Clinical Significance of Thyroid Disease in Patients With Inflammatory Myopathy

Abstract

We conducted the current study to determine the prevalence, incidence density, and clinical significance of thyroid disease in a series of 109 patients diagnosed with idiopathic inflammatory myopathy. We analyzed 109 patients diagnosed with idiopathic inflammatory myopathy during a 20-year period (1986-2006). Routine determination of thyroid profile, including hormone levels and antithyroid antibodies (antithyroid peroxidase and antithyroglobulin antibody systematically, and antithyroid-stimulating hormone receptor antibody when appropriate) was carried out at onset and at least once again during the follow-up period. Human leukocyte antigen (HLA) study was performed by polymerase chain reaction sequence-specific oligonucleotide typing. Six patients (5.5%) developed thyroid disease (hypo- or hyperthyroidism), with an incidence density of 8.7 new cases per 1000 person-years; 4 of the 6 cases were of autoimmune origin (3.6%). Thyroid dysfunction, whether autoimmune or not, was clearly related with onset or relapse of disease activity. Neoplastic disease was detected in 3 of 4 (75%) patients with autoimmune thyroid disease, a significantly higher frequency than was observed in the remaining patients in the series (12 of 103, 11.7%; p < 0.05; RR: 22.8; 95% confidence interval, 2.2-236.6). HLA DRB1*04 was found in 4 of the 6 patients with thyroid disease and inflammatory myopathy. Thyroid disorders are clinically relevant in patients with inflammatory myopathies. An association was observed between autoimmune thyroid disease and cancer. Thyroid assessment is strongly recommended in patients with idiopathic inflammatory myopathy and clinical relapse.

Hashimoto's Encephalopathy

“…Interestingly, seroepidemiological studies have shown that antithyroid antibodies are found in 10%–20% of the healthy population 64 and increase with aging, 65 especially in women 32 . Antithyroid antibodies have also been associated with myopathy, 66 chronic fatigue syndrome, 67 peripheral neuropathy, 68 mood and anxiety disorders, 69 borderline personality disorder, 70 depression, 71 Alzheimer's disease, 72 Wegener's granulomatosis, 73 juvenile idiopathic arthritis, 74 and 34%–41% of fibromyalgia patients 75 . Because antithyroid antibodies have been linked to such a large and variable group of disorders as well as appearing in the overall general healthy population makes it unlikely that there is any direct antigen within the brain that is shared by thyroid antibodies and are thus not necessarily disease specific.…”

Adult-Onset Still’s Disease Associated with Thyroid Dysfunction: Case Report and Review of the Literature

“…Secondly, the cross reactivity of other autoantibodies with thyroid antigens or anti-thyroid autoantibodies or autorective T cells with other tissues and organs likely result in the concurrent diseases [15]. Thirdly, from genetically, HLA-DRB1*04 alleles correlated the two diseases [16-18]. …”

Dermatomyositis related to autoimmune thyroiditis

“…Recently, it has been generally accepted that autoimmune thyroiditis (AIT), an organ‐specific autoimmune disease, may often become related to systemic autoimmune diseases, for instance, SLE, PSS and rheumatoid arthritis (RA) 5–7 . However, the reports on the association of DM with AIT are very few, to our knowledge, the association between them has been reported in six cases 8–12 . From these limited evidences, a cross‐linkage of autoimmune disease or a common genetic basis, may be present in these patients, although we can not exclude the possibility that the relationship represents a random finding.…”