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Autoimmune Thyroid Disorders in Juvenile Chronic Arthritis and Systemic Lupus Erythematosus

  • D. Mihailova
  • R. Grigorova
  • B. Vassileva
  • G. Mladenova
  • N. Ivanova
  • St. Stephanov
  • K. Lissitchky
  • E. Dimova
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 455)

Abstract

The appearance of autoimmune thyroiditis in the course of other autoimmune diseases, which do not affect specific organs (systemic lupus erythematosus, Sjögren syndrome, rheumatoid arthritis and others), is more frequent than is usually believed. Nevertheless, it is scarcely studied, especially in children. The purpose of this study was to look for autoimmune lesions of the thyroid gland in children suffering from juvenile chronic arthritis (JCA) and systemic lupus erythematosus (SLE). Twenty seven children having JCA and twelve children with SLE, aged 5 to 18 years, were enrolled into study. In all of them the disease was in an active phase. The serum levels of total thyroid hormones (T3, T4) and TSH, thyroid antibodies (TAB and MAB) and antinuclear antibodies (ANAB) were analyzed using respectively fluoroimmunologic, microhemagglutination and indirect immunofluorescention tests. According to our results, autoimmune thyroiditis was found in 12 out of 27 children with JCA (44.4%); 85.2% of them were euthyroid, 11.1% had a compensated hypothyroidism, and 3.7% had Hashi-toxicosis. From a clinical point of view, very interesting was the combination of JCA, autoimmune thyroiditis and pseudoxanthoma elasticum in a 13-year old girl. Positive thyroglobulin antibodies (1:80-1:5120) were found in 17 out of 27 cases of JCA (63%). The microsomal antibodies were elevated (1:100–1:1600) in 7 out of 27 (25.9%); antinuclear antibodies (1:80–1:640) were detected in 15 out of 27 cases of JCA (55.5%). A simultaneous elevation of all three kinds of antibodies was found in 14.8% of children with JCA, and of TAB and MAB—in 18.5%. Thyroid gland disorders were detected also in children suffering from SLE. Thyroglobulin antibodies were positive (1:80-1:5120) in 7 out of 12 cases. Antinuclear antibodies (1:320–1:2560) were detected in 8 out of 12 cases (66.7%). The serum levels of T3, T4 and TSH were in the reference limits in all children with SLE. The present study suggests that involvement of the thyroid gland is not uncommon in autoimmune disease in Autoimmune thyroiditis can occur in association with other autoimmune diseases, affecting some organs or systems, such as the insulin-dependent diabetes mellitus, pernicious anaemia, thrombocytopenia, vitiligo, as well as some chromosomal aberrations—Turner’s syndrome, Noonan’s syndrome and Down’s disease [1]. The appearance of autoimmune thyroiditis together with other autoimmune diseases which do not affect specific organs (such as systemic lupus erythematosus, Sjögren syndrome) is the reason to classify them in a common subgroup of the autoimmune poly endocrine syndromes—type HID [2]. The rheumatic diseases are—more frequently than suspected—associated with autoimmune thyroiditis, but this connection is not well studied. The literature offers very scarce information on the problem, especially for the childhood. The purpose of this study was to look for autoimmune lesions of the thyroid gland in children suffering from juvenile chronic arthritis (JCA) and systemic lupus erythematosus (SLE).

Keywords

Arthritis Europium Retina Interferon Thrombocytopenia 

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References

  1. 1.
    Karahanyan-Djambazova, E. Physiology and Pathology of the Thyroid Gland in Children. Plovdiv, Polygraphia, pp l72 et seq. (in Bulgarian) 1994Google Scholar
  2. 2.
    Lorini, R. et al. IDDM and Autoimmune Thyroid Disease: A Pediatric Point of View. In: Fifth International ISPAD Course. Sesto Alta Val Pusteria, March 11–18, 1995.Google Scholar
  3. 3.
    Arnett, F. et al. The American Rheumatism Association 1987 Revised Criteria for the Classification of Rheumatoid Arthritis. Arthr. Rheumat, 31: 315(1988).CrossRefGoogle Scholar
  4. 4.
    Tan, E. et al. The 1982 Revised Criteria for the Classification of Systemic Lupus Erythematosus. Arthr. Rheum. 25: 1271–1277(1982).CrossRefGoogle Scholar
  5. 5.
    Le Riche, N., D. Bell. Hashimoto’s Thyroiditis and Polyarthritis: A Possible Subset of Seronegative Polyarthritis. Ann. Rheum. Dis., 43: 594–598 (1984).CrossRefGoogle Scholar
  6. 6.
    Sakata, S. et al. A case of Rheumatoid Arthritis Associated with Silent Thyroiditis. J. Endocrinol. Invest, 15: 377–380(1992).PubMedGoogle Scholar
  7. 7.
    Miller, F. et al. Prevalence of Thyroid Disease and Abnormal Thyroid Function Test Results in Patients with Systemic Lupus Erythematosus. Arthritis Rheum. 30: 1124–1131 (1987).PubMedCrossRefGoogle Scholar
  8. 8.
    Wartofsky, L., K. Burman. Alterations in Thyroid Function in Patients with Systemic Illness: The Euthyroid Sick Syndrome. Endocr. Rev. 3: 164–217 (1982).PubMedCrossRefGoogle Scholar
  9. 9.
    Vassileva, B. Congenital Hypothyroidism and Thyromegaly in Children. Sofia, 1995, 172 pp. (doct. diss., in Bulgarian)Google Scholar
  10. 10.
    Eberhard, B. et al. Presence of Thyroid Abnormalities in Children with Systemic Lupus Erythematosus. J. Pediatr., 119: 277–279 (1990).Google Scholar
  11. 11.
    Goh, K., F. Wang. Thyroid Disorders in Systemic Lupus Erythematosus. Ann. Rheumat. Dis., 45: 576–583 (1986).CrossRefGoogle Scholar
  12. 12.
    Doniach, D. et al. Autoimmune Thyroiditis in Children and Adolescents. Acta Paediatr. Scand., 54: 260–274(1965).PubMedCrossRefGoogle Scholar
  13. 13.
    Scherbaum, W. Pathogenesis of Autoimmune Thyroiditis. Nuklearmediziner, 16: 241–249 (1993).Google Scholar
  14. 14.
    Utiger, R. The Pathogenesis of Autoimmune Thyroid Disease. N. Engl. J. Med, 325: 278–279 (1991).PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1999

Authors and Affiliations

  • D. Mihailova
    • 1
  • R. Grigorova
    • 1
  • B. Vassileva
    • 1
  • G. Mladenova
    • 1
  • N. Ivanova
    • 1
  • St. Stephanov
    • 1
  • K. Lissitchky
    • 1
  • E. Dimova
    • 1
  1. 1.Medical UniversitySofiaBulgaria

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