsomal antibodies in a Finnish population. Acta Endocrinol 90:33

    PubMed  CAS  Google Scholar 

  19. Tunbridge WMG, Brewis M, French JM, Appleton D, Bird T, Clark F, Evered DC, Evans JG, Hall R, Smith P, Stephenson J, Young E (1981) Natural history of autoimmune thyroiditis. Br Med J 282:258

    Article  CAS  Google Scholar 

  20. Mazzaferi EI (1993) Management of solitary thyroid nodule. N Engl J Med 328:553–559

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Figen Tarhan.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Tarhan, F., Orük, G., Niflioğlu, O. et al. Thyroid involvement in ankylosing spondylitis and relationship of thyroid dysfunction with anti-TNF α treatment. Rheumatol Int 33, 853–857 (2013).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Ankylosing spondylitis
  • Anti-TNF α treatment
  • Thyroid dysfunction
  • TNF α