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The spectrum of thyroid disorders in systemic lupus erythematosus

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Abstract

To study the spectrum of thyroid disorders in systemic lupus erythematosus (SLE). Hundred SLE patients as per American Rheumatology Association(ARA) classification criteria underwent clinical examination, including assessment of disease activity (SLEDAI) and laboratory evaluation for serum triiodothyronine (T3),free thyroxine (FT4), thyroid stimulating hormone (TSH), antithyroperoxidase (TPO) antibody and antithyroglobulin (TG) antibody. Hundred age- and sex-matched apparently healthy individuals served as control. Thirty-six (36%) lupus patients had thyroid dysfunction when compared to 8 (8%) of controls and all of them were women. Primary hypothyroidism was the commonest dysfunction in 14 (14%), while subclinical hypothyroidism and subclinical hyperthyroidism was seen in 12 (12%) and 2 (2%), respectively. Eight (8%) had isolated low T3 consistent with sick euthyroid syndrome. Eighteen (50%) of thyroid dysfunction were autoimmune in nature (autoantibody positive) and rest 18 (50%) were non-autoimmune. Euthyroid state with the elevation of antibodies alone was seen in 12 (12%) of the lupus patients. In contrast, only 5 (5%) of controls had primary hypothyroidism and 3 (3%) had subclinical hypothyroidism, while none had hyperthyroidism. SLEDAI score and disease duration were compared between lupus patients with thyroid dysfunction to those with normal thyroid function. A statistically significant association was found between SLEDAI and thyroid dysfunction of sick euthyroid type.SLE disease duration had no statistically significant association with thyroid dysfunction. Prevalence of thyroid autoantibodies in lupus patients was 30% when compared to 10% of controls. Ninety-six (96%) of the SLE patients were ANA positive, while 4 (4%) of them were ANA negative but were anti-Sm antibody positive. There were no suggestions of any other autoimmune endocrine diseases like diabetes or Addison’s disease (clinically and on baseline investigations) in our lupus cohort and hence no further work up was done for these diseases. Thyroid disorders are frequent in SLE and are multifactorial with a definite higher prevalence of hypothyroidism as well as thyroid autoantibodies.

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References

  1. White RG, Williams E (1961) Lymphadenoid goiter and syndrome of systemic lupus erythematosus. Lancet I:368–373

    Google Scholar 

  2. Hijmans W, Doniach D, Roitt IM, Holborow EJ (1961) Serological overlap between lupus erythematosus, rheumatoid arthritis, and thyroid autoimmune disease. Br Med J 2:909–914

    PubMed  CAS  Google Scholar 

  3. Turnbridge WM, Evered DC, Hall R et al (1977) The spectrumof thyroid disease in community. The Wickhamsurvey. Clin Endocrinol 7:41–93

    Google Scholar 

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

    PubMed  CAS  Google Scholar 

  5. Miller FW, Moore GF, Weintraub BD, Steinberg AD, Burman KD (1993) Thyroid stimulating and thyrotropin binding-inhibitory immunoglobulin activity in patients with systemic lupus erythematosus having thyroid function abnormalities. Thyroid 1:229–234

    Google Scholar 

  6. Tsai RT, Chang TC, Wang CR, Chuang CY, Chen CY (1993) Thyroid disorders in Chinese patients with systemic lupus erythematosus. Rheumatol Int 13:9–13

    PubMed  CAS  Google Scholar 

  7. Park DJ, Cho CJ, Lee SH, Park SH, Kim HY (1995) Thyroid disorders in Korean patients with systemic lupus erythematosus. Scand J Rheumatol 24:13–17

    PubMed  CAS  Google Scholar 

  8. Pyne D, Isemberg DA (2002) Autoimmune thyroid disease in systemic lupus erythematosus. Ann Rheum Dis 61:70–77

    PubMed  CAS  Google Scholar 

  9. Kakehasi AM, Dias VN, Duarte JE, Lanna CCD, de Carvalho MAP (2006) Thyroid abnormalities in systemic lupus erythematosus: a study in 100 Brazilian patients. Rev Bras Reumatol 46:375–479

    Google Scholar 

  10. Porkodi R et al (2004) Thyroid dysfunction in SLE and rheumatoid arthritis. J Indian Rheumatol Assoc 12:88–90

    Google Scholar 

  11. Appenzeller S, Pallone Ana T, Natalin Ricardo A, Costallat Lilian T (2009) L: prevalence of thyroid dysfunction in systemic lupus erythematosus. J Clin Rheumtol 15:117–119

    Google Scholar 

  12. Perez EB, Kraus A, Lopez G, Cifuentes M, Alarcon-Segovia D (1995) Autoimmune thyroid disease in primary Sjögren’s syndrome. Am J Med 99:480–484

    PubMed  CAS  Google Scholar 

  13. Dent GR, Edward OM (1978) Autoimmune thyroid disease and the polymyalgia rheumatica-giant cell arteritis syndrome. Clin Endocrinol 9:215–219

    CAS  Google Scholar 

  14. Roitt IM, Doniach D, Campbell PN, Hudson RV (1956) Auto-antibodies in Hashimoto’s disease (lynphadenoid goiter); preliminary communications. Lancet 271:820–821

    PubMed  Google Scholar 

  15. Kochupillai N, Goswami R (2000) J Assoc Physicians India 48(Suppl):53–66

    Google Scholar 

  16. Weetman AP, Walport MJ (1987) The association of autoimmune thyroiditis with systemic lupus erythematosus. Br J Rheumatol 26:359–361

    PubMed  CAS  Google Scholar 

  17. Vianna JL, Haga HJ, Asherson RA, Swana G, Hughes GR (1991) A prospective evaluation of antithyroid antibody prevalence in 100 patients with systemic lupus erythematosus. J Rheumatol 18:1193–1195

    PubMed  CAS  Google Scholar 

  18. Rodrigues LH, Cataggio PM (1989) Systemic lupus erythematosus and thyrotoxicosis: a hitherto little recognized association. Ann Rheum Dis 48:424–427

    Google Scholar 

  19. Abraham Z, Rozenbaum M, Feuerman EJ, Kinarty A, Lahat N (1994) Adolescent systemic lupus erythematosus and Graves’ disease. Clin Exp Rheumatol 12:90–91

    PubMed  CAS  Google Scholar 

  20. Boey ML, Fong PH, Lee JSC, Ng WY, Thai AC (1993) Autoimmune thyroid disease in SLE in Singapore. Lupus 2:51–54

    PubMed  CAS  Google Scholar 

  21. Bermudez F, Surks MI, Oppenheimer JH (1975) High incidence of decreased serum triiodothyronine concentration in patients with nonthyroidal disease. J Clin Endocrinol Metab 41:27–40

    PubMed  CAS  Google Scholar 

  22. Chow CC, Mak TW, Chan CH, Cockram CS (1995) Euthyroid sick syndrome in pulmonary tuberculosis before and after treatment. Ann Clin Biochem 32:385–391

    PubMed  Google Scholar 

  23. Phillips RH, Valente WA, Caplan ES, Connor TB, Wiswell JG (1984) Circulating thyroid hormone changes in acute trauma: prognostic implications for clinical outcome. J Trauma 24:116–119

    PubMed  CAS  Google Scholar 

  24. Eber B, Schumacher M, Langsteger W, Zweiker R, Fruhwald FM, Pokan R et al (1995) Changes in thyroid hormone parameters after acute myocardial infarction. Cardiology 86:152–156

    PubMed  CAS  Google Scholar 

  25. Burr WA, Griffiths RS, Black EG, Hoffenberg RA, Meinhold H, Wenzel KW (1975) Serum triiodothyronine and reverse triiodothyronine concentrations after surgical operations. Lancet 2:1277–1279

    PubMed  CAS  Google Scholar 

  26. Chopra IJ, Solomon DH, Chopra U, Young RT, Chua-Teco GN (1974) Alterations in circulating thyroid hormone and thyrotropin in hepatic cirrhosis, evidence of euthyroidism despite subnormal serum triiodothyronine. J Clin Endocrinol Metab 39:501–511

    PubMed  CAS  Google Scholar 

  27. Finucane JF, Griffiths RS, Black EG, Hall CL (1977) Effects of chronic renal disease on thyroid hormone metabolism. Acta Endocrinol 84:750–758

    PubMed  CAS  Google Scholar 

  28. Burger A, Dinichert D, Nicod P (1976) Effect of amiodarone on serum triiodothyronine, reverse triiodothyronine, thyroxine and thyrotropin. J Clin Investigation 58:255–259

    CAS  Google Scholar 

  29. Chopra IJ, Williams DE, Orgiazzi J, Soloman DH (1975) Opposite effects of dexamethasone on serum concentrations of 3, 3′–5′-triiodothyronine (reverse T3) and 3, 3′, 5-triiodothyronine(T3). J Clin Endocrinol Metab 41:911–920

    PubMed  CAS  Google Scholar 

  30. Verhoeven RP, Visser TJ, Docter R (1977) Plasma thyroxine, 3, 3′-5-triiodothyronine and 3, 3′, 5-triiodothyronine during B-adrenergic blockade in hyperthyroidism. J Clin Endocrinol Metab 44:1002–1005

    PubMed  CAS  Google Scholar 

  31. Eberhard BA, Laxer RM, Eddy AA, Silverman ED (1991) Presence of thyroid abnormalities in children with systemic lupus erythematosus. J Pediatr 119:277–279

    PubMed  CAS  Google Scholar 

  32. Kausman D, Isenberg DA (1995) Thyroid autoimmunity in systemic lupus erythematosus. The clinical significance of a fluctuating course. Br J Rheumatol 34:361–364

    PubMed  CAS  Google Scholar 

  33. Magaro M, Zoli A, Altomonte L et al (1992) The association of silent thyroiditis with active systemic lupus erythematosus. Clin Exp Rheumatol 10:67–70

    PubMed  CAS  Google Scholar 

  34. Kohno Y, Naito N, Saito K, Hoshioka A, Niima H, Nakajima H et al (1989) Anti-thyroid peroxidase antibody in sera of patients with systemic lupus erythematosus. Clin Exp Immunol 75:217–221

    PubMed  CAS  Google Scholar 

  35. Punzi I, Betterle C (2004) Chronic autoimmune thyroiditis and rheumatic manifestations. Joint Bone Spine 71:275–283

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, IPGMER, Room no. 302, Junior Doctors Hostel, 242 AJC Bose Road, Kolkata, West Bengal, 700020, India

    Kundan Kumar

  2. Department of Internal Medicine, N.B. Medical College, Darjeeling, West Bengal, India

    Alakes Kumar Kole

  3. Department of Internal Medicine, IPGMER, Kolkata, West Bengal, India

    Partha Sarathi Karmakar

  4. Department of Internal Medicine and Rheumatology and Clinical Immunology, IPGMER, Kolkata, West Bengal, India

    Alakendu Ghosh

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  1. Kundan Kumar
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  2. Alakes Kumar Kole
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  4. Alakendu Ghosh
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Correspondence to Kundan Kumar.

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Kumar, K., Kole, A.K., Karmakar, P.S. et al. The spectrum of thyroid disorders in systemic lupus erythematosus. Rheumatol Int 32, 73–78 (2012). https://doi.org/10.1007/s00296-010-1556-5

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  • DOI: https://doi.org/10.1007/s00296-010-1556-5

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