Elsevier

The American Journal of Medicine

Volume 123, Issue 2, February 2010, Pages 183.e1-183.e9
The American Journal of Medicine

AJM online
Clinical research study
Prevalence and Relative Risk of Other Autoimmune Diseases in Subjects with Autoimmune Thyroid Disease

https://doi.org/10.1016/j.amjmed.2009.06.030Get rights and content

Abstract

Background

Common autoimmune disorders tend to coexist in the same subjects and to cluster in families.

Methods

We performed a cross-sectional multicenter study of 3286 Caucasian subjects (2791 with Graves' disease; 495 with Hashimoto's thyroiditis) attending UK hospital thyroid clinics to quantify the prevalence of coexisting autoimmune disorders. All subjects completed a structured questionnaire seeking a personal and parental history of common autoimmune disorders, as well as a history of hyperthyroidism or hypothyroidism among parents.

Results

The frequency of another autoimmune disorder was 9.67% in Graves' disease and 14.3% in Hashimoto's thyroiditis index cases (P = .005). Rheumatoid arthritis was the most common coexisting autoimmune disorder (found in 3.15% of Graves' disease and 4.24% of Hashimoto's thyroiditis cases). Relative risks of almost all other autoimmune diseases in Graves' disease or Hashimoto's thyroiditis were significantly increased (>10 for pernicious anemia, systemic lupus erythematosus, Addison's disease, celiac disease, and vitiligo). There was relative “clustering” of Graves' disease in the index case with parental hyperthyroidism and of Hashimoto's thyroiditis in the index case with parental hypothyroidism. Relative risks for most other coexisting autoimmune disorders were markedly increased among parents of index cases.

Conclusion

This is one of the largest studies to date to quantify the risk of diagnosis of coexisting autoimmune diseases in more than 3000 index cases with well-characterized Graves' disease or Hashimoto's thyroiditis. These risks highlight the importance of screening for other autoimmune diagnoses if subjects with autoimmune thyroid disease present with new or nonspecific symptoms.

Section snippets

Materials and Methods

We designed the protocol for our national UK collection of DNA for studies of genetic susceptibility to autoimmune thyroid diseases14, 15, 16 to include prospective and systematic collection of clinical data, including information regarding the coexistence of other common autoimmune disorders in index cases and their parents. Patients were recruited between February 2002 and July 2007.

The study cohort (n = 3286) comprised 2791 Caucasian subjects with Graves' disease (2317 female/474 male) and 495

Results

Some 9.67% of the 2791 subjects with Graves' disease and 14.3% of the 495 patients with Hashimoto's thyroiditis had another autoimmune disorder (P = .005). Among index cases with Graves' disease and Hashimoto's thyroiditis, rheumatoid arthritis was most common (Table 2A,B). There were higher prevalences of Addison's disease (10-fold higher, P < .001) and pernicious anemia (3-fold higher, P = .004) in those with Hashimoto's thyroiditis, when compared with subjects with Graves' disease. There were no

Discussion

We have quantified the risk of coexisting autoimmune diseases in more than 3000 index cases with well-characterized Graves' disease or Hashimoto's thyroiditis. Rheumatoid arthritis was the most prevalent coexisting autoimmune disease in subjects with autoimmune thyroid disease and in their parents. We demonstrated high relative risks for the diagnosis of several organ-specific autoimmune disorders, including pernicious anemia, Addison's disease, and celiac disease. There were quantitative

Conclusions

Overall, our data provide strong evidence of significantly increased risks of coexisting autoimmune diseases in subjects with autoimmune thyroid disease. Given the strikingly increased relative risks for other autoimmune diseases compared with the general UK population, as well as the nonspecific symptoms and thus well-documented frequent delay in diagnosis of these disorders,32, 33 we propose that a low threshold for screening for these diagnoses should be used. This applies especially to

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    Funding: The study was supported by the Wellcome Trust. The study sponsor had no role in the study design; the collection, analysis, or interpretation of the data; the writing of the report; or the decision to submit the paper for publication.

    Ethical Approval: The study was approved by a Multi Center Research Ethics Committee and corresponding Local Ethics Research Committees.

    Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript.

    Authorship: All authors had access to the data and played a role in writing this manuscript. The corresponding author had full access to all the data in the study and had final responsibility for submission for publication.

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