High Prevalence of Hypothyroidism In Systemic Lupus Erythematosus Patients Without an Increase in Circulating Anti-Thyroid Antibodies

Domingues, Sol Lara; Gonçalves, Fabrícia Torres; Jorge, Miguel Tanús; Limongi, Jean Ezequiel; Ranza, Roberto; Jorge, Paulo

doi:10.4158/ep161664.or

Cited by 15 publications

(31 citation statements)

References 36 publications

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“…For example, some studies applied drug utilization approaches or electronic health record analysis based on prescriptions data, pharmacy claims, or surveys to identify consumption of antithyroid medication and estimate the prevalence of treated hypothyroidism [21, 51-54]. Furthermore, many studies investigated the prevalence of this disorder or its role as a risk factor for other diseases in specific populations, for example in pregnant women, patients with diabetes, patients with cardiovascular diseases, or immunocompromised individuals [12, 24, 55-59]. Therefore, there is room and need for systematically review of the evidence on the prevalence of undiagnosed hypothyroidism in the general population.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Undiagnosed Hypothyroidism in Europe: A Systematic Review and Meta-Analysis

Mendes

Alves

Silverio³

et al. 2019

Eur Thyroid J

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Background: Patients with undiagnosed hypothyroidism are not treated for the disease and are at high risk of developing serious complications, with major impact on public health. There is a need to systematically review the available evidence on this topic. Objective: To identify the prevalence of undiagnosed hypothyroidism in Europe. Methods: A systematic review of the literature (Medline, EMBASE, and Cochrane Central) was performed to identify epidemiological studies on the prevalence of undiagnosed hypothyroidism among European populations published between January 2008 and April 2018. The Newcastle-Ottawa Scale was used to assess the methodological quality of the included studies. Random-effects meta-analyses were performed to pool estimates of proportions (with 95% confidence intervals [CIs]) of undiagnosed (1) subclinical, (2) overt, and (3) total hypothyroidism. Results: The search returned 15,565 citations (4,526 duplicates). Twenty papers were included in the study. Fourteen and 6 studies were of good and moderate methodological quality, respectively. The results of the meta-analyses were as follows for the prevalence of undiagnosed hypothyroidism: subclinical, 4.11% (95% CI 3.05–5.31%, I² = 99.32%); overt, 0.65% (95% CI 0.38–0.99%, I² = 96.67%); and total, 4.70% (95% CI 2.98–6.79%, I² = 99.53%). According to the sensitivity analysis, the prevalence of hypothyroidism tends to be higher in female patients, in those aged ≥65 years, among studies with lower sample sizes, in those with thyroid-stimulating hormone levels <4.5 mIU/L, and in Eastern and Southern Europe. Conclusions: The current evidence suggests that a considerable proportion of the European population has hypothyroidism, particularly subclinical hypothyroidism, which is undiagnosed. This issue deserves further investigation because of possible deleterious consequences for public health.

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Section: Discussionmentioning

confidence: 99%

Prevalence of Undiagnosed Hypothyroidism in Europe: A Systematic Review and Meta-Analysis

Mendes

Alves

Silverio³

et al. 2019

Eur Thyroid J

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“…SLE is a multifactorial autoimmune disease with a complex pathogenesis and clinical manifestations (28). The present case and previous studies suggest that hypothyroidism is more likely to occur in patients with SLE in whom there is a higher incidence of anti-thyroid antibodies (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26); the reason for this remains elusive. The pathogenesis of hypothyroidism in patients with SLE may be due to the following factors: i) Autoimmunity has an important role in hypothyroidism associated with SLE (29).…”

Section: Discussionmentioning

confidence: 64%

“…A systematic literature search of the PubMed and CNKI databases was performed to identify studies published from 1987 to the present day containing information on the prevalence of hypothyroidism in SLE patients (Table II). The majority of the studies identified reported a high incidence of hypothyroidism in patients with SLE; the prevalence of clinical hypothyroidism reported in the literature ranged from 3.0 to 21.4% (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). The prevalence was higher in females compared with that in males, with the incidence rate estimated to be 9-fold higher in females (26).…”

Section: Discussionmentioning

confidence: 99%

“…SLE is a prototype of autoimmune diseases characterized by its multi-organ involvement. Previous reports indicated that the presence of positivity for anti-thyroglobulin antibodies (A-TG) and anti-thyroid peroxidase antibodies (TPOAb) in patients with SLE were significantly higher than those in the control group of healthy individuals (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Patients with SLE have a variety of AAbs, including anti-Smith (anti-Sm) and anti-nucleosome antibodies (30), which tend to cause autoimmune inflammation.…”

Section: Discussionmentioning

confidence: 99%

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Systemic lupus erythematosus with hypothyroidism as the initial clinical manifestation: A case report

Zhang

Liu

et al. 2020

Exp Ther Med

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Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease and hypothyroidism is an organ-specific autoimmune disease. The two diseases may occur successively or simultaneously. The majority of previous studies observed that thyroid disease was more frequent in patients with SLE than in the general population, particularly those who had a higher incidence of anti-thyroid antibodies. However, there are no reported cases of SLE with hypothyroidism as the initial clinical manifestation, to the best of our knowledge. The present study reported on a case of SLE with this unusual initial clinical manifestation and reviewed the literature to estimate the prevalence of clinical hypothyroidism in patients with SLE (range, 3.0-21.4%). The case of the present study had no obvious facial erythema, photosensitivity or recurrent oral ulcers, and only had hypothyroidism as the initial clinical symptom, but the laboratory examination supported the diagnosis of SLE. The present study suggested that in the clinical diagnosis, attention should be paid to screening for connective tissue diseases when diagnosing hypothyroidism, and the importance of thyroid dysfunction should also be recognized in the treatment of SLE.

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“…In addition, in a study of families with both SLE and thyroid disease, a site on chromosome 5 (5q14. [3][4][5][6][7][8][9][10][11][12][13][14][15] was reported to be a susceptibility gene shared by patients with SLE and AITD (15).…”

Section: Autoimmune Thyroid Diseasementioning

confidence: 99%

Thyroid Disease in Lupus: An Updated Review

Klionsky

Antonelli

2020

ACR Open Rheumatology

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In the following review, we seek to provide an overview of the current understanding of various thyroid manifestations affecting patients with systemic lupus erythematosus (SLE), including topics ranging from thyroid-related complications to SLE in pregnancy. Autoimmune diseases tend to coincide, and an association between thyroid disease and SLE has been reported for more than 50 years. There is no evidence that the coexistence of thyroid disease and lupus alters the disease course or manifestations of either. Both hypothyroidism and thyroid nodules are seen more frequently in patients with SLE than in the general population. The rate of thyroid cancer is twice as prevalent in patients with SLE compared with those without SLE. Several forms of thyroid disease are more common among patients with SLE, with adverse consequences in pregnancy. Future work will require delineating the mechanism behind these associations and understanding the role of antirheumatic agents with concomitant thyroid disease.

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High Prevalence of Hypothyroidism In Systemic Lupus Erythematosus Patients Without an Increase in Circulating Anti-Thyroid Antibodies

Cited by 15 publications

References 36 publications

Prevalence of Undiagnosed Hypothyroidism in Europe: A Systematic Review and Meta-Analysis

Prevalence of Undiagnosed Hypothyroidism in Europe: A Systematic Review and Meta-Analysis

Systemic lupus erythematosus with hypothyroidism as the initial clinical manifestation: A case report

Thyroid Disease in Lupus: An Updated Review

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